MMID Exam 1 October 9 2003

Question 1 - Single Best Answer

Highly Active Anti-Retroviral Therapy (HAART) consists of which of the following?

A) cocktail of drugs includes immune modulators to stimulate a more effective Th-2 response
B) cocktail of drugs that includes antivirals and peptides that block gp120-mediated cell entry
C) cocktail of antivirals that can reduce viral load and eventually clear the infection
D) cocktail of antivirals that can reduce viral load and slow down the progression to drug resistance

Question 2 - Single Best Answer

Which of the following would be a requirement for BSE to cause nvCJD in humans?

A) Cattle would have to have been fed rendered by-products
B) The human recipient would need to have a predisposing mutation in their PrP in order to be predisposed to infection with BSE
C) The recipient would had to have eaten improperly cooked meats.
D) The prion must have a mechanism to be transported from the gut to the CNS.

Question 3 - Single Best Answer

Papillomavirus induced cervical carcinoma is usually characterized by

A) infection with high risk human papillomaviruses (HPV) such as HPV16 and HPV18
B) increased expression of the viral oncogenes E6 and E7
C) integration of viral DNA into cellular chromosomal DNA
D) disruption of the viral E2 transcriptional transactivator gene
E) all of the above

Question 4 - Single Best Answer

Acute hepatitis A infection diagnosis is made by the presence of:

A) IgM antibody to Hepatitis A antigen
B) IgG antibody to Hepatitis A antigen
C) All of the above
D) None of the above

Question 5 - Single Best Answer

EBV mononucleosis is transmitted by ____________and diagnosed by _____________.

A) saliva, atypical lymphocytes
B) fecal-oral transmission, heterophile antibody+
C) sexual transmission, monospot+
D) sexual transmission, atypical lymphocytes
E) saliva, antibodies to sheep red blood cells

Question 6 - Single Best Answer

The appearance of Koplik spots in measles is due to which of the following viral proteins?

A) G
B) H
C) F
D) N
E) HN

Question 7 - Single Best Answer

In the years following the introduction of Myxoma in Australia to curb the rabbit population, which of the following were observed?

A) the myxoma virus became more virulent and the rabbits became more resistant
B) the myxoma virus became less virulent and the rabbits became more resistant
C) the myxoma virus became less virulent and the rabbits became less resistant
D) the myxoma virus became more virulent and there was no change in the rabbit susceptibility
E) the myxoma virus became less virulent and there was no change in the rabbit susceptibility

Question 8 - Single Best Answer

Steroids are sometimes given for EBV mononucleosis. This is done

A) if there is airway blockage
B) to reduce the fever
C) to counteract the interferon
D) to prevent bacterial superinfection

Question 9 - Single Best Answer

Which of the following is a component of every virus?

A) RNA
B) DNA
C) lipid
D) carbohydrate
E) protein

Question 10 - Single Best Answer

The most important thing for a child with fever, diarrhea, and high urine specific gravity is to

A) diagnose the cause of the diarrhea
B) give antibiotics for the concurrent urinary tract infection
C) rehydrate, either orally or intravenously
D) give aspirin to reduce the fever
E) give peptobismol for comfort, the infection is self limiting

Question 11 - Single Best Answer

The term „positive strand RNA¾ refers to

A) genomic viral RNA that is mRNA like in its nucleotide sequence
B) genomic viral RNA that is the reverse complement of mRNA
C) any RNA that can serve as a template for RNA replication
D) any viral RNA that is packaged into a virus particle.
E) any viral RNA that is transcribed from a DNA template.

Question 12 - Single Best Answer

Risk factors for rotavirus diarrhea are

A) under 5 years, cruise ships
B) under 5 years, malnutrition
C) daycare centers, unpasteurized milk
D) malnutrition, adults
E) adults, cruise ships

Question 13 - Single Best Answer

From what source would you attempt to obtain a patient sample for culture of HIV?

A) throat swab
B) stool sample
C) blood
D) urine
E) Kaposi¼s sarcoma biopsy

Question 14 - Single Best Answer

Hepatitis viruses that are spread via the fecal-oral route, through contaminated food and water, can also be spread via sexual transmission.

A) true
B) false

Question 15 - Single Best Answer

Which of the following viruses would be LEAST stable in the environment?

A) human JC polyomavirus
B) human papillomvirus 16 (HPV16)
C) influenza virus
D) human parvovirus B19
E) poliovirus

Question 16 - Single Best Answer

The dark urine in viral hepatitis is a result of

A) breakdown of the RBC¼s in the liver
B) breakdown of the hepatocytes releasing unconjugated bilirubin
C) decrease in the excretion of conjugated bilirubin via the bile
D) increase in the production of conjugated bilirubin in the hepatocytes

Question 17 - Single Best Answer

Which of the following viruses have a killed virus vaccine currently used for prevention of disease?

A) hepatitis C virus
B) rotavirus
C) measles
D) Norwalk virus
E) hepatitis A virus

Question 18 - Single Best Answer

Which of the following quantities represents a measure of only infectious virus?

A) TCID50
B) pfu/ml
C) LD50
D) ffu/ml (focus forming units per ml)
E) all of the above

Question 19 - Single Best Answer

A child with a runny nose, slight cough, and a mild conjunctivitis but no white spots visible on the buccal mucosa and no rash MOST likely has

A) Koplik spot negative measles
B) German measles
C) a cold
D) B19 viral infection
E) croup

Question 20 - Single Best Answer

It is estimated that 2/3 of HSV-2 infections result from exposure to which of the following?

A) dirty toilet seats
B) a lesion (chancre)
C) asymptomatic partner
D) contaminated water
E) dirty needles

Question 21 - Single Best Answer

Which of the following is true?

A) rhinoviruses are good candidates for vaccine development
B) Coxsackie B virus is the causative agent of herpangina
C) translation of the genome of poliovirus is the first step in reproduction after uncoating of the virus in infected cells
D) most picornavirus infections are symptomatic
E) poliovirus is not shed in feces during asymptomatic infections

Question 22 - Single Best Answer

A 55-year-old male citizen of Mexico who arrived a month ago to visit his son and daughter-in-law in Florida for the summer, was evaluated at an urgent-care center for a 7-day history of increasing pain in his left arm, chest and shoulder. He also complained of sore throat, anxiety, insomnia, nausea and vomiting. He said he had received a bite from a cat on his arm and that the pain had started after that. He was transferred to the hospital and treated for chest pain, but evaluation ruled out cardiac disease and pneumonia. He rejected all oral fluids and continued to complain of the pain. He was sent to the mental health unit where he was noted to be anxious and have impaired memory. He also tried to bite the therapist. He was diagnosed with anxiety disorder and given tranquilizers and discharged. The next day he couldn¼t breathe and was given mouth-to-mouth resuscitation by his daughter. He died shortly thereafter. His daughter should be counseled to

A) watch for signs of EBV
B) take amantadine to prevent influenza
C) get anti-rabies shots
D) allow his corneas to be used for corneal transplants

Question 23 - Single Best Answer

What step in replication do all viruses have in common?

A) entry into cells via endocytotic vesicles.
B) DNA replication
C) synthesis of (-)strand RNA from (+)strand RNA
D) synthesis of mRNA
E) budding from the plasma membrane

Question 24 - Single Best Answer

Which of the following two human herpesviruses are causally associated with lymphomas?

A) Herpes simplex virus 1 and 2
B) EBV and KSHV
C) Cytomegalovirus and Epstein-Barr virus
D) HHV-6 and HHV-7
E) EBV and HHV-6

Question 25 - Single Best Answer

Complications from influenza infection include

A) diarrhea
B) conjunctivitis
C) hemorrhagic cystitis
D) skin rash
E) secondary bacterial infection and pneumonia

Question 26 - Single Best Answer

Which of the following is not a characteristic of a human equilibrium virus?

A) can maintain a infection chain in humans
B) no contemporary animal reservoirs
C) tends to have a low level of virulence in humans
D) stable relationship with the human host
E) like HIV, is able to persist for years before it kills the host

Question 27 - Single Best Answer

Resolved hepatitis B infection diagnosis is made by the presence of:

A) Core antigen (HBcAgA)
B) HBxAg
C) IgG antibody to Hepatitis B core antigen (HBcAb) in the presence of Hepatitis B surface antibody (HBsAb)
D) All the above
E) None of the above

Question 28 - Single Best Answer

Which of the following best describes the composition of the HIV provirus?

A) enveloped capsid with two virion RNA molecules associated with the reverse transcriptase
B) partially assembled capsid with two virion RNA molecules and associated reverse transcriptase awaiting envelopment
C) capped and polyadenylated RNA genome awaiting reverse transcription
D) double-stranded cDNA containing a single LTR preparing to integrate
E) integrated double-stranded cDNA containing two LTRs

Question 29 - Single Best Answer

A child with a barking cough and stridor almost certainly has

A) measles
B) rabies
C) croup
D) influenza
E) a cold

Question 30 - Single Best Answer

Mumps, polio, yellow fever, and Coxsackie viruses all have in common which of the following stages in infection?

A) viremia
B) fecal/oral route of infection
C) infection by bite of insect
D) final target organ
E) sexually transmitted

Question 31 - Single Best Answer

Which of the following viruses would you most likely find latent in sacral ganglia?

A) HSV-1 and HHV-8
B) HSV-2 and VZV
C) HHV-8 and EBV
D) HIV and HHV-6
E) HHV-6 and HHV-7

Question 32 - Single Best Answer

The symptoms in croup are thought to be due to

A) an immune reaction
B) denuding of the ciliated respiratory epithelium
C) infection of the tonsils
D) a superinfecting bacteria
E) production of interferon

Question 33 - Single Best Answer

What is a disadvantage of the Sabin live poliovirus vaccine?

A) it is safe for administration to immunodeficient patients
B) the ease of administration
C) there is the induction of secretory IgA
D) the virus can revert to wild type during replication in humans
E) it does not give lifelong immunity

Question 34 - Single Best Answer

Which of the following viruses would you predict show the LEAST genetic variation over time?

A) smallpox virus
B) rhinovirus
C) yellow fever virus
D) rubella virus
E) Influenza virus

Question 35 - Single Best Answer

Mr. Jones had had a slight fever, muscle aches, and a cough for a day or so when he suddenly became profoundly tired and went to bed for three days. He was just starting to feel better when his symptoms returned, even worse than before. He also noticed that his sputum was a funny darkish color. He now almost certainly has

A) influenza rhinotracheitis following a cold
B) influenza viral pneumonia
C) bacterial pneumonia
D) infectious mononucleosis
E) hepatitis

Question 36 - Single Best Answer

Human papillomaviruses are transmitted by

A) the respiratory route
B) the oral fecal route
C) insect vectors
D) direct contact through breaks in the skin
E) all of the above

Question 37 - Single Best Answer

Rotavirus infection

A) has a long incubation period
B) is a major cause of death in developed countries
C) results in the release of large amounts of virus during diarrhea
D) is asymptomatic in infants and symptomatic in adults
E) causes fusion of infected cells

Question 38 - Single Best Answer

Which of the following is not true regarding Ebola virus?

A) closely related to Marburg virus
B) long prodromal period
C) a filovirus
D) non-equilibrium virus in humans
E) a very high lethality rate in humans

Question 39 - Single Best Answer

A hemagglutination inhibition assay is used for what purpose?

A) to quantify virus particles
B) to quantify virus infectivity
C) to measure the presence of viral antigen in patient serum.
D) to measure the presence of viral nucleic acid in patient serum
E) to quantify antiviral antibodies in patient serum

Question 40 - Single Best Answer

A young woman develops fever, chills, and myalgia, headache and a stiff neck following a first episode of genital lesions. Which of the following tests would routinely be done?

A) blood test for HHV 1 virus
B) CSF analysis for possible meningitis
C) CAT scan for possible tumor
D) serological test for HHV2
E) viral culture of vaginal swab

Question 41 - Single Best Answer

A 21 year old patient presents with a papular rash that developed two days after the onset of fever (101öF). Two days later the papules become more pustular. All are at relatively the same stage of development and are umbilicated. The rash is also present on the palms. Based on this presentation you suspect which of the following?

A) Chickenpox
B) Smallpox
C) Measles
D) Roseola
E) Cowpox

Question 42 - Single Best Answer

Influenza virus replication

A) involves a DNA intermediate
B) uses the host RNA polymerase for synthesis of the coding regions of viral mRNA
C) uses the host poly(A) polymerase for polyadenylation of viral mRNA
D) involves release of virus by lysis of infected cells
E) takes place in the cell nucleus

Question 43 - Single Best Answer

Rotavirus, rabies virus, and parainfluenza virus all have in common which of the following virion features?

A) positive strand, single stranded RNA
B) an RNA dependent RNA polymerase packaged in the virion
C) an envelope
D) glycoprotein spikes
E) DNA genome

Question 44 - Single Best Answer

Synthesis of human papillomavirus capsid proteins occurs

A) in the upper spinous layers of the epithelium
B) in the lower spinous layers of the epithelium
C) in suprabasal epithelial cells
D) in basal squamous epithelial cells
E) in all of the above

Question 45 - Single Best Answer

In addition to reverse transcriptase and RNase activities, HBV requires which of the following to initiate replication of it¼s genome?

A) Viral P protein
B) tRNA
C) delta antigen
D) intact LTRs
E) poly purine tract

Question 46 - Single Best Answer

A fomite is

A) any substance capable of adsorbing and retaining contagious particles
B) the primary site of virus replication
C) a route of spread of infection from a primary site to a secondary site.
D) a non-infectious defective virus genome that causes recurring late stage disease
E) a live attenuated virus used for immunization

Question 47 - Single Best Answer

Adenovirus infection causes

A) acute respiratory disease
B) gastroenteritis
C) keratoconjunctivitis
D) hemorrhagic cystitis
E) all of the above

Question 48 - Single Best Answer

Which of the following viruses causes pleurodynia with fever and extreme thoracic and pleuritic chest pain?

A) echovirus
B) Coxsackievirus A
C) Norwalk virus
D) poliovirus
E) Coxsackievirus B

Question 49 - Single Best Answer

The finding that HBV genomes are integrated into the genomes of many PHC tumors has implicated integration as a promoter of this disease. What other factor related to chronic HBV infection is likely a co-factor of HBV oncogenesis?

A) viral oncogene
B) HbSAg
C) chronic inflammation
D) IgM anti-Hbc

Question 50 - Single Best Answer

The human parvovirus B19

A) packages an RNA polymerase in the virion
B) requires co-infection with adenovirus for productive replication
C) replicates only in non-dividing cells
D) spreads within the body via nervous tissue
E) can cause a life threatening aplastic crisis in a patient with chronic hemolytic anemia

Question 51 - Single Best Answer

Many retroviruses encode specialized proteins that augment their pathogenic program in certain hosts. Which of the following statements accurately describes the role of HIV¼s nef gene?

A) promoter/enhancer
B) envelope protein
C) alteration of cell activation signals
D) capsid protein
E) viral oncogene

Question 52 - Single Best Answer

A central difficulty in developing an effective vaccine for AIDS is that?

A) HIV does not elicit a strong humoral response
B) killed HIV vaccines have poor efficacy
C) the body does not normally mount a cellular response to HIV infection
D) there are too many HIV serotypes to ever target sufficiently with vaccines

Question 53 - Single Best Answer

Which of the following vaccines have the potential to shed as live virus into the environment?

A) VZV (Oka)
B) Polio (Salk)
C) Hepatitis B (subunit)
D) Influenza (injection)

Question 54 - Single Best Answer

The human polyomavirus BK

A) packages an RNA polymerase in the virion
B) causes progressive multifocal leukoencephalopathy in immunocompromised patients, notably AIDS patients
C) establishes a common, lifelong, asymptomatic persistent infection in kidneys
D) spreads within the body via nervous tissue
E) can cause a life threatening aplastic crisis in a patient with chronic hemolytic anemia

Question 55 - Single Best Answer

Which of the following is a NOT a serious concern regarding reinstating universal vaccination against Smallpox?

A) postvaccinia encephalitis
B) severe reactions in the immunocompromised
C) spread of the vaccinia from healthy vaccinees to immunocompromised family members and co-workers
D) reversion of vaccinia to a more virulent form of virus (like Smallpox)
E) generalized vaccinia

Question 56 - Single Best Answer

Which virus infects and causes disease in infants in the face of maternal antibody?

A) mumps
B) poliovirus
C) respiratory syncytial virus
D) measles
E) rubella

Question 57 - Single Best Answer

Considering all virus infections collectively, what is the most common pattern of infection?

A) unapparent, that is, no clinical symptoms
B) acute infection.
C) latent infection
D) persistent infection
E) chronic infection

Question 58 - Single Best Answer

Treatment success is unreliable, serious chronic liver disease is recognized, vaccine is not available and therefore avoiding infection by universal precautions is particularly important for:

A) Hepatitis A
B) Hepatitis B
C) Hepatitis C
D) Hepatitis D
E) Hepatitis E
F) All the above
G) None of the above

Question 59 - Single Best Answer

The influenza virus vaccine

A) is a live virus vaccine containing influenza B and C types, which confer cross protection against influenza A
B) formulation must be reconsidered each year to account for emergence of new influenza A strains
C) is a subunit vaccine consisting of three different hemagglutinin molecules expressed in yeast using recombinant DNA technology
D) is grown in a continuous line of African green monkey kidney cells
E) none of the above

Question 60 - Single Best Answer

A 32-year old male with a history of i.v. drug use presents with fever, malaise, and jaundice. Lab results indicate liver enzymes are elevated and suggest Hepatitis B as a cause. Which of the following is diagnostic of an acute Hepatitis B infection?

A) HbSAg
B) Dane particle
C) IgM anti-Hbc
D) anti-Hbe
E) Hbe

Question 61 - Single Best Answer

Which of the following viruses can cause orchitis, parotitis and asceptic meningitis?

A) rubella
B) mumps virus
C) respiratory syncytial virus
D) Norwalk virus
E) dengue virus

Question 62 - Single Best Answer

The definitive method for determining the virus type in a human papillomavirus infections is

A) western blot of patient serum against viral proteins
B) hemagglutination inhibition
C) virus culture
D) test for pathogenesis in mice
E) specific test for viral DNA sequence.

Question 63 - Single Best Answer

Which of the following characteristics of a virus would be the most problematic for vaccine development?

A) multiple serotypes with rapid drift
B) stable virion
C) infective during prodromal stage
D) no persistent infection
E) cattle are a secondary host

Question 64 - Single Best Answer

Antigenic drift among influenza viruses results from

A) infection of humans with viruses from birds
B) accumulated small changes in the major antibody binding sites on the influenza hemagglutinin
C) reassortment of viruses containing different hemagglutinin and neuraminidase subtypes
D) changes in the V3 loop of the CD4 binding surface glycoprotein
E) changes in the proofreading capability of the viral RNA polymerase

Question 65 - Single Best Answer

Adenovirus infections

A) do not result in a viremia
B) may persist for months
C) are transmitted only by the respiratory route
D) are rare
E) are caused by three adenovirus serotypes

Question 66 - Single Best Answer

A sample of influenza contains 1012 particles per ml as assayed by electron microscopy and 104 hemagglutinin (HA) units per ml. Why are these numbers so different?

A) because the HA assay detects only infectious virus while the electron microscopy assay detects all particles whether or not they are infectious.
B) because many (in this case 108) virus particles are required to completely agglutinate red blood cells.
C) because the influenza hemagglutinin binds red blood cells very poorly.
D) because the electron microscopy assay detects only infectious virus while the HA assay detects only non infectious particles.
E) because the serial dilution used to set up the HA assay introduces error into the assay.

Question 67 - Single Best Answer

Rabies virus

A) replicates first in muscle cells at the site of the wound
B) crosses the blood brain barrier during viremia to infect the brain
C) has a short incubation period
D) has a live attenuated viral vaccine
E) is transmitted by the bite of insects

Question 68 - Single Best Answer

Which virus infects endothelial cells?

A) VZV
B) HSV
C) HHV-8
D) HHV-6
E) HHV-7

  Updated: July 15, 2004