Lecture 1

1. The 'germ theory of disease’ that states that some microorganisms can
produce infectious diseases was postulated by:
a. Ignaz Semmelweiss.

b. Anton van Leeuwenhoek.

c. Joseph Lister.

d. Louis Pasteur.

e. Robert Koch.

2. Scientists give names to microorganisms using a hierarchical system that

contains the following groups: Domain, Kingdom, Phylum, Class, Order, Family,
Genus and Species. In the bacterium Escherichia coli, what is "Escherichia" and
what is "coli"?
a. Domain: Escherichia. Family: coli

b. Family: Escherichia. Species: coli

c. Family: Escherichia. Genus: coli

d. Genus: Escherichia. Species: coli

e. Kingdom: Escherichia. Genus: coli

3. Which of the following body sites contains normal flora?

a. The brain

b. The nose

c. The blood

d. The spleen

e. The bone marrow

4. Which of the following body sites is sterile?

a. The mouth
b. The esophagus

c. The liver

d. The conjunctivae

e. The outer ear

5. Which of the following molecules are virulence factors?

a. Immunoglobulins

b. Toxins

c. The proteins of the "complement"

d. Interferons

e. T-cell-receptors (TCR)

6. Microorganisms that cause infectious diseases when the immune system is

NOT working properly are called:
a. Nosocomial pathogens.

b. Opportunistic pathogens.

c. Commensal pathogens.

d. Systemic pathogens.

7. What is TRUE about the infectious process?

a. Virulence factors are chemical components produced by leukocytes.

b. Host damage is only produced by the microorganism itself.

c. A strong immune response may produce damage.

d. “Infection” has the same meaning as “disease”.

e. Commensalism produces important host tissue damage.

8. What is 'self-tolerance'?
a. The ability of the immune system to fight foreign antigens.

b. The ability of the immune system to fight self antigens.

c. The ability of the immune system to recognize self antigens and not fight against them.

d. The ability of the adaptive immune system to remember prior exposures to foreign antigens.

9. Which cells of the immune system produce antibodies?

a. Neutrophils

b. T lymphocytes

c. B lymphocytes

d. Dendritic cells

e. Macrophages

10. An important difference between the innate immunity and the adaptive
immunity is:
a. The innate immune response is slower

b. The innate immune response has memory

c. Millions of different antigens are recognized by the adaptive immune system but not by the innate
immune system

d. Phagocytes produce antibodies in the innate immune system, and lymphocytes produce antibodies in
the adaptive immune system

e. The innate immune system may react against self antigens, but not the adaptive immune system

Lecture 2
1. During the cellular immune response, antigens are recognized by T-cells when
they are presented (displayed) inside MHC molecules of antigenpresenting cells
(APC). What is TRUE about antigen recognition by T-cells?
a. CD4+ T-cells recognize antigens presented inside MHC-class I molecules.

b. CD8+ T-cells recognize antigens presented inside MHC-class I molecules.

c. CD8+ T-cells recognize antigens presented inside MHC-class II molecules.

d. CD4+ T-cells and CD8+ T-cells recognize antigens presented inside MHC-class I molecules.

e. CD4+ T-cells and CD8+ T-cells recognize antigens presented inside MHC-class II molecules.
2. Which one is the main function of the cellular immune response?
a. The production of antibodies by B-cells to fight against extracellular bacteria.

b. The production of antibodies by neuthophils to fight against extracellular bacteria.

c. The production of antibodies by CD4+ T-cells to fight against intracellular pathogens.

d. Macrophages (that are activated by CD4+ Th1- cells) and CD8+ cells work together to destroy
intracellular pathogens.

3. What is TRUE about the T-helper 1 (Th1) response?

a. It is induced by the production of IL-4.

b. Th1 cells produce interferon-gamma (IFN-γ).

c. T-cells CD8+ are never activated during Th1 responses.

d. It is the main response against helminths (worms).

e. It is the main response against extracellular microorganisms.

4. What is TRUE about the T-helper 2 (Th2) response?

a. It is induced by the production of IL-12.

b. Th2 cells produce interferon-gamma.

c. The Th2 respose is important to fight against helminths.

d. Its principal function is the phagocytemediated defense.

e. Eosinophils cannot be activated during a Th2 response.

5. About the humoral adaptive immune response it is FALSE that:

a. It is mediated by antibodies.

b. It is the main response against tumoral cells.

c. It is the main response against toxins.

d. It is the main response against extracellular microorganisms.

e. It is the main response against the extracellular stage of intracellular microorganisms.

6. Which one is a difference between a "primary" humoral immune response
and a "secondary" humoral immune response against an antigen?
a. The primary response is faster than the secondary response.

b. IgG is produced during the primary response and IgM is produced during the secondary response.

c. Naïve B-cells are activated during the primary response and memory B cells are activated during the
secondary response.

d. The affinity of antibodies in the primary response is higher than in the secondary response.

7. During the humoral immune response, antigens are recognized by receptors

of B-cells. How are antigens recognized by B-cells?
a. Antigens are recognized by the TCR.

b. Antigens are recognized by the CD4 molecule placed on the cell membrane of the B-cell.

c. Antigens cannot be recognized by the B-cell. Antigens are only recognized by T-cells.

d. Antigens are recognized by an IgM or IgD placed on the cell membrane of the B-cell.

8. The humoral immune response against TI antigens is different to TD antigens.

Which one is an important difference?
a. CD4+ Th cells help during the immune response against TI antigens but not against TD antigens.

b. TI antigens induce primary responses, and TD antigens only induce secondary responses.

c. Most TI antigens only induce primary responses, but TD antigens induce primary and secondary
responses.

d. Memory cells are produced against TI antigens, but not against TD antigens.

9. Which one is NOT a mechanism of action of antibodies:

a. Antibodies can enter inside infected cells and destroy intracellular pathogens.

b. Antibodies can block the binding of pathogens to cellular receptors.

c. Antibodies can opsonize pathogens and promote their phagocytosis by macrophages.

d. Antibodies can activate the "complement system".

10. What is "affinity maturation"

a. It is the process that leads to increased affinity of antibodies against TI antigens.

b. It is the process that leads to increased affinity of antibodies against TD antigens.

c. It is the process that leads to increased affinity of T-cells against TI antigens.

d. It is the process that leads to increased affinity of phagocytes against TD antigens.

Lecture 3
1. Some bacteria can produce toxic chemical substances called "toxins". Toxins
may be either classified as "exotoxins" or "endotoxins". What is an
"endotoxin"?
a. It is a teichoic acid produced by Gramnegative bacteria.

b. It is a protein produced by Gram-positive and Gram-negative bacteria.

c. It is the lipid (lipid A) component of the lipopolysaccharide of Gram-negative bacteria.

d. It is a lipid secreted by Gram-negative bacteria

2. Gram-positive bacteria are more permeable than Gram-negative ones. Why?

a. Because Gram-positive bacteria contain teichoic acids.

b. Because Gram-positive do not have outer membrane.

c. Because Gram-positive bacteria have lipopolysaccharide.

d. Because Gram-positive bacteria have many porins.

3. A long linear polysaccharide made of many repeated saccharide units that can
be found in the outer membrane of many Gram-negative bacteria is called:
a. Core polysaccharide.

b. Lipid A.

c. O-antigen.

d. C-polisaccharide

4. A very thick and sticky polysaccharide or proteic layer that is tightly bound to
the bacterial cell wall is called
a. Glycocalix

b. Slime layer

c. Capsule

d. Outer membrane

5. Which is the difference between an "anaerobic facultative" bacterium and an

"obligate anaerobic" one?
a. An "anaerobic facultative" bacterium can survive in the presence of oxygen and can utilize it if it is
available. However, an "obligate anaerobic" one cannot survive in the presence of oxygen.

b. An "anaerobic facultative" bacterium can survive in the presence of oxygen and but cannot utilize it.
However, an "obligate anaerobic" one cannot survive in the presence of oxygen.

c. An "anaerobic facultative" bacterium cannot survive in the presence of oxygen. However, an

"obligate anaerobic" one can survive in the presence of oxygen but cannot utilize it.

d. An "anaerobic facultative" bacterium cannot survive in the presence of oxygen. However, an "obligate
anaerobic" one can survive in the presence of oxygen and can utilize it.

6. What is "sporulation"
a. The process by which most bacteria produce endospores for reproduction when environmental
conditions are favorable.

b. The process by which some bacteria produce endospores for reproduction when environmental
conditions are non-favorable.

c. The process by which some bacteria produce endospores to survive long time when environmental
conditions are nonfavorable.

d. The process by which some bacteria divide into two daughter cells when environmental conditions
are non-favorable.

7. A process by which a bacterium gets genetic material from another

bacterium through the infection by a bacteriophage virus is called
a. Transformation

b. Conjugation

c. Transduction

d. Transposition
8. Which of the following features is NOT related with a bacterial plasmid?
a. It is made of double stranded DNA

b. It is a circular molecule

c. It can replicate autonomously

d. It is inserted into the bacterial chromosome

9. What is a "pleomorphic" bacterium?

a. A bacterium with spherical shape.

b. A bacterium with rod-like shape.

c. A curved bacterium.

d. A bacterium that may show different shapes.

10. Which of the following mutations is less dangerous for a microorganism?

a. Missense mutations.

b. Nonsense mutations.

c. Insertions.

d. Deletions.

Lecture 4
1.Which one of the following bacteria are Gram-positive cocci, catalase-positive,
coagulase-positive?
a.Streptococcus pyogenes

b.Streptococcus pneumoniae

c.Staphylococcus epidermidis

d.Staphylococcus aureus

2.A patient is suffering a very severe necrotizingpneumonia caused by a

community-acquiredmethicillin-resistantStaphylococcus aureus(CA-MRSA).
Which one may be the virulence factorrelated with the severity of the disease?
a.Toxic Shock Syndrome Toxin-1 (TSST-1)

b.Coagulase

c.Panton-Valentine leukocidin

d.Exfoliative toxin

3.Which is a good antimicrobial treatment againstMRSA?

a.Penicilin

b.Cloxacillin

c.Vancomycin

d.Meropenem

4.Which one are Gram-positive diplococci, alfa-hemolytic, optochin-susceptible?

a.Streptococcus pyogenes

b.Streptococcus pneumoniae

c.Streptococcus agalactiae

d.Streptococcus viridansgroup

5.Which is the most important virulence factor ofStreptococcus pyogenes?

a.The Lancefield antigen A

b.The capsule

c.The M-protein

d.The streptokinase

6.Which is the most important virulence factor ofStreptococcus pneumoniae?

a.The capsule

b.The pneumolysin

c.The autolysin

d.The streptokinase
7.Which is the antimicrobial treatment of choice ofpharyngitis caused
byStreptococcus pyogenes?
a.Amoxicillin

b.Amoxicillin-clavulanate

c.Ampicillin

d.Penicilin

8.Which of the following infectious diseases can beprevented with a vaccine?

a.Rheumatic fever

b.Meningitis caused byStreptococcuspneumoniae

c.Neonatal sepsis caused byStreptococcusagalactiae

d.Endocarditis caused byStreptococcusviridans

9.Lancefield antigen B is specific of:

a.Streptococcus pyogenes

b.Streptococcus pneumoniae

c.Streptococcus agalactiae

d.Streptococcus viridansgroup

10.Which of the following streptococci is related withsepsis and meningitis in

Vietnam after the contactwith sick pigs?
a.Streptococcus mutans

b.Streptococcus suis

c.Streptococcus pneumoniae

d.Streptococcus bovi

Lecture 5
1.Diphtheria is a very severe disease that may be lethalfor children, but
fortunately it is uncommonnowadays. What isFALSEabout diphtheria?
a.It is produced by the bloodstream invasionofCorynebacterium diphtheriae.

b.It is caused by the effects of the diphtherictoxin.

c.Patients may die as a result of myocarditis.

d.It is inially manifested as a pharyngitis withpseudomembranes.

2.Which is the most important treatment fordiphtheria?

a.Penicillin.

b.Erythromycin.

c.Azytromycin.

d.Antitoxin.

3.A 85-year old male is admitted to hospital with feverof 38.8ºC, confusion and
neck stiffness. Acerebrospinal fluid (CSF) sample is taken, and Gram-positive
rods are seen in the Gram-staining. Whichisthe best antimicrobial treatment for
this patient?
a.Cefotaxime.

b.Ceftriaxone.

c.Ampicillin plus gentamycin.

d.Cefazolin

.4.A 21-year old female is admitted to the emergencyroom with fever of 39.2ºC,
headache and neckstiffness. Both Kerning and Brudzinsky signs arepositive.
Gram-negative diplococci are seen in theGram-staining of a CSF sample. Which
is the bestantimicrobial treatment for this patient?
a.Ampicillin plus gentamycin.

b.Cefotaxime.

c.Cefuroxime.

d.Cefazolin.

5.How is respiratory anthrax acquired?

a.By the ingestion of contaminated milk orcheese.

b.By the inhalation of bacteria in dropletsfrom another patient.

c.By the inhalation of spores fromcontaminated animals.

d.By the ingestion of unwashed rawvegetables.

6.What isFALSEaboutNeisseria?
a.MostNeisseriaare normal flora of the upperrespiratory tract.

b.Neisseria gonorrhoeaecan be found as acommensal of the genitourinary tract.

c.Neisseria meningitidiscan be found as acommensal of the upper respiratory tract.

d.Neisseria meningitidishas a polysaccharidecapsule.

7.Gonorrhoea is a common sexually transmittedinfection. What isFALSEabout

the clinicalmanifestations of gonorrhoea?
a.Gonorrhoea in men is typically manifestedas urethritis.

b.Gonorrhoea in women is manifested ascervicitis.

c.Gonorrhoea in men is typicallyasymptomatic.

d.Gonorrhoea in women may be complicatedwith pelvic inflammatory disease.

8.A good empirical treatment of sexually transmittedurethritis (gonococcal and

non-gonococcal) is:
a.Ceftriaxone (single dose, intramuscularly)and azithromycin (single dose, orally).

b.Penicillin (single dose, intramuscularly) andvancomycin (single dose, orally).

c.Azithromycin (single dose, intramuscularly)and amoxicillin (twice daily for one week,orally).

d.Clindamycin (single dose, orally) andmetronidazol (twice daily for one week,orally).

9.A 35-year old male attends his friend's weddingparty and eats fried rice. Three
hours later he andhisfriends start vomiting, with nausea and abdominalpain.
What is the best antimicrobial treatment forthis patient?
a.Penicillin.

b.Vancomycin.
c.Clindamycin.

d.None.

10.Which is the most important virulence factor ofNeisseria meningitidis?

a.The ability for antigenic switching.

b.The polysacchraride capsule.

c.The pili.

d.The protease IgA1.

Lecture 6
1. Which is a feature of bacteria of the family Enterobacteriaceae?
a. They are oxidase positive.

b. They are obligate anaerobic.

c. They can ferment glucose.

d. They are halophilic.

2. Which one of the following bacteria may cause meningitis in newborns?

a. Shiga-toxin E. coli (STEC).

b. Entero-invasive E. coli (EIEC).

c. E. coli with K1 capsular antigen.

d. S. dysenteriae type 1

3. The most important pathogenic mechanism in dysentery caused by Shigella

dysenteriae is?
a. Invasion.

b. Shiga toxin production.

c. Cholera toxin.

d. Loss of microvilli. e. Pili (adhesins).

4. What is FALSE about melioidosis?
a. It is endemic in Vietnam.

b. It is caused by Burkholderia pseudomallei.

c. It can produce a latent infection.

d. Pneumonia is common. e. It is typically acquired by the fecal-oral route.

5. What is FALSE about typhoid fever?

a. It is a systemic disease.

b. It is a mild disease.

c. It is mainly caused by Salmonella Typhi.

d. Bacteremia is common. e. High fever is common.

6. Which one is NOT a good antimicrobial drug to treat Pseudomonas

aeruginosa infections?
a. Ceftazidime.

b. Ciprofloxacin.

c. Tobramycin.

d. Amoxixillin-clavulanate. e. Amikacyn.

7. How is primary pneumonic plague acquired?

a. By inhalation from another infected patient.

b. By inoculation from a flea bite.

c. By ingestion of spores.

d. By inhalation of bacteria from contaminated soil.

8. Which bacteria do not cause gastroenteritis?

a. Entero-invasive E. coli (EIEC).

b. Entero-pathogenic E. coli (EPEC).

c. Klebsiella pneumoniae.
d. Salmonella enterica e. Yersinia pseudotuberculosis.

9. Cholera toxin is a "A-B5" exotoxin. Which is its mechanism of toxicity?

a. It inhibits the synthesis of proteins.

b. It increases the levels of intracellular cAMP

c. It causes the loss of enterocyte microvilli.

d. It is an invasin.

10. Most cases of the current pandemic of cholera are caused by:
a. V. cholera O139.

b. V. cholera O157:H7.

c. V. cholera O1 'Classic' biotype.

d. V. cholera O1 'El Tor' biotype.

Lecture 7
1. Which bacteria are NOT a cause of meningitis?
a. Streptococcus pneumoniae.

b. Streptococcus agalactiae.

c. Escherichia coli K1.

d. Listeria monocytogenes. e. Bordetella pertussis.

2. Epiglottitis is a medical emergency. It is caused by Haemophilus influenzae

type b. Which is the most dangerous clinical finding?
a. Severe cough.

b. Airway obstruction.

c. High fever.

d. Important sore throat.

3. Which antimicrobials are the first choice to treat Bordetella pertussis

infections?
a. Vancomycin.

b. Penicillin.

c. Macrolides.

d. Chloramphenicol.

e. Linezolid.

4. Which bacterial infection CANNOT be prevented with a vaccine?

a. Haemophilus influenzae type b infections.

b. "Whooping cough".

c. Peptic ulcers caused by Helicobacter pylori.

d. Diphtheria.

5. Campylobacter jejuni is possibly the most common cause of bacterial

diarrhea worldwide. Which food is strongly related with its transmission?
a. Raw vegetables.

b. Seafood (mainly oysters).

c. Cheese made with unpasteurized milk.

d. Poultry (chicken).

6. Which cancer is related with chronic Helicobacter pylori infection?

a. Lung cancer.

b. Gastric mucosa–associated lymphoid tissue (MALT) lymphoma.

c. Colon cancer.

d. Acute leukemia.

7. How is Legionella pneumophila acquired?

a. By the inhalation of spores from contaminated soil.

b. By the inhalation of aerosols from contaminated water sources.

c. By the inhalation of droplets from another infected patient: Person to person transmission.
d. By the inhalation of spores from contaminated air-conditioning water tanks.

8. Which serological test is useful for the follow-up of patients with syphilis?
a. FTA-ABS.

b. TPPA.

c. TPHA.

d. VDRL

9. What is a "chancre"?
a. It is the typical lesion of "primary syphilis": It is a very painful ulcer.

b. It is the typical lesion of "primary syphilis": It is a painless ulcer.

c. It is the typical lesion of "secondary syphilis": It is a maculo-papular rash.

d. It is the typical lesion of "congenital syphilis": It is a malformation of the teeth.

10. How is leptospirosis acquired?

a. By the ingestion of undercooked food contaminated with rat urine.

b. By the inhalation of spores from soil contaminated with rat urine.

c. By the inoculation through the skin or mucous membranes after contact with rat urine. d. By the
inhalation of water contaminated with rat urine.

Lecture 8
1. Which one of the following antimicrobials is NOT a first-line treatment of
tuberculosis active disease? a. Isoniazid
b. Rifampin

c. Pyrazinamide

d. Ethambutol e. Streptomycin

2. A healthy 50-year old woman is found to have a positive 'tuberculin skin test'
(TST). What is the meaning of this finding?
a. She is suffering an active tuberculosis disease and should start treatment with four drugs as soon as
possible.

b. She may be either infected by Mycobacterium tuberculosis or she has been vaccinated with BCG.

c. She has never been infected by any Mycobacterium.

d. She is suffering a latent tuberculosis infection (LTBI) and should start treatment with isoniazid
immediately because she has a very high risk of developing active disease.

3. Why is the cell wall of Mycobacterium different to other Gram-positive

bacteria?
a. Because it contains lipopolysaccharide (LPS).

b. Because it has a very high amount of teichoic acids.

c. Because it has a very high content of lipids, mainly mycholic acids.

d. Because it has an outer membrane made of phospholipids.

4. Which is the most important immune defense against tuberculosis?

a. The humoral immune response: Antibodies against mycholic acids.

b. The humoral immune response: Antibodies against the PPD.

c. The Th1 cellular immune response.

d. The Th2 cellular immune response.

5. Which of the following patients with tuberculosis is more contagious?

a. A patient with positive TST and normal chest X-ray.

b. A patient with positive TST, normal chest Xray, and sputum smear with acid-fast positive bacilli.

c. A patient with positive TST, cavitation in the upper right lobe of the lung, and sputum smear without
acid-fast positive bacilli.

d. A patient with positive TST, cavitation in the upper right lobe of the lung, and sputum smear with
acid-fast positive bacilli.

6. About the clinical findings of tuberculosis, which of the following is FALSE?

a. Primary pulmonary tuberculosis in adults is usually asymptomatic.

b. Primary pulmonary tuberculosis in children is usually symptomatic.

c. Primary tuberculosis is more contagious than post-primary tuberculosis.

d. A patient with latent tuberculosis infection (LTBI) is not contagious.

7. What is a multidrug-resistant tuberculosis (MDR-TB) strain?

a. A strain that is resistant to isoniazid.

b. A strain that is resistant to, at least, isoniazid and rifampin.

c. A strain that is resistant to, at least, isoniazid and ethambutol.

d. A strain that is resistant to, at least, isoniazid and pyrazinamide.

8. In order to prevent tetanus, what should we do in a non-vaccinated individual

with a dirty and large wound in the foot?
a. Vaccination only.

b. Antitoxin (immunoglobulin) only.

c. Proper wound management only.

d. Vaccination and proper wound management. e. Vaccination, antitoxin (immunoglobulin) and proper
wound management.

9. Several hours after eating home-made canned food, four members of the
same family are attended at the emergency room because of flaccid paralysis
that began in the head and currently affects the whole body. They are probably
suffering:
a. Generalized tetanus.

b. Localized tetanus.

c. Guillain-Barré syndrome.

d. Botulism.

10. It is TRUE about Clostridium difficile infection:

a. It causes flaccid paralysis.

b. It causes spastic contraction of muscles.

c. Normal flora in colon protects against Clostridium difficile colonization.

d. It is easily prevented with DTP vaccine. e. It is acquired by inoculation of spores in wounds.

Lecture 9

1. Which of the following herpesviruses infection can be prevented with a

vaccine?
a. Herpes simplex virus 1

b. Varicella-Zoster virus

c. Epstein-Barr virus

d. Cytomegalovirus

e. Kaposi's sarcoma virus

2. Which of the following is NOT a serologic criterion of an acute infection?

a. The finding of an IgM-positive in a single serum sample.

b. The finding of an IgG-positive in a single serum sample.

c. Seroconversion demostrated in two different serum samples (taken two weeks apart).

d. The 4-fold rise in IgG titer in two different serum samples (taken two weeks apart).

3. What is "zoster" (or shingles)?

a. A very itchy rash in the whole body caused by the HHV-3 (VZV) primary infection.

b. A very itchy rash in the whole body caused by the HHV-3 (VZV) reactivation.

c. A very painful rash in the whole body caused by the HHV-3 (VZV) reactivation.

d. A very painful rash in a skin dermatome caused by the HHV-3 (VZV) reactivation.

4. Which of the following is a common feature of all herpesviruses?

a. They are RNA viruses.

b. The cause latent infections.

c. They cause chronic infections.

d. They are oncogenic.

5. Which of the following viruses is oncogenic?
a. Cytomegalovirus.

b. Herpes simplex type 1.

c. Epstein-Barr virus.

d. Roseoloviruses.

6. What are "heterophil antibodies"?

a. Specific IgG against capsid proteins of Epstein-Barr virus.

b. Specific IgM against capsid proteins of Epstein-Barr virus.

c. Non-specific IgM against many different, often unknown antigens.

d. Non-specific IgG against glycoproteins of the envelope.

7. What is the difference between "chronic infections" and "latent infections"?

a. In "chronic infections" the virus is replicating slowly inside the host cell, while in "latent infections"
there is not any viral replication.

b. In "latent infections" the virus is replicating slowly inside the host cell, while in "chronic infections"
there is not any viral replication.

c. In "chronic infections" the virus is replicating quickly inside the host cell, while in "latent infections"
the virus is replicating slowly

d. "Chronic infections" are persistent infections, while in "latent infections" are acute infections.

8. Which of the following viruses is the most common cause of opportunistic

viral diseases in transplant patients?
a. Herpes simplex type 1.

b. Epstein-Barr virus.

c. Kaposi's sarcoma virus.

d. Cytomegalovirus.

9. Which antiviral drug is useful to treat Herpes simplex type 1 encephalitis?

a. Acyclovir

b. Ganciclovir

c. Cidofovir

d. Foscarnet

10. A 18-year old male complains about sore-throat, intense fatigue and fever for around four days.
Cervical swollen lymph nodes and splenomegaly are found on physical examination. An Epstein-Barr
virus (EBV) serologic test is performed and these are the results: Paul-Bunnell test negative, IgM-anti-
VCA positive, IgG-VCA positive, IgG-anti-EBNA negative. Which is the interpretation of these results?

a. The patient is suffering an acute EBV infection.

b. The patient is not suffering an acute EBV infection: These results evidence a past EBV infection.

c. The patient has never been infected with EBV.

d. The patient is suffering a chronic EBV infection.

Lecture 10
1. About the epidemiology of Hepatitis B virus infection it is TRUE that:

a. Most perinatally-acquired infections are symptomatic.

b. Most infections acquired by adults become chronic.

c. Around 90% of perinatally-acquired infections become chronic.

d. The prevalence in Viet Nam is low.

2. Hepatitis B virus infection is NOT acquired by:

a. By parenteral transmission.

b. By sexual transmission.

c. Vertically.

d. By ingestion (fecal-oral route)

3. Which of the following is a serologic marker of active viral replication?

a. HBe antigen (HBeAg) in serum.

b. Antibody against HBcAg (anti-HBc) in serum.

c. Antibody against HBeAg (anti-HBe) in serum.

d. Antibody against HBsAg (anti-HBs) in serum.

4. About the structure of hepatitis B virus, where is the surface antigen (HBsAg)
placed?
a. In the capsid.

b. Bound to the nucleic acid.

c. At the envelope, in three different forms (large, medium and small).

d. In the tegument.

5. It is TRUE about the pathogenesis of hepatitis B that:

a. Hepatitis B virus is highly cytopathic.

b. The host immune response is the most important responsible of the damage.

c. Hepatitis B infection in adults always becomes chronic.

d. Antibodies against HBcAg are protective.

6. The serologic marker of a chronic hepatitis B infection is:

a. HBsAg-positive more than six months.

b. HBeAg-positive more than six months.

c. Anti-HBs-positive more than six months.

d. Anti-HBc-positive more than six months.

7. HBsAg-negative, Anti-HBs-positive, Anti-HBcnegative is typical of:

a. Past (cured) hepatitis B infection.

b. Person vaccinated against HBV.

c. Chronic infection in replicative phase.

d. Chronic infection in non-replicative phase.

8. HBsAg-negative, Anti-HBs-positive, Anti-HBc-positive is typical of:

a. Past (cured) hepatitis B infection.
b. Person vaccinated against HBV.

c. Chronic infection in replicative phase.

d. Chronic infection in non-replicative phase.

9. Which is the typical serologic profile of a chronic HBV infection in replicative

phase?
a. HBsAg-negative, Anti-HBs-positive, HBeAgnegative, Anti-HBe-negative.

b. HBsAg-negative, Anti-HBs-negative, HBeAgpositive, Anti-HBe-negative.

c. HBsAg-positive, Anti-HBs-negative, HBeAgpositive, Anti-HBe-negative.

d. HBsAg-positive, Anti-HBs-negative, HBeAgnegative, Anti-HBe-positive.

10. What is FALSE about hepatitis D virus (HDV) infection?

a. Patients with HDV are always infected with hepatitis B virus.

b. Patients with a past (cured) HBV infection can be infected with HDV.

c. The envelope of HDV contains HBsAg.

d. In susceptible individuals, vaccination against hepatitis B virus also prevents HDV infection.

Lecture 11
1. Which serotypes of human papilloma virus (HPV) are the most important
cause of cervical cancer in women?
a. HPV 1 and 2.

b. HPV 3 and 4.

c. HPV 6 and 11.

d. HPV 16 and 18.

2. How are papillomaviruses transmitted?

a. By contact.

b. By inhalation.

c. By ingestion.
d. Transplacentally.

3. Which of the following viral infections can be prevented by vaccination?

a. Syncytial respiratory virus (SRV).

b. Human parainfluenzae virus (HPIV) types 1 and 3.

c. HPV 16 and 18.

d. Middle-East respiratory syndrome coronavirus (MERS-Co).

4. Which of the following clinical manifestations is NOT caused by HPV?

a. Cutaneous warts.

b. Progressive multifocal leukoencephalopathy (PML).

c. Genital warts.

d. Laryngeal papillomas.

e. Cervical cancer.

5. What is the most common cause of bronchiolitis in infants?

a. Parainfluenza viruses.

b. Influenza A virus.

c. Respiratory syncitial virus (RSV).

d. Haemophilus influenzae type b.

6. Which clinical manifestation is NOT caused by parvovirus B19?

a. A “slapped cheek” exanthem in infected children.

b. Arthropathy in adults.

c. Severe anemia in healthy children.

d. Pure red cell aplasia in immunosuppressed patients.

7. A 14-month old baby with inspiratory stridor, barking dry cough, hoarseness,
dyspnea and important subcostal, intercostal and sternal recession is likely to
be suffering:
a. A severe laryngotracheitis (croup).

b. A mild bronchiolitis.

c. A severe pneumonia.

d. A severe sinusitis.

8. A 9-month old baby is admitted to the hospital with fever (38ºC) and dry
cough. Physical examination: tachypnea with subcostal recession, hyperinflated
chest and expiratory wheezes. Which infection is likely suffering this baby?
a. This is a typical severe pneumonia caused by Cytomegalovirus.

b. The child is likely to be suffering a laryngotracheitis (croup) caused by influenza A virus.

c. The child is likely to be suffering a brochiolitis possibly caused by respiratory syncitial virus (RSV).

d. This is the typical presentation of a common cold caused by new coronaviruses.

9. Genetic changes are very common in Influenza A viruses. These changes are
caused by different mechanisms. What is TRUE about the mechanisms of these
genetic changes?
a. Antigenic shifts are caused by small mutations in the hemagglutinin gene.

b. Antigenic shifts are caused by small mutations in neuraminidase gene.

c. An antigenic drift is caused by reassortments of segments when two or more different virus strains
infect the same host cell.

d. An antigenic drift is caused by mutations in the hemagglutinin and/or neuraminidase genes.

10. Which is the most common and important complication of an influenza virus
infection?
a. Myocarditis.

b. Encephalitis.

c. A bacterial pneumonia (for example, caused by Streptococcus pneumoniae).

d. A viral pneumonia caused by the influenza virus itself.

Lecture 12
1. The most important route of transmission of Hepatitis A virus is:
a. Sexually.

b. By the fecal-oral route.

c. Parenterally.

d. Transplacentally.

e. By blood transfussion.

2. About the hepatitis C virus (HCV) infection, it is FALSE that:

a. Vaccines are available.

b. Liver cancer is associated with HCV.

c. Precautions for transmission of HCV are similar to that of hepatitis B.

d. The use of condoms for safe sex is recommended for males infected with hepatitis C.

3. Which of the following hepatitis viruses belongs to the family Flaviviridae?

a. Hepatitis A virus.

b. Hepatitis B virus.

c. Hepatitis C virus.

d. Hepatitis D virus.

e. Hepatitis E virus.

4. The most common outcome after acute hepatitis C is:

a. Death.

b. Chronic hepatitis C.

c. Cure and recovery.

d. Latent infection.

e. Superinfection with hepatitis D.

5. In a patient with hepatitis, the serologic profile antiHCV-positive, HBsAg-

positive, anti-HBc-positive, anti-HBs-negative is most likely:
a. An acute hepatitis C infection.

b. Both chronic hepatitis B and C infections.

c. A chronic hepatitis C infection in a hepatitis B-vaccinated person.

d. A chronic hepatitis C in a past (cured) hepatitis B.

6. Which of the following viral hepatitis NEVER causes chronic infections?

a. Hepatitis A.

b. Hepatitis B.

c. Hepatitis C.

d. Hepatitis D.

e. Hepatitis E.

7. About the pathogenesis of HCV infection it is FALSE that:

a. Liver damage is caused by the host immune response.

b. Liver cancer may be developed after many years of HCV infection.

c. Cirrhosis may be developed after many years of HCV infection.

d. Chronic HCV infection progresses very quickly.

8. Which is the most important risk factor to suffer a fulminant hepatitis caused
by Hepatitis E virus?
a. Children younger than 14 years.

b. Adults older than 55 years.

c. Pregnant women.

d. Immunosuppresed patients.

9. Which of the following viral hepatitis can be also transmitted from animal to
humans (zoonotic)?
a. Hepatitis A.
b. Hepatitis B.

c. Hepatitis C.

d. Hepatitis E.

10. Which of the following hepatitis viruses can initially replicate in the
intestinal mucosa before infecting the liver?
a. Hepatitis A.

b. Hepatitis B.

c. Hepatitis C.

d. Hepatitis D

Lecture 13
1. Which is the most common cause of viral meningitis?
a. Herpes simplex type 1.

b. Herpes simplex type 2.

c. Enteroviruses.

d. Dengue virus.

2. It is FALSE about enteroviruses that:

a. Enteroviruses mostly cause intestinal disease.

b. Polioviruses are enteroviruses.

c. They are transmitted by the fecal-oral route.

d. Poor sanitation increases transmission.

e. Some enteroviruses can cause meningitis.

3. Which statement is FALSE about the pathogenesis of dengue?

a. Macrophages are important target host cells.

b. Dengue can cause hemorrhagic fever.

c. Most dengue virus infections are mild.

d. Immune protection after recovery from dengue is serotype-specific.

e. The first infection with a dengue serotype is always more severe than the second or third.

4. Which is the most important treatment measure for dengue?

a. Acetylsalicylic acid (aspirin) for the treatment of fever.

b. Acetylsalicylic acid (aspirin) for the treatment of severe arthralgias.

c. Fluid replacement therapy.

d. Acyclovir to inhibit the virus replication inside macrophages.

5. Which is an important advantage of the "Salk vaccine" against poliomyelitis?

a. It is excreted in stool, so it can spread to close contacts.

b. It is safe and cannot cause paralytic disease.

c. It is the cheapest one.

d. It produces very high levels of antibodies in the intestine.

6. How are enteroviruses transmitted?

a. By inhalation.

b. By skin contact.

c. By the fecal-oral route.

d. Transplacentally.

7. Which is the most important and dangerous feature of severe dengue?

a. Thrombopathy, with abnormal platelet function

b. Thrombocytopenia.

c. Coagulopathy.

d. Plasma leakage.

8. Which of the following laboratory findings is seen in most patients with

dengue?
a. Anemia.
b. Leucocytosis.

c. Low hematocrit.

d. Thrombocytopenia.

9. Which of the following dengue virus proteins is found in the blood of patients
and is useful for the diagnosis?
a. E protein.

b. NS1 protein.

c. M protein.

d. C protein.

10. Which of the following patients with dengue is likely to suffer a mild
disease?
a. A 13-year old child with a primary infection.

b. An adult with a secondary infection.

c. A 5-year old child with a secondary infection.

d. A pregnant woman with a secondary infection.

Lecture 14
1. Important target cells for rabies virus are:
a. Monocytes-macrophages.

b. Dendritic cells.

c. T-cells.

d. Neurons.

2. What is FALSE about rabies?

a. Rabies is found in Viet Nam.

b. Rabies is almost always lethal.

c. Post-exposure prophylaxis is only useful before the virus has invaded the peripheral nerves.
d. A single dose of a live-attenuated vaccine should be given to all infants that live in endemic areas.

3. Which is NOT a clinical manifestation of Yellow fever?

a. Liver failure.

b. Renal failure.

c. Plasma leakage.

d. Coagulopathy.

4. About the Japanese encephalitis it is FALSE that:

a. It is endemic in Viet Nam, mainly in Ha Noi and near rural areas.

b. It is transmitted from human to human by a vector.

c. Most infections are mild or asymptomatic.

d. It is transmitted from pigs to humans by a vector.

5. Which of the following viruses is NOT a Flaviviridae?

a. Dengue virus.

b. Yellow fever virus.

c. Hepatitis C virus.

d. Japanese encephalitis virus. e. Rabies virus.

6. Which of the following measures is the most useful to prevent rabies in a

community?
a. Vaccination of animals (dogs, cats…).

b. Vaccination of all children younger than 15 years.

c. Post-exposure prophylaxis with rabies immunoglobulin.

d. Post-exposure prophylaxis with rabies vaccine.

7. Which is the most specific sign of encephalitic (furious) rabies?

a. Aggressiveness.

b. Opisthotonos.
c. Hydrophobia.

d. Seizures.

e. Coma.

8. A person has been bitten by a dog suspicious to have rabies. Which of the
following measures is NOT recommended to prevent the development of
rabies?
a. Immediate administration of ribavirin and amantadin.

b. Cleaning the wound properly and using antiseptics.

c. Post-exposure prophylaxis with anti-rabies immunoglobulins.

d. Post-exposure prophylaxis with a rabies vaccine.

9. Which animals are the most important source of infection of Japanese

encephalitis?

a. Monkeys.
b. Pigs.

c. Horses.

d. Birds.

10. Which of the following viral diseases is NOT transmitted by a vector?

a. Dengue.

b. Yellow fever.

c. Japanese encephalitis

d. West Nile encephalitis.

e. Rabies.

Lecture 15
1. Why cannot HIV-1 be succesfully controlled by the immune system?
a. Because antibodies against gp120 do not appear.
b. Because antibodies against gp41 do not appear.

c. Because HIV-1 easily mutates and escapes to the immune response.

d. Because CD4+ T-cells and CD8+ T-cells are destroyed by the virus.

2. The current pandemic of acquired immunodeficiency syndrome (AIDS) is

caused by:
a. HIV-1 group O.

b. HIV-1 group M.

c. HIV-1 group P.

d. HIV-2 group M.

3. Which of the following cells is NOT a target for HIV1?

a. CD4+ T-cells.

b. Macrophages.

c. Neutrophils.

d. Microglial cells in the brain.

4. Which is the common route of HIV transmission in the world?

a. The sexual route.

b. Sharing needles among intravenous drug users.

c. Vertical (from mother to child).

d. By blood transfusion.

5. After an infection with HIV-1, which one is the first laboratory marker that
appears in serum?
a. IgM anti-HIV-1 gp120.

b. IgM anti HIV-1 gp41.

c. HIV-1 p24 antigen.

d. HIV-1 RNA.
6. Which HIV-1 protein binds host cells receptors?
a. gp41.

b. gp120.

c. p24.

d. p17.

7. An HIV-positive patient is suffering a Kaposi's sarcoma. Laboratory data: CD4+

T-cell count: 50 cells/mm3. HIV-RNA: 160000 copies/mL. What is TRUE about
this patient.
a. This is the typical clinical case of an acute infection caused by HIV-1.

b. This patient has AIDS.

c. Kaposi's sarcoma is not a typical opportunistic disease in HIV-positive patients.

d. The count of CD4+ cells is normal.

8. Which of the following microorganisms is a typical opportunistic pathogen in

HIV infected persons in South East Asia?
a. Varicella-zoster virus.

b. Burkholderia pseudomallei.

c. Hepatitis C virus.

d. Penicillium marneffei.

9. Which antiviral drug is recommended to prevent mother-to-child HIV

transmission during delivery?
a. Lamivudine (3TC).

b. Zidovudine (AZT).

c. Ritonavir.

d. Tenofovir.
10. Toxoplasma gondii and Pneumonystis jirovecii are typical opportunistic
pathogens in HIV-infected people. Which antimicrobial is useful to prevent
these opportunistic infections?
a. Isoniazid.

b. Itraconazol.

c. Azithromycin.

d. Co-trimoxazol (TMP-SXT).