(A) Haemophilus influenzae
(B) Herpes simplex virus
(C) Influenza virus
(D) Mycobacterium tuberculosis
(E) Neisseria meningitidis
2- A 45-year-old woman was diagnosed with bacterial endocarditis. What is the characteristic fundoscopic feature of this disease?
(A) Cherry red macula
(B) Janeway lesions
(C) Macular star
(D) Retinal artery aneurysms
(E) Roth's spots
3- A 40 year old single man returned from holiday in Europe with mild bloody diarrhoea which had lasted for two weeks. He had lost 2.5 kg in weight, had occasional lower abdominal cramping discomfort and a painful swelling of his left knee. What is the most likely diagnosis?
(A) amoebiasis
(B) campylobacter infection
(C) Crohn's disease
(D) gonococcal septicaemia
(E) ulcerative colitis
4- The morphological appearance of Pneumocystis carinii infection in the lung is best characterised as which one of the following?
(A) A bronchopneumonia with abscess formation
(B) A haemorrhagic and necrotizing pneumonia
(C) An acute respiratory distress syndrome (ARDS) with widespread hyaline membrane formation
(D) An interstitial pneumonitis with foamy intra-alveolar exudate
(E) An organizing bronchopneumonia
5- A 70-year-old man presented to his GP with a two-day history of increasing confusion. He also complained of a headache. He was febrile on examination; nuchal rigidity was noted. A lumbar puncture was performed and CSF microscopy revealed: WBC 800 cells/mL (<(E) 90% neutrophils. A few Gram-positive diplococci were also noted. What is the cause of his meningitis?
(A) Cryptococcus neoformans
(B) Haemophilus influenzae
(C) Listeria monocytogenes
(D) Neisseria meningitidis
(E) Streptococcus pneumoniae
6- A 19-year-old man returned to the UK two weeks after working in a refugee camp in sub-Saharan Africa. On examination he was febrile, dyspnoeic and widespread inspiratory crackles were present. He had an extensive maculo-papular rash, conjunctivitis, generalized stomatitis and some bluish-grey spots on the buccal mucosa. What is the most likely diagnosis?
(A) Epidemic typhus
(B) Epstein Barr virus infection
(C) Leptospirosis
(D) Measles
(E) Parvovirus infection
7- Twenty of thirty patients in an adult ward develop colicky abdominal pain and diarrhoea without vomiting between 21:00 and 01:00 hrs. Meat stew was served for lunch at noon. Which of the following is the likely diagnosis?
(A) Bacillus Cereus
(B) Clostridium perfringens
(C) Enterotoxigenic E.Coli
(D) Enterovirus
(E) Staphylococcus Aureus
8- Which of the following is true of tetanus?
(A) failure to culture Clostridium tetani from the wound would make the diagnosis doubtful
(B) infection confers lifelong immunity
(C) there is a characteristic EEG
(D) Clostridium-specific intravenous immunoglobulin is of no benefit once spasm has started
(E) cephalic tetanus causes severe dysphagia
9- A 19-year-old male student attends casualty complaining of an urethral discharge. Gram stain shows numerous neutrophils, some of which contain gram-negative intracellular diplococci. The patient is treated with Ceftriaxone, 250 mg as an im injection. Five days later, the patient re-attends with persisting discharge. Which of the following is the most likely cause of this discharge?
(A) Chlamydia trachomatis
(B) Penicillin-resistant Neisseria gonorrhoeae
(C) Re-infection with Neisseria gonorrhoeae
(D) Ureaplasma urealyticum
(E) Urethral stricture
10- A 20 year-old-woman presented with a solitary, crusted, thickened lesion on her face one month after returning from a holiday in Central America. What is the most likely diagnosis?
(A) Cutaneous anthrax
(B) Cutaneous leishmaniasis
(C) Impetigo
(D) Leprosy
(E) Onchocerciasis
11- A 35-year-old man presented with cellulitis of his right leg. On examination he was mildly confused and febrile (40.1°C) with a pulse was 120 / minute and BP 80/55 mmHg. He was treated with intravenous benzylpenicillin and flucloxacillin. Group A Streptococcus was isolated from two sets of blood cultures. There was no significant clinical improvement after 24 hours. What antibiotic should be added?
(A) Ciprofloxacin
(B) Clindamycin
(C) Gentamicin
(D) Rifampicin
(E) Vancomycin
12- Regarding the epidemiology of infections, which of the following statements is true?
(A) Resistant vivax malaria is a major problem in Kenya.
(B) Diphtheria has been eradicated in most parts of the world.
(C) Polio has been eradicated in most parts of the world.
(D) Tetanus has been eradicated in most parts of the world.
(E) The AIDS epidemic seems to be declining worldwide.
13- A 22 year old male presents with generalised pruritus of six weeks duration. Examination reveals little except for erythematous papules between the fingers. Which ofthe following therapies would be most appropriate for this patient?
(A) Astemizole
(B) Calamine lotion
(C) Chlorpromazine
(D) Ciprofloxacin
(E) Permethrin cream
14- In HIV disease, patients first become susceptible to infection with Pneumocystis carinii when the CD4 cell count falls to:
(A) <1000 cells/mm3
(B) <500 cells/mm3
(C) <350 cells/mm3
(D) <200 cells/mm3
(E) <50 cells/mm3
15- Which of the following is true concerning a hepatitis E infection?
(A) It can be transmitted with hepatitis B.
(B) It is a recognised cause of chronic liver disease.
(C) CT scan of the liver with contrast shows diagnostic appearances.
(D) The incidence of chronic liver disease is reduced by administration of alpha interferon.
(E) It does not result in a carrier state.
16- Which statement regarding tinea capitis is correct?
(A) It is most commonly caused by the fungus microsporum canis.
(B) Its presence should suggest immunological deficiency.
(C) It often results in permanent alopecia.
(D) It causes patches that fluoresce dull green under Wood's lamp.
(E) It is effectively treated with topical Nystatin ointment.
17- A 25-year-old Turkish woman arrived in the UK with a three month history of weight loss and intermittent fevers. On examination, the patient was emaciated, febrile (39?C) and pale, and an enlarged liver (5 cm below the costal margin) and spleen (10cm below the costal margin) were present.
Investigations revealed:
Haemoglobin 7.2g/dL (11.5-16.(E)
White cell count 2.4 x 109/L (4-1(A)
Platelet count 117 x 109/L (150-400)
Thick and thin films no parasites identified CXR normal
What is the most likely diagnosis?
(A) HIV infection
(B) Infectious mononucleosis
(C) Malaria
(D) Miliary tuberculosis
(E) Visceral leishmaniasis
18- A 22-year-old female student attended Casualty complaining of fever and rigors for two days. She had returned from a sabbatical in Africa six weeks previously. She was febrile (39.9°C) and a mild petechial rash was also noted.
Laboratory investigations showed.
- Hb 10.1 g/dL (11.5-16.(E)
- WBC 3.0 x 109/L (4-1(A)
- Platelets 115 x 109/L (150-400)
- Prothrombin time Normal
What is the most likely diagnosis?
(A) Acute HIV infection (seroconversion illness)
(B) Cytomegalovirus infection
(C) Dengue fever
(D) Plasmodium falciparum malaria
(E) Typhoid fever
19- A 20-year-old caucasian student returns from Ghana with a spiking temperature and nocturnal sweats. She has 0.5% of red blood cells infected with plasmodium falciparum. Select one of the following answers relating to quinine therapy in this case:
(A) quinine contraindicated in those taking mefloquine prophylactically
(B) quinine must always be given parenterally initially
(C) pregnancy is a contraindication for quinine
(D) glucose level should be monitored in those on treatment with quinine
(E) dose of quinine should be reduced in liver impairment
20- Which of the following statements is true about immunological reactions?
(A) Serum sickness is caused by a type II reaction.
(B) Grave's Disease is caused by a type IV reaction.
(C) Angio-neurotic oedema is the most severe form of type I reaction.
(D) Urticaria usually responds to Cimetidine.
(E) Deficiencies in the terminal components of complement increase the risk of meningococcal disease.
21- A 41-year-old African man has a history of multiple episodes of sudden onset of severe abdominal pain and back pain lasting for hours. Each time this happens, his peripheral blood smear demonstrates numerous sickled erythrocytes. A haemoglobin electrophoresis shows 94% Hgb S, 5% Hgb F, and 1% Hgb A2. He now has increasing pain in his right groin radiating to the anterior aspect of the thigh and to the knee. His temperature was 38°C and examination of his hip revealed pain on internal rotation. A radiograph reveals irregular bony destruction of the femoral head. The most likely organism to be responsible for these findings is?
(A) Candida albicans
(B) Clostridium perfringens
(C) Group B streptococcus
(D) Salmonella species
(E) Yersinia pestis
22- A 35 year old woman with alcoholic cirrhosis is admitted with deteriorating encephalopathy and abdominal discomfort. An ascitic tap revealed a polymorphonuclear cell count of 350 cells per mm3. Which of the following is the most appropriate therapy?
(A) Intravenous amoxicillin
(B) Intravenous cefotaxime
(C) Intravenous metronidazole
(D) Oral neomycin
(E) Oral norfloxacin
23- A 36 year old woman presents with dyspnoea, cough and fever. Crackles are heard on auscultation of the lungs. Circulating precipitans to Micropolyspora faeni are positive. Which of the following is the most likely diagnosis?
(A) Malt workers' lung
(B) Pigeon fanciers' lung
(C) Allergic Bronchopulmonary Aspergillosis
(D) Brucellosis
(E) Farmers' lung
24- Which of the following would be indicated in the treatment of a 30 year old HIV positive male with pneumocystis carinii pneumonia? Blood gases reveal a P02 of 55mmHg whilst breathing 28% oxygen.
(A) Atovaquone
(B) Clindamycin
(C) Leucovirin
(D) Pentamidine
(E) Trimethoprim-sulphamethoxazole
25- Two strains of Escherichia coli are isolated and both are resistant to ampicillin. Strain A retains its resistance to amplicillin when grown form multiple generations in the absence of ampicillin. However strain B loses its resistance when grown in the absence of ampicillin. Which of the following best explains the loss of antibiotic resistance in strain B?
(A) Changes in the bacterial DNA gyrase
(B) Downregulation of the resistance gene
(C) Loss of a plasmid containing the resistance gene
(D) Mutations in the resistance gene
(E) Transposition of another sequence into the resistance gene
26- A 63 year old patient with known alcohol related cirrhosis presented with ascites, abdominal tenderness and peripheral oedema. A diagnostic tap revealed a neutrophil count of 400/mm3 (normal <250mm(C). Which of the following would be of most immediate benefit?
(A) fluid restriction and a no added salt diet
(B) intravenous antibiotics
(C) oral spironolactone
(D) therapeutic paracentesis
(E) trans-jugular intrahepatic porto-systemic shunt
27- Which of the following is correct regarding infection with Salmonella typhi
(A) children are particularly likely to become carriers
(B) most carriers are female
(C) faecal culture is almost always positive during the first week of illness
(D) relapse does not occur if antibiotics are taken for 2 weeks
(E) vaccinated individuals who develop the disease will have a mild illness
28- Which of the following is a true of cutaneous anthrax?
(A) causes a black eschar which overlies pus
(B) lesions are usually painful and tender
(C) lesions are associated with marked oedema
(D) Mortality is approximately 20% despite antibiotic therapy
(E) Is very likely to occur in subjects exposed to anthrax spores
29- Toxoplasmosis
(A) can cause fits in AIDS
(B) infection in the first trimester of pregnancy is seldom harmful to fetus
(C) undercooked meat is an important cause of infection
(D) infection usually by respiration
(E) prophylactic immunoglobulins should be given to pregnant women if their IgM anti-toxoplasma antibodies detected.
30- A 26-year-old man with a history of alcohol and drug abuse was admitted with a 14 day history of fever, cough and fatigue. He was emaciated. His temperature was 39.4°C. Cervical and axillary lymphadenopathy were present. Chest X-ray revealed bilateral areas of pulmonary shadowing. Which of the following is the most likely diagnosis?
(A) alcoholic cardiomyopathy
(B) pneumococcal pneumonia
(C) pneumocystis pneumonia
(D) pulmonary tuberculosis
(E) tricuspid endocarditis
31- Which of the following is true of Spontaneous bacterial peritonitis?
(A) A survival rate of over 50% is expected at one year
(B) Gentamicin is the treatment of choice
(C) is characteristically caused by aerobic bacteria.
(D) is diagnosed by culture of ascitic fluid.
(E) is due to intestinal perforation
32- You are an occupational health physician and have been asked by an anxious employee about contraindications to pertussis immunisation. Which of the following is a contraindication?
(A) Eczema
(B) Cow's milk protein intolerance.
(C) Fever to 39.5°C following the first dose.
(D) Redness of >2.5cm at the injection site after the first dose.
(E) Hydrocephalus
33- The antibiotic combination Quinipristin and Dalfopristin are
(A) effective against resistant mycobacterium TB.
(B) indicated in subjects with chronic renal impairment.
(C) particularly effective in the treatment of pseudomonas infection in Cystic fibrosis.
(D) administered orally.
(E) Effective against multi-resistant Staph Aureus
34- Which of the following is the commonest cause of traveller's diarrhoea?
(A) E. Coli
(B) Entamoeba Histolytica
(C) Giardia Lamblia
(D) Shigella Flexneri
(E) Yersinia enterocolitica
35- Which of the following is true concerning Whooping cough (pertussis)?
(A) is a greater threat to children during the second 6 months of life, after maternal antibody has declined, than during the first 6 months
(B) may lead to hemiplegia
(C) is characteristically associated with a polymorph leucocytosis
(D) is associated with convulsions less frequently than is the case with other febrile conditions
(E) rapidly resolves with antibiotic treatment
36- A 30 year old renal transplant recipient presented with non-Hodgkin's lymphoma. Which virus is most likely to be of aetiological significance?
(A) Adenovirus
(B) Cytomegalovirus
(C) Epstein Barr virus
(D) Herpes simplex type 1
(E) Varicella-zoster
37- A 49-year-old man with a long history of alcoholism presents with cough, haemoptysis and pleuritic chest pain. He has had night sweats and 10 kg weight loss in the last three months. On chest X-ray tgere is a subtle nodular pattern throughout the lung. He underwent a transbronchial biopsy which showed multinucleated giant cells, epithelioid cells and necrotic debris. Which of the following is the most likely diagnosis?
(A) Aspergillosis
(B) Pneumocystis carinii pneumonia
(C) Small cell carcinoma
(D) Squamous cell carcinoma
(E) Tuberculosis
38- Which of the following concerning IgG is correct?
(A) It has a molecular weight of 50,000 kd.
(B) It is monovalent.
(C) It comprises the majority of circulating antibody in serum.
(D) It differs from other isotypes in not being able to cross the placental barrier.
(E) It is the major antibody produced during the primary response.
39- Four members of a football team develop diarrhoea due to Salmonella enteritidis. Eating which food was the most likely source of the infection?
(A) chicken at a fast food outlet 20 hours earlier
(B) fried rice at a takeaway 4 hours earlier
(C) raw eggs in milk 6 hours earlier
(D) raw oysters at a hotel 24 hours earlier
(E) soft cheeses 48 hours earlier
40- A 68-year-old man has been very ill for months following the onset of chronic liver disease with hepatitis C infection. He experiences a sudden loss of consciousness and then exhibits paraplegia on the right. A cerebral angiogram reveals lack of perfusion in the left middle cerebral artery distribution. The most likely cardiac lesion to be associated with this finding is?
(A) Acute rheumatic fever
(B) Left atrial myxoma
(C) Libman-Sacks endocarditis
(D) Non-bacterial thrombotic endocarditis
(E) Paradoxical thromboembolus
41- Which of the following is a feature of Vancomycin-resistant enterococci?
(A) cause resistant infective diarrhoea
(B) produce an enzyme that inactivates vancomycin
(C) may be found in healthy community volunteers not recently hospitalized
(D) high dose ampicillin is the treatment of choice
(E) are commonly vancomycin-dependent
42- An 85 year old patient from an elderly care home, experiences sudden onset of dyspnea and palpitations. A pulmonary ventilationperfusion scan is performed and indicates a high probability for a perfusion defect involving a pulmonary arterial branch. Which of the following findings or conditions is the one that is the most important factor favouring development of her complaint?
(A) A neutrophilia
(B) An increased platelet count
(C) Cirrhosis of the liver
(D) Generalized atherosclerosis
(E) Poor nutrition
43- A young man from India presents with fever of 4 months duration and splenomegaly. What is the most likely diagnosis?
(A) Coccidiomycosis
(B) Giardiasis
(C) Tropical sprue
(D) Typhoid
(E) Visceral leishmaniasis
44- A 35-year-old man returned from a two-week holiday complaining of pain in the loins and painful swollen knees. On examination he was afebrile and had significant bilateral knee effusions. Mild penile erythema was also noted.
Laboratory investigations showed.
- Hb 15.6 g/dL
- WBC 16.2 x 109/l
- Neutrophils 14.1 x 109/l
- ESR 65 mm/h
- Rheumatoid factor 10 IU/L
Urinalysis No cells, casts or bacteria seen
What is the most likely diagnosis?
(A) Arthritis due to Neisseria gonorrhoeae infection
(B) Lymphogranuloma venereum
(C) Reactive arthritis
(D) Reitter's syndrome
(E) Rheumatoid arthritis
45- A 40-year-old man has had decreased mentation with confusion as well as increasing incoordination and loss of movement in his right arm over the past 6 weeks. An MRI scan shows 0.5 to 1.5 cm lesions in cerebral hemispheres in white matter and at the grey-white junction that suggest demyelination. A stereotatic biopsy is performed, and immunohistochemical staining of the tissue reveals JC papovavirus in oligodendrocytes. Which of the following laboratory test findings is most likely to be associated with these findings?
(A) CD4 lymphocyte count of 90/microliter
(B) Haemoglobin A1c of 9.8%
(C) HDL cholesterol of 0.7 mmol/L
(D) Oligoclonal bands in CSF
(E) Serum sodium of 110 mmol/L
46- Which one of the following statements concerning T-lymphocytes is correct?
(A) Are the primary host response in bacterial infection
(B) Compose the majority of lymphocytes in plasma
(C) Are infected by Epstein-Barr virus in infectious mononucleosis
(D) produce IgG
(E) T cell lymphoma has a better prognosis
47- You are considering starting a patient on Griseofulvin. Which of the following statements concerning its pharmacology is true?
(A) It is active against Candida albicans.
(B) It is active against aspergillus.
(C) It should not be used in renal failure.
(D) It used for a maximum of 2 weeks.
(E) It is associated with drug-induced Stevens Johnson syndrome.
48- A 14 year old boy presents with fever. Which of the following might contribute to a diagnosis of rheumatic fever?
(A) The finding of target lesions on the hands.
(B) The finding of tender nodules in the fingertips.
(C) A prolonged PR interval on ECG.
(D) A CRP of 10.
(E) Positive Romberg's sign.
49- A 75 year old man has a history of Chronic Lymphocytic Leukaemia. He has had treatment with several courses of chemotherapy and has now been admitted to hospital with pneumonia. His past medical history revealed that he had suffered several previous upper respiratory tract infections over the previous six months. Which of the following components of his immune system is likely to be deficient?
(A) Complement
(B) Immunoglobulin G
(C) Macrophages
(D) Mast cells
(E) T lymphocytes
50- Which of the following is true of the the T cell response to antigen?
(A) A process of affinity maturation of the T cell receptor occurs.
(B) Intact antigen is presented in association with self MHC molecules.
(C) Co-operation with other cell types is required for T cell recognition of antigen.
(D) gamma/delta + T cells respond to antigen presented in association with MHC class II molecules.
(E) Interactions of the TcR with an appropriate Ag/MHC complex activates a resting T cell.
51- A 40-year-old man presented with pityriasis versicolor. What is the most appropriate treatment?
(A) methotrexate
(B) oral terbinafine
(C) psoralen with ultraviolet light (PUVA) therapy
(D) topical selenium sulphide
(E) phototherapy with ultraviolet light (UVB)
52- Which of the following suggests a diagnosis of molluscum contagiosum rather than chickenpox?
(A) Presence of macules and papules
(B) Absence of erythema surrounding lesions
(C) Lesions disappearing within a month
(D) Presence of pruritis
(E) Positive contact history
53- Ten individuals are admitted to casualty with profuse vomiting after attending a retirement dinner in a chinese restaurant. They all ate at roughly 7 pm and became ill at roughly midnight. Nine ate a mixture of dishes except one female who ate vegetarian dishes with her rice. What is the most likely infective organism?
(A) Salmonella enteriditis
(B) Staphylococcus aureus
(C) E. Coli
(D) Clostridium perfringens
(E) Bacillus cereus
54- A 27 year old man presents with fever, urethritis and arthralgia. He is found to have a swollen ankle with a pustular rash on the dorsal aspect of his foot. What is the most likely diagnosis?
(A) Gonococcal sepsis
(B) Lyme disease
(C) Reiter's syndrome
(D) Staphylococcal arthritis
(E) Tuberculous arthritis
55- A 63 year old female presents with a one day history of confusion with headaches. On examination she is confused, with a Glasgow ComaScale of 13 and a temperature of 39.5. She has nuchal rigidity and photophobia. CSF examination reveals a glucose of 0.5 mmol/l, a white cell count of 2500 per mm and Gram positive Cocci in pairs. Which of the following is correct?
(A) The most likely infective organism is Staphylococcus Aureus
(B) The organism is likely to be penicillin resistant.
(C) Rifampicin should be given to close contacts.
(D) Nerve deafness would be a common complication in this case.
(E) A characteristic rash would be expected.
56- A young teenager presents with fever and headache. He has received oral Amoxycillin for 3 days. Which of the following CSF findings would exclude a partially treated meningitis?
(A) Negative gram stain
(B) A CSF glucose of 45% of blood glucose
(C) A white cell count of 50
(D) A negative CSF culture
(E) Negative Kernig's Sign
57- Which of the following statments is characteristic of acute hepatitis B infection?
(A) Most patients present with splenomegaly.
(B) It confers immunity to hepatitis A.
(C) It commonly presents with distal joint arthritis.
(D) There is increased infectivity in the presence of the e antigen.
(E) Pruritis is an important early symptom.
58- Giardia lambdia infection
(A) is often symptomatic
(B) is usually spread faecal-orally
(C) is eradicated by mebendazole
(D) causes steatorrhoea
(E) diagnosed by stool culture
59- Which of the following statements is true of psittacosis (ornithosis):
(A) It is only a risk from contact with psittacines (parrots), not other birds
(B) It usually causes many polymorphs to be present in the sputem
(C) It is more of a risk to children than to adults who are exposed to birds
(D) It does spread from person to person
(E) Infection responds rapidly to penicillin therapy
60- Which of the following is true of Koplik's spots?
(A) Are diagnostic of Measles
(B) Located opposite the incisor teeth.
(C) Only appear when fever is over 39°C
(D) They appear as red papules on the plamar surface of the hands
(E) Typically appear two days after the rash.
61- Which of the following statement is true of infections with Mycobacterium tuberculosis:
(A) non-sputum producing patients are non-infectious
(B) a positive tuberculin test indicates active disease
(C) lymph node positive disease requires longer treatment than pulmonary disease
(D) in pregnant women treatment should not be given until after delivery
(E) pyrazinamide has high activity against active extracellular organisms
62- Which of the following statements concerning zoonotic diseases is true?
(A) Brucellosis is characterised by neutrophil leucocytosis.
(B) Brucellosis is a recognised cause of spondylitis.
(C) Toxoplasmosis causes visceral larva migrans.
(D) Toxoplasmosis causes posterior uveitis.
(E) Serological evidence of toxoplasmosis is rare in adults.
63- A 42-year-old man with advanced HIV disease presented with a tonic-clonic seizure. He had been diagnosed with HIV 10 years previously, but had elected not to take antiretroviral therapy. A CT scan of his brain showed a 2 cm ring-enhancing lesion in the right parietal lobe. What is the probable causative agent?
(A) Cryptococcus neoformans
(B) Mycobacterium avium intracellulare
(C) Mycobacterium tuberculosis
(D) Pneumocystis carinii
(E) Toxoplasma gondii
64- In herpes simplex encephalitis which of the following statements is correct?
(A) brain MRI is characteristically normal
(B) temporal lobe involvement is common
(C) fits are uncommon
(D) cold sores or genital herpes are usually present
(E) viral identification by PCR on cerebrospinal fluid is non-specific
65- A 52-year-old woman was admitted with malaise and leg weakness. Her illness started with a sore throat while travelling in Eastern Europe. On examination she was febrile (39.1°C) with several areas of exudates on her pharynx and extensive cervical lymphadenopathy. There was weakness of the legs with absent tendon reflexes. What is the most likely diagnosis?
(A) Acute myeloid leukaemia
(B) Cytomegalovirus infection
(C) Diphtheria
(D) Glandular fever
(E) Streptococcal tonsillitis
66- Which of the following concerning Corynebacterium diphtheriae is correct?
(A) Causes skin infection
(B) Infection is often complicated by myocardial fibrosis after recovery from severe infection
(C) Is most unlikely to cause infection in an individual with a positive Schick test
(D) Mitis strain is generally more virulent than the intermedius strain
(E) Toxin is better absorbed through the nasal than the pharyngeal mucosa
67- A 43-year-old woman develops a progressive, ascending motor weakness over several days. She is hospitalized and requires intubation with mechanical ventilation. She is afebrile. A lumbar puncture is performed with normal opening pressure and yields clear, colorless CSF with normal glucose, increased protein, and cell count of 5/microliter, all lymphocytes. She gradually recovers over the next month. Which of the following conditions most likely preceded the onset of her illness?
(A) Ketoacidosis
(B) Staphylococcus aureus septicemia
(C) Systemic lupus erythematosus
(D) Viral pneumonia
(E) Vitamin B12 deficiency
68- Which of the following is true of anthrax?
(A) It is caused by an aerobic, gram negative rod.
(B) It causes trivial disease in the host herbivore population.
(C) Gastrointestinal anthrax is the most usual form of disease in humans.
(D) Eshars are usually painless.
(E) Sputum culture has a high yield in inhalational anthrax.
69- Which of the following forms of encephalitis is caused by a neuroimmunological response?
(A) Herpes simplex
(B) Measles
(C) HIV infection
(D) Enteral viruses
(E) Cytomegalovirus
70- A 40-year-old man with a long history of alcohol abuse is admitted with a subacute illness, comprising headache, fever, meningism and ataxia. MRI brain showed patchy high signal abnormality of the brain stem. CSF analysis showed polymphonuclear pleocytosis and low glucose. He had failed to improve after 3 days of intravenous cefotaxime treatment. The most likely diagnosis of the meningitis is:
(A) Mycobacterium tuberculosis
(B) Cryptococcus neoformans
(C) Nocardia asteroides
(D) Staphyloccus aureus
(E) Listeria monocytogenes
71- Which of the following is correct regarding human varicella zoster immunoglobulin (VZIG)?
(A) Is used to treat severe chicken pox infection
(B) Is recommended for all patients with eczema exposed to chickenpox.
(C) Is invariably protective against severe varicella.
(D) Should be given to a 14 day old whose mother has developed chickenpox
(E) Should be given to a 20 week pregnant non-immune female who has been exposed to a case of chicken pox.
72- Which of the following is a contraindication to immunisation?
(A) Infantile eczema requiring topical steroids.
(B) Oral poliomyelitis vaccine to a child on oral steroids.
(C) A history of prolonged jaundice.
(D) A child with congenital adrenal hyperplasia on oral cortisone.
(E) A child with cerebral palsy.
73- Which of the following statements is correct of hepatitis C virus infection?
(A) Cell cultures of virus are routinely used to assess response to drug therapy
(B) High antibody titres are an indication for therapy
(C) Less than 5% of cases lead to chronic infection
(D) More likely to be transmitted by the sexual route than hepatitis B virus
(E) Treatment with ribavirin and interferon alpha is more effective than interferon alpha alone
74- In the diarrhoea associated with cholera toxin, there is activation of which of the following enzyme systems?
(A) Adenylate cyclase.
(B) ATP.
(C) Guanylate cyclase.
(D) Na-glucose co-transporter.
(E) Na+/K+ ATPase pump.
75- Regarding diphtheria which of the following statments is correct?
(A) It is predominantly spread from cutaneous lesions.
(B) It is characterised by an inflammatory exudate forming a greyish membrane on the buccal mucosa.
(C) It produces a toxin which affects the myocardium, nervous and adrenal tissues.
(D) 3 doses of toxoid provides 75% protection.
(E) About 50 cases per year are seen in the UK.
76- Which of the following is true of BCG vaccination?
(A) is contraindicated in neonates
(B) is a killed polysaccharide antigen vaccine
(C) should be given to all children who have a strongly positive tuberculin test
(D) is presently routinely offered in the UK at age 16 years
(E) Provides protection against leprosy
77- Which of the following micro-organisms is generally sensitive to Benzylpenicillin?
(A) Bordetella pertussis
(B) Cryptococcus neoformans
(C) Mycoplasma pneumoniae
(D) Streptococcus Pneumonaie
(E) Streptococcus Viridans
78- A-30-year-old man developed a febrile illness three days after returning from a holiday in Thailand. He was admitted complaining of severe myalgia. On examination he was febrile (39?C) with a diffuse macular rash on the trunk. There was no lymphadenopathy.
Investigations revealed:
- Haemoglobin 15.1 g/dL (13.0-18.0)
- White cell count 7.5 x 109/L (4-1(A)
- Platelet count 105 x 109/L (150-400)
- Serum total bilirubin 18 µmol/L (1-2(B)
- Serum alanine aminotransferase 120 U/L (5-3(E)
What is the most likely diagnosis?
(A) Acute HIV infection (seroconversion illness)
(B) Dengue fever
(C) Hepatitis E
(D) Secondary syphilis
(E) Typhoid
79- Primary Pulmonary tuberculosis:
(A) Leads to pleural effusion
(B) Is highly infective
(C) Commonly leads to military TB
(D) May be totally asymptomatic
(E) Usually produces cavitation
80- A 54-year old woman was admitted with acute breathlessness. On examination she had a temperature of 37.9oC, a respiratory rate of 32 breaths per minute, a pulse of 120 beats per minute, a blood pressure of 100/60 mmHg, and a peak expiratory flow rate of 250 litres per minute.
Auscultation of the heart and chest was normal.
The Chest X-ray was normal and
blood gases on air showed:
- pH 7.35 (7.36 - 7.4(D)
- Pa02 6.0
- kPa (11.3 - 12.6)
- PaC02 3.9
- kPa (4.7 - 6.0)
- Serum bicarbonate 20 mmol/l (20 - 28)
She was started on high flow oxygen. What is the most important next treatment?
(A) amoxycillin intravenously
(B) aminophylline intravenously
(C) intravenous fluids
(D) low molecular weight heparin
(E) nebulised salbutamol
81- A 30-year-old intravenous drug abuser develops acute aortic regurgitation due to infective endocarditis. Which of the following is least likely to be found on clinical examination?
(A) decreased cardiac output
(B) decrescendo diastolic murmur
(C) hypotension
(D) mitral valve pre-closure
(E) peripheral vasodilatation
82- Which of the following is correct regarding Herpes simplex encephalitis?
(A) shows a peak incidence in the Autumn
(B) is associated with a polymorphonuclear pleocytosis in the CSF
(C) produces a diffuse, evenly distributed inflammation of cerebral tissues
(D) produces a typical EEG pattern with lateralised periodic discharges at 2 Hz
(E) should be treated with acyclovir as soon as the diagnosis is confirmed by urgent CSF viral antibody titres
83- Herpes zoster infection :
(A) Gamma Interferon is an effective treatment.
(B) produces latent infection within the anterior horn cells
(C) causes urinary incontinence
(D) causes congenital limb deformity
(E) associated pneumonitis is equally common in smokers and nonsmokers
84- A 25 year old male homosexual is admitted with dyspnoea and weight loss of 2 months duration. He is diagnosed with Pneumocystis pneumoniae due to AIDS. Which of the following concerning Pneumocystis pneumonia is true?
(A) May have an extra pulmonary presentation
(B) is always associated with X-ray changes
(C) is caused by a bacterium
(D) elevated serum antibodies to P. carinii helpful diagnostically
(E) is best treated with intravenous pentamidine
85- A 45-year-old man returned from a two-week trip in Zimbabwe. Fourteen days later he presented with fever, headaches and a widespread rash. On examination there was generalised ymphadenopathy and a widespread maculopapular rash. What is the most likely diagnosis?
(A) acute HIV infection
(B) schistomsomiasis
(C) strongyloidiasis
(D) tick typhus
(E) typhoid fever
86- A 50-year-old man presented to hospital feeling generally unwell for 3 days. He had returned from a business trip to Thailand six weeks previously and had taken mefloquine as prophylaxis against malaria. On examination he was afebrile, temperature 36.5°C, Pulse was 100/minute and regular, his BP was 85/60 mm Hg.
Investigations showed:
- Hb 14.2 g/dL (13.0-18.0)
- WBC 19.0 x 109/L (4- 1(A)
- Neutrophils 18.0 xl09/L (1.5-7.0)
- AST 72 IU/L (1-3(A)
- Alkaline phosphatase 255 (45-10(E)
What is the most likely diagnosis?
(A) Acute HIV infection (seroconversion illness)
(B) Dengue fever
(C) Gram-negative bacteraemia
(D) Hepatitis B
(E) Mefloquine-induced hepatitis
87- A 70 year old woman developed herpes zoster ophthalmicus. Which one of the following is most likely to be a complication of this condition?
(A) Hyphaema
(B) Keratitis
(C) Keratoconus
(D) Posterior subcapsular cataract
(E) Scleromalacia
88- Which is true regarding Eczema Herpeticum?
(A) Is invariably fatal if untreated.
(B) Usually has an indolent onset.
(C) Only a single crop of vesicles usually appear.
(D) Is typically associated with a high fever for over a week.
(E) Is more severe in reactivation disease.
89- A 28 year old male presents with a four day history of profuse bloody diarrhoea after returning from a holiday in the Far East. Which of the following regarding his illness is true?
(A) a negative amoebic fluorescent antibody test excludes a diagnosis of acute amoebic dysentry
(B) Cysts to E. histolytica in the stools confirms a diagnosis of acute amoebic dysentry
(C) cholera is a likely diagnosis
(D) Giardiasis is a likely diagnosis
(E) shigellosis is a likely diagnosis
90- Which of the following infections is least likely to cause myocarditis?
(A) Coxsackie virus
(B) Diphtheria
(C) Chagas Disease
(D) Syphillis
(E) Toxoplasmosis
91- Chronic liver disease is NOT a complication of
(A) Haemosiderosis
(B) Hepatitis C
(C) alpha1 antitrypsin deficiency
(D) cystic fibrosis
(E) haemochromatosis
92- A 25-year-old previously healthy woman has worsening fatigue with dyspnoea, palpitations, and fever over the past one week. Her vital signs on admission to the hospital show Temperature 38.9°C Respiratory rate 30/min Pulse 105 bpm and BP 95/65 mmHg. Her heart rate is irregular. An ECG shows diffuse ST-T segment changes. A Chest X-ray shows mild cardiomegaly. An echocardiogram shows slight mitral and tricuspid regurgitation but no valvular vegetations. Her troponin I is 12 ng/mL.
She recovers over the next two weeks with no apparent sequelae. Which of the following laboratory test findings best explains the underlying etiology for these events?
(A) ANCA titer of 1:80
(B) Anti-streptolysin O titer of 1:512
(C) Blood culture positive for Streptococcus, viridans group
(D) Coxsackie B serologic titer of 1:160
(E) Total serum cholesterol of 9.6 mmol/l
93- A 18 year old homosexual male developed progressive pneumonia not responding to antibiotics. Methenamine silver staining of the sputum showed small circular cyst and Giemsa staining demonstrated the small, punctate nuclei of the trophozoites and intracystic sporozoite. Which is the most likely organism?
(A) Toxoplasma gondii
(B) Trypanosoma cruzi
(C) Cryptococcus neoformans
(D) Leishmania donovani
(E) Pneumocystis carinii
94- Which is true of herpes simplex encephalitis?
(A) brain MRI is characteristically normal
(B) fits are uncommon
(C) genital herpes is usually present
(D) temporal lobe involvement is common
(E) viral identification using polymerase chain reaction on CSF is non-specific
95- A 38 year old female presents with red target lesions confined to the hands and is diagnosed with erythema multiforme. Which of the following could be the cause?
(A) Cytomegalovirus infection
(B) Ureaplasma urealyticum
(C) Group B Streptococci
(D) Langerhan's cells histiocytosis
(E) Penicillin V
96- In the diagnosis of rheumatic fever, which of the following may be helpful?
(A) A generalised macular-papular rash.
(B) ASO titre of less than 1:200.
(C) Polyarthritis.
(D) Staphylococcus aureus grown on throat culture.
(E) Splinter haemorrhages.
97- A 56-year-old man from Thailand presented with abdominal pain and a mass in the right upper quadrant. He reported that he had been diagnosed with viral hepatitis several years previously. Investigations showed:
Serum alpha-fetoprotein 13,500 IU/L (< 10)
What is the most likely underlying viral infection?
(A) Hepatitis A virus
(B) Hepatitis B virus
(C) Hepatitis C virus
(D) Hepatitis D virus
(E) Hepatitis E virus
98- Regarding pneumonia caused by Legionella pneumophilia, which of the following is true?
(A) is associated with hyponatremia
(B) is best treated with intravenous amoxycillin and clavulanic acid
(C) is common in AIDS patients
(D) is readily diagnosed by standard aerobic culture of sputum
(E) should be managed on the ward in a respiratory isolation cubicle
99- A 19-year-old male student attends casualty complaining of an urethral discharge. Gram stain shows numerous neutrophils, some of which contain gram-negative intracellular diplococci. The patient is treated with Ceftriaxone, 250 mg as an im injection. Five days later, the patient re-attends with persisting discharge. Which of the following is the most likely cause of this discharge?
(A) Chlamydia trachomatis
(B) Penicillin-resistant Neisseria gonorrhoeae
(C) Re-infection with Neisseria gonorrhoeae
(D) Ureaplasma urealyticum
(E) Urethral stricture
100- A 27 year old man presents with fever, urethritis and arthralgia. He is found to have a swollen ankle with a pustular rash on the dorsal aspect of his foot. What is the most likely diagnosis?
(A) Gonococcal sepsis
(B) Lyme disease
(C) Reiter's syndrome
(D) Staphylococcal arthritis
(E) Tuberculous arthritis
101- A 22 year old male presents with generalised pruritus of six weeks duration. Examination reveals little except for erythematous papules between the fingers. Which ofthe following therapies would be most appropriate for this patient?
(A) Astemizole
(B) Calamine lotion
(C) Chlorpromazine
(D) Ciprofloxacin
(E) Permethrin cream
102-A 38-year-old male with a diagnosis of HIV presents with lethargy, confusion, personality change and a seizure. CT shows multiple uniformly enhancing mass lesions in both cerebral hemispheres What treatment is indicated?
(A) ketoconazole
(B) pyrimethamine and sulfonamide
(C) rifampicin and pyrazinimide
(D) broad spectrum antibiotics
(E) corticosteroids
103-Which RBC antigen is involved in the entry of P. vivax into red blood cells?
(A) Anti-D
(B) Anti-S
(C) Duffy
(D) Kell
(E) Kidd
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