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Past papers 3 Flashcards

1
Q

A 2 month old child brought for routine vaccinations. What is reason to not give full normal vaccination?

a. Coryzal illness and temp 36.5
b. Born prematurely at 34 weeks
c. Older brother just been diagnosed with leukaemia
d. Sister just developed chickenpox
e. Father has epilepsy

A

Older brother just been diagnosed with leukaemia

  • Minor illnesses
    without fever or systemic upset are not valid reasons to postpone immunisation. If an
    individual is acutely unwell (for example with a fever above 38.5 C), immunisation may be
    postponed until they have fully recovered. This is to avoid wrongly attributing any new
    symptom or the progression of symptoms to the vaccine.
  • premature birth is not a contraindication. In fact, they gain more benefit from immunisation
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2
Q

Flu vaccine not indicated for-

COPD
CCF
Inflammatory bowel disease
Asplenia

A

Inflammatory bowel disease

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3
Q

Following is true about Bordetella:

Polymorphonuclear leucocytosis seen during infection

can be clinically diagnosed initially within days of onset

organism isolated from throat for several days following infection

vaccine gives life long immunity

tetracycline effective in paroxysmal stage

A

Polymorphonuclear leucocytosis seen during infection

Cattharal phase last 1-2 weeks, before paroxysmal stage. Need to give doxycycline in first 21 days to reduce symptoms

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4
Q

Child with leukaemia on chemotherapy. Due for a polio booster. Method for immunisation:

OPV
IPV
don’t vaccinate, just protect from food borne viruses
vaccinate family members with OPV
give immunoglobulin for polio
A

IPV

OPV - live virus

don’t vaccinate, just protect from food borne viruses - this is impossible

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5
Q

A. Recombinant vaccine produced in a yeast
B. Vaccine which stimulates antibodies against capsular polysaccharides
C. A skin lesion 4-6 weeks following vaccination means successful vaccination
D. Vaccine containdicated in eczema
E. Idiopathic thrombocytopenic purpura is a rare but recognised complication of this vaccine

i. Meningococcus C
ii. BCG
iii. MMR
iv. DPT
v. Influenza
vi. Small pox
vii. Yellow fever
viii. HBV vaccine

A

A. Recombinant vaccine produced in a yeast
HBV

B. Vaccine which stimulates antibodies against capsular polysaccharides
Meningococcus C

C. A skin lesion 4-6 weeks following vaccination means successful vaccination
BCG
Smallpox?

D. Vaccine containdicated in eczema
smallpox

E. Idiopathic thrombocytopenic purpura is a rare but recognised complication of this vaccine
MMR

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6
Q

Baby born to mother with chickenpox – baby is 1 day old. No details as to when mother developed VZV. What prophylaxis for baby?

A

VZIG

No time for IgG to cross-placenta, so baby at risk.

If baby had chickenpox, would give aciclovir

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7
Q

A 6 yr old boy is bitten by a dog whilst on holiday in India. His parents bring him home and he presents to A+E 6/7 after the bite. Best management is:

  • Rabies vaccination
  • Human immune globulin and rabies vaccination
  • Immune globulin only
  • Ribavirin
A

Human immune globulin and rabies vaccination

infiltrate immunoglobulin in wound, and any left over give IM

Do not give immunoglobulin if more than 7 days have elapsed after the first dose of vaccine, or more than 1 day after the second dose of vaccine.

Patients presenting for rabies PEP even months after having beenbitten should be treated as if the contact had recently occurred

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8
Q 
HBIG
HBIG and hep B vaccination
High dose hep B vaccination
VZIG
VZIG plus vaccination
VZV vaccination
HNIG
Do nothing
  1. Baby of hep B eAg positive mother
  2. Neonate whose mother develops chickenpox 2 days post delivery
  3. Non-immune pregnant woman in contact with measles
  4. CRF patient, not currently on dialysis but who will be commencing dialysis in the near future
  5. Non-pregnant paediatric nurse, is not varicella immune, who has been looking after her mother with ophthalmic zoster
A
  1. Baby of hep B eAg positive mother
    HBIG and hep B vaccination
  2. Neonate whose mother develops chickenpox 2 days post delivery
    VZIG
  3. Non-immune pregnant woman in contact with measles
    HNIG
  4. CRF patient, not currently on dialysis but who will be commencing dialysis in the near future
    High dose hep B vaccination
  5. Non-pregnant paediatric nurse, is not varicella immune, who has been looking after her mother with ophthalmic zoster
    VZV vaccination
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9
Q

Which of the following vaccines are given at 12-15 months to prevent interference with maternal antibodies?

  • BCG
  • MMR
  • DPT
A

MMR

DPT given at 8/12/16 weeks old

BCG given teenager - now no longer given

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10
Q

If a person is repeatedly HepBsAg pos, HepBeAg pos, IgM core antibody negative and IgG core antibody negative, they are what?

Acute infection
Carrier
Vaccinated

A

Acute infection

or my have chronic infection, but be immunocompromised

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11
Q

What is vector for yellow fever?

Anopheles
Aedes aegypti
Sandfly

A

Aedes aegypti

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12
Q

What is the vector for epidemic Typhus?

  • Xenopsylla cheopis
  • Aedes Aegypti
  • Pediculus humanus
A

pediculus humanus - body louse

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13
Q

What is the vector for bubonic plague?

  • Xenopsylla cheopis
  • Aedes Aegypti
  • Pediculus humanus
A

Xenopsylla cheopis is rat flea - transmit bubonic plague

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14
Q
  1. Ixodes tick
  2. Aedes mosquito
  3. Anopheles mosquito
  4. Reduvid bug
  5. Mastomys rat
  6. Human louse
  7. Tse tse fly
  8. Culex mosquito
  9. Sandfly
  10. A Brazilian with Megaoesophagus
  11. A patient with malaria
  12. A 40 yr old Ugandan woman at Lake Victoria with progressive illness, now in coma
  13. A person hiking in USA with centrifugal rash on leg.
A
  1. A Brazilian with Megaoesophagus
    Reduviid bug
  2. A patient with malaria
    Anopheles mosquito
  3. A 40 yr old Ugandan woman at Lake Victoria with progressive illness, now in coma
    Tsetse fly - African trypanosomiasis
  4. A person hiking in USA with centrifugal rash on leg.
    Ixodes tick

Mastomys rat - transmits Lassa

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15
Q

Which statements are true -

Dengue virus infection result from bites by Aedes mosquitoes

Cases of dengue haemorrhagic fever usually result from reinfection by a different serotype of dengue virus

Pigs act as the reservoir for dengue virus

Yellow fever is prevalent throughout Asia

Yellow fever may be prevented by vaccination

A

Dengue virus infection result from bites by Aedes mosquitoes T

Cases of dengue haemorrhagic fever usually result from reinfection by a different serotype of dengue virus T

Pigs act as the reservoir for dengue virus F

Yellow fever is prevalent throughout Asia F although Aedes mosquito is there

Yellow fever may be prevented by vaccination T

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16
Q
  1. Which one of these has an animal reservoir?

Dengue
EBV
S. epidermidis
Yellow Fever

A

Dengue - monkeys act as reservoir in sylvatic life cycle

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17
Q

The following is true of rabies virus -

The majority of cases worldwide result from bat bites

Infection may be prevented by active and passive immunisation

Rabies vaccine is a live attenuated vaccine

The animal reservoir differ from country to country

May be diagnosed by serology

A

The majority of cases worldwide result from bat bites F

Infection may be prevented by active and passive immunisation T

Rabies vaccine is a live attenuated vaccine F

The animal reservoir differ from country to country T

May be diagnosed by serology F

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18
Q

Which viruses are not routinely grown in culture

A ADV
B Echo
C Parvo
D HSV
E Flu A
A

Parvovirus B19

Viral culture is a laboratory technique in which samples of a virus are placed to different cell lines which the virus being tested for is able to infect. If the cells show changes, known as cytopathic effects, then the culture is positive

Viruses grown in culture -
adenovirus, cytomegalovirus, enteroviruses, herpes simplex virus, influenza virus, parainfluenza virus, rhinovirus, respiratory syncytial virus, varicella zoster virus, measles and mumps.

Molecular testing has replaced viral culture. But culture still required in certain circumstances e.g unknown pathogen

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19
Q

Detergent has been swapped for sodium hypochlorite, which virus is the most likely to have survived?

Influenza
Hep A
HIV

A

HAV

Influenza/ HIV are enveloped viruses

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20
Q

A. Binds to 30s ribosome and inhibits peptide chain elongation
B. Activated by thymidine kinase and inhibits viral DNA polymerase
C. Binds to 50s ribosome and inhibits peptide chain elongation
D. Binds to 30s and causes misreading of mRNA codons
E. Inhibits viral reverse transcriptase

i. Tetracycline
ii. Gentamicin x
iii. Ciprofloxacin x
iv. Amantadine
v. Linezolid
vi. Acyclovir x
vii. Erythromycin x
viii. Zidovudine x

A

A. Binds to 30s ribosome and inhibits peptide chain elongation
Tetracyclines

B. Activated by thymidine kinase and inhibits viral DNA polymerase
Aciclovir

C. Binds to 50s ribosome and inhibits peptide chain elongation
Linezolid

D. Binds to 30s and causes misreading of mRNA codons
Gentamicin - aminoglycosides

E. Inhibits viral reverse transcriptase
Zidovudine

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21
Q

Why are prion diseases not classified as viruses?

What is a viroid?

A

Prion - a self-propagating misfolded conformer of a protein that is responsible for a number of diseases that affect the brain and other neural tissue

Prions consist solely of protein, with no enclosed nucleic acid - no genes of RNA/ DNA. Thus, they are definitely not viruses despite sharing the superficial properties of size and infectiousness.

Viroid - plant pathogens that consist of just a short section of RNA, but without the protein coat typical of viruses

22
Q

4yrs old child from Kenya presents with 3 months history of chicken pox unresponsive to acyclovir.

Next step:

check HIV status
EM from skin lesions
Specifics IF for VZV
resistance testing for acyclovir

A

resistance testing for acyclovir

The genetic support of acyclovir resistance is often a single mutation in the viral thymidine kinase (TK) gene, which is required to phosphorylate acyclovir to acyclovir monophosphate

Even if HIV positive, would expect response to aciclovir

23
Q

A. Enveloped, icosahedral DNA virus, grows in many cell lines
B. Non enveloped positive sense RNA virus, grows easily
C. Slow growing DNA virus in fibroblast cell lines, narrow host range
D. Small DNA virus, grows in Cells in S phase
E. Enveloped icosahedral RNA virus, not much CPE

i. Rubella
ii. CMV
iii. Influenza
iv. Polio
v. HHV-6
vi. HSV
vii. VZV
viii. Parvovirus

A

A. Enveloped, icosahedral DNA virus, grows in many cell lines
HSV

B. Non enveloped positive sense RNA virus, grows easily
Polio - icosahedral, but non-enveloped

C. Slow growing DNA virus in fibroblast cell lines, narrow host range
VZV

D. Small DNA virus, grows in Cells in S phase
Parvovirus B19

E. Enveloped icosahedral RNA virus, not much CPE
Rubella

24
Q 
Basic virology
a-	Adeno virus
b-	Vaccinia virus
c-	Influenza virus 
d-	Parvo virus
e-	Papova virus (Papillomaviridae and Polyomaviridae) 
f-	Paramyxo virus
g-	Reo virus
  • ve sense SS RNA virus with 8 segments
  • circular double stranded DNA virus
  • linear double stranded DNA virus
  • double stranded RNA virus
A

-ve sense ssRNA virus with 8 segments
Influenza

-circular double stranded DNA virus
Papova viruses (Papillomaviridae and Polyomaviridae)

-linear double stranded DNA virus
adenovirus
vaccinia

-double stranded RNA virus
Reovirus

Parvovirus has linear single stranded DNA
Paramyxovirus is -ssRNA virus

25
Q

Which virus grows best in human fibroblasts?

VZV
HBV
HCV
rhinovirus

A

VZV

26
Q

Virus grows in MRC 5 cells, at 33°C.
Acid labile

What is the virus?

A

Rhinovirus

lower temperature - URTI

27
Q

Why is vaccinia unique amongst DNA viruses?

A

Replicates in cytoplasm, whereas every other virus replicates in nucleus

28
Q

What is a virus quasi-species?

A

A quasispecies is a well-defined distribution of mutants that is generated by a mutation-selection process

population structure of viruses with a large numbers of variant genomes (related by mutations). Quasispecies result from high mutation rates as mutants arise continually and change in relative frequency as viral replication and selection proceeds.

29
Q

44 Some infectious organisms may have ‘quasi species’ as an evasion strategy, one organism to employ this method of host immune evasion is

A HDV
B HAV
C HCV
D CMV

A

HCV - genotypes

other examples -
HBV
HIV - HIV 1 and HIV 2
influenza
flaviviruses (HCV)

More commonly seen in RNA viruses, as they have higher replication rates, and higher mutation rates

30
Q

An 18 year old woman with viral meningitis has CSF sent for cell culture.
After 5 days, a dramatic CPE is seen in MRC5, monkey kidney and
Fibroblast lines. What is the most likely cause?

Enterovirus 71
Echovirus 11
Mumps virus
HSV

A

Echovirus

31
Q

A four year old child with diarrhoea for several days has stool taken for
EM. Numerous 75nm icosahedral particles are seen.

Rotavirus
Enteric adenovirus
Norovirus
Astrovirus
Calicivirus
A

rotavirus

32
Q
  1. Last antibody to be detected following EBV infection
A  EBV IgA
B Heterophil 
C IgM capsid
D IgG nuclear protein
E IgG capsid
A

D IgG nuclear protein - EBNA

33
Q

Farmer with wound.

Microscopy shows GNR,
growing aerobically

What is potential organism?

A 
Burkholderia
Brucella
Francisella
Bordetella
Legionella
Pseudomonas
34
Q
  1. A young surfer develops a wound on forearm. Microscopy shows a GNR.

a. V. vulnificus
b. M. marinum
c. Spirillum
d. Erysipelothrix
e. V. parahaemolyticus

A

vibrio vulnifucus

V. parahaemolyticus - causes GI illness

35
Q
  1. Lab importance of deoxycholate
    a. Faecal coliform count
    b. salmonella culture
    c. select salmonella/shigella
    d. E coli selection
A

For enteric pathogens

Particularrly with salmonella species

36
Q
  1. Management of leprosy

a. dapsone + Rifampicin
b. rif/ isoniazid and pyrazinamide
c. dapsone and isoniazid
d. quinolone and isoniazid

A

Dapsone and rifampicin
+/- clofazimine

for 6-12 months depending if paucibacillary or multibacillary leprosy

37
Q
  1. Infection that requires an intermediate snail host.

a. schistosomiasis
b. Echnococcus
c. T solium
d. W bancroftii

A

schistosomiasis

38
Q
  1. A person returns from Africa with plasmodium falciparum. The parasitaemia count is 2.5 %. What should be his treatment regimen be?
A

Parasite count >5% is severe

Non-severe
- artemether/ lumefantrine 4 tablets at 0, 8, 24, 36, 48 and 60 h

  • Atovaquone-proguanil
  • quinine + doxycycline
39
Q
  1. There is only one UVC theatre and the surgeons are squabbling. Which procedure should take place in the theatre based on evidence?

a. VP shunt
b. Hip replacement
c. CABG
d. Central line in a neutropenic patient
e. Meningioma removal

A

?

40
Q
  1. What distinguishes vCJD from CJD?

a. Invariable death
b. Diagnosis at older age
c. Long clinical course
d. prions in tonsil

A

Classic (sporadic) CJD diagnosed median age 68
Variant CJD diagnosed median age 28

CJD falls into four categories: 
sporadic (classic) -85% of case total
variant
familial
iatrogenic
41
Q

Why are prions not classified as viruses?

A

No nucleic acid

42
Q
  1. a man develops a painful penile ulcer on return from a trip to Thailand. There is GNR on microscopy.

What is the organism

A

Haemophilus ducreyi - chancroid

43
Q
  1. In a CAT 3 lab. Only one is mandatory

a. Shiny wooden bench
b. HEPA filter
c. Disposable loops
d. Containment shower
e. Sealed for fumigation

A

sealed for fumigation?

44
Q
  1. In a CAT 3 room, a spillage must be cleaned with

a. 10000ppm of chlorine
b. Water and detergent
c. Heat at 60 C

A

10000ppm of chlorine

45
Q
  1. This sample should be worked up in the Cat 3

a. HIV + blood
b. PUO from Thailand
c. Influenza
d. Sputum from man with cough and night sweats.

A

TB?

Although PUO from Thailand could be melioidosis

46
Q

17.A Young child attends clinic for a Influenza vaccine. What would prevent the child from having the vaccine?

a. epilepsy
b. cystic fibrosis
c. congenital heart disease
d. egg allergy

A

egg allergy

47
Q
  1. the haematology department are setting up a travel vaccine protocol for a man one year after his BMT. What vaccine should he not have.

a. Hep A
b. Typhoid(whole cell)
c. Yellow fever
d. Diphtheria
e. Meningococcal

A

yellow fever - live vaccine

48
Q
  1. A patient with Chronic granulomatous disease has recurrent staph infection. What is the mechanism

a. chemotaxis inhibition
b. oxidase
c. lack of c3d receptor
d. Failure of phagollysosome fusion

A

Failure of phagollysosome fusion - do not produce hydrogen peroxide

49
Q

20.Which infection is associated with least human- human transmission?

a. Q fever
b. Leprosy
c. Salmonellosis
d. Pertussis

A

Q fever

50
Q
  1. C Psittaci diagnosis should be obtained by

a. PCR
b. Sputum culture
c. Sputum PCR
d. Blood culture
e. Clotted serology
f. EDTA PCR

A

Sputum PCR?

Question Bank (33 decks)

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