Hepatitis

Which of the following hepatitis viruses has the highest risk of transmission
during needlestick injury?
Hepatitis B

Which of the following is the MOST ACCURATE predictor of disease

progression in hepatitis C?
Histology

Which of the following is NOT a typical manifestation of hepatitis A infection?

Dark tarry stools - must be clay colored stools

What is the most common clinical manifestation of hepatitis B?

Jaundice

Which hepatitis infection is most likely to have the extra-hepatic manifestation

of Bell's palsy?
Hepatitis E

Which hepatitis virus never causes chronic hepatitis in otherwise healthy

people?
Hepatitis A
Diagnosis of Hepa B
At what point during infection do symptoms of hepatitis B commonly appear?
 2–4 months
Which of the following antibodies against the hepatitis B virus is first to
appear?
IgM anti-HBc

Which of the following antibodies against the hepatitis B virus is last to

appear?
Anti-HBs

A patient underwent a serology testing panel for hepatitis B virus. The

results were positive for IgG anti-HBc and anti-HBs only, and the rest of the
parameters had negative results. How can these results be interpreted
The patient had a prior infection of hepatitis B.

Which parameter(s) will be positive in the serological panel of a patient

who is vaccinated against hepatitis B
Anti-Hbs

A donor intends to give blood and brings in a report showing the hepatitis B
serology tests. The report shows that HBsAg, anti-HBc IgG, and anti-HBe
are positive. Anti-HBs and HBeAg are negative. What is the appropriate
next step in the management of the donor?
Defer collection of blood from this donor.

At what point during infection do symptoms of hepatitis B commonly

appear?
2-4 months
HEPA C

A patient who is positive for hepatitis C develops red discoloration of the

skin of the digits akin to digital infarcts and presents with asymmetric
neuropathy. Urinalysis shows proteinuria without casts. Which of the
following is the MOST likely diagnosis?
Mixed essential cryoglobulinemia

A patient who is positive for hepatitis C develops red discoloration of the

skin of the digits akin to digital infarcts and presents with asymmetric
neuropathy. Urinalysis shows proteinuria without casts. What is the MOST
likely cause of these infarcts?
Hyperviscosity due to cryoglobulins

Which of the following indicates a prior infection of HCV?

Anti-HCV by ELISA

Which of the following leads to further progression of a hepatitis C

infection?
Alcohol
A 55-year-old man is diagnosed with cirrhosis secondary to hepatitis C.
Which complication should this patient be screened for yearly?
Hepatocellular carcinoma

Which of the following is NOT a risk factor for hepatitis C?

Poor sanitation
 Acute Viral Meningitis

Which of the following is not a known cause of viral meningitis?.

Rotavirus
A 35-year-old male is brought to the ER with an altered sensorium. His
roommate says that he has been acting strangely for the last several days.
His heart rate is 68, temperature 101 F, respiratory rate 18, and blood
pressure 122/78 mm Hg. Physical examination is difficult to perform. He
tests positive for HSV-2. Which of the following patterns is most likely seen
in his CSF?
Glucose: 35 mg/dl RBC: 485 cells/ml WBC: 400 cells/ml

Toxicogenic Bacterial Diarrhea

.

A patient presents with watery diarrhea, which does not show fecal
leukocytes. Yesterday, he consumed a sandwich with egg-based mayonnaise.
Which of the following organisms can cause such a presentation?
Staphylococcus aureus

Which of the following organisms is associated with rewarming of precooked

foods?
Clostridium perfringens

The enterotoxin in traveler's diarrhea is derived from which of the following?

Plasmid

Which kind of toxin is produced by Clostridium botulinum?

Neurotoxin
Which second messenger does enterotoxigenic, E. coli-producing, heat-stable
enterotoxin use in the extracellular signaling pathway?
Cyclic GMP

A patient recently traveled to a Southeast Asian country and described his

stools to be like rice water. Stool examination does not reveal any leukocytes.
Which of the following organisms can cause this presentation?
Vibrio cholerae

A patient has fried rice from a favorite Asian diner. He develops nausea
and vomiting within 6 hours of consumption. What is the probable
causative organism?
Bacillus cereus.

Complications of Community Acquired Pneumonia

A 65 year old male patient is being treated for pneumococcal pneumonia.

His CRP level before treatment was 300. After 4 days of antibiotics, his
fever broke and CRP levels went back to normal. A few days later, he
started to develop fever again, CRP levels were measured to be 150. what
is the best next course of action?
Repeat CXR to check for pleural effusion

Which of the following is NOT a common complication associated with

pneumonia?
Interstitial lung disease

A 24-year-old male is diagnosed with pneumonia. A culture of the pleural

effusion returns positive for Klebsiella species. Which of the following was
the patient's most likely risk factor for contracting this pathogen?
Excessive alcohol consumption
 Neisseria Meningitidis (Meningococcus): Signs & Symptoms

What is the typical incubation period for Neisseria meningitidis?

 3-4 days

A 19-year-old college student recently went hiking with his dormitory

friends in the mountains of the southeastern part of America. He now
presents to the emergency room with fever, malaise, and a full body non-
blanching petechial rash. He is hypotensive and tachycardic. Lumbar
puncture and blood cultures have been sent to the laboratory. Which of the
following diseases are the most likely diagnoses to be considered?
 Meningococcal meningitis and Rocky Mountain spotted fever
What is the approximate case-fatality rate of meningococcus meningitis?
 9-12%
A 2-year-old child is brought to the emergency department for a one-day
history of lethargy and poor feeding and episodes of vomiting. He had been
tugging on his left ear for the past several days. He appears ill. On physical
examination, he has a fever and is mildly tachycardic. Examination of the neck
shows nuchal rigidity. Signs of otitis media are seen in the left ear. He does
not have any rash. A lumbar puncture is obtained and appears abnormal on
initial review. Which of the following organisms is most likely to be found in the
cerebrospinal fluid?
 Streptococcus agalactiae
A 72-year-old man is brought in from the nursing home for increased lethargy
and altered mental status from his baseline. Caretakers note that he has not
had any fevers, but hasn't been eating well and appears to be moving more
slowly than usual and avoiding turning his head. He does not have any rash.
Lumbar puncture confirms meningitis. Which of his symptoms is most
predictive of mortality from this illness?
 Absence of fever
A previously healthy young adult is brought to the emergency department with
confusion and a wide based gait after flu-like symptoms one week ago. An
MRI shows abnormalities of the cerebellum. Spinal fluid shows pleocytosis.
Which of the following conditions and etiologies are most likely?
 Rhomboencephalitis; Listeria Spp.

Rhomboencephalitis; Listeria Spp.

Which of the following is the most common route of infection in the urinary
tract system?
Ascending
Which of the following is the most appropriate pharmacotherapy in an
asymptomatic quadriplegic patient with an indwelling urinary catheter and
bacteriuria?
No pharmacotherapy is required

Which of the following is LEAST LIKELY a risk factor for pyelonephritis?

Sepsis
Which of the following best defines vesicourethral reflux?
The retrograde passage of urine from the bladder into the upper urinary tract

Which of the following patients is most likely to benefit from antibiotic therapy?
A pregnant woman with asymptomatic bacteruria