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?
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?
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?
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 nurse develops clinical symptoms consistent with hepatitis. She recalls sticking herself with a needle approximately 5 months before, after drawing blood from a patient. Serologic tests for HBsAg, and antibodies to HBsAg and HAV are all negative; however, she is positive for HBcAg IgM
antibody. Which of the following characterizes the current health state of the nurse?
a. Does not have hepatitis B
b. Has resolved hepatitis B
c. Has chronic hepatitis B
d. Is in window period of acute hepatitis B
e. Was immunized with HBsAg
|2. A 65-year-old Florida fisherman forgot his insect repellent on a recent sporting trip. A week later, he developed fever, chills, headache, and flulike symptoms. He was brought to the Emergency Department by his wife with photophobia, extreme lethargy, and severe headache. CNS examination revealed cranial nerve deficits and hemiparesis. The patient was admitted to intensive care with a grave prognosis. Which of the following is the vector that transmitted the infection from which this man is suffering?
d. Sand fly
|3. A local school district finds a large number of student absences, with the children presenting with rhinorrhea, nasal obstruction, headache, and malaise, but no fever. A strain of rhinovirus is the most likely etiologic agent of these infections. By which method is this virus most frequently spread?
a. Fecal–oral route
b. Hand-to-hand contact
c. Respiratory droplets
d. Sexual contact
e. Vertical transmission
|4. A 10-month-old infant who was born 4 weeks premature was brought to the Emergency Department with high fever, rhinorrhea, cough, and difficulty breathing. On examination, the baby had dyspnea and tachypnea; rales and wheezing were heard over both lungs. The baby was admitted to Pediatric Intensive Care where she suffered respiratory failure and was placed on mechanical ventilation. Two different types of tests for respiratory syncytial virus (RSV or Pneumovirus) were negative, as were tests for parainfluenza virus, influenza A and B viruses, and adenovirus. Which of the following viruses is the most likely etiologic agent?
b. HSV type 1
c. Human metapneumovirus
d. Parvovirus B19
|5. Kuru was a fatal disease of certain New Guinea natives and was characterized by tremors and ataxia; Creutzfeldt–Jakob disease (CJD) is characterized by both ataxia and dementia. CJD has been accidentally transferred to others by contaminated growth hormone from human pituitary glands, corneal transplants, and contaminated surgical instruments. These diseases are thought to be caused by which of the following?
a. Cell wall-deficient bacteria
b. Environmental toxins
e. Slow viruses
|6. Kuru was a fatal disease of certain New Guinea natives and was characterized by tremors and ataxia; Creutzfeldt–Jakob disease (CJD) is characterized by both ataxia and dementia. CJD has been accidentally transferred to others by contaminated growth hormone from human pituitary glands, corneal transplants, and contaminated surgical instruments. These diseases are thought to be caused by which of the following?
a. Cell wall-deficient bacteria
b. Environmental toxins
e. Slow viruses
|7. A patient who works in an industrial setting presents to his ophthalmologist with prominent subconjunctival hemorrhage, periorbital swelling, and corneal changes consistent with keratitis. The patient reported severe photophobia and the sensation that something was in his eye. Nine other workers developed similar symptoms 7 days later. The differential diagnosis should include infection with which of the following viruses?
b. Epstein–Barr virus
d. Respiratory syncytial virus
|8. A hospital worker is found to be positive for hepatitis B surface antigen. Subsequent tests reveal the presence of HBeAg as well. Which of the following best describes the worker?
a. Has a biologic false-positive test for hepatitis
b. Is highly contagious
c. Is less contagious
d. Is not contagious
e. Has resolved hepatitis B
|9. An extended family met for a family reunion in a rural area of Texas. All reported numerous mosquito bites. One week later several family members had headache, nausea, fever, and malaise. Two developed stiff neck and severe headache that resolved over the next 5 days, and an 8- month-old was hospitalized with diffuse encephalitis. All family members recovered completely except the infant who was left with a seizure disorder. An arbovirus was confirmed as the etiologic agent by serologic testing of the effected persons. Which of the following is the most likely etiologic agent?
a. Dengue virus
b. Lymphocytic choriomeningitis virus
c. Rubella virus
d. Western equine encephalitis virus
|10. A 2-month-old infant was admitted to the medical center in February for treatment of bronchiolitis. An immunofluorescent assay was positive for a respiratory virus. As the infant was struggling to breathe, ribavirin treatment was started immediately. With which virus was this infant infected?
a. Coxsackievirus A
e. Respiratory syncytial virus
|11. In January, a 74-year-old woman from Iowa is brought to the emergency department by her husband. He states that she had recent onset of high fever and headache. During the last 2 days, she has been confused and cannot perform daily chores. Shortly after arrival she suffers a seizure. Her physical examination indicates some weaknesses in her left side and neck stiffness. Magnetic resonance imaging images show encephalitis localized to the right temporal lobe. What is the most likely causative agent?
b. Coxsackievirus B
c. HSV type 1
d. Listeria monocytogenes
|12. An 8-month-old girl suddenly developed a high fever (103°F). Her pediatrician examined her and found no signs of upper respiratory tract infection, meningitis, or encephalitis. Two days later, the girl’s fever reached 105°F and she suffered a febrile seizure. By the time the child was brought to the pediatrician’s office, her temperature had dropped. The doctor noted a generalized papular rash. What was the doctor’s most likely diagnosis for this child?
a. Erythema infectiosum caused by parvovirus B19
b. Hand-foot-and-mouth disease caused by Coxsackievirus A
c. Measles caused by Morbillivirus
d. Roseola infantum caused by human herpes virus 6
e. Rubella caused by rubella virus
|13. A 5-month-old infant, seen in the emergency room in winter, presents with fever and persistent cough with wheezing. Her mother states that the baby’s older brother, age 3, had recently had a runny nose, sore throat, and fever. Physical examination of the infant revealed tachypnea and tachycardia; expiratory wheezes were heard over both lungs. The baby was cyanotic and retractions were observed and a chest x-ray showed hyperinflated lung fields. Which of the following is most likely the cause of this infection?
c. Parainfluenza virus
d. Respiratory syncytial virus
|14. Which one of the following groups of people is most likely to be at increased risk for HIV infection?
a. Sexual partners of IV drug abusers who share needles
b. Receptionists at a hospital
c. Persons who received blood transfusions in 2013
d. Members of a household in which there is a person who is HIV-positive
e. Factory workers whose coworkers are HIV-positive
|15. An obstetrician sees a pregnant patient who was exposed to rubella virus in the 18th week of pregnancy. She does not remember getting a rubella vaccination. Which of the following is the best immediate course of action?
a. Administer rubella immune globulin
b. Administer rubella vaccine
c. Order a rubella antibody titer to determine immune status
d. Reassure the patient because rubella is not a problem until after the 30th week
e. Terminate the pregnancy
|16. Two viral vaccines are expected to reduce the incidence of cancers. Which vaccines are these?
a. Adenovirus and mumps virus vaccines
b. HAV and poliovirus vaccines
c. HPV 16/18 and hepatitis B vaccines
d. Measles virus and rubella virus vaccines
e. Rotavirus and VZV vaccines
|17. A group of healthcare workers from the United States staffing a clinic in India were working with children admitted with acute flaccid paralysis. The illness began with fever, nausea, vomiting, and severe headache followed by neck stiffness, muscle pain and weakness, and onstipation. None of the workers became ill because they had been vaccinated against this disease. Which viral vaccine protected these workers?
b. Measles virus
d. Rubella virus
e. Yellow fever virus
|18. A group of healthcare workers from the United States staffing a clinic in India were working with children admitted with acute flaccid paralysis. The illness began with fever, nausea, vomiting, and severe headache followed by neck stiffness, muscle pain and weakness, and constipation. None of the workers became ill because they had been vaccinated against this disease. Which viral vaccine protected these workers?
b. Measles virus
d. Rubella virus
e. Yellow fever virus
|19. Along with several children at his elementary school who had similar symptoms, a 6-year-old boy was sent home from school because his eyes were red with a watery, nonpurulent discharge. He had a fever of 102°F and complained of sore throat. A rapid test for Group A Streptococcus was negative and his doctor told the boy’s mother that her child would recover within a week. Which of the following organisms was the most likely cause of his infection?
b. Chlamydia trachomatis
c. Haemophilus aegyptius
d. HSV type 1
e. Staphylococcus aureus
|20. A husband and wife performed the yearly spring cleaning of their mountain cabin, located in the southwestern part of the United States. The woman presented to her physician 2 weeks later with fever, myalgia, headache, and nausea, followed by progressive pulmonary edema and respiratory failure. How did she acquire this viral infection?
a. Contact with her husband
b. Drinking water in the cabin
c. Inhaling aerosolized rodent excreta
d. Mosquito bite
e. Tick bite