TOPNOTCH MEDICAL BOARD PREP MICRO-PARA PRACTICE TEST 4 HANDOUT BY DR.

ALLEN LICHAUCO
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A 50/M farmer from Zamboanga presented with
IMPORTANT LEGAL INFORMATION hemoptysis and chest x-ray result compatible with
pulmonary tuberculosis. Which of the following
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7.
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extent guaranteed by law. 8.
B. Massive cytolysis
DISCLOSURE C. Malignant transformation
The handouts/review materials must be treated with utmost confidentiality. It shall be the D. Transient aplasia
responsibility of the person, whose name appears therein, that the handouts/review materials A 27/M was brought to the ER because of
are not photocopied or in any way reproduced, shared or lent to any person or disposed in any
manner. Any handout/review material found in the possession of another person whose name
progressive general weakening and symmetrical
does not appear therein shall be prima facie evidence of violation of RA 8293. Topnotch review involvement of both upper and lower extremities.
materials are updated every six (6) months based on the current trends and feedback. Please He also presented with doubling of vision, difficulty
buy all recommended review books and other materials listed below.
THIS HANDOUT IS NOT FOR SALE! of swallowing, and slurring of speech. Moments
later, he suddenly went into respiratory distress
and went into cardiac arrest. Upon history taking
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with the relative, the patient had leftover canned
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sardines for breakfast several hours ago. Which is
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the MOST probable diagnosis?
A. Neisseria meningitidis
MICROBIOLOGY AND B. Listeriosis
C. Tetanus
PARASITOLOGY PRACTICE TEST 4 D. Botulism
Which of the following statements is CORRECT
By Allen Khriztofer P. Lichauco, MD regarding the disease process of diphtheria?
A. The Corynebacterium diphtheriae invades
A 40/F came at the OPD with chronic dry cough and deep tissue and enter the bloodstream.
low-grade fever. PE revealed a cachectic patient B. The Corynebacterium diphtheriae produce
with harsh breath sounds. No enlarged lymph nodes 10. toxin that can be absorbed and result in distant
were palpated. X-ray showed increased density of toxic damage.
both upper lung fields. Which of the following forms C. The clinical manifestations result from the
1.
of tuberculosis is the patient manifesting? inflammatory response to the organism.
A. Ghon complex D. Involvement of the heart, kidney, adrenals, and
B. Latent tuberculosis other organs results from miliary spread.
C. Primary tuberculosis Which of the following cells possess direct cytotoxic activity
D. Reactivation tuberculosis with the ability to kill infected or cancerous cells?
Which of the following diagnostic tests can be used A. Cytokines
to establish the diagnosis of Hansen’s disease? 11.
B. B lymphocytes
A. Skin biopsy C. CD4 T lymphocytes
2.
B. Serology D. CD8 T lymphocytes
C. Polymerase chain reaction Which of the following antibody titers are found in
D. Enzyme immunoassay rheumatic individuals and indicate recent or
Which of the following protozoal diseases presents recurrent streptococcal infection?
with interstitial myocarditis in its chronic stage? 12. A. Anti-M protein
A. Amoebiasis B. Anti-DNAse B
3.
B. Chagas disease C. Anti-Hyaluronidase
C. Leishmaniasis D. Anti-Streptolysin O
D. Toxoplasmosis What developmental stage of Trypanosoma cruzi is
A 40/M gardener presented at the ER with massive found in the heart muscles?
hemoptysis, dyspnea, and fatigue. On history, he is a A. Amastigote
chronic smoker, and he often makes compost from 13.
B. Epimastigote
dead leaves and decaying vegetations for a living. X- C. Promastigote
ray revealed a spherical mass with a crescenteric- D. Trypomastigote
shaped air around the mass. Sputum culture was Which of the following types of protozoa does the
positive for aspergillus. What is the MOST opportunistic intestinal protozoa Cryptosporidium
4. appropriate management for this patient? species belongs to?
A. Admit patient and start on IV antifungal 14. A. Amebae
medications. B. Flagellates
B. Conservative management such as increasing C. Ciliates
oral fluid intake. D. Sporozoans
C. Lobectomy to remove mass and surrounding What layer of the tuberculous granuloma can the
tissues. tubercle bacilli be isolated and cultured?
D. Start patient with oral antifungal medications. A. Central zone
What is the major virulence factor of S. pyogenes? 15.
B. Mid-zone of pale epithelioid cells
A. T substance C. Peripheral zone of fibroblast and lymphocytes
5. B. P substance D. Peripheral fibrosed and calcified tissue
C. M protein Which of the following statements BEST describes
D. Streptolysin O the histology of fungus ball formed by aspergilloma?
Which of the following is the drug of choice for the A. Collection of vascular tissue and cellular debris
treatment of cutaneous larva migrans? 16. B. Collection of cells with a center of caseous necrosis
A. Mebendazole C. Collection of fibrous mass with stromal fat tissue
6.
B. Ivermectin D. Collection of hyphae, mucus, and cellular
C. Cryosurgery debris
D. Larval extraction
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 TOPNOTCH MEDICAL BOARD PREP MICRO-PARA PRACTICE TEST 4 HANDOUT BY DR. ALLEN LICHAUCO
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What is the most common microorganism in Which of the following processes describe the
infected wounds from cat bites? clinical manifestations of toxic shock syndrome?
A. Staphylococcus aureus A. Hemolysis
17. 28.
B. Streptococcus viridans B. Tissue necrosis
C. Pasteurella multocida C. Cytokine release
D. Bacteroides fragilis D. Antigen-antibody reaction
A 45/F obese diabetic presented at the OPD with Which of the following is responsible for the
erythematous pruritic patches growing beneath her development of antibiotic resistance in MRSA?
breasts and armpit areas. On history, she is often A. Alteration in bacterial cell wall
29.
searing and exposed to hot stove for her cooking job. B. Plasmid-mediated resistance
On PE, the patches had presence of satellite lesions C. Staphylococcal cassette chromosome mec
18. scattered around the area. Which of the following is D. B-lactamase production
the MOST probable etiology? A 45/M burn patient developed fever, hypotension,
A. Candidiasis and anuria while admitted. On PE, there is necrosis
B. Cryptococcosis of the skin involved in the burn. What is the medical
C. Aspergillosis term for this skin-associated septic process?
30.
D. Mucormycosis A. Scarlet fever
Which of the following statements is CORRECT B. Rose spots
regarding the vaccine used against smallpox? C. Erythema multiforme
A. It is attenuated variola virus. D. Ecthyma gangrenosum
19. B. It is perfectly safe with no serious complication. An 8/M suddenly developed profuse diarrhea
C. It is a distinct species of poxvirus. described as passage of rice-water stools with
D. It is the same cowpox virus used by Edward associated vomiting which led to dehydration and
Jenner in 1978. electrolyte imbalances. Which of the following is the
Which of the following characteristics distinguishes 31. MOST probable etiologic agent?
the community acquired-MRSA from the hospital A. Escherichia coli
acquired-MRSA? B. Shigella
20. A. More resistant to antibiotics C. Salmonella
B. More tissue invasiveness D. Vibrio cholerae
C. Less transmissible A 15/F from Latin America presented with fever and
D. Slower in multiplication unilateral swelling of the right eyelid. On PE, there is
Which of the following statements characterizes the a furuncle-like nodule at her right leg which seemed
distinctive property of a negative sense RNA virus? to originate from an insect bite. What is the MOST
A. The isolated RNA is infectious. 32. probable etiologic agent for this disease?
21. B. The genome is single stranded. A. Toxoplasma gondii
C. The virions carry an RNA polymerase. B. Trypanosoma cruzi
D. Its molecule functions as an mRNA within the C. Trypanosoma brucei
infected cell. D. Leishmania sp.
What does a positive tuberculin skin test mean? How does a Cryptosporidium induce its prominent
A. Active disease clinical feature of watery diarrhea?
22. B. Absence of primary infection A. Formation of pseudomembranous colitis
33.
C. Infection in the past B. Habitation of the gastrointestinal mucosa
D. Immunity to the disease C. Submucosal erosion of the colon
Which of the following microscopic findings is D. Toxin liberated in the intestines
consistent with Candida albicans infection? A 25/M was walking barefooted in the beach of La
A. Spaghetti and meatball appearance of hyphae Union a week before he noticed a serpiginous
23.
B. Tobacco-like configuration of hyphal elements pruritic lesion on his left leg. The lesion continues to
C. Scabies mites with their eggs and debris extend which prompted him to consult. Which of the
D. Oval budding spores and pseudohyphal elements 34. following is the MOST probable diagnosis?
A 50/M presented at the OPD with claw deformity of A. Tinea corporis
both hands. On PE, there is reduced sensation of the B. Linear verruca vulgaris
pulp of the small finger and apparently enlarged, C. Creeping eruption
sensitive nerves at the elbows. There are also pale, D. Contact urticaria
anesthetic macular lesions around 5 cm in diameter Which of the following parasites will MOST likely
24. on his forearms. Which of the following is the MOST cause disease among children who are in direct
probable diagnosis? intimate contact with their pet dogs?
A. Guillain-Barre syndrome 35. A. Echinococcus granulosus
B. Herpes simplex B. Fasciola hepatica
C. Herpes zoster C. Hymenolepis nana
D. Leprosy D. Onchocerca volvulus
How does Escherichia coli get on food? A 25/F presented at the OPD with vaginal itching.
A. Aerosol Upon PE, there was foul-smelling, greenish vaginal
25. B. Contaminated plates discharge. Microscopy of the discharge was negative
C. Sneezing for clue cells, hyphae, and spores. Which of the
D. Food handlers 36. following is the MOST probable causative agent?
Which of the following laboratory procedures can A. Chlamydia trachomatis
be used to document the causative organism of B. Gardnerella vaginalis
genital herpes? C. Candida albicans
26. A. 10% KOH D. Trichomonas vaginalis
B. Tzanck smear A 30/F presented at the OPD with increased vaginal
C. Burrow ink test discharge with fishy odor. Upon PE, there is thin
D. Gram staining whitish gray discharge adherent to the vaginal wall
Which of the following virulence factors of P. but none in the cervical os. Which of the following is
aeruginosa is responsible for septic shock? 37. the MOST probable disease?
A. Lipooligosaccharide A. Bacterial vaginosis
27.
B. Heat-labile enterotoxin B. Gardnerella vaginitis
C. Pyrogenic exotoxin C. Candida vulvovaginitis
D. Shiga-like toxin 1 D. Trichomonas vaginitis

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 TOPNOTCH MEDICAL BOARD PREP MICRO-PARA PRACTICE TEST 4 HANDOUT BY DR. ALLEN LICHAUCO
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A 2-day-old newborn presented with fever and A 35/F presented at the OPD with abdominal pain
generalized erythematous rash with sloughing of and profuse diarrhea. Upon laboratory tests, the
the upper layers of the epidermis which were organism is a non-lactose fermenter, and the blood
managed and were healed completely. Which of the culture was negative. Which of the following is the
38. following is the MOST probable etiologic agent? 47. MOST probable causative agent?
A. Staphylococcus aureus A. Vibrio cholerae
B. Pseudomonas aeruginosa B. Escherichia coli
C. Clostridium perfringens C. Salmonella typhimurium
D. Salmonella typhi D. Enterococcus
A 10/M with unknown vaccination status presented What distinguishes adaptive immunity from innate
at the ER with sudden weakness and inability to immunity?
move his right leg. Upon history, the patient A. Phagocytosis
48.
complained of sore throat and myalgia days before B. Microbial sensors
with febrile episodes. What is the MOST likely C. Antigen specific antibody
39.
etiologic agent to consider for this case? D. Proinflammatory cytokines
A. Poliovirus Which of the following cells are preferentially
B. Coxsackievirus infected and killed by HIV?
C. Clostridium botulinum A. B lymphocytes
49.
D. Clostridium tetani B. T lymphocytes
Which of the following is INCORRECT regarding the C. Plasma cells
pathophysiology of tuberculosis infection? D. Polymorphonuclear cells
A. Tubercle bacilli spread in the host by direct Which of the following mechanisms explains the
extension through the lymphatic channels and clinical manifestations of paralytic poliomyelitis?
bloodstream, and via the bronchi and GIT. A. Destruction of lower motor neurons
50.
40. B. Considered as Type IV cell-mediated (delayed) B. Degeneration of peripheral nerves
hypersensitivity reaction. C. Permanent blockade of neurotransmitters
C. The hallmark of infections with M. tuberculosis D. Inflammation of the muscles
is the presence of granulomas. Which of the following cells are primarily targeted by EBV?
D. Dependent on the number of mycobacteria in A. B lymphocytes
the inoculum despite host immune status. 51. B. T lymphocytes
Which of the following statements explain the role C. Plasma cells
of cleaning up water-holding receptacles and plant D. Polymorphonuclear cells
containers during the rainy season? Which of the following statements regarding non-
A. Plants will die easily in dirty receptacles. typhoidal Salmonella enterocolitis is CORRECT?
B. Stagnant water becomes foul-smelling, murky, A. Antimicrobial therapy is essential.
41. 52.
and are good breeding places for insects. B. Bacteremia is usual.
C. Moist plants are home to mosquitoes, which C. Stool culture result are usually essential.
can easily travel to nearby homes. D. Replacement fluid or electrolyte is essential.
D. Mosquito breeds in domestic water holding A 30/M military recruit was brought to the ER due
receptacles and can easily travel to homes. to hemoptysis. Upon history, the illness started with
A 5/F was brought to the ER for homogenous fever, sore throat, and non-productive cough. Other
vesicular eruptions more abundant on the face and recruits were also noted to have similar symptoms.
less on the trunk and extremities. The primary CXR results showed pulmonary consolidation. The
consideration for this case was smallpox. Which of patient was up and about, appearing physical well.
the following can be done to specifically confirm it? 53.
Which of the following pathogens is the MOST likely
42. A. Virus isolation by inoculation of vesicular fluid consideration for this patient?
into chick embryo A. Streptococcus pneumoniae
B. Immunohistochemistry of viral antigens in B. Hemophilus influenzae
tissues/materials from skin lesions C. Mycoplasma pneumoniae
C. Antibody assay D. Neisseria gonorrhoeae
D. Direct examination under electron microscopy Which of the following statements is CORRECT
Which of the following microorganisms is MOST regarding transposons?
commonly associated in mild, untreated diabetic A. Enzymatic products of bacterial genetic expression
foot ulcer infection? 54. B. Mobile and transferable segments of bacterial DNA
43. A. Escherichia coli C. Proteins expressed by the chromosomal genes
B. Staphylococcus aureus of the bacteria.
C. Klebsiella pneumoniae D. Viruses that have infected a bacterium.
D. Proteus mirabilis Which of the following immunoglobulins is the most
A 40/M with cystic fibrosis presented at the ER with abundant antibody isotype in mucosal secretions
fever, dyspnea, and productive cough. Which of the and is responsible for mucosal immunity?
following pathogens is considered as a significant 55. A. IgG
cause of morbidity and mortality in such case? B. IgA
44.
A. Shigella C. IgM
B. Klebsiella D. IgD
C. Pseudomonas Which of the following diseases present with hilar
D. Enterococci lymphadenopathy and peripheral granulomatous
Which of the following helminths infects human via lesion in the middle or lower lung lobes?
the penetration of its larvae through the skin? 56. A. Cytomegalic viral disease
A. Enterobius vermicularis B. Leptospirosis
45.
B. Diphyllobothrium latum C. Primary tuberculosis
C. Necator americanus D. Secondary syphilis
D. Trichuris trichiura Which of the following organisms present with
Which of the following appropriately describes the ground itch characterized by erythema and intense
goal of WHO campaign to address smallpox disease? pruritus usually at the feet and ankles?
A. Appropriate isolation strategy of patients 57. A. Small insects beneath seaweeds
46.
B. Global eradication B. Larva of duodenale worms
C. Prompt diagnosis and treatment C. Papilloma virus from wet leaves
D. Reversal of the whole disease process D. Algae or fungi in the seashore

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 TOPNOTCH MEDICAL BOARD PREP MICRO-PARA PRACTICE TEST 4 HANDOUT BY DR. ALLEN LICHAUCO
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This handout is only valid for October 2023 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly.
Which of the following diagnostic laboratory tests is Which of the following laboratory diagnostic tests is
the most reliable method for the documentation of considered as the most reliable method to identify
Sporothrix schenckii from the biopsy of a suspected an active dengue infection?
ulcerated lesion? 68. A. Analysis of paired acute and convalescent sera
58.
A. Fungal culture B. Platelet count
B. Fluorescent antibody staining C. Isolation of the virus
C. Fungal cell wall stain D. Serologic diagnosis
D. Potassium hydroxide smear Which of the following serotypes of Salmonella
Which of the following diseases is associated with causes septicemia after oral infection with possible
EBV infection? focal lesions in the bones, lungs, and meninges but
A. Congenital anomalies without any gastrointestinal manifestations?
59. 69.
B. Kaposi sarcoma A. S. typhi
C. Burkitt lymphoma B. S. paratyphi
D. Hepatoma C. S. typhimurium
What is the treatment of choice for sporotrichosis? D. S. choleraesuis
A. Amphotericin B treatment A 35/M with history of promiscuity consulted at the
60. B. Potassium iodide saturation solution OPD for painful swelling of the left knee. On PE, the
C. Oral itraconazole left knee was swollen with ballottement. On
D. Infection is self-limiting arthrocentesis and synovial fluid analysis, 30 cc of
Which of the following statements appropriately clear yellowish non-purulent fluid was aspirated
describes the contributory factors leading to 70. and showed no WBC or RBC. What is the most useful
cutaneous candidiasis? diagnostic exam to identify the causative agent?
A. Use of antiperspirants and deodorants A. Gram stain
61.
B. Use of lotions, cologne, and rubbing alcohol B. Culture
C. Use of dusting powders beneath breast and C. Biochemical technique
armpits D. Tuberculin test
D. Sweaty areas, warm, moist, and unaerated Which of the following is considered as the MOST
Which of the following is a major complication of important source of salmonellosis among humans?
pelvic inflammatory disease? A. Human carriers working as food handlers
71.
A. Dysfunctional bleeding B. Household pets
62.
B. Dysmenorrhea C. Meats and meat products
C. Recurrent abdominal pains D. Milk and dairy products
D. Infertility Which of the following clinical laboratory features
Which of the following mechanisms describes the distinguishes lepromatous type from tuberculoid
route of transmission of the HSV-2? type of Hansen’s disease?
A. Prolonged contact with moldy moist area 72. A. Anesthetic skin lesions
63.
B. During childbirth B. Insidious onset
C. Through pediculosis pubic lice C. Superficial nerve involvement
D. Through insect bites D. Negative lepromin test
Which of the following statements is CORRECT What is the most common sexually transmitted viral
regarding the historically significant smallpox infection?
disease? A. Genital herpes
73.
A. An infection gave complete protection against B. Molluscum contagiosum
reinfection. C. Human immunodeficiency virus
64.
B. Majority of cases of smallpox were not D. Human papillomavirus
clinically apparent. A 25/F presented at the ER with erythematous
C. The virus had a broad range of animal hosts sunburn-like rash. Upon PE, her BP was 70/40
aside from human. mmHg, and her temperature was 39oC. Pelvic
D. The infectious virus had several serotypes. examination shows that she is having her menstrual
An 18/F presented with fever, malaise, headache, period with a tampon in place. Lab results revealed
fatigue, and sore throat. Upon PE, there were 74. elevated liver enzymes and creatinine. Which of the
enlarged lymph nodes and splenomegaly. Blood following is the MOST probable cause of the disease?
tests revealed elevated SGOT and SGPT, A. A superantigen
leukocytosis with lymphocytic predominance. She B. Hemolysin
was advised by the physician to avoid contact sports C. Peptidoglycan
65.
until resolution in 2-4 weeks. Which of the following D. An endotoxin
is the MOST probable etiologic agent? Which of the following is the MOST serious
A. Cytomegalovirus complication of PID from untreated gonorrhea?
B. Human papillomavirus 6 A. Infertility
75.
C. Human papillomavirus 7 B. Uterine degeneration
D. Epstein-Barr virus C. Glomerulonephritis
Which of the following statements signify that the D. Endometrial carcinoma
infecting pathogen has already been eliminated Which of the following is the MOST important
after treatment in patients with lymphogranuloma virulence factor in community acquired-methicillin
venereum? resistant Staphylococcus aureus infection?
66.
A. Positive culture 76. A. Coagulase
B. Incomplete healing of the suppurative adenitis B. Exfoliative toxin
C. Decline in the complement-fixing antibodies C. Panton-Valentine leucocidin
D. High titer of agglutinating bodies D. Enterotoxin
Which of the following fungi is the most common Which of the following explains the “fishy” odorous
cause of meningoencephalitis in an HIV patient? vaginal secretions in cases of bacterial vaginosis?
A. Coccidioides immitis A. Motile trichomonads produce odorous amine.
67.
B. Cryptococcus neoformans B. There is growth of yeast, whitish curd-like
C. Candida albicans 77. cottage cheese.
D. Aspergillus fumigatus C. Overgrowth of anaerobes, decreased lactobacilli,
and increased vaginal pH.
D. Lack of vaginal hygiene causing the increase in
various microorganisms

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 TOPNOTCH MEDICAL BOARD PREP MICRO-PARA PRACTICE TEST 4 HANDOUT BY DR. ALLEN LICHAUCO
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This handout is only valid for October 2023 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly.
Which of the following explains the ineffectivity of
penicillin, cephalosporin, and vancomycin on the
treatment of mycoplasmal infections?
78. A. Beta-lactamase production
B. Bacteria are cell wall defective
C. Chromosomal generation of resistance protein
D. Plasmin-mediated resistance to penicillin
A 30/F became nauseous with associated vomiting
bouts after 4 hours of eating Yang Chow fried rice in
a newly opened cafeteria across the street. Which of
the following is the most likely etiologic agent?
79.
A. Bacillus cereus
B. Clostridium perfringens
C. Staphylococcus aureus
D. Streptococcus viridans
Which of the following laboratory diagnostic tests is
considered as the standard for documentation of a
whipworm infection?
80. A. Direct fecal smear
B. Saturated brine flotation technique
C. Iodine formaldehyde technique
D. Scotch tape method
Which of the following statements is CORRECT
about post-streptococcal diseases?
A. The rates of nephritis and rheumatic fever are
similar following untreated related infection.
B. Anti-streptococcal chemoprophylaxis
81. recommended in glomerulonephritis patients.
C. Either skin infection or pharyngitis precedes
rheumatic fever.
D. Rheumatic fever has a marked tendency to be
reactivated by recurrent streptococcal
infections.
A 40/F horticulturist, consulted at the OPD because
of multiple subcutaneous nodules and abscesses
occurring along the lymphatics of her left upper
extremities. Upon history, she revealed trauma
while tending to her plants several months ago.
82.
What is the most probable diagnosis?
A. Chromoblastomycosis
B. Erythema nodosum
C. Sporotrichosis
D. Tuberculosis
Which of the following is the appropriate
management for a patient with findings of positive
clue cells upon microscopy of vaginal discharge?
83. A. Cloxacillin 500 mg QID for 10 days
B. Fluconazole 200 mg once per week for 2 weeks
C. Cotrimoxazole 960 mg OD for 14 days
D. Metronidazole 500 mg BID for 2 weeks
Which of the following complications should be
considered in an open untreated diabetic foot ulcer?
A. Osteomyelitis
84.
B. Neural damage
C. Venous insufficiency
D. Bacterial-fungal infections
A 15/M presented at the ER with fever and myalgia.
He then developed bleeding, shock, and eventually
died. Which of the following statements explains the
susceptibility of this patient to a severe dengue?
A. He had concurrent dengue and malarial
infection.
85.
B. He had secondary dengue with a different
serotype as previous.
C. He had secondary dengue with same serotype
as previous.
D. He had completed dengue vaccination
previously.
A 40/F diabetic consulted at the OPD for vaginal
pruritus described as burning sensation and
increased discharge. Upon PE, the discharge was
thick, white with “cottage cheese” appearance. The
pH of the vaginal secretions was normal. Which of
86.
the following is the MOST probable diagnosis?
A. Chlamydia
B. Bacterial vaginosis
C. Trichomonas vaginitis
D. Candida vulvovaginitis
TOPNOTCH MEDICAL BOARD PREP MICRO-PARA PRACTICE TEST 4 HANDOUT BY DR. ALLEN LICHAUCO
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A 30/M consulted at the OPD for multiple painful
grouped vesicular lesions on his left suprapubic
area. Upon history, the patient revealed that this
condition has been recurring thrice now since a year
ago. Which of the following is the MOST probable
87.
diagnosis for this patient’s case?
A. Primary syphilis
B. Folliculitis
C. Herpes genitalis
D. Scabies
Which of the following vaginal diseases is NOT
sexually transmitted?
A. Bacterial vaginosis
88.
B. Trichomoniasis
C. Lymphogranuloma venereum
D. Genital herpes
There were reports of cases of sporadic diarrhea in
an urban poor community which mostly lasted for a
week. However, one patient suffered from severe
diarrhea which lasted for a month. It was later found
that the patient was suffering from AIDS. Which of
89.
the following is the MOST probable causative agent?
A. Cryptosporidium hominis
B. Clostridium perfringens
C. Entamoeba histolytica
D. Enterococci
is A 35/M, known promiscuous, presented at the OPD
with swollen painful mass at the perirectal area.
Upon history, he first noticed a small evanescent
papule at the anal area 2 weeks before consultation.
Which of the following is the MOST probable
90.
etiologic agent for the disease?
A. Herpes simplex virus
B. Chlamydia trachomatis
C. Mycobacterium tuberculosis
D. Treponema pallidum
There was a Christmas party in a nursery school
where spaghetti, hotdog, marshmallows, and ice
cream were served during lunch. Later in the
afternoon, many of the children suddenly developed
nausea and vomiting with some abdominal cramps
and diarrhea. The symptoms only lasted until the
91.
evening of the same day. Which of the following is
the MOST likely etiologic agent?
A. Staphylococcus aureus
B. Clostridium perfringens
C. Shigella dysenteriae
D. Escherichia coli
What is the main pathophysiologic hallmark of
dengue hemorrhagic fever?
A. Depletion of clotting factors
92.
B. Cytotoxic against erythrocytes
C. Diminished platelet count
D. Increased vascular permeability
How is mycoplasmal pneumonia diagnosed?
A. Serology
93. B. Gram stain
C. Clinical recognition
D. Nucleic acid amplification test
A 35/M presented at the OPD with hemoptysis. Upon
history, he was previously treated for PTB with
reported poor compliance. Chest x-ray revealed a
circular lucency totally surrounding a soft tissue
mass in the pulmonary cavity. What is the
94.
radiographic sign described in the patient’s case?
A. Crescent moon sign
B. Monod sign
C. Monroe sign
D. Silhouette sign
Which of the following diseases presents with
classic “rose spots” lesions appearing at the chest
and abdomen areas during the 2nd week of the
illness?
95.
A. Cholera
B. Shigellosis
C. Typhoid fever
D. Hemolytic uremic syndrome
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Where is the Salmonella typhi site of multiplication? 4. A. ADMIT PATIENT AND START ON IV ANTIFUNGAL
A. Lymphoid tissue MEDICATIONS
96. B. Intestinal tract • The most likely diagnosis for this patient’s case is invasive
C. Blood vessel pulmonary aspergillosis. Take note of the radiologic features
D. Gall bladder differentiating aspergilloma and invasive aspergillosis:
Which of the following is the second most common o Monod sign (gas surrounding the aspergilloma) – aspergilloma.
cause of uncomplicated UTI particularly in young o Air crescent sign (presence of crescent-shaped space
sexually active females? between mass and lung cavity) – invasive aspergillosis.
97. A. Escherichia coli • Invasive pulmonary aspergillosis requires aggressive treatment
B. Proteus mirabilis with IV antifungal medications such as voriconazole or
C. Klebsiella pneumoniae amphotericin B to control the infection.
D. Staphylococcus saprophyticus • In severe cases with massive hemoptysis and significant lung
A 60/M with poorly controlled diabetes consulted involvement, surgical options such as lobectomy may also be
the OPD for a chronic foot ulcer noted on the left sole considered but initial treatment typically involves IV antifungal
of his right foot. The lesion was painless but started therapy. Oral antifungal medications would not be appropriate
draining pus and blood, smell strongly, with the for the patient’s severe symptoms and findings.
ulcer getting deeper. Which of the following types of
98.
wounds does the patient have? 5. C. M PROTEIN
A. Cancerous ulcer • The major virulence factor of Streptococcus pyogenes is the M
B. Stasis ulcer protein. It is a filamentous structure anchored to the cell
C. Trophic ulcer membrane that penetrates and projects from the streptococcal
D. Arterial ulcer cell wall. It prevents phagocytosis, promotes adherence to host
Which of the following laboratory diagnostics is the cells, and invades the host immune system.
preferred test if there is suspicion of chlamydia
infection in a pregnant woman? 6. B. IVERMECTIN
99. A. Pap smear • The drugs of choice for cutaneous larva migrans (CLM) are
B. Culture and sensitivity topical thiabendazole, oral albendazole, or ivermectin.
C. Gram stain of vaginal smear • It intensifies GABA-mediated neurotransmission in nematodes
D. Nucleic acid amplification test and causes immobilization of parasites, facilitating their
Which of the following drugs is NOT part of the triple removal by the reticuloendothelial system. Selective toxicity
therapy with PPI for Helicobacter pylori infection? occurs in humans GABA is a neurotransmitter only in the CNS
A. Amoxicillin and ivermectin does not cross the blood-brain barrier.
100.
B. Clarithromycin • Other clinical uses of ivermectin include onchocerciasis,
C. Tetracycline strongyloidiasis, and some forms of filariasis.
D. Omeprazole • Mebendazole has poor bioavailability, absorption, and should
not be used as a first line medication
DISCUSSION
Maxfield L, Crane JS. Cutaneous Larva Migrans. [Updated 2023 Jun 28]. In: StatPearls [Internet]. Treasure Island (FL):
StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507706/

1. D. REACTIVATION TUBERCULOSIS 7. A. PARAGONIMIASIS

• Reactivation tuberculosis is characterized by chronic tissue
lesions, the formation of tubercles, caseation, and fibrosis.
Regional lymph nodes are only slightly involved, and they do not
caseate. This type almost always begins at the apex of the lung,
where the oxygen tension is highest.
• Primary tuberculosis infection usually occurs in childhood and
involves any part of the lung but most often the mid-lung fields
or the base. Enlarged hilar and mediastinal lymph nodes are
typically observed.
• Latent tuberculosis infection usually presents with positive
tuberculin skin test reaction. Majority of the patients are
asymptomatic and cannot spread TB bacteria to others. They
may develop TB disease if not treated accordingly.
• In the lungs, Paragonimus worms provoke a granulomatous
reaction that gradually gives rise to the development of a fibrotic
cyst containing blood-tinged purulent material, adult worms,
and eggs. Chest x-ray findings may also be seen in pulmonary
tuberculosis (PTB). Since PTB and paragonimiasis are usually
co-endemic, PTB should always be ruled out.
• The other choices are not typically associated with hemoptysis
and are less likely to mimic pulmonary tuberculosis in terms of
clinical presentation and CXR findings.
• REMEMBER: Paragonimiasis closely resembles tuberculosis. “In
suspected cases of tuberculosis, a history of crab-eating plus
sputum examinations, image findings, and serodiagnosis are
necessary to rule out paragonimiasis”. (Nakagura et al., 2002)

2. A. SKIN BIOPSY 8. C. MALIGNANT TRANSFORMATION

• Skin biopsy is the primary diagnostic test to establish the
diagnosis of Hansen’s disease, also known as leprosy, caused by
Mycobacterium leprae.
• Scrapings with a scalpel blade from skin or nasal mucosa or from
a biopsy of earlobe skin are smeared on a slide and stained by
the Ziehl-Neelsen technique. Biopsy of skin or of a thickened
nerve gives a typical histologic picture.
• The other choices may be used as supportive or complementary
tests, but the definitive diagnosis is confirmed thru skin biopsy.
3. B. CHAGAS DISEASE
• In the chronic stage, the most serious complication is chagasic
cardiomyopathy associated with fibrosis in response to the
presence of intracellular parasites in heart tissue. When fibrosis
occurs in the conduction system of the heart, arrhythmias can
develop that can lead to sudden death.
• Acute Chagas disease presents with chagoma (subcutaneous
inflammatory nodule) at the site of Trypanosoma cruzi entry and
Romaña sign (unilateral swelling of the eyelids) which is
characteristic at onset especially in children. The primary lesion
is accompanied by fever, acute regional lymphadenitis, and
dissemination to blood and tissues. Can also be asymptomatic.
• A virus is regarded as oncogenic because of its ability to induce
malignant transformation of cells. EBV is the causative agent of
acute infectious mononucleosis and is associated with
nasopharyngeal carcinoma, Burkitt lymphoma, Hodgkin and
non-Hodgkin lymphomas, other lymphoproliferative disorders
in immunodeficient individuals, and gastric carcinoma.
9. D. BOTULISM
• A chief risk factor for botulism lies in home-canned foods,
particularly string beans, corn, peppers, olives, peas, and
smoked fish or vacuum-packed fresh fish in plastic bags.
• Symptoms begin 18-24 hours after ingestion of the toxic food,
with visual disturbances (incoordination of eye muscles, double
vision), inability to swallow, and speech difficulty. Bulbar
paralysis signs are progressive, and death occurs from
respiratory paralysis or cardiac arrest.
• REVIEW: common board questions involve the ability to
recognize and differentiate botulism and tetanus.
• Tetanus is usually contracted through a contaminated wound,
especially deep puncture wounds or wounds with soil.
Symptoms are characterized by muscle stiffness and spams
(lockjaw, neck). It may appear within days to weeks after initial
infection with muscle stiffness and spams worsening over time.

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10. B. THE CORYNEBACTERIUM DIPHTHERIAE PRODUCE
TOXIN THAT CAN BE ABSORBED AND RESULT IN DISTANT
TOXIC DAMAGE
• Diphtheria toxin is absorbed into the bloodstream and cause
distant toxic damage to various organs and tissues in the body.
The clinical manifestations in diphtheria are primarily because
of its toxin depending on the organ involvement (heart, kidney,
and adrenals) rather than the direct invasion of deep tissues by
the bacterium.
• RECALL: Diphtheria is an example of toxemia (disease caused by
the spread of bacteria and their toxins in the bloodstream).
o Classic pharyngeal finding in C. diphtheriae infections – gray
pseudomembrane.
11. D. CD8 T LYMPHOCYTES
• CD8 T lymphocytes (cytotoxic T lymphocytes) have direct
cytotoxic activity hence the ability to kill infected or cancerous
cells. They recognize antigens on the surface of target cells and
induces apoptosis through various mechanisms such as the
release of perforin and granzymes.
• The CD4 T lymphocytes (helper T cells) play a crucial role in
activating and regulating other immune cells such as B cells.
They help coordinate the immune response by assisting other
immune cells.
• REVIEW: The corresponding receptors for the two subsets.
o CD8+ T cells – Major Histocompatibility Complex class I
o CD4+ T cells - Major Histocompatibility Complex class II
o Mnemonic: 8 x 1 = 8 = 4 x 2
12. D. ANTI-STREPTOLYSIN O
• ASO titers document antecedent pharyngitis.
• Anti-DNAse B titers document antecedent skin infection.
• Anti-streptokinase antibodies decrease efficacy of streptokinase
in managing patients with myocardial infarction.
13. A. AMASTIGOTE
• Amastigote (intracellular) – most common in heart muscle, liver,
and brain; Trypomastigote (extracellular) – bloodstream.
• Epimastigote – in the vector.
14. D. SPOROZOANS
• Cryptosporidium hominis (intestinal sporozoan) can infect the
intestine in immunocompromised persons and cause severe,
intractable diarrhea.
15. A. CENTRAL ZONE
• Granulomas consist of three zones: (1) a central area of large,
multinucleated giant cells containing tubercle bacilli, (2) a mid-
zone of pale epithelioid cells often arranged radially, and (3) a
peripheral zone of fibroblasts, lymphocytes, and monocytes.
16. D. COLLECTION OF HYPHAE, MUCUS, AND CELLULAR DEBRIS
• An aspergilloma is a fungus ball or mycetoma composed of
Aspergillus hyphae along with cellular debris and mucus.
Aspergillus species colonize the preexisting cavity in the lung
parenchyma and form a fungus cavity.
17. C. PASTEURELLA MULTOCIDA
• P. multocida occurs worldwide in the respiratory and
gastrointestinal tracts of many domestic and wild animals. It is
perhaps the most common organism in human wounds inflicted
by bites from cats and dogs.
18. A. CANDIDIASIS
• Forms of cutaneous candidiasis include invasion of the skin,
which occurs when the skin is weakened by trauma, burns, or
maceration.
• Intertriginous infection occurs in moist, warm, parts of the body
such as the axillae, groin, and intergluteal or inframammary
folds; it is most common in obese and diabetic individuals.
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19. C. IT IS A DISTINCT SPECIES OF POXVIRUS
• The vaccine is made from a virus called vaccinia, which is a
poxvirus similar to smallpox, but less harmful. The smallpox
vaccine contains live vaccinia virus, not a killed or weakened
virus like many other vaccines.
• All vaccines can have side effects, though the risk of severe
complications from the vaccine is relatively low compared to the
risk of contracting the disease itself. It is not perfectly safe.
• Edward Jenner developed the smallpox vaccine in 1796.
20. B. MORE TISSUE INVASIVENESS
• Community acquired-MRSA-colonized individuals and their
close contacts are more likely to develop skin and soft tissue
infections.
• Skin and soft tissue sites were greatly affected in patients of both
groups, 61% in HA-MRSA group and 86% CA-MRSA patients.
• Community acquired-MRSA strains tend to be less resistant and
more transmissible than hospital acquired-MRSA. The
multiplication rate can vary between strains and individuals.
21. C. THE VIRIONS CARRY AN RNA POLYMERASE
• The virion RNA is negative sense and must therefore be copied
into the complementary plus-sense mRNA before proteins can
be made. Thus, besides needing to code for an RNA-dependent
RNA-polymerase, these viruses also need to package it in the
virion so that they can make mRNAs upon infecting the cell.
• Whereas positive-sense RNA viruses’ genome can act as an
mRNA directly within the infected cell.
22. C. INFECTION IN THE PAST
• A positive tuberculin test result indicates that an individual has
been infected in the past. It does not imply that active disease or
immunity to disease is present.
• It suggests that the individual has been infected with the TB
bacteria and the immune system has reacted to presence of the
bacteria by producing an immune response.
23. D. OVAL BUDDING SPORES AND PSEUDOHYPHAL
ELEMENTS
• Tissue biopsies and other specimens may be examined in Gram-
stained smears or histopathologic slides for pseudohyphae and
budding cells. As with dermatophytosis, skin or nail scrapings
are first placed in a drop of KOG and calcofluor white.
• Spaghetti and meatballs appearance – Malassezia furfur
• Tobacco-like configuration of hyphal elements – Phytophthora
infestans (Nice to know only!)
• Scabies – burrows on interdigitations (pathognomonic feature)
24. D. LEPROSY
• Also called Hansen’s disease. Caused by Mycobacterium leprae,
an acid-fast bacillus that likes cool temperatures (infects skin
and superficial nerves – “glove and stocking” loss of sensation).
Diagnosed via skin biopsy.
25. D. FOOD HANDLERS
• Contamination is typically spread when feces come into contact
with food or water. Human carriers can spread infections when
food handlers do not use proper hand washing hygiene after
using the restroom or before handling food.
• E. coli can also be introduced to food through contaminated
water, cross-contamination from other raw foods, or inadequate
cooking temperatures.
26. B. TZANCK SMEAR
• In stained smears of scrapings or swabs of the base of vesicles
(Tzanck smear), multinucleated giant cells are seen.
27. A. LIPOOLIGOSACCHARIDE
• Lipooligosaccharide (endotoxin) is a major virulence factor of
Pseudomonas aeruginosa and is responsible for inducing septic
shock. It plays a direct role in causing fever, shock, oliguria,
leukocytosis, leukopenia, disseminated intravascular
coagulation, and adult respiratory distress syndrome.
• The other choices are associated with other bacterial pathogens.
o Heat-labile enterotoxin – Bacillus cereus
o Pyrogenic exotoxin A – Streptococcus pyogenes
o Shiga-like toxin – recall: ABCDE mnemonic in handout
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28. C. CYTOKINE RELEASE
• Toxic shock syndrome toxin-1 is a superantigen which causes
potent cellular disruption without needing to enter the cells.
TSST-1 stimulates most T-cells by binding directly to MHC-II and
T-cell receptors. The net result is the production of large
amounts of the cytokines IL-2, IFN-gamma, and TNF.
29. C. STAPHYLOCOCCAL CASSETTE CHROMOSOME MEC
• Resistance to nafcillin is encoded and regulated by a sequence of
genes found in a region of the chromosome called the SCC mec.
Specifically, the mecA and mecC genes on this locus encode
affinity penicillin-binding protein responsible for the resistance.
30. D. ECTHYMA GANGRENOSUM
• Hemorrhagic necrosis of skin occurs often in sepsis often caused
by Pseudomonas aeruginosa infection; the lesions, called
ecthyma gangrenosum, are surrounded by erythema and often
do not contain pus. They often occur in immunocompromised
individuals or in patients with significant burns.
31. D. VIBRIO CHOLERAE
• Clinical findings of disease due to V. cholerae present with
sudden onset of nausea and vomiting, followed by profuse
diarrhea with abdominal cramps. Stools resemble “rice water”
contain mucus, epithelial cells, and large numbers of vibrios.
32. B. TRYPANOSOMA CRUZI
• T. cruzi are introduced when infected bug feces are rubbed into
the conjunctiva, the bite site, or a break in the skin. Unilateral
swelling of the eyelids (Romaña’s sign) is characteristic at
onset, especially on children. At the site of T. cruzi entry, there
may be a subcutaneous inflammatory nodule or chagoma.
33. B. HABITATION OF THE GASTROINTESTINAL MUCOSA
• Cryptosporidium inhabits the brush border of mucosal epithelial
cells of the gastrointestinal tract, especially the surface of villi of
the lower small bowel.
• Pseudomembranous colitis is typically caused by Clostridium
difficile infection.
34. C. CREEPING ERUPTION
• Cutaneous larva migrans is also called creeping eruption. It is
acquired when bare skin (often the hands and feet) contacts the
soilborne larvae of Ancylostoma caninum, the dog hookworm.
Larvae migrate in the epithelial layers of the skin and leave red,
itchy tracts on the skin.
35. A. ECHINOCOCCUS GRANULOSUS
• Humans can be exposed to these eggs by “hand-to-mouth”
transfer or contamination. By ingesting food, water, or soil
contaminated with stool from infected dogs.
• Children who have close contact with dogs infected with E.
granulosus tapeworm, especially if they handle the dog’s feces or
if they often pet the dog’s fur.
36. D. TRICHOMONAS VAGINALIS
• Trichomoniasis – motile pear-shaped trichomonads (frothy
yellow-green foul-smelling discharge; “strawberry cervix”)
• The absence of clue cells, hyphae, and spores rules out other
common causes of vaginal discharge like vaginosis (Gardnerella
vaginalis) and Candida albicans (yeast infection). Chlamydia
trachomatis does not typically produce the same discharge.
37. A. BACTERIAL VAGINOSIS
• Bacterial vaginosis – clue cells, positive KOH whiff test (thin,
white discharge with fishy odor).
38. A. STAPHYLOCOCCUS AUREUS
• Staphylococcal scalded skin syndrome (Ritter disease) is a
disease characterized by denudation of the skin caused by
exotoxin producing strains of the Staphylococcus sp. Nikolsky
sign – separation of epidermis upon manual stroking of skin.
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39. A. POLIOVIRUS
• Poliomyelitis is caused by poliovirus (fecal-oral transmission).
It replicates in lymphoid tissue of oropharynx and small
intestine before spreading via bloodstream to CNS. Infection
causes destruction of cells in anterior horn of spinal cord (LMN
death). Polio often begins with flu-like symptoms and then can
lead to asymmetric muscle weakness or paralysis. Preventable
by vaccination.
• While botulism can also present with muscle weakness or
paralysis, it is typically characterized by symmetric descending
paralysis (initially cranial nerve involvement – eye symptoms),
absence of fever, and intact sensorium.
40. D. DEPENDENT ON THE NUMBER OF MYCOBACTERIA IN
THE INOCULUM DESPITE HOST IMMUNE STATUS
• Tuberculosis infection is not solely dependent on the number of
mycobacteria in the inoculum. The host’s immune status plays a
significant role in determining its outcome.
• The production and development of lesions and their healing or
progression are determined chiefly both by the number of
mycobacteria in the inoculum, their subsequent multiplication,
and the type of host immune response.
41. D. MOSQUITO BREEDS IN DOMESTIC WATER-HOLDING
RECEPTACLES AND CAN EASILY TRAVEL TO HOMES.
• Mosquitoes lay eggs near the edges of lakes and ponds, or among
plants in swamps and marshes, or in containers that hold water.
42. A. VIRUS ISOLATION BY INOCULATION OF VESICULAR
FLUID INTO CHICK EMBRYO
• Virus isolation can be carried out by inoculation of vesicular
fluid onto the chorioallantoic membrane of chick embryos. This
test can distinguish cases of smallpox from generalized vaccinia
because the lesions produced by these viruses on the membrane
differ markedly. Other tests on the choices cannot distinguish
the specific smallpox from other poxviruses.
43. B. STAPHYLOCOCCUS AUREUS
• Diabetic foot infections are classified as mild, moderate, or
severe. Gram-positive bacteria, such as S. aureus and beta-
hemolytic streptococci, are the most common pathogens in
previously untreated mild and moderate infection. Severe,
chronic, or previously treated infections are often
polymicrobial.
44. C. PSEUDOMONAS
• P. aeruginosa causes chronic pneumonia which is a significant
cause of morbidity and mortality in cystic fibrosis patients.
45. C. NECATOR AMERICANUS
• Necator americanus, Ancylostoma spp. – larvae penetrate skin
from walking barefoot on contaminated beach or soil.
• Ascaris lumbricoides, Trichuris trichiura – fecal-oral
• Taenia solium – ingestion of larvae encysted in undercooked
pork.
46. B. GLOBAL ERADICATION
• In 1980, the world health organization (WHO) declared
smallpox eradicated and no cases of naturally occurring
smallpox have happened since. The last known natural case was
in Somalia in 1977.
47. C. SALMONELLA TYPHIMURIUM
• Salmonella are facultative gram-negative rods, non-lactose-
fermenter, produce hydrogen sulfide, and are cultured in Xylose
Lysine Deoxycholate (XLD) agar.
• Other choices also present with diarrhea but are not non-lactose
fermenter. REVIEW: The Gram-positive and Gram-negative lab
algorithms since they were past PLE questions like this that
present similarly, and the answer can only be delineated by
knowing the algorithm.
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48. C. ANTIGEN SPECIFIC ANTIBODY
• Immune responses are normally directed against the antigen
that provoked them and are said to be antigen specific.
Specificity and immunologic memory are two properties that
distinguish adaptive immunity from innate immunity.
• REVIEW: Adaptive immunity & Innate immunity
o Innate immunity – relies on general mechanisms and receptors
such as phagocytosis, microbial sensors, and proinflammatory
cytokines to provide immediate but nonspecific first line
defense against a wide range of pathogens.
o Adaptive immunity – presence of antigen-specific antibodies
and T cells. This recognition is highly specific, meaning that the
immune system can differentiate different pathogens and
mount a tailored response.
49. B. T LYMPHOCYTES
• The cardinal feature of HIV infection is the depletion of T helper-
inducer lymphocytes – the result of HIV replication in this
population of lymphocytes as well as of the death of uninfected
T cells by indirect mechanisms.
50. A. DESTRUCTION OF LOWER MOTOR NEURONS
• Poliovirus can spread along axons of peripheral nerves to the
CNS, where it continues to progress along the fibers of the LMN
to increasingly involve the spinal cord or the brain.
• The destruction of the motor neurons leads to muscle weakness
and paralysis as seen in paralytic poliomyelitis.
51. A. B LYMPHOCYTES
• The major target cell for EBV (HHV-4) is the B lymphocyte. EBV
is a member of the herpesvirus family and is known to establish
lifelong latent infections in B cells. When human B lymphocytes
are infected with EBV, continuous cell lines can be established,
indicating that cells have been immortalized by the virus.
52. D. REPLACEMENT FLUID OR ELECTROLYTE IS ESSENTIAL
• Since non-typhoidal Salmonella gastroenteritis is typically a self-
limited illness, antimicrobial therapy is not necessary and not
recommended. In cases with severe diarrhea, replacement of
fluids and electrolytes is essential.
• Bacteremia can occur in some cases but not usual. Stool culture
is done to confirm the diagnosis but is not essential for all cases.
53. C. MYCOPLASMA PNEUMONIAE
• The classic cause of atypical “walking pneumonia”. Occurs
frequently in those < 30 years old; outbreaks in military recruits,
prisons, colleges. CXR results appear more severe than the
patient presentation itself.
• Streptococcus pneumoniae and Hemophilus influenzae can cause
pneumonia but are more likely to result in a more severe
presentation. Neisseria gonorrhoeae is not a common cause of
the respiratory symptoms presented in the case.
54. B. MOBILE AND TRANSFERABLE SEGMENTS OF
BACTERIAL DNA
• Transposons, also known as “jumping genes”, are DNA segments
that are mobile. They can replicate and insert copies at sites
within the same or a different chromosome. They can therefore
alter the genetic constitution of an organism.
55. B. IGA
• Secretory IgA prevents attachments of bacteria and viruses to
mucous membranes.
• It is the most abundant antibody isotype in mucosal secretions.
56. C. PRIMARY TUBERCULOSIS
• When a host has first contact with tubercle bacilli, an acute
exudative lesion develops and rapidly spreads to the lymphatics
and regional lymph nodes, the lymph node under undergoes
massive caseation, which usually calcifies (Ghon lesion), and the
tuberculin test result becomes positive.
• The other choices do not typically present with granulomatous
lung lesions.
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57. B. LARVA OF DUODENALE WORMS
• Hookworm (Ancylostoma duodenale and Necator americanus)
infection occurs when larvae penetrate the skin usually through
the hands and feet. Repeated episodes of larval skin invasion
result in a pruritic, popular rash known as ground itch.
58. A. FUNGAL CULTURE
• Fungal culture is the most reliable method of diagnosis for
sporotrichosis. Specimens from a biopsy of a suspected
ulcerated lesion are streaked on IMA or SDA containing
antibiotics and are incubated. The identification is confirmed by
growth at 35oC and conversion to yeast form.
• The other choices may be useful for diagnosing fungal infections
but are not as reliable as fungal culture for the specific
identification of Sporothrix schenckii.
59. C. BURKITT LYMPHOMA
• EBV is the causative agent of acute infectious mononucleosis
and is associated with Burkitt lymphoma, nasopharyngeal CA,
Hodgkin and non-Hodgkin lymphomas, and gastric carcinoma.
60. C. ORAL ITRACONAZOLE
• In some cases, the infection is self-limited, but treatment is still
often recommended to speed up recovery and prevent
complications, especially in severe or disseminated cases.
Although the oral administration of saturated solution of
potassium iodide in milk is quite effective, it is difficult for many
patients to tolerate. The treatment of choice is oral itraconazole
or another azole. For systemic disease or cases that do not
respond to oral antifungals, IV amphotericin B is given.
61. D. SWEATY AREAS, WARM, MOIST, AND UNAERATED
• Intertriginous infection occurs in moist, warm, parts of the body
such as the axillae, groin, and intergluteal or inframammary
folds. Interdigital involvement follows repeated prolonged
immersion in water; it is common in homemakers, bartenders,
cooks, and vegetable and fish handlers.
62. D. INFERTILITY
• Pelvic inflammatory disease (PID) is strongly associated with
infertility. The infection can lead to scarring and damage to the
fallopian tubes and other reproductive organs, which can make
it difficult for patients to conceive or carry pregnancy to term.
Specifically, infertility risk increases with the number of PID
episodes: 12% with one episode, 20% with two episodes, and
40% with three or more episodes.
63. B. DURING CHILDBIRTH
• Herpes simplex virus type 2 is mainly transmitted during sex
through contact with genital or anal surfaces, skin, sores, or
fluids of someone infected with the virus.
• Peripartum neonatal transmission can occur when there is
shedding of the virus from the genital tract around the time of
delivery.
64. A. AN INFECTION GAVE COMPLETE PROTECTION AGAINST
REINFECTION
• Infection with one virus within the Orthopoxvirus genus induces
an immune response that reacts with all other members of the
group. They are closely related antigenically. Survival of an
attack of smallpox gave complete protection against reinfection.
• Most cases of smallpox are clinically apparent, infected patients
typically develop signs and symptoms of the disease such as
fever, malaise, and exanthems.
• The smallpox virus is primarily a human pathogen and is not
known to naturally infect other animal species.
• Unlike other viruses such as dengue and rhinovirus, smallpox is
caused by a single serotype of the variola virus.
65. D. EPSTEIN-BARR VIRUS
• Infectious mononucleosis presents with fever, pharyngitis,
hepatosplenomegaly, and lymphadenopathy. There is an
increased risk of splenic rupture. It is also called “kissing
disease” and is common in teens and young adults.
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This handout is only valid for October 2023 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly.
66. C. DECLINE IN THE COMPLEMENT-FIXING ANTIBODIES
• Oral doxycycline and erythromycin for 21 days are effective
therapies. Some drug-treated persons have a marked decline in
complement-fixing antibodies, which may indicate that the
infective agent has been eliminated from the body. Late stages
of LGV require surgery.
67. B. CRYPTOCOCCUS NEOFORMANS
• In immunocompromised patients, the yeasts may multiply and
disseminate preferentially to the CNS. Cryptococcosis presents
as chronic meningitis, which can resemble a brain tumor, brain
abscess, and degenerative CNS disease.
68. A. ANALYSIS OF PAIRED ACUTE AND CONVALESCENT SERA
• Analysis of paired acute and convalescent sera to show a
significant rise in antibody titer is the most reliable evidence of
an active dengue infection.
69. D. SALMONELLA CHOLERAESUIS
• This serotype of Salmonella is known to cause bacteremia after
oral infection with subsequent seeding of organs such as
osteomyelitis, pneumonia, and meningitis as the most common
sequelae with no gastrointestinal manifestations. Common in
patients with sickle cell anemia or cancer.
70. B. CULTURE
• Definitive diagnosis of gonococcal arthritis (disseminated
gonococcal infection) is made through identification of the
etiologic pathogen in a specimen from a non-mucosal site (i.e.,
synovial fluid, blood, or skin lesions). A positive culture result
helps distinguish gonococcal arthritis from other pathogens that
cause septic arthritis.
71. C. HUMAN CARRIERS WORKING AS FOOD HANDLERS
• Salmonella can be acquired from various reservoirs, humans,
animals, or a contaminated environmental source. The feces of
people who have unsuspected subclinical disease or who are
carriers are known important source of contamination. Carriers
“shedding” organisms who are working as food handlers are a
major source of larger outbreaks of salmonellosis.
72. D. NEGATIVE LEPROMIN TEST
• In lepromatous type, the course is progressive and malignant,
with nodular skin lesions; slow, symmetric nerve involvement;
abundant acid-fast bacilli in the skin lesions; continuous
bacteremia; and a negative lepromin skin test result. The cell-
mediated immunity is markedly deficient, and the skin is
infiltrated with suppressor T cells.
• In tuberculoid type, the course is benign and nonprogressive,
with a small number of macular skin lesions containing few
bacilli, severe asymmetric nerve involvement of sudden onset,
and a positive lepromin skin test result. The cell-mediated
immunity is intact, and the skin is infiltrated with helper T cells.
• The other choices may also be associated with leprosy but are
not specific for distinguishing between the lepromatous and
tuberculoid types. Although, superficial nerve involvement
tends to be more pronounced in lepromatous leprosy.
73. D. HUMAN PAPILLOMAVIRUS
• HPV genital infections are sexually transmitted and represent
the most common sexually transmitted disease in the US.
74. A. A SUPERANTIGEN
• Toxic shock syndrome toxin (TSST-1) is a superantigen that
binds to MCH II and T-cell receptor, resulting in polyclonal T-cell
activation and cytokine release. It is commonly associated with
the use of tampons, especially the high-absorbency ones, during
menstruation.
75. A. INFERTILITY
• Pelvic inflammatory disease (PID) is strongly associated with
infertility. The infection can lead to scarring and damage to the
fallopian tubes and other reproductive organs, which can make
it difficult for patients to conceive or carry pregnancy to term.
Specifically, infertility risk increases with the number of PID
episodes: 12% with one episode, 20% with two episodes, and
40% with three or more episodes.
TOPNOTCH MEDICAL BOARD PREP MICRO-PARA PRACTICE TEST 4 HANDOUT BY DR. ALLEN LICHAUCO
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
This handout is only valid for the October 2023 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly.
76. C. PANTON-VALENTINE LEUCOCIDIN
• CA-MRSA isolates are characterized by the presence of Panton-
Valentine leucocidin and the presence of SCCmec type IV. PVL is
a cytotoxin that kills leukocytes and causes tissue necrosis. It
plays a significant role in the ability of CA-MRSA to cause more
aggressive and invasive infections compared to the other strains
of Staphylococcus aureus.
• Coagulase, exfoliative toxin, and enterotoxin are also virulence
factors of S. aureus, but they are not closely associated to the
virulence of CA-MRSA infections compared to PVL.
77. C. OVERGROWTH OF ANAEROBES, DECREASED
LACTOBACILLI, AND INCREASED VAGINAL PH
• Vaginal discharge of bacterial vaginosis often has a distinct
“fishy” odor and contains many anaerobes (due to decrease in
lactobacilli) in addition to Gardnerella vaginalis. The pH of the
vaginal secretions is greater than 4.5 (normal pH is <4.5).
• Trichomoniasis – motile trichomonads produce odorous amine.
• Candidiasis – growth of yeast, whitish curd-like cottage cheese.
78. B. BACTERIA ARE CELL WELL DEFECTIVE
• Mycoplasmas are mostly resistant to penicillins, cephalosporins,
and vancomycin since they have no cell walls. The said
antibiotics primarily target the cell wall of bacteria as their
mechanism of action. Tetracyclines and erythromycins are the
current drugs of choice in mycoplasmal pneumonia. Their
mechanism of action is by inhibiting bacterial protein synthesis.
79. A. BACILLUS CEREUS
• B. cereus is known to cause food poisoning after consuming rice
dishes that have been reheated or improperly cooked.
• Food poisoning caused by B. cereus has two distinct forms
namely the emetic type and diarrheal type. Common source of
infection is reheated rice. Emetic type causes nausea and
vomiting within 1-5 hours. Diarrheal type causes watery, non-
bloody diarrhea and GI pain within 8-18 hours.
80. A. DIRECT FECAL SMEAR
• The standard method for diagnosing the presence of whipworm
(Trichuris trichiura) is by microscopically identifying
whipworm eggs in a stool sample. Because eggs may be difficult
to find in light infections, a concentration procedure such as
saturated salt flotation and merthiolate-iodine formaldehyde
concentration techniques may be recommended.
• Scotch tape method (perianal cellophane swab) is used for the
detection of Enterobius vermicularis eggs.
81. D. RHEUMATIC FEVER HAS A MARKED TENDENCY TO BE
REACTIVATED BY RECURRENT STREPTOCOCCAL INFECTION
• The first attack of rheumatic fever usually produces only slight cardiac
damage, which, however, increases with each subsequent attack. It is
therefore important to protect such patients from recurrent S. pyogenes
infections by giving prophylactic penicillin administration.
• Rheumatic fever has a marked tendency to be reactivated by recurrent
streptococcal infections, but nephritis does not. Therefore, anti-
streptococcal chemoprophylaxis is not recommended in such patients.
• Rheumatic fever is more commonly preceded by infection of the
respiratory tract (pharyngitis). RF is NOT associated with the
cutaneous manifestation of Streptococcal infection. Nephritis is
more commonly preceded by infection if the skin.
• The rates of occurrence and timing of the development of APSGN
and ARF can differ depending on the risk factors and prevalence
such as access to healthcare, geographic location, and socio-
economic conditions.
82. C. SPOROTRICHOSIS
• The conidia or hyphal fragments of S. schenckii are introduced to
the skin by trauma. Patients frequently recall a history of trauma
associated with outdoor activities and plants. The initial lesion
develops as a granulomatous nodule that may progress to form
a necrotic or ulcerative lesion. Multiple subcutaneous nodules
and abscesses occur along the lymphatics.
• Chromoblastomycosis – subcutaneous mycoses with melanized
sclerotic bodies (copper-penny bodies), cauliflower-like lesions.
• Erythema nodosum – symptom of coccidiomycosis that suggests
robust immune response; characterized by the sudden onset of
erythematous, firm, solid, deep nodules or plaques, tender, and
mainly localized at the extensor surfaces of the legs.
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 TOPNOTCH MEDICAL BOARD PREP MICRO-PARA PRACTICE TEST 4 HANDOUT BY DR. ALLEN LICHAUCO
For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/
This handout is only valid for October 2023 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly.
83. D. METRONIDAZOLE 500 MG BID FOR 2 WEEKS 94. B. MONOD SIGN
• The vaginosis attributed to Gardnerella vaginalis is suppressed • The Monod sign (aspergilloma) describes gas surrounding the
by metronidazole, suggesting an association with anaerobes. mycetoma.
Oral metronidazole is generally curative. • The air crescent sign (invasive aspergilloma) is seen as a sickle-
shaped lucency partially surrounding a soft tissue mass in the
84. A. OSTEOMYELITIS pulmonary cavity. This usually heralds recovery and is the result
• Osteomyelitis is a common complication of a diabetic foot ulcer. of increased granulocyte activity.
Unlike in hematogenous osteomyelitis and direct inoculation
(open fracture), in the diabetic foot, there is a contiguous spread 95. C. TYPHOID FEVER
of pathogens from infection, complicating a diabetic foot ulcer to • Rose spots, 1-4 mm blanching pink macules, are the classic
the bones underlying these ulcers. This is a serious condition cutaneous manifestation of enteric fever. They are typically
that requires prompt medical attention. observed on the chest and abdomen. They are fairly uncommon
in patients with uncomplicated fever.
85. B. HE HAD SECONDARY DENGUE WITH A DIFFERENT
SEROTYPE AS PREVIOUS 96. A. LYMPHOID TISSUE
• Dengue hemorrhagic fever is most common in patients infected • After ingestion of contaminated food or water, the salmonellae
with a different serotype after their initial infection due to reach the small intestine, from with they pass through the
antibody-dependent enhancement of the disease. epithelium via specialized M-cells overlying the Peyer’s patches,
and then enter the intestinal lymphatics with subsequent
86. D. CANDIDA VULVOVAGINITIS invasion into the bloodstream. The organisms multiply within
• Candida vulvovaginitis – pseudo-hyphae, pH normal 4.0-4.5; the intestinal lymphoid tissue and are excreted in stools.
(thick, white cottage cheese discharge).
• Trichomonas vaginitis – motile pear-shaped trichomonads, pH > 97. D. STAPHYLOCOCCUS SAPROPHYTICUS
4.5; (frothy, yellow-green, foul-smelling discharge). • Staphylococcus saprophyticus – second leading cause of UTI
• Bacterial vaginosis – clue cells, pH > 4.5, positive KOH whiff test; particularly in young, sexually active females.
(thin, white discharge with fishy odor). • Escherichia coli – leading cause of UTI in which colonies show
strong pink lactose-fermentation on MacConkey agar.
87. C. HERPES GENITALIS • Klebsiella pneumoniae – third leading cause of UTI where there
• The characteristic lesions of HSV infection begin as group 2-4 are large mucoid capsule and viscous colonies in culture.
mm vesicles with associated underlying erythema that progress • Proteus mirabilis – associated with struvite stones; motility
to vesicopustules, erosions, and ulcerations with local pain and causes “swarming” on agar, produces urease.
itching as its most common symptoms.
• Primary syphilis – painless ulcer (chancre) 98. C. TROPHIC ULCER
• Folliculitis – inflamed hair follicles (not vesicular lesions) • A trophic ulcer, also known as neuropathic or neurotrophic
• Scabies – mite infestation resulting in burrows. ulcer, is a pressure ulcer caused by external trauma to a part of
the body that is in poor condition because of disease, vascular
88. A. BACTERIAL VAGINOSIS insufficiency, or loss of afferent nerve fibers. This type of ulcer
• Associated with sexual activity, but not sexually transmitted. often occurs in patients with poorly controlled diabetes and
Non-painful as well versus vaginitis. Characterized by neuropathy.
overgrowth of certain anaerobic bacteria in vagina due to • The characteristics of trophic ulcers include painlessness (loss
decrease in lactobacilli. of sensation), drainage & smell (infection), and deeper ulcer
over time (the patient does not feel pain thus fail to recognize
89. A. CRYPTOSPORIDIUM HOMINIS and take protective measures to prevent further damage).
• Cryptosporidium presents as severe diarrhea in HIV/AIDS or
other immunocompromised patients and mild disease (watery 99. D. NUCLEIC ACID AMPLIFICATION TEST
diarrhea) in immunocompetent hosts. • Specific NAAT for both gonorrhea and chlamydial infection have
largely supplanted the use of culture. NAAT yield high sensitivity
90. B. CHLAMYDIA TRACHOMATIS and specificity and provide increased female specimen testing
• Lymphogranuloma venereum is an infection of the lymphatics options including urine, endocervical swabs, and vaginal swabs.
presenting with painless genital ulcers and painful regional
lymphadenopathy. The causative pathogens are C. trachomatis 100. C. TETRACYCLINE
serotypes L1, L2, and L3. • Triple therapy: Amoxicillin (1 g BID), Clarithromycin (500 mg
• Treponema pallidum – etiology of syphilis BID), and Omeprazole (standard dose BID) for 7-14 days.
• Quadruple therapy: Metronidazole (250 mg QID), Tetracycline
91. A. STAPHYLOCOCCUS AUREUS (500 mg QID), bismuth (dose-dependent on preparation), and
• Food poisoning caused by staphylococcal enterotoxin is Omeprazole (standard dose BID) for 10-14 days.
characterized by a short incubation period (1-8 hours).
Presenting with violent nausea, vomiting, and diarrhea with
rapid convalescence.
• C. perfringens – typically have a longer incubation period. END OF MICROBIOLOGY AND PARASITOLOGY
• S. dysenteriae – severe bloody diarrhea. PRACTICE TEST 4
• E. coli – symptoms vary depending on the specific strain.

92. D. INCREASED VASCULAR PERMEABILITY

• The key pathological feature of dengue hemorrhagic fever is
increased vascular permeability with plasma leakage into the
interstitial spaces associated with increased levels of vasoactive
cytokines. This can lead to life-threatening shock in patients.

93. C. CLINICAL RECONITION

• The diagnosis of M. pneumoniae is largely made by the clinical
recognition of the syndrome. Lab tests are of secondary value.

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For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
This handout is only valid for the October 2023 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly.