100 MCQs in Tropical Medicine

**Asrafee** · 04-25-2008, 01:00 AM

100 MCQs in Tropical Medicine

Each question has 5 parts. Each part must be marked true or false.

1. The following are recognised causes of eosinophilia
a. malaria
b. visceral leishmaniasis
c. Churg-Strauss syndrome
d. drug hypersensitivity
e. visceral larva migrans (toxocariasis)

2. Giardia lamblia
a. is usually acquired by ingestion of food or water contaminated by the trophozoites
b. trophozoites have four flagella
c. can effectively be treated by mepacrine
d. cysts are killed by standard chlorination of water
e. cysts survive in water boiled for ten minutes

3. Mosquitoes are the vector in the following disorders
a. onchocerciasis
b. visceral leishmaniasis
c. myiasis
d. African trypanosomiasis
e. Bancroftian filariasis

4. Consumption of raw fish or shellfish is associated with infection caused by
a. Clonorchis sinensis
b. Ancylostoma duodenale
c. Schistosoma japonicum
d. Vibrio parahaemolyticus
e. Paragonimus westermani

5. Following splenectomy for trauma
a. thrombocytopaenia is typical
b. pneumococcal vaccine should be given
c. malaria is more severe
d. prophylactic penicillin should be taken for six weeks
e. Heinz bodies are characteristically seen on the blood film

6. Nephrotic syndrome is a recognised complication of infection with
a. Schistosoma mansoni
b. Plasmodium malariae
c. Hepatitis B virus
d. Mycobacterium leprae
e. Loa loa

7. HIV positive patients may receive
a. measles vaccine
b. TY21a (oral typhoid vaccine)
c. Hib vaccine
d. BCG
e. Havrix (hepatitis A vaccine)

8. Steroids are of benefit in the treatment of
a. visceral leishmaniasis
b. Eschericia coli septicaemia
c. cerebral malaria
d. severe typhoid fever
e. herpes zoster recrudescence (shingles)

9. In tuberculoid leprosy
a. peripheral nerves are involved symmetrically
b. the lepromin test is positive
c. hair growth is normal in affected skin lesions
d. smear negative cases can be treated with steroids alone
e. skin lesions usually have a well-demarcated, raised edge

10. Plasmodium falciparum
a. causes more severe disease in pregnancy
b. is associated with recurrent relapses after initial treatment because of liver hypnozoites
c. is the only malarial parasite causing greater than 20% parasitaemia
d. infection is typically associated with thrombocytopaenia
e. is the only cause of cerebral malaria

11. The following infectious diseases are correctly matched to their period of infectivity:
a. chicken pox: from appearance of rash until the last spot is crusted over
b. rubella: 7 days before onset of rash until 4 days after onset of rash
c. mumps: 7 days before salivary swelling until appearance of salivary swelling
d. scarlet fever: from appearance of rash until completion of 1 day's penicillin
e. measles: from onset of prodrome until 4 days after onset of rash

12. Amoebic liver abscess:
a. should be treated by diloxanide furoate alone
b. should be aspirated routinely
c. is associated with eosinophilia
d. usually affects the right lobe of the liver
e. occur most commonly in men aged 20-60 years

13. A woman who had not previously travelled abroad spent five days in Zambia. She went on safari on the fifth day and on the following day she became ill with fever and an erythematous rash. She is likely to be suffering from:
a. hepatitis A
b. loa loa
c. falciparum malaria
d. brucellosis
e. Hodgkin's disease

14. In enteric fever
a. severe cases should receive high dose dexamethasone
b. ciprofloxacin is the treatment of choice in the UK. for adults
c. jaundice is a recognised complication
d. myocarditis is a recognised complication
e. if perforation of the bowel occurs it should be managed conservatively because surgery carries too high a mortality.

15. Hepatitis B.
a. Babies born to hepatitis B e antigen positive (HBeAg+ve) mothers should be given active and passive immunisation at birth.
b. According to current DHSS guidelines, children in the UK. should be vaccinated against hepatitis B by age 16.
c. Co-infection with delta virus may occur in intravenous drug abusers but occurs less commonly in homosexuals.
d. Super-infection with delta virus causes a clinical deterioration.
e. Is the major underlying cause of hepatocellular carcinoma.

16. E.coli 0157 / H7:
a. is a bowel commensal
b. causes haemorrhagic colitis
c. is an important cause of cholera-like illness
d. is a recognised cause of the haemolytic uraemic syndrome
e. can be prevented from causing clinical illness by vaccination

17. Melioidosis:
a. is caused by Pseudomonas pseudotuberculosis
b. is more common in diabetics
c. should be treated with cefuroxime
d. is confined to equatorial Africa and South America
e. is commonly complicated by parotitis

18. The following neoplasms have a known infective aetiology:
a. Burkitt's lymphoma
b. squamous carcinoma of the penis
c. hepatocellular carcinoma
d. squamous carcinoma of the bronchus
e. nasopharyngeal carcinoma

19. Characteristic findings in visceral leishmaniasis (kala azar) include:
a. eosinophilia
b. pancytopaenia
c. polyclonal hypergammaglobulinaemia
d. positive leishmanin test
e. lymphadenopathy

20. Parvovirus B19:
a. is the causative agent of fifth disease (erythema infectiosum)
b. was discovered after parvovirus B16
c. antibodies are present in 70% of the UK adult population
d. is a recognised cause of aplastic anaemia
e. is known to cause hydrops fetalis

21. Subcutaneous nodules are a typical finding in:
a. neurofibromatosis
b. hydatid disease
c. cysticercosis
d. onchocerciasis
e. trichinosis

22. Characteristic features of kwashiorkor include:
a. patient aged less than 1 year
b. anorexia
c. flakey discoloured skin
d. hepatomegaly
e. splenomegaly

23. Concerning meningococcal disease:
a. vaccine is available for meningococci groups A and C
b. sporadic outbreaks in the UK. are usually due to type B meningococcus
c. close contacts should be treated prophylactically with oral amoxycillin 3g as a single dose
d. outbreaks of disease occur seasonally in parts of sub-Saharan Africa.
e. is the most common cause of bacterial meningitis in the UK.

24. Staphylococcus epidermidis:
a. is coagulase positive
b. on microscopy are Gram positive cocci in chains
c. are usually sensitive to penicillin
d. grown in blood cultures are due to contamination and should be ignored
e. are destroyed by povodine iodine

25. Concerning tuberculin skin testing:
a. patients with tuberculous pericarditis are usually tuberculin positive
b. previous BCG vaccination usually results in a strongly positive reaction
c. pulmonary sarcoidosis gives a positive tuberculin test in about 30% of cases
d. if the sputum microscopy and culture are negative for mycobacteria, pulmonary tuberculosis can only be diagnosed if the tuberculin test is positive.
e. the test is usually negative in miliary tuberculosis

26. Hookworm
a. is usually spread by the faeco-oral route
b. is usually diagnosed by microscopy of adhesive tape prints taken from the perianal area
c. may block the pancreatic duct causing pancreatitis
d. eggs can be readily distinguished microscopically from those of Strongyloides sp.
e. commonly causes diarrhoea in non-immunes

27. The following are associated with an increased risk of vertical transmission of HIV
a. breast feeding
b. high titres of p24 antigen in maternal serum perinatally
c. low maternal CD4 counts during pregnancy
d. prolonged labour
e. HIV-1 compared to HIV-2

28. Concerning African trypanosomiasis
a. it has an incubation period of 4-6 months
b. it may cause erythema chronicum migrans in light skinned persons
c. the Gambian form progresses more rapidly
d. the Gambian form is associated with a more prominent chancre
e. the Gambian form can be treated with pentamidine

29. Vivax malaria
a. may be complicated by anaemia
b. may be complicated by jaundice
c. in a traveller may present more than six months after exposure
d. is sensitive to chloroquine
e. may co-exist with falciparum malaria in the same patient

30. The following infections are zoonoses
a. salmonellosis
b. leprosy
c. tularaemia
d. Weil's disease (leptospirosis)
e. cholera

31. A fever of two weeks' duration associated with neutropaenia is characteristically due to
a. disseminated tuberculosis
b. brucellosis
c. malaria
d. influenza B
e. amoebic liver abscess

32. Quinine
a. is gametocidal for mature gametocytes of Plasmodium falciparum.
b. is active against schizonts of Plasmodium malariae
c. resistance occurs in Plasmodium falciparum in South East Asia
d. cerebrospinal fluid levels are much lower than serum levels following oral or intravenous administration
e. causes hypoglycaemia

33. Rheumatic fever
a. is most common in the third decade
b. is more common in areas of social deprivation
c. causes erosive arthritis
d. relapse rate may be reduced by prophylactic antibiotics
e. is more common following streptococcal pharyngitis than streptococcal cellulitis

34. The following are correctly paired
a. erythema nodosum tuberculosis
b. erythema marginatum Lyme disease
c. erythema multiforme orf
d. erythema induratum syphilis
e. erythema infectiosum parvovirus B19

35. HIV-associated Kaposi's sarcoma is
a. radiosensitive
b. chemosensitive
c. a cause of pleural effusion
d. more common in intravenous drug abusers than homosexuals
e. associated with infection by HHV-8 (Herpes hominis virus type

36. Cholera
a. Vibrio cholera of the 01 serotype is the only cause of clinical disease
b. low gastric pH protects against infection
c. cholera toxin produces its effect by reducing intracellular levels of cAMP
d. hypoglycaemia is a recognised complication in children
e. fever is usual in adults

37. The following drugs are contraindicated or should be used with caution in epileptics:
a. doxycycline
b. chloroquine
c. ciprofloxacin
d. mefloquine
e. metronidazole

38. Hepatitis C
a. cirrhosis develops in most untreated cases
b. blood transfusion is the commonest mode of transmission in the UK.
c. most children born to hepatitis C infected mothers will have the infection
d. a normal serum alanine transaminase level excludes active liver disease
e. genotype 1 has the most favourable response to treatment

39. Coagulopathy is a recognised complication of
a. epidemic typhus
b. relapsing fever
c. pneumococcal septicaemia
d. envenomation by Latrodectus spiders (black widow spiders)
e. envenomation by Physalia physalis (Portuguese-man-of-war)

40. Cryptococcal meningitis
a. is caused only by Cryptococcus neoformans neoformans
b. is more common than cryptococcal pneumonia
c. characteristically causes leucopaenia
d. only occurs in the immunosuppressed
e. should be treated with ketoconazole

41. Dengue fever
a. is spread by the vector Aedes aegypti
b. has an incubation period of 2-3 weeks
c. is caused by a flavivirus
d. characteristically causes severe myalgia
e. is more likely to cause haemorrhage in patients previously infected by a Dengue virus

42. Spastic paraparesis is a recognised complication of infection with
a. Streptococcus pyogenes
b. Polio virus
c. Mycobacterium tuberculosis
d. Taenia saginata
e. Plasmodium vivax

43. Giardiasis
a. can be diagnosed by duodenal biopsy
b. leaves the small bowel morphologically normal
c. has an incubation period of less than 48 hours
d. causes abdominal distension
e. usually responds to treatment with metronidazole

44. The following are correctly paired:
a. Schistosoma haematobium: Biomphalaria ssp
b. Onchocerca volvulus: Culex quinquefasciatus
c. Loa loa: Chrysops dimidiata
d. Borrelia duttoni (relapsing fever): soft tick (Ornithodorus moubata
e. Rickettsia tsutsugamushi: tromboculid mite

45. Enteric fever
a. Bone marrow culture increases diagnostic yield in those previously given antibiotics.
b. is zoonotic
c. is associated with poor sanitation
d. the incubation period is usually 4-6 weeks
e. rose spots occur in typhoid but not paratyphoid fever

46. Brucellosis
a. is caused by a Gram positive bacillus
b. causes spondylitis
c. is treated with tetracycline
d. is a recognised cause if chronic depression
e. is contracted from unpasteurised milk

47. A 35 year old woman presented shocked with a one week history of sore throat and fever. Her blood pressure was 80 mmHg systolic, temperature 39.5C and pulse 130. She was mildly jaundiced and had a macular erythematous rash that blanched on pressure. She was oliguric and had biochemical evidence of renal failure. Her creatine kinase was twice the upper limit of normal. The differential diagnosis includes:
a. myocardial infarction
b. meningococcal septicaemia
c. leptospirosis
d. toxic shock syndrome
e. Rocky Mountain spotted fever

48. Travellers' diarrhoea
a. the single most common causative organism is entero-invasive E. coli
b. has an incubation period of at least 48 hours
c. may be due to Aeromonas ssp.
d. may be due to Cryptosporidium
e. should be treated with antibiotics

49 The following are recognised features of infective endocarditis
a. erythema marginatum
b. Roth spots
c. proteinuria
d. Osler's nodes
e. splenomegaly
Answer 49

50. The following are characteristic features of acute schistosomiasis
a. fever
b. eosinophilia
c. convulsions
d. myocarditis
e. incubation period of 4-6 weeks

51. Hepatocellular carcinoma
a. is more common in men than women
b. is radiosensitive
c. is associated with intake of aflotoxin
d. usually presents with weight loss, right hypochondrial pain and hepatomegaly
e. progress of the disease can be monitored by serial measurement of the tumour marker inhibin

52. The following are recognised associations
a. Hanta virus: haemorrhagic fever with renal syndrome
b. E.coli 0157/H7: haemolytic uraemic syndrome
c. Plasmodium vivax: tropical splenomegaly syndrome
d. HTLV-1: AIDS
e. Chlamydia trachomatis: Fitzhugh Curtis syndrome

53. Effective malaria control interventions include:
a. mass use of Fansidar chemoprophylaxis
b. use of pyrethroid impregnated mosquito nets
c. vaccination with SPf66
d. larviciding
e. eradication of mosquito breeding sites

54. In lepromatous leprosy
a. neuropathy occurs before skin lesions
b. skin lesions are typically anaesthetic
c. skin lesions are typically symmetrical
d. the lepromin test is positive
e. leonine facies occurs

55. The following occur in Chagas' disease (American trypanosomiasis)
a. lymphadenopathy
b. meningoencephalitis
c. Calabar swelling
d. mega-oesophagus
e. saddle-nose deformity

56. Chloroquine
a. is contraindicated in pregnancy
b. is schizonticidal for P.ovale
c. is the treatment of choice for non-falciparum malaria
d. causes cinchonism
e. inhibits plasmodial haemin polymerase

57. Blindness is a recognised complication of:
a. leprosy
b. onchocerciasis
c. vitamin A deficiency
d. cysticercosis
e. toxoplasmosis

58. The following may present with fever and diarrhoea
a. malaria
b. Entamoeba coli
c. dengue
d. Campylobacter enteritis
e. brucellosis

59. Chicken pox
a. has an incubation period of 3-5 days
b. rash is preceded by Koplic's spots in the mouth
c. fever settles when the rash appears
d. should be treated by topical acyclovir
e. may follow from close contact with a case of shingles

60. Hepatitis A
a. the virus has double stranded DNA
b. the incubation period is 2-6 weeks
c. the illness is milder in young people
d. is maximally infectious at the peak of jaundice
e. can be prevented by active immunisation

61 Typical features of tropical splenomegaly syndrome are:
a. very low or absent malarial antibody titres
b. increased serum IgM
c. lymphocytic infiltration of hepatic sinusoids
d. Plasmodium falciparum parasitaemia
e. favourable response to prolonged anti-malarial drug therapy

62. Visceral leishmaniasis is typically caused by
a. L.donovani
b. L.tropica
c. L.chagasi
d. L.major
e. L.infantum

63. Concerning HIV infection in pregnancy:
a. pregnancy approximately doubles the rate of progression to AIDS
b. the rate of vertical transmission of HIV is greater than 50%
c. perinatal administration of zidovudine to the mother reduces vertical transmission
d. breast feeding increases vertical transmission.
e. transmission of HIV to the neonate is confirmed if the neonate is HIV antibody positive

64. Buruli ulcers are characteristically:
a. painful
b. undermined
c. caused by Fusobacterium
d. secondarily infected
e. responsive to penicillin

65. Concerning plague:
a. it is caused by Bacillus pestis
b. the main vector is the rat
c. the pneumonic form is more common than the bubonic form
d. fraction I antigen in the bacterial capsular envelope confers anti-phagocytic activity
e. direct person to person spread may occur (i.e. without a vector)

66. Rabies vaccination
a. should be given annually to dogs in endemic areas
b. may usefully be given many months after exposure
c. Post-exposure vaccination is unnecessary if pre-exposure vaccination has been given
d. Specific rabies immunoglobulin for human use may be prepared from horse serum
e. is unnecessary after cat bites

67. In a cholera epidemic
a. cases have copious watery diarrhoea
b. intravenous rehydration therapy has no place
c. the most important public health intervention is the provision of clean water and good sanitation
d. mass chemoprophylaxis with oral tetracycline should be arranged urgently
e. mass vaccination should be undertaken

68. Epstein-Barr virus is associated with
a. hairy cell leukaemia
b. leiomyosarcoma in young people with AIDS
c. nasopharyngeal carcinoma
d. teratogenesis
e. oral hairy leukoplakia

69. Hydatid disease is
a. acquired in the UK.
b. caused by dog tapeworm
c. usually accompanied by eosinophilia
d. treated with albendazole
e. best diagnosed by microscopy of fluid obtained from ultrasound guided aspiration of the suspected cyst

70. Vitamin A (retinol)
a. is found in green leafy vegetables
b. high dose supplementation in pregnancy is teratogenic
c. supplementation reduces mortality from measles
d. supplementation reduces mortality from diarrhoeal disease
e. supplementation reduces mortality from respiratory disease

71. Thalidomide is used in the treatment of
a. HIV-associated peripheral neuropathy
b. hyperemesis gravidarum
c. erythema nodosum leprosum
d. Behcet's disease
e. HIV-associated mouth ulcers

72. Hepatitis A vaccination (Havrix):
a. is a live vaccine
b. is teratogenic
c. has >75% protective efficacy
d. causes mild hepatitis in some patients
e. should be offered to haemophiliacs who are hepatitis A antibody negative

73. Yellow fever
a. has an incubation period of 3-6 days
b. has a case fatality rate of about 50%
c. is caused by a flavivirus
d. is spread by anopheline mosquitoes
e. epidemics should be controlled by strict isolation of cases

74. Tuberculosis control:
a. Sputum negative cases of pulmonary tuberculosis are of more public health importance than sputum positive cases because they are more likely to remain undiagnosed.
b. Children with tuberculosis have usually acquired their disease from a child contact.
c. Close contacts of a sputum positive case should be offered immediate BCG.
d. BCG is at least 50% effective in preventing pulmonary tuberculosis.
e. Twice weekly supervised treatment regimens have comparable efficacy to standard daily regimens.

75. Strep. pyogenes
a. is the most common bacterial cause of tonsillitis
b. asymptomatic pharyngeal carriage occurs in about 10% of children
c. septicaemia carries a mortality similar to meningococcal septicaemia
d. pharyngitis may be complicated by suppurative cervical adenitis
e. causes scarlet fever

76. Amphotericin B is used in the treatment of:
a. visceral leishmaniasis
b. dermatophyte infections of the nails
c. azole resistant oral candida
d. primary amoebic meningoencephalitis caused by Naegleria species
e. cryptococcal meningitis

77. Typical features of tropical pulmonary eosinophilia include:
a. lymphadenopathy
b. absolute eosinophilia
c. microfilaraemia
d. raised serum Ig E
e. rapid response to mebendazole

78. The following drugs are used in the treatment of Legionnaires' disease:
a. rifampicin
b. gentamicin
c. erythromycin
d. ciprofloxacin
e. azithromycin

79. Acute post-streptococcal glomerulonephritis of childhood:
a. occurs after cellulitis but not pharyngitis
b. should be treated with steroids
c. is fatal in about half of all cases
d. is usually crescentic on microscopy
e. usually presents with acute renal failure

80. Suppurative lymphadenopathy may be caused by:
a. cat scratch fever
b. lymphogranuloma venereum
c. tuberculosis
d. sarcoidosis
e. plague

81. Legionnaires' disease:
a. can be acquired by drinking infected water
b. smokers are more susceptible
c. most cases are sporadic
d. hyponatraemia is typical
e. may cause rigors

82. Typical features of botulism include:
a. circumoral parasthaesia
b. extensor plantars
c. diarrhoea
d. fever
e. post-tetanic potentiation on EMG (electromyography)

83. Concerning anti-tuberculous chemotherapy:
a. pyrazinamide causes hyperuricaemia
b. isoniazid causes a lupus-like syndrome
c. twice weekly regimens should be continued for at least 12 months
d. pyridoxine is only needed by slow acetylators
e. rifampicin can only be given orally

84. The following are recognised complications of meningococcal infection:
a. deafness
b. reactive polyarthritis
c. purulent monoarthritis
d. alopecia
e. pericarditis

85. The following may cause pulmonary cavitation
a. Mycobacterium tuberculosis
b. Aspergillus fumigatus
c. Staph. aureus
d. Klebsiella ssp
e. Strep. pneumoniae

86. The paralysis of polio virus infection
a. is upper motor neurone type
b. is asymmetrical
c. usually affects the lower limbs more severely than the upper limbs
d. is more severe if strenuous physical exercise occurred in the incubation period
e. may be caused by polio vaccination

87. Rickettsiae:
a. cannot be cultured on artificial media
b. may cause an eschar
c. are spread by arthropods
d. are usually sensitive to tetracyclines
e. cause melioidosis

88. Concerning cholera:
a. it has an incubation period of 1-5days.
b. it causes an inflammatory cell infiltrate in the lamina propria of the mucosa of the small intestine
c. it causes muscle cramps
d. the diagnosis is confirmed by dark field microscopic examination of the stool
e. compared to the classical biotype, the El Tor strain produces more severe illness

89. The following are recognised features of onchocerciasis:
a. keratitis
b. diarrhoea
c "hanging groin"
d. Calabar swelling
e. eosinophilia

90. The following conditions and drug treatments are correctly paired:
a. onchocerciasis: ivermectin
b. schistosomiasis: praziquantel
c. visceral leishmaniasis: suramin
d. Rhodesian trypanosomiasis: pentavalent antimony
e. hydatid disease: albendazole

91. Fever, diarrhoea and eosinophilia in a returned traveller may be due to each of the following as the sole causative agent:
a. Strongyloides stercoralis
b. Aeromonas hydrophila
c. Schistsoma mansoni
d. Capillaria philippinensis
e. Plasmodium falciparum

92. A positive VDRL (venereal disease research laboratory) test with negative TPHA and FTA (Treponema pallidum haemagluttinin and fluorescent treponemal antibody) tests is consistent with:
a. early infectious primary syphilis
b. treated syphilis
c. glandular fever
d. late syphilis
e. previous yaws infection

93. Diphtheria:
a. "bull neck" is diagnostic
b. it is caused by Gram positive bacilli
c. toxin absorption is greatest in pharyngeal disease
d. palatal paralysis is a recognised complication
e complete heart block is a manifestation of toxin-induced myocarditis

94. Leptospirosis:
a. usually causes a self-limiting disease
b. is caused by Gram positive bacilli
c causes leucopaenia
d. causes jaundice
e. causes meningitis

95. Praziquantel is used in the treatment of:
a. amoebiasis
b. toxocariasis (visceral larva migrans)
c. paragonimiasis (lung fluke)
d. trypanosomiasis (African sleeping sickness)
e. schistosomiasis

96. Loa loa
a. is confined to Central and West Africa
b. is spread by the vector Aedes aegypti
c. may cause a high eosinophilia (>10x10^9/L)
d. is diagnosed by histological examination of skin snips
e. is treated with DEC

97. Genital ulcers:
a. may be due to herpes simplex virus
b. are associated with an increased incidence of HIV
c. if painful and associated with lymphadenopathy, are likely to be due to chancroid
d are found in gonorrhoea
e. if well-defined and beefy red, are likely to be due to granuloma inguinale

98. HIV in Africa:
a. Circumcision is associated with lower rates of HIV infection amongst African men.
b. Infection rates are generally higher in rural populations.
c. Pneumocystis pneumonia is a more common presentation of AIDS than in Europe.
d. The provision of HIV testing kits is a priority for good case management.
e. Pulmonary tuberculosis is often associated with HIV infection.

99. The World Health Organisation's Expanded Programme for Immunisation (EPI) includes immunisation against:
a. cholera
b. hepatitis A
c. rubella
d. smallpox
e. typhoid

100. The following infectious agents cause dementia:
a. gonococcus
b. HIV
c. Brucella abortus
d. Borrelia recurrentis
e. HTLV-1

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