1. A 16 year old girl presents to the office complaining of throat pain, difficulty swallowing, and trismus. Physical examination shows erythema and enlargement of the left tonsillar pillar. In addition, the patient holds her head to the left side and has muffled speech. The most likely diagnosis is:
A. Peritonsillar abscess
B. Streptococcal pharyngitis
C. Tonsillar cancer
D. Epiglottitis
2. Which of the following statements about rapid streptococcal screening tests (enzyme immunoassays) is FALSE?
A. Their accuracy approaches that of latex agglutination tests
B. They are fairly predictive of streptococcal infections if positive
C. They are quick and easy to perform
D. They should be confirmed by culture if results are negative
E. They are typically more sensitive than specific
3. Which of the following statements about influenza is FALSE in general practice.
A. Symptoms include fever, cough, coryza, headache, myalgias, and fatigue
B. Influenza a is the most common cause of the flu
C. Diagnosis requires acute and convalescent titers
D. Immunization for healthy adults should be recommended at 65 years of age
4. Which of the following statements about giardiasis is FALSE?
A. Transmission occurs through fecal-oral contamination
B. Chlorination of drinking water kills the cyst
C. Diagnosis can be achieved by inspection of the stool for cysts.
D. The trophozoite form is responsible for symptoms
5. Which of the following statements about zidovudine (AZT) is FALSE?
A. AZT is a macrolide antibiotic
B. AZT inhibits reverse transcriptase
C. AZT administration requires monitoring of central blood counts
D. Concomitant use of acetaminophen or trimethoprim-sulfacmethoxazole may increase the risk of toxicity
E. Side effects may include headaches, paresthesias, and dizziness
6. Which of the following conditions is a contraindication to influenza vaccination?
A. Allergy to eggs
B. Allergy to red dye
C. Allergy to penicillin
D. Allergy to milk
E. Allergy to dust mites
7. The average length of time between infection with HIV and the development of AIDS is:
A. 1 year
B. 3 years
C. 5 years
D. 10 years
E. 20 years
8. A 26 year old single man presents to your office complaining of a painless ulcer that formed on his penis approximately 3 months ago. The ulcer healed, but an erythematous rash on the palms and soles of his feet has recently developed. He also reports generalized fatigue, malaise, fever, headache, and arthralgias. The most likely diagnosis is:
A. Gonorrhea
B. Chancroid
C. Syphilis
D. Reiter?s syndrome
E. Lyme disease
9. Which of the following infections causes tabes dorsalis?
A. Gonorrhea
B. Tuberculosis
C. Syphilis
D. Bacterial meningitis
10. A 32 year old sportsman who recently attended a wild game feed banquet consumed summer sausage made form bear meat. He complains of abdominal discomfort, diarrhea, and muscle tenderness. The most likely diagnosis is
A. Trichinosis
B. Salmonella infection
C. Giardia infection
D. Ascariasis
E. Viral gastroenteritis
11. A 68 year old patient is seen for a general examination. Current recommendations for immunizations include:
A. Tetanus booster every 5 years
B. Influenza vaccination yearly
C. Pneumococcal vaccination yearly
D. Hepatitis booster every 5 years
12. A 34-year-old man in otherwise good health presents with coughing spasms followed by post-tussive emesis for three weeks. You suspect pertussis and collect a nasopharyngeal swab for a culture. According to the Centers for Disease Control and Prevention, which one of the following is the best next step?
A. Prescribe an inhaled beta agonist to relieve symptoms
B. Prescribe antibiotics only if the culture is positive.
C. Treat close household members with antibiotics.
D. Administer a whole-cell pertussis vaccine
13. Patients with syphilis who are allergic to penicillin should be desensitized and given penicillin therapy. Use of an alternative regimen would be most reasonable in patients with which one of the following conditions?
A. Pregnancy
B. A positive test for human immunodeficiency virus (HIV).
C. Early disease.
D. A history of Jarisch-Herxheimer reaction.
E. Concomitant gonorrheal infection.
14. Which one of the following diseases can have an incubation period of longer than 21 days?
A. Dengue fever.
B. Leptospirosis.
C. Malaria.
D. Typhoid fever.
15. Which one of the following factors does not increase the risk of developing herpes zoster?
A. Increasing age.
B. Human immunodeficiency virus infection.
C. Asian race.
D. Hodgkin's lymphoma.
16. Which one of the following statements about antibiotic prophylaxis for traveler's diarrhea is correct?
A. It is not routinely recommended.
B. Metronidazole is recommended.
C. Azithromycin is recommended.
D. Ciprofloxacin is recommended.
E. Rifampicin is recommended.
17. Which one of the following statements about the diagnosis of active tuberculosis is false?
A. Three sputum specimens should be obtained for acid-fast staining.
B. The Mantoux test is negative in 10 to 25 percent of patients with active disease.
C. The sputum culture remains the gold standard for the diagnosis of tuberculosis.
D. Nucleic acid amplification tests are an acceptable alternative to sputum culture.
E. In children, early-morning gastric washings are more likely than bronchoscopy to yield a diagnosis.
18. An otherwise healthy, immunocompetent healthcare worker converts to a positive PPD. Which of the following drugs is recommended for this person?
A. Rifampin
B. Pyrazinamide
C. Ethambutol
D. Streptomycin
E. Isoniazid
19. A 14-year-old white male experiences a sudden onset of severe headache, chills, fever, myalgia, nausea, and vomiting. Three days later he presents to the ER with a pink macular rash around his wrists and ankles. This presentation is most closely associated with which of the following?
A. Secondary syphilis
B. Kawasaki's disease
C. Rocky mountain spotted fever
D. Toxic shock syndrome
E. Scarlet fever
20. Which of the following is NOT included in the group of viral exanthems?
A. Measles
B. Mumps
C. Rubella
D. Roseola
E. Fifth disease
21. A 23 years old married women present with lower abdominal pain, vaginal discharge, dyspareunia. On examination there is cervical discharge cervical excitation and groin tenderness?
A. Acute appendicitis
B. Acute pelvic inflammatory disease (PID)
C. Uncomplicated cervicitis
D. Ectopic pregnancy
E. Threatened abortion.
22. If hospitalization was chosen for this patient, which of the following regimens is first-line treatment for her condition?
A. Intravenous (IV) Ampicillin and Gentamicin
B. IV cefotetan and doxycycline
C. IV ceftriaxone
D. IV ciprofloxacin
E. IV ampicillin
23. If outpatient management was chosen for the patient, which of the following regimens is first line treatment for her condition?
A. Oral ofloxacin with or without metronidazole .
B. Intramuscular (IM) cefoxitin, oral probenecid and po doxycycline
C. IM ceftriaxone, oral doxycycline with or without po metronidazole.
D. Any of the above
E. None of the above
24. Which of the following statements regarding the relationship between combined oral contraceptive pills (OCPs) and Pelvic inflammatory disease is true?
A. OCPs decrease the risk of this condition
B. OCPs increase the risk of this condition
C. OCPs do not influence this condition at all
D. OCPs are contraindicated in patients with the condition
E. none of the above
25. Which of the following organisms is not associated with this condition?
A. Neisseria gonorrhea
B. Chlamydia trachomatis
C. Gardnerella hominis
D. Bacteroides fragilis
E. Beta-hemolytic streptococcus
26. A 24 years old sexually active man presents with uretheral discharge. His urethral gram stain reveals WBCs per oil immersion field. There are no intracellular gram-negative diplococci seen. What is the most likely diagnosis in this patient?
A. Gonorrhea
B. Acute prostatitis
C. Epididymitis
D. Nongonococcal urethritis
E. Bacterial cystitis
27. What is the most likely organism causing Non-gonococcal urethritis?
A. Chlamydia trachomatis
B. Ureaplasma urealyticum
C. Trichomonas vaginalis
D. Neisseria gonorrhea
E. Herpes simplex virus
28. Case same as above. You prescribe an appropriate antibiotic regimen for this patient and for his current sexual partner. Both he and his partner completed the recommended regimen. He states that they have been in a monogamous relationship. His symptoms have resolved completely. He wants to know if the "infection is gone" and if he should have a test of cure. Which of the following statement can you tell the patient?
A. He should have a test of cure 2 weeks after treatment
B. He should have a test of cure 6 months after treatment
C. He and his partner should have a test of cure 2 weeks after treatment
D. He and his partner should have a test of cure 6 months after treatment
E. He and his partner do not need a test of cure
29. Which of the following statements about syphilis is true?
A. Primary syphilis is associated with a single, painful chancre
B. Secondary syphilis is associated with skin lesions and lymphadenopathy
C. Latent syphilis is associated with constitutional symptoms
D. Treatment for primary syphilis is oral penicillin
E. The recommended treatment for early-latent and late-latent syphilis is the same
30. Which of the following statements about syphilis testing is true?
A. Dark-field microscopy of lesion exudates is the most convenient way to confirm Treponema pallidum
B. Nontreponemal tests (i.e., rapid plasma reagin [RPR])can be falsely positive in certain med?ical conditions
C. Trcponemal-specifjc test (i.e., fluorescent trep?onemal antibody-absorption test [FTA-ABS]) titers decline after syphilis treatment
D. RPR titers can be used interchangeably.with Venereal Disease Research Laboratory (VORL) titers
E. none of the above
31. What is the treatment of choice in patients who are not allergic to penicillin for primary or secondary syphilis?
A. IM benzathine penicillin G in a single dose
B. IM benzathinc penicillin G once a week for 3 weeks
C. IV Alqueous crystalline penicillin G for 10-14 days
D. PO probenecid for 10-14 days
E. PO doxycycline
32. Which of the following statements about human immunodeficiency virus (HIV) is false?
A. HIV testing should be offered to all patients seeking evaluation for STDs
B. The HIV-2 strain is endemic to the United States
C. HIV testing is available through urine, oral mucosal, and blood samples
D. Initial positive screening test should be followed by a more specific confirmatory test
E. Repeat serologic testing should not be done prior to 3 months after exposure.
33. Which of the following tests is NOT helpful in the diagnosis of active pulmonary tuberculosis?
A. Chest x-ray
B. Gram's stain of sputum
C. Sputum culture
D. Blood culture
E. DNA probe studies
34. Gram's stain of the CSF on a child suspected for meningitis reveals gram-positive diplococci. The patient should be treated with which of the following combinations?
A. Ampicillin + vancomycin
B. Ceftriaxone + gentamicin
C. Ampicillin + gentamicin
D. Vancomycin + ceftriaxone
E. Ampicillin + cefaclor
35. Which of the following is not appropriate antibiotic treatment for uncomplicated, early-stage Lyme disease in the nonpregnant patient?
A. Doxycycline
B. Amoxicillin
C. Ceftriaxone
D. Azithromycin
E. Cefuroxime
36. In the revised Jones criteria for the diagnosis of acute rheumatic fever (ARF), which of the following is NOT included among the major manifestations?
A. Subcutaneous nodules
B. Carditis
C. Chorea
D. Fever
E. Polyarthritis
37. Infants born to HbsAg-negative mothers should receive hepatitis B vaccine according to which of the following schedules?
A. One dose by age 2 months
B. Two doses before school age
C. Three doses before school age
D. Four doses: three before school age and one teenage booster
E. Five doses: four before school age and one teenage booster
38. A patient with no history of treatment for primary syphilis presents with symptoms and signs consistent with secondary syphilis. During your workup on this patient, you would expect to find all of the following except:-
A. Generalized lymphadenopathy
B. Condyloma lata
C. Elevated alkaline phosphatase
D. Generalized maculopapular rash
E. Superficial painless gummas
39. Which of the following is NOT among the usual causes of acute sinusitis?
A. Streptococcus pneumoniae
B. Escherichia coli
C. Haemophilus influenzae
D. Staphylococcus aureus
E. Streptococcus pyogenes
40. A person planning to travel in rural equatorial Africa for a month should be advised to be vaccinated for:-
A. Malaria
B. Traveler's diarrhea
C. Plague
D. Yellow fever
E. Typhus
41. Which of the following organisms is recognized as a major cause of peptic ulcer disease (PUD)?
A. Campylobacter jejuni
B. Helicobacter pylori
C. Clostridium difficile
D. Pseudomonas aeruginosa
E. Enterotoxigenic Echerchia coli
42. Which of the following is TRUE about hepatitis B?
A. It is the most common form of acute viral hepatitis.
B. Even without treatment, it seldom progresses to chronic disease.
C. It is a vaccine-preventable liver disease.
D. Its prevalence is related to the quality of the water supply.
E. Food-borne hepatitis B is a common mode of transmission.
43. A teenage patient presents with fever soethroat, nausea, upper abdominal pain. On examination bilateral anterreor lymphadenopathy , mild hepatomeyaly and tonsillar exudates are presents The diagnosis mononucleosis is supported predomin and by all of the following except:-
A. A positive heterophile test
B. Atypical lymphocytes on the differential
C. Lymphadenopathy
D. Pharyngitis
E. Cough
44. A 14 years old boy who has returened from mountain camping, presents with severe headache, chills, fever myalgia, nausea and vomiting.Three days later he developed pink macular rash around wrist and ankles. Which of the following regimens is the treatment of choice for this patient?
A. Gentamicin, 2 mg/kg IV q8h 3 ? 14 days
B. Ampicillin, 250 mg po qid 3 ? 10 days
C. Vancomycin, 1 g IV q12h 3 ? 7 days
D. Doxycycline, 100 mg po bid 3 ? 10 days.
E. Metronidazole, 500 mg po tid 3 ? 14 days.
45. A 6 years old child is brought to your clinic with sudden onset of sore throat, difficulty in swallowings, headache and abdominal pain. There is no cough or coryza. His temperature is 400C and tonsillar exudates are presents What treatment would you offer for this child?
A. Azithromycin
B. Amoxicillin
C. Ciprofloxacin
D. No antibiotics, rest, fluid, acetaminophen, and Saline gargles
E. None of the above
46. In the pediatric population what is the incidence of group A streptoc ccus pharyngitis is
A. 5% to 15%
B. 15% to 30%
C. 10% to 20%
D. 20% to 30%
E. Nobody really knows for sure
47. The entire reason for treating group A beta?hemolytic streptococcus is to prevent which of the following sequelae.
A. Pyelonephritis
B. Rheumatic fever
C. Glomerulonephritis
D. A and C
E. All of the above
48. Which specific infections are associated with group A beta-hemolytic streptococcus?
A. Erysipelas
B. Scarlet fever
C. Impetigo
D. All of the above
E. A & C only
49. Recent practice guidelines recommend which of the following regarding diagnosis of group A beta-hemolytic streptococcus in children?
A. Clinical presentation alone should enable a physician to diagnose a streptococcal throat
B. A negative rapid strep test rules out streptococcal? throat.
C. A negative rapid strep test must be confirmed by a throat culture to rule out streptococcal throat
D. A positive rapid strep test alone is 100 % proof of a streptococcal infection
E. None of the Above
50. Recurrent Tonsillitis usually is caused by which of the following?
A. Group A beta-hemolytic streptococcus
B. Parainfiuenzae virus
C. Rhinovirus
D. Adenovirus
E. Epstein-Barr virus
51. Which of the following is (are) a complication(s) of tonsillectomy?
A. Hemorrhage
B. Postoperative throat infection
C. Pulmonary edema
D. A and B
E. All of the Above
52. An adult with a high risk for bacterial endocarditis is scheduled for a dental extraction. The patient has a history of penicillin allergy. Which of the following is an appropriate oral prophylactic drug to give this patient?
A. Amoxicillin
B. Vancomycin
C. Clindamycin
D. Doxycycline
E. Gentamicin
53. An 8 years old girl from a village comes with 5 days history of intermittent with chills and myalgias. There are no respiratory, abdominal and urinary complains. Her examination is normal and she is afebrile in your clinic.
Which ONE medicine would you prescribe for her?
A. Chloramphemicol
B. Chloroquin
C. Ceftriaxone
D. Amoxicillin
E. Nalidixic acid
54. If you have to select only one investigation, which one would you like to choose?
A. CBC
B. ESR
C. MP
D. Blood culture
E. Urine DR
55. Mr. Ashraf presented to your clinic with intermittent fever and you treated him with Chloroquine. He did not respond and his blood film shows Falciparum malaria. The patient is otherwise stable. How would you teat him?
A. Tab. Quinine 600 mg TDS for 1 week
B. Tab. Halofantrine 500 mg 6 hourly
C. Tab. Sulphadoxine + Pyremethamine 3 tablets
D. Tab. Artemether 80 mg OD for 5 days
E. Any of the above
56. Mrs. Shamim has been referred to you by a gynecologist for treatment of malaria. She is in her 3rd month of gestation. Her blood film shows P. vivax. How would you manage her?
A. Arthemether
B. Quinine
C. Halofantrine
D. Chloroquin
E. Sulphadoxine + Pyremetham
57. A 25 years old women presents to your clinic with intesmitt and fever with chills and rigors. Her blood film shows P. falciparum. How would you manager her?
A. Arthemether
B. Quinine
C. Halofantrine
D. Chloroquine
E. Sulphadoxine + Pyremethamine
58. Mrs. Janjua presents to your clinic with intermittent fever with chills, backache, nausea and headache. Her husband tells you that she has started speaking irrelevant sentences. She looks sleepy during physical examination. What is the most likely diagnosis in her case?
A. Septicemia
B. Meningitis
C. Cerebral malaria
D. B and C
E. Any of the above
59. Case same as above. Her blood test done a day before show P. falciparum. What treatment should be most suitable for her?
A. Quinine
B. Chloroquine
C. Mefloquin
D. Artemether
E. Halofantrine
60. Dilshad is a 24 years old carpenter who presented to you with P. vivax for the third time in six months. According to your advice he has been using mosquito repellants and mosquito net regularly. What is the most likely explanation for repeated vivax infections?
A. Resistance
B. Fake drugs
C. Hypnozoites
D. Repeated infections
E. Drug reaction
61. Case same as above. Which single investigation would you like to order before treating this patient for recurrent vivax infection?
A. Blood sugar
B. Coomb?s test
C. G6PD test
D. Reticulocyte count
E. B and C
62. Case same as above. How would you treat him?
A. Primaquine
B. Mefloquine
C. Halofantrine
D. Arthemether
E. Sulphadoxine + Pyremethamine
63. Which sexually transmitted disease (s) is/are vaccine preventable:-
A. Chancre
B. Lymphogranuloma venerium
C. Hepatitis B
D. Gonorrhea
E. C and D
64. According to CDC recommendations which vaccine (s) is/are recommended for health care workers:-
A. MMR
B. Hepatitis B
C. Vericella
D. Influenza
E. All of the above
65. Which vaccine is recommended specifically for females only:-
A. Human Papilloma virus
B. Hepatitis B
C. Vericella
D. Rubella
E. Hepatitis E
66. A mother brings her 2 years old son for vaccination. He has received BCG and first doses of Polio, DPT and Hepatitis B. How would you manage this case according to EPI?
A. Restart vaccination
B. Resume vaccination
C. Give double dose
D. Give another booster after completion of series
E. Check protective antibody levels and then make schedules
67. A 16 years old healthy boy comes to you clinic for vaccination. He has never received any vaccine. How would you manage this case in accordance with literature if all vaccines are available in your town?
A. DT
B. Hepatitis B
C. MMR
D. Varicella
E. All of the above
68. A 45 years old man comes for vaccination. He has never received any vaccine. His medical and social history are unremarkable. How would you manage this case according to literature assuming that all vaccines are available?
A. DT
B. Hepatitis B
C. MMR
D. Vericella
E. A & B
F. All of the above
69. A 25 years old nurse comes to your clinic for vaccination. She has not received any vaccine. How would you manage this case?
A. Hepatitis B
B. MMR
C. Varicella
D. Influenza
E. All of the Above
70. The health minister asks your expert opinion about vaccination of Fire Brigade Department. All workers have already received primary vaccination for dT and Hepatitis B. Which vaccine would you specifically advise for this department?
A. Influenza
B. Pneumoccal
C. Meningococcal
D. Typhoid
E. Hepatitis A
71. A 60 years old healthy man comes to your clinic for vaccination. His hepatitis B vaccination is complete and he has also received 10 yearly booster of DT. What would you advise to him?
A. Influenza vaccine
B. Pneumococcal vaccine
C. Meningococcal
D. Typhoid
E. A and B
72. A 20 years old patient of valvular heart disease comes to your clinic for vaccination. All primary vaccines are complete. What else would you like to advise specifically in relation to his cardiac problem?
A. Influenza vaccine
B. Pneumococcal vaccine
C. Yellow Fever
D. Human Papilloma
E. A and B
F. All of the above
73. A surgeon refers a 35 years patient to you for vaccination after splenectomy for severe ITP. Her primary vaccines are complete. What would advise specifically in relation to her surgery?
A. Pneuurococcal
B. Hemphilus influenza
C. Meningococcal
D. Typhoid
E. A, B and C
F. All of the above
74. Your advised MMR vaccine to a 17 years old girl. Next week she comes with her husband and a positive pregnancy test. How would you manage this patient?
A. Don?t tell her any thing about vaccine
B. Advise abortion
C. Advise Rubella 1gM
D. Advise Rubella 1gG
E. Explain and advise to continue with the pregnancy
75. According to available literature, what is the most likely outcome of this fetus?
A. Normal
B. Mild abnormalities
C. Severe abnormalities
D. Preterm fetal demise
E. None of the above
76. A newly married woman comes to you for preconception counseling. She tells you that she has febrile illness with generalized macular rash few years ago. How would you manage this case?
A. Give MMR and advise contraception for 3 months
B. There is no need for vaccine in her case
C. Check Rubella 1gM and then give MMR
D. Check Rubella 1gG and then give MMR
E. Check both Rubella 1gM + 1gG and then give MMR
77. A 35 years old patient has been referred to you for opinion. He was admitted in ICU a month ago with tetanus from which he recovered. What would you advise him about tetanus vaccination?
A. Vaccinate according to 0,1,6 schedule
B. Give a booster dose
C. Check tetanus 1gG level and then decide
D. There is no need of vaccination now
E. None of the above
78. You have got a job in UK. On the very first day of your job, a man comes to you for vaccination before visiting Pakistan. His primary vaccination of Polio, DT, Hepatitis B, Vericella and MMR are complete. What else would you advice for him?
A. Hepatitis A
B. Typhim Vi
C. Meningococcal
D. A and B
E. All of above
79. A 27 years housemaid comes to your clinic with vaginal discharge. Her husband is a heroin addict and she has 4 children to look after. She admits that she has been having commercial sex off and on for her living. On examination white purulent discharge is visible at the external OS. How would you treat her?
A. Ampicillin + Gentamycin + Metronidazole
B. Clotrimazole vaginal pessasies
C. Doxycycline
D. Cap. Fluconazol 150 mg stat
E. Cefixime 400 mg stat + Doxycycline for 7 days
80. What else would you like to tell her?
A. Contraception
B. Use of condoms
C. Vaccination against Hepatitis B after screening
D. A and B
E. All of the above
81. A 35 years old woman complains of foul smelling greenish frothy vaginal discharge since 1 week. Her husband is asymptomatic and denies any extramarital contacts. How would you treat her?
A. Ceftriaxone 250 mg I/M
B. Azithromycin stat
C. Doxycycline for 2 weeks
D. Metronidazole 2 G stat
E. Fluconazole 150 mg 2 tab
82. How would you treat her husband?
A. Ceftriaxone 250 mg I/M
B. Azithromycin stat
C. Doxycycline for 2 weeks
D. Metronidazole 2 G stat
E. Fluconazole 150 mg 2 tab stat
83. A 25 years old man presents with painful ulcer on penis and bilateral inguinal lymphadenopathy. What is the most likely diagnosis?
A. Cancer
B. Chancroid
C. Lymphogranuloma venerium
D. Herpes simplex
E. Any of the above
84. Which single antibiotic would you like to choose in this case?
A. Ciprofloxacin
B. Erythromycin
C. Spectinomycin
D. Ceftriaxone
E. Benzathin penicillin
85. A 12 years old boy presented to your clinic with history of intermittent fever with rigors, body aches and headache. Suspecting malaria you prescribed chloroquin. Two days later he presents with jaundice and weakness. His labs show: Total bilirubin=6.2 Direct bilirubin= 1.0 Indirect bilirubin= 5.2 SGPT=36 Alkaline phosphatase= 170
What is the most likely interpretation?
A. Chloroquin resistant malaria
B. Gilbert?s syndrome
C. Acute viral hepatitis
D. Cholestatic jaundice
E. Hemolytic jaundice
86. A 19 years old woman presents with history of high grade fever, diarrhea and pain in the right hypochondrium for 1 month later on she also developed cough and shortness of breath. X-ray shows:How would you treat this patient?
A. Amoxicillin for 10 days and follow up X-ray after 1 month
B. Start Anti-tuberculous therapy
C. Ultrasound upper abdomen, aspiration of pleural fluid and then advise treatment
D. Echocardiography for rheumatic disease
E. Repeat X-ray after 1 month and then advise treatment
87. Which of the following is (are) a complication(s) of disseminated gonococcal infection (DGI)?
A. Arthritis
B. Tenosynovitis
C. Bacteremia
D. Endocarditis
E. All of the above
88. A 24-year-old female comes to your office with a 2-day history of dysuria accompanied by painful genital lesions that have coalesced to form ulcers. There is no previous history of this condition. She has had three sexual partners in the past and inconsistently uses barrier contraceptive methods. You tell the patient the most likely diagnosis is:
A. Herpes simplex infection
B. Chancroid
C. Human papillomavirus (hpv) infection
D. Granuloma inguinale
E. Primary syphilis
89. A 25-year-Old sexually active female comes to your office with a 2-week history of "growths" in the vulvar region. On examination, you find multiple cauliform. What is the most likely diagnosis in this patient?
A. Condyloma lata
B. Condyloma acuminatum
C. Herpes simplex type 1
D. Herpes simplex type 2
E. None of the above.
90. A 19 years old girl has been brought to you by her mother because of vomiting since 1 week. She also complains of dizziness, lethargy and frequency of micturition. She is worried about her health because she wants to participate in a fashion show after 3 days. What else would you ask in history in order to narrow down your differential diagnosis?
A. Last menstrual period (LMP)
B. Lower abdomen and groin pain.
C. Vaginal discharge.
D. Sexual contact
E. All of the above.
91. What would be your first line of investigations?
A. Urinalysis, ?-HCG, ultrasound pelvis.
B. Urine analysis, blood sugar, SGPT
C. SGPT, urine analysis, ultrasound upper abdomen.
D. Urinalysis, ultrasound pelvis
E. CBC, urine analysis, ultrasound KUB
92. All of the following are risk factors for sexually transmitted diseases except:-
A. Married status
B. Multiple sexual partners
C. Urban residence
D. Prior history of STDs
E. Young age (15 to 24 years)
93. All of the following are STD associated syndromes except:-
A. Vaginal discharge
B. Oral ulcers
C. Pelvic inflammatory syndrome
D. Neonatal conjunctivitis
E. Urethral discharge
94. All of the following are aims of treatment of sexually transmitted diseases except:-
A. Etiological diagnosis before starting treatment
B. Education on risk reduction and prevention
C. Promotion of safe sex
D. Partner notification and treatment
E. Effective treatment
95. Which one of the following statements about screening practices for tuberculosis is correct?
A. All children should be screened at the one-year well-child visit.
B. False-positive and false-negative results are rare with the Mantoux test.
C. Foreign-born persons should be screened annually for at least five years.
D. Persons receiving immuno-suppressive drugs or corticosteroids should be screened.
E. A Mantoux test that produces 10 mm of induration is always considered positive.
96. The most common adverse effects of fluoroquinolones involve which one of the following systems?
A. Central nervous.
B. Urinary tract.
C. Gastrointestinal tract.
D. Respiratory.
E. Cardiovascular.
97. The addition of fluoride to quinolones has allowed which one of the following previously resistant bacteria to be effectively treated?
A. Escherichia coli.
B. Klebsiella species.
C. Pseudomonas aeruginosa.
D. Bacteroides species.
CME for Family Physicians
Infectious Diseases
MCQ # Answer MCQ # Answer MCQ # Answer MCQ # Answer
1 A 26 D 51 E 76 D
2 E 27 A 52 C 77 A
3 C 28 E 53 B 78 D
4 B 29 B 54 C 79 E
5 A 30 B 55 E 80 E
6 A 31 A 56 D 81 D
7 D 32 B 57 D 82 D
8 C 33 D 58 E 83 C
9 C 34 D 59 A 84 B
10 A 35 C 60 C 85 E
11 B 36 D 61 C 86 C
12 C 37 B 62 A 87 E
13 C 38 E 63 C 88 A
14 C 39 B 64 E 89 B
15 C 40 D 65 A 90 E
16 A 41 B 66 B 91 A
17 D 42 C 67 E 92 A
18 E 43 E 68 E 93 B
19 C 44 D 69 E 94 A
20 B 45 B 70 A 95 D
21 B 46 B 71 E 96 C
22 B 47 B 72 E 97 C
23 D 48 D 73 E
24 A 49 C 74 E
25 E 50 A 75 A
A. Peritonsillar abscess
B. Streptococcal pharyngitis
C. Tonsillar cancer
D. Epiglottitis
2. Which of the following statements about rapid streptococcal screening tests (enzyme immunoassays) is FALSE?
A. Their accuracy approaches that of latex agglutination tests
B. They are fairly predictive of streptococcal infections if positive
C. They are quick and easy to perform
D. They should be confirmed by culture if results are negative
E. They are typically more sensitive than specific
3. Which of the following statements about influenza is FALSE in general practice.
A. Symptoms include fever, cough, coryza, headache, myalgias, and fatigue
B. Influenza a is the most common cause of the flu
C. Diagnosis requires acute and convalescent titers
D. Immunization for healthy adults should be recommended at 65 years of age
4. Which of the following statements about giardiasis is FALSE?
A. Transmission occurs through fecal-oral contamination
B. Chlorination of drinking water kills the cyst
C. Diagnosis can be achieved by inspection of the stool for cysts.
D. The trophozoite form is responsible for symptoms
5. Which of the following statements about zidovudine (AZT) is FALSE?
A. AZT is a macrolide antibiotic
B. AZT inhibits reverse transcriptase
C. AZT administration requires monitoring of central blood counts
D. Concomitant use of acetaminophen or trimethoprim-sulfacmethoxazole may increase the risk of toxicity
E. Side effects may include headaches, paresthesias, and dizziness
6. Which of the following conditions is a contraindication to influenza vaccination?
A. Allergy to eggs
B. Allergy to red dye
C. Allergy to penicillin
D. Allergy to milk
E. Allergy to dust mites
7. The average length of time between infection with HIV and the development of AIDS is:
A. 1 year
B. 3 years
C. 5 years
D. 10 years
E. 20 years
8. A 26 year old single man presents to your office complaining of a painless ulcer that formed on his penis approximately 3 months ago. The ulcer healed, but an erythematous rash on the palms and soles of his feet has recently developed. He also reports generalized fatigue, malaise, fever, headache, and arthralgias. The most likely diagnosis is:
A. Gonorrhea
B. Chancroid
C. Syphilis
D. Reiter?s syndrome
E. Lyme disease
9. Which of the following infections causes tabes dorsalis?
A. Gonorrhea
B. Tuberculosis
C. Syphilis
D. Bacterial meningitis
10. A 32 year old sportsman who recently attended a wild game feed banquet consumed summer sausage made form bear meat. He complains of abdominal discomfort, diarrhea, and muscle tenderness. The most likely diagnosis is
A. Trichinosis
B. Salmonella infection
C. Giardia infection
D. Ascariasis
E. Viral gastroenteritis
11. A 68 year old patient is seen for a general examination. Current recommendations for immunizations include:
A. Tetanus booster every 5 years
B. Influenza vaccination yearly
C. Pneumococcal vaccination yearly
D. Hepatitis booster every 5 years
12. A 34-year-old man in otherwise good health presents with coughing spasms followed by post-tussive emesis for three weeks. You suspect pertussis and collect a nasopharyngeal swab for a culture. According to the Centers for Disease Control and Prevention, which one of the following is the best next step?
A. Prescribe an inhaled beta agonist to relieve symptoms
B. Prescribe antibiotics only if the culture is positive.
C. Treat close household members with antibiotics.
D. Administer a whole-cell pertussis vaccine
13. Patients with syphilis who are allergic to penicillin should be desensitized and given penicillin therapy. Use of an alternative regimen would be most reasonable in patients with which one of the following conditions?
A. Pregnancy
B. A positive test for human immunodeficiency virus (HIV).
C. Early disease.
D. A history of Jarisch-Herxheimer reaction.
E. Concomitant gonorrheal infection.
14. Which one of the following diseases can have an incubation period of longer than 21 days?
A. Dengue fever.
B. Leptospirosis.
C. Malaria.
D. Typhoid fever.
15. Which one of the following factors does not increase the risk of developing herpes zoster?
A. Increasing age.
B. Human immunodeficiency virus infection.
C. Asian race.
D. Hodgkin's lymphoma.
16. Which one of the following statements about antibiotic prophylaxis for traveler's diarrhea is correct?
A. It is not routinely recommended.
B. Metronidazole is recommended.
C. Azithromycin is recommended.
D. Ciprofloxacin is recommended.
E. Rifampicin is recommended.
17. Which one of the following statements about the diagnosis of active tuberculosis is false?
A. Three sputum specimens should be obtained for acid-fast staining.
B. The Mantoux test is negative in 10 to 25 percent of patients with active disease.
C. The sputum culture remains the gold standard for the diagnosis of tuberculosis.
D. Nucleic acid amplification tests are an acceptable alternative to sputum culture.
E. In children, early-morning gastric washings are more likely than bronchoscopy to yield a diagnosis.
18. An otherwise healthy, immunocompetent healthcare worker converts to a positive PPD. Which of the following drugs is recommended for this person?
A. Rifampin
B. Pyrazinamide
C. Ethambutol
D. Streptomycin
E. Isoniazid
19. A 14-year-old white male experiences a sudden onset of severe headache, chills, fever, myalgia, nausea, and vomiting. Three days later he presents to the ER with a pink macular rash around his wrists and ankles. This presentation is most closely associated with which of the following?
A. Secondary syphilis
B. Kawasaki's disease
C. Rocky mountain spotted fever
D. Toxic shock syndrome
E. Scarlet fever
20. Which of the following is NOT included in the group of viral exanthems?
A. Measles
B. Mumps
C. Rubella
D. Roseola
E. Fifth disease
21. A 23 years old married women present with lower abdominal pain, vaginal discharge, dyspareunia. On examination there is cervical discharge cervical excitation and groin tenderness?
A. Acute appendicitis
B. Acute pelvic inflammatory disease (PID)
C. Uncomplicated cervicitis
D. Ectopic pregnancy
E. Threatened abortion.
22. If hospitalization was chosen for this patient, which of the following regimens is first-line treatment for her condition?
A. Intravenous (IV) Ampicillin and Gentamicin
B. IV cefotetan and doxycycline
C. IV ceftriaxone
D. IV ciprofloxacin
E. IV ampicillin
23. If outpatient management was chosen for the patient, which of the following regimens is first line treatment for her condition?
A. Oral ofloxacin with or without metronidazole .
B. Intramuscular (IM) cefoxitin, oral probenecid and po doxycycline
C. IM ceftriaxone, oral doxycycline with or without po metronidazole.
D. Any of the above
E. None of the above
24. Which of the following statements regarding the relationship between combined oral contraceptive pills (OCPs) and Pelvic inflammatory disease is true?
A. OCPs decrease the risk of this condition
B. OCPs increase the risk of this condition
C. OCPs do not influence this condition at all
D. OCPs are contraindicated in patients with the condition
E. none of the above
25. Which of the following organisms is not associated with this condition?
A. Neisseria gonorrhea
B. Chlamydia trachomatis
C. Gardnerella hominis
D. Bacteroides fragilis
E. Beta-hemolytic streptococcus
26. A 24 years old sexually active man presents with uretheral discharge. His urethral gram stain reveals WBCs per oil immersion field. There are no intracellular gram-negative diplococci seen. What is the most likely diagnosis in this patient?
A. Gonorrhea
B. Acute prostatitis
C. Epididymitis
D. Nongonococcal urethritis
E. Bacterial cystitis
27. What is the most likely organism causing Non-gonococcal urethritis?
A. Chlamydia trachomatis
B. Ureaplasma urealyticum
C. Trichomonas vaginalis
D. Neisseria gonorrhea
E. Herpes simplex virus
28. Case same as above. You prescribe an appropriate antibiotic regimen for this patient and for his current sexual partner. Both he and his partner completed the recommended regimen. He states that they have been in a monogamous relationship. His symptoms have resolved completely. He wants to know if the "infection is gone" and if he should have a test of cure. Which of the following statement can you tell the patient?
A. He should have a test of cure 2 weeks after treatment
B. He should have a test of cure 6 months after treatment
C. He and his partner should have a test of cure 2 weeks after treatment
D. He and his partner should have a test of cure 6 months after treatment
E. He and his partner do not need a test of cure
29. Which of the following statements about syphilis is true?
A. Primary syphilis is associated with a single, painful chancre
B. Secondary syphilis is associated with skin lesions and lymphadenopathy
C. Latent syphilis is associated with constitutional symptoms
D. Treatment for primary syphilis is oral penicillin
E. The recommended treatment for early-latent and late-latent syphilis is the same
30. Which of the following statements about syphilis testing is true?
A. Dark-field microscopy of lesion exudates is the most convenient way to confirm Treponema pallidum
B. Nontreponemal tests (i.e., rapid plasma reagin [RPR])can be falsely positive in certain med?ical conditions
C. Trcponemal-specifjc test (i.e., fluorescent trep?onemal antibody-absorption test [FTA-ABS]) titers decline after syphilis treatment
D. RPR titers can be used interchangeably.with Venereal Disease Research Laboratory (VORL) titers
E. none of the above
31. What is the treatment of choice in patients who are not allergic to penicillin for primary or secondary syphilis?
A. IM benzathine penicillin G in a single dose
B. IM benzathinc penicillin G once a week for 3 weeks
C. IV Alqueous crystalline penicillin G for 10-14 days
D. PO probenecid for 10-14 days
E. PO doxycycline
32. Which of the following statements about human immunodeficiency virus (HIV) is false?
A. HIV testing should be offered to all patients seeking evaluation for STDs
B. The HIV-2 strain is endemic to the United States
C. HIV testing is available through urine, oral mucosal, and blood samples
D. Initial positive screening test should be followed by a more specific confirmatory test
E. Repeat serologic testing should not be done prior to 3 months after exposure.
33. Which of the following tests is NOT helpful in the diagnosis of active pulmonary tuberculosis?
A. Chest x-ray
B. Gram's stain of sputum
C. Sputum culture
D. Blood culture
E. DNA probe studies
34. Gram's stain of the CSF on a child suspected for meningitis reveals gram-positive diplococci. The patient should be treated with which of the following combinations?
A. Ampicillin + vancomycin
B. Ceftriaxone + gentamicin
C. Ampicillin + gentamicin
D. Vancomycin + ceftriaxone
E. Ampicillin + cefaclor
35. Which of the following is not appropriate antibiotic treatment for uncomplicated, early-stage Lyme disease in the nonpregnant patient?
A. Doxycycline
B. Amoxicillin
C. Ceftriaxone
D. Azithromycin
E. Cefuroxime
36. In the revised Jones criteria for the diagnosis of acute rheumatic fever (ARF), which of the following is NOT included among the major manifestations?
A. Subcutaneous nodules
B. Carditis
C. Chorea
D. Fever
E. Polyarthritis
37. Infants born to HbsAg-negative mothers should receive hepatitis B vaccine according to which of the following schedules?
A. One dose by age 2 months
B. Two doses before school age
C. Three doses before school age
D. Four doses: three before school age and one teenage booster
E. Five doses: four before school age and one teenage booster
38. A patient with no history of treatment for primary syphilis presents with symptoms and signs consistent with secondary syphilis. During your workup on this patient, you would expect to find all of the following except:-
A. Generalized lymphadenopathy
B. Condyloma lata
C. Elevated alkaline phosphatase
D. Generalized maculopapular rash
E. Superficial painless gummas
39. Which of the following is NOT among the usual causes of acute sinusitis?
A. Streptococcus pneumoniae
B. Escherichia coli
C. Haemophilus influenzae
D. Staphylococcus aureus
E. Streptococcus pyogenes
40. A person planning to travel in rural equatorial Africa for a month should be advised to be vaccinated for:-
A. Malaria
B. Traveler's diarrhea
C. Plague
D. Yellow fever
E. Typhus
41. Which of the following organisms is recognized as a major cause of peptic ulcer disease (PUD)?
A. Campylobacter jejuni
B. Helicobacter pylori
C. Clostridium difficile
D. Pseudomonas aeruginosa
E. Enterotoxigenic Echerchia coli
42. Which of the following is TRUE about hepatitis B?
A. It is the most common form of acute viral hepatitis.
B. Even without treatment, it seldom progresses to chronic disease.
C. It is a vaccine-preventable liver disease.
D. Its prevalence is related to the quality of the water supply.
E. Food-borne hepatitis B is a common mode of transmission.
43. A teenage patient presents with fever soethroat, nausea, upper abdominal pain. On examination bilateral anterreor lymphadenopathy , mild hepatomeyaly and tonsillar exudates are presents The diagnosis mononucleosis is supported predomin and by all of the following except:-
A. A positive heterophile test
B. Atypical lymphocytes on the differential
C. Lymphadenopathy
D. Pharyngitis
E. Cough
44. A 14 years old boy who has returened from mountain camping, presents with severe headache, chills, fever myalgia, nausea and vomiting.Three days later he developed pink macular rash around wrist and ankles. Which of the following regimens is the treatment of choice for this patient?
A. Gentamicin, 2 mg/kg IV q8h 3 ? 14 days
B. Ampicillin, 250 mg po qid 3 ? 10 days
C. Vancomycin, 1 g IV q12h 3 ? 7 days
D. Doxycycline, 100 mg po bid 3 ? 10 days.
E. Metronidazole, 500 mg po tid 3 ? 14 days.
45. A 6 years old child is brought to your clinic with sudden onset of sore throat, difficulty in swallowings, headache and abdominal pain. There is no cough or coryza. His temperature is 400C and tonsillar exudates are presents What treatment would you offer for this child?
A. Azithromycin
B. Amoxicillin
C. Ciprofloxacin
D. No antibiotics, rest, fluid, acetaminophen, and Saline gargles
E. None of the above
46. In the pediatric population what is the incidence of group A streptoc ccus pharyngitis is
A. 5% to 15%
B. 15% to 30%
C. 10% to 20%
D. 20% to 30%
E. Nobody really knows for sure
47. The entire reason for treating group A beta?hemolytic streptococcus is to prevent which of the following sequelae.
A. Pyelonephritis
B. Rheumatic fever
C. Glomerulonephritis
D. A and C
E. All of the above
48. Which specific infections are associated with group A beta-hemolytic streptococcus?
A. Erysipelas
B. Scarlet fever
C. Impetigo
D. All of the above
E. A & C only
49. Recent practice guidelines recommend which of the following regarding diagnosis of group A beta-hemolytic streptococcus in children?
A. Clinical presentation alone should enable a physician to diagnose a streptococcal throat
B. A negative rapid strep test rules out streptococcal? throat.
C. A negative rapid strep test must be confirmed by a throat culture to rule out streptococcal throat
D. A positive rapid strep test alone is 100 % proof of a streptococcal infection
E. None of the Above
50. Recurrent Tonsillitis usually is caused by which of the following?
A. Group A beta-hemolytic streptococcus
B. Parainfiuenzae virus
C. Rhinovirus
D. Adenovirus
E. Epstein-Barr virus
51. Which of the following is (are) a complication(s) of tonsillectomy?
A. Hemorrhage
B. Postoperative throat infection
C. Pulmonary edema
D. A and B
E. All of the Above
52. An adult with a high risk for bacterial endocarditis is scheduled for a dental extraction. The patient has a history of penicillin allergy. Which of the following is an appropriate oral prophylactic drug to give this patient?
A. Amoxicillin
B. Vancomycin
C. Clindamycin
D. Doxycycline
E. Gentamicin
53. An 8 years old girl from a village comes with 5 days history of intermittent with chills and myalgias. There are no respiratory, abdominal and urinary complains. Her examination is normal and she is afebrile in your clinic.
Which ONE medicine would you prescribe for her?
A. Chloramphemicol
B. Chloroquin
C. Ceftriaxone
D. Amoxicillin
E. Nalidixic acid
54. If you have to select only one investigation, which one would you like to choose?
A. CBC
B. ESR
C. MP
D. Blood culture
E. Urine DR
55. Mr. Ashraf presented to your clinic with intermittent fever and you treated him with Chloroquine. He did not respond and his blood film shows Falciparum malaria. The patient is otherwise stable. How would you teat him?
A. Tab. Quinine 600 mg TDS for 1 week
B. Tab. Halofantrine 500 mg 6 hourly
C. Tab. Sulphadoxine + Pyremethamine 3 tablets
D. Tab. Artemether 80 mg OD for 5 days
E. Any of the above
56. Mrs. Shamim has been referred to you by a gynecologist for treatment of malaria. She is in her 3rd month of gestation. Her blood film shows P. vivax. How would you manage her?
A. Arthemether
B. Quinine
C. Halofantrine
D. Chloroquin
E. Sulphadoxine + Pyremetham
57. A 25 years old women presents to your clinic with intesmitt and fever with chills and rigors. Her blood film shows P. falciparum. How would you manager her?
A. Arthemether
B. Quinine
C. Halofantrine
D. Chloroquine
E. Sulphadoxine + Pyremethamine
58. Mrs. Janjua presents to your clinic with intermittent fever with chills, backache, nausea and headache. Her husband tells you that she has started speaking irrelevant sentences. She looks sleepy during physical examination. What is the most likely diagnosis in her case?
A. Septicemia
B. Meningitis
C. Cerebral malaria
D. B and C
E. Any of the above
59. Case same as above. Her blood test done a day before show P. falciparum. What treatment should be most suitable for her?
A. Quinine
B. Chloroquine
C. Mefloquin
D. Artemether
E. Halofantrine
60. Dilshad is a 24 years old carpenter who presented to you with P. vivax for the third time in six months. According to your advice he has been using mosquito repellants and mosquito net regularly. What is the most likely explanation for repeated vivax infections?
A. Resistance
B. Fake drugs
C. Hypnozoites
D. Repeated infections
E. Drug reaction
61. Case same as above. Which single investigation would you like to order before treating this patient for recurrent vivax infection?
A. Blood sugar
B. Coomb?s test
C. G6PD test
D. Reticulocyte count
E. B and C
62. Case same as above. How would you treat him?
A. Primaquine
B. Mefloquine
C. Halofantrine
D. Arthemether
E. Sulphadoxine + Pyremethamine
63. Which sexually transmitted disease (s) is/are vaccine preventable:-
A. Chancre
B. Lymphogranuloma venerium
C. Hepatitis B
D. Gonorrhea
E. C and D
64. According to CDC recommendations which vaccine (s) is/are recommended for health care workers:-
A. MMR
B. Hepatitis B
C. Vericella
D. Influenza
E. All of the above
65. Which vaccine is recommended specifically for females only:-
A. Human Papilloma virus
B. Hepatitis B
C. Vericella
D. Rubella
E. Hepatitis E
66. A mother brings her 2 years old son for vaccination. He has received BCG and first doses of Polio, DPT and Hepatitis B. How would you manage this case according to EPI?
A. Restart vaccination
B. Resume vaccination
C. Give double dose
D. Give another booster after completion of series
E. Check protective antibody levels and then make schedules
67. A 16 years old healthy boy comes to you clinic for vaccination. He has never received any vaccine. How would you manage this case in accordance with literature if all vaccines are available in your town?
A. DT
B. Hepatitis B
C. MMR
D. Varicella
E. All of the above
68. A 45 years old man comes for vaccination. He has never received any vaccine. His medical and social history are unremarkable. How would you manage this case according to literature assuming that all vaccines are available?
A. DT
B. Hepatitis B
C. MMR
D. Vericella
E. A & B
F. All of the above
69. A 25 years old nurse comes to your clinic for vaccination. She has not received any vaccine. How would you manage this case?
A. Hepatitis B
B. MMR
C. Varicella
D. Influenza
E. All of the Above
70. The health minister asks your expert opinion about vaccination of Fire Brigade Department. All workers have already received primary vaccination for dT and Hepatitis B. Which vaccine would you specifically advise for this department?
A. Influenza
B. Pneumoccal
C. Meningococcal
D. Typhoid
E. Hepatitis A
71. A 60 years old healthy man comes to your clinic for vaccination. His hepatitis B vaccination is complete and he has also received 10 yearly booster of DT. What would you advise to him?
A. Influenza vaccine
B. Pneumococcal vaccine
C. Meningococcal
D. Typhoid
E. A and B
72. A 20 years old patient of valvular heart disease comes to your clinic for vaccination. All primary vaccines are complete. What else would you like to advise specifically in relation to his cardiac problem?
A. Influenza vaccine
B. Pneumococcal vaccine
C. Yellow Fever
D. Human Papilloma
E. A and B
F. All of the above
73. A surgeon refers a 35 years patient to you for vaccination after splenectomy for severe ITP. Her primary vaccines are complete. What would advise specifically in relation to her surgery?
A. Pneuurococcal
B. Hemphilus influenza
C. Meningococcal
D. Typhoid
E. A, B and C
F. All of the above
74. Your advised MMR vaccine to a 17 years old girl. Next week she comes with her husband and a positive pregnancy test. How would you manage this patient?
A. Don?t tell her any thing about vaccine
B. Advise abortion
C. Advise Rubella 1gM
D. Advise Rubella 1gG
E. Explain and advise to continue with the pregnancy
75. According to available literature, what is the most likely outcome of this fetus?
A. Normal
B. Mild abnormalities
C. Severe abnormalities
D. Preterm fetal demise
E. None of the above
76. A newly married woman comes to you for preconception counseling. She tells you that she has febrile illness with generalized macular rash few years ago. How would you manage this case?
A. Give MMR and advise contraception for 3 months
B. There is no need for vaccine in her case
C. Check Rubella 1gM and then give MMR
D. Check Rubella 1gG and then give MMR
E. Check both Rubella 1gM + 1gG and then give MMR
77. A 35 years old patient has been referred to you for opinion. He was admitted in ICU a month ago with tetanus from which he recovered. What would you advise him about tetanus vaccination?
A. Vaccinate according to 0,1,6 schedule
B. Give a booster dose
C. Check tetanus 1gG level and then decide
D. There is no need of vaccination now
E. None of the above
78. You have got a job in UK. On the very first day of your job, a man comes to you for vaccination before visiting Pakistan. His primary vaccination of Polio, DT, Hepatitis B, Vericella and MMR are complete. What else would you advice for him?
A. Hepatitis A
B. Typhim Vi
C. Meningococcal
D. A and B
E. All of above
79. A 27 years housemaid comes to your clinic with vaginal discharge. Her husband is a heroin addict and she has 4 children to look after. She admits that she has been having commercial sex off and on for her living. On examination white purulent discharge is visible at the external OS. How would you treat her?
A. Ampicillin + Gentamycin + Metronidazole
B. Clotrimazole vaginal pessasies
C. Doxycycline
D. Cap. Fluconazol 150 mg stat
E. Cefixime 400 mg stat + Doxycycline for 7 days
80. What else would you like to tell her?
A. Contraception
B. Use of condoms
C. Vaccination against Hepatitis B after screening
D. A and B
E. All of the above
81. A 35 years old woman complains of foul smelling greenish frothy vaginal discharge since 1 week. Her husband is asymptomatic and denies any extramarital contacts. How would you treat her?
A. Ceftriaxone 250 mg I/M
B. Azithromycin stat
C. Doxycycline for 2 weeks
D. Metronidazole 2 G stat
E. Fluconazole 150 mg 2 tab
82. How would you treat her husband?
A. Ceftriaxone 250 mg I/M
B. Azithromycin stat
C. Doxycycline for 2 weeks
D. Metronidazole 2 G stat
E. Fluconazole 150 mg 2 tab stat
83. A 25 years old man presents with painful ulcer on penis and bilateral inguinal lymphadenopathy. What is the most likely diagnosis?
A. Cancer
B. Chancroid
C. Lymphogranuloma venerium
D. Herpes simplex
E. Any of the above
84. Which single antibiotic would you like to choose in this case?
A. Ciprofloxacin
B. Erythromycin
C. Spectinomycin
D. Ceftriaxone
E. Benzathin penicillin
85. A 12 years old boy presented to your clinic with history of intermittent fever with rigors, body aches and headache. Suspecting malaria you prescribed chloroquin. Two days later he presents with jaundice and weakness. His labs show: Total bilirubin=6.2 Direct bilirubin= 1.0 Indirect bilirubin= 5.2 SGPT=36 Alkaline phosphatase= 170
What is the most likely interpretation?
A. Chloroquin resistant malaria
B. Gilbert?s syndrome
C. Acute viral hepatitis
D. Cholestatic jaundice
E. Hemolytic jaundice
86. A 19 years old woman presents with history of high grade fever, diarrhea and pain in the right hypochondrium for 1 month later on she also developed cough and shortness of breath. X-ray shows:How would you treat this patient?
A. Amoxicillin for 10 days and follow up X-ray after 1 month
B. Start Anti-tuberculous therapy
C. Ultrasound upper abdomen, aspiration of pleural fluid and then advise treatment
D. Echocardiography for rheumatic disease
E. Repeat X-ray after 1 month and then advise treatment
87. Which of the following is (are) a complication(s) of disseminated gonococcal infection (DGI)?
A. Arthritis
B. Tenosynovitis
C. Bacteremia
D. Endocarditis
E. All of the above
88. A 24-year-old female comes to your office with a 2-day history of dysuria accompanied by painful genital lesions that have coalesced to form ulcers. There is no previous history of this condition. She has had three sexual partners in the past and inconsistently uses barrier contraceptive methods. You tell the patient the most likely diagnosis is:
A. Herpes simplex infection
B. Chancroid
C. Human papillomavirus (hpv) infection
D. Granuloma inguinale
E. Primary syphilis
89. A 25-year-Old sexually active female comes to your office with a 2-week history of "growths" in the vulvar region. On examination, you find multiple cauliform. What is the most likely diagnosis in this patient?
A. Condyloma lata
B. Condyloma acuminatum
C. Herpes simplex type 1
D. Herpes simplex type 2
E. None of the above.
90. A 19 years old girl has been brought to you by her mother because of vomiting since 1 week. She also complains of dizziness, lethargy and frequency of micturition. She is worried about her health because she wants to participate in a fashion show after 3 days. What else would you ask in history in order to narrow down your differential diagnosis?
A. Last menstrual period (LMP)
B. Lower abdomen and groin pain.
C. Vaginal discharge.
D. Sexual contact
E. All of the above.
91. What would be your first line of investigations?
A. Urinalysis, ?-HCG, ultrasound pelvis.
B. Urine analysis, blood sugar, SGPT
C. SGPT, urine analysis, ultrasound upper abdomen.
D. Urinalysis, ultrasound pelvis
E. CBC, urine analysis, ultrasound KUB
92. All of the following are risk factors for sexually transmitted diseases except:-
A. Married status
B. Multiple sexual partners
C. Urban residence
D. Prior history of STDs
E. Young age (15 to 24 years)
93. All of the following are STD associated syndromes except:-
A. Vaginal discharge
B. Oral ulcers
C. Pelvic inflammatory syndrome
D. Neonatal conjunctivitis
E. Urethral discharge
94. All of the following are aims of treatment of sexually transmitted diseases except:-
A. Etiological diagnosis before starting treatment
B. Education on risk reduction and prevention
C. Promotion of safe sex
D. Partner notification and treatment
E. Effective treatment
95. Which one of the following statements about screening practices for tuberculosis is correct?
A. All children should be screened at the one-year well-child visit.
B. False-positive and false-negative results are rare with the Mantoux test.
C. Foreign-born persons should be screened annually for at least five years.
D. Persons receiving immuno-suppressive drugs or corticosteroids should be screened.
E. A Mantoux test that produces 10 mm of induration is always considered positive.
96. The most common adverse effects of fluoroquinolones involve which one of the following systems?
A. Central nervous.
B. Urinary tract.
C. Gastrointestinal tract.
D. Respiratory.
E. Cardiovascular.
97. The addition of fluoride to quinolones has allowed which one of the following previously resistant bacteria to be effectively treated?
A. Escherichia coli.
B. Klebsiella species.
C. Pseudomonas aeruginosa.
D. Bacteroides species.
CME for Family Physicians
Infectious Diseases
MCQ # Answer MCQ # Answer MCQ # Answer MCQ # Answer
1 A 26 D 51 E 76 D
2 E 27 A 52 C 77 A
3 C 28 E 53 B 78 D
4 B 29 B 54 C 79 E
5 A 30 B 55 E 80 E
6 A 31 A 56 D 81 D
7 D 32 B 57 D 82 D
8 C 33 D 58 E 83 C
9 C 34 D 59 A 84 B
10 A 35 C 60 C 85 E
11 B 36 D 61 C 86 C
12 C 37 B 62 A 87 E
13 C 38 E 63 C 88 A
14 C 39 B 64 E 89 B
15 C 40 D 65 A 90 E
16 A 41 B 66 B 91 A
17 D 42 C 67 E 92 A
18 E 43 E 68 E 93 B
19 C 44 D 69 E 94 A
20 B 45 B 70 A 95 D
21 B 46 B 71 E 96 C
22 B 47 B 72 E 97 C
23 D 48 D 73 E
24 A 49 C 74 E
25 E 50 A 75 A
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