1. Note the Correct Answer Regarding Bacillus Anthracis

1. Note the correct answer regarding Bacillus anthracis:

Spores are quickly destroyed in soil
B anthracis is gram-positive rods
The anthrax toxin consists of three distinct antigenic components
The organism generally exists in the endospore form in nature
B anthracis is found in soil only in equatorial Africa

2. Note the correct answer regarding antrax modes of transmission:

Anthrax primarily is a disease of herbivores
Illness in humans most commonly occurs following contact with infected humans
Bacillus anthracis can be used as a Bioterrorist Weapon
Consumption of contaminated undercooked meat can lead to cutaneous anthrax
Cases following laboratory exposure have been recognized

3. Note the wrong answer regarding the clinical features in cutaneous antrax:

Ulcer is surrounded by a satellite vesicles and edematous halo
Ulcer is painful with a black eschar
Regional lymphadenopathy may be painful
The membrane/exudate of the ulcer contains numerous anthrax bacilli
There is relatively large extent of associated edema

4. Note what is not characteristic for oropharyngeal anthrax:

Patients may complain of unilateral sore throat/difficulty swallowing
The ulcer may be accompanied by a membrane
The ulcer may be is associated with local edema and cervical adenopathy.
On chest radiograph can be revealed mediastinal widening
Death may result from asphyxiation due to neck edema or toxemia

5. Note what is characteristic for intestinal anthrax:

Patients complain of vomiting, severe abdominal pain, hematemesis, bloody diarrhea, fever.
Primary intestinal anthrax has a local lesion resembling the ulcer of oropharyngeal anthrax
Multiple anthrax ulcerative lesions are found throughout the GI tract secondary to hematogenous spread.
Intestinal anthrax is not difficult to recognize
Case-fatality rate where patients received antibiotic therapy remain very high

6. Note what is characteristic for inhalational anthrax:

There is no fatality where patients received antibiotic
Incubation period is 1-60 days in weapon-grade anthrax

Illness may be biphasic with an initial prodrome followed by severe respiratory distress
Inhalational anthrax presents as hemorrhagic mediastinitis
Multiple anthrax ulcerative lesions are found in oropharyngs

7. Note what is not characteristic for anthrax:

Patients with inhalational anthrax have a good prognosis
Patients with septicemic anthrax may develop overwhelming toxicity or shock
Postexposure prophylaxis for bioterrorist anthrax should be continued for 60 days
Hemorrhagic meningoencephalitis is a characteristic presentation of CNS lesion in antrax
Intravenousadministration of antibiotics is recommended in cases of gastrointestinal antrax

8. Note what is characteristic for anthrax:

The availability of anthrax vaccine is limited to military personnel
If treated early, patients with cutaneous anthrax have a good prognosis
Gram stain of CSF reveals many gram-negative diplococcal
In inhalational antrax abnormal chest radiograph can reveal mediastinal widening, infiltrates, consolidation and pleural effusion.
Person-to-person transmission is recognized in inhalational disease

9. What clinical scenario is not characteristic for antrax:

Cutaneous anthrax
Oropharyngeal anthrax
Inhalational anthrax
Kidney antrax
Intestinal anthrax

What is not correct regarding Clostridium botulinum :
Cl. botulinum are spore-forming, anaerobic bacillus
Cl. botulinum may exist in soil or marine sediments throughout the world
Clostridial spores are highly heat resistant
The toxin is heat labile
Botulism is a disease caused by spores of Cl. botulinum

2. Note the correct answer regarding botulism pathogenesis:

The toxin causes blockade of neuromuscular conduction
The toxin causes demielinisation
Blockade of neurotransmitter release at the nerve terminal is considered permanent
Botulism is a disease caused by the neurotoxins of Clostridium botulinum
The toxin causes direct cytolysis of endothelial cells

3. Name the 3 clinical scenarios of botulism disease:

Food poisoning botulism
Wound infection botulism
Kidney botulism
Respiratory botulism
Infant botulism

4. Note the correct answer regarding botulism disease

The onset of symptoms can be abrupt or can evolve over several days
Typically, patients are febrile
Patients generally remain alert and responsive
Abdominal pain, with nausea and vomiting may precede or follow paralysis
The patients generally have hypersalivation

5. What is not characteristic for ophtalmoplegia syndrome in botulism:

Mydriasis - pupil dysfunction with poorly reactive pupils
Diplopia (double vision)
Lacrimation
Anisocoria - lesion of the nn.ciliares breves
Blepharoptosis - lesion of the III nerve

6. What is not characteristic for pharyngal neuropathic and glottal neuropathic syndroms in botulism:

Dysphagia - impairment of swallowing and drinking
Impairment of the palatinate reflex
Blepharoptosis - lesion of the III nerve
Dysphonia
Hoarse voice

7. What syndromes can be revealed in botulism:

Ophtalmoplegia syndrome
Pharyngal neuropathic syndrome
Muscular (miastenia) syndrome
Meningitis syndrome
Toxic shock syndrome

8. What syndromes can be revealed in botulism:

Hypovolemia shock
Gastrointestinal syndrome
Respiratory difficulties
Ophtalmoplegia syndrome
Encephalitic syndrome

9. What syndrome is not characteristic for non severe form of botulism:

Gastrointestinal syndrome
Respiratory difficulties
Pharyngal neuropathic syndrome
Ophtalmoplegia syndrome
Muscular (miastenia) syndrome

10. What is not characteristic for muscular (miastenia) syndrome in botulism:

Muscle weakness
A generally symmetric descending flaccid paralysis
Paralytic ileus advancing to severe constipation and urinary retention.
Convulsions
Gastric dilation

11. What is not characteristic for wound botulism:

The number of patients with WB and a history of chronic intravenous drug abuse has increased
Patients may be febrile, but this is more likely due to the wound infection rather than the WB syndrome
Often, the wound appears quite benign
Wound botulism is the rarest form of botulism
Gastrointestinal symptoms are always present in wound botulism

12. Note the correct answer regarding botulism disease:

The diagnosis of botulism requires a high degree of clinical suspicion
Wound infection requires incision and thorough debridement of the infected wound
Urinary catheterization may be required for urinary retention
Stomach and intestinal irrigation is not required
The demonstration of toxin in serum involves a bioassay in mice

13. Note the correct answer regarding botulism treatment:

Mechanical ventilation is considered when vital capacity is less than 30% of predicted.
Antitoxin will neutralize toxin already bound to neuromuscular junctions
Stress ulcer prophylaxis also is a standard component of intensive care management
An antitoxin may be beneficial, even when provided several wk after toxin ingestion
The antitoxin should be given after receiving laboratory confirmation of diagnosis.

14. Note the correct answer regarding botulism treatment:

HBIG - human botulinum immune globulin, ("Baby-BIG") is benefical for infant botulism
Botulism (infant and wound) should be treated with antibiotics to stop toxigenesis
Antitoxin has effect on established neurologic deficits.
Botulism antitoxin is an equine antitoxin
Equine antitoxin frequently is used in infant botulism

1. What Brucella species do not cause Brucellosis in humans?:

Brucella melitensis
Brucella abortusbovis
Brucella ovis
Brucella suis
Brucella canis

2. Note the correct answer regarding Brucella species:

coccobacill
diplococcal
gram-negative
intracellular aerobes
intracellular anaerobs

3. Note the correct answer regarding Brucellosis transmission:

transmission occurs through direct contact with animals, their carcasses or excreta, or by-products of abortion
infection may penetrate through damaged skin
can be directly transmitted from human to human
transmission occurs through ingestion of contaminated food products
transmission occurs through sexual contact

4. Note the correct answer regarding Brucellosis:

Brucellosis is a frequent entity in many industrialized nations
Symptoms of brucellosis are protean in nature, and none are specific enough to make the diagnosis
Brucella do not survive well in aerosols and do not resist drying
Brucellosis do not cause chronic forms
Standard culturing techniques require short incubation periods

5. Note the correct answer regarding clinical manifestation of Brucellosis:

Lung infection is very common
Congestive cardiac failure is characteristic for the young people
Fever (intermittent, undulant) can be associated with: chills, sweats and relative bradycardia
Neuropsychiatric symptoms consist of headache, depression, fatigue, emotional instability, irritability
Pain in the spine is an early and constant symptom, either in the neck or over the lumbar area

6. Note the correct answer regarding clinical manifestation of Brucellosis:

Orchitis and epididymitis are not characteristic
Urinary infections have no distinguishing features (pyelo- and glomerulonephritis may develop).
Cirrhosis is a frequent manifestation
Abdominal tenderness is associated with enlargement of the liver and/or the spleen.
Osteoarticular findings are characterized by tenderness, swelling over affected joints, bursitis, decreased range of motion

7. Note the correct answer regarding Brucellosis:

Osteoarticular, genitourinary, and hepatosplenic involvement are most common complications
Radiographic findings in patients with osteoarticular disease occur early in the course of illness
Radionuclide scintigraphy is not sensitive for detecting skeletal abnormalities
Monotherapeutic antimicrobial regimen is the mainstay of therapy
This disease is easily curable with antiviral treatment

8. Note the correct answer regarding treatment of Brucellosis

Multidrug antimicrobial regimens are the mainstay of therapy
Monotherapeutic approaches has a high relapse rates
Drugs displaying clinical activity against Brucella spp. are doxycycline, gentamicin, rifampin
Drugs displaying clinical activity against Brucella spp. are penicylline, erytromycine
Despite appropriately treated within the first months of onset, the infection has a very high risk of relapse or chronic disease.

1. Note the wrong answer regarding viral hepatitis

VHA is an DNA virus
VHB is an DNA virus
VHE is an RNA virus
VHD is an RNA virus
VHC is an RNA virus

2. Note the wrong answer regarding viral hepatitis

Major transmission of virus in VHA is by fecal-oral way
Major transmission of virus in VHB is by sexual or by parenteral way
Major transmission of virus in VHC is by parenteral way
Major transmission of virus in VHE is by parenteral way
Major transmission of virus in VHD is by sexual or by parenteral way

3. Note the correct answers regarding viral hepatitis

The chronicity rate in VHA is <10%
The chronicity rate in VHD superinfection is 100%
The chronicity rate in VHD coinfection is <10%
The chronicity rate in VHB is 50-70%
The chronicity rate in VHC is 50-70%

4. Note the correct answers regarding viral hepatitis

For VHA is usual to be fulminant
Serologic testing IgM anti-HAV is required to confirm a diagnosis of acute HAV infection
HAV RNA can be detected in the blood and stool of the majority of persons during the acute phase
Symptomatic HEV infection is most common in young adults aged 15-40 years
In general, viral hepatitis E lead to chronic form in 5-7% of cases

5. Note the correct answers regarding viral hepatitis

Hepatitis E is more severe among pregnant women, especially in third trimester
The cause of death in pregnant women in VHE are acute hepatic failure, haemorrhage, acute renal failure
Hepatitis E virus causes acute sporadic and epidemic viral hepatitis
Hepatitis C should be suspected in outbreaks of waterborne hepatitis
Acute hepatitis B is characterized by the simultaneous presence of HBsAg and anti-HBc IgG

6. Note the correct answers regarding viral hepatitis

Fulminate viral hepatitis A occurs frequently in pregnancy
Most outbreaks of VHD in developing countries have been associated with contaminated drinking water
After resolution, both total anti-HBc antibodies and anti-HBs antibodies are present
There is no chronic (long-term) infection in VHC
In chronic HBV carriers, total anti-HBc antibodies are present, whereas anti-HBs antibodies are absent

7. Note the correct answers regarding viral hepatitis

HCV does not integrate into host DNA like hepatitis B virus
Hepatitis A virus causes acute sporadic and epidemic viral hepatitis
In general, VHD-coinfection is a self-limiting viral infection followed by recovery
Occasionally (very rarely) a fulminant form of VHA develops
Hepatitis C should be suspected in outbreaks of waterborne hepatitis

8. Note the correct answers regarding viral hepatitis

The nucleotide sequence of HCV is highly variable, that accounts for resistance to antibodies
VHB contains a single-stranded genome of RNA
The pathogenesis of liver damage in VHC is due to a combination of direct cytopathic and of immune mediated mechanisms
In VHC infections are often inapparent or subclinical
Chronic infection does not occur in VHD

9. Note the correct answers regarding viral hepatitis

HBV is an extremely resistant strain capable of withstanding extreme temperatures and humidity
Appears that VHB-virus is not direct cytotoxic
HBV-DNA in hepatocyte may exist as an integrated (double-stranded, intranuclear) form or as an episomal (free) form.
The HBV carrier rate variation is 50-70% worldwide
Hepatocellular carcinoma is frequent in VHE hepatitis

10. Note the correct answers regarding viral hepatitis

Serum transaminases are elevated even before jaundice appear
HBsAg may be detected in incubation period
For VHE is characteristic the extrahepatic manifestations like arthritis or membranous glomerulonephritis
IgM anti-HBc appears late in the disease
HBsAg is borne by surface viral proteins

11. Note the correct answers regarding viral hepatitis

The prejaundice manifestation in VHA includes dyspeptic syndrome, arthralgic syndrome
HBeAg (E antigen) indicates HBV replication
HBsAb (antibody to surface antigen) indicates long term immunity
Pegylated interferon is used for the treatment of VHA and VHE hepatitis
The vaccines presently used for VHB immunization are composed of HBsAg

12. Note the correct answers regarding viral hepatitis

HBeAg (E antigen) correlates with high infectivity
Pegylated interferon is used for the treatment of VHC, VHB and VHD hepatitis
All newborns must be vaccinated for VHE
VHD consists of an RNA genome
The transmission of the Delta agent mirrors that of HEV

13. Note the wrong answer regarding viral hepatitis

All newborns must be vaccinated for VHB
The transmission of the Delta agent mirrors that of HBV
HDV has a direct cytopathic effect
HBsAb (antibody to surface antigen) may indicate chronic carrier status
The clinical expression of acute hepatitis D may range from mild to severe, fulminant hepatitis

14. Note the correct answers regarding viral hepatitis

HBeAg (E antigen) can be present in acute or chronic infection
HBsAg (surface antigen) may indicate chronic carrier status
IgM anti-HAV can persists for 6 months
VHE has a significant risk factors for carcinogenesis
HBV has a direct cytopathic effect

15. Note the wrong answer regarding viral hepatitis

Patients with cirrhosis must be checked every 3-6 months with alpha-fetoprotein measurements
HDV can be acquired either as a co-infection or as a superinfection
Hepatitis D does not increase the incidence of hepatocellular carcinoma over hepatitis B infection
Fulminant hepatic failure results from fibrotic change
Delta infection of a previously healthy carrier of VHB may induce an acute hepatitic picture

16. Note the wrong answer regarding viral hepatitis

Primary Delta infection in a HBsAg carrier is often severe
Hepatitis D does not increase the incidence of extrahepatic disease over hepatitis B infection
In fulminant hepatic failure the patient has an acute onset of severe mental changes
100% of superinfected with HDV carriers of HBV develop chronic infection
Hepatitis C should be suspected in outbreaks of waterborne hepatitis occurring in developing countries

17. Note the wrong answer regarding viral hepatitis

VHA in children is mostly asymptomatic or causes a very mild illness
Typical signs and symptoms of hepatitis include jaundice, anorexia, an enlarged, tender liver
VHA is more severe in pregnant women and cause death in 20% of cases
IgG anti-HAV can remains detectable for the person's lifetime
IgM anti-HEV appers early in the course of infection

18. Note the wrong answer regarding viral hepatitis

Symptomatic HAV infection is most common in young adults aged 15-40 years in endemic areas
HAV RNA can be detected in the blood and stool of the majority of persons during the acute phase of infection
Serologic testing to IgM anti-HBc is required to confirm a diagnosis of acute HBV infection
The usual clinical presentation of VHA is fever, malaise, anorexia, nausea, abdominal discomfort and jaundice
In VHA jaundice occurs in only a small proportion of young children, but a majority of adults

1. Name the correct answer regarding types of fever:

In continuous fever temperature remains above normal throughout the day and does not fluctuate more than 1°C in 24 hours
In remittent fever temperature remains above normal throughout the day and fluctuates more than 1°C in 24 hours
Intermittent fever is the fever with regular shift of normal and high temperature with deviations of 3- 4C
Recurrent fever is the fever with regular shift of high temperature, lasting for 2-4 hours, and normal temperature lasting also for 2-4 hours
Undulant fever is a long lasting fever with irregular temperature deviations

2. Name the correct answer regarding infectious definitions:

Communicable disease is an infectious disease that does not spreads from person to person.
Infectious disease is damage or alteration of host cells resulting from an infection
Infection is the ability of a microorganism to invade a suitable host, evade host defenses, to multiply and colonize host tissues.
Latent infection is an infection that is inactive though continuing to infect, and which remains capable of producing symptoms.
Systemic infection is an infection that is limited to a small area of the body

3. Name the wrong answer regarding infectious definitions:

Symptomatic infection is an infection by a microorganism which results in some sort of expression of lack of health (i.e., disease).
Asymptomatic infection is colonization of the body by a microorganism that does not cause symptoms.
Opportunistic infection is an infection by a microorganism that normally does not cause disease but becomes pathogenic when the body's immune system is impaired.
Contagious disease an infectious disease that very slow and seldom spreads from person to person
Nosocomial infections are infections which are a result of treatment in a hospital or a healthcare service unit, but secondary to the patient's original condition

4. Name the correct answer regarding desensitize fractional method