Select the ONE answer that is BEST in each question!
A 27-year-old man presents to his primary care physician with complaints of a fever, headache, muscle aches, and swollen glands. The physician observes disseminated lymphadenopathy, pharyngitis, and a rash on the man’s upper chest. The patient states that he had been to a party 2 weeks ago where he experimented with injecting drugs to get high. Needles were shared among the party-goers. A rapid latex test for human immunodeficiency virus (HIV) antibodies performed in the physician’s office is negative. The doctor has a strong suspicion that this man has acute retroviral syndrome. Which of the following tests is most likely to support a diagnosis of HIV infection at this time?
A 9-year-old male with a history of fever and nonspecific symptoms presents with a bright red cheeks and a macular lacy rash over his body. Which of the following viruses is the most likely cause of this disease?
A 24-year-old pregnant woman presents near term with lesions suspicious for primary genital herpes. Culture identifies the presence of HSV type 2. At the time of delivery, she still has active genital lesions. Which of the following should be done to avoid transmitting the virus to the baby?
An HIV-positive patient, after treatment with tenofovir/emtricitabine plus ritonavir-boosted atazanavir, has a CD4 T-cell count of 325/µL and a viral load of less than 50 copies of HIV RNA/mL. Previously her CD4+ T-cell count was 280/µL and viral load was 100,000 copies/mL. Which of the following best describes this patient?
An HIV-positive patient with a viral load of 100,000 copies/mL of HIV RNA and a drop in his CD4 T-cell count from 240 to 50/µL has been diagnosed with Pneumocystis jiroveci pneumonia. Which of the following is the best description of the stage of this patient’s HIV disease?
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A 19-year-old college student presents to the student health clinic complaining of sore throat, fever, swollen neck lymph nodes, and malaise of several days. His complete blood count shows WBC count 22,000/µL with 10% neutrophils, 28% lymphocytes, 47% reactive lymphocytes, and 15% monocytes. His monospot test is positive. Which of the following is causing this student’s infection?
During a medical checkup for a new insurance policy, a 60-year-old grandmother is found to be positive by a conventional EIA screening test for antibodies against HIV-1. She has no known risk factors for exposure to the virus. Which of the following is the most appropriate next step?
A 74-year-old man who lived in Illinois developed malaise, fever, cough, and sore throat in August. Two days later, he visited his doctor because of severe headache, nausea and vomiting, and continued fever. He told his doctor that the mosquitoes had been fierce in the last 2 weeks and that he had been bitten numerous times. The doctor noted tremors in the man’s hands as well as fever of 104°F, and admitted him to the hospital for tests. Examination of CSF revealed normal glucose and protein with 150 lymphocytes/µL; PCR assays for HSV and West Nile virus (WNV) on the CSF were negative. Despite supportive care, the man slipped into a coma and died. Which of the following viruses was most likely responsible for this man’s illness?
A 64-year-old man complained of poor memory and difficulty with vision that was progressing rapidly and myoclonic jerks. Cerebrospinal fluid examination at a reference laboratory revealed the presence of 14-3-3 protein. Over the next 6 months his cognitive deterioration became severe and he died 2 months later. At autopsy, spongiform encephalopathy was noted. Which of the following is the most appropriate diagnosis for this man?
In 2003, the zoonotic severe acute respiratory syndrome (SARS) coronavirus caused a pandemic in which over 8000 people were infected and the mortality rate was 10%. In 2012, a novel coronavirus was isolated from 12 persons in Saudi Arabia, Qatar, and Britain with severe respiratory illness; so far, 50% have died. Which of the following syndromes is more commonly caused by other known types of human coronaviruses?
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A 35-year-old intravenous (IV) drug abuser with known chronic hepatitis B virus (HBV) status suddenly presents with an acute hepatitis episode. He develops massive hepatic necrosis and dies. Which of the following is most likely responsible for the change in his condition?
Which of the following antiviral compounds inhibits activity of the pyrophosphate-binding site of viral DNA polymerases and is used to treat serious infections with cytomegalovirus?
A clinic associated with a medical school and located in a lower income city district documents a series of cases involving echoviruses in school-age children. Most cases experienced common cold symptoms plus mild fever and maculopapular rash; some were hospitalized with acute onset of fever, headache, nuchal rigidity, and petechial rash. All experienced complete recovery within 1 week without specific antiviral therapy. Which of the following body systems is the main target of echoviruses?
A 15-year-old boy is taken to his pediatrician after experiencing fever, malaise, and anorexia followed by tender swelling of his parotid glands. Which of the following is the most likely complication to occur in this patient?
A 3-year-old child who had not been immunized presents at the physician’s office with symptoms of coryza, cough, conjunctivitis, and photophobia. He has a low-grade fever, and small, bluish-white ulcerations are seen on the buccal mucosa opposite the lower molars. What is the causative agent of this child’s symptoms?
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A sexually active woman was seen for a routine gynecologic exam that included a Pap smear. The report indicated cervical intraepithelial neoplasia. In situ hybridization showed the presence of human papillomavirus (HPV) type 16 genomes within the neoplastic cells. Which of the following processes is required for HPV to lead to the development of cancer?
Two siblings, ages 2 and 4, experience fever, rhinitis, and pharyngitis that result in laryngotracheobronchitis. Both have a harsh, bark-like cough and hoarseness. Which of the following viruses is the leading cause of their syndrome?
An outbreak of hepatitis occurred in an area of India with poor sanitation. Most of the patients reported fever, nausea with vomiting, and weight loss occurring over several days followed by jaundice and pruritus. Testing quickly ruled out HAV. A number of women in the area are pregnant. For which of the following are these women at risk?
An 18-year-old man was taken to an emergency medicine department because of fever and headache for 36 hours and now complaint of a stiff neck. No bacterial agents appeared to be involved and an initial diagnosis of aseptic meningitis was made. Which of the following laboratory findings in the examination of his cerebrospinal fluid led to this diagnosis?
A street person well known to the local public health clinic appears to have acute symptoms of hepatitis and tests positive for HDV antigen. Knowing that HDV requires HBV, which of the following sets of test results shows this patient had chronic HBV infection and was superinfected with HDV?
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| 1. A 27-year-old man presents to his primary care physician with complaints of a fever, headache, muscle aches, and swollen glands. The physician observes disseminated lymphadenopathy, pharyngitis, and a rash on the man’s upper chest. The patient states that he had been to a party 2 weeks ago where he experimented with injecting drugs to get high. Needles were shared among the party-goers. A rapid latex test for human immunodeficiency virus (HIV) antibodies performed in the physician’s office is negative. The doctor has a strong suspicion that this man has acute retroviral syndrome. Which of the following tests is most likely to support a diagnosis of HIV infection at this time?
a. CD4 lymphocyte count b. HIV antibody test by enzyme-linked immunosorbent assay (EIA) c. HIV p24 antigen d. Reverse transcriptase polymerase chain reaction (PCR) for HIV RNA e. Western blot for HIV antibodies |
| 2. A 9-year-old male with a history of fever and nonspecific symptoms presents with a bright red cheeks and a macular lacy rash over his body. Which of the following viruses is the most likely cause of this disease?
a. Herpes simplex virus (HSV) type 1 b. Parvovirus B19 c. Rubella virus d. Rubeola (measles) virus e. Varicella-zoster virus (VZV) |
| 3. A 24-year-old pregnant woman presents near term with lesions suspicious for primary genital herpes. Culture identifies the presence of HSV type 2. At the time of delivery, she still has active genital lesions. Which of the following should be done to avoid transmitting the virus to the baby?
a. Cesarean delivery b. Internal fetal monitoring c. Rupture of the membranes to speed delivery d. Vaginal delivery |
| 4. An HIV-positive patient, after treatment with tenofovir/emtricitabine plus ritonavir-boosted atazanavir, has a CD4 T-cell count of 325/µL and a viral load of less than 50 copies of HIV RNA/mL. Previously her CD4+ T-cell count was 280/µL and viral load was 100,000 copies/mL. Which of the following best describes this patient?
a. This patient is no longer in danger of opportunistic infection b. The 5-year prognosis is excellent c. The patient’s HIV screening test is most likely negative d. The patient is not infectious e. The antiretroviral therapy has been effective |
| 5. An HIV-positive patient with a viral load of 100,000 copies/mL of HIV RNA and a drop in his CD4 T-cell count from 240 to 50/µL has been diagnosed with Pneumocystis jiroveci pneumonia. Which of the following is the best description of the stage of this patient’s HIV disease?
a. HIV infection, stage 1 b. HIV infection, stage 2 c. HIV infection, stage 3 (AIDS) d. HIV infection, stage unknown |
| 6. A 19-year-old college student presents to the student health clinic complaining of sore throat, fever, swollen neck lymph nodes, and malaise of several days. His complete blood count shows WBC count 22,000/µL with 10% neutrophils, 28% lymphocytes, 47% reactive lymphocytes, and 15% monocytes. His monospot test is positive. Which of the following is causing this student’s infection?
a. Adenovirus b. Cytomegalovirus c. Echovirus d. Epstein–Barr virus e. Human metapneumovirus |
| 7. During a medical checkup for a new insurance policy, a 60-year-old grandmother is found to be positive by a conventional EIA screening test for antibodies against HIV-1. She has no known risk factors for exposure to the virus. Which of the following is the most appropriate next step?
a. Immediately begin antiretroviral therapy b. Perform the EIA screening test a second time c. Request that a viral blood culture be done by the laboratory d. Tell the patient that she is likely to develop AIDS e. Test the patient for Pneumocystis jiroveci infection |
| 8. A 74-year-old man who lived in Illinois developed malaise, fever, cough, and sore throat in August. Two days later, he visited his doctor because of severe headache, nausea and vomiting, and continued fever. He told his doctor that the mosquitoes had been fierce in the last 2 weeks and that he had been bitten numerous times. The doctor noted tremors in the man’s hands as well as fever of 104°F, and admitted him to the hospital for tests. Examination of CSF revealed normal glucose and protein with 150 lymphocytes/µL; PCR assays for HSV and West Nile virus (WNV) on the CSF were negative. Despite supportive care, the man slipped into a coma and died. Which of the following viruses was most likely responsible for this man’s illness?
a. Coltivirus b. Dengue virus c. Erythrovirus (parvovirus B19) d. La Crosse virus e. St. Louis encephalitis virus |
| 9. A 64-year-old man complained of poor memory and difficulty with vision that was progressing rapidly and myoclonic jerks. Cerebrospinal fluid examination at a reference laboratory revealed the presence of 14-3-3 protein. Over the next 6 months his cognitive deterioration became severe and he died 2 months later. At autopsy, spongiform encephalopathy was noted. Which of the following is the most appropriate diagnosis for this man?
a. Sporadic Creutzfeldt–Jakob disease (CJD) b. Familial CJD c. Iatrogenic CJD d. Variant CJD |
| 10. In 2003, the zoonotic severe acute respiratory syndrome (SARS) coronavirus caused a pandemic in which over 8000 people were infected and the mortality rate was 10%. In 2012, a novel coronavirus was isolated from 12 persons in Saudi Arabia, Qatar, and Britain with severe respiratory illness; so far, 50% have died. Which of the following syndromes is more commonly caused by other known types of human coronaviruses?
a. Common cold b. Herpangina c. Meningitis d. Pneumonia e. Vesicular lesions |
| 11. A 35-year-old intravenous (IV) drug abuser with known chronic hepatitis B virus (HBV) status suddenly presents with an acute hepatitis episode. He develops massive hepatic necrosis and dies. Which of the following is most likely responsible for the change in his condition?
a. A hepatitis B mutant has developed b. He has contracted hepatitis D virus (HDV) c. He has developed cirrhosis d. His food contained hepatitis A virus (HAV) e. His food contained hepatitis E virus (HEV) |
| 12. Which of the following antiviral compounds inhibits activity of the pyrophosphate-binding site of viral DNA polymerases and is used to treat serious infections with cytomegalovirus?
a. Amantadine b. Foscarnet c. Ganciclovir d. Ribavirin e. Zidovudine |
| 13. A clinic associated with a medical school and located in a lower income city district documents a series of cases involving echoviruses in school-age children. Most cases experienced common cold symptoms plus mild fever and maculopapular rash; some were hospitalized with acute onset of fever, headache, nuchal rigidity, and petechial rash. All experienced complete recovery within 1 week without specific antiviral therapy. Which of the following body systems is the main target of echoviruses? |
a. Bloodstream
b. Central nervous system (CNS)
c. Intestinal tract
d. Lymphoid tissues
e. Upper respiratory tract
14. A 15-year-old boy is taken to his pediatrician after experiencing fever, malaise, and anorexia followed by tender swelling of his parotid glands. Which of the following is the most likely complication to occur in this patient?
a. Guillain–Barré syndrome
b. Hemorrhage
c. Myocarditis
d. Oophoritis
e. Orchitis
15. A 3-year-old child who had not been immunized presents at the physician’s office with symptoms of coryza, cough, conjunctivitis, and photophobia. He has a low-grade fever, and small, bluish-white ulcerations are seen on the buccal mucosa opposite the lower molars. What is the causative agent of this child’s symptoms?
a. Adenovirus
b. HSV
c. Influenzavirus
d. Measles virus
e. Rubella virus
16. A sexually active woman was seen for a routine gynecologic exam that included a Pap smear. The report indicated cervical intraepithelial neoplasia. In situ hybridization showed the presence of human papillomavirus (HPV) type 16 genomes within the neoplastic cells. Which of the following processes is required for HPV to lead to the development of cancer?
a. Integration of the viral genome
b. Loss of HPV E6 and E7 genes
c. Mutation of the virus
d. Viral replication
17. Two siblings, ages 2 and 4, experience fever, rhinitis, and pharyngitis that result in laryngotracheobronchitis. Both have a harsh, bark-like cough and hoarseness. Which of the following viruses is the leading cause of their syndrome?
a. Adenovirus
b. Coxsackievirus B
c. Parainfluenza virus
d. Rhinovirus
e. Rotavirus
18. An outbreak of hepatitis occurred in an area of India with poor sanitation. Most of the patients reported fever, nausea with vomiting, and weight loss occurring over several days followed by jaundice and pruritus. Testing quickly ruled out HAV. A number of women in the area are pregnant. For which of the following are these women at risk?
a. Chronic hepatitis
b. Fetal hydrops
c. Fulminant hepatic failure
d. Guillain–Barré syndrome
e. Reye syndrome
19. An 18-year-old man was taken to an emergency medicine department because of fever and headache for 36 hours and now complaint of a stiff neck. No bacterial agents appeared to be involved and an initial diagnosis of aseptic meningitis was made. Which of the following laboratory
findings in the examination of his cerebrospinal fluid led to this diagnosis?
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a. Decreased protein content
b. Elevated glucose concentration
c. Eosinophilic pleocytosis
d. Lymphocytic pleocytosis
e. Neutrophilic pleocytosis
20. A street person well known to the local public health clinic appears to have acute symptoms of hepatitis and tests positive for HDV antigen. Knowing that HDV requires HBV, which of the following sets of test results shows this patient had chronic HBV infection and was superinfected with HDV?
a. HBsAg +, HBeAg +, Anti-HBcAg IgM +, Anti-HBcAg IgG -, Anti-HBsAg –
b. HBsAg +, HBeAg +, Anti-HBcAg IgM -, Anti-HBcAg IgG +, Anti-HBsAg –
c. HBsAg -, HBeAg -, Anti-HBcAg IgM -, Anti-HBcAg IgG +, Anti-HBsAg +
d. HBsAg -, HBeAg -, Anti-HBcAg IgM -, Anti-HBcAg IgG -, Anti-HBsAg +
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