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PCP SOUTHERN LUZON CHAPTER ONLINE BOARD REVIEW COURSE 2010

INFECTIOUS DISEASES MODULE NO. 4 FUNGAL, PROTOZOAL AND HELMINTHIC DISEASES

Select the best answer:
___D__1. The main potential toxicity of Amphotericin B: A. Hepatotoxicity B. CNS toxicity, including hallucinations and delirium C. Pulmonary infiltrates D. Nephrotoxicity p. 1243 ___A__2. The following are true of AZOLES used in the treatment of fungal infections,except: A. Consistently predictable fungicidal effect ( theyre fungistatic, not fungicidal) B. Available in parenteral and oral preparations C. Useful for deep organ systemic mycoses D. Have virtually no nephrotoxic potential P. 1243 ___D__3. Which of the following is a potential adverse effect of Fluconazole? A. Hepatotoxicity B. Metallic taste in the mouth C. Alopecia and muscle weakness D. All of the above p. 1243 ___C__4. Patients considered at high risk for cryptococcosis, except: A. Those with advanced HIV infection and CD4+ T cell count < 200/L B. Those with hematologic malignancies C. Those who have received multiple antibiotics D. Solid organ transplant recipients on immunosuppressive therapy p. 1251 ___B__5. The most common predisposing factor to Cryptococcosis worldwide : A. Expanding avian (pigeon) population B. Acquired immunodeficiency syndrome C. More widespread organ transplantation D. High prevalence of eucalyptus trees p.1251 ___A__6. The usual clinical presentation of cryptococcosis: A. Chronic meningoencephalitis B. Pulmonary granulomatosis C. Chronic dermatophytosis D. Generalized lymphadenopathy and splenomegaly p. 1251 ___C__7. Which of the following is the most sensitive and specific diagnostic test for cryptococcal meningitis? A. CSF India ink stain B. CSF findings of mononuclear pleocytosis, low glucose, high protein C. CSF cryptococcal antigen D. Extremely elevated CSF opening pressure P. 1252 ___D__8. Poor prognostic markers for CNS cryptococcosis include the following, except: A. Positive CSF assay for yeast cells by India ink stain

B. Low CSF glucose C. High CSF pressure D. Marked CSF pleocytosis (it should be low CSF pleocytosis, < 2/L) p. 1253 ___A___9. The presence of hyphae or pseudohyphae on wet mount (saline and KOH) indicates infection due to: A. Candida B. Blastomyces C. Aspergillus D. Histoplasma p. 1255 ___B___10. Unexplained oropharyngeal thrush in a young, otherwise healthy person may raise the possibility of underlying: A. Malignancy B. HIV infection C. Miliary TB D. Chronic glucocorticoid use p. 1254 ___C___11. Candida may cause infection between the digits of the hands or toes known as: A. Onychomycosis B. Monilial whitlow C. Erosio interdigitalis blastomycetica D. Monilial intertrigo P. 1254 ___D___12. Preferred treatment for oral thrush: A. Oral Fluconazole 100- 200 mg/day B. Nystatin C. Caspofungin D. Clotrimazole troches TABLE P. 1255 ___B___13. The agent of choice for the treatment of candidemia and suspected disseminated candidiasis: A. Amphotericin B B. Fluconazole C. Caspofungin D. Voriconazole p. 1255 ___C___14. Chest CT scan showing a large pulmonary nodule with a positive halo or crescent sign strongly suggests: A. Pneumocystis infection C. Aspergillosis B. Histoplasmosis D. Atypical mycobacterial infection P. 1259 ___B___15. Chronic sinusitis complicated by adjacent facial skin necrosis leading to unilateral blindness occurring in a poorly controlled diabetic suggests: A. Blastomycosis C. Invasive candidiasis B. Mucormycosis D. Mixed anaerobic infection p. 1261 ___A___16. A patient presenting with hypopigmented macules, with KOH smear of skin scrapings showing characteristic spaghetti and meatballs appearance, most likely has: A. Tinea versicolor B. Sporotrichosis C. Candida dermatosis D. Grabuloma annulare p. 1263 ___D___17. The causative agent of tinea versicolor: A. Microsporum C. Trichophyton B. Epidermophyton D. Malassezia furfur P. 1263

___D___18. Dermatophytosis, including tinea or ringworm, can be caused by: A. Trichophyton C. Microsporum B. Epidermophyton D. All of the above P. 1264 ___B___19. The most common cause of tinea pedis: A. Microsporum B. Trichophyton rubrum C. Epidermophyton floccosum D. Candida spp. P. 1265 ___D___20. Tinea infections resistant to topical azoles may be treated with which of the following oral antifungal agents? A. Terbinafine B. Griseofulvin C. Itraconazole D. All of the above p. 1265 ___C___21.Preferred antifungal agent of choice for nail infections (tinea unguium): A. Griseofulvin C. Itraconazole B. Clotrimazole D. Ketoconazole P. 1265 ___C___22. If amebiasis is the 3rd most common cause of death worldwide from parasitic disease, what is the first (most common)? A. Malaria B. Trypanosomiasis C. Schistosomiasis (Amebiasis is 3rd , behind schistosomiasis and malaria) D. Filariasis p. 1275 ___B___23. The most common type of amoebic infection: A. Amebic colitis B. Asymptomatic cyst passage C. Amoebic liver abscess D. Ameboma P. 1277 ___A___24. The usual mode of infection for E. histolytica: A. Ingestion of viable cysts from fecally contaminated food, water or hands B. Direct rectal inoculation C. Ingestion of trophozoites from contaminated food or water D. Oral and anal sexual practices P. 1275 ___C___25. True statements regarding amoebic colitis, except: A. May mimic inflammatory bowel disease B. Cecal involvement may mimic acute appendicitis C. Fulminant colitits with toxic megacolon is a common complication (rare) D. Virtually all patients have heme-positive stools p. 1276 ___C___26. Which of the following is LEAST associated with amoebic liver abscess? A. Fever B. Abdominal pain C. Jaundice D. Right sided pleural effusion P. 1276 ___B___27. The definitive diagnosis of amebic colitis is established by: A. Serology B. Demonstration of hematophagous trophozoites C. Culture D. PCR of amoeba DNA p. 1277

___B___28. Drug of choice for the asymptomatic cyst carrier of amoebiasis: A. Metronidazole B. Iodoquinol or Paromomycin C. Tinidazole D. Mebendazole TABLE P. 1278 ___A___29. Drug of choice for amoebic liver abscess: A. Metronidazole plus luminal agent B. Iodoquinol or Paromomycin C. Tinidazole D. Mebendazole TABLE P. 1278 ___D___30. Which of the following is an indication for aspiration of amoebic liver abscess? A. Need to rule out a pyogenic abscess B. Threat of imminent rupture C. Need to prevent rupture of left-lobe abscesses into the pericardium D. All of the above P. 1278 ___C___31.Which of the following is NOT true regarding the malarial parasites life cycle? A. Female anopheline mosquito inoculates sporozoites B. Infected hepatocytes burst, discharging merozoites into the blood C. Gametocytes develop into sporozoites which are ingested by the biting mosquito D. Infected RBCs rupture to release daughter merozoites P. 1280 ___C___32. Which of the following is LEAST associated with malaria? A. Splenomegaly C. Generalized rash B. Myalgias D. Headache p. 1283 ___D___33. Cerebral malaria commonly presents with the following signs and symptoms, except: A. Seizures B. Obtundation and delirium leading to coma C. Increased or decreased muscle tone D. Nuchal rigidity (signs of meningeal irritation are rare) p. 1283 ___B___34. Hypoglycemia in severe malaria is predominantly a consequence of: A. Drug-induced hyperinsulinemia B. Failure of hepatic gluconeogenesis C. Inadequate nutritional intake D. Pancreatic failure p. 1283 ___A___35. The presence of ring forms and banana shaped gametocytes on thin blood films is highly diagnostic of malaria caused by: A. Plasmodium falciparum B. Plasmodium vivax C. Plasmodium ovale D. Plasmodium malariae p. 1280 ___C___36. Currently the drug of choice for the treatment of severe malaria: A. Chloroquine B. Quinidine C. Artesunate D. Quinine p. 1288 ___B___37. If Quinine or quinidine is given instead for severe malaria, what is its potential MAJOR toxicity? A. Cardiac arrhythmias B. Hypoglycemia

C. Anaphylaxis D. Cinchonism TABLE p. 1290 ___D___38. Cinchonism as a minor toxic effect of quinidine or quinine refers to: A. Temporary loss of vision B. Very bitter taste of the tablet C. Transient generalized rash D. Tinnitus, high-frequency hearing loss, nausea, vomiting, dysphoria TABLE p. 1290 ___A___39. Treatment of choice for uncomplicated malaria caused by P. ovale, vivax, or malariae: A. Chloroquine C. Artemether/Artesunate B. Quinine D. Sulfadoxine/pyrimethamine P. 1291 ___D___40. The currently recommended first-line treatment for uncomplicated falciparum malaria: A. Primaquine B. Chloroquine C. Mefloquine D. Artemisin combination regimen p. 1291 ___D___41. Which of the following drugs is effective for chemoprophylaxis against falciparum malaria? A. Mefloquine B. Doxycycline C. Atovaquone-proguanil D. All of the above p. 1293 ___A___42. The only safe, effective drug for chemoprophylaxis for pregnant women travelling to areas with drug-resistant malaria: A. Mefloquine B. Doxycycline C. Atovaquone-proguanil D. Primaquine P. 1293 ___C___43. Still the drug of choice for chemoprophylaxis in drug-sensitive P. falciparum areas: A. Mefloquine B. Doxycycline C. Chloroquine D. Primaquine p. 1293 ___B___44. True statements regarding malaria chemoprophylaxis, except: A. Antimalarial drugs should be started 2 days to 1-2 weeks before departure B. Antimalarial drugs should generally be continued for 1 week after departure (4 weeks) C. Mefloquine is widely used as it is effective against drug-resistant falciparum malaria D. Doxycycline should not be used by pregnant women or children <8 yrs old p. 1293 ___D___45. The swimmers itch, an itchy maculopapular rash that develops in the affected are several days after exposure, is seen in this type of infection: A. Strongyloidiasis B. Filariasis C. Ancylostomiasis D. Schistosomiasis p. 1333 ___C___46. Katayama fever, a serum sickness-like syndrome with fever, lymphadenopathy and hepatosplenomegaly, is caused by: A. Paragonimus C. Schistosoma sp. B. Fasciola hepatica D. Clonorchis sinensis p. 1333 ___B___47. What is the snail vector of Schistosoma japonicum?

A. Onchocerca volvulus B. Oncomelania quadrasi C. Toxoplasma gondii D. Chrysops FYI ___C___48. Schistosomiasis caused by S. japonicum is associated with the following, except: A. Intestinal symptoms, including abdominal pain and bloody diarrhea B. Pulmonary symptoms, including cough, fever, dyspnea C. Hepatosplenomegaly, leading to postsinusoidal cirrhosis (presinusoidal) D. CNS symptoms, including focal seizures p. 1333 ___B___49. Drug of choice for Schistosomiasis: A. Triclobendazole C. Niclosamide B. Praziquantel D. Metrifonate P. 1334 ___A___50. Muscle pain, fever, periorbital edema associated with intense eosinophilia point to which parasitic infection? A. Trichinellosis C. Toxoplasmosis B. Leishmaniasis D. Onchocerciasis P. 1316 ___A___51. Interstitial pulmonary infiltrates associated with Ascaris larval migration: A. Loefflers syndrome C. Dresslers syndrome B. Pontiac fever D. Hamman Rich syndrome P. 1320 ___B___52. Cutaneous larva migrans, or creeping eruption, a serpiginous skin rash that develops at the contact site, is associated with: A. W. bancrofti B. Ancylostoma C. Cyclospora D. Capillaria P. 1318 ___D___53. Violent upper abdominal pain with nausea occurring within hours after ingesting raw fish such as sushi may suggest which parasitic infection? A. Capillariasis C. Trichuriasis B. Angiostrongyliasis D. Anisakiasis P. 1323 ___A___54. This parasitic infection can be acquired from ingestion of raw fish and presents with abdominal pain, diarrhea and a severe wasting syndrome: A. Capillariasis C. Trichuriasis B. Angiostrongyliasis D. Anisakiasis P. 1323 ___D___55. Ascariasis can be treated with which of the following? A. Albendazole B. Pyrantel pamoate C. Ivermectin D. All of the above TABLE P. 1320 ___B___56. Treatment of choice for ascariasis during pregnancy: A. Albendazole B. Pyrantel pamoate C. Ivermectin D. Mebendazole p. 1320 ___C___57. Lymphatic filariasis is usually caused by this nematode species: A. Loa loa B. Mansonella ozzardi C. Brugia malayi D. Onchocercal volvulus p. 1324

___A____58. The treatment of choice for lymphatic filariasis: A. Diethylcarbamazine B. Ivermectin C. Pyrimethamine/ Sulfadiazine D. Praziquantel P. 1326 ___D____59. Neurocysticercosis, which can be a cause of seizures, is due to what type of parasitic infection? A. Diphyllobothriasis B. Hymenolepiasis C. Fascioliasis D. Taeniasis (solium) p. 1337 ___C____60. Treatment of choice for taeniasis: A. Diethylcarbamazine B. Ivermectin C. Praziquantel D. Pyrimethamine/ Sulfadiazine P. 1338 MATCHING: ___C__61. Taenia solium ___E__62. Schistosoma japonicum ___B__63. Paragonimus westermani ___K__64. Schistosoma hematobium ___J __65. Diphyllobothrium latum ___H__66. Ascaris lumbricoides ___A__67. Ancylostoma sp. ___F__68. Trichuris trichiura ___G__69. Brugia malayi ___D__70. Toxoplasma gondii

A. Cutaneous larva migrans B. Endemic hemoptysis C. Cerebral cysticercosis D. Congenital infection E. Presinusoidal cirrhosis F. Rectal prolapse G. Lymphatic filariasis H. Lofflers syndrome I. Blackwater fever J. Megaloblastic anemia K. Bladder carcinoma

*********************** ___I __71. AIDS A. Mebendazole ___K__72. Disseminated candidiasis B.Pyrimethamine/sulfadiazine ___D__73. Taeniasis C. Doxycycline ___H__74. Malaria D. Praziquantel ___G__75. Giardiasis E. Diethylcarbamazine (DEC) ___F__76. Mycobacterium avium complex F. Azithromycin ___B__77. Toxoplasmosis G. Metronidazole ___L__78. Cytomegalovirus H. Artemisinin ___A__79. Enterobiasis I. Zidovudine ___E__80. Filariasis K. Amphotericin B ___C__81. Lymphogranuloma venerium L. Gancyclovir

TRUE OR FALSE:
FACTORS INDICATING A POOR PROGNOSIS IN SEVERE FALCIPARUM MALARIA: ___T__82. Marked agitation ___F__83. Hyperthermia (>40 C) (hypothermia <36.5 C)

___F__84. Hyperglycemia (hypoglycemia) ___T__85. Hyperventilation

TABLE p.1284

REGARDING CANDIDIASIS: ___F___86. Candida is a normal human commensal, particularly in the skin, mouth, stool and vagina. (not normally found in the stool) ___F___87. HIV infection is an independent risk factor for vulvovaginal thrush. (for oral candidiasis) ___T___88. Recovery of Candida from sputum is almost never indicative of underlying pulmonary candidiasis and by itself does not warrant antifungal treatment. ___F___89. The diagnosis of Candida infection is established by demonstrating fungal elements with a spaghetti and meatballs appearance. (hyphae and pseudohyphae; spaghetti and meatballs appearance is seen in tinea versicolor) ___T___90. Candida albicans sepsis usually occurs as a complication of intravascular catheter infection. pp. 1254-1256

END OF MODULE
CAUTION: ALL RIGHTS RESERVED. THIS DOCUMENT IS PROTECTED BY COPYRIGHT. NO PART OF THIS DOCUMENT MAY BE REPRODUCED IN ANY FORM OR BY ANY MEANS, INCLUDING PHOTOCOPYING, WITHOUT WRITTEN PERMISSION FROM PCP SOUTHERN LUZON CHAPTER.