Micro-Para (Reviewer) Flashcards
- Carlo has leukemia; unfortunately, he was exposed to HBsAg positive blood. The best immediate management which can be given to him is to give:
a. recombinant Hep B
b. Vaccine passive immunization
c. anti-viral drugs
d. vitamins
b. Vaccine passive immunization
Rationale: In cases of exposure to HBsAg positive blood, the best immediate management is to provide passive immunization with hepatitis B immune globulin (HBIG) to provide immediate protection.
- Mario, a 45-year-old executive is a sickly guy. He always complains of coughs and colds. He used to be a smoker but he had stopped since he was in his early thirties. His doctor said that he is often attacked by organisms which attack/attach to the mucous membranes of his respiratory tract. These organisms then do which of the following actions against its host:
a. breakdown of IgA by producing proteases
b. evasion of phagocytosis by means of their capsule
c. excretion of hyaluronidase
d. neutralization of lysozymes
a. breakdown of IgA by producing proteases
Rationale: Many pathogens that infect the respiratory tract produce IgA proteases to break down IgA antibodies, facilitating their ability to infect mucous membranes.
- A child who is breastfed is not usually prone to diarrhea, this is probably because of:
a. the presence of hydrolytic enzymes in the saliva which kills most bacteria
b. the acidity of the stomach
c. presence of proteolytic enzymes and active macrophages in the small intestines
d. all of the above
d. all of the above
Rationale: Breastfeeding provides various protective factors including hydrolytic enzymes, the acidity of the stomach, and the presence of proteolytic enzymes and active macrophages in the intestines, which collectively help prevent diarrhea.
- Luna was diagnosed to have a starting skin cancer, which somehow spontaneously resolved. Aside from a possible miracle, the doctor said it could be due to Luna’s natural killer cells. Which is NOT a characteristic of natural killer (NK) cells?
a. morphologically related to T cells
b. they can lyse malignant cells
c. they resemble large granular lymphocytes
d. all of the above
d. all of the above
Rationale: NK cells are morphologically related to T cells, can lyse malignant cells, and resemble large granular lymphocytes.
- Martin suffers from a runny nose, itchy eyes, and frequent sneezing especially during the months of March to May and November to January. He probably has:
a. Type I hypersensitivity
b. Type II hypersensitivity
c. Type III hypersensitivity
d. Type IV hypersensitivity
a. Type I hypersensitivity
Rationale: The symptoms of runny nose, itchy eyes, and frequent sneezing, especially during specific seasons, are indicative of Type I hypersensitivity, commonly associated with allergies like hay fever.
- Vivian was rushed to the hospital for shortness of breath. She gave a history of taking penicillin for her sore throat two days prior to admission. She gave no history of allergy to penicillin. Laboratory tests done on her blood showed the presence of antibodies which hemolyze her own RBCs. She is probably suffering from:
a. Type I hypersensitivity
b. Type II hypersensitivity
c. Type III hypersensitivity
d. Type IV hypersensitivity
b. Type II hypersensitivity
Rationale: The presence of antibodies that hemolyze RBCs after penicillin administration suggests a Type II hypersensitivity reaction, where antibodies target and destroy the body’s own cells.
- Athena was born December 2004. She has an older brother Bitoy who got sick with chickenpox when Athena was one month old. Ikay, another older sister of Athena, got sick with chickenpox while she did not. This is because of:
a. Maternal IgA
b. Athena’s IgA
c. Maternal IgG
d. Athena’s IgG
c. Maternal IgG
Rationale: Maternal IgG antibodies are transferred to the infant through the placenta and provide immunity to the baby in the first few months of life, protecting Athena from chickenpox.
- Isabel becomes a different person during the months of December. In these months, she is grouchy because of hay fever. Her doctor explained that she is allergic to pollen and the major culprit is the so-called IgE, which is a homocytotropic immunoglobulin that binds to all of the following cells below except:
a. eosinophils
b. mast cells
c. basophils
d. neutrophils
d. neutrophils
Rationale: IgE binds to eosinophils, mast cells, and basophils but not to neutrophils.
- Betty has colds almost every three months. But she is not bothered because she noticed that even without treatment she gets better. The self-limiting nature of her colds, which is often of viral etiology, is partly attributed to:
a. Gamma interferon
b. Alpha interferon
c. Beta interferon
d. All choices are correct except A
d. All choices are correct except A
Rationale: Alpha and beta interferons play roles in antiviral responses, helping to limit the duration and severity of viral infections such as the common cold.
- Mike was sick with pneumonia, for which he almost died. Before his discharge from the hospital, he asked the doctor to explain to him his illness and how he was able to recover. The doctor talked about the germs having slimy materials around them. That it was necessary for some substance to coat the germs so that the scavenger’s cells in the body can eat them up. The doctor was referring to opsonization. Which of the following substances is involved in opsonization?
a. C3a
b. C3b
c. C2a
d. C2b
b. C3b
Rationale: C3b is involved in opsonization, coating pathogens to enhance their recognition and ingestion by phagocytes.
- A 7-year-old girl was brought to the dermatology section of UPHR Medical Center for swollen, weeping earlobes with some signs of crusting. One earlobe has an almost embedded tiny earring. The doctor said the girl was probably allergic to the nickel component of the fancy earrings. This condition is also termed as:
a. Contact hypersensitivity
b. Tuberculin hypersensitivity
c. Atopic hypersensitivity
d. Immune complex hypersensitivity
a. Contact hypersensitivity
Rationale: Contact hypersensitivity, also known as contact dermatitis, is an allergic reaction caused by direct contact with an allergen such as nickel in earrings.
- Nonong was an OFW from Puerto Rico. He came home because he was diagnosed with syphilis. He consulted a local doctor for a second opinion. The doctor scrapped off the base of the ulcer found in his buccal mucosa. He explained to Nonong that he will add to the specimen a substance which he called antibody to which will be attached a certain dye which will emit light under a “dark microscope.” This immunologic diagnostic test is probably:
a. Immunoblotting
b. Immunofluorescence
c. ELISA
d. Radioimmunoassay
b. Immunofluorescence
Rationale: Immunofluorescence involves using antibodies tagged with a fluorescent dye to detect the presence of specific antigens under a microscope.
- Jake had typhoid fever. When seen by the doctor he has already been on the third week and had started to feel better. If you can enter Jake’s body which of the following items below would show that he had achieved an adaptive immune response against typhoid bacilli?
a. physical barriers
b. chemical barriers
c. clonal expansion of effector cells
d. phagocytosis
c. clonal expansion of effector cells
Rationale: Clonal expansion of effector cells indicates an adaptive immune response, where specific immune cells proliferate in response to an antigen.
- Doy was diagnosed to have an infectious disease of unknown etiology. Examination of his blood showed that the complement levels are normal. In infections, one defense against the agent is the activation of the complement. What then among the items below is the best trigger for the of complement activation?
a. IgG
b. Mannose-containing bacterial glycolipids
c. Microbial surfaces
d. IgM-antigen immune complexes
d. IgM-antigen immune complexes
Rationale: IgM-antigen immune complexes are potent activators of the complement system, initiating the classical pathway of complement activation.
- A 13-year-boy from Ilocos tested negative in the lepromin test. He presents with multiple, erythematous, anesthetic lesions all over the body. The skin test shows which type of hypersensitivity:
a. Type I Hypersensitivity
b. Type II hypersensitivity
c. Type III hypersensitivity
d. Type IV hypersensitivity
d. Type IV hypersensitivity
Rationale: The lepromin test and the presentation of multiple erythematous, anesthetic lesions indicate a Type IV hypersensitivity reaction, which is a delayed-type hypersensitivity.
- Roy was found to have antibodies to AIDS by the ELISA method. To confirm the diagnosis, antigens of the virus must be detected in his blood. Which of the following methods will identify the HIV antigen mix in a complex mixture of proteins:
a. Western blotting
b. Southern blotting
c. Eastern blotting
d. Northern blotting
a. Western blotting
Rationale: Western blotting is used to detect specific proteins, such as HIV antigens, in a complex mixture.
- The human vaccine for this viral infection is made of killed virus grown in human diploid fibroblasts or chicken fibroblasts:
a. Rubella
b. Rabies
c. Jap B encephalitis
b. Rabies
Rationale: The human rabies vaccine is made from killed virus grown in human diploid fibroblasts or chicken fibroblasts.
- Luisa is an absent-minded medical intern. She was asked by the resident to get some influenza vaccines from the refrigerator in the call room and to bring them to the OPD for immunization of the old nurses in the section. Luisa followed the instructions. Unfortunately, she did not find the resident so she placed the vaccine on the table with a short note. After 2-4 hours, the resident came and found the vaccines. Influenza is a killed viral vaccine; all of the following are its disadvantages EXCEPT:
a. high stability at room temperature
b. shorter duration of immunity
c. poor CMI produced
d. no IgA produced
a. high stability at room temperature
Rationale: Killed viral vaccines like the influenza vaccine are less stable at room temperature compared to live vaccines, making high stability an incorrect disadvantage.
- Allan was bitten by his dog in the lower leg. The wound is not deep but it bled. In the decision to give postexposure prophylaxis the following are considered except which of the following:
a. manner of attack
b. nature of biting animal
c. severity of the bite
d. none of the choices
d. none of the choices
Rationale: When deciding whether to administer post-exposure prophylaxis (PEP) for rabies after a dog bite, several factors are considered, including:
- Manner of attack: This can indicate whether the dog was provoked or behaving aggressively without provocation, which may suggest a higher risk of rabies.
- Nature of biting animal: Understanding whether the animal is a domestic pet, stray, or wild animal helps assess the likelihood of rabies.
- Severity of the bite: The depth and extent of the bite wound can influence the risk of rabies transmission and the need for PEP.
- Laura was in her 2nd month of pregnancy when she tested positive for Rubella antibodies. Despite this, she decided to continue with the pregnancy. She delivered the baby 4 weeks earlier than the expected date. At a glance, the baby seemed normal. She asked her doctor what could be the possible effect if her baby got congenital rubella. Which of the following could explain any abnormality that may be later seen in Laura’s baby?
a. infected cells in the baby have a reduced growth rate
b. hypoplastic organs result in abnormalities in the embryonic cells which have a reduced growth rate
c. structural anomalies due to hypoplastic organs
d. all of the above
d. all of the above
Rationale: Congenital rubella syndrome (CRS) can result in various abnormalities and complications for the baby due to the teratogenic effects of the rubella virus on the developing fetus. The effects can include:
- Infected cells in the baby have a reduced growth rate: Rubella virus infection in utero can lead to reduced cell growth and proliferation, affecting overall fetal development.
- Hypoplastic organs result in abnormalities in the embryonic cells which have a reduced growth rate: The virus can cause hypoplasia (underdevelopment) of organs, leading to structural anomalies and reduced function.
- Structural anomalies due to hypoplastic organs: The developmental abnormalities can manifest as structural defects in the heart, eyes, ears, and other organs, which are typical manifestations of CRS.
- A baby born with congenital rubella was found to be deaf. Defects in rubella are grouped into broad categories, i.e., temporary, developmental, permanent. Deafness is under:
a. temporary
b. developmental
c. permanent
d. none of the choices
c. permanent
Rationale: Deafness resulting from congenital rubella is a permanent defect, as it causes lasting damage to the auditory system.
- Ana is getting married and thus was advised to get her Rubella vaccine shot. Which of the following is/are true of the rubella vaccine?
a. it is a live attenuated vaccine
b. it is given to prevent congenital rubella infection
c. vaccinated children pose no threat to mothers who are susceptible and pregnant
d. all of the above
d. all of the above
Rationale: The rubella vaccine is a live attenuated vaccine, it is given to prevent congenital rubella infection, and vaccinated children do not pose a threat to susceptible and pregnant mothers.
- Jay, a 9-month-old baby, is rushed to the ER for fever and persistent cough. On examination, rales are heard on his left chest and an infiltrate in the left lung is seen on the chest x-ray film. The diagnosis given is pneumonia. Which of the following viruses is the most likely cause?
a. Rhinovirus
b. Respiratory syncytial virus
c. Adenovirus
b. Respiratory syncytial virus
Rationale: Respiratory syncytial virus (RSV) is a common cause of pneumonia in infants and young children.
- In this viral infection, humans are dead-end hosts, thus virus shedding does not occur.
a. measles
b. Rabies
c. influenza
d. chickenpox
b. Rabies
Rationale: In rabies, humans are dead-end hosts, meaning the virus is not shed from an infected person and cannot be transmitted to others.
- A ten-year-old girl complained of difficulty and pain in swallowing. It was accompanied by a runny nose and fever. Upon examination, rales are heard on his left chest and an infiltrate in the left lung is seen on the chest x-ray film. The diagnosis given is upper respiratory infection. The most likely etiologic agent for this case is:
a. adenovirus
b. Respiratory syncytial virus
c. Rhinovirus
d. Coronavirus
a. adenovirus
Rationale: Adenovirus is a common cause of respiratory infections in children and can present with a variety of symptoms including fever, sore throat (pharyngitis), runny nose, and lower respiratory tract involvement (pneumonia), which can be seen as infiltrates on a chest x-ray. Adenoviruses can also cause more severe respiratory infections, especially in children, leading to symptoms that align well with the given case.
Clue words: “difficulty and pain in swallowing,” “runny nose,” “fever,” “rales,” “infiltrate in the left lung,” “upper respiratory infection,” “adenovirus”
- Ramon, a 4-year-old boy, was seen by a pediatrician for complaints of low-grade fever, cold, and rash on the face which showed a typical “slapped cheek” appearance. Complaints of flu-like symptoms such as malaise and myalgias were also noted. The pediatrician gave a diagnosis of erythema infectiosum of the fifth disease which is caused by which of the following viruses:
a. Hanta virus
b. B19 parvovirus
c. Herpes simplex
d. Coxsackie viruses
b. B19 parvovirus
Rationale: Erythema infectiosum, or fifth disease, is caused by B19 parvovirus and is characterized by a “slapped cheek” appearance and flu-like symptoms.
- Last summer, a community hospital in Laguna, recorded 25 cases of pharyngoconjunctivitis among the grade five students from a private school in the nearby municipality. It was learned that all of them attended a summer camp, which lasted for 2 weeks. Which of the following adenovirus serotypes are most likely involved?
a. types 3 and 7
b. types 1 and 70
c. types 40 and 45
d. types 8 and 10
a. types 3 and 7
Rationale: Adenovirus types 3 and 7 are commonly associated with pharyngoconjunctivitis outbreaks.
- A 2 ½-year-old boy was noticed by his mother to have less appetite for solid food, but when given ice cream and soft drinks he was quite happy. This was unusual because he likes to eat and play with solid foods. The mother examined him and found that he has some swollen nodules in his neck. Suspecting something in the mouth, she examined the mouth and found vesicular lesions in the buccal mucosa. This is probably caused by:
a. Candida albicans
b. Streptococcus pyogenes
c. Measles virus
d. Herpes simplex virus
d. Herpes simplex virus
Rationale: Herpes simplex virus can cause vesicular lesions in the buccal mucosa, leading to reduced appetite for solid foods.
- Yoyong, a 15-year-old boy acquired chickenpox. When vesicular lesions became evident, he was “isolated” by his mother from the rest of the family by confining him to his room. After a week, his pocks subsided with some lesions already developing scabs. It was at this time that two other siblings started showing the same signs and symptoms he had. Which of the following items below best describes the disease/etiologic agent involved in Yoyong’s case?
a. the virus infects only humans
b. the disease is highly contagious
c. both are correct
d. neither one is correct
c. both are correct
Rationale: Chickenpox (varicella) virus infects only humans and the disease is highly contagious, explaining the spread to Yoyong’s siblings.
- Idang is due two deliver in two weeks’ time. Unfortunately, she had premature labor and delivered a stillborn baby boy. The baby was autopsied and the one finding was the presence of cells that look like “owls eye,” i.e. cells with large intranuclear inclusion bodies. The most probable diagnosis is:
a. Congenital measles
b. Congenital rubella
c. Congenital chickenpox
d. congenital cytomegalovirus infection
d. congenital cytomegalovirus infection
Rationale: The presence of cells with “owl’s eye” inclusions is characteristic of congenital cytomegalovirus infection.
- JR, a macho dancer from the red district, did not report for work for almost three days. RJ, his friend, became worried and went to his place. He found JR with fever, headache, and feels weak and tired. They went to the clinic and was found to have enlarged lymph nodes and spleen and slightly icteric conjunctiva. Blood exam showed large, atypical lymphocytes. The most probable diagnosis is:
a. Cytomegalovirus infectious mononucleosis
b. Infectious mononucleosis
c. Herpes simplex infection
d. Mumps
b. Infectious mononucleosis
Rationale: Infectious mononucleosis, commonly caused by the Epstein-Barr virus (EBV), is characterized by fever, headache, fatigue, enlarged lymph nodes, spleen, icteric conjunctiva, and atypical lymphocytes.
- A 28-year-old woman has recurrent genital herpes. Which of the following about genital herpes infection is true?
a. cannot be transmitted in the absence of apparent lesions
b. reactivation of latent virus during pregnancy poses no threat to the newborn
c. can be caused by either herpes simplex type 1 or type 2
d. recurrent episodes are more severe than the primary infection
c. can be caused by either herpes simplex type 1 or type 2
Rationale: Genital herpes can be caused by either herpes simplex virus type 1 (HSV-1) or type 2 (HSV-2).
- MR consulted a dermatologist for the small, pink, wart-like lesions on her face, arms, back, and buttocks. The diagnosis given was molluscum contagiosum infection. Which of the following about this is NOT true?
a. virus has a wide range of host
b. transmission is by direct and indirect contact
c. it is considered a sexually transmitted disease
d. the virus has a DNA genome
a. virus has a wide range of host
Rationale: Molluscum contagiosum virus is specific to humans, hence it does not have a wide range of hosts.
- Motong is a leukemia patient. He was admitted for post-transfusion hepatitis. Test showed the etiologic agent to be flavivirus. This virus is:
a. Hepatitis A
b. Hepatitis B
c. Hepatitis C
d. Hepatitis E
c. Hepatitis C
Rationale: Hepatitis C virus (HCV), a flavivirus, is commonly associated with post-transfusion hepatitis.
- Ferdie was diagnosed as a carrier of Hepatitis B. In one of his follow-ups in the clinic, anti-HBe antibodies were detected in his serum. This means that:
a. he is now developing resistance
b. his HB virus titer is now low
c. it has no meaning
d. a mistake was committed because HBs Ag and anti-HBe do not exist together in the blood
b. his HB virus titer is now low
Rationale: The presence of anti-HBe antibodies suggests a lower viral replication and a decrease in the infectiousness of Hepatitis B.
- Lola, a middle-aged woman, complained of acute onset fever, and nausea. Her eyes were “yellow” and she was surprised to see her urine to be dark colored. She consulted a private clinic and the laboratory test done on her blood was positive for HAV IgM antibody. What will you tell Lola if you are the physician?
a. That she acquired the disease through sexual contact
b. that probably it was transmitted to her when she had a blood transfusion
c. to be very careful, because she can transmit the infection to other members of her family by person-to-person spread
d. that she might develop liver carcinoma in the future
c. to be very careful, because she can transmit the infection to other members of her family by person-to-person spread
Rationale: Hepatitis A virus (HAV) is typically transmitted via the fecal-oral route, making person-to-person spread within a household common.
- A young executive from Makati was hospitalized for myopericarditis with mild congestive heart failure that increases over several weeks. The attending physician gave a diagnosis of Coxsackie B5 infection. Other than his conditions what other syndrome/s is/are associated with this virus?
a. herpangina
b. aseptic meningitis
c. acute hemorrhagic conjunctivitis
d. all of the above
d. all of the above
Rationale: Coxsackie B virus can cause herpangina, aseptic meningitis, and acute hemorrhagic conjunctivitis, in addition to myopericarditis.
- After getting his first salary, Bitoy went to the seaside restaurant and feasted on seafood, particularly raw oyster with his favorite beer. After 24 hours, he became ill with sudden onset of vomiting, diarrhea and headache. He consulted a private clinic and the physician, after a thorough examination, ruled out a bacterial etiology. To him, the most probable viral etiologic agent is:
a. Astrovirus
b. Norwalk virus
c. Rotavirus
d. Hepatitis A virus
b. Norwalk virus
Rationale: Norwalk virus (norovirus) is a common cause of gastroenteritis associated with the consumption of contaminated seafood, leading to symptoms like vomiting, diarrhea, and headache.
- A 45-year-old woman from a ranch in Mindanao, complained of fever, malaise, and sore throat, followed by nausea, vomiting and then sudden stupor. She was diagnosed to be suffering from eastern equine encephalitis. The control of this disease in humans could be accomplished by eradication/control of:
a. ticks
b. birds
c. mosquitoes
d. sandflies
c. mosquitoes
Rationale: Eastern equine encephalitis virus is transmitted by mosquitoes, so controlling mosquito populations can help prevent the disease.
- DJ went to Boracay last summer. He had a good tan except on some portion of his neck down to his upper back which showed minimal scaling. After a week, the tan portion of his skin started to peel. To his surprise, the “untanned” portion of his skin seemed to have become bigger. His skin started to return to its normal color but the “untanned” portion seemed to stand out this time looking more whitish than his normal light brown skin. The most likely diagnosis is:
a. Leprosy
b. superficial mycoses
c. avitaminosis
b. superficial mycoses
Rationale: The description suggests a superficial fungal infection, such as tinea versicolor, which can cause hypopigmented patches on the skin.
DJ consulted a dermatologist for the whitish discoloration which showed after his Boracay escapade. The doctor made a KOH mount of the skin scrapings and found, short, stout, angular hyphal elements. The skin lesions also fluoresce under the Wood’s lamp. The most likely etiologic agent is:
a. Tinea corporis
b. Pityriasis versicolor
c. White piedra
d. candidiasis
b. Pityriasis versicolor
Rationale: Pityriasis versicolor, caused by Malassezia species, presents with short, stout, angular hyphal elements and fluoresces under Wood’s lamp.
Clue words: “whitish discoloration,” “KOH mount,” “short, stout, angular hyphal elements,” “fluoresce under the Wood’s lamp”
Melanie is a cook in a small restaurant responsible for the barbecue stand. Later, because of arthritis, she was reassigned to the counter as the one taking the orders. She noticed that her left hand still showed the blackish discoloration caused by handling charcoal. She had not noticed it before because after cooking, she does not wash her hand often because of fear of “pasma”. This time she used alcohol to clean the discoloration, but to her surprise, it had no effect on the “dirt”. After trying to remove it to no avail for a week, she decided to consult a doctor. The diagnosis given was tinea nigra. The etiologic agent of this is:
a. Hortaea werneckii
b. Cladosporium spp.
c. Trichophyton spp.
d. Exophiala hortai
a. Hortaea werneckii
Rationale: Tinea nigra is caused by Hortaea werneckii, leading to blackish discoloration on the skin that cannot be removed by washing or alcohol.
Clue words: “blackish discoloration,” “tinea nigra,” “Hortaea werneckii”
A group of “street oldies” was taken to the DSWD. They were given a bath, fresh clothes, and something to eat. A medical team was also present who did some quickie check-ups on them. One man became the center of attraction of the doctors and interns because of the presence of soft, yellowish nodules on the hair of his axilla and beard. The interns thought of them as the eggs and nits of lice. They were, however, proven wrong after they had squeezed some of it. The most likely diagnosis for this is:
a. Black piedra
b. Trichophyton hair infection
c. White piedra
d. Excess soap suds
c. White piedra
Rationale: White piedra, caused by Trichosporon species, presents with soft, yellowish nodules on hair.
Clue words: “soft, yellowish nodules,” “hair of his axilla and beard,” “eggs and nits of lice”
Vic plays basketball almost every day after school for the last 6 weeks until the vesicular lesions in his both feet, particularly in the toe webs, became ulcerative and painful. Also, he gets embarrassed in the shower room because his feet smell. The obvious diagnosis is athlete’s foot. Three of the following dermatophytes below are common etiologic agents of athlete’s foot except:
a. T.mentagrophytes
b. T. rubrum
c. E. flocossum
d. M. canis
d. M. canis
Rationale: M. canis typically causes infections in animals and is less common in athlete’s foot, which is usually caused by T. rubrum, T. mentagrophytes, and E. floccosum.
Clue words: “vesicular lesions,” “toe webs,” “athlete’s foot”
RC, a 40-year-old farmer consulted a dermatologist for the multiple sinuses in his left arm that seem to follow a line. According to him, it started as small wounds caused by rose thorns when he was pruning the ground roses. The discharge from the sinuses showed oval budding cells that are variable in shape but often fusiform. The discharge was cultured in SAB. Growth in SAB yielded septate hyphae with small conidia clustered at the tip of conidiophores, appearing like daisies with a stem. The most likely identification of this organism is:
a. Trichophyton mentagrophytes
b. Phialophora species
c. Sporothrix schenckii
d. Cladosporium carrionii
c. Sporothrix schenckii
Rationale: Sporothrix schenckii causes sporotrichosis, presenting with linear lesions and characteristic conidia growth that resembles daisies.
Clue words: “multiple sinuses,” “rose thorns,” “septate hyphae,” “daisies with a stem”
A farmer from Laguna consulted the district hospital for his “big foot” with draining sinuses. He has been with it for almost three years now. He was forced to see a doctor because he could no longer do his job in the farm. The doctor noted that black granules are coming out of the sinuses. The most probable diagnosis is:
a. sporotrichosis
b. mycetoma
c. elephantiasis
d. chromoblastomycosis
b. mycetoma
Rationale: Mycetoma is characterized by chronic infection with draining sinuses that produce black granules.
Clue words: “big foot,” “draining sinuses,” “black granules”
The black granules coming out of the sinuses in the “big foot” of a farmer are hard and showed intertwined septate hyphae. Which of the following is the most likely etiologic agent?
a. Madurella grisea
b. Actinomyces
c. Nocardia spp.
d. Trichophyton rubrum
a. Madurella grisea
Rationale: Madurella grisea is a common cause of mycetoma, characterized by hard black granules and septate hyphae.
Clue words: “black granules,” “intertwined septate hyphae,” “big foot”
Jojo, a Filipino migrant in California, came home for a two-month vacation. He thought he could relax, but on his second week in the Philippines, he had no choice but to seek medical help for a small draining sinus on his left chest at the level of the axilla. Other symptoms were cough and fever. Examination of the discharge using 10% KOH showed sac-like structures with spore-like structures inside. The most likely diagnosis is:
a. Histoplasmosis
b. Coccidioidomycosis
c. Blastomycosis
d. Tuberculosis
b. Coccidioidomycosis
Rationale: Coccidioidomycosis (Valley Fever) can present with draining sinuses and is identified by sac-like structures with endospores in tissue samples.
Clue words: “small draining sinus,” “sac-like structures with spore-like structures,” “cough and fever”
An elderly woman with pneumonia developed bloody diarrhea on the 7th hospital day, accompanied by abdominal cramps and fever. The doctors got worried because her fever caused by pneumonia had lysed as early as her 3rd hospital day. She was immediately placed in the ICU, and all antibiotics were stopped. She has been on ampicillin for 5 days prior to admission and on admission was started with clindamycin and augmentin. Her condition is probably caused by:
a. Enterohemorrhagic Escherichia coli
b. Shigella dysenteriae
c. Clostridium difficile
d. Vibrio parahemolyticus
c. Clostridium difficile
Rationale: Clostridium difficile infection is commonly associated with antibiotic use and presents with bloody diarrhea, abdominal cramps, and fever.
Clue words: “bloody diarrhea,” “antibiotics,” “pneumonia”
Severino had an accident that resulted in the amputation of his right leg, two inches above the knee. About five days post-op, signs of wound infection were evident. Local wound care was given, and the exudate was sent to the lab. The doctors were willing to wait for the lab results before changing antibiotics. After two days, the culture came with no organism isolated from the specimen as reported. They suspected anaerobic infection. Anaerobic infection is usually suspected when:
a. there is the presence of a foul smell
b. the site of infection is near a mucosal surface
c. there is gas in tissues
d. all of the above
d. all of the above
Rationale: Anaerobic infections are characterized by a foul smell, proximity to mucosal surfaces, and the presence of gas in tissues.
Clue words: “wound infection,” “no organism isolated,” “anaerobic infection”
George was rushed to the hospital for fever and pain in the right lower abdomen. Rectal exam was compatible with the diagnosis of appendicitis. He was again rushed to the operating table because of unstable vital signs. On opening up, he was found to have a ruptured appendicitis with abscess formation around it. The exudates later yielded Bacteroides fragilis. Which of the following factors promotes abscess formation by B. fragilis?
a. capsule
b. lipopolysaccharide
c. pili
d. superoxide dismutase
a. capsule
Rationale: The capsule of Bacteroides fragilis is a significant virulence factor that promotes abscess formation by evading the immune response and facilitating adherence.
Clue words: “ruptured appendicitis,” “abscess formation,” “Bacteroides fragilis”
GC, a 20-year-old girl working in the call center, consulted a gynecologist because of whitish-gray vaginal discharge with a bad odor of about a week duration. Previous to it, she had several sexual relationships with her boyfriend of two months. With her condition, she felt guilty and decided to lead a clean life as soon as she gets well. The doctor got some fluid from the vaginal canal, placed some on the slide, and some she tested for pH which was 5.5 against the normal value of 4.5. Wet mount showed many epithelial cells which appear granular. No PMN was noted. Which of the following is the most likely diagnosis?
a. Trichomonas vaginalis
b. Yeast vaginitis
c. Gonorrhea
d. Bacterial vaginosis
d. Bacterial vaginosis
Rationale: Bacterial vaginosis presents with a whitish-gray discharge, a higher pH, and clue cells (granular epithelial cells) without PMNs.
Clue words: “whitish-gray vaginal discharge,” “pH 5.5,” “granular epithelial cells”
A 67-year-old man was taken to the ER for difficulty in breathing. He has been feeling weak since 4 days ago. He has a chronic cigarette cough since he was in his 40s but did not bother to see a doctor for his complaints until his son noticed that he looked worst. On physical examination, inspiratory and expiratory wheezes and rales were noted over the right lower lung. His chest x-ray further revealed patchy lower right lung infiltrates. The differential diagnosis for this patient is:
a. Streptococcus pneumoniae
b. Legionella pneumophila
c. Mycoplasma pneumoniae
d. all of the above
d. all of the above
Rationale: The differential diagnosis for pneumonia in a chronic smoker with these symptoms includes Streptococcus pneumoniae, Legionella pneumophila, and Mycoplasma pneumoniae.
Clue words: “difficulty in breathing,” “chronic cigarette cough,” “patchy lower right lung infiltrates”
Joe was diagnosed with lung cancer and in his bronchial washing acid-fast bacilli were seen mixed with the cancer cells. Joe had been given the full short course of the TB regimen before and so the doctor suspected a drug-resistant strain. The bronchial washing was cultured, and it grew orange-colored colonies when exposed to light. The most probable etiologic agent is:
a. Mycobacterium tuberculosis
b. Mycobacterium smegmatis
c. Mycobacterium kansasii
d. Mycobacterium avium complex
c. Mycobacterium kansasii
Rationale: Mycobacterium kansasii produces orange colonies when exposed to light and can cause pulmonary infections.
Clue words: “lung cancer,” “acid-fast bacilli,” “orange-colored colonies”
- You are giving lectures to TB patients about the characteristics of Mycobacterium tuberculosis. This is to convince them that they should cover their mouths when coughing and avoid spitting in the environment. Which of the following characteristics should NOT be emphasized to them?
a. The organism is grown in complex media
b. The organism is resistant to drying and survives for long periods in dried sputum
c. The organism is resistant to acid and alkali
d. The organism is found in the droplet nuclei discharged by the infected person.
a. The organism is grown in complex media
Rationale: Mycobacterium tuberculosis is grown in specialized media, not complex media, and this is less relevant to patient behavior compared to the other characteristics.
Clue words: “lectures to TB patients,” “Mycobacterium tuberculosis”
- A visiting media team conducted the “search for the child with primary complex” in an elementary school in Tanay. After a thorough physical examination, the children in two grade one sections were skin tested using tuberculin at a dose of 5TU. Which of the following statements on PPD is correct?
a. The tuberculin skin test becomes positive within 4-6 weeks after primary infection.
b. Immunization with BCG will result in a positive PPD that may last for 3-7 years.
c. Persons who had been PPD positives before but are healthy may fail to give a positive PPD test when tested again.
d. All of the above are correct.
d. All of the above are correct.
Rationale: All the listed statements about the PPD (tuberculin skin test) are correct: it becomes positive within 4-6 weeks after infection, BCG immunization can cause a positive PPD, and previous positives may not always test positive again.
Clue words: “tuberculin skin test,” “PPD”
- About fifty percent of the grade one students from Barrio Tubibi were found to have primary tuberculosis. Which of the following features of tuberculosis is most correct?
a. Characterized by acute exudative lesions that rapidly spread to the lymphatics and regional lymph nodes
b. All organisms are killed by the immune response that develops during primary infection
c. It is often accompanied by severe pulmonary edema
d. Caseous materials streaked with blood are often seen in expectorated sputum
a. Characterized by acute exudative lesions that rapidly spread to the lymphatics and regional lymph nodes
Rationale: Primary tuberculosis is characterized by acute exudative lesions and spread to lymph nodes.
Clue words: “primary tuberculosis,” “acute exudative lesions”
- Paul, a 33-year-old lawyer from Ilocos, was seen in the OPD with a maculopapular rash over his trunk but not in his mouth or on his palms. He is a bachelor and travels around the Philippines a lot. The attending doctor’s impression was secondary syphilis. He ordered an RPR test to be done, which turned out to be reactive. Paul was advised to send his serum to a diagnostic test for TPHA or FTA-ABS test, which later turned out to be positive. Which of the following diseases can be ruled out?
a. Atypical measles
b. Secondary syphilis
c. Coxsackie virus infection
d. German measles
b. Secondary syphilis
Rationale: The positive RPR and TPHA/FTA-ABS tests confirm secondary syphilis, ruling out other conditions.
Clue words: “maculopapular rash,” “RPR test,” “TPHA or FTA-ABS”
- You Ming, a 14-year-old exchange student from China, joined the annual Boy Scout camping. They stayed in the province for two weeks. On their second week, You Ming, together with some boys, went to the forest and came back with many insect bites. You was so afraid because they even extracted a fat-bellied tick from his right leg. At the end of the two weeks, he noticed the tick bite to be reddish but flat. It grew bigger every day, with clearing of the central area. With the expansion of the lesion came fever, chills, myalgias, and headache. At this point, his guardian brought him to the hospital. The most likely diagnosis is:
a. Leptospirosis
b. Lyme disease
c. Scrub typhus
d. Rat-bite fever
b. Lyme disease
Rationale: The description of the expanding rash with central clearing (erythema migrans) and systemic symptoms is characteristic of Lyme disease, caused by tick bites.
Clue words: “tick bite,” “reddish but flat,” “clearing of the central area,” “fever, chills, myalgias”
- An MMDA traffic enforcer was admitted to the hospital for the sudden onset of high fever (39C), headache, and pain in his calf muscles. On admission, his blood tests showed increased PMN, abnormal liver and renal function tests. On physical examination, he also had subconjunctival hemorrhage. He also had a history of wading in the floodwaters of Tondo, about 10 days prior to the illness. The diagnosis of the attending medical intern was leptospirosis. Which of the following would be most likely to confirm the diagnosis?
a. Test acute and convalescent sera using the RPR
b. Culture the blood on Thayer Martin agar
c. Test acute and convalescent serum for antileptospiral antibodies
d. Do a dark-field examination of serum and urine for leptospires
c. Test acute and convalescent serum for antileptospiral antibodies
Rationale: Confirming leptospirosis involves testing for antileptospiral antibodies in acute and convalescent serum samples.
Clue words: “sudden onset of high fever,” “pain in his calf muscles,” “subconjunctival hemorrhage,” “wading in the floodwaters”
- A 31-year-old female from Southern Mindanao is brought in for chronic diarrhea of two months’ duration. Stool examination reveals larvae with a prominent genital primordium. What is your probable diagnosis?
a. Capillariasis
b. Hookworm infection
c. Strongyloidiasis
d. Ascariasis
c. Strongyloidiasis
Rationale: The presence of larvae with a prominent genital primordium is characteristic of Strongyloides stercoralis, which causes strongyloidiasis.
Clue words: “chronic diarrhea,” “larvae,” “prominent genital primordium”
- A 10-year-old girl with perianal pruritus was brought by her mother to her pediatrician. What is your most probable diagnosis?
a. Ascariasis
b. Trichuriasis
c. Enterobiasis
d. Hookworm infection
c. Enterobiasis
Rationale: Enterobiasis (pinworm infection) is the most common cause of perianal pruritus in children.
Clue words: “perianal pruritus,” “10-year-old girl”
- A 10-year-old girl with perianal pruritus was brought by her mother to her pediatrician. Based on your probable diagnosis, what diagnostic procedure will you request to support your diagnosis?
a. Stool concentration technique
b. Direct fecal smear
c. Harada-Mori stool culture
d. Cellulose tape swab
d. Cellulose tape swab
Rationale: The cellulose tape swab (scotch tape test) is used to diagnose Enterobiasis by capturing the eggs of Enterobius vermicularis.
Clue words: “perianal pruritus,” “diagnostic procedure”
- A 15-year-old boy from Davao del Norte is noted to have pallor and malnutrition. Stool examination reveals an ovum with a thin colorless cell wall. What is your diagnosis?
a. Ascariasis
b. Trichuriasis
c. Enterobiasis
d. Hookworm infection
d. Hookworm infection
Rationale: Hookworm infection leads to iron deficiency anemia (pallor) and malnutrition. The ova of hookworms have a thin, colorless cell wall.
Clue words: “pallor,” “malnutrition,” “ovum with a thin colorless cell wall”
- A 15-year-old boy from Davao del Norte is noted to have pallor and malnutrition. Stool examination reveals an ovum with a thin colorless cell wall. The probable diagnosis is hookworm infection. Name the portal of entry of this worm.
a. Oral ingestion
b. Inhalation
c. Skin penetration
d. Mosquito bite
c. Skin penetration
Rationale: Hookworm larvae penetrate the skin to enter the human body.
Clue words: “hookworm infection,” “portal of entry”
- Ova with flat bi-polar plugs were seen in the stool specimen of a 16-year-old female with chronic diarrhea from Compostela Valley province. What is your diagnosis?
a. Capillariasis
b. Hookworm infection
c. Strongyloidiasis
d. Ascariasis
a. Capillariasis
Rationale: Capillariasis is characterized by the presence of ova with bipolar plugs.
Clue words: “ova with flat bi-polar plugs,” “chronic diarrhea”
- Ova with flat bi-polar plugs were seen in the stool specimen of a 16-year-old female with chronic diarrhea from Compostela Valley province. If your diagnosis is correct, how did this patient acquire the infection?
a. Eating of salad
b. Eating raw infected snail
c. Eating raw infected freshwater fish
d. Eating raw or improperly cooked meat
c. Eating raw infected freshwater fish
Rationale: Capillariasis is often acquired by eating raw or undercooked freshwater fish containing the infectious larvae.
Clue words: “ova with flat bi-polar plugs,” “chronic diarrhea,” “eating raw infected freshwater fish”
- A 24-year-old abaca farmer from Sorsogon with fever associated with signs and symptoms of inflammation of the lymph glands was brought to the Outpatient Department of the Philippine General Hospital. What parasitic diagnostic procedure will you request in the laboratory?
a. Stool examination
b. Sputum examination
c. Thick blood film
d. Urine examination
c. Thick blood film
Rationale: A thick blood film is used to diagnose parasitic infections such as malaria and filariasis that cause lymphadenitis.
Clue words: “fever,” “inflammation of the lymph glands,” “diagnostic procedure”
- A 24-year-old abaca farmer from Sorsogon with fever associated with signs and symptoms of inflammation of the lymph glands was brought to the Outpatient Department of the Philippine General Hospital. Microscopic finding in the blood taken at 10:00 pm revealed the presence of larvae. What is your diagnosis?
a. Malaria
b. Toxoplasmosis
c. Filariasis
d. Angiostrongyliasis
c. Filariasis
Rationale: The presence of larvae (microfilariae) in a blood sample taken at night is characteristic of filariasis.
Clue words: “fever,” “inflammation of the lymph glands,” “presence of larvae”
- A 24-year-old abaca farmer from Sorsogon with fever associated with signs and symptoms of inflammation of the lymph glands was brought to the Outpatient Department of the Philippine General Hospital. Microscopic finding in the blood taken at 10:00 pm revealed the presence of microfilariae. What drug can you prescribe to this patient?
a. Mebendazole
b. Metronidazole
c. Diethylcarbamazine
d. Praziquantel
c. Diethylcarbamazine
Rationale: Diethylcarbamazine (DEC) is the drug of choice for treating filariasis.
Clue words: “presence of microfilariae,” “drug to prescribe”
A 40-year-old male overseas worker complaining of muscle pains seeks medical attention upon his arrival in the Philippines. Biochemical tests showed elevated creatinine, phosphokinase, lactate dehydrogenase, and myokinase levels. Results of a complete blood count showed high blood eosinophilia. What is your most probable diagnosis?
a. Taeniasis
b. Capillariasis
c. Trichinosis
d. Filariasis
c. Trichinosis
Rationale: Trichinosis, caused by Trichinella spiralis, presents with muscle pain, elevated muscle enzymes, and high blood eosinophilia.
Clue words: “muscle pains,” “elevated creatinine, phosphokinase, lactate dehydrogenase, and myokinase,” “high blood eosinophilia”
A 40-year-old male overseas worker complaining of muscle pains seeks medical attention upon his arrival in the Philippines. Biochemical tests showed elevated creatinine, phosphokinase, lactate dehydrogenase, and myokinase levels. Results of a complete blood count showed high blood eosinophilia. What other laboratory test would you recommend to confirm your probable diagnosis?
a. Bentonite flocculation test
b. Montenegro test
c. Sabin Feldman test
d. Knott’s blood concentration test
a. Bentonite flocculation test
Rationale: The Bentonite flocculation test is used to diagnose trichinosis by detecting antibodies against Trichinella spiralis.
Clue words: “muscle pains,” “elevated muscle enzymes,” “high blood eosinophilia,” “confirm your probable diagnosis”
A 40-year-old male overseas worker complaining of muscle pains seeks medical attention upon his arrival in the Philippines. Biochemical tests showed elevated creatinine, phosphokinase, lactate dehydrogenase, and myokinase levels. Results of a complete blood count showed high blood eosinophilia. Serological tests may confirm your diagnosis, but since there is no available serological test, what would you request to confirm your diagnosis?
a. Skin test
b. Muscle biopsy
c. Rectal biopsy
d. Skin scraping
b. Muscle biopsy
Rationale: A muscle biopsy can confirm trichinosis by demonstrating the presence of Trichinella larvae in the muscle tissue.
Clue words: “muscle pains,” “elevated muscle enzymes,” “high blood eosinophilia,” “confirm your diagnosis”
A flat whitish worm, measuring 1.5 cm long, was submitted to the Diagnostic Parasitology Laboratory for identification. It was found in the underwear of a 7-year-old girl complaining of abdominal discomfort and occasional itchiness of the perianal area. What parasitic infection would you consider?
a. Enterobiasis
b. Taeniasis
c. Strongyloidiasis
d. Heterophydiasis
b. Taeniasis
Clue words: “flat whitish worm,” “abdominal discomfort,” “perianal area”
- A flat whitish worm, measuring 1.5 cm long, was submitted to the Diagnostic Parasitology Laboratory for identification. It was found in the underwear of a 7-year-old girl complaining of abdominal discomfort and occasional itchiness of the perianal area. Laboratory results identified the worm as a segment of a Taenia saginata. How did this patient acquire the infection?
a. Eating of infected pork salad
b. Eating raw infected snail
c. Eating raw infected freshwater fish
d. Eating raw infected beef
d. Eating raw infected beef
Rationale: Taenia saginata is acquired by eating raw or undercooked beef containing the larvae.
Clue words: “Taenia saginata,” “raw infected beef”
- A flat whitish worm, measuring 1.5 cm long, was submitted to the Diagnostic Parasitology Laboratory for identification. It was found in the underwear of a 7-year-old girl complaining of abdominal discomfort and occasional itchiness of the perianal area. Laboratory results identified the worm as a segment of a Taenia saginata. What is the drug of choice for this parasitic infection?
a. Mebendazole
b. Albendazole
c. Praziquantel
d. Piperazine
c. Praziquantel
Rationale: Praziquantel is the drug of choice for treating Taenia saginata infection.
Clue words: “Taenia saginata,” “drug of choice”
- An adult roundworm, measuring 27 cm in length, was seen in the colon of a 10-year-old boy who died of pneumonia. Manifestations such as lung infiltration, asthmatic attacks, and edema of the lips were documented before the patient died. What is the most probable parasitic infection you can identify in this case?
a. Trichuriasis
b. Ascariasis
c. Capillariasis
d. Hookworm infection
b. Ascariasis
Rationale: Ascariasis, caused by Ascaris lumbricoides, is characterized by large roundworms and respiratory symptoms.
Clue words: “adult roundworm,” “lung infiltration,” “10-year-old boy”
- A fisherman from Davao Oriental was rushed to a nearby hospital with chest pain, persistent cough, and hemoptysis as his main complaints. Patient interview revealed excessive drinking of native alcohol together with raw mountain crabs as their “pulutan.” What is the Diagnostic work-up you should include for this patient?
a. Chest x-ray
b. Sputum examination
c. Stool examination
d. All of the above
b. Sputum examination
- A fisherman from Davao Oriental was rushed to a nearby hospital with chest pain, persistent cough, and hemoptysis as his main complaints. Patient interview revealed excessive drinking of native alcohol together with raw mountain crabs as their “pulutan.” Chest x-ray demonstrated patchy, cloudy infiltration of the lungs with nodular shadows and calcified spots. What parasitic infection can you consider?
a. Pulmonary tuberculosis
b. Paragonimiasis
c. Ascariasis
d. Strongyloidiasis
b. Paragonimiasis
Rationale: Paragonimiasis, caused by the lung fluke Paragonimus, can present with chest symptoms and characteristic lung findings on x-ray.
Clue words: “chest x-ray,” “patchy, cloudy infiltration,” “nodular shadows,” “calcified spots”
- A fisherman from Davao Oriental was rushed to a nearby hospital with chest pain, persistent cough, and hemoptysis as his main complaints. Patient interview revealed excessive drinking of native alcohol together with raw mountain crabs as their “pulutan.” Chest x-ray demonstrated patchy, cloudy infiltration of the lungs with nodular shadows and calcified spots. Paragonimiasis is the parasitic infection you are considering? What social factor strongly contributes to your diagnosis?
a. Drinking habits
b. Occupation
c. Eating habits
d. Gender
c. Eating habits
Rationale: The consumption of raw or undercooked freshwater crabs, a known source of Paragonimus infection, is a key social factor contributing to the diagnosis.
Clue words: “raw mountain crabs,” “eating habits”
