Question 1 - Single Best Answer
A 68 year old male with a history of heart and kidney transplant on immunosuppressive therapy presents with altered mental status, fever, diarrhea, productive cough and was found on exam to have decreased breath sounds with bilateral harsh breath sounds, bilateral eye injection and redness. Lab work revealed leukocytosis of 14,000 on initial exam, bacterial cultures were negative and CT chest revealed patchy consolidation in the right upper lobe, left lower lobe. Which of the following viruses is the most likely cause of these symptoms:
A) adenovirus
B) human polyomavirus BK
C) influenza virus
D) herpes simplex virus type 1
E) respiratory syncytial virus
F) rotavirus
Question 2 - Best 2 Answers
A 22 year old college student presents with sore throat, malaise and lymphadenopathy. You order blood work. Which of the following serological findings is consistent with CMV mononucleosis?
A) IgM VCA antibody positive
B) heterophile antibody positive
C) atypical lymphocytes present
D) all of the above
E) none of the above
Question 3 - Single Best Answer
Which virus can cause both fatal myocarditis in newborns and pleurodynia?
A) Coxsackievirus B
B) Coxsackievirus A
C) Poliovirus
D) Norwalk virus
E) Enterovirus
Question 4 - Single Best Answer
Which of the following is NOT a functional property of the HIV long terminal repeat elements?
A) promoter
B) enhancer
C) protease
D) integration sequences
Question 5 - Single Best Answer
Which of the following virus families contains viruses that package enzymes in the virion?
A) Poxviridae
B) Retroviridae
C) Rhabdoviridae
D) Hepadnaviridae
E) Reoviridae
F) none of the above
G) all of the above
Question 6 - Single Best Answer
Which of the following is true of rotavirus infection?
A) The virus causes fusion of infected cells.
B) The virus has a long incubation period
C) The double stranded, segmented RNA genome is never completely uncoated, and the core synthesizes mRNA which is extruded
D) Is a major cause of death in developed countries
E) The virus has a single protein coat
Question 7 - Single Best Answer
The clinical significance of the incubation period in viral hepatitis is that:
A) although there are no symptoms, viral shedding may still occur.
B) this is the only time that treatment can be successful.
C) symptoms during this time include mild forms such as flu-like and change in taste.
D) only RNA viruses cause an incubation period.
E) None of the above are true.
Question 8 - Single Best Answer
Pregnant women with AIDS most often die from
A) tuberculosis
B) Pneumocyctis carinii (jiroveci) pneumonia
C) Kaposi's sarcoma
D) vaginal candidiasis
E) Mycobacterium avium complex
Question 9 - Single Best Answer
The ability of ingested CNS material from an animal with BSE to result in disease in humans results from the ability of the agent to?
A) induce apoptosis in neurons
B) cause gliomas
C) catalyze mis-folding of a cellular protein
D) cause depletion of neurotransmitters
Question 10 - Single Best Answer
Integration of human papillomavirus DNA into the host cell chromosome
A) is correlated with development of cervical carcinoma
B) is required for development of cervical carcinoma
C) is the sole event required for development of cervical carcinoma
D) only occurs in high risk HPV types
E) all of the above
Question 11 - Single Best Answer
Which of the following statements about rotavirus infections is TRUE?
A) Infection of the intestinal tract causes the loss of electrolytes and prevents readsorption of water leading to dehydration.
B) Infection is spread by respiratory droplets.
C) There is no currently licensed live rotavirus vaccine.
D) Infections in adults are more severe than in children.
E) Asymptomatic infections do not lead to shedding of the virus in the feces.
Question 12 - Single Best Answer
Which of the following is the most important factor in resolving a hepatitis B infection and preventing chronicity?
A) anti-HbsAg
B) effective T cell response
C) neutralizing antibody
D) quick administration of antivirals
Question 13 - Single Best Answer
Which of the following is NOT an example of a cytopathic effect?
A) hemadsorbtion
B) Negri bodies
C) syncytium formation
D) Cowdry type A intranuclear inclusions
E) koilocytosis
Question 14 - Single Best Answer
Respiratory syncytial virus
A) Infection includes a viremic stage.
B) Infects infants in the presence of maternal antibody.
C) Causes bronchiolitis due to the virus killing the bronchiols.
D) Infection gives lifetime immunity to reinfection.
E) Infection can be treated with amantadine.
Question 15 - Single Best Answer
Chronic infection with hepatitis A virus is diagnosed by:
A) shift in anti-HAV antibodies from IgM to IgG
B) detection of HAV RNA in blood
C) increase in liver enzyme levels and prothrombin time
D) resolution of HAV antigen in blood
E) None of the above - there is no chronic infection with HAV.
Question 16 - Single Best Answer
Differences between Flumist and injected flu vaccine are
A) the composition of only the injected vaccine has to be changed every year; the composition of the Flumist remains the same
B) injected flu vaccine produces IgA, while Flumist does not
C) Flumist is a live attenuated virus, while the injectable vaccine is inactivated virus
D) the injected vaccine has been shown to cause bacterial pneumonia, due to desquamation of the tracheal epithelium, while Flumist has not
E) Flumist has to be given to the elderly every year, while the injectable vaccine is only give every 5 years
Question 17 - Single Best Answer
A patient presents with severe jaundice, fever and malaise and you order blood work. Which of the following serologic findings is diagnostic of an acute hepatitis B infection?
A) anti-HBc (IgG)
B) HbsAg
C) anti-HBc (IgM)
D) anti-HBc (total)
Question 18 - Single Best Answer
Human polyomavirus infections
A) are most likely transmitted via a respiratory route.
B) are widespread.
C) are predominantly asymptomatic.
D) establish persistence or clinical latency in kidneys.
E) all of the above
Question 19 - Single Best Answer
Dengue virus infection gives more severe disease when the individual already has
A) cell mediated immune response to another serotype of Dengue
B) neutralizing antibody to another serotype of Dengue
C) non-neutralizing antibody to another serotype of Dengue
D) non-neutralizing antibody to yellow fever virus
Question 20 - Single Best Answer
Which of the following is NOT a problem or complication of vaccinia vaccination?
A) generalized vaccinia
B) post vaccinial encephalitis
C) establishment of latency
D) spread of vaccine to family members
Question 21 - Single Best Answer
Consider the following list of viruses:
Question 22 - Single Best Answer
Which of the following is true about congenital rubella syndrome (CRS)?
A) The virus crosses the placenta after mosquito vectored infection of pregnant women.
B) After infection in the first trimester the presence of maternal antibody in the second trimester of pregnancy clears the virus from the fetus.
C) For about 20% of infants with CRS the symptoms are severe bilateral deafness and visual defects.
D) A killed virus vaccine is given along with the vaccines for measles and mumps.
Question 23 - Single Best Answer
A 55 year old man living in Ocala is taken to the Emergency Room with a high fever, stiff neck, severe headache and lethargy. There have been three fatal cases of EEE in the county. The cases in horses make the physician suspect that the man has EEE because
A) EEE is transmissible directly between horses and humans
B) EEE is transmissible from horses to birds and birds can transmit the disease directly to humans
C) EEE is transmissible from horses to mosquitoes and the man could have been bitten by a mosquito
D) EEE in horses indicates mosquitoes in the area are infected with EEE.
Question 24 - Single Best Answer
Cytomegalovirus colitis primarily occurs in:
A) infants and children
B) young adults
C) elderly
D) immunocompromised
E) All of the above without any predilection.
Question 25 - Single Best Answer
The gene for ICP4 is located in the short repeat of HSV-1. How many copies of this gene are present in each viral genome?
A) 1
B) 2
C) 3
D) 4
Question 26 - Single Best Answer
Cite an example of the use of a temperature sensitive virus mutant in the treatment or prevention of virus disease.
Question 27 - Single Best Answer
Which of the following is true of poliovirus infection of humans?
A) The majority of infections are symptomatic.
B) Bulbar poliomyelitis results from infection of the anterior horn cells of the spinal cord.
C) Post-polio syndrome is due to persistent long term infection with the virus resulting in disease years later.
D) Paralytic poliomyelitis gives asymmetric flaccid paralysis of one or more limbs with no loss of sensory neurons.
Question 28 - Single Best Answer
Creutzfeld Jacob and Kuru are diseases believed to be caused by an infectious agent known as a
Question 29 - Single Best Answer
Hemagglutination inhibition is used to measure
A) virus binding to erythrocytes in patient blood
B) virus capsid proteins in patient serum
C) virus nucleic acid in patient serum
D) antibody in patient serum that binds to erythrocytes
E) antibody in patient serum that binds to virus
Question 30 - Single Best Answer
One of the major disadvantages of the live oral poliovirus vaccine is:
A) That it doesn't give lifelong immunity.
B) The virus can revert to wild type during replication in the body and cause disease.
C) The vaccine does not induce secretory IgA antibody.
D) It does not produce immunity to all three serotypes of poliovirus.
E) The ease of administration.
Question 31 - Single Best Answer
Diagnosis of rotavirus diarrhea is most often made by:
A) Detection of secretory IgA antibodies in stool.
B) Detection of IgG antibodies in blood.
C) Detection of virus in stool.
D) Hemagglutination
E) None of the above - diagnosis is made by clinical symptoms only.
Question 32 - Single Best Answer
New cases of HIV infection in the USA TODAY are
A) almost exclusively in men
B) are about 70% in men
C) are split equally between men and women
D) are about 60% in women
E) are almost all in women
Question 33 - Single Best Answer
What feature of Hantavirus is typical of a non-equilibrium human viral infection?
A) high rate of lethality
B) high mutation frequency
C) efficient human to human spread
D) tropism for respiratory tract
Question 34 - Single Best Answer
Potential complications from influenza infection include
A) secondary bacterial infection leading to pneumonia
B) primary viral pneumonia
C) muscle involvement (myositis and cardiac involvement)
D) CNS involvement (encephalopathy and encephalitis)
E) all of the above
Question 35 - 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 virus reproduction after entry of the RNA into the cell.
D) Most picornavirus infections are symptomatic
E) Poliovirus is not shed in feces during asymptomatic infections
Question 36 - Single Best Answer
The HIV co-receptor responsible for macrophage tropism is?
Question 37 - Single Best Answer
Which of the following viruses is most sensitive to detergent inactivation?
A) adenovirus
B) hepatitis C
C) human papillomavirus
D) rotavirus
E) hepatitis E virus
Question 38 - Single Best Answer
Measles virus and mumps virus infections are similar in which of the following?
A) The incubation period is the same.
B) The viruses rarely cause asymptomatic infections.
C) The infected individual is shedding infectious virus before the onset of symptoms of the diseases.
D) Virus infections can be prevented by killed virus vaccines.
E) The viruses are stable to detergents and heat.
Question 39 - Single Best Answer
Mr. Johnson, a 60-year-old retired pilot returning from Thailand develops fever, myalgias, and non-productive cough after a severe and sudden attack of tiredness. You diagnose influenza, prescribe rest and analgesics, and after three days he is feeling better. He then develops a sudden shaking chill and a cough producing rusty sputum. This pattern of disease in an influenza infection whereby one is feeling better and then has a relapse is indicative of
A) influenza pneumonia
B) other viral pneumonia
C) rhinotracheitis from influenza
D) bacterial pneumonia
Question 40 - Single Best Answer
A major difference in epidemiology between Norwalk virus and rotavirus is:
A) Norwalk is present in the United States, Rotavirus is limited to the developing world.
B) Norwalk is transmitted by food, Rotavirus is transmitted by water.
C) Norwalk only causes disease immunocompromised, Rotavirus can strike otherwise healthy people.
D) Norwalk causes disease any age group, Rotavirus strikes mainly children.
E) None of the above - the epidemiology between these viruses is essentially identical.
Question 41 - Single Best Answer
Which of the following vaccines does NOT have the potential for ³break-through² or to be shed by the vaccinated individual?
A) polio (OPV)
B) varicella
C) Smallpox (vaccinia)
D) rabies
Question 42 - Single Best Answer
What is the mechanism of papillomavirus transmission?
Question 43 - Single Best Answer
Which of the following is true of a rabies virus infection?
A) The short incubation period necessitates pre-exposure immunization with rabies vaccine.
B) The virus has a viremic stage.
C) Antibody response to the virus infection occurs two weeks after the replication of the virus in muscle cells at the site of the bite.
D) Disease can be prevented post-exposure with a killed virus vaccine and injections of rabies immune globulin.
Question 44 - Single Best Answer
A nurse calls you from the ER and has concerns about the presentation of a 35 year old male. He has a high fever and a rash that she fears might be consistent with smallpox. Upon examination you conclude that the patient has chicken pox because
A) lesions of the rash are all at the same stage of development
B) the patient's fever developed after the appearance of the rash
C) the rash has a higher density on the face than other parts of the body
D) there are abundant lesions on the palms
Question 45 - Single Best Answer
Why do RNA viruses mutate more than DNA viruses?
A) RNA is chemically less stable than DNA
B) RNA viruses have segmented genomes, which promotes rapid evolution of new virus strains through reassortment.
C) The RNA dependent RNA polymerases used by RNA viruses lack a proofreading function; DNA dependent DNA polymerases used by DNA viruses possess a proofreading function.
D) Genomes of DNA viruses are smaller than the genomes of RNA viruses so there are fewer targets for mutation.
E) The capsids of DNA viruses are more susceptible to environmental damage, including chemical damage of the nucleic acid, than are the capsids of RNA viruses.
Question 46 - Single Best Answer
Which of the following is true of hepatitis viruses?
A) The severity of the acute hepatitis is mild or subclinical for HAV and HCV.
B) HGV causes 20% mortality in pregnant women.
C) HCV infection gives rise to good neutralizing antibody response.
D) HEV and HAV infections give rise to poor neutralizing antibody and cell mediated immune responses.
E) All of the above.
Question 47 - Single Best Answer
A 45 year old patient suspected of having hepatitis has the following lab tests:
A) he has HAV now and has had HBV in the past
B) he has a current infection with HAV and a reactivated HBV infection
C) he has a primary infection with HBV now and has had HAV in the past
D) he has a reactivated HBV infection now and has had HAV in the past
E) he is chronically infected with both HAV and HBV
Question 48 - Single Best Answer
Based on predictions of the virus-host adaptation model, one would predict HIV infections in humans would eventually
A) become less lethal
B) become less persistent
C) become less efficient in human to human spread
D) die out as a human viral infection
Question 49 - Single Best Answer
Of the virus assays listed below, which ones represent ³physical² assays as opposed to ³biological² assays?
Question 50 - Single Best Answer
A 25 year old pregnant female presents with jaundice. She returned a month ago from a trip to India. You suspect viral hepatitis as a possible cause and order serological tests. Because of her condition, which of the following would pose the greatest risk?
A) Hepatitis A
B) Hepatitis B
C) Hepatitis C
D) Hepatitis D
E) Hepatitis E
Question 51 - Single Best Answer
Hydrops fetalis is a manifestation of congenital infection with
A) toxoplasma
B) parvovirus B19
C) CMV
D) rubella
E) HSV2
Question 52 - Single Best Answer
For which of the following viruses is integration of their genome into the host cell genome an essential part of the viruses replication cycle?
A) HIV
B) HBV
C) EBV
D) HPV
Question 53 - Single Best Answer
A patient, presenting with subacute memory loss complicated by acute delirium and clinical evidence of predominantly left hemisphere dysfunction, was found to have radiographic evidence of highly asymmetric, multifocal white matter disease. As the differential diagnosis for causes of acquired leukoencephalopathy in adults includes opportunistic infections, a search for causes of immunosuppression was undertaken, demonstrating HIV infection with a high viral RNA load and low CD4+ lymphocyte count. The opportunistic infection that is most likely the cause of the white matter disease is:
A) cytomegalovirus
B) herpes simplex virus
C) human polyomavirus JC
D) Epstein-Barr virus
E) Pneumocystis jiroveci (carinii)
Question 54 - Single Best Answer
List three targets for anti-HIV drugs
Question 55 - Single Best Answer
Which feature of Ebola virus have prevented it from spreading far from the sites of outbreaks?
A) high infectivity
B) genetic instability of the virus between outbreaks
C) short prodromal period
D) high virion stability
Question 56 - Single Best Answer
Influenza A hemagglutinins of the same subtype
A) are all identical in amino acid sequence
B) are all serologically cross reactive
C) may vary in amino acid sequence by up to 10%
D) may vary in amino acid sequence by up to 75%
E) are always associated with the same neuraminidase subtype
Question 57 - Single Best Answer
Arthropod transmitted togaviruses and flaviviruses all cause flu like symptoms with fever, headache and malaise due to:
A) Their site of replication in the upper respiratory tract.
B) The infection of the meninges.
C) The good induction of interferon.
D) The common final target organ of each virus.
E) Their site of replication in the liver.
Question 58 - Single Best Answer
THIS QUESTION HAS BEEN DISCARDED AS INAPPROPRIATE. A BLUEBERRY MUFFIN RASH MAY ALSO ACCUR WITH CMV ALTHOUGH IT WOULD HAVE TO BE IN UTERO TRANSMISSION. A pregnant 16 year old female from Haiti is brought to the hospital in labor. She had had a flu-like illness with low-grade fever, maculopapular rash, and lymphadenopathy during the second month of pregnancy. The baby was born with a blueberry muffin-like rash and cataracts. This baby's problem was most likely
A) due to a genetic defect
B) an infection acquired during passage through the birth canal
C) could have been prevented by vaccination of the mother
D) not caused by a virus but an infection of the mother by another type of microbe
E) none of the above
Question 59 - Single Best Answer
Which of the following statements is NOT true of hepatitis B surface antigen (HBsAg)?
A) It forms filaments.
B) It is always detectable during an active infection.
C) It is a component of the HepB vaccine.
D) It is a component of the HDV virion.
E) It is causes "ground glass" histopathology in liver.
Question 60 - Single Best Answer
Which of the following is the most common result of a virus infection?
A) acute infection
B) latent infection
C) inapparent infection
D) persistent infection
E) chronic infection
Question 61 - 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 62 - Single Best Answer
The dark urine seen in hepatitis is due to which of the following in the urine
A) blood
B) serum proteins
C) conjugated bilirubin
D) unconjugated bilirubin
E) urea which is concentrated by the dehydration that occurs with hepatitis
Question 63 - Single Best Answer
What is the best method to determine if a patient with Hepatitis C is responding to treatment?
A) examine HCV antibody levels
B) perform an HCV RNA test
C) examine levels of HCV capsid protein in blood
D) perform a urine HCV antigen test
E) None of the above - there are no effective treatments for HCV infection
Question 64 - Single Best Answer
Which of the following statements is NOT true of HAART therapy for HIV infections?
A) It is a combination of 3 antivirals
B) It can eliminate detectable levels of HIV in the serum
C) If HAART therapy is withdrawn, the virus will re-bound
D) It prevents the formation of drug-resistant mutants
Question 65 - Single Best Answer
Consider the list below and name proteins encoded by influenza that are targeted by anti-influenza viral drugs:
Question 66 - Single Best Answer
The sylvan and urban cycles of togavirus and flavivirus transmission can be distinguished
A) by the type of animal reservoir.
B) by the nature of the insect vector.
C) because the urban cycle does not require an insect vector.
D) by the level of viremia of the virus in the human host.
E) by the final target organ of the virus.
Question 67 - Single Best Answer
A 19 year old college student presents to the student health clinic with fever, fatigue, and a very sore throat. Physical examination shows pharyngitis, cervical and axillary lymphadenopathy, and splenomegaly. Lab tests showed atypical lymphocytes and heterophile antibodies. The student MOST LIKELY contracted her disease from
A) mosquito bite
B) being coughed on by someone with the same disease (respiratory transmission)
C) kissing someone with the same disease
D) sexual activity
E) ingestion of contaminated food
Question 68 - Single Best Answer
Because hepatitis D Virus is defective, its viral structure is:
A) HDV RNA with no coat proteins or envelope.
B) HDV DNA coated with host membrane only.
C) HDV DNA coated with HEV surface antigen
D) HDV RNA with HBV surface antigen.
E) None of the above. Because it is defective, it does not make viral particles.
Question 69 - Single Best Answer
Which of the following viruses is NOT associated with promoting oncogenesis?
A) CMV
B) HBV
C) EBV
D) HPV
Question 70 - Single Best Answer
Reassortment of influenza virus genome segments
A) contributes to the periodic influenza epidemics that occur between pandemics
B) involves only the hemagglutinin and neurmanidase genes
C) occurs only in birds
D) may result in the appearance of new pandemic strains of virus in humans
E) all of the above
Question 71 - Single Best Answer
Which of the following is true for the neurological involvement after measles virus infection?
A) Meningitis occurs about 1 week following the rash.
B) Lethal SSPE can occur years after infection and is due to persistent mutant measles virus replication in the brain.
C) Acute disseminated encephalomyelitis or ADEM occurs only in immunosuppressed people is due to virus replication in the brain.
D) Measles inclusion body encephalitis or MIBE occurs in normal people with no virus replication in the brain and is due to a demyelination autoimmune response.
Question 72 - Single Best Answer
MOST cases of perinatal transmission of HIV infection
A) are due to transplacental transmission of the virus
B) occur only after invasive procedures such as a placental biopsy
C) occur during normal vaginal delivery
D) occur during C-sections
E) are due to breast feeding
Question 73 - Single Best Answer
Standard treatment of rotavirus infection is:
A) highly active antiviral chemotherapy (HAAC)
B) rehydration containing glucose and salts
C) antiperistaltics
D) post-exposure vaccination, not unlike for rabies
E) None of the above - this is a self-limiting disease that does not require treatment.
Question 74 - Single Best Answer
Which of the following is responsible for priming synthesis of the first strand of the Hepatitis B genome during replication?
A) P protein
B) cellular tRNA
C) LTR
D) the overhang of the partial single-stranded genome acts as a primer
Question 75 - Single Best Answer
Name two groups of individuals who are at risk of serious disease following infection with B19 parvovirus.
Question 76 - Single Best Answer
A vaccine is available for which of the following viruses?
A) HCV
B) HAV
C) HEV
D) Dengue virus
E) Rhinovirus
Question 77 - Single Best Answer
In a teenaged patient with a severe sore throat a throat swab is taken and cultured on blood agar
A) to test for EBV
B) to test for antibodies to EBV
C) to test for a bacterial infection
D) to test for Burkett's lymphoma
Question 78 - Single Best Answer
A patient who has recurrent HSV-2 asks if they should use condoms when they do not have lesions present. You correctly inform them that, based on epidemiologic studies
A) a person is generally infectious one day before, and one day after a lesion is present
B) 2/3 of HSV-2 infections result from asymptomatic shedding
C) HSV-2 is not spread by sexual contact
D) HSV-2 can only be efficiently spread while a lesion is present
Question 79 - Single Best Answer
Consider the following list of diagnostic tests for a virus infection. Which three of these tests are used for diagnosing a human papillomavirus (HPV) infection?
Question 80 - Single Best Answer
A Gram stain is used to
A) see Negri bodies in the brain
B) visualize viruses in the spinal fluid
C) examine a PAP smear
D) visualize bacteria
E) visualize prions
Question 81 - Single Best Answer
A feature shared between avian influenza and the 1918 pandemic strain is?
A) same hemaglutinin and neuraminidase serotypes
B) inverted mortality curve in humans
C) deaths primarily from bacterial pneumonia
D) natural resistance to Tamiflu
Question 82 - Single Best Answer
The human papillomavirus (HPV) genome is replicated using
A) the host cell coded DNA dependent DNA polymerase
B) a virus coded DNA dependent DNA polymerase
C) a virus coded RNA dependent DNA polymerase
D) a virus coded RNA dependent RNA polymerase
E) a DNA dependent DNA polymerase encoded by an adenovirus helper