OS217 IDS 2 with Explanations

A 22-year old male is admitted with a fever of 39.3C with heart rate of 130 bpm and respiratory rate of 28 bpm. Chest X-ray shows right lower lobe infiltrates with WBC counts of 2,000. Which of the following would most indicate that the patient is septic and at risk for mortality? A. Glasgow Coma Score < 15 B. Plt < 150,000 C. Crea < 1.2 mg/dl D. SBP > 100

A. Glasgow Coma Score < 15 qSOFA or "quick SOFA" guidelines were created to facilitate easier identification of patients potentially at risk of dying from sepsis. A qSOFA score of greater than 2 points indicates organ dysfunction. Each criterion is equivalent to 1 pt. This includes 3 things: ● Respiratory rate ≥22/min ● Change in mental status ● Systolic blood pressure ≤100 mmHg

A fisherman who also handles, cuts, and cleans the fishes that he catches comes to you with erythematous areas on his fingers and knuckles. Aspiration of the main hand lesion drew fluid, which on gram stain, showed thin, pleomorphic, non-spore forming gram-positive rods under the microscope. The preferred treatment is: (2021, 2023) A. Penicillin B. Amoxicillin-clavulanic acid C. Doxycycline D. Levofloxacin

A. Penicillin

For the above case, the empiric antibiotic regimen you will start (as long as not penicillin allergic) based on latest Infectious Diseases Society of America of Skin and Soft Tissue Infections (SSTI) Guidelines will be: a. Penicillin plus clindamycin b. Piperacillin-tazobactam plus vancomycin c. Meropenem plus clindamycin d. CT scan or MRI e. Ceftazidime plus doxycycline

A. Penicillin plus clindamycin Necrotizing fascitis is most likely caused by GAS (~60% of cases). Penicillin plus clindamycin is recommended Clostridium sp. - Penicillin plus clindamycin Aeromonas hydrophilia - Doxycycline plus ciprofloxacin Polymicrobial - Vancomycin plus Piperacillin-tazobactam .

Which of the following terms was eliminated in the new sepsis definitions due to possible redundancy and confusion? A. Severe sepsis B. Septic shock C. Sepsis D. Infection

A. Severe sepsis In the old SIRS criteria, severe sepsis was defined as sepsis complicated by organ dysfunction. By fulfilling at least 2 of the 4 criteria, a patient would be considered septic. However, this meant that some patients with severe infection but not sepsis can still be considered septic while some patients who are already septic but only satisfy less than 2 of the criteria won't be captured by the definition. This heavily affects management and outcomes for patients. New guidelines have since been established which include the Sequential Organ Failure Assessment (SOFA) and qSOFA (quick SOFA) scoring to address this limitation.

Which feature of the chest radiograph is the most sensitive sign of ventilator-associated pneumonia? A. air bronchograms B. Interstitial infiltrates C. Hilar lymphadenopathy D. Unilateral pleural effusion

A. air bronchograms

Which of the following risk factors facilitate aspiration of oropharyngeal contents into the lower respiratory tract? A. presence of nasogastric tube B. Prior antimicrobial therapy C. Upper abdominal surgery D. Use of proton pump inhibitors

A. presence of nasogastric tube

Refer to the case from previous question At what minimum interval should MMR and varicella be given if the patient does not receive the vaccines simultaneously?

Answer: 4 weeks

LU5 medical students should use alcohol to disinfect their hands prior to touching a 22 year old housewife consulting the Ambulatory Clinic because of abdominal pain. This action is in compliance with: A. Moment 1 of Hand Hygiene B. Moment 2 of Hand Hygiene C. Moment 3 of Hand Hygiene D. Moment 4 of Hand Hygiene

Answer: A. Moment 1 of Hand Hygiene is before touching a patient. Moment 2 is before a clean/aseptic procedure. Moment 3 is after body fluid exposure risk. Moment 4 is after touching a patient. Moment 5 is after touching patient's surroundings. Source: Trans 11, p. 3.

The risk of acquiring HIV from a needle stick exposure from and HIV positive patient who is on ARVs is: A. 0% B. 0.5% C. 3% D. 0.3%

Answer: A. 0% An HIV positive patient on ARVs has undetected and untransmittable viral load (U=U campaign).

Urine sample should immediately be brought to the laboratory. If there is a delay of __ hours, it should be refrigerated or placed in ice A. 1-2 hours B. 3-4 hours C. 4-5 hours D. It is not necessary for the urine to be placed in ice or refrigerated even with delay

Answer: A. 1-2 hours

What is the optimal amount of blood volume when ordering for blood culture? a. 5-10 ml in aerobic culture medium and 5-10 ml in aerobic culture medium b. 2-4 ml in aerobic culture medium and 5-10 ml in aerobic culture medium c. 2-4 ml in aerobic culture medium and 2-4 ml in aerobic culture medium d. NOTA

Answer: A. 5-10 ml in aerobic culture medium and 5- 10 ml in aerobic culture medium For proper collection and processing of specimen, draw at least 20 ml of blood for adults. 5-10 ml is placed in aerobic culture medium and 5-10 ml in anaerobic culture medium. (2021 Trans 4, page 2)

Which of the following is not a chronic manifestation of filariasis? A. Adenolymphangitis B. Elephantiasis C. Lymphedema D. Hydrocoele

Answer: A. Adenolymphangitis Adenolymphangitis (ADL) or dermatoadenolymphangitis (DADL) are found in acute filiarial disease. Epididymo- orchitis is another acute manifestation.

Which of the following is not an option for use to interrupt transmission for elimination of lymphatic filariasis? (2023, 2020) A. Albendazole alone B. Albendazole plus diethylcarbamazine C. Diethylcarbamazine medicated salt D. Diethylcarbamazine alone

Answer: A. Albendazole alone Prevention, control and elimination include: ● Identification of endemic areas (mapping) ○ Initiate elimination campaigns in endemic areas identified ● Elimination strategy focused on implementation of annual mass treatment programs ○ DEC alone ○ DEC + albendazole (current regimen in the Philippines, given to ages 2-65) ○ Albendazole + Ivermectin ● Personal protective measures (e.g. mosquito net use and insecticide spraying) ● Health education Source: Trans 2, p. 5.

What would be the most appropriate dosing regimen for a 3rd year old male with pneumonia who will be given Ampicillin 200 mg/kg/day IV? A. Ampicillin 50 mg/kg every 6 hours B. Ampicillin 200 mg/kg as a single dose every 24 hours C. Ampicillin 100 mg/kg every 12 hours D. NOTA

Answer: A. Ampicillin 50 mg/kg every 6 hours Ampicillin is a time-dependent antibiotic and has a half- life of 1 hour. Choice A will have the highest remaining dose level above the MIC at the last hour before another dose will be given to the patient. Source: Trans 13b, p. 3.

Which of the following is a permanent contraindication to vaccination? A. Anaphylaxis after influenza vaccination B. Encephalopathy following varicella vaccination C. Giving MMR to the husband of a pregnant wife D. Recent administration of PPD/TB skin test

Answer: A. Anaphylaxis after influenza vaccination A severe allergic reaction (i.e., anaphylaxis) to a vaccine or vaccine component is one of the two permanent contraindications (CIs) to vaccination in adults. Choice B is incorrect because the only other permanent CI in adults is unexplained encephalopathy occurring within 7 days of pertussis vaccination. Choice C and D are incorrect because a pregnancy in the household and TB skin testing are both invalid CIs to vaccination (in adults and children). Additionally, review the list of permanent CIs in pediatric patients and invalid CIs in patients of all ages: Source: Trans 14, p. 5; Trans 15, p. 2

The currently recommended gold standard in diagnosis of lymphatic filariasis is: (2023, 2020) A. Antigen detection B. Wet smear C. Antibody detection D. Detection of microfilariasis through blood concentration method

Answer: A. Antigen detection Antigen detection using an immunoassay (ELISA) for circulating filarial antigens is the gold standard for the diagnosis of lymphatic filariasis. Source: Trans 2, p. 4.

HIV is quite difficult to cure because of: A. Antiretroviral resistance B. Low genetic diversity C. Absence of any kind of humoral immune response D. A persistent viral reservoir of integrated proviral DNA

Answer: A. Antiretroviral resistance Hybrid types, or circulating recombinant forms of HIV, have shown implications of developing drug resistance. An example would be hybrid type CRF01_AE, which is the main lineage of HIV in the Philippines, has already shown baseline drug resistance, making treatment difficult. Source: Trans 7, p. 1.

The following are situations wherein switch from parenteral to oral therapy should not be used, EXCEPT: (2020, 2021) A. Bacterial meningitis using chloramphenicol B. Neonates C. Infective endocarditis D. Severe nausea and vomiting

Answer: A. Bacterial meningitis using chloramphenicol.

P. falciparum schizonts in Giemsa stained blood smears indicate the following: (2023, 2022) A. Bad prognosis B. Strong immunity C. No bearing in prognosis D. Good prognosis

Answer: A. Bad prognosis Schizonts are rarely seen in RBCs except in severe cases of falciparum malaria. They are composed of 8-32 merozoites sequestered in the microcirculation in the brain. Presence of schizonts in blood smears indicate bad prognosis - 30-50% mortality rate depending on intensive care of the patient (patient is already having multiple organ failure and may die within a few hours). Trans 1, page 2

The risk of mother-to-child transmission of HIV infection increases when? (2021, 2023) A. Breastfeeding is continued over time B. Non-invasive delivery procedures are used C. Maternal viral load is low D. Sexually transmitted infections are treated early

Answer: A. Breastfeeding is continued over time Longer duration of breastfeeding can increase the risk of transmission as it increases the duration of exposure to an infected mother's breast milk. Other risk factors include invasive delivery procedures that increase contact with the mother's infected blood or body fluids, high maternal viral load, and the presence of STIs. Although choice D may also imply the presence of an STI, if the STI is treated early, then choice A may be the better answer. Source: Trans 9, p. 1.

What statement is true about vaccination and breastfeeding? A. Breastfeeding is not a contraindication to any vaccination. B. Breastfeeding is a contraindication to live vaccine but not to DNA vaccines. C. Breastfeeding should be withheld for 2 weeks after receipt of a live vaccine. D. Only the rabies vaccine is safe and indicated for pregnancy and lactation.

Answer: A. Breastfeeding is not a contraindication to any vaccination.

A patient with known HIV/AIDS presents to you for follow up. His most recent Cd4 lymphocyte count is 55 cells/uL and his HIV viral load is 356,000 copies/mL. The following statement is true regarding his HIV parameters - A. CD4 cell count is a marker of disease progression while viral load is a marker of immunologic function. B. CD4 cell count is a marker of immunologic function while viral load is a marker of disease progression. C. CD4 cell count and viral load are both markers of immunologic function. D. CD4 cell count and viral load are both markers of disease progression.

Answer: A. CD4 cell count is a marker of disease progression while viral load is a marker of immunologic function.

A 48 year old with bronchogenic carcinoma develops new fever and increased respiratory secretions while admitted at the ICU. He has been on a mechanical ventilator for one week. The diagnostic work-up to determine the cause of this new development should include: A. Chest radiograph, endotracheal aspirate for gs/cs B. Choice A plus procalcitonin C. Choice A plus high resolution chest CT scan D. Choice A plus bronchoscopy with bronchoalveolar lavage for histopathology, gram stain, culture, statins for fungal, AFB, and PCP

Answer: A. Chest radiograph, endotracheal aspirate for gs/cs

A 48 year old with bronchogenic carcinoma develops new fever and increased respiratory secretions while admitted at the ICU. He has been on mechanical ventilator for one week. The diagnostic work-up to determine the cause of this new development should include: (2021, 2020) A. Chest radiograph, endotracheal aspirate for gs/cs B. Choice A plus procalcitonin C. Choice A plus high resolution chest CT scan D. Choice A plus bronchoscopy with bronchoalveolar lavage for histopathology, gram stain, culture, stains for fungal, AFB and PCP

Answer: A. Chest radiograph, endotracheal aspirate for gs/cs

To reduce the risk for contracting [diseases], medical students who will work on the medical wards for the first time should be properly immunized or show proof of adequate antibody levels against which of the following infectious agents: A. Chicken pox, measles, hepatitis B B. Dengue, chickenpox, hepatitis B C. Hepatitis B and tuberculosis (BCG scar or PPD) D. At least first dose of hepatitis B, seasonal influenza

Answer: A. Chicken pox, measles, hepatitis B Not mentioned in the lecture and trans but HepB, MMR and Varicella are the required vaccines for LU5 students before their duties as ICC in PGH. Source: HICU Requirements.

Drug of choice in CAP in pediatric population ages 5 y/o to adolescence is: A. Clarithromycin B. Vancomycin C. Cloxacillin D. Cefuroxime

Answer: A. Clarithromycin Children (>5 years) and adolescents: Erythromycin OR Clarithromycin OR Azithromycin From NAG 2018/2019

Which of the following patients probably has the highest risk of COVID-19 acquisition? A. Clinic secretary of pulmonologist B. A medical records officer in a hospital C. Medical representative working from home D. An employee assigned to sort incoming letters and parcels

Answer: A. Clinic secretary of pulmonologist The occupational groups most at risk for acquiring COVID-19 are healthcare workers in the hospital/clinics, transport workers, service and sales workers, cleaning and domestic workers, and public safety workers. While A and B are considered high risk jobs, choice A has the most substantial exposure to possible COVID-19 infected individuals. Source: Lan, FY. et al. (2020). Work-related COVID-19 transmission in six Asian countries/areas: a followup study

This antibiotic does not have MRSA coverage: A. Cloxacillin B. Co-trimoxazole C. Clindamycin D. Doxycycline

Answer: A. Cloxacillin. It is for methicillin-sensitive Staphylococcus aureus.

A 6/F, asthmatic, is due for her 2nd dose of varicella vaccine. She has been on inhaled steroids for the past 3 weeks. You decided to give her the vaccine. Which of the following statement is true regarding steroid use? A. Corticosteroids are considered immunosuppressive at 20mg or more/day of prednisone B. Patient on inhaled steroid cannot receive varicella vaccine C. Varicella vaccine is contraindicated for asthmatic patients D. Patient on inhaled steroids can be given varicella vaccine 2 weeks off steroids

Answer: A. Corticosteroids are considered immunosuppressive at 20mg or more/day of prednisone.

In the absence of a specific chemoprophylactic agent for patients with severely low CD4 count, the Philippine Society for Microbiology and Infectious Diseases recommends patients to immediately start antiretroviral therapy to prevent which opportunistic protozoan infection? A. Cryptosporidiosis B. Isosporiasis C. Toxoplasmosis D. Cyclosporiasis

Answer: A. Cryptosporidiosis ART is the chemoprophylaxis for Filipino PLHIV with low CD4 counts. Source: Trans 3, p. 5.

Felids represent potential sources of which pair of opportunistic protozoan infections? A. Cryptosporidiosis and toxoplasmosis B. Isosporiasis and cyclosporiasis C. Cyclosporiasis and cryptosporidiosis D. Toxoplasmosis and isosporiasis

Answer: A. Cryptosporidiosis and toxoplasmosis Cryptosporidium is transmitted through zoonosis (calves, kittens, rodents, puppies, and birds). Cats are the definitive hosts of Toxoplasma. The transmission of isosporiasis and cyclosporiasis is from human to human. Cyclosporiasis can also be transmitted through ingestion of contaminated water or vegetables. Source: Trans 3, pp. 3-4.

An 18-month old boy from the province was brought to the clinic for the first time for his well-child visit. He has not yet received his DPT/IPV/Hib booster, MMR and varicella second doses. History revealed that he was diagnosed with Kawasaki disease at age 13 months. Which of the vaccines can be given at this visit? A. DPT/IPV/Hib B. MMR and varicella C. DPT/IPV/Hib, MMR and varicella vaccines D. None

Answer: A. DPT/IPV/Hib.

Administration of antimicrobials to patients with signs and symptoms of disease indicative of infection with a particular organism or set of organisms (2020, 2021) A. Empiric therapy B. Definitive therapy C. De-escalation therapy D. Switch therapy

Answer: A. Empiric therapy

In the Philippines, who are the target recipients of annual mass treatment for elimination of lymphatic filariasis? (2023, 2020) A. Everybody in endemic provinces > 2 years old B. Everybody in endemic municipalities > 5 years old C. Everybody in endemic provinces > 5 years old D. Everybody in endemic municipalities > 2 years old

Answer: A. Everybody in endemic provinces > 2 years old Eligible for MDA: (1) entire population at risk of LF transmission, i.e. the entire population (>2 y/o) in an area where transmission occurs (implementation unit) except those excluded; (2) in the Philippines, 2-65 y/o (previously November, now every July together with mass treatment for STH infections) Members of the entire population at risk of LF transmission that are > 2 years old are eligible for mass drug administration (MDA). Source: Trans 2, p. 5.

Which among the statement/s is/are FALSE? A. For live, injected vaccines, the first dose administered at the recommended age usually is not enough to provide protection. B. An additional dose is administered to provide another opportunity for vaccine response in the small proportion of recipients who do not respond to the first dose. C. The immunity following live vaccines is long-lasting and booster doses are usually not necessary. D. None of the above

Answer: A. For live, injected vaccines, the first dose administered at the recommended age usually is not enough to provide protection. Live attenuated vaccines produce immunity in most recipients with one dose. Its advantages: mimic natural infection, highly immunogenic, provide long-lasting protection, and single dose often sufficient. A second dose is needed because a small percentage of recipients do not respond to the first dose of an injected live vaccine. A second dose is recommended to provide a very high level of immunity in the population: Insurance dose. Unduly delaying the second dose is not necessary. Source: Trans 14, p. 2, 5.

A 19/M sustained a laceration when he accidentally stepped on a rusty piece of metal on the street. PE shows a 3cm laceration on the lateral left foot with no frank infection. He tells you that he allegedly received complete vaccination when he was child, How will you manage this patient? A. Give tetanus vaccine and immunoglobulin B. Give tetanus vaccine only C. No further treatment as long as vaccination as a child is properly documented D. Give tetanus immunoglobulin only

Answer: A. Give tetanus vaccine and immunoglobulin

Which of the ff are considered the most important goals for the control and prevention of emerging infectious diseases? (2021, 2020) A. Globally linked surveillance and response B. Clinical diagnosis and management C. Basic science research D. Quarantine and isolation

Answer: A. Globally linked surveillance and response

Which of the following are considered the most important goal for the control and prevention of emerging infectious diseases? A. Globally linked surveillance and response B. Clinical diagnosis and management C. Basic science research D. Quarantine and isolation

Answer: A. Globally linked surveillance and response According to the lecture, all choices are included in the goals for control and prevention of emerging infectious diseases (EIDs). However, globally linked surveillance and response is the most important goal of all. Source: Trans 5, p. 6.

Which among the following is a conjugate vaccine? A. Hib B. Dtap C. Hep A D. MMR

Answer: A. Hib

A theoretical vaccine X is made by using a weakened version of the whole organism. This type of vaccine: A. Induces the most robust immune response B. May be given to a pregnant woman C. Should not be administered with MMR D. Will most likely require multiple doses

Answer: A. Induces the most robust immune response Vaccine X is a Live Attenuated Vaccine (LAV) which is derived from a weakened disease-causing pathogen. A is correct because LAVs elicit excellent immune response. Choice B is incorrect because LAVs should not be given to pregnant/immunocompromised patients. Choice C is incorrect because there are no contraindications on simultaneous administration of vaccines. Choice D is incorrect because LAVs most likely will only require a single dose. Source: Trans 15, pp.1-2

Which of the following factors is considered to be the greatest challenge in the control of emerging and re-emerging infectious diseases? (2021, 2020) A. International trade and travel B. Microbial adaptation and change C. War and famine D. Intent to harm

Answer: A. International trade and travel The ease of international trade and travel makes infection control more difficult.

TRUE of treating infectious diseases: A. Local resistance is very important B. All fevers must be treated with an antimicrobial C. Getting a specimen after the 1st dose of antibiotic is ideal D. Guidelines from the United States is directly applicable to the Philippines

Answer: A. Local resistance is very important Empiric treatment with antimicrobials is directed against the most likely pathogens and takes into consideration drug allergy history, hepatic/renal function, possible antibiotic side effects, resistance potential, and cost. Choice B is wrong since there are fevers in viral illnesses and malignancies which do not need to be treated with antimicrobials. Choice C is wrong since specimens taken before the first dose of antibiotics are ideal. Choice D is wrong because antimicrobial choice depends on the most likely organisms and resistance patterns, which differ from one place to another. Source: Ther Exam 1 Trans 6, p. 1.

A 10 year old boy comes in for a catch -up dose of MMR. Mother claimed he has low grade fever and is currently on antibiotic for urinary tract infection. Which of the following is true? A. Mild illness is not a contraindication to vaccination B. Vaccination needs to be postponed until complete resolution of fever C. Vaccination is absolutely contraindicated for patients taking antibiotics D. Acute illness reduce vaccine efficacy

Answer: A. Mild illness is not a contraindication to vaccination CDC released a document stating that mild illness is usually not a reason to reschedule vaccination, thus not a contraindication to vaccination. Taking antibiotics does not contraindicate vaccination. Source: https://www.cdc.gov/vaccines/hcp/patient- ed/conversations/downloads/fs-child-sick.pdf

The following are true about Hand Hygiene (HH): A. Most healthcare-associated infections (HAIs) are transmitted by contact primarily via hands of patients, thus hand hygiene remains to be the single most important means to prevent transmission of HAIs pathogens. B. The WHO five moments of HH include: before patient contact, before aseptic procedure, after patient contact, after contact with patient's environment or body fluids and after using the restroom. C. It is estimated that an increase in the HH compliance by 1.5-2.0 fold would result in a 90% reduction of HAIs. D. Resident flora of the hands are usually organisms of high virulence such as coagulase-negative staphylococci, Micrococcus and Corynebacterium which are not easily removed through hand washing; while transient flora are the less virulent gram positive and gram negative bacteria which almost never cause nosocomial infections.

Answer: A. Most healthcare-associated infections (HAIs) are transmitted by contact primarily via hands of patients, thus hand hygiene remains to be the single most important means to prevent transmission of HAIs pathogens.

Chemical examination of the stool of a patient with chronic diarrhea tests positive for D'Xylose. The presence of which of the following is consistent with this finding? A. Oocysts with wrinkled cellophane appearing morulae B. Brow-shaped tachyzoites with large nuclei C. Bright red spheres with four crescentic sporozoites D. Elongated, ovoid oocysts with bilayered cyst walls

Answer: A. Oocysts with wrinkled cellophane appearing morulae Infection with Cyclospora presents with malabsorption of D-xylose from the jejunum, which causes flatulence and watery diarrhea. The distinctive feature of Cyclospora is a central "wrinkle cellophane"-appearing morula. The brow-shaped tachyzoites with large nuclei refer to Toxoplasma gondi. Bright red spheres with four crescentic sporozoites refer to Cryptosporidium. Elongated, ovoid oocysts with bilayered cyst walls refer to Cystoisospora belli. Source: Trans 3, p. 3.

All vaccines can be administered at the same visit EXCEPT: A. PCV-13 and meningococcal vaccine B. DPT-HIB-IPV and PCV-13 C. Hepatitis B and polio D. Rotavirus and oral polio

Answer: A. PCV-13 and meningococcal vaccine You can administer PCV13 or PPSV23 at the same time as most other routine childhood vaccinations, with one exception. Do not give PCV13 with Menactra®, a meningococcal conjugate vaccine. Children with functional or anatomic asplenia or HIV should not receive Menactra ® before the age of 2 years. This timing avoids interference with the immunologic response to the infant series of pneumococcal conjugate vaccine (PCV13). Source: CDC (2019). Administering Pneumococcal Vaccines

What is TRUE about the use of chloroquine/hydroxychloroquine in COVID-19? A. Risk of side effects greater B. Acts by inhibiting RdRp enzyme C. Demonstrated minimal benefit when given with azithromycin D. Part of standard care of COVID-19

Answer: A. Risk of side effects greater Adverse effects are common in these drugs, such as QT prolongation with an increased risk of cardiac complications. Source: Trans 6, p. 7.

Growth of which of the following organisms necessitates immediate removal of the central line when CLABSI is suspected? A. Staphylococcus aureus B. Staphylococcus epidermidis C. Staphylococcus haemolyticus D. Staphylococcus saprophyticus

Answer: A. Staphylococcus aureus From the CPG released by the Infectious Diseases Society of America (which is the same CPG used by Dr. Henson as the basis for CLABSI management in his lecture on healthcare- associated infections), an S. aureus infection necessitates removal of the catheter (third lowest box from the figure below), with subsequent antibiotic treatment given for ≥14 days. Sources: Mermel, L. A ., Allon, M., Bouza, E ., et al. (2009). Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America; Trans 10, p. 6.

Which statement is TRUE about bats as the natural host of coronaviruses? A. There is probably an intermediate host that facilitates transmission of the virus from bats to humans. B. Migration of bats to human settlements are a common occurrence resulting in zoonotic outbreaks. C. Less than 35 species of viruses found in bats are coronaviruses. D. Civet cats are the proposed reservoir hosts for SARSCoV-2.

Answer: A. There is probably an intermediate host that facilitates transmission of the virus from bats to humans. Bats are thought to be a natural reservoir for SARSCoV-2, but it has been suggested that humans became infected through an intermediate host, such as the pangolin. 35% of viruses found in bats are coronaviruses. Civet cats are intermediate hosts for SARS-CoV. Source: Trans 6, p. 2

In the setting of immunodeficiency, reactivation of a previously latent infection is seen in which of the following opportunistic diseases? A. Toxoplasmosis B. Cryptosporidiosis C. Isosporiasis D. Cyclosporiasis

Answer: A. Toxoplasmosis Weakened immune response such as in the setting of acquired immunodeficiency due to HIV infection can cause higher susceptibility to infections and malignancies, increase severity of infections by supposedly low virulence organisms, and reactivation of previous latent infections such as in toxoplasmosis. This reactivation does not happen in the other diseases included in the choices. Source: Trans 3, p. 1.

The following are steps to decrease antimicrobial resistance in hospitals, EXCEPT: (2020, 2021) A. Usage of carbapenems for all patients in the ER B. Vaccinate C. Treat infection, not contamination D. Get the catheters out

Answer: A. Usage of carbapenems for all patients in the ER. Carbapenem is a broad-spectrum antibiotic, and should be used with caution.

Several factors contribute to the re-emergence of vaccine-preventable diseases. Which among the ff factors is caused by vaccine failure? A. Waning of immunity after vaccination B. Serotype replacement C. Personal belief and religious exemptions D. Missed opportunities related to clinician practice

Answer: A. Waning of immunity after vaccination

Which of the following filarial worm is described as with graceful curves and no terminal nuclei? A. Wuchereria bancrofti B. Brugia malayi C. Loa loa D. Ascaris lumbricoides

Answer: A. Wuchereria bancrofti

Which of the following is not a morphologic description of Wuchereria microfilariae? A. kinky curvature B. short cephalic space C. lack of terminal nuclei D. none of those mentioned

Answer: A. kinky curvature. Wuchereria microfilaria are 270 - 290 um, enclosed in hyaline sheath, nuclei arranged in 2 or 3 rows and is distinctly conspicuous, graceful appearance, short cephalic space. Brugian microfilaria are 177 to 230 um in size, with 2 columns of confluent nuclei, have angular curves and secondary kinks, with terminal nuclei.

The stage of filarial development that causes chronic deforming disease is

Answer: Adult

The LU6 medical student finishes getting 5 mL of blood for laboratory testing of a 48 year old Presumptive TB case with Chronic Hepatitis B admitted to a non-COVID ward. To reduce risk for needlestick injury, the best next action would be: A. Perform Hand Hygiene immediately B. Immediately discard the syringe with the needle onto a puncture-resistant container C. First recap the needle onto its original cover to secure the sharp and then immediately discard into the puncture-resistant container D. Hand the syringe with the blood to the assisting nurse and doff gloves

Answer: B. For sharps management: ● Do not recap ● Do not bend or break by hand ● No need to remove needles from disposable syringes ● Dispose used sharp immediately directly at the point of use ● Place in puncture resistant container Source: Trans 11, p. 8.

In catheterized symptomatic women, how much colony forming units (CFUs) should grow in the urine culture for it to be considered significant? A. 100 B. 1,000 C. 10,000 D. 100,000

Answer: B. 1,000 Catheterized symptomatic women are diagnosed at ≥ 10^3 CFU/mL. Source: Trans 10, p. 3.

At what time should you extract blood to diagnose bancroftian filariasis? A. 10 AM - 2 AM B. 10 PM - 2 AM C. 10 AM - 2 PM D. 10 PM - 2 PM

Answer: B. 10 PM - 2 AM Nocturnal periodic (peak between 10PM & 2AM)

Tetanus toxoid should be administered to patients without toxoid vaccination within: A. 5 years B. 10 years C. 15 years D. 20 years

Answer: B. 10 years

A 24 y.o. man got hit by a car while riding his motorcycle. On arrival at PGH, he was found to have a ruptured spleen that required total splenectomy. How many doses of PPSV23 should he receive in his lifetime if he lives until the age of 70 years? A. 2 B. 3 C. 7 D. 8

Answer: B. 3

A 2/F was brought to your clinic for catch-up vaccination. Her family is planning to transfer her to Davao in 6 months. Upon review of her baby books, you noted that he received the following vaccines: BCG, DTP/IPV/Hib and Hep B 3 doses, measles. What vaccines will you give her? At what minimum interval should MMR and varicella be given if a patient did not receive the vaccine simultaneously? A. 2 weeks B. 4 weeks C. 8 weeks D. No minimum interval

Answer: B. 4 weeks

If live, injected vaccines are not administered at the same visit, they should be separated by at least? A. No interval needed B. 4 weeks C. 2 weeks D. 3 months

Answer: B. 4 weeks Generally, there are no contraindications to the simultaneous administration of any vaccines, but for two live, injected vaccines, the spacing of vaccine combinations not given simultaneously should be at least 4 weeks apart. No minimum interval is required for other vaccines. Source: Trans 15, p. 2.

Annual mass treatment for lymphatic filariasis elimination in identified implementation units in the Philippines should be implemented for at least: (2023, 2020) A. 7 years B. 5 years C. 3 years D. 9 years

Answer: B. 5 years Mass Drug Administration recommendation is single dose, once yearly for around 4-6 years. Source: Trans 2, p. 5.

Which of the following parameters portend a higher risk for cytokine storm among COVID-19 patients? A. Low IL-6 B. >50% area of lung injury C. Elevated CD4+ count D. Leukocytosis > 14,000 cells/cu. mm

Answer: B. >50% area of lung injury The parameters that portend higher risk factors for developing cytokine storm amongst COVID-19 patients are: ≥50% area of lung injury, decreased CD4 and CD8 counts, and increased IL-6 levels. Among the choices, only B is a risk factor for developing cytokine storm. Source: Trans 6, p. 6.

De-escalation therapy is: (2022) A. Administration of antimicrobials to patients with signs and symptoms of disease indicative of infection with a particular organism or set of organisms B. A change in antibiotic therapy from broad-spectrum coverage to narrower spectrum regimen or from multiple antibiotics to a single antibiotic C. Use of narrow-spectrum antibiotic once the pathogen is identified D. Change from parenteral to oral route Defined as a change in antibiotic therapy from broad spectrum coverage to a narrower spectrum regimen or from multiple antibiotics to a single antibiotic: (2020) A. Empiric therapy B. Definitive therapy C. De-escalation therapy D. Switch therapy

Answer: B. A change in antibiotic therapy from broad-spectrum coverage to narrower spectrum regimen or from multiple antibiotics to a single antibiotic A - Empiric C - Definitive D - Switch therapy Answer: C. De-escalation therapy ● Empiric - Administration of antimicrobials to patients with signs and symptoms of disease indicative of infection with a particular organism or set of organisms; Oftentimes a broad spectrum for very ill patients. It is directed against the most likely pathogens, and takes into consideration drug allergy history, hepatic/renal function, possible antibiotic side effects, resistance potential, and cost. ● Definitive - use of narrow-spectrum antibiotic once the pathogen is identified ● Switch therapy - change from parenteral to oral route

32 year old woman with: febrile, tachycardic, tachypneic, left lower field consolidation, WBC of 2,000. Which of the following would additionally promote the diagnosis of sepsis according to the qSOFA bedside prompt? A. SBP > 100 B. Altered mentation C. Platelet > 150,000 D. Creatinine < 1.2

Answer: B. Altered mentation The qSOFA score (also known as quickSOFA) is a bedside prompt that may identify patients with suspected infection who are at greater risk for a poor outcome outside the intensive care unit (ICU). It uses three criteria, assigning one point for low blood pressure (SBP≤100 mmHg), high respiratory rate (≥22 breaths per min), or altered mentation (Glasgow coma scale<15)

This process results in a new strain of virus particles which cannot be inhibited as effectively by the antibodies that were originally targete against previous strains allowing the virus to spread throughout a partially immune population: A. Gene assortment B. Antigenic drift C. Gene variations D. Antigenic shift

Answer: B. Antigenic drift

The most prevalent HIV serotype in the Philippines? A. A B. B C. AE D. E

Answer: B. B Prevalence data Note: The recent rise in HIV cases is attributed to AE though, so I'm not entirely sure here

Mansonia is the vector of: A. W. bancrofti B. B. malayi C. Both D. Neither

Answer: B. B . malayi

Patients on total parenteral nutrition (TPN) are at greatest risk for which of the following organisms? A. Burkholderia cepacia B. Candida albicans C. Pseudomonas aeruginosa D. Staphylococcus aureus

Answer: B. Candida albicans Refer to the table below. Source: Trans 10, p. 6

A 45-year old presents with neutropenic fever. He has been on levofloxacin as an outpatient. Which of the following antimicrobials would be most appropriate as initial monotherapy? A. Ceftriaxone B. Cefepime C. Cephalexin D. Cefuroxime

Answer: B. Cefepime Cefepime, imipenem/cilastatin, meropenem, or piperacillin/tazobactam is recommended as empirical monotherapy if the febrile neutropenic patient has no complications of infection

The anti-helmintic combination used in lymphatic filariasis mass deworming programs is A. Albendazole-mebendazole B. Diethyl carbamazine-albendazole C. Albendazole-thiobendazole D. Albendazole-ivermectin

Answer: B. Diethyl carbamazine-albendazole LF Elimination ● Mass treatment with DEC + Albendazole; >2 years of age ● Duration - 5 years (1x every year) ● Coverage - 85% ● The objective is to reduce prevalence to <1/1,000 ● Sustained surveillance for 5 years following mass treatment

Which of the following diseases would have the greatest potential to cause a pandemic? A. Disease X with Ro = 0.69 in the community B. Disease Y with Ro = 18 in the community C. Disease Z with Ro = 1 in the healthcare setting D. Disease A with Ro = 3 in the healthcare setting

Answer: B. Disease Y with Ro = 18 in the community Basic reproduction number (Ro) is the number of people that one sick person will infect (on average, assuming no prior immunity and that everyone is equally susceptible) or a measure of the transmission potential of a disease. Ro rate of 1.0 indicates no transmission. Ro of 18 and 3 indicate that on average, each case infected 18, and 3, respectively. Ro values for some viruses: MERS (0.60-0.69), Hepatitis C (2), Ebola (2), HIV (4), SARS (4), Mumps (10), Measles (18) Source: Trans 5, p. 4.

The recommended antibiotic regimen for a Vibrio vulnificus non-purulent skin and soft tissue infection is: A. Penicillin plus clindamycin B. Doxycycline plus ceftazidime C. Doxycycline plus ciprofloxacin D. Vancomycin plus piperacillin/tazobactam

Answer: B. Doxycycline plus ceftazidime

The following are permanent contraindications to vaccination except? A. SCID B. Duck allergy C. Encephalopathy not due to another identifiable cause D. Intussusception following oral RV vaccine

Answer: B. Duck allergy See #12 for list of permanent contraindications. Duck allergy belongs to allergies to products not present in vaccines and thus is an invalid contraindication to vaccination. Source: Trans 14, p. 5

What terms refer to a reduction in the indigenous sustained transmission of an infection in a geographic area? A. Control B. Elimination C. Eradication D. Vaccination

Answer: B. Elimination

An HIV cure which entails preventing HIV from coming out of its latent state without eliminating the persistent reservoirs is known as a: A. Sterilizing cure B. Functional cure C. Atypical cure D. Virtual cure

Answer: B. Functional cure Functional cure "locks up the virus" in the cell without causing any disease, while a sterilizing cure means that there are no more reservoirs of the virus detected. The sterilizing cure is the gold standard. Source: Trans 7, p. 12.

Which is an absolute contraindication to vaccination? A. Giving MMR to the husband of a pregnant wife B. Giving Varicella vaccine to a post-transplant patient C. Fever, cough, and colds D. Recent administration of PPD/TB skin test

Answer: B. Giving Varicella vaccine to a post- transplant patient Live attenuated vaccines such as varicella are contraindicated in immunocompromised people such as the case in choice B

Which of the following statements is true about the pathologic features of Bancroftian filariasis? (2023, 2020) A. The pathogenic response is characterized as a cell- mediated rather than humoral immune response B. Granuloma formation leads to further lymphatic obstruction C. Dead or dying worms no longer cause lymphatic obstruction D. Only adult worm stage cause lymphatic dilatation

Answer: B. Granuloma formation leads to further lymphatic obstruction Calcification of necrotizing granulomas with dead worms lead to lymphatic destruction. Choice A is incorrect because BOTH humoral and cell-mediated immune responses are present in Bancroftian filariasis. Choice C is incorrect because dead or dying worms elicit the MOST SEVERE inflammation. Choice D is incorrect because LARVAL OR ADULT worms invade the lymph vessels and cause lymphatic dilatation. Source: Trans 2, p. 2. 2020 explanation: Both adult and larval worms cause lymphatic dilation causing lymphatic damage. Both the humoral and cell-mediated responses are involved in the pathologic response. Dead or decaying worms elicit the most severe inflammation.

A typical cutaneous lesion that has an elliptical vesicle surrounded by an erythematous halo. The long axis of the lesion is oriented along the skin lines usually caused by enteroviruses, HSV, but most commonly Coxsackievirus A16. A. Congenital Varicella syndrome B. Hand, foot, mouth disease C. Exanthema subitum D. Herpes simplex 2

Answer: B. Hand, foot, mouth disease Hand, foot, mouth disease is characterized by a typical cutaneous lesion which is a.) an elliptical vesicle surrounded by an erythematous halo, and b) the long axis of the lesion is oriented along skin lines. These papulovesicular lesions are usually found in the anterior of the mouth, on the hands, feet, and buttocks and can heal spontaneously in 5-7 days. Lesions in the hand and feet usually take longer, however. It usually presents with fever (average of 38.3°C) initially and can present after 2-3 days with abdominal pain, anorexia, malaise, sore mouth, cough. Etiologic agents include enteroviruses, HSV, and Coxsackie virus A16 which is the most common. It has an incubation period of 6-8 days and can be transmitted via direct contact with infected nasal or oral secretions, or infected fecal material, or aerosolized droplets in a fecal-oral or oral-oral route.

Which of the ff factor contributed to the large Ebola outbreak in West Africa in 2014? A. Cultural diversity B. International indifference C. Timely international aid and response D. Isolation of >80% cases

Answer: B. International indifference

Suppose you develop a new vaccine which is a weakened form of the whole organism. Which of the ff. is true? A. You cannot administer it with MMR B. It stimulates the most robust immune response among the diff. kinds of vaccines C. Needs to be administered in multiple doses D. Can be given to pregnant women

Answer: B. It stimulates the most robust immune response among the diff. kinds of vaccines From feedback: Also, live vaccines stimulate the strongest immune response since they replicate the process of adaptive immunity in a natural infection and confers almost lifelong immunity to that particular organism

Which of the following are all known to be endemic for Bancroftian filariasis? A. Sorsogon, Cebu, Romblon B. Leyte, Northern Samar, Surigao del Norte C. Palawan, Iloilo, Guimaras D. Basilan, Tawi-tawi, Lanao del Norte

Answer: B. Leyte, Northern Samar, Surigao del Norte

The most important parasitic disease (2022, 2021, 2020) A. Filariasis B. Malaria C. Amoebiasis D. Can't recall

Answer: B. Malaria From 2022 OS 217 Malaria Trans

Brugian filariasis may be acquired through exposure to mosquitoes belonging to Genus: (2023, 2020) A. Anopheles B. Mansonia C. Culex D. Aedes

Answer: B. Mansonia In the life cycle of Brugia malayi, Mansonia spp. is the intermediate host, and animals are definitive hosts. Humans are incidental hosts. Source: Trans 2, p. 3.

Which of the following is not a strategy for elimination of lymphatic filariasis? (2023, 2020) A. Conducting hydrocelectomy missions in known endemic areas B. None of those mentioned C. Disability management training of local health workers in known endemic areas D. Mass drug administration using antifilarial drugs

Answer: B. None of those mentioned The National Filariasis Elimination Program includes mapping, mass drug administration (MDA), morbidity management and disability prevention (MMDP), and surveillance. The choices all fall under these categories. Source: Trans 2, pp. 5-6.

A patient presents to you with history of an influenza-like illness (ILI) about 4 weeks prior to consultation. The patient admits to intravenous drug use, multiple sexual partners, and MSM activity. Which of the following symptoms is NOT usually associated with acute HIV syndrome? A. Fever B. Oral thrush C. Aseptic meningitis D. Cervical lymphadenopathy

Answer: B. Oral thrush. Acute phase is characterized by flu- like symptoms. Oral thrush happens later in the course of the disease.

Mixed falciparum and vivax malaria can be diagnosed by the following tests EXCEPT: A. ICT malaria (card) B. Paracheck test (casette) C. Indirect Fluorescent Antibody Test (IFAT) D. Blood smear

Answer: B. Paracheck test (casette)

What phase of WHO Pandemic Alert is described as the presence of verified human-to-human transmission of an animal or human-animal influenza reassortment virus able to cause "community-level outbreaks"? A. Phase 3 B. Phase 4 C. Phase 5 D. Phase 6

Answer: B. Phase 3 Phase 3 is limited human-human transmission, Phase 5 involves two countries (needs to be specified to be Phase 5 since Phase 5 involves community-level outbreaks), Phase 6 is for pandemics (likewise, needs indications of global spread to be Phase 6).

What would be empiric therapy (if not pen allergic) according to the latest infectious disease society of America mgt of skin and soft tissue infections? a. Penicillin + Clindamycin b. Piperacillin-tazobactam + Vancomycin c. Meropenem + Clindamycin d. Ceftatriaxone + Doxycycline

Answer: B. Piperacillin-tazobactam + Vancomycin This is a case of Necrotizing Fasciitis (as discussed in SSTI trans), commonly caused by Clostridium perfringens in a patient with no co-morbids. But recall that our patient is diabetic, and in diabetic patients polymicrobial soft tissue infections are more common. Guidelines for Nonpurulent > Severe > Polymicrobial SSTI is Piptaz-Vanco (excellent g(+), g(-), and MRSA coverage).

A patient with HIV returns for follow-up in your clinic. His most recent Cd4 lymphocyte count is 175/uL. On examination, he is cachectic. His vital signs are stable. He has oropharyngeal thrush and cervical lymphadenopathy. His lungs are clear to auscultation bilaterally. Heart sounds are distinct, with regular rate and rhythm. You start him on an antimicrobial primarily for the prophylaxis of - - A. Toxoplasmosis B. Pneumocystis jirovecii pneumonia (PCP) C. Mycobacterium Avium Complex (MAC) D. Cytomegalovirus (CMV)

Answer: B. Pneumocystis jirovecii pneumonia (PCP)

Which of the following statements regarding the establishment of HIV infection is accurate? A. Primary infection -> establishment of infection in gut associated lymphoid tissue -> HIV immune response -> massive viremia -> immune activation -> increased virus replication -> destruction of immune system B. Primary infection -> establishment of infection in gut associated lymphoid tissue -> massive viremia -> HIV immune response -> immune activation -> increased virus replication -> destruction of immune system C. Primary infection -> massive viremia -> establishment of infection in gut associated lymphoid tissue -> HIV immune response -> immune activation -> increased virus replication -> destruction of immune system D. Primary infection -> increased virus replication -> establishment of infection in gut associated lymphoid tissue -> HIV immune response -> massive viremia -> immune activation -> destruction of immune system

Answer: B. Primary infection -> establishment of infection in gut associated lymphoid tissue -> massive viremia -> HIV immune response -> immune activation -> increased virus replication -> destruction of immune system

A 34/M was newly diagnosed with HIV. His CD4 count was found to be 50 cells/mm3. He would like to receive vaccinations as soon as possible. Which of the following vaccines can be safely given immediately, if indicated? (2023, 2022) A. MMR B. Rabies C. Varicella D. Yellow fever

Answer: B. Rabies The CD4 count of the patient shows that he is immunocompromised, which warrants that he should not receive any LAVs. Choice B is correct because the Rabies vaccine is an inactivated/killed vaccine, which can be safely given to immunocompromised patients. Choices A, C, and D are all LAVs which make them incorrect. Source: Trans 15, p. 1.

Erysipelas is a superficial infection of the skin that has this as a distinctive feature: A. Slapped-cheek appearance B. Raised border with sharply demarcated border C. Erythematous areas of the hands because of fish exposure D. Well-demarcated, brown-red macular patches, with a wrinkled appearance and fine scales

Answer: B. Raised border with sharply demarcated border

The most common side effects of the antiretroviral drug NNRTI class used in children: A. Lipodystrophy, hepatic steatosis B. Rash, abdominal liver function tests and fever C. Hyperlipidemia and abnormal liver function tests D. Hyperglycemia and lipodystrophy

Answer: B. Rash, abdominal liver function tests and fever "Rash, which is the most common adverse effect associated with all NNRTIs, usually develops within the first few weeks of therapy and resolves with continued treatment. All NNRTIs except etravirine have the ability to cause some degree of hepatotoxicity. Delavirdine and efavirenz can increase transaminase levels, while nevirapine can cause severe toxicity, including hepatic necrosis in patients with CD4 counts that exceed 250 cells/μL." Source: Multiply-cited references in Medscape. (2019). What are the adverse effects of nonnucleoside reverse transcriptase inhibitors (NNRTIs) in antiretroviral therapy of HIV infection?

Which of the following ACCURATELY describes a public health emergency of international concern (PHE-IC)? A. Confined with a national border B. Requires immediate multinational action C. Recurring or seasonal with expected consequences D. Widespread with or without devastating complications

Answer: B. Requires immediate multinational action A Public Health Emergency of International Concern (PHEIC) is defined as an extraordinary event which is determined, as provided by these regulations: 1. To constitute a public health risk to other States through the international spread of the disease; 2. To potentially require a coordinated international response Thus, this definition implies a situation that is: ● Serious (making choice D wrong), ● Unusual or unexpected (making choice C wrong) ● Carries implications for public health beyond the affected State's national border (making choice A wrong) ● And may require immediate international action (thus, choice B is the correct answer) Source: Trans 5, p. 3.

A 1-year-old girl did not get any immunizations because her mother had refused to have her vaccinated. She had no significant illnesses until the last 5 days, when she developed moderate to high grade fever accompanied by dry, hacking cough, red eyes and congestion. The differential diagnosis for a patient presenting with fever, cough, conjunctivitis in an unvaccinated child can be: A. Diphtheria B. Rubeola C. Dengue D. Pertussis

Answer: B. Rubeola Measles/Rubeola presents with the 3Cs: coughing, coryza/runny nose, and conjunctivitis. Fever is also present. Source: Exam 1 Trans 9, p. 3.

True of treating infectious diseases (2020, 2021) A. Guideline from the United Kingdom can be directly applicable to the Philippines B. Sensitivity patterns of the locality should be considered C. Patients with high grade fever should always be given an antibiotic D. Obtain the specimen for culture after the 2nd dose of antibiotic

Answer: B. Sensitivity patterns of the locality should be considered

Based on the current evidence, what is the benefit of using remdesivir, an investigational antiviral against COVID-19? A. Decreased mortality by about 40% B. Shortens clinical disease by about 4 days C. Decreased duration of mechanical ventilation D. Disease A with Ro=3 in the healthcare setting

Answer: B. Shortens clinical disease by about 4 days Among RNA-dependent RNA polymerase inhibitors being evaluated as alternative therapeutic strategies, remdesivir, which halts SARS-CoV-2 replication, shows reduction in symptomatic duration by 4 days. Source: Trans 6, p. 7

Which of the following approaches can increase the risk of HIV transmission during breastfeeding? (2021, 2023) A. Practicing exclusive breastfeeding B. Supplementing breast milk with commercial infant formula C. Taking ARV therapy while breastfeeding D. Obtaining early treatment of breast problems

Answer: B. Supplementing breast milk with commercial infant formula Mixed feeding (i.e. giving water, other liquids, or solid food in addition to breastfeeding) increases risk of transmission as it can cause microabrasions in the gut of the infant that can serve as entry points for infection. Other risk factors include high maternal viral load, longer duration of breastfeeding, breast abscesses/nipple fissures/mastitis, and oral diseases in the baby. Source: Trans 9, p. 2.

A 55 year-old male presented with a 4 day history of left lower leg erythema, swelling, without sharp margins on visual exam, and on palpation was noted to be hot, shiny, and exquisitely tender. CBC revealed leukocytosis. Left lower leg X-ray revealed abundant gas. For necrotizing fasciitis, the emergent thing to do is: a. Observe response for 3 days on empiric antibiotics b. Surgical inspection/debridement c. CT scan or MRI d. Hyperbaric oxygen therapy

Answer: B. Surgical inspection and debridement Surgery and debridement is the first-line treatment for Necrotizing fasciitis as mentioned by the lecturer. Furthermore, extensive debridement of all tissues that can be easily elevated off the fascia with gentle pressure. Wide debridement of all necrotic and poorly perfused tissues is associated with more rapid clinical improvement (medscape).

Healthcare associated infections follow basic epidemiologic patterns that are predictable and thus help to direct prevention and control measures in the medical wards and ICUs. Which among the following statements are true regarding healthcare associated infections? A. Proper suctioning, frequent tubing changes and selective decontamination of the gut are some of the strongly recommended means of reducing risk for ventilator-associated pneumonias. B. The most important control measure shown by randomized control trials to reduce risk for surgical site infections is the administration of prophylactic antibiotics defined as giving of systemic antibiotics within two hours before the start of high-risk operative procedures. C. Catheter-related urinary tract infections are easily preventable through routine use of any one of the following strategies: use of antimicrobial-coated urinary catheters, irrigation of catheters with antibiotics, use of topical meatal antibiotics, and drainage bags with disinfectants D. Airborne precaution with the use of special N95 masks is the most important preventive measure for all areas of the hospital and for all types of health care associated infections.

Answer: B. The most important control measure shown by randomized control trials to reduce risk for surgical site infections is the administration of prophylactic antibiotics defined as giving of systemic antibiotics within two hours before the start of high-risk operative procedures.

Healthcare associated infections follow basic epidemiologic patterns that are predictable and thus help to direct prevention and control measures in the medical wards and ICUs. Which among the following statements are true regarding healthcare associated infections? A. Proper suctioning, frequent tubing changes and selective decontamination of the gut are some of the strongly recommended means of reducing risk for ventilator-associated pneumonias. B. The most important control measure shown by randomized control trials to reduce risk for surgical site infections is the administration of prophylactic antibiotics defined as giving systemic antibiotics within two hours before the start of high-risk operative procedures. C. Catheter-related urinary tract infections are easily preventable through routine use of any one of the following strategies: use of antimicrobial-coated urinary catheters, irrigation of catheters with antibiotics, use of topical meatal antibiotics, and drainage bags with disinfectants. D. Airborne precaution with the use of special N95 masks is the most important preventive measure for all areas of the hospital and for all types of healthcare associated infections.

Answer: B. The most important control measure shown by randomized control trials to reduce risk for surgical site infections is the administration of prophylactic antibiotics defined as giving systemic antibiotics within two hours before the start of high-risk operative procedures.

TRUE of the status of antibiotic resistance of Streptococcus pneumoniae in the Philippines (2018 data): A. There is high penicillin resistance at 43% B. There is cotrimoxazole resistance at 17% C. There is no data on S. pneumoniae resistance in the Philippines D. There is no chloramphenicol resistance

Answer: B. There is cotrimoxazole resistance at 17% TMP-SMX is otherwise known as Cotrimoxazole. Source: Trans 13b, p. 9.

HIV drug resistance resulting in treatment failure on antiretrovirals is most commonly due to: A. Spontaneous mutation B. Transmitted drug resistance C. Poor adherence D. Poor viral potency of the medications

Answer: B. Transmitted drug resistance In a study by Dr. Salvana this 2020, they found out that there is a high rate of tenofovir failure in the CRF01_AE predominant HIV epidemic in the Philippines. One of the implications was that there is possible transmitted drug resistance Source: Trans 7, p. 7.

A blood smear showing enlarged RBCs, with Schuffner's dots and amoeboid trophozoites is diagnostic of the following: (2023, 2022) A. Primate malaria B. Vivax malaria C. Falciparum malaria D. Zoonotic malaria

Answer: B. Vivax malaria Primate malaria refers to malaria found in primates, e.g. P. malariae and P. knowlesi. Zoonotic malaria refers to malaria, which are transmitted from animal to human. Trans 1, page 10

Which Ebola species pathogenic to humans is genetically closest to Ebola Reston? A. Bundibugyo Ebolavirus B. Zaire Ebolavirus C. Sudan Ebolavirus D. Tai Forest Ebolavirus

Answer: B. Zaire Ebolavirus Ebola Reston Virus is the only known Asian origin with genetic characteristics similar to the virus first identified in Zaire. Source: Trans 5, p. 3.

Broad spectrum antibiotics in septic patients once definitive culture data is available should: (Choices were not noted)

Answer: Be narrowed in a clinically improving patient to prevent the emergence of resistance

In several reports showing performance of health professionals during observation of Hand Hygiene moments show that the MOST and the LEAST moments complied to are as follows respectively A. Moment 1 most; Moment 5 least B. Moment 2 most; Moment 4 least C. Moment 3 most; Moment 1 least D. Moment 4 most; Moment 3 least

Answer: C. According to Ma'am's lecture, out of the five moments of Hand Hygiene, moment 3 (after body fluid exposure risk) is most followed while moment 1 (before touching a patient) is least followed. Source: Trans 11, p. 3.

Among the H-E-A-L-S strategies of the PGH Hospital Infection Control Unit, the most important pillar which has been demonstrated to directly translate to improve clinical outcomes and prevention of morbidity and mortality is: A. H: Hand Hygiene B. E: Environmental Disinfection C. A: Antimicrobial Stewardship D. L: Lowering HAIs thru bundles

Answer: C. Objectives of AMS include improvement of patient outcomes and minimization of harm to the patient and future patients. Source: Trans 11, p. 7.

The medical student was assigned to be the Student in Charge (SIC) of a 33-year old newly diagnosed bacteriologically confirmed TB male with HIV. The PPE he should don prior to entering the Isolation Room so he can interview and examine the patient for the first time is/are: A. Hazmat, N95 mask, gloves, shoe cover, face shield B. Gown, N95 mask, gloves, shoe cover, face shield C. N95 mask, gloves, face shield D. N95 mask and eye protection

Answer: C. Pulmonary TB requires airborne precaution, so an N95 mask is a must. We want to be careful with bodily fluids, so gloves are necessary, especially since the patient has HIV. Source: Trans 11, pp. 5-7.

The risk of acquiring HIV from unprotected sex from an HIV positive person with ARVs and with low viral load for the past 6 months is A. 0.50% B. 0.30% C. 0% D. 3%

Answer: C. 0% Vague question since low viral load isn't clearly defined quantitatively (<200 copies/mL) and qualitatively (if it's already undetectable or untransmissible). But given that it's also context specific in that it has low viral load in the last 6 months, this is usually associated with no risk (0% risk) of passing on HIV to a sexual partner given that these patients are on "durable" antiretroviral therapy (ART) for that given time. Best answer would still be C .

Which patient is most likely to have a Zika virus infection? A. 22/M with severe headache and persistent high-grade fever despite round the clock paracetamol B. 82/M with fever, seizure and conjunctivitis C. 33/F with temperature of T=38C of 2 days duration now complaining of rash on the trunk D. 19/F with fever and severe joint pains

Answer: C. 33/F with temperature of T=38C of 2 days duration now complaining of rash on the trunk.

What is the optimal amount of blood volume when ordering for blood culture? A. 2-4 mL in aerobic culture medium and 5-10 mL in anaerobic culture medium B. 2-4 mL in aerobic culture medium and 2-4 mL in anaerobic culture medium C. 5-10 mL in aerobic culture medium and 5-10 mL in anaerobic culture medium

Answer: C. 5-10 mL in aerobic culture medium and 5-10 mL in anaerobic culture medium

What would be the most appropriate dosing regimen for a 1- year old boy being treated for urinary tract infection with Amikacin 15 mg/kg/day IV? A. Amikacin 5 mg/kg every 8 hours B. NOTA C. Amikacin 15 mg/kg as a single dose every 24 hours D. Amikacin 7.5 mg/kg every 12 hours

Answer: C. Amikacin 15 mg/kg as a single dose every 24 hours Source: Trans 13b, p 4.

The predominant HIV-1 subtype in the Philippines switched from what subtype to the current CRF01_AE? A. C B. CRF02_AG C. B D. CRF99_F1B

Answer: C. B The predominant subtype in the Philippines has shifted from subtype B to subtype CRF01_AE . Source: Trans 7, p. 7.

Which of the ff is not a recommended component of the WHO Southern Hemisphere vaccine? A. A/Michigan/45/2015 (H1N1) pdm09-like virus B. A/Hongkong/4801/2014 (H3N2)-like virus C. B/Guangdong/H7N9 D. B/Brisbane/60/2008-like virus

Answer: C. B/Guangdong/H7N9

Mansonia sp is a known vector of A. Wuchereria B. Brugia C. Both A and B D. Neither

Answer: C. Both A and B

The following mechanisms have been implicated in the pathology of malaria EXCEPT A. Cell anoxia B. Cell responses to TNF C. Cell apoptosis D. Cytoadherence

Answer: C. Cell apoptosis. Malaria is characterized by periodic (with interval) and sequential (one after the other) attacks of chills, fever and sweating; including prostration (severe weakness). Some RBCs have knobs of proteins on their surface which serve as proteins for the parasite. These knobs attach to the endothelial wall receptors slow flow of blood anoxia necrosis/death of cells affected (usually vital organs). Macrophages release TNF which resets the thermoregulatory center temperature at a higher level fever.

Which of these penicillins can be used for typhoid fever? A. Penicillin VK B. Amoxicillin C. Chloramphenicol D. Clavulanic Acid

Answer: C. Chloramphenicol Chloramphenicol is the first line drug for uncomplicated fever. Chloramphenicol is also indicated for life-threatening H. influenzae infections (meningitis, acute epiglottitis, sepsis, very severe pneumonia), brain abscess and severe anaerobic infections caused by Bacteroides. Penicillin VK is active against streptococci, pneumococci, meningococci and oral anaerobes. Amoxicillin is active against S. pneumoniae, oral anaerobes and susceptible H. influenzae. Clavulanic acid adds anaerobic activity to amoxicillin. Source: Trans 13a, pp. 2,5.

An LU5 student spends the weekend with his elderly parents. Thereafter he returns to the dormitory for his usual online classes. He learns later from his sibling that his mother tested positive for the SARS-CoV-2 and is going to be admitted at a hospital close to their home. He has no symptoms. The best course of action is: A. File a leave of absence and volunteer to watch his mother inside the hospital with PPE: N95, hazmat, gloves, goggles, shoe cover, hair cover. B. File a leave of absence and go on self-quarantine at the dormitory C. Continue with online classes while observing self quarantine, communicate with class monitor and parents via phone D. Continue with online classes during daytime and take turns with siblings to watch his mom in hospital during nighttime

Answer: C. Continue with online classes while observing self quarantine, communicate with class monitor and parents via phone The Department of Health recommends a 14-day home quarantine to individuals who are not showing any symptoms but had close contact with a COVID positive patient . Source: Department of Health. (2020). COVID-19 FAQS.

In the mass treatment for lymphatic filariasis, which of the following is not an approved combination? A. DEC + Albendazole + Ivermectin B. DEC + Albendazole C. DEC + Ivermectin D. NOTA

Answer: C. DEC + Ivermectin Ivermectin is the preferred treatment if the patient has Mazotti reaction -- a severe immunologic response to DEC in patients with onchocerciasis

What does PCR of HIV detect? A. Antibodies B. Antigens C. DNA and RNA D. Viral load

Answer: C. DNA and RNA

When is the best period to draw blood to diagnose malaria? (2021) A. Cold period B. Period of Diaphoresis C. Febrile Period D. Incubation Period The best time to collect peripheral blood for the laboratory diagnosis of malaria is: (2020) A. Chilling (cold) phase B. Febrile (hot) phase C. Peak of the fever D. Sweating (cold) phase

Answer: C. Febrile period Febrile period corresponds to the release of merozoites into the bloodstream. The finding of a merozoite/trophozoite in thin blood smear microscopy is the gold standard in diagnosing malaria. Answer: C. Peak of the fever. Pathophysiology: CHILLS (before schizogony) FEVER (release of merozoites) SWEATING (body's compensation for elevated body temperature) ● Clinical correlate: Best time to collect blood sample for diagnosis - during the release of merozoites (when patient is febrile)

HIV can give rise to circulating recombinant forms because its genome is A. Haploid B. Circular C. Functionally diploid D. Functionally haploid

Answer: C. Functionally diploid The HIV virus consists of 2 strands of RNA which are functionally diploid and contribute to viral diversity. Source: Trans 7, p. 1.

A resident sustains a hollow-needle stick injury while extracting blood from a patient who has HIV, HBV (HBeAg+) and HCV and is not on antiretrovirals. Which disease is she at highest risk for, assuming she is not currently infected with any of these diseases, and her anti-HBs titer has always come back non-reactive despite multiple HBV immunizations with different brands of HBV vaccine? A. HIV B. HCV C. HBV D. She is not at risk for any of the diseases

Answer: C. HBV The risks of acquiring a blood-borne infection from an injury with a needle used on an infected patient are: 1 in 3 for Hepatitis B, 1 in 30 for Hepatitis C, and 1 in 300 for HIV. Source: Trans 11, p. 8.

A 60 year old post stroke patient on peritoneal dialysis develops fever at home. On the subsequent peritoneal dialysis, the drainage from the peritoneal dialysis (PD) was found to be turbid. The insertion site of the PD catheter was erythematous and had some discharge. The situation is best described as: A. Community acquired peritonitis with PD catheter infection B. Hospital acquired peritonitis with PD catheter infection C. Healthcare associated peritonitis with PD catheter infection D. This is not an infection but part of the natural course of dialysis

Answer: C. Health care associated peritonitis with PD catheter infection

A major protective factor for HIV transmission in Filipinos is A. Low condom use B. High birth rate C. High circumcision rate D. Piety

Answer: C. High circumcision rate Circumcision allows for greater keratinization of the glans penis, allowing for less mucosal surfaces which HIV viruses penetrate.

One of the LU5 classmates is diagnosed to have COVID-19. Other than a sore throat and loss of smell, he seems okay. He lives in a condominium with three other classmates. The best course of action is: A. Inform the College COVID focal person of the situation and send the COVID student back to his home. B. Inform the College COVID focal person of the situation and seek admission to PGH. c. Inform the College COVID focal person of the situation and arrange for home quarantine of the four classmates: 1 case and the 3 exposed to case. d. Inform the College COVID focal person of the situation and move the other classmates to dorm with other classmates.

Answer: C. Inform the College COVID focal person of the situation and arrange for home quarantine of the four classmates: 1 case and the 3 exposed to case. Since he has mild symptoms, it would be unnecessary for him to be admitted to PGH (choice B). Home quarantine is the best option for him and his roommates since they are all assumed to be contagious, so choices A and D cannot be done. Source: DOH. (2018). Public Advisory No. 14 - Clarification on Management and Referral of Close Contacts of Confirmed COVID19 Cases

The strongest risk factor/s to the development of ventilator-associated pneumonia is/are: A. Age of patient B. Position of patient during feeding C. Intubation D. Location in the hospital (private room vs ICU)

Answer: C. Intubation

The purpose of the insecticide treated nets (ITNs) in malaria control is A. Prevent outdoor biting mosquitoes B. Stop mosquito development C. Kill the larvae of mosquitoes D. Prevent indoor biting mosquitoes

Answer: C. Kill the larvae of mosquitoes An ITN repels, disables or kills mosquitoes that come into contact with the insecticide on the netting material. Source: World Health Organization (2015). Guidelines for malaria vector control 3rd Ed.

Hospital antimicrobial stewardship programs include the following, EXCEPT: A. Formulary/ antibiotic restrictions B. De-escalation therapy C. Mandatory usage of American practice guidelines D. Education of healthcare providers

Answer: C. Mandatory usage of American practice guidelines

The risk of transmitting HIV to a patient by an HIV-positive gastroenterologist who is not on antiretroviral medications doing a rectal examination is: A. 0.3% B. 1% C. Minimal D. 5%

Answer: C. Minimal Although HIV transmission is possible in healthcare settings, it is extremely rare. Medical experts emphasize that the careful practice of infection control procedures, including universal precautions, protects patients as well as healthcare providers from possible HIV transmission in medical and dental settings. Routine rectal examination falls under Category I, which are procedures considered safe because of minimal risk of viral transmission to patients. Source: Trans 7, p. 9; CDC . (2011). HIV in healthcare settings. Retrieved from https://www.cdc.gov/hai/organisms/hiv/hiv.html

The natural mode of transmission of Plasmodium or the malaria parasite is (2023, 2021, 2020) A. Congenital transmission B. Through blood contaminated needles C. Mosquito bite D. Blood transfusion

Answer: C. Mosquito bite Malaria is transmitted by mosquito bites of Anopheles flavirostris (primary vector in the Philippines) and Anopheles litoralis (secondary vector). Source: Trans 1, p. 4

What is correct about Typhidot? a. Detects O and H antigen b. Expensive c. Not quantitative d. Need 2 sera

Answer: C. Not quantitative Uses nitrocellulose strip

The most common oral and mucocutaneous presentation of HIV infection in pediatric age group: A. Herpes labialis B. Aphthous ulcers C. Oral candidiasis D. Oral hairy leukoplakia

Answer: C. Oral candidiasis The most common oral disease and mucocutaneous presentation of HIV infection is candidiasis caused by Candida albicans. Source: Trans 8, pp. 2-3.

This species of Plasmodium clinically presents with the shortest incubation period (2023, 2020) A. P. ovale B. P. malariae C. P. falciparum D. P. vivax

Answer: C. P. falciparum P. falciparum, the most virulent species of Plasmodium, has the shortest incubation period ranging from less than a week of infection to 8-11 days. The following are the incubation periods for the other Plasmodium species: ● P. vivax: 10-17 days ● P. ovale: 10-17 days ● P. malariae: 18-40 days Source: Trans 1, p. 4.

Which phase of pandemic influenza is characterized by verified human-to-human transmission of an animal or human animal influenza reassortant virus able to cause sustained "community-level outbreaks?" A. Phase 2 B. Phase 3 C. Phase 4 D. Phase 5

Answer: C. Phase 4

The most virulent malaria species A. Plasmodium falciparum B. Plasmodium vivax C. Plasmodium malariae D. Plasmodium knowlesi

Answer: C. Plasmodium malariae

A 2/F was brought to your clinic for catch-up vaccination. Her family is planning to transfer her to Davao in 6 months. Upon review of her baby books, you noted that he received the following vaccines: BCG, DTP/IPV/Hib and Hep B 3 doses, measles. What vaccines will you give her? A. Pneumococcal, rotavirus, MMR, varicella, Hep A B. Pneumococcal, influenza, MMR, varicella, Hep A, DTP/IPV/Hib booster dose, Hep A, cervical cancer vaccines C. Pneumococcal, influenza, MMR, varicella, Hep A, DTP/IPV/Hib booster dose, Hep A D. Pneumococcal, rotavirus, influenza, MMR, varicella, Hep A, DTP/IPV/Hib booster dose, Hep A

Answer: C. Pneumococcal, influenza, MMR, varicella, Hep A, DTP/IPV/Hib booster dose, Hep A

Complicated or severe falciparum malaria includes the following conditions EXCEPT A. Cerebral malaria B. Pulmonary edema C. Portal hypertension D. Blackwater fever

Answer: C. Portal hypertension

Which of the following is a passive, artificial immunization? (2023) A. Breastfeeding B. Measles infection C. Post-exposure rabies immunoglobulin injection D. Varicella vaccination Which of the following is a passive, natural immunization? (2022) A. Breastfeeding B. Varicella vaccination C. Post-exposure rabies immunoglobulins injection D. Measles infection

Answer: C. Post-exposure rabies immunoglobulin injection Passive immunization is the provision of preformed antibodies to combat disease. Choice A is incorrect because although it is passive, it is a natural procedure. Choices B and D are incorrect because these are examples of active immunization, procedures which provide antigens (i.e., microorganisms or parts of microorganisms) to stimulate antibody production in the host. Answer: A. Breastfeeding Source: Nelson's Textbooks of Pediatrics 8E, p. 363; Healthline. (2019). What You Need to Know About Acquired Immunity.

Drug for malaria used against hypnozoites A. Chloroquine B. Mefloquine C. Primaquine D. Arthemeter-Lumefantrine

Answer: C. Primaquine Chloroquine is not used due to resistance Mefloquine is for Prophylaxis Coartem is for uncomplicated malaria infection

Which of the following accurately describes SARS-CoV-2? A. 50% related to SARS-CoV of 2003 B. Belongs to alphacoronavirus 2B C. Primary targets are cells with ACE2 receptors D. Independent of TMPRSS2 for viral attachment and fusion

Answer: C. Primary targets are cells with ACE2 receptors SARS-CoV-2 targets cells such as nasal and bronchial epithelial cells and pneumocytes through the viral structural spike (S) protein that binds to ACE2 receptors in target cells. It is 90% related to SARS-CoV (2003) and 50% related to MERS-CoV (2014). It belongs to Betacoronavirus group 2B . Without TMPRSS2, even if there is attachment of the spikes to ACE2 receptors, there will be no fusion of spikes to ACE2 receptors. Source: Trans 6, p. 2

The laboratory confirmation of malaria is done by microscopy (gold standard) or A. PCR B. IFAT C. RDT D. ELISA

Answer: C. RDT

Which vaccine is recommended for selected healthcare workers only? A. Pneumococcal polysaccharide vaccine B. Hepatitis B vaccine C. Rabies vaccine D. Influenza vaccine

Answer: C. Rabies vaccine Especially those who handle animals directly.

Which among these is considered an AIDS-defining condition? A. Peripheral neuropathy B. Papular Pruritic Eruption C. Recurrent Pneumococcal Pneumonia D. Recurrent URTI (sinusitis, pharyngitis, tonsillitis)

Answer: C. Recurrent Pneumococcal Pneumonia

In 2017, the global targets for TB has dramatically changed so that government health systems are now working towards ending TB. The pillars which served as guide for all of us in the Philippines so that "Sama-sama tuldukan and TB" include integrated, patient-centered TB care and prevention. This means: A. Assuring that anti-TB medications available are accessible to patients at all times. B. Enabling patients to work even during the period of active Tb so that they can continue to be economically stable. C. Reducing stigma related to TB care by dedicating special fast track lines in public services such as public transportation and cash transfers. D. Proving a strict monitoring system s that patients who do not comply on their daily medications are quickly identified and punished

Answer: C. Reducing stigma related to TB care by dedicating special fast track lines in public services such as public transportation and cash transfers.

A 4-week old baby is brought in for her well-baby visit. The mother is worried about the diarrhea outbreak in her neighborhood. She asks if her baby can receive the rotavirus vaccine. Which of the following is correct regarding the rotavirus vaccine? A. Rotavirus vaccine is given at a maximum age of 8 weeks B. Rotavirus vaccine is given at a minimum age of 4 weeks C. Rotavirus vaccine can be given as early as 6 weeks of life D. Rotavirus vaccine is given as single dose

Answer: C. Rotavirus vaccine can be given as early as 6 weeks of life. Rotavirus can be given as a 3-dose or 2-dose series, depending on the type of vaccine. Minimum age of administration is 6 weeks of life, maximum age is at 8 months.

Which of the following findings indicate malarial disease with poor prognosis? A. Ring form B. Gametocyte C. Schizont D. Trophozoite

Answer: C. Schizont 30-50% mortality rate depending on intensive care of the patient (patient is already having multiple organ failure and may die within a few hours) Schizonts indicate poor prognosis in malaria. Thirty to fifty percent will die since this finding is predictive of multiple organ failure in a few hours.

What is a key feature of pyomyositis? A. High CK-MM B. Rhabdomyolysis C. Severe muscle pain D. Erythematous? Unrecalled

Answer: C. Severe muscle pain Myalgia, fever, myositis, subcutaneous nodules and recurrent abscess formation are the most common symptoms of pyomyositis occurring in 80-99% of patients

A 29/F comes to you desirous to receive varicella vaccine. She is currently in contraception but wants to be pregnant a few months after receiving the vaccine. However, on history, you noted that she might have had chickenpox at 7 years already but she is not quite sure. What will you tell her? A. She should not receive the vaccine anymore because of the vague history in the past. B. She may not receive the vaccine because she is currently non-child-bearing. C. She may receive the vaccine. D. You need anti-varicella titers first before you can give the vaccine.

Answer: C. She may receive the vaccine. A possible history of varicella is not a contraindication to varicella vaccination. It is not contraindicated in non-pregnant women of child-bearing age.

The pk/pd parameter, which determines success in time- dependent antibiotics is: A. Cmax:MIC ratio B. AUC:MIC ratio C. T>MIC D. T:AUC ratio

Answer: C. T>MIC T>MIC - the cumulative percentage of time over a 24- hour period that the drug concentration exceeds the MIC . Time- dependent antibiotics maximizes the duration of exposure. Source: Trans 13b, p. 2

Which of the following patients would fall under PROBABLE case of COVID-19 based on the WHO Case definitions? A. 26/male cashier with cough and fever of 3 days duration, now asymptomatic B. 35/female with allergic rhinitis with some degree of loss of smell who consulted to you for a prescription of her antihistamines C. 45/male admitted for incessant cough and whose CT scan showed peripheral ground glass opacities D. 21/male who presented with fever and behavioral changes upon arrival from Cagayan Valley

Answer: C. The WHO defines Probable & Suspect cases as the following: Source: Trans 6, p. 5

What do rapid HIV tests detect? A. The presence of HIV antigen B. The quality of HIV C. The presence of HIV antibody D. The presence of viral RNA

Answer: C. The presence of HIV antibody HIV antibody tests only look for antibodies to HIV in your blood or oral fluid. In general, antibody tests that use blood from a vein can detect HIV sooner after infection than tests done with blood from a finger prick or with oral fluid. Most rapid tests and the only currently approved HIV self-test are antibody tests. HIV ELISA is screening test that detects HIV antibody and is highly sensitive (>99%), but it can sometimes have false positives. Sources: Centers for Disease Control and Prevention (2020). Types of HIV Tests; Trans 7, p. 8.

A heterosexual couple wants to have a baby. The woman is infected with HIV and has been on ARVs for two years and her viral load is <200 copies/mL for the last 6 months. Her most recent viral load is undetectable, done last week. The man is seronegative and was tested last week. Both are currently faithful and have had no other sexual partners in the last year. What are their options? A. The antiretrovirals will slow down the progression to AIDS, but it does not affect infectivity so they should NOT conceive naturally. Refer to fertility specialist for IVF. B. The man should start PrEP to decrease his risk of being infected with HIV by 91% while they are trying to conceive. C. The risk of transmitting HIV to the man from unprotected sex is zero, and so they can go ahead and have a baby naturally without any other intervention. D. The man is probably infected and is in the window period, so they shouldn't try to conceive until you can retest her.

Answer: C. The risk of transmitting HIV to the man from unprotected sex is zero, and so they can go ahead and have a baby naturally without any other intervention. In one study (Rodger et al., 2019), it is found that there is no transmission between gay couples, if the positive partner had a viral load that is under 200 copies/mL. The same could apply to this monogamous heterosexual couple where the seropositive partner has undetectable viral loads, i.e., <200 copies/mL. Source: Trans 7, p. 10; Rodger, A . J. et al. (2019). Risk of HIV transmission through condomless sex in serodifferent gay couples with the HIV-positive partner taking suppressive antiretroviral therapy (PARTNER): final results of a multicentre, prospective, observational study.

Treatment of HIV in the newest WHO guidelines recommends which combination of drugs as the first line? A. Only one drug from either NRTI, NNRTI (efavirenz), PI (lopinavir-ritonavir) or integrase inhibitor (dolutegravir) B. One PI (lopinavir-ritonavir) and one NNRTI (efavirenz) or NRTI C. Two NRTIs and one NNRTI (efavirenz) or integrase inhibitor (dolutegravir) D. Two NNRTIs (efavirenz plus raltegravir) and one NRTI or PI (lopinavir-ritonavir)

Answer: C. Two NRTIs and one NNRTI (efavirenz) or integrase inhibitor (dolutegravir) / D . Two NNRTIs (efavirenz plus raltegravir) and one NRTI or PI (lopinavir-ritonavir) HIV should always be treated with combination therapy. According to the WHO recommendations, the first-line ART regimens are as follows: 1. Dolutegravir (DTG) in combination with a nucleoside reverse- transcriptase inhibitor backbone as the first line regimen for PLHIV initiating ART 2. Efavirenz at low dose in combination with an NRTI backbone as an alternative first-line regimen 3. For infants and children (who cannot have DTG), a raltegravir (RAL)-based regimen is the alternative, and it is the first-line regimen for neonates Rule in C because of the presence of dolutegravir which is a first- line drug. However, since the lecturer acknowledged that dolutegravir is still not in use in the Philippines (but is "on the way"), it's possible to use efavirenz (alternative first-line). Source: Trans 7, p. 9.

Indication/s for the use of PCR in malaria diagnosis include the following A. diagnosis of mixed P. falciparum and P. vivax infection B. active malaria case detection C. detection of P. malariae and P. knowlesi D. malaria outbreak investigation

Answer: C. detection of P. malariae and P. knowlesi. Microscopy remains to be the gold standard in malaria diagnosis. Aside from detection of P. malariae and P. knowlesi strains, PCR is also used to detect chloroquine resistant strains.

As a malaria preventive measure, chemoprophylaxis is indicated to the following high risk groups EXCEPT A. short-term visitors B. pregnant women C. permanent residents of endemic communities D. occupationally exposed groups

Answer: C. permanent residents of endemic communities. Chemoprophylaxis is done for non-immune travelers and pregnant women. Common regimen: ● Doxycycline - 100 mg daily, start 2-3 days prior to travel and continue up to 4 weeks upon leaving the area (except in pregnant or lactating women, children less than 7 years old ● Mefloquine - 250 mg once a week 1 week before travel, continue up to 4 weeks upon leaving the area

Which is TRUE about antigenic drift in influenza viruses? A. happens only occasionally B. produces a new influenza subtype whose surface antigen is a mix of two or more original strains C. results in a new strain of virus which cannot be inhibited as effectively by previously produced antibodies D. only seen in Influenza type A viruses

Answer: C. results in a new strain of virus which cannot be inhibited as effectively by previously produced antibodies Antigenic drift is a mechanism for variation in viruses that involves the accumulation of mutations within the genes that code for antibody-binding sites. This results in a new strain of virus particles which cannot be inhibited as effectively by the antibodies that were originally targeted against previous strains, making it easier for the virus to spread throughout a partially immune population. On the other hand, antigenic shift is the process by which two or more different strains of a virus, or strains of two or more different viruses, combine to form a new subtype having a mixture of the surface antigens of the two or more original strains. It happens suddenly, leads to epidemics and pandemics, and more devastating. Source: Trans 5, p. 4.

A 45-year old presents with neutropenic fever. He has been on levofloxacin as outpatient. Which of the following antimicrobials would be most appropriate as initial monotherapy?

Answer: Cefepime

The LU7 who was asked by the nurse in charge to insert a 22 gauge IV catheter onto the left arm of an 82 year old female dons a pair of clean gloves. This action is to comply with: A. Aseptic procedure B. Standard precautions C. Contact precautions D. All of the above

Answer: D. Donning gloves before an aseptic procedure is done in the example. It is also part of standard precautions because donning gloves before touching a patient is part of hand hygiene, which is part of standard precautions. It is also part of contact precautions because donning gloves helps reduce risk of transmission of epidemiologically important microorganisms. Source: Trans 11, pp. 3-5.

A 7-year old gasping child suspected to have meningococcemia is urgently brought to the Pediatric ER. Staff in the ER must be protected with the following PPEs to seeing the case: A. Face mask and face shield B. N95 mask and face shield C. Gown, N95 mask and face shield D. Hazmat, N95 mask, face shield and gloves

Answer: D. Standard precautions (goggles/face shield/spectacles + surgical mask + gloves + gown) are recommended by the WHO when dealing with possible meningococcemia. C is the closer answer, but lacks gloves. Given that meningococcemia is possibly fatal, the more protected answer seems rational. Source: WHO. (n.d.) Meningococcal Meningitis.

The following condition should be satisfied for malaria elimination to be achieved A. 0% prevalence B. <5% malaria prevalence C. <1/1000 incidence D. 0 (zero) indigenous or local malaria cases

Answer: D. 0 (zero) indigenous or local malaria cases For a country to be certified malaria-free by WHO, there should be zero local cases of malaria for 3-5 years. Choice A refers to eradication. Choice C refers to the population at risk in the Philippines. Source: 2022 Trans 1 Malaria, p. 8.

How many larval stages of lymphatic filarial worms are seen in the mosquito vector or intermediate host? A. 0 B. 1 C. 2 D. 3

Answer: D. 3

Recommended interval between administration of pRBC and varicella vaccine: A. 2 months B. 9 months C. 3 months D. 6 months

Answer: D. 6 months For Packed RBCs (pRBC) there is a 6-month recommended interval between Ab-containing products and Varicella Vaccination. Source: Trans 14, p. 4.

A 6/F was brought to your clinic for her second dose of varicella vaccine. 2 weeks prior to her visit, she was admitted for DHF and was given fresh frozen plasma. When is the best time to give her due vaccine? A. 3 months B. 5 months C. 6 months D. 7 months

Answer: D. 7 months

A 72 year old male patient admitted for Congestive Heart Failure at the Intensive Care Unit develops fever at the fifth day of hospitalization. His vital signs are: T=39.8ºC; HR 135/min; RR36/min. He had increased respiratory secretions when the endotracheal tube is suctioned. He also had a foley catheter in place since admission. The components of the VAP Prevention Bundle which should be observed in the care of this patient include: A. Head elevation up to 30-45 degrees B. Sedation vacation to allow early weaning C. Hand hygiene for all staff D. All of the above

Answer: D. AOTA

Examples of antibiotic misuse: A. Given when they are not needed B. Self-medication C. Continued when they are no longer necessary D. AOTA

Answer: D. AOTA Given when they are not needed, recycling antibiotic prescription and/or self-medication, and continued when they are no longer necessary are stated explicitly under examples of inappropriate antimicrobial use in Dr. Maramba-Lazarte's lecture. Source: Trans 13b, p. 5

A 72 year old male patient admitted for congestive heart failure at the ICU develops fever at the 5th day of hospitalization. His vitals were T = 39.8, heart rate = 135/min, respiratory rate = 36/min. Large amounts of respiratory secretions were removed when the endotracheal tube was suctioned. He also has a Foley catheter in place since admission. At this point, the next step/s to do is/are: a. Get chest xray and collect a urine specimen for urinalysis and urine culture b. Perform blood culture c. Start empiric antibiotics for HCAI immediately d. AOTA

Answer: D. AOTA Health-care associated infections may involve resistant organisms, which means that the use of wider spectrum empiric antibiotics along with the routine diagnostic tests is not contraindicated especially since the patient is symptomatic.

Primary prevention of malaria control? A. Early treatment and detection B. Sleeping inside ITN(insecticide treated nets) C. Residual pesticide spraying D. Anti-mosquito repellant

Answer: D. Anti-mosquito repellant A is secondary prevention, B & C malaria vectors are usually found in slow moving streams. D Mosquito repellants to prevent mosquito bites.

The first-line antimalarial for uncomplicated falciparum malaria is: (2021, 2020) A. Chloroquine B. Primaquine C. Quinine D. Arthemeter-lumefantrine

Answer: D. Arthemeter-lumefantrine. Chloroquine is no longer used anymore due to resistance rates in the Philippines. Primaquine is indicated in the 4th day of illness in combination to Arthemeter-Lumefantrine and Quinine + Tetracycline/Doxycycline to prevent transmission and to destroy gametocytes. Quinine is a second-line drug used in cases where Arthemeter-Lumefantrine fails.

Celene consulted the ER for cough and runny nose of 3 days duration. She does not want to be admitted but wanted an NPS/OPS for SARS-CoV-2 done to make sure she does not have COVID-19. CXR shows no active infiltrates and WBC was 4,000 cells/cu. mm. She also wanted a prescription for azithromycin. What is the BEST advice to give to Celene regarding azithromycin? A. Prescribe 7 days of azithromycin to maximize its antiinflammatory effect. B. Prescribe azithromycin for 3 days as part of the bundles for COVID-19 treatment and prevention. C. Based on high quality studies, azithromycin has NOT been shown to provide clinical benefit in COVID-19. D. Azithromycin is not warranted because her illness is probably viral.

Answer: D. Azithromycin is not warranted because her illness is probably viral. Celene's condition is most likely viral in etiology thus antibiotics are not needed. Use of antibiotics in patients with COVID-19 is reserved only for patients with radiologic findings, coinfection, who are immunocompromised and/or critically ill. Choice A is promoting antibiotic resistance; B is false, azithromycin is not part of the bundle. Evidence on the efficacy and safety of adding azithromycin to the treatment for COVID-19 is limited by low quality studies. Source: Trans 6, p. 6.; Furtado, R. et al. (2020). Azithromycin in addition to standard of care versus standard of care alone in the treatment of patients admitted to the hospital with severe COVID19 in Brazil (COALITION II): a randomised clinical trial.

What region is not a known endemic area for lymphatic filariasis in the Philippines? A. MIMAROPA (IV-B) B. Caraga (XIII) C. Central Visayas (VII) D. Central Luzon (III)

Answer: D. Central Luzon (III) Lymphatic filariasis is endemic in 46 provinces between 12 regions. These include all of Mindanao except Lanao region (Region X), Visayas, and Quezon, MIMAROPA and Region V

In fully susceptible S. typhi strains, which antibiotic is best to use? A. Amoxicillin B. Ceftriaxone C. Chloramphenicol D. Ciprofloxacin

Answer: D. Ciprofloxacin Table 160-1 HPIM20 Based on the figure above, optimal treatment for fully susceptible S. typhi is Ciprofloxacin or azithromycin.

The recommended antibiotic for infected animal bite-related wounds is: A. Co-trimoxazole B. Cefuroxime C. Clindamycin D. Co-amoxiclav

Answer: D. Co-amxiclav Antibiotic of choice must be active against both aerobic and anaerobic organisms. Co-amoxiclav or ampicillin-sulbactam are the first choice antibiotics.

The RECOVERY Trial arm has shown mortality benefit among COVID-19 patients on oxygen support from which intervention? A. Remdesivir B. Anti-IL6 monoclonal antibody (tocilizumab) C. Arbidol D. Dexamethasone

Answer: D. Dexamethasone The RECOVERY trial showed that 6 mg daily dexamethasone led to reduced 28-day all-cause mortality but only in patients that required oxygen supplementation. Remdesivir showed a reduction in symptomatic duration by 4 days. Source: Trans 6, p. 7.

A medical student develops fever and vesicular rash on the night before his rotation at the Cancer Ward. The fever disappears the next day and he decided it was probably safe to go to his post. If you were the monitor of the student in the Cancer Ward consults you, the best next steps is/are: A. Allow the student to work with a surgical mask. B. Allow the student to work with an N95 mask. C. Allow the student to work only at healthy nonfebrile patients. D. Do not allow the student to work until seen at the student clinic and viral exanthems are ruled out.

Answer: D. Do not allow the student to work until seen at the student clinic and viral exanthems are ruled out.

What is the primary reason identified for the widespread outbreak in Ebola in West Africa in 2004? A. Delay in international aid B. Ease of travel between the affected countries C. Personal belief and religious exemptions D. Failure to isolate cases

Answer: D. Failure to isolate cases Sir mentioned in the lecture that the Ebola outbreak is mostly attributed to the failure to isolate cases. Source: Dr. Roman lecture video. (2014). West African Ebola Outbreak: What went wrong? Time stamp 29:27.

Which of the following statements is FALSE? A. Available data indicate intervals between doses that are longer than those routinely recommended do not affect seroconversion rate or titer when the schedule is completed. B. Doses administered 5 days or more before the minimum interval or age should not be counted as valid and should be repeated as age appropriate. C. It is not necessary to restart a series or add doses of any vaccine because of an extended interval between doses. D. For routine vaccination, vaccine doses can be administered at intervals of recommended minimum ages or earlier.

Answer: D. For routine vaccination, vaccine doses can be administered at intervals of recommended minimum ages or earlier. Dosing intervals of the same vaccine should NOT be administered at intervals LESS than the recommended minimum or earlier than the minimum ages (except measles outbreak or impending travel). Source: Trans 15, p. 2.

A 55 year-old male presented with a 4 day history of left lower leg erythema, swelling, without sharp margins on visual exam, and on palpation was noted to be hot, shiny, and exquisitely tender. CBC revealed leukocytosis. Left lower leg X-ray revealed abundant gas. Surgical debridement was planned. The gram stain of the intraoperative specimen will likely show: A. Gram positive cocci in chains B. Gram positive cocci in clusters C. Gram negative bacilli D. Gram positive bacilli

Answer: D. Gram positive bacilli. The patient has necrotizing fasciitis, caused by Group A Strep, usually S. pyogenes

A sexually active 30 year-old health worker who had unprotected sexual intercourse about 1 week ago is worried about the possibility of HIV infection. Which serologic test would be positive at this stage? A. Gp 41 B. P24 antigen C. HIV antibody D. HIV viral load

Answer: D. HIV viral load

Severe falciparum malaria clinically presents as any of the following conditions EXCEPT: A. Cerebral malaria B. Severe anemia C. Pulmonary edema D. Heart failure

Answer: D. Heart failure The major complications of severe malaria include cerebral malaria, pulmonary edema, acute renal failure, severe anemia, and/or bleeding

A 56/female diabetic and hypertensive presents at the ER with difficulty of breathing after one week of cough. Her BP 90/60 RR 38 O2 sats was 88% at room air for which she was hooked 6lpm oxygen support via nasal cannula. Her WBC is 6,000 cells/cu. mm. CRP was 5x elevated and ESR was 4x elevated. An x-ray done was consistent with acute respiratory distress syndrome. She is probably in what stage of the illness? A. Incubation period B. Viral response phase C. Pulmonary phase D. Hyperinflammatory phase

Answer: D. Hyperinflammatory phase The hyperinflammation phase (Stage 3) is characterized by very elevated inflammatory markers. Additionally, it is in this stage wherein ARDS develops. The other stages include Stage 1/early infection stage wherein the body is directing response against the virus, and the virus is still detectable. This is where mild constitutional/clinical symptoms occur (e.g., fever, dry cough, diarrhea, headache). The second stage is the pulmonary phase. This is where the patient begins to develop shortness of breath, hypoxia, and more obvious signs of pneumonia. Source: Trans 6, p. 3.

A mainstay in the management of purulent skin and soft tissue infections: A. Co-trimoxazole B. Doxycycline C. Culture and susceptibility of pus before appropriate antibiotic D. Incision and drainage

Answer: D. Incision and drainage

The following are advantages of switching from parenteral to oral therapy, EXCEPT: A. Reduction in hospital acquired infections, and infected IV lines B. Reduction in the risk of adverse effects C. Reduction in treatment costs D. Increased failure of therapy

Answer: D. Increased failure of therapy

A 5/F has a history of egg allergy manifested as anaphylactic shock. What vaccine should not be administered? A. MMR B. Varicella C. MMR-V D. Influenza

Answer: D. Influenza

A 34-year old male is admitted for seizures and difficulty of breathing. His chest x-ray shows ground glass infiltrates and a sputum silver stain shows Pneumocystis jirovecii cysts. His MRI shows several lesions in his basal ganglia and a fundoscopy shows several retinal lesions. He is started on cotrimoxazole and steroids and improves, His CD4 count is likely: (2023, 2021) A. Greater than 500 cells/uL B. Less than 100 cells/uL C. Greater than 350 cells/uL D. Less than 200 cells/uL but greater than 100 cells/uL A male patient developed dyspnea and fever. His chest x-ray shows ground glass infiltrates and a silver-stained sputum sample showed Pneumocystis jiroveci cysts. He is given clotrimazole and steroids and improves. His CD4 count is likely: (2022) A. 500 cells/uL B. <200 cells/uL C. >350 cells/uL D. <350 cells/uL but >200 cells/uL

Answer: D. Less than 200 cells/uL but greater than 100 cells/uL The recommendation is to give cotrimoxazole as a prophylaxis for PCP pneumonia (Pneumocystis jirovecii aka Pneumocystis carinii) when CD4 counts are less than 200 cells/μL. Source: Trans 7, p. 8. Answer: B. <200 cells/uL

Which is true about the dengue vaccine? A. Shows benefit across all identified outcomes including development of symptomatic dengue infection, mortality, adverse drug reactions and bleeding B. Affords greatest protection against DENV-1 C. Minimal reduction in severe Dengue infections D. No efficacy studies in adults but extrapolation on antibody titer data from 9-16 years may show benefit

Answer: D. No efficacy studies in adults but extrapolation on antibody titer data from 9-16 years may show benefit

A 28 year old female came in the hospital with a chief complaint of a bullous on her buttocks. She was prescribed an oral antibiotic but it did not respond to treatment. It was then incised and pus was drained out of it. The patient has fever and her BP was 100/90, HR= 120, and RR= 24. According to the Infectious Diseases Society of America 2014 Guidelines on Management of Skin and Soft Tissue infections guidelines how will you classify this case a. NPSSTI Moderate Case b. NPSSTI Severe Case c. PSSTI Moderate Case d. PSSTI Severe Case

Answer: D. PSSTI Severe Case PSSTI since pus was drained out, oral antibiotics did not work and she is tachycardic, tachypneic, and she has fever.

Capsular switching of the predominant Streptococcal serotype causing pneumonia is an example of which factor that contribute to the emergence of vaccine-preventable disease? A. Failure to vaccinate by the healthcare system B. Vaccine failure and waning immunity C. Patient refusal D. Pathogen escape from vaccine-induced immunity

Answer: D. Pathogen escape from vaccine-mediated immunity In Table 1 of the trans, predominant Streptococcal serotype causing pneumonia is the example explicitly stated as an example of pathogen escape from vaccine-mediated immunity.

If two rapid HIV tests are performed and the first test is positive and second test is negative, it indicates that the? A. Patient is immunocompromised B. Patient is HIV-negative C. Patient is HIV-positive D. Patient's HIV status needs to be confirmed with additional testing

Answer: D. Patient's HIV status needs to be confirmed with additional testing Rapid tests belong to fourth generation immunoassays. Only in a negative result would any of the immunoassays be conclusive right away. If the first test is positive, then it has to be confirmed. More tests may be necessary, as stated in the algorithm below: As observed, after testing positive in the first test, another test is necessary. If the second test comes out negative, then it must be repeated, and the rightmost figure is then gauged. Again, since rapid tests are fourth-generation, then the patient is HIV- inconclusive, and retest in 14 days is required. Source: Trans 8, p. 4.

In 2009, a new Influenza A(H1N1) strain outbreak first became popular in Mexico and was genotyped in California, USA. This has been categorized to which pandemic influenza phase: A. Phase 3 B. Phase 4 C. Phase 5 D. Phase 6

Answer: D. Phase 6

Microscopic detection of enlarged RBCs with amoeboid trophozoites and Schuffner's dots are characteristic of: A. Plasmodium falciparum B. Plasmodium malariae C. Plasmodium ovale D. Plasmodium vivax

Answer: D. Plasmodium vivax P. vivax characteristics: - Trophozoite: irregularly-shaped/amoeboid - Gametocyte: oval-shaped - Schizont: 8-24 merozoites - Salient features: enlarged RBC, Schuffner's dots

A 56 year old man with alcoholic liver disease is scheduled for transplant. He has a history of measles and chicken pox during childhood. What vaccine is indicated for the patient? A. MMR B. Influenza C. Polio D. Pneumococcal

Answer: D. Pneumococcal Clinicians should aim to prevent as many comorbidities as possible in every adult patient, whether the patient especially those with chronic diseases such as Alcoholic liver disease. One way to prevent comorbidities is to vaccinate patients against certain infections, including influenza, pneumococcal disease, HAV, and/or HBV

Prior to Zika, what was the last infectious pathogen that caused an epidemic of congenital defects? A. Dengue B. Tuberculosis C. HIV D. Rubella

Answer: D. Rubella Although dengue, TB, and HIV may present with congenital defects, they are not usually associated. The most intuitive seems to be rubella (considering congenital rubella syndrome). This was also mentioned by Dr. Roman in his lecture (lecture time stamp: 56:56). Source: Dr. Roman. (2020). The Story of Emerging Infectious Diseases in the Philippines, Time stamp 56:56.

A patient with chronic obstructive pulmonary disease (COPD) and a history of recurrent pneumonia is admitted for HAP. In choosing an empiric antibiotic regimen, which of the following bacteria MUST be covered? A. Mycobacterium tuberculosis B. Pseudomonas aeruginosa C. Staphylococcus aureus D. Streptococcus pneumoniae

Answer: D. Streptococcus pneumoniae In certain comorbidities, certain pathogens are commonly associated. Specifically, for COPD where S. pneumonia, H. influenzae and M. catarrhalis are the commonly found pathogens. Source: Trans 10 p. 2

Which body fluid does NOT transmit HIV infection? A. Semen B. Breast milk C. Blood D. Sweat

Answer: D. Sweat Only certain body fluids—blood, semen, pre-seminal fluid, rectal fluids, vaginal fluids, and breast milk—from a person who has HIV can transmit HIV. These fluids must come in contact with mucous membrane or damaged tissue or be directly injected into the bloodstream (from a needle or syringe) for transmission to occur. Mucous membranes are found inside the rectum, vagina, penis, and mouth. Source: Trans 8, p. 2.

The gold standard in the laboratory diagnosis of malaria is: A. Rapid diagnostic tests (RDTs) B. Polymerase chain reaction (PCR) C. Serologic tests D. Thin and thick blood smears

Answer: D. Thin and thick blood smears Gold standard for diagnosis of malaria is microscopic examination of Giemsa-stained Thick and Thin Blood smears. Thick smears are used to differentiate between positive and negative blood smears, while thin smears are used to know the specific species. Source: Trans 1, p. 5.

Morphologically, mature oocysts of which pair of coccidians would have the same number of both sporocysts and sporozoites? A. Cystoisospora and Cyclospora B. Cryptosporidium and Toxoplasma C. Cyclospora and Cryptosporidium D. Toxoplasma and Cystoisospora

Answer: D. Toxoplasma and Cystoisospora Toxoplasma and Cystoisospora both produce mature oocysts with 2 sporocysts with 4 sporozoites each. Cystoisospora - 2 sporocysts, 4 sporozoites each Cryptosporidium - 1 sporocyst, 4 sporozoites Cyclospora - 2 sporocysts, 2 sporozoites each Toxoplasma - 2 sporocysts, 4 sporozoites each Source: Trans 3

Which of the following organisms can complete its life cycle even in the absence of a human host? A. Cryptosporidium hominis B. Cystoisospora belli C. Cyclospora cayetanensis D. Toxoplasma gondii

Answer: D. Toxoplasma gondii For T. gondii, definitive hosts are cats. Humans are accidental hosts (dead-end hosts). The other choices needed a human host to complete the life cycle. Source: Trans 3, p. 4.

There exists in all HIV-infected individuals a pool of latently infected cells that serve as a reservoir for the virus. The following are examples of these reservoir sites EXCEPT- A. Bone marrow B. Lymphoid tissue C. Peripheral blood D. Central nervous system

Answer: D. central nervous system.

An HIV positive test in a 4 month old infant born to an HIV-infected mother who is breastfeeding indicates that A. the child is infected with HIV B. the child is not infected with HIV C. a confirmatory antibody test should be performed a week later D. the infant may have HIV but needs follow-up testing using the best methods appropriate for the infant's age

Answer: D. the infant may have HIV but needs follow-up testing using the best methods appropriate for the infant's age

Shifting to a different antibiotics based on culture and sensitivity results (Choices were not noted)

Answer: Definitive therapy

A 25-year old mother with known travel to Latin America delivered a preterm infant with microcephaly, intracranial calcifications, bilateral cataracts, and clubfeet. Diagnostic test that is least likely to be relevant in determining the etiologic agent in the infant: no choices in the samplex

Answer: Dengue virus IgG test

The primary intervention for malaria control is

Answer: Early diagnosis and treatment

This type of media contains extra nutrients and co factors to allow growth of fastidious organisms

Answer: Enriched

Wolbachia is associated with severe pathology in the following parasitic infection

Answer: Filariasis

Which of the following is NOT TRUE when collecting specimens probably suggesting anaerobic infections?

Answer: For post operative gangrenous cellulitis caused by Clostridium perfringens, exudates from the post operative site is an adequate specimen already for examination

In the filarial life cycle, the infective stage is

Answer: L3

A first year college student was required to update her vaccination records. She needs to receive hepatitis B, MMR, and varicella, and cervical cancer vaccine. Which vaccines can you give during her first consult?

Answer: MMR, varicella, Hepa B, and cervical cancer vaccine

Which of the following are considered re-emerging infectious diseases? (Choices were not noted)

Answer: Malaria, chikungunya, pertussis

Several factors contribute to the re-emergence of vaccine preventable diseases. Which among the following factors is caused by failure to vaccinate by healthcare system? (Choices were not noted)

Answer: Misses opportunities related to clinician practice

The following disease control intervention is effective for both malaria and LF

Answer: Mosquito control

HIV is difficult to cure because of (Choices were not noted)

Answer: Persistence of virus integrated into the genomic DNA in the target cells

A 6-year-old girl, asthmatic, is due for her second dose of varicella vaccine. She has been on inhaled steroids for the past 3 weeks. You decided to give her the vaccine. Which of the following statements is true regarding steroid use? A 2-year-old female was brought to your clinic for catch-up vaccination. Her family is planning to transfer to Davao in 6 months. Upon review of her baby book, you noted that she received the following vaccines: BCG, DTP/IPV/Hib, and Hep B x 3 doses, measles What vaccines will you give her?

Answer: Pneumococcal, influenza, MMR, varicella, Hep A, DTP/IPV/Hib booster dose, Hep A

A 28/F comes to you because she had an abscess on her left buttocks that grew from 3 cm in size to 8 cm within a span of 1 week, associated with pain, warmth, and tenderness. She went to a surgeon, who drained it, and gave oral coamoxiclav. But despite above, she continued to have purulent drainage from the incision site, and with surrounding erythema that was still warm and very tender. Her blood pressure was 100/60, HR 110 bpm, RR 24 bpm, and temp 38.4C. based on the management algorithm of skin and soft tissue infection (SSTI) by the Infectious Disease Society of America, you would classify the case as (Choices were not noted)

Answer: Purulent, severe SSTI

Separating or restricting the movement of asymptomatic family members and neighbors who may have been exposed to a person with a communicable disease is called:

Answer: Quarantine

A patient with cerebral malaria should be treated with?

Answer: Quinine

The laboratory confirmation of malaria is done by microscopy (gold standard) or

Answer: RDT

A 34/M was newly diagnosed with HIV. His CD4 count was found to be 50 cells/mm3. He would like to receive vaccinations as soon as possible. Which of the following vaccines can be safely given immediately, if indicated?

Answer: Rabies

A positive HIV antibody test in a 4 month old infant born to an HIV infected mother who is breastfeeding indicates that

Answer: The infant may be infected with HIV but requires follow-up testing using the best available tests for the infant's age

The diagnostic method for both malaria and LF is

Answer: Thick blood smear

Ecthyma begins like impetigo but reaches the a. Epidermis b. Dermis c. Subcutaneous fat d. Fascia

B. Dermis Begins like impetigo BUT penetrates through dermis. Treated the same as impetigo

If you ever get a patient with occupational anthrax (works with raw wools/animal skins): A. Refer for incision and debridement B. Give penicillin, the drug of choice C. Prescribe oral ciprofloxacin, the drug of choice D. Write a prescription for doxycyclin

B. Give penicillin, the drug of choice

Which of the following is a conjugate vaccine? A. Diphtheria vaccine B. Haemophilus influenzae type b vaccine C. Hepatitis A vaccine D. Varicella vaccine

B. Haemophilus influenzae type b vaccine FDA categorizes Hib vaccine as a polysaccharide conjugate vaccine, which is a type of inactivated bacterial vaccine. Manufacturers make it by joining a piece of the polysaccharide capsule that surrounds the Hib bacterium to a protein carrier. Diphtheria, Hepatitis A, and Varicella vaccines are toxoid, inactivated whole cells, and live attenuated vaccines, respectively. Thus, Choices A, C, and D are incorrect. Sources: U.S. Department of Health and Human Services (HHS): Vaccines.gov. (2020). Vaccine Types; Trans 14, pp. 2-3.

A 20 year old gentleman, with h/o CML underwent a splenectomy a few months ago. Which of the following vaccines should he be immunized with? A. Influenza vaccine B. Meningococcal vaccine C. Haemophilus type B vaccine D. Human papillomavirus vaccine

B. Meningococcal vaccine

The recommended treatment for patients involved in an outbreak of impetigo caused by methicillin-susceptible Staphylococcus aureus A. Topical mupirocin B. Oral cloxacillin C. Oral clindamycin D. Oral doxycycline

B. Oral cloxacillin

Steroids in sepsis should be started A. Only when there is a positive ACTH result B. Never because they are harmful C. As a last resort after maximizing hydration and pressors D. Always right after antibiotics have been administered

C. As a last resort after maximizing hydration and pressors Steroids can be given in sepsis only when fluid resuscitation and vasopressor therapy have not been able to restore hemodynamic stability. Current recommendations include use of low-dose corticosteroids as an adjunct to the treatment regimen without significant risk of side effects. Higher doses are associated with significant potential side effects.

Which of the following is the most important risk factor for developing catheter-associated urinary tract infection (CAUTI)? A. Elderly female B. Presence of diabetes mellitus C. Duration of indwelling catheter D. Prior antimicrobial therapy

C. Duration of indwelling catheter

A 4-week old baby is brought in for her well-baby visit. The mother is worried about the diarrhea outbreak in her neighborhood. She asks if her baby can receive the rotavirus vaccine. Which is correct? A. Rotavirus vaccine is given at maximum of 8 weeks B. It is given at a minimum age of 4 weeks C. It may be given as early as 6 weeks of life D. It is given as a single dose

C. It may be given as early as 6 weeks of life Minimum age is 6 weeks, maximum age is 8 months. It is a 3- or 2-dose series. See pedia immunization schedule.

Which of the following is/are property of adaptive immunity? A. Specificity B. Memory C. Specity, memory, specialization D. Specificity memory, specialization, reactive to self

C. Specificity, memory, specialization

A 5 yr old female has a history of egg allergy manifested as anaphylactic shock. What vaccine should not be administered? A. MMR B. Varicella C. MMR-V D. Influenza

D. Influenza Influenza vaccines contain egg proteins. Allergy to components of vaccines, either live or inactivated, is a contraindication. (p. 7, Exam 1 Trans 3) However, CDC guidelines (2017) has more detailed recommendations found here: https://www.cdc.gov/flu/protect/vaccine/egg- allergies.htm

Ecthyma begins like impetigo but penetrates the dermis. Treatment is A. IV antibiotic B. Oral and IV antibiotic C. Topical and IV antibiotic D. Same as for impetigo

D. Same as for impetigo

Hallmarks of myositis and myonecrosis A. Rhabdomyolysis B. Elevated Ck-MM or total C. Characteristic findings on MRI D. Severe muscle pain

D. Severe muscle pain

Which of the following is not true when collecting specimens probably suggesting anaerobic infections: A. For post-operative gangrenous cellulitis caused by Clostridium perfringens, exudates from the post operative site is an adequate specimen already for examination B. Can't remember huhu mahaba C. Can't remember huhu mahaba D. Can't remember huhu mahaba

No answer

A series of five neonatal sepsis cases were diagnosed at the neonatal intensive care unit over the last month. If you were the Infectious Disease consultant working with the head of the Neonatal ICU, the next best steps to do is/are: A. Temporarily close the neonatal ICU B. Send water samples from the faucet for microbiologic studies C. Attribute the problem to the mothers who had infections while they were pregnant and passed them to their babies D. Do an outbreak investigation and thoroughly study all possible sources of the infection

No answer was provided

HIV-exposed infants should be given cotrimoxazole prophylaxis beginning A. At birth B. At 2 weeks C. At 4-6 weeks D. At the 12th week immunization visit

No answer was provided

Most appropriate site for vaccination among infants is: A. Deltoid part of the upper arm B. Fatty part of the buttocks C. Any part of the buttocks D. Anterolateral aspect of the thigh

No answer was provided

The gold standard for the laboratory diagnosis of malaria A. PCR B. Thick and thin blood smears C. RDT D. Serology

No answer was provided

Treatment of sepsis requires that we: A. Start narrow spectrum antibiotics to prevent emergence of bacterial resistance B. Fluid restrict the patient to prevent pulmonary congestion C. Get cultures at all cost because we need to know what organism is causing the infection D. Restore tissue perfusion to prevent further ischemic damage

No answer was provided

What can be done to broad spectrum IV empiric treatment in septic patients once culture results come back? A. Switch to oral narrow spectrum regardless of site and sensitivity B. - C. Continue up to 14 days regardless D. Narrow spectrum as long as patient is responding

No answer was provided

Which of the following supports the diagnosis of clinical lymphatic filariasis? A. Recurrent symptoms of adenolymphangitis B. Nocturnal smear showing microfilariae C. Card test positive for filarial antigen D. NOTA

no answer

Which body fluid does not transmit HIV infection? (Choices were not noted)

​​Answer: Sweat