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|1. A patient with HIV infection that has progressed to AIDS had been treated previously for cytomegalovirus pneumonia. For which additional CMV disease would this patient also be at risk?
a. Aplastic crisis
b. Kidney failure
d. Reye syndrome
|2. An estimated 6.2 million new HPV infections occur annually in the United States. The peak incidence occurs in adolescents and young adults under 25 years of age. Which of the following specimens is best for screening for the presence of HPV infection of the cervix?
a. DNA molecular probe for HPV genomes
b. HPV-specific antibodies
c. Pap smear on cells from cervix for koilocytes
d. PCR for HPV DNA
e. Viral culture for HPV
|3. A business man who contracted dengue in the Philippines during a business trip in 2011 took his family to the Caribbean for a vacation in 2012. The entire family was plagued with mosquito bites while walking early one morning. Four days later, the man, his wife, and their 17-olddaughter experienced sudden onset of fever of 103 to 104°F, chills and severe head, back, and muscle aches. He had pain behind his eyes. Their 12-year-old son had similar symptoms but lessened in intensity, while their 6-year-old daughter had fever that broke and returned and a rash. Their fevers lasted 3 to 4 days with onset of rash in all. Shortly after their fevers subsided, the man and the 6-year-old developed abdominal pain, petechiae, and bleeding gums. What complication did this man and child develop?
a. Acute respiratory distress syndrome
b. Dengue hemorrhagic fever
d. Guillain–Barré syndrome
e. Secondary bacterial infection
|4. A 16-year-old male developed chest pain and dyspnea, which gradually worsened. He was examined in the Emergency Department where tachycardia and signs of heart failure were noted. Electrocardiographic changes were seen and chest x-ray revealed cardiomegaly. An enterovirus was isolated from a stool specimen. Which of the following was the agent most likely isolated?
a. Coxsackievirus A
b. Coxsackievirus B
c. Echovirus 11
d. Enterovirus 70
e. Poliovirus 3
|5. A 38-year-old woman has developed crops of vesicular lesions. After 3 days, she developed pneumonia and was hospitalized. Which of the following would be most likely to be present in lung cells obtained by bronchoalveolar biopsy?
a. Cowdry A inclusion bodies
b. Guarnieri bodies
d. Negri bodies
e. Owl’s eye cells
|6. A patient diagnosed with influenza reported onset of symptoms 18 hours ago. Which of the following is the most appropriate treatment for this patient?
|7. A group of 15 young college students harvested oysters from a bay near Galveston despite a warning sign that the area was contaminated with sewage. Ten ate the oysters raw. Twenty-five days later, six of them presented to their physicians with sudden onset of acute jaundice and liver function abnormalities. Which of the following is the most likely cause of their infections?
|8. An 18-month old developed acute gastroenteritis with fever and watery diarrhea that lasted 10 days. She had been vaccinated against rotavirus at 2 and 4 months of age as recommended. Eight days later, both of her brothers, ages 3 and 6, developed acute gastroenteritis. Which of the following tests would most likely reveal the etiologic agent of their gastroenteritis?
a. Culture for Norovirus
b. DFA for enterovirus on intestinal biopsy
c. EIA for adenovirus 40/41
d. EM examination of stool for astrovirus
e. Serology for Rotavirus
|9. An outbreak of diarrhea in a day care center is suspected to be of rotaviral origin. Which test is most appropriate to diagnose this outbreak?
c. Electron microscopy
d. Histologic examination of biopsy
|10. Adults and children experienced an outbreak of diarrhea with nausea and vomiting while aboard a cruise ship in the Caribbean. The causative agent was detected by EIA testing. Which virus listed below was most likely responsible for this outbreak?
a. Adenovirus 40/41
|11. An outbreak of diarrhea occurred among elderly patients in an assisted care facility, which had been repeatedly cited by the public health department for poor hygiene practices. The agent that caused the infections had a starlike morphology in electron micrographs. EIA tests for several agents of viral gastroenteritis were negative. Which virus was most likely responsible for this outbreak?
a. Adenovirus 40/41
|12. A young refugee from Afghanistan developed mild fever, cervical lymphadenopathy, and a rash that began on her face and spread downward over her trunk. After 3 days, the rash disappeared. She had not been immunized against any infections except diphtheria and tetanus. What is the best diagnosis for this child?
b. Erythema infectiosum
d. Hand-foot-and-mouth disease
|13. A 57-year-old man diagnosed previously with chronic hepatitis C is being treated for his infection. Which of the following tests is the best to evaluate his therapy for an early virologic response?
a. HCV IgG
b. HCV IgM
c. HCV RNA level
d. Liver biopsy
e. Serum ALT levels
|14. A 45-year-old man with active chronic hepatitis B infection is being treated to reduce liver inflammation and fibrosis and to prevent progression to cirrhosis. He is HBeAg-positive and had begun a 48-week course of pegylated IFN-α, but he was unable to tolerate the side effects. Which of the following would be the best antiviral to treat this patient?
|15. Two weeks after a series of mid-July thunderstorms resulted in an explosion of the mosquito population, a 10-year-old boy living on a farm in southern Minnesota was brought to the emergency room by his parents. He has a 2-day history of fever, headache, and vomiting, but today he appeared confused. His cerebrospinal fluid was clear with 100 WBC (75% lymphocytes) and a head CT was normal. Enterovirus infection was quickly ruled out by PCR testing. Which of the following is the most likely cause of his symptoms?
a. La Crosse virus
c. Rabies virus
d. St. Louis encephalitis virus
e. Venezuelan equine encephalitis virus
|16. Which of the following would be present in a neonate with congenital rubella syndrome (CRS) but not in a neonate with cytomegalic inclusion disease (congenital CMV infection)?
a. Intrauterine growth retardation
c. Mental retardation
d. Patent ductus arteriosus
e. Sensorineural hearing loss
|17. Viruses have various ways of entering the human body and producing disease. Which of the following descriptions accurately describes the route of transmission and target disease for the virus indicated?
a. Coronavirus: fecal–oral; peptic ulcers
b. Echovirus: fecal–oral; aseptic meningitis
c. HIV: respiratory droplet; anemia
d. Influenzavirus: blood-borne; maculopapular rash
e. Rabies virus: rodent-borne; pneumonia
|18. A 68-year-old man from central California who liked to sit in the park and doze developed fever, headache, muscle weakness, and nausea and vomiting. His muscle weakness progressed, and he was admitted to the hospital with acute flaccid paralysis. No focal lesions were seen on MRI. After a prolonged hospital stay, he was discharged to a rehabilitation center where he regained function. With which virus was this man most likely infected?
b. St. Louis encephalitis virus
|19. An immunocompromised patient presented with a progressive cerebral deterioration evidenced by difficulty speaking, memory loss, and loss of coordination that led to paralysis. An MRI revealed lesions in the white matter; brain biopsy revealed foci of demyelination, astrocytosis, and nuclear inclusion bodies within oligodendrocytes. Normal CSF findings (cell count, glucose, protein) were present, but viral DNA was found in the CSF by PCR. Which of the following viruses causes is the etiologic agent of this patient’s disease?
b. JC polyomavirus
c. Prion variant CJD
d. Measles virus
|20. A sexually active 17-year-old man presents to the local free clinic to check some small papules that appeared on his penis. The papules are small, white lesions with a central depression. There is no discharge or pain on urination. What is the virus most likely causing these lesions?
b. Coxsackievirus A
c. HPV type 6
e. Orf virus
|21. A 3-month-old infant born at prematurely at 30 weeks of gestation is in the neonatal intensive care unit in November. The first cases of respiratory syncytial virus have been diagnosed in the city. Which of the following may be given to this infant as prophylaxis to prevent respiratory syncytial virus (RSV) infection?
c. Pooled immunoglobulin
|22. Malnourished children are at risk for complications of measles, leading to greater morbidity and mortality. Which of the following should be given to children to reduce these risks?
a. Vitamin A
b. Vitamin B
c. Vitamin C
d. Vitamin D
e. Vitamin E
|23. Which of the following immune responses is required to prevent target infection by poliovirus, EEEV, and La Crosse virus?
a. Complement activation
b. Cytotoxic T cells specific for the virus
c. Natural killer cells
d. Neutralizing IgG specific for the virus
|24. A 45-year-old woman living in Washington, DC, had been complaining to her landlord about mice in her apartment. A week ago, she suffered flu-like symptoms accompanied by swollen lymph nodes and a rash, which had resolved over 5 days. Four days later, she developed a severe headache and other signs of viral encephalitis. She reported no contact with mosquitoes. With which virus was she most likely infected?
a. La Crosse virus
b. Lassa fever virus
c. Lymphocytic choriomeningitis virus
d. Sin Nombre hantavirus
e. Western equine encephalitis virus
|25. An elderly man had been in several military conflicts during the early 1980s and received blood transfusions for injuries. He recently consulted his physician for what was diagnosed as cryoglobulinemia and glomerulonephritis. Additional testing revealed that he was infected by a flavivirus whose transmission was bloodborne. Which of the following viruses was involved in this infection?
|26. An outbreak of influenza occurred in a rural community. Since influenza can be treated if therapy is begun within 48 hours of onset of symptoms, specific detection of the virus is important. Which of the following tests listed is the most rapid for detection of influenza viruses?
a. Cold agglutinin test
b. Culture of respiratory secretions on monkey kidney cells
c. Detection of influenza antigen in respiratory secretions
d. Electron microscopy of sputum
e. Paired sera for specific antibody response