Afeffi Pediatric

Infectious Diseases
Common Presentations
1) All of the following are cause of pruritus, except:

A. Dermatitis herpetiformis
B. Pheochromocytoma
C. Uremia
D. Prurigo nodularis
E. Pregnancy
Answer: B* Pheochromocytoma
Description:
Pheochromocytoma is excessive amount of adrenalin and noradrenalin secretion by an adenoma
in the adrenal gland medulla.
Its clinical features include: HTN (paroxysmal or persistent in nature), Sweating, Tachycardia,
Weight loss, Tremor and Hyperglycemia but no pruritus in pheochromocytoma.
Causes of pruritus include wide range of diseases, ranging from skin conditions like eczema,
dermatitis, psoriasis and allergies, or even dry skin.
It is important to know that presence of uremia or hyperbilirubinemia also can cause pruritus.
So in case of renal failure or liver failure, cases of jaundice including cholestasis induced by
pregnancy are all known to cause pruritus.

A. Multiple sclerosis
B. Diabetes mellitus
C. Acromegaly
D. Chronic renal failure
E. Obstructive jaundice
Answer: C* Acromegaly
Description:
Acromegaly is a disease of increased growth hormone secretion and not known to cause itching.
It's also common for people with MS to experience strange sensations (also known as
dysesthesias). These sensations can feel like pins and needles, burning, stabbing, or
tearing. Itching (pruritus)

A. Scabies
B. Hodgkin's disease
C. Hepatitis C
D. Polycythemia rubra vera
E. Rheumatoid arthritis
Answer: E* Rheumatoid arthritis
Description:
Rheumatoid arthritis is not known cause of itching.
Despite the cause of itching in case of Hodgkin’s symptome is not known but about 25% of cases
experience itching.
It's also common for people with MS to experience strange sensations (also known as
dysesthesias). These sensations can feel like pins and needles, burning, stabbing, or
tearing. Itching (pruritus)
Common Drugs
4) One of the following is bacteriostatic antibiotic:
A. Penicillin
B. Aminoglycosides
C. Erythromycin
D. Imipenem
E. Aztreonam
Answer: C* Erythromycin
Description:
Erythromycin is a macrolide antibiotic that acts as bacteriostatic antibiotic while other choices are
bacteriocidal.
There are two types if bacteria according to their mood of action (bacteriostatic and bacteriocidal)
Bacteriostatic antibiotics: these are antibiotics that slow the growth of bacteria
Bactericidal antibiotics: these are antibiotics that kill the bacteria
The following table shows a classification of antibiotics according to their mood of action.
Bactericidal antibiotics Bacteriostatic antibiotics

1. Penicillins 1. Chloramphenicol
2. Cephalosporins 2. Macrolides
3. Quinolones 3. Sulphonamides
4. Aminoglycosides 4. Tetracyclines
5. Isoniazid 5. Trimethoprim
6. Metronidazole
7. Nitrofurantoin
8. Rifampicin
5) Which of the following antibiotics is the best treatment for pseudomembranous colitis:
A. Ampicillin
B. Flucloxacillin
C. Gentamycin
D. Vancomycin
E. Cefuroxime
Answer: D* Vancomycin
Description:
Pseudomembranous colitis is a clostridium difficile toxin mediated diarrhea due to recent use of
antibiotics that killed the normal flora in intestine.
The first line in treatment is metronidazole and if not responsive vancomycin can be used.
Of the choices vancomycin is the best therapy for pseudomembranous colitis.
6) One of the following is active against pseudomonas infection:

A. Penicillin G
B. Streptomycin
C. Tetracycline
D. Cefepime
E. Cephalothin
Answer: D* Cefepime
Description:
Pseudomonas is an aerobic gram negative bacillus.
It is sensitive for antibiotics like:
- Carbapenems (except Ertapenem) – first line
- Tigecycline
- Cefepime (4th generation cephalosporin)
- Aminoglycosides (gentamycin, Amikacin)
- Fluoroquinolones (but not Moxifloxacin)
7) Infections with Giardia lamblia are best treated with:

A. Tetracycline
B. Salazopyrin
C. Gentamycin
D. Amphotericin B
E. Metronidazole
Answer: E* Metronidazole
Description:
Giardia lamblia is a flagellated parasite that cause bloody diarrhea by covering the intestinal
lining without invasion.
The first line of treatment is metronidazole.
8) The drug of choice for a child with pneumococcal pneumonia is:

A. Penicillin
B. Streptomycin
C. Chloramphenicol
D. Sulfa drugs
E. Erythromycin
Answer: A* Penicillin
Description:
In children younger than five years of age with pneumococcal pneumonia, initial treatment of
pneumonia includes IV ampicillin or nafcillin plus gentamicin or cefotaxime (for neonates).
So from the above choices penicillin will be the best to choose.
9) Each of the following penicillins is penicillinase resistant, except:
A. Ampicillin
B. Oxacillin
C. Nafcillin
D. Dicloxacillin
E. Cloxacillin
Answer: A* Ampicillin
Description:
Penicillinase enzyme is secreted by some bacteria leading to destruction of Beta-lactam
antibiotics resulting in insensitivity to this drug.
Penicillinase resistant drugs include:
- Methicillin
- Nafcillin
- Oxacillin
- Dicloxacillin
- Cloxacillin
- Amoxicillin with clavulanic acid
- Ticarcillin with clavulanic acid.
Their use is restricted to the treatment of infections caused by penicillinase-producing
staphylococci, including methicillin sensitive S. aureus (MSSA).
Penicillinase resistant antibiotics have no activity against gram negative bacteria.
10) The following antimicrobial drugs are effective against staphylococci, except:
A. Teicoplanin
B. Metronidazole
C. Imipenem
D. Cephalexin
E. Cloxacillin
Answer: B* Metronidazole
Description:
Metronidazole mechanism of action is by inhibition of DNA synthesis, this function occur when
metronidazole is partially reduced, and because this reduction only happen in anaerobic bacteria
so metronidazole has little effect against aerobic bacteria like staph aureus.
Other mentioned choices are effective against staphylococcus aureus.
11) All of the following are antiviral drugs, except:

A. Acyclovir
B. Vidarabine
C. Amphotericin B
D. Ganciclovir
E. Interferon
Answer: C* Amphotericin B
Description:
Amphotericin B is an antifungal drug not antiviral, it is used in the treatment of candidiasis,
aspergillosis. It is also used as antiprotozoal drug for the treatment of leishmaniasis and
amebiasis.
Specific Infections
Gastroenteritis
12) One of the following is the most common cause of diarrhea:
A. Bacterial
B. Fungal
C. Viral
D. Parasitic
E. None of above
Answer: C* viral
Description:
Viral diarrhea is the most common cause of diarrhea; Rotavirus is the most common cause of
viral diarrhea especially in children.
Other choices are also known to cause diarrhea but less common than viral.
13) The following is correct about food poisoning, except:

A. Salmonella food poisoning is common
B. Incubation period of salmonella food poisoning is 12-48 hours
C. Incubation period of staphylococcal food poisoning is 1-6 hours
D. Amanita poisoning is a type of mushroom poisoning
E. Clostridium tetani can cause food poisoning
Answer: E* Clostridium tetani can cause food poisoning

Description:
Clostridium tetani is a spore forming bacteria that transmitted to human by wound contamination,
then release toxin causing convulsions and spasms of the body. It is not a cause of diarrhea.
Food poisoning results from ingestion of a bacterial toxin, leading to general symptoms of
fatigue, malaise, abdominal pain, fever, and dizziness, as well as watery or bloody diarrhea.
Incubation period varies according to bacteria type. Staphylococcus aureus has the shortest
incubation period of around 6 hours while clostridia species may have incubation period of 12 –
72 according to type.
14) All of the following can cause food poisoning by causing gastrointestinal tract infection,
except:
A. Salmonella
B. Streptococcus
C. Staphylococcus
D. Vibrio parahaemolyticus
E. Fungus
Answer: B* Streptococcus
Description:
Streptococci are unusual to cause food poisoning.
Food poisoning results from ingestion of a bacterial toxin, leading to general symptoms of
fatigue, malaise, abdominal pain, fever, and dizziness, as well as watery or bloody diarrhea.
Incubation period varies according to bacteria type. Staphylococcus aureus has the shortest
incubation period of around 6 hours while clostridia species may have incubation period of 12 –
72 according to type.
15) Which of the following organism is not a cause of invasive diarrhea:

A. Salmonella
B. Giardia
C. Campylobacter
D. Shigella
E. Amebiasis
Answer: B* Giardia
Description:
Giardia lamblia is a flagellated parasite that cause watery diarrhea by covering the mucosal lining
of the intestine but never invade through the mucosa. So it is called non-invasive diarrhea.
16) All of the following can cause food poisoning by producing toxin, except:
A. Staphylococcus
B. Clostridium perfringens
C. Clostridium botulinum
D. Salmonella
E. Bacillus cereus
Answer: D* Salmonella
Description:
Salmonella is a gram negative bacilli that may transmit to people GI tract by food and invade
mucosa (but without forming a toxin) then cause diarrhea.
The mentioned cases above are known to produce toxins.
17) The incubation period of a food poisoning by chemical poisons is usually:

A. Less than 1 hour
B. 8 hours
C. 12 hours
D. 18 hours
E. More than 18 hours
Answer: A* Less than 1 hour

Description:
Chemical poisoning has shorter incubation period than bacterial poisoning, its incubation period
last less than 1 hour.
The following table shows the incubation period of the most common causes of poisoning:
Contaminant Incubation period
Campylobacter 2-5 days
Clostridium botulinum 12-72 hours
Clostridium perfringens 8.16 ours
E. Coli O157:H7 1-8 hours
Staphylococcus aureus 1-6 hours
Shigella 24-48 hours
Norwalk virus 12-48 hours
Salmonella 1-3 days
18) Which one of the following is usually not a feature of staphylococcal food poisoning:
A. Abdominal cramps
B. Fever
C. Hypotension
D. Vomiting
E. Diarrhea
Answer: B* Fever
Description:
Fever is not prominent feature in staphylococcal food poisoning, general symptoms plus vomiting
and diarrhea are the whole mark of this disease.
19) The characteristic incubation period for staphylococcus aureus food poisoning is:
A. 1 to 6 hrs
B. 8 to 24 hrs
C. 1 to 4 days
D. 6 to 15 days
E. 15 to 21 days
Answer: A* 1 to 6 hrs
Description:
Salmonella 1-3 days
20) Regarding staphylococcal food poisoning all of the following statements are true,
except:
A. Contaminated meats and confectionery constitute the most outbreak
B. Vomiting and severe abdominal cramps are prominent symptoms
C. The acute symptoms usually subside within 12 hours
D. Central nervous system manifestations are usually present
E. Majority of patients require no specific treatment
Answer: D* Central nervous system manifestations are usually present

Description:
Staphylococcus aureus enterotoxin is stable in acid environment making it not to break down by
stomach acidity and to cause food poisoning.
Incubation period is 1-6 hours then followed by general symptoms of abdominal pain, fatigue,
along with vomiting and diarrhea. Note that fever is not prominent symptom here and there are no
neurological manifestations.
This is a self-limited disease and no need to for specific treatment.
21) Staphylococcal food poisoning is characterized by all of the following, except:
A. Short incubation period
B. It is a common source-type of epidemic
C. Fever is a common symptom of the disease
D. Symptoms are usually of short duration
E. The diseases is usually brief and only requires rest and sedation
Answer: C* Fever is a common symptom of the disease

Description:
Staphylococcus aureus enterotoxin is stable in acid environment making it not to break down by
stomach acidity and to cause food poisoning.
Incubation period is 1-6 hours then followed by general symptoms of abdominal pain, fatigue,
along with vomiting and diarrhea. Note that fever is not prominent symptom here and there are no
neurological manifestations.
This is a self-limited disease and no need to for specific treatment.
22) Salmonella can reach the food from one of the following:
A. Animal excreta at time of slaughter
B. From human excreta
C. Raw to cooked food by hand, surfaces and utensils in kitchen
D. Water polluted by sewage
E. All of above
Answer: E* All of above

Description:
In salmonella raw or contaminated meat, poultry, milk, or egg yolks, survives inadequate
cooking. It can be spread by knives, cutting surfaces or an infected food handler, as well as water
polluted by sewage.
23) The incubation period of a food born salmonella outbreak is:

A. 30-60 minutes
B. 4 hours
C. 1 day
D. 4 days
E. 30 days
Answer: C* 1 day
Description:
Salmonella 1-3 days
24) A child complaining of bloody diarrhea, vomiting and abdominal pain 20 hours after
eating a chicken mostly likely has:
A. Staphylococcal food poisoning
B. Botulism
C. Appendicitis
D. Salmonella food poisoning
E. Meckel's diverticulitis
Answer: D* Salmonella food poisoning

Description:
Giving the history of vomiting and diarrhea so this is a case of food poisoning and then you have
to look for the incubation period which is about day in this case so salmonella is the most likely
etiology.
Staphylococcus aureus has shorter incubation period up to hours while other mentioned choices
are less likely because lake of specific symptoms for their diagnosis.
25) Which of the following organisms are used for routine testing of water:
A. Typhoid
B. Salmonella
C. Coliform
D. Streptococci
E. Staphylococci
Answer: C* Coliform
Description:
Coliform bacteria is a broad spectrum of bacteria that present in out environment, they can cause
poisoning to human and they are commonly used as an indicator of sanitary quality of food and
water.
Malaria
26) Which of the following drugs is useful for Plasmodium falciparum malaria
chemoprophylaxis:
A. Emetine hydrochloride
B. Trimethoprim
C. Chloroquine
D. Metronidazole
E. Rifampicin
Answer: C* Chloroquine
Description:
Treatment of malaria includes:
- Chloroquine-sensitive areas: ACT or chloroquine
- Chloroquine-resistant areas: ACT
- Primaquine: after treatment of Ovale or Vivax malaria (to destroy liver hypnozoite and
prevent relapse)
 ACT: Artemisinin-based combination therapy

 ACTs should be avoided in pregnant women
 Plasmodium falciparum is chloroquine sensitive
Tuberculosis (TB)
27) All of the following statements regarding tuberculosis are true, except:
A. The risk of developing TB disease is greatest within the first year following infection
B. Most cases of tuberculosis occur as a result of primary infection
C. Isoniazid chemoprophylaxis may be given to selected high risk patients over 35 years of age
D. Incidence of the disease among elderly is higher than that of middle aged
E. Most cases of tuberculosis can be successfully treated with antituberculous drugs
Answer: B* Most cases of tuberculosis occur as a result of primary infection

Description:
TB an infection caused by mycobacterium Tuberculosis (an Acid fast bacilli bacteria that can
cause caseating granuloma)
It is transmitted by inhalation invade the immunity  survive and replicated in macrophages
TB can be latent in 95% and primary active disease in 5%, or secondary active disease (activation
of latent infection)
So primary cases are only 5% of cases
28) One of the following is etiological agent of Pott’s disease:

A. Actinomyces israelii
B. Haemophilus influenza
C. Treponema Pallidum
D. Mycobacterium tuberculosis
E. Coccidioides immitis
Answer: D* Mycobacterium tuberculosis

Description:
Pott’s disease is a TB of vertebral body, caused by mycobacterium tuberculosis.
Lower thoracic vertebrae are the most common affected site 50% of cases, followed by lumbar
vertebra.
Back pain with localized tenderness, spinal deformity, muscle spasms and neurological features
may present in this disease.
Constitutional symptoms (fever, night sweating, anorexia and weight loss) also present in this
disease.
29) The mode of transmission of tuberculosis is mostly:

A. Droplet
B. Airborne
C. Common vehicle
D. Contaminated hands
E. Sexual
Answer: B* Airborne
Description:
It is transmitted by inhalation invade the immunity  survive and replicated in macrophage
Airborne mood of transmission differs from Droplet; in airborne mood, the nucleus of the droplet
remains suspended in air then after long period it get inhaled by another person and been
transmitted.
Droplet transmission root should be more rapid and requires presence of the two persons at the
same time in front of each other ant one receives droplet from the other.
30) Mycobacterium tuberculosis is characteristically transmitted by one individual to

another by:
A. Airborne transmission
B. Contact with blood products
C. Food contamination
D. Contaminated water supply
E. Insect vector
Answer: A* Airborne transmission

Description:
It is transmitted by inhalation invade the immunity  survive and replicated in macrophage
Airborne mood of transmission differs from Droplet; in airborne mood, the nucleus of the droplet
remains suspended in air then after long period it get inhaled by another person and been
transmitted.
Droplet transmission root should be more rapid and requires presence of the two persons at the
same time in front of each other ant one receives droplet from the other.
31) Only one of the following is a site of primary TB:

A. Bone
B. Testis
C. Kidney
D. Tonsil
E. Stomach
Answer: D* Tonsil
Description:
Primary TB accounts for 5% of cases of TB.
TB can infect any part of the body but as this disease has airborne transmission, it will never be
primary transmitted to bone, testes kidneys or stomach. But tonsils, intestine, Skin and respiratory
system may be affected by primary TB.
32) All of the following may be sites of primary TB, except:

A. Skin
B. Bone
C. Lung
D. Ileum
E. Tonsil
Answer: B* Bone
Description:
Primary TB accounts for 5% of cases of TB.
TB can infect any part of the body but as this disease has airborne transmission so it will never be
primary transmitted to bone, testes kidneys or stomach. But tonsils, intestine, Skin and respiratory
system may be affected by primary TB.
33) A positive tuberculin test (PPD) is considered when the induration diameter is:
A. 3millimeter
B. 5millimeter
C. 7millimeter
D. 9millimeter
E. 10millimeter and more
Answer: E* 10millimeter and more

Description:
The table below shows a summary to how interpretation of Mantoux test in details.
Mantoux test interpretation:
PPD test or Mantoux test considered positive if one of the following:
- Induration ≥ 15 mm induration
- Induration ≥ 10 mm induration and one of the following
o Recent arrival from high prevalence country
o I.V drug user
o Child < 4 years
- Induration ≥ 5 mm induration and one of the following:
o HIV positive
o Recent contact with TB pt.
o Typical TB changes on CXR
o Organ transplant
34) The least amount of reaction which would be considered a definite positive reaction to
PPD in children is:
A. Any reaction
B. Over 5mm erythema
C. Over 5mm induration
D. Over 10mm erythema
E. Over 10mm induration
Answer: E* Over 10mm induration

Description:
The table below shows a summary to how interpretation of Mantoux test in details.
Mantoux test interpretation:
PPD test or Mantoux test considered positive if one of the following:
- Induration ≥ 15 mm induration
- Induration ≥ 10 mm induration and one of the following
o Recent arrival from high prevalence country
o I.V drug user
o Child < 4 years
- Induration ≥ 5 mm induration and one of the following:
o HIV positive
o Recent contact with TB pt.
o Typical TB changes on CXR
o Organ transplant
35) All the following are anti tuberculosis drugs except:

A. Isoniazid
B. Rifampicin
C. Methimazole
D. Pyrazinamide
E. Ethambutol
Answer: C* Methimazole
Description:
Methimazole is an antithyroid drug that used in treatment in hyperthyroidism.
Treatment of TB is as the following:
- The drugs that can be used for TB treatment (RIPE):
o Rifampin
o Isoniazid (INH)
o Pyrazinamide
o Ethambutol)
- Standard treatment: (4 drugs for 2 months then 2 drugs for 4 months)
o Rifampin, INH, pyrazinamide, and Ethambutol for 2 months then
o Rifampin, INH for 4 months
- For patients that have previously treated for TB add streptomycin (some drug
resistance may present in this case)
36) All of the following are anti-tuberculous drugs, except:

A. Streptomycin
B. Ethambutol
C. Kanamycin
D. Rifampicin
E. Isonicotinic acid hydrazide (INH)
Answer: C* Kanamycin
Description:
Kanamycin is an antibiotic of aminoglycoside group that is not active against TB.
o Rifampin
o Isoniazid (INH)
o Pyrazinamide
o Ethambutol)
37) All of the following are anti-tuberculous drugs, except:

A. Rifampicin
B. Isoniazid
C. Co-trimoxazole
D. Pyrazinamide
E. Ethambutol
Answer: C* Co-trimoxazole
Description:
Cotrimoxazole is a mixture of two antibiotics (trimethoprim and sulfamethoxazole) also called
TMP/SMX; it is not effective against TB.
o Rifampin
o Isoniazid (INH)
o Pyrazinamide
o Ethambutol)
38) One of the following anti-tuberculous treatments causes optic neuritis:

A. Pyrazinamide
B. INH
C. Rifampicin
D. Streptomycin
E. Ethambutol
Answer: E* Ethambutol
Description:
Side effects of the drugs used in TB treatment are important to know for JMC exam.
Here is a summary of TB drugs and their side effects and how to treat these side effects.
Drug Adverse effects Treatment

Rifampicin Red colour of body secretions No need for treatment
Isoniazid Peripheral neuropathy Prophylactic with pyridoxine
Pyrazinamide Hyperuricemia Treat if symptomatic only
Ethambutol Optic neuritis/ colour vision Adjust dose in renal failure
Herpes Virus Infections

39) Herpes Zoster occurs after infected with:
A. Smallpox
B. Chickenpox
C. Measles
D. Mumps
E. Rubella
Answer: B* Chickenpox
Description:
This virus may become latent after primary infection of chicken-Pox in childhood, then later at
adulthood will reactivate and presented with (Shingles).
It Present with sever burning pain at specific dermatome site with vesicular rash that does not
cross the Medline of the body.
Infectious Mononucleosis
40) All of the following are true about infectious mononucleosis, except:
A. Caused by Epstein-Barr herpes virus
B. Myocarditis may occur
C. Splenic rupture is a recognized complication
D. Liver function tests are usually normal
E. Blood smear shows atypical large lymphocytes and lymphocytosis
Answer: D* Liver function tests are usually normal

Description:
80-100% of patients with Infectious mononucleosis have elevated liver enzymes
Infectious mononucleosis is a viral infection caused by EBV, and spread via infected droplets.
Tender splenomegaly which is risky to rupture is a feature, as well as hepatitis.
Lymphocytosis with atypical lymphocytes is a laboratory feature of infectious mononucleosis
41) All of the following about infectious mononucleosis (glandular fever) is correct, except:
A. Sore throat
B. Cervical lymphadenopathy
C. Ampicillin is a drug of choice
D. Splenomegaly
E. Mild hepatitis is common
Answer: C* Ampicillin is a drug of choice

Description:
If ampicillin or amoxicillin used in patient with infectious mononucleosis; diffuse rash will
develop. So they are contraindicated.
Other choices are known features of infectious mononucleosis.
Toxoplasma
42) Acquisition (transmission) of Toxoplasma occurs in all of the following situations,
except:
A. Contact with an acutely infected adult
B. Contact with cat feces of an infected cat
C. Ingestion of inadequately cooked meat of an infected cow
D. Blood transfusion from an acutely infected person
E. Transplacentally to the fetus from an acutely infected mother
Answer: A* Contact with an acutely infected adult

Description:
Toxoplasmosis is caused by the protozoan parasite Toxoplasma gondii.
Toxoplasmosis is not passed from person-to-person, except in instances of mother-to-child
(congenital transmission) and blood transfusion or organ transplantation. People typically become
infected by three principal routes of transmission:
- Foodborne
- Animal-to-human (zoonotic)
- Mother-to-child (congenital)
43) All of the following diseases may be transmitted by milk, except:

A. Brucellosis
B. Tuberculosis
C. Staphylococcus food poisoning
D. Q fever
E. Toxoplasmosis
Answer: E* Toxoplasmosis
Description:
Toxoplasmosis is not passed from person-to-person, except in instances of mother-to-child
(congenital transmission) and blood transfusion or organ transplantation. People typically become
infected by three principal routes of transmission:
- Foodborne
- Animal-to-human (zoonotic)
- Mother-to-child (congenital)
Brucellosis transmitted to human by ingestion of milk from infected cattle of goat.
Bovine TB infection is generally transmitted to humans through consuming unpasteurized
milk or milk products obtained from infected cattle
Q fever caused by the bacteria Coxiella burnetii. The bacteria are most commonly found in cattle,
sheep, and goats around the world and transmitted to human by milk or milk products ingestion.
Enterotoxin from staphylococcus if present in milk is a cause of food poisoning.
Viral Hepatitis
44) All of the following about hepatitis infection are false, except:
A. Hepatitis B is transmitted by fecal oral route
B. Vaccination is available for hepatitis C
C. Incubation period for hepatitis A is 15-45 days
D. Hepatitis D is a DNA virus
E. Interferon treatment is required for hepatitis E
Answer: C* Incubation period for hepatitis A is 15-45 days

Description:
Hepatitis A virus has incubation period of 15-45 days.
HBV is transmitted by sex, saliva, blood transfusion, as well as vertical transmission
Vaccination is not available for both hepatitis C and E.
All hepatitis viruses are RNA virus except hepatitis B which is a DNA virus.
Interferon can be used in the treatment of hepatitis C infection but not E.
45) In hepatocellular carcinoma, all the following are true except:
A. It can be caused by hepatitis A
B. It may lead to cirrhosis
C. It leads to increased alfa fetoprotein
D. It may cause fever
E. It can be associated with polycythemia
Answer: A* It can be caused by hepatitis A

Description:
To acquire hepatocellular carcinoma (HCC) a chronic process injuring the liver is required.
Hepatitis A never become chronic, it can cause fulminant hepatic failure nut never cause liver
cirrhosis or hepatocellular carcinoma.
Cirrhosis is a feature of HCC as it causes chronic injury to liver. Alpha fetoprotein is a tumor
maker for HCC and will be elevated. Most malignancies cause fever, night sweating, anorexia
and weight loss so it is expected to be seen in HCC.
Erythropoietin is a hormone secreted by liver anda kidneys that increase production of RBC’s in
bone marrow, in case of HCC there may be increased amount of its production leading to
polycythemia.
46) All the following are DNA viruses except:

A. Rubella virus
B. Herpes simplex virus
C. Hepatitis B
D. Adenovirus
E. Epstein-Bar virus
Answer: A*Rubella
Description:
RNA viruses, also known as retroviruses, have RNA as their genetic material
Of the above choices, Rubella is the only RNA virus.
Some examples of retroviruses are hepatitis viruses (except HBV) and HIV.
47) All of the following about hepatitis B vaccination are false, except:
A. Hepatitis B vaccine is given in 2 doses
B. Vaccine is protective for maximum 10 years after administration
C. Vaccine is safe in immune-compromised persons
D. Vaccine offers also partial protection against hepatitis C infection
E. Vaccine should not be used in children younger than 10 years of age
Answer: C* Vaccine is safe in immune-compromised persons

Description:
Focus here you have to choose the “True” sentence.
HBV vaccine is formed of the surface antigen of the virus and it will be never be live or
infectious.
Killed vaccines and recumbent antigen vaccines are all safe in immunocompromised patients
while live vaccines are not.
48) The incubation period of infectious hepatitis is:

A. 3 days
B. 5 days
C. 7 days
D. 10 days
E. Over 15 days
Answer: E* Over 15 days

Description:
Incubation period of hepatitis viruses are from 2 to 6 weeks
For example; HAV incubation period is 15-45 days, HBV incubation period is 45-160 days, HCV
from 2weeks to 6 months.
49) Patients with hepatitis A are most infectious:

A. Infectious during the rise of bilirubin
B. Infectious during the rise of aspartate aminotransferase (AST) serum level
C. Infectious two weeks after jaundice subsides
D. Infectious when both bilirubin and AST are elevated
E. Infectious before the appearance of jaundice
Answer: E* Infectious before the appearance of jaundice

Description:
Transmission of infection in HAV is by oral fecal rout, it can occur before the appearance of
jaundice.
HAV infection gives lifelong immunity, but vaccine gives 10 years immunity
50) In hepatitis A infection all of the following are true, except:

A. Transmitted by feco-oral route
B. Cause marked elevation on the liver enzymes
C. Chronic active hepatitis is a recognized complication
D. The disease gives long life immunity
E. Infectivity is high before the appearance of jaundice
Answer: C* Chronic active hepatitis is a recognized complication

Description:
HAV never become chronic
HAV and HEV have fecal-oral route of transmission
Usually infectious before the appearance of jaundice
HAV infection gives lifelong immunity, but vaccine gives 10 years immunity
51) Regarding hepatitis A all are true, except:

A. The vaccine is available after the age of one year
B. It is more severe in children than in adults
C. In small children most cases are anicteric
D. May present an anicteric in some cases less than 5 years of age
E. No specific treatment needed in most cases (prognosis is usually good)
Answer: B* It is more severe in children than in adults

Description:
In adults; HAV symptoms may be very severe and require admission, usually more severe than it
in children. In small children especially less than 5 years old it may present without jaundice
(Anicteric HAV infection), HAV never become chronic, HAV and HEV have fecal-oral route of
transmission, Usually infectious before the appearance of jaundice, HAV infection gives lifelong
immunity, but vaccine give 10 years immunity
52) Chronic carrier is an important source of spread of all of the following, except:
A. Amoebic dysentery
B. Typhoid
C. Bacillary dysentery
D. Cholera
E. Infectious hepatitis (hepatitis A)
Answer: E* Infectious hepatitis (hepatitis A)

Description:
HAV will never be malignant, this point is questioned more than one time in JMC exams.
Other mentioned choices may be chronic.
53) All of the following about hepatitis B infection are true, except:
A. May be transmitted sexually
B. Can cause chronic active hepatitis
C. Hepatoma is recognized complication
D. Vaccination is available
E. Caused by RNA virus
Answer: E* Caused by RNA virus

Description:
Hepatitis B virus is the only DNA hepatitis virus. Other Hepatitis viruses (A,C,D,E) are RNA
viruses.
Its transmission is by blood transfusion, saliva, sex and vertical transmission.
Hepatoma and hepatocellular carcinoma are a complications of HBV
Hepatitis B vaccine is composed of surface antigen and is available for use.
54) Regarding Viral hepatitis all are true except:

A. Hepatitis A is the commonest
B. All viruses are RNA except hepatitis B is DNA
C. Hepatitis A and E don't produce chronic illness
D. Transmission is similar in all types
E. Hepatitis C is responsible for most chronic cases
Answer: D* Transmission is similar in all types

Description:
Transmission of HAV and HEV is by oral fecal rout while C and B transmitted parenterally. So
transmission is not similar in all hepatitis viruses.
55) The greatest risk for infection transmitted by blood transfusion is present in one of the
following:
A. Syphilis
B. Hepatitis B
C. Hepatitis C
D. Human immunodeficiency virus (HIV)
E. Urinary tract infection
Answer: C* Hepatitis C
Description:
Hepatitis C is the most common virus transmitted via blood transfusion.
CMV became more common after routine testing for hepatitis B and C for all blood products
before transfusion
Note that hepatitis B is the most common virus transmitted by needle stick injury.
56) All of the following are the causes of chronic hepatitis, except:
A. Hepatitis B
B. Hepatitis C
C. Methyldopa
D. Alpha-1-antitrypsin deficiency
E. Ulcerative colitis
Answer: E* Ulcerative colitis

Description:
Ulcerative colitis is not associated with chronic hepatitis, it is associated with primary sclerosing
cholangitis.
Hepatitis B and C are associated with chronic infection, they are a risk of hepatocellular
carcinoma and liver cirrhosis.
Methyldopa is a known cause of drug induced hepatitis and may lead to hepatic cirrhosis.
In alpha-1-antitrypsine deficiency; 10% of patients are associated with chronic hepatitis and liver
cirrhosis.
AIDS.
57) All of the following about acute HIV infection are true, except:
A. It is associated with a very high viral load
B. It occurs in at least 70% of HIV infection
C. Patients have low infectiousness in this stage
D. Maculopapular rash can occur in the upper trunk
E. It is diagnosed by viral PCR
Answer: C* Patients have low infectiousness in this stage

Description:
HIV have two main phases; the primary phase of acute infection phase, and the other phase called
AIDS phase.
In primary HIV infection : (2-4 weeks)
It occur in 70% of HIV infections, 50% asymptomatic, characterized by high viral load.
Fever, pharyngitis, lymphadenopathy, myalgia, arthralgia, headache, diarrhea (same symptoms of
mononucleosis)
Maculopapular rash (usually at trunk), oral and genital ulcer
Symptomatic recovery takes 1-10 weeks
In primary infection: PCR, (antibody test may be negative at this stage)
In AIDS phase there will be development of opportunistic infections, tumors, and other clinical
features. AIDS phase is diagnosed by antibody test.
58) All of the following about acquired immunodeficiency syndrome (AIDS) are true,
except:
A. It is transmitted by sexual contact
B. It can be transmitted by blood transfusion
C. The incubation period varying from one year to ten years
D. Kaposi's sarcoma can occur
E. Vaccine is available
Answer: E* Vaccine is available

Description:
There is no vaccination for HIV virus.
AIDS is transmitted by sex, blood transfusion, organ transplantation, exposure to infected blood,
vertical transmission as well as needle stick injury.
Depletion of CD4 count takes long period so it has a long incubation period (from one year to ten
years)
Kaposi sarcoma is expected to present in AIDS patient who has CD4 from 200-500 cells/mm 3
59) All of the following about AIDS are true, except:

A. Can be transmitted from mother to fetus
B. Is caused by retrovirus
C. Causes dementia
D. Pneumocystis carinii pneumonia is a recognized complication
E. T4 T8 ratio is high
Answer: E* T4 T8 ratio is high

Description:
In AIDS patient; the production of HIV specific CD8 positive cells will cause a large fall in
T4:T8 ratio.
HIV is a RNA retrovirus that affect CD4 (T helper cells)
HIV dementia is a known complication of AIDS patients who has CD4 100-200 cells/mm 3
PCP Pneumocystis carinii pneumonia is the most common pneumonia in HIV patients, it occur in
patients who has CD4 100-200 cells/mm3
Infections and other disorders that may be encountered by patients with HIV according to the
CD4 count:
CD4 count < 50 cells/mm³ - CMV retinitis
- Mycobacterium avium/intercellulare (MAI)
CD4 count 50 - 100 cells/mm³ - Aspergillosis

- Candidiasis
- Meningitis
- CNS lymphoma
CD4 count 100 - 200 cells/mm³ - Cerebral toxoplasmosis

- Pneumocystis jiroveci pneumonia (PCP)
- HIV dementia
CD4 count 200 - 500 cells/mm³ - Oral thrush
- Shingles
- Kaposi sarcoma
60) All of the following about AIDS are true, except:

A. May be transmitted through kidney transplantation
B. CD4 count is normal or raised
C. Carriers are infectious
D. Affects mainly the helper T-cells (T4)
E. Affect the central nervous system
Answer: B* CD4 count is normal or raised

Description:
CD4 count will be decreased but this will take 1 to 10 years of incubation period.
HIV is a RNA retrovirus that affect CD4 (T helper cells)
Infectivity of HIV starts as soon as the patient acquires the virus, even during incubation period.
CNS lymphoma, cerebral toxoplasmosis, HIV dementia, and meningitis are neurological
manifestations of HIV infection.
Candida albicans.
61) All of the following about candidiasis are true, except:
A. It is more common in diabetes
B. It may complicate treatment with antibiotics
C. It may cause vaginitis
D. It is usually accompanied by systemic upset
E. It may be seen in immune compromised patients
Answer: D* It is usually accompanied by systemic upset

Description:
Candidiasis is an infection with fungus candida albicans, it usually affect immunocompromised
patients like diabetics, HIV patients or those who are on steroid therapy.
This infection is usually local with no systemic effects.
Esophagitis with oral thrush, vaginitis are an examples on candida infection.
In patients who are on antibiotics treatment; the normal flora will be killed giving more chance
for candida to grow and cause infection.
62) Candidiasis may complicate all of the following, except:

A. Diabetes mellitus
B. Hodgkin's disease
C. Antibiotic therapy
D. AIDS
E. Thyrotoxicosis
Answer: E* Thyrotoxicosis
Description:
Decreased immunity in DM, steroid use, HIV and hodgkin’s lymphoma increases the risk of
candida to grow and cause infection.
Thyrotoxicosis is not associated with candidiasis.
63) All of the following conditions predispose to Candida infection, except:

A. Pregnancy
B. Diabetes mellitus
C. Hypoparathyroidism
D. Anhidrosis
E. Hypothyroidism
Answer: D* Anhidrosis
Description:
Fungal infection in general are in love with wet environment, and infect areas of high humidity
like oral cavity, vagina, esophagus as well as areas of high sweating rate.
Anhidrosis is defined as decreased sweat gland secretions, and this will decrease the chance of
candida to grow.
Gram Positive Infections.

64) The most common infecting organism in acute lymphangitis is:
A. Streptococcus
B. Staphylococcus
C. Pneumococcus
D. E. coli
E. Pseudomonas
Answer: A* Streptococcus
Description:
Lymphangitis is an inflammation of the lymphatic system, which is a major component of your
immune system. Lymphatic system is a network of organs, cells, ducts, and glands. The glands
are also called nodes and can be found throughout your body.
Infectious lymphangitis can be caused by bacteria and viruses.
The most common infectious cause of lymphangitis is acute streptococcal infection.
Gram Negative Infections.

65) All the following are Gram negative bacilli, except:
A. Salmonella
B. Klebsiella
C. Listeria
D. E. coli
E. Campylobacter
Answer: C* Listeria
Description:
Listeria is a gram positive rod shape bacteria that are facultatively anaerobic.
Other mentioned choices are gram negative bacteria
Following are some classes and examples on bacteria classifications:
- Gram positive Cocci: (Staphylococci, Streptococci, Pneumococci)
- Gram Negative cocci: (Gonococci, Meningococci)
- Gram positive Bacilli: (Diphtheria, Anthrax)
- Gram negative Bacilli: (Vibrio cholera, E. coli, Klebsiella, Proteus, Pseudomonas,
Salmonella, Shigella)
- Acid fast staining (Ziehl-nelson stain): (Mycobacterium tuberculosis, Mycobacterium
leprae)
Brucellosis.
66) Regarding brucellosis, one of the following is true:
A. It is caused by gram positive bacilli
B. The most virulent form is brucella abortus
C. Treatment can be achieved by doxycycline and rifampin for 6 weeks
D. Meningitis is the commonest cause of death
E. Diagnosis is obtained by blood cultures in chronic cases
Answer: C* Treatment can be achieved by doxycycline and rifampin for 6 weeks

Description:
Doxycycline and rifampicin for 6-8 weeks is the main treatment for brucella.
Brucella is a gram negative bacteria, it transmitted to human by contact with animals or animal
products. Brucella melitensis is the most virulent form of brucella.
The most common cause of death in brucellosis is endocarditis
Diagnosis is done by brucella titre not cultures.
67) 20 years old male presented with fever, arthritis, increase in ESR and brucella titer, the
best management is:
A. Repeat titer in 3 months
B. 6 weeks of doxycycline and rifampin
C. 6 weeks of doxycycline
D. 6 weeks of rifampin
E. 2 weeks of doxycycline and rifampin
Answer: B* 6 weeks of doxycycline and rifampin

Diagnosis:
This is a classic presentation of brucellosis, the treatment is consistent of Doxycycline and
rifampicin for 6-8 weeks (choice B)
68) All of the following about brucellosis are true, except:

A. It is caused by gram-negative coccobacillus
B. Orchitis may occur
C. Benzylpenicillin is the antibiotic of choice
D. Osteomyelitis may occur
E. Infective endocarditis is the commonest cause of death
Answer: C* Benzylpenicillin is the antibiotic of choice

Description:
The antibiotics of choice for brucellosis is doxycycline and rifampicin for 6-8 months
It is a gram negative coccobacilli infection
Complications include osteomyelitis, infective endocarditis, meningoencephalitis, orchitis, ,dental
depression, peripheral neuropathy.
The most common cause of death in brucellosis is endocarditis.
A. It is occupational disease
B. It causes peripheral neuropathy
C. It causes mental depression
D. It causes Leucocytosis
E. Infective endocarditis is a recognized complication
Answer: D* It causes Leucocytosis

Description:
Brucellosis is usually associated with leukopenia not Leucocytosis
Brucellosis is a gram negative coccobacilli infection transmitted to human by contact with animal
or animal products (so it can be occupational)

A. It is a recognized cause of splenomegaly
B. It may present with backache
C. Infective endocarditis may occur
D. Man to man transmission is common
E. Rifampicin may be used in the treatment
Answer: D* Man to man transmission is common

Description:
The route of transmission in brucellosis is by contact with infected animals or their products but
there is no human to human transmission.
Back pain and splenomegaly are known features.

A. Brucella is a gram-negative coccobacillus
B. The incubation period varies from 1 to 3 weeks
C. The onset of acute brucellosis is insidious
D. Vaccine is available for use in humans
E. Doxycycline with rifampicin usually effective
Answer: D* Vaccine is available for use in humans

Description:
There is no vaccination for brucella bacteria and it is no possible to cure infected animals.
Brucellosis is an infection with gram negative coccobacilli, it has an insidious onset after an
incubation period of 2-6 weeks.
Answer: E* All of above

72) Regarding brucellosis, one of the following statements is true:
A. Caused by gram positive bacteria
B. Skin test is diagnostic
C. It is a multisystem disease
D. Man to man transmission
E. The drug of choice is ampicillin
Answer: C* It is a multisystem disease

Description:
Complications of brucellosis include osteomyelitis, infective endocarditis, meningoencephalitis,
orchitis, ,dental depression, peripheral neuropathy. So it is a multisystem disease.
It is caused by gram negative coccobacilli, transmitted by contact with animals and animal
products, and diagnosed with brucella antibody titre.
73) Characteristic features of brucellosis include the following, except:

A. Leucocytosis
B. Spondylitis
C. Marked sweating
D. Mental depression
E. Fever
Answer: A* Leucocytosis
Description:
Leucopenia not leucocytosis will present in case of brucellosis
Other mentioned features are known to occur in case of brucellosis
74) Penicillin could be a drug of choice for treatment of the following, except:
A. Scarlet fever
B. Brucellosis
C. Pneumococcal meningitis
D. Streptococcal skin infection
E. Tonsillitis
Answer: B* Brucellosis
Other mentioned choices are responsive to treatment with penicillins.
Tetanus.
75) All of the following are true about tetanus, except:
A. Trismus is characteristic
B. The longer incubation period is better in the prognosis
C. CSF is usually normal
D. Temperature is usually very high
E. If the patient survives, recovery is complete
Answer: D* Temperature is usually very high

Description:
In Tetanus; fever is not a feature.
Trismus is difficult mouth opening resulting from masseter muscle spasm due to tetanus toxin.
In cephalic tetanus; Short incubation period with high mortality and CSF analysis will be normal
Prognosis is excellent in case of proper treatment and if patient survive.
76) Concerning tetanus, one is not correct:

A. It is the result of wound infection by gram-positive anaerobic bacilli of clostridia group
B. There are exotoxic noninvasive organisms
C. These organisms live normally and actively in soil
D. This disease is best prevented by active immunization and proper wound management
E. The usual cause of death in established tetanus is respiratory failure
Answer: C* These organisms live normally and actively in soil

Description:
77) Concerning tetanus, one is not correct:

A. It's the result of wound infection by gram negative anaerobic rod of clostridia group
B. There are exotic noninvasive organism
C. This disease is best prevented by active immunization and proper wound management
D. The usual cause of death is established tetanus is respiratory failure
E. Mild cases of tetanus can be treated with tetanus immunoglobulin IV or IM
Answer: A* It's the result of wound infection by gram negative anaerobic rod of clostridia group
Description:
Tetanus results from wound contamination with a spor forming bacteria known as Clostridia
tetani which is a gram positive anaerobic bacteria)
Exotic disease is a disease which is never been present in a country or eradicated. So tetanus is
not an exotic disease, but is an exotoxic disease (producing an exotoxin)
Proper wound management along with proper immunization as the following is important to
prevent complications:
- Clean wound and last dose was <10 years  nothing
- Clean wound and last dose was >10 years  booster dose
- Contaminated wound and last dose <5years  nothing
- Contaminated wound and last dose >5 years  give booster dose
Respiratory failure is the most common cause of death in tetanus.
78) The cause of death in established tetanus is:

A. Septic shock
B. Heart failure
C. Renal failure
D. Respiratory failure
E. Pulmonary embolism
Answer: D* Respiratory failure

Description:
The most common cause of death in case of tetanus is respiratory muscle involvement and
respiratory failure.
Septic shock, heart failure, renal failure and PE are not present in tetanus.
79) All of the following diseases may be water born, except:

A. Typhoid fever
B. Tetanus
C. Bacillary dysentery
D. Cholera
E. Infectious hepatitis (hepatitis A)
Answer: B* Tetanus
Description:
Tetanus results from wound contamination with a spor forming bacteria known as Clostridia
tetani which is a gram positive anaerobic bacteria), it is usually inhibit in soil and it is not water
born disease.
Other mentioned choices can be transmitted by water born route.
Typhoid Fever.
80) All of the following about typhoid fever are true, except:
A. Is caused by salmonella typhi
B. Leucopenia is present
C. Blood culture is positive during the first week
D. Chloramphenicol is the drug of choice
E. Severe diarrhea is a prominent symptom
Answer: E* Severe diarrhea is a prominent symptom

Description:
Typhoid fever (also known as enteric fever) is caused by Organism salmonella typhi and
paratyphi (A, B, C)  gram negative bacilli.
It can cause abdominal pain, splenomegaly, hepatomegaly and intestinal hemorrhage and
constipation but not cause diarrhea.
Treatment include Antibiotics (chloramphenicol, amoxicillin, cefixime, cotrimoxazole,
ceftriaxone, or Azithromycin) for 14 days
Lab test will show anemia and leucopenia due to toxic depression on bone marrow, as well as
positive blood culture for salmonella typhi (40-60%) in the first week of infection.
81) All of the following about typhoid fever are true, except:
A. Humans are only reservoirs
B. Headache is a prominent symptom
C. Rose spots occur during the second week
D. Splenomegaly can occur
E. Leucocytosis is usually present
Answer: E* Leucocytosis is usually present

Description:
Leucopenia not leucocytosis is a feature of typhoid due to bone marrow suppression,
Clinical features include:
- Prodromal '1st week'
o Headache, anorexia, fever, coated tongue, sore throat, relative bradycardia,
abdominal pain and constipation.
- 2nd week
o Higher fever
o Tachycardia (due to Myocarditis)
o Diffuse abdominal pain with splenomegaly and may be hepatomegaly
o Rose spots (erythematous Maculopapular rash on lower chest and abdomen) last
7-12 days
rd
- 3 week – stage of complications:
o Intestinal hemorrhage
o Encephalitis
th
- 4 week
o Gradual improvement and decline of fever
82) During the first week of typhoid fever, all of the following may be found, except:
A. Headache
B. Constipation
C. A palpable spleen
D. Sore throat
E. Positive blood culture
Answer: C* A palpable spleen

Description:
Splenomegaly present in the second week of typhoid fever, not first week.
In typhoid fever it is important to recognize the timing of signs and symptoms of the diseases,
they are as the following:
o Positive blood culture (40 – 60 % in the 1st week)
- 2nd week
o Higher fever
7-12 days
rd
o Encephalitis
- 4th week
83) The followings are features of the first week of typhoid fever, except:
A. Constipation
B. Leucocytosis
C. Dry cough
D. Positive blood culture
E. Headache
Answer: B* Leucocytosis
Description:
Leucopenia not leucocytosis is a feature of typhoid due to bone marrow suppression,
Other mentioned features are a first week manifestations of typhoid.
- 2nd week
o Higher fever
7-12 days
- 3rd week – stage of complications:
o Encephalitis
th
- 4 week
84) The following are common features of typhoid fever, except:

A. Diarrhea
B. Dysphagia
C. Headache
D. Splenomegaly
E. Leucocytosis
Answer: E* Leucocytosis
Description:
Leucopenia not leucocytosis is a feature of typhoid due to bone marrow suppression.
Dysphagia here may be due to sore throat.
- 2nd week
o Higher fever
7-12 days
rd
o Encephalitis
th
- 4 week
85) A 20 years old patient presented with 5 days history of gradually increasing fever,
headache and constipation. Provisional diagnosis of typhoid fever was suggested.
Diagnosis can be best confirmed at this stage by which of the following:
A. Widal test
B. Blood cultured
C. Urine culture
D. Stool culture
E. Clinical examination
Answer: B* Blood cultured

Description:
Blood culture is positive in 40 – 60 % in the 1st week in case of typhoid fever, and out patient here
has % days duration of the disease.
Widal test will be positive in the second week and it is not specific and cant confirm the diagnosis
Urine and stool cultures are of no value in typhoid, while clinical examination will show no more
than coated tongue, sore throat and relative bradycardia in this stage of disease and these findings
are not specific.
86) All of the following drugs may be used in the treatment of typhoid fever, except:
A. Chloramphenicol
B. Ampicillin
C. Cotrimoxazole
D. Ceftriaxone
E. Tetracycline
Answer: E* Tetracycline
Description:
Antibiotics treatment for typhoid include: (chloramphenicol, amoxicillin, cefixime,
cotrimoxazole, ceftriaxone, or Azithromycin) for 14 days
Tetracycline is not effective against Typhoid.
Bacillary Dysentery.
87) All of the following about Shigellosis are true, except:
A. The inoculum size is very small
B. Enterotoxin is produced
C. The major disease manifestations are due to colonic invasion
D. Bacteriemia occurs in approximately one third of the patients
E. Man is the only host
Answer: D* Bacteriemia occurs in approximately one third of the patients
Description:
Leucocytosis, dehydration, lethargy, along with hypothermia or fever above 39.5c are features of
bacteremia, reported in no more than 7% of patients with shigellosis.
Shigellosis is a type of food poisoning caused by infection with the Shigella species.
Acute bloody diarrhea, Abdominal cramping, Tenesmus, Urgency, Fever, Occasional vomiting
and Dehydration results mainly from colonic invasion in shigellosis.
88) The most important reservoir of Shigella (bacillary dysentery) is:

A. Bird
B. Rodent
C. Dog
D. Cow
E. Men
Answer: E* Men
Description:
Men is the only host for bacillary dysentery.
Shigellosis is a type of food poisoning caused by infection with the Shigella species.
Acute bloody diarrhea, Abdominal cramping, Tenesmus, Urgency, Fever, Occasional vomiting
and Dehydration results mainly from colonic invasion in shigellosis.
Cholera.
89) The following about cholera are true, except:
A. Individuals with achlorhydria are more susceptible to infection
B. Disease is mediated by exotoxin
C. Causes metabolic acidosis
D. Usually involves huge bowels
E. Tetracycline is used in treatment
Answer: D* Usually involves huge bowels

Description:
Inside the small intestine (not large intestine), V. cholerae attaches to the intestinal wall and starts
producing cholera toxin. The toxin enters intestinal cells, causing them to release water and ions,
including sodium and chloride ions.
Cholera is an infection with bacterium Vibrio cholera, leading to severe watery diarrhea and
dehydration.
This dehydration results in significant hypovolemia with its attendant hypotension and
hypoperfusion (shock). In addition, severe electrolyte disturbances (primarily hypokalemia) and
metabolic acidosis may lead to cardiac dysrhythmias and other complaints
Reduced or absence of stomach acidity (hypochlorhydria or achlorhydria) are main risk fr
acquiring cholera.
Symptoms of cholera include severe watery diarrhea and dehydration along with its
complications due to colonic involvement.
Treatment of Vibrio cholera include good hydration and antibiotics like tetracycline (which
decrease the period of communicability).
90) All of the following are true about cholera, except:

A. Carriers exceed those with symptoms and carrier state can persist for a few months
B. The disease is caused by enterotoxin elaborated by the organism
C. The disease is transmitted through contaminated water or food
D. Tetracycline shortens the period of communicability
E. Mass vaccination is the best method to control the spread of the disease
Answer: A* Carriers exceed those with symptoms and carrier state can persist for a few months
Description:
Most patients who acquire Vibrio cholera bacteria will develop symptoms
Cholera is an infection with bacterium Vibrio cholera, leading to severe watery diarrhea and
dehydration. It spreads mostly by unsafe water and unsafe food that has been contaminated with
human feces containing the bacteria.
Inside the small intestine (not large intestine), V. cholerae attaches to the intestinal wall and starts
producing cholera toxin. The toxin enters intestinal cells, causing them to release water and ions,
including sodium and chloride ions.
Treatment of Vibrio cholera include good hydration and antibiotics like tetracycline (which
decrease the period of communicability).
91) All of the following factors shorten the viability period of Vibrio cholera, except:
A. Dryness
B. Chemotherapeutics
C. Coldness
D. High temperatures
E. Disinfectants
Answer: C* Coldness
Description:
Vibrio cholera bacteria has gene that help adaptation in cold temperature so it will stay viable in
cold temperature.
Dryness, hotness, disinfectant and chemotherapeutics are factors that decrease viability of Vibrio
cholera.
Spirochetes.
***) All of the following are viral disease, except:
A. Warts
B. AIDS
C. Herpes zoster
D. Lyme disease
E. Varicella
Answer: D* Lyme disease

Description:
Lyme disease is a disease that caused by bacteria Borrelia burgdorferi that is transmitted to
human by tick bite after infected from deer of mice.
Clinical features: There are three stages:

- Stage 1 (early localized disease): skin reaction around the site of tick bite "erythema
migrans", associated with fever, headache, and regional lymphadenopathy.
- Stage 2 (early disseminated disease): hematologic and lymphatic dissemination, fever,
malaise, arthralgia, and metastatic areas of erythema migrans, Other complications
(meningitis, cranial nerve palsy, peripheral neuropathy, carditis, heart block)
- Stage 3 (late disease): arthritis (large joints), polyneuritis and encephalopathy
Diagnosis:
- Clinical diagnosis is important with history of travel to specific areas
- Anti-Borrelia antibodies (more sensitive in late stage)
Treatment:
- Doxycycline or amoxicillin for 14 days
Rabies.
92) The incubation period for rabies is:
A. 24 hours
B. 2 to 3 days
C. 2 to 3 weeks
D. 1 to 2 months
E. 6 to 12 months
Answer: D* 1 to 2 months
Description:
Rabies is a viral infection that can cause brain infection
it is a DNA rhabdovirus, Most commonly transmitted by Dog bite, (others; bat, raccoon and
skunk bites)  virus travel up at nerve axons to CNS
Incubation period is 1-2 months
93) Immunization against rabies (post-exposure) is given in 6 doses as follows:

A. At 0, 5, 9, 14, 60, 90
B. At 0, 5, 14, 21, 30, 120
C. At 0, 3, 7, 14, 30, 90
D. At 0, 3, 10, 21, 60,120
E. At 0, 3, 30, 60, 90,120
Answer: C* At 0, 3, 7, 14, 30, 90

Description:
Treatment of Dog bite include the following:
- Clean wound with soap and water
- Do NOT stitch the wound (it increases the risk of transmission of virus to CNS)
- Anti-rabies serum:
o If dog is dead  brain biopsy and give anti-rabies serum if positive for virus
o If dog is live  put in quarantine and give anti-rabies serum if dog dies within 10
days to any reason
o If dog is not reachable  give anti-rabies serum
Anti-rabies serum is given in 6 doses at: (0, 3, 7, 14, 30 and 90 days)

Infiltrate human rabies immunoglobulin around the site of bite
Gastrointestinal Protozoa.
94) Which of the following areas of the large bowel most frequently involved by amebiasis:
A. Rectum
B. Sigmoid
C. Cecum
D. Splenic flexure
E. Transverse colon
Answer: C* Cecum
Description:
Amebiasis is a disease resulting from intestinal infection with parasite Entameba histolytica.
Resulting in abdominal pain, fever, diarrhea and loss of appetite
It most commonly affect Cecum.
95) The drug of choice in treatment of amoebic hepatitis is:

A. Methicillin
B. Rifampicin
C. Mebendazole
D. Metronidazole
E. Omeprazole
Answer: D* Metronidazole
Description:
Amebic hepatitis or amebic abcess in liver usually transmitted from infected colon by portal
system to affect liver.
The drug of choice is Metronidazole.
Leishmaniasis.
96) Cutaneous leishmaniasis can be transmitted through the:
A. Bite of an infective female anopheles mosquito
B. Bite of infective female sandfly
C. Bite of infective Glossina (tsetse) fly
D. Bite of infective Aedes mosquitoes
E. Bite of infective male sandfly
Answer: B* Bite of infective female sandfly

Description:
Cutaneous leishmaniasis is an infection of skin with parasite of leishmania type.
A bite from infected female (not male) sandfly is the main rout of transmission for this disease.
Note that the bite from female anopheles mosquito transmit malaria not leishmaniasis, while
Glossina tsetse fly bite transmits the African trypanosomiasis (sleeping sickness).
Aedes mosquito transmits Dengue fever.
97) Airborne transmission occurs in all of the following, except:

A. Streptococcal infection
B. Brucellosis
C. Tuberculosis
D. Leishmaniasis
E. Anthrax
Answer: D* Leishmaniasis
Description:
A bite from infected female (not male) sandfly is the main rout of transmission for leishmaniasis.
Other mentioned choices are transmitted by airborne rout.
Meningitis
98) One of the following is the most common cause of meningitis:
A. Bacterial
B. Fungal
C. Viral
D. Parasitic
E. None of above
Answer: C* Viral
Description:
Vial meningitis is still the most common cause of meningitis.
Meningitis is an inflammation of meninges, present with headache, fever and meningism .
the following table shows the most common cause of meningitis in specific groups of patients.
Patient group Most common organism
Most common cause in general Viral meningitis
Age -3 months Group B streptococci
E coli
Listeria monocytogenes
Age 3 months – 6 years Neisseria meningitidis
Streptococcus pneumonia
H influenza
Age 6 years to 60 years Neisseria meningitidis
Above age 60 years Streptococcus pneumonia
Neisseria meningitidis
Immunosuppressed patients Listeria monocytogenes
Post traumatic meningitis Streptococcus pneumonia
99) 35 years old male presented with headache, fever and positive meningeal signs, the next
step in management is:
A. Give ceftriaxone and vancomycin
B. Do CT scan
C. Do LP
D. Do CXR
E. Do blood culture
Answer: A* Give ceftriaxone and vancomycin

Description:
The most important step in the management of patient who has meningitis is to start antibiotics
therapy.
Do not delay antibiotics after imaging, LP or waiting for culture results
Always start empirical antibiotic therapy as soon as you diagnose your patient with meningitis.
100) Post traumatic meningitis all true except:

A. Occurs within 2 weeks in most of the cases
B. Most of the cases are associated with base skull fracture
C. Antibiotics is the main line of treatment
D. CSF fistula should be treated if present
E. Gram positive cocci are the most common organisms to cause infection
F. Non of the above
Answer: F* Non of the above

Description:
Dural tear and CSF leakage along with fractures involving basal skull and paranasal sinuses are
all predispose to development of meningitis.
Here meningitis is usually early occurring within 2 weeks of injury, the most common cause of
infection in patients over 60 years old or those with post traumatic meningitis is streptococcus
pneumonia which is a gram positive cocci.
Antibiotics is the mainline of treatment and if CSF leak present it should be treated
conservatively or surgically if not responsive.
So, all of mentioned choices are true .
101) The most common organism in post traumatic meningitis is:

A. Staphylococcus
B. Meningococcus
C. Pneumococcus
D. Streptococcus
E. H. influenza
Answer: C* Pneumococcus
Description:
Dural tear and CSF leakage along with fractures involving basal skull and paranasal sinuses are
all predispose to development of meningitis.
In post traumatic meningitis, streptococcus pneumonia is the most common cause which are a
gram positive diplococci. Other organisms may also implicated but here the question is asking
about the most common cause.
E coli
H influenza
102) A gram stain report from cerebrospinal fluid CSF showed gram positive diplococci,
the organism is:
A. Neisseria meningitidis
B. B hemolytic streptococci group B
C. Streptococcus pneumonia
D. Haemophilus influenzae
E. Escherichia coli
Answer: C* Streptococcus pneumonia

Description:
Streptococcus pneumonia is the most common cause of meningitis in patients > 60 years old or
those with post traumatic meningitis.
Streptococcus pneumonia is a gram positive diplococci that considered a commensal organism in
respiratory tract and is also responsible for most community acquired pneumonia.
E coli
H influenza
103) Meningitis caused by Haemophilus influenzae type B is most common in children of

age:
A. Under 2 months
B. 3 months - 4 years
C. 5 years - 8 years
D. 8 years - 10 years
E. Over 11 years of age
Answer: B* 3 months - 4 years

Description:
E coli
H influenza
104) A 15 months old child developed hydrocephalus following meningitis. The most
likely causative organism is:
A. E. coli
B. Salmonella
C. Meningococci
D. H. influenza
E. Listeria monocytogenes
Answer: C* Meningococci
Description:
The most common cause of meningitis in age group of 3 months to 6 years is neisseria
meningitidis (meningococci) followed by pneumococci then H influenza type B.
E coli
H influenza
105) The most common organism causing meningitis in toddlers (6 months - 3 years) is:
A. Diplococcus pneumonia
B. Group C Neisseria meningitides
C. Group A hemolytic streptococcus
D. Haemophilus influenzae type B
E. E. coli
Answer: B* Group C Neisseria meningitides

Description:
The most common cause of meningitis in age group of 3 months to 6 years is neisseria
meningitidis (meningococci) followed by pneumococci then H influenza type B.
E coli
H influenza
106) At what age meningitis cannot be excluded with confidence in children presenting
with febrile convulsions:
A. Five years
B. Four years
C. Three years
D. Nine months
E. All ages
Answer: E* All ages

Description:
In children, when the anterior fontanel still open; it is not possible to exclude meningitis by
clinical examination only, especially in patients presented with convulsions.
Anterior fontanel usually closed at 18 months age. So before this age it is not possible to exclude
meningitis with confidence in patient who presents with febrile convulsions.
107) Incubation period meningococcal meningitis is usually:

A. 7-10 days
B. 2-3 days
C. 8-15 days
D. 3 weeks
E. 10-20 days
Answer: D* 2-3 days
108) In bacterial meningitis affecting a 15 years old boy which of the following organisms
is most often implicated:
A. Streptococcus
B. Staphylococcus
C. Meningococcus
D. Haemophilus influenza
E. Pneumococcus
Answer: C* Meningococcus
Description:
E coli
H influenza
109) The following are typical changes in CSF in pyogenic meningitis, except:
A. High protein
B. High glucose
C. High polymorph cells
D. High CSF pressure
E. Turbid CSF
Answer: B* High glucose

Description:
CSF interpretation in case of meningitis is as the following:
Bacterial Viral TB
Appearance Cloudy Clear Slightly cloudy
Glucose Low Normal Low
Protein High Normal/high High
WBC 10-5000/mm3 15-1000/mm3 10-1000/mm3
Polymorphs Lymphocytes lymphocytes
Note that n Pyogenic (bacterial) meningitis, CSF glucose will be low.
110) Characteristic cerebrospinal fluid findings in viral meningitis don’t include:

A. White cell count may be low
B. There may be early polymorphonuclear cell reaction
C. Normal sugar content
D. Elevated protein
E. Positive direct smear for AFB
Answer: E* Positive direct smear for AFB

Description:
positive smear for Acid fast bacilli indicates presence of TB meningitis.
CSF interpretation in case of meningitis is as the following:
Bacterial Viral TB
Appearance Cloudy Clear Slightly cloudy
Glucose Low Normal Low
Protein High Normal/high High
WBC 10-5000/mm3 15-1000/mm3 10-1000/mm3
Polymorphs Lymphocytes lymphocytes
111) Empirical treatment of neonatal meningitis is:

A. Ampicillin and vancomycin
B. Vancomycin and ceftriaxone
C. Amoxicillin and cefotaxime
D. Amikacin and cefotaxime
E. Cefuroxime and ampicillin
Answer: C* Amoxicillin and cefotaxime

Description:
According to age group; empirical therapy for meningitis differ. The following table shows the
newest guidelines:
Age group Empirical therapy to start
0-3 months age I.V cefotaxime and Amoxicillin
3 months – 50 years I.V cefotaxime
Above 50 years I.V cefotaxime and Amoxicillin
112) The following about meningococcal meningitis are true, except:

A. Causes petechial skin rash
B. CSF is normal
C. Penicillin is the drug of choice
D. Vaccination is helpful
E. Rifampicin is the drug of choice for the close contacts
Answer: B* CSF is normal

Description:
In bacterial meningitis CSF analysis will be cloudy with increased protein and WBC count along
with decreased CSF sugar. So it will never be normal.
Meningococcal meningitis is a bacterial infection of meninges by bacterium Neisseria
meningitides. It is transmitted by droplet and results in petechial rash.
The drug of choice is either I.V cefotaxime or Benzylpenicillin
Rifampicin is used for prophylaxis for the close contacts.
113) The most common route of infection of most types of meningitis is the:
A. Blood stream
B. Direct extension from the middle ear
C. Extension from a skull fracture
D. Extension from the cribriform plate
E. Wounds
Answer: A* Blood stream
***) All of the following are indications for lumbar puncture, except:
A. Diagnosis of meningitis
B. Diagnosis of multiple sclerosis
C. Suspicion of a mass lesion in the brain
D. Benign intracranial hypertension
E. Intrathecal injection of drugs
Answer: C* Suspicion of a mass lesion in the brain
Encephalitis.
***) Each of the following statements is true about encephalitis, except:
A. CSF sugar is either normal or little raised
B. In most cases the etiology is viral agents
C. Prognosis is generally good
D. CSF cells are mainly segmented neutrophils
E. Some meningeal signs may present
Answer: C* Prognosis is generally good
***) The viral encephalitis is specifically treated with:

A. Penicillin
B. Hyperimmune rabbit serum
C. Gamma globulin
D. Steroids
E. Supportive treatment
Answer: E* Supportive treatment
Osteomyelitis.
***) The usual causative microorganism of the hematogenous acute osteomyelitis is:
A. Beta-hemolytic streptococcus
B. E.coli
C. Staphylococcus aureus
D. Mycobacterium TB
E. Clostridium
Answer: C* Staphylococcus aureus
***) The commonest causative organism in osteomyelitis is:

A. Pseudomonas
B. Tubercle bacillus
C. Streptococcus
D. Treponema pallida
E. Staphylococcus
Answer: E* Staphylococcus
***) Regarding acute osteomyelitis all are true, except:

A. Usually caused by hematogenous spread
B. Most commonly caused by staphylococcus aureus
C. Often yields positive blood culture
D. May affect more than one bone
E. X-ray is diagnostic in the early course of the disease
Answer: E* X-ray is diagnostic in the early course of the disease

***) X-ray findings in acute hematogenic osteomyelitis are visible after:
A. 1 week
B. 2 weeks
C. 3 weeks
D. 4 weeks
E. 5 weeks
Answer: B* 2 weeks
***) A school boy who presents with a three days illness caused by acute osteomyelitis is likely
to have all of the following, except:
A. Severe localized pain
B. Fever
C. Neutrophil Leucocytosis
D. Abnormal limb X-ray
E. A blood culture growth of staphylococci
Answer: D* Abnormal limb X-ray

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Infectious Diseases

1) All of the following are cause of pruritus, except:

2) All of the following are cause of pruritus, except:

3) All of the following are cause of pruritus, except:

Bactericidal antibiotics Bacteriostatic antibiotics

6) One of the following is active against pseudomonas infection:

7) Infections with Giardia lamblia are best treated with:

8) The drug of choice for a child with pneumococcal pneumonia is:

11) All of the following are antiviral drugs, except:

13) The following is correct about food poisoning, except:

Answer: E* Clostridium tetani can cause food poisoning

15) Which of the following organism is not a cause of invasive diarrhea:

17) The incubation period of a food poisoning by chemical poisons is usually:

Answer: A* Less than 1 hour

Answer: D* Central nervous system manifestations are usually present

Answer: C* Fever is a common symptom of the disease

Answer: E* All of above

23) The incubation period of a food born salmonella outbreak is:

Answer: D* Salmonella food poisoning

 ACT: Artemisinin-based combination therapy

Answer: B* Most cases of tuberculosis occur as a result of primary infection

28) One of the following is etiological agent of Pott’s disease:

Answer: D* Mycobacterium tuberculosis

29) The mode of transmission of tuberculosis is mostly:

30) Mycobacterium tuberculosis is characteristically transmitted by one individual to

Answer: A* Airborne transmission

31) Only one of the following is a site of primary TB:

32) All of the following may be sites of primary TB, except:

Answer: E* 10millimeter and more

Answer: E* Over 10mm induration

35) All the following are anti tuberculosis drugs except:

36) All of the following are anti-tuberculous drugs, except:

37) All of the following are anti-tuberculous drugs, except:

38) One of the following anti-tuberculous treatments causes optic neuritis:

Drug Adverse effects Treatment

Herpes Virus Infections

Answer: D* Liver function tests are usually normal

Answer: C* Ampicillin is a drug of choice

Answer: A* Contact with an acutely infected adult

43) All of the following diseases may be transmitted by milk, except:

Answer: C* Incubation period for hepatitis A is 15-45 days

Answer: A* It can be caused by hepatitis A

46) All the following are DNA viruses except:

Answer: C* Vaccine is safe in immune-compromised persons

48) The incubation period of infectious hepatitis is:

Answer: E* Over 15 days

49) Patients with hepatitis A are most infectious:

Answer: E* Infectious before the appearance of jaundice

50) In hepatitis A infection all of the following are true, except:

Answer: C* Chronic active hepatitis is a recognized complication

51) Regarding hepatitis A all are true, except:

Answer: B* It is more severe in children than in adults

Answer: E* Infectious hepatitis (hepatitis A)

Answer: E* Caused by RNA virus

54) Regarding Viral hepatitis all are true except:

Answer: D* Transmission is similar in all types

Answer: E* Ulcerative colitis