1. Infectious diseases of the skin
1) The causative organism for Brucellosis is which of the following:
A. Acid fast bacilli
B. Gram positive cocci
C. Gram negative rodCorrect Choice
D. Gram positive rod
E. Gram negative cocci
Brucella species which cause Brucellosis are gram negative rods. Brucellosis, aka undulant fever, is
characterized by an acute febrile illness with headache and joint pain. CNS and cardiac
manifestations can also occur. It is acquired by contact with infected animals or contaminated dairy
products. Treatment is with doxycycline and rifampin
2) What is the most likely diagnosis of this lesion occurring on the hand of a butcher?
A. Heck's disease
B. Butcher's wart
C. Contagious ecthymaCorrect Choice
D. Molloscum contagiosum
E. Ecthyma gangrenosum
Contagious ecthyma, or orf, occurs most frequently among shepherds and butchers as it is a viral
disease that is more common among sheeps and goats. It is caused by a farmyard pox, which also
cause Milker's nodules. The lesions tend to heal spontaneously after several weeks
3) For which of the following smallpox vaccination complications is the administration of vaccine
immune globulin indicated?
A. Vaccinia keratitis
B. Mild generalized vaccinia
C. Post-vaccinal encephalitis
D. Eczema vaccinatumCorrect Choice
E. Erythema multiforme
Vaccinia immune globulin can be administered to treat some of the complications associated with
vaccinia vaccination. Vaccinia immune globulin is indicated for inadvertent inoculation with
extensive involvement or ocular implantations, eczema vaccinatum, generalized vaccinia (severe or
recurrent), and progressive vaccinia. It is not recommended for inadvertent inoculation with mild
reaction, generalized vaccinia (mild or limited), post-vaccination encephalitis, and isolated vaccinia
keratitis
4) What characteristic color is seen on diascopy of this lesion?
A. Coral red
B. Orange
C. Blue
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2. D. Red
E. Apple jellyCorrect Choice
Leishmaniasis recidivans is a type of Old World leishmaniasis. Clinically, it appears as a red papule
covered with white scale. On diascopy, it has a characteristic apple jelly color
5) Measles is caused by a:
A. Togavirus
B. Rhabdovirus
C. Picornavirus
D. ParamyxovirusCorrect Choice
E. Adenovirus
The measles virus is an RNA virus belonging to the Paramyxovirus family
6) Contagious pustular dermatitis (Orf) is caused by a:
A. Poxvirus Correct Choice
B. Gram-positive spore-forming rod
C. Papovavirus
D. Herpesvirus
E. Paramyxovirus
Orf is caused by orf virus (OV), a poxvirus of the genus Parapoxvirus
7) Butcher's warts are caused by which human papilloma virus (HPV) type?
A. 7Correct Choice
B. 2
C. 5
D. 3
E. 13
Butcher's warts are caused by HPV type 7
8) An 18-year old man presents to the Dermatology Clinic with a nontender penile erosion that has
been present for 2 weeks. An indurated border and nontender bilateral inguinal lymphadenopathy
are also noted. What is the most likely diagnosis?
A. Lymphogranuloma venereum
B. Herpes simplex
C. Chancroid
D. Primary syphilisCorrect Choice
E. HIV
A painless chancre with an indurated border is characteristic of primary syphilis. Associated painless
lymphadenopathy ("buboes") is also a common feature
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3. 9) What is the causative agent of this parasitic eruption which also causes patchy pulmonary
infiltrate and eosinophilia?
A. Filariasis
B. Dracunculiasis
C. Larva migransCorrect Choice
D. Larva currens
E. Gnathostomiasis
Larva migrans is caused by Ancylostoma braziliense, a hookworm of cats and dogs. It also
associated with Loeffler's syndrome, patchy infiltrate of the lungs with eosinophilia. Treatment for
this parasitic infection is ivermectin or albendazole
10) One of your colleagues returned from a vacation to India with fever, vomiting, pleural effusions,
ascites and conjunctival petechiae. She also has a diffuse macular rash with notable areas of
sparing that your attending refers to as “white islands in a sea of red”. What is your diagnosis?
A. Malaria
B. Leishmania
C. Leptospirosis
D. Typhoid
E. Dengue hemorrhagic feverCorrect Choice
Dengue fever is caused by an Arbovirus and transmitted by the mosquito, Aedes aegypti and may
cause Dengue Shock Syndrome and Dengue Hemorrhagic Fever. The infection starts with sudden
onset of high fever, backache, retroorbital pain, bone and joint pain, depression and malaise. The
disease is also called "break-bone fever." One to seven days after onset of fever, rash presents
characteristically starting on the dorsum and hands and feet spreading to limbs and torso. The
eruption may become confluent with small, round islands of sparing, the so called "white islands in
a sea of red." Treatment is generally supportive as no antivirals are effective
11) The treatment of choice for acyclovir-resistant herpes simplex virus infection is:
A. Saquinivir
B. Valcyclovir
C. Indinivir
D. FoscarnetCorrect Choice
E. Famciclovir
Foscarnet directly inhibits viral DNA polymerase (without requiring phosphorylation by TK) and is
therefore effective in acyclovir-resistant HSV infections. Cidofovir can also be used
12) Tricomycosis axillaris is caused by:
A. Burkholderia mallei
B. Corynebacterium tenuis Correct Choice
C. Proteus species
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4. D. Micrococcus sedentarius
E. Corynebacterium minitissimum
Corynebacterium tenuis
13) Which of the following are inconsistent with the diagnosis of staphylococcal scalded skin
syndrome?
A. Prognosis is good in children with low mortality when anitbiotics are administered early
B. Swabs and cultures of fluid filled blisters overwhelmingly grow staphCorrect Choice
C. Initial event is usually a localized staph infection
D. Cell necrosis does not occur in staphylococcal scalded skin syndrome as it does in T.E.N
E. Epidermal changes are produced by exfoliative toxins of staphlococcus
Staphylococcal scalded skin syndrome: Lesions extend far beyond areas of actual staphylococcal
infection, by action of the epidermolytic exotoxin elaborated by the staphylococcus in remote sites.
Usually the staphylococci are present at a distant focus such as the parynx, nose ear, or conjuctiva.
If cultures are taken they should be obtained fromthe mucous membranes because the skin
erythema and desquamation is due to the distant effects of the exfoliative toxin, unlike the sitaution
in bullous impetigo, where S. aureus is present in the lesions. Epidermal changes are produced by
exfoliative toxins of Staphylococcus. Inital event is usually a localized Staph infection. Prognosis is
good in children with low mortality when anitbiotics are administered earyl. Cell necrosis does not
occur in SSS as it does in toxic epidermal necrolysis
14) Which of the following is the vector for Dengue fever?
A. Lutzomyia verrucarum
B. Phlebotomus papatasii
C. Xenopsylla cheopis
D. Aedes aegyptiCorrect Choice
E. Culex mosquito
Dengue fever also known as "break-bone" fever is characterized by sudden high fever, backache,
retro-orbital pain, bone/joint pain, weakness, and malaise. It is caused by an arbovirus (RNA virus)
which is transmitted by Aedes aegypti, a species of mosquito
15) Which virus is most commonly associated with oral hairy leukoplakia?
A. Human papilloma virus
B. Epstein-Barr virusCorrect Choice
C. Parvovirus
D. Pox virus
E. Herpes virus
Oral hairy leukoplakia is an oral mucosal infection most often caused by the Epstein-Barr virus,
which occurs in immunocompromised patients. Clinically, thick, white plaques are noted on the
lateral sides of the tongue, often fissured
16) Which Rickettsial infection has a negative Weil-Felix test?
4

5. A. Rickettsialpox (R. akari)Correct Choice
B. Rocky Mountain Spotted Fever (R. rickettsii)
C. Epidemic typhus (R. prowazekii)
D. Mediterranean fever (R. conorii)
E. Endemic typhus (R. typhi)
Rickettsia are short, gram-negative rods which are strict intracellular parasites. The bacteria is
transmitted via tick which much be attached for more than 6 hours. The Weil-Felix test exploits
cross-reactivity between the Proteus vulgaris antigen and RIckettsia
17) A pool worker develops these painful erythematous nodules with ulceration on his fingers and
then his arms. The antibiotic of choice to treat this infection is:
A. Ceftriaxone
B. Trimethoprim-sulfamethoxasole
C. MinocyclineCorrect Choice
D. Dapsone
E. Penicillin
Sporotrichoid spread may be seen in cutaneous leishmaniasis, actinomycosis, atypical mycobacterial
infections, deep fungal infection, and melanoma. Mycobacterium marinum is associated with skin
injury followed by exposure to contaminated water, usually from an aquarium, lake, or pool. The
treatment of choice for M. marinum infections is minocycline
18) A 20-month old child develops a high fever followed 2 days later by a sudden eruption of rose
pink macules and papules with white halos as the fever subsides. What is the most likely diagnosis?
A. Measles
B. Rubella
C. Exanthem Subitum Correct Choice
D. Erythema infectiosum
E. Scarlet fever
The cutaneous features of Exanthem Subitum (Roseola infantum, Sixth Disease)as described in the
question develop as the fever subsides. While the other diagnoses are part of the differential
diagnosis of "fever and rash" in children, only roseola infantum has this characteristic clinical course
19) WHO recommendations for the treatment of multibacillary leprosy include all of the following
EXCEPT:
A. Clofazimine
B. All of these answers are recommended for the treatment of multibacillary leprosy.
C. Rifampin
D. Dapsone
E. ClarithromycinCorrect Choice
Clarithromycin is not part of the WHO recommendations for the treatment of multibacillary leprosy
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6. 20) The most likely cause of the childhood infection shown is:
A. E. coli
B. Pseudomonas Aeruginosa
C. Group A Streptococcus Correct Choice
D. S. Aureus
E. H. influenza
This is an example of perianal streptococcal “cellulitis.” The causative organism is Group A
streptococcus
21) In addition to Kaposi’s sarcoma, HHV-8 infection is also the causative agent in:
A. Pyogenic granuloma
B. Pityriasis rosea
C. Angiosarcoma
D. Primary effusion lymphomaCorrect Choice
E. Bacillary angiomatosis
Human herpes virus 8 is a double stranded DNA virus. It is thought to be pathogenic in Kaposi’s
sarcoma, primary effusion lymphoma, and Castleman’s disease. Primary effusion lymphoma is a
rare B-cell lymphoma seen predominantly in patients with AIDS
22) The nonvenereal treponematosis shown is caused by which of the following organisms?
A. T. pertenue
B. T. pallidum (subsp. endemicum)
C. B. duttonii
D. T. carateum Correct Choice
E. T. pallidum
The depigmented patches on the hands shown are characteristic of the late (tertiary) stage of pinta.
The causative organism is T. carateum
23) A 52 year-old butcher presents with a tender lesion on his left hand as shown. The treatment of
choice for this condition is:
A. Chloramphenicol
B. Ciprofloxacin
C. Tetracycline
D. Penicillin Correct Choice
E. Azithromycin
The clinical description and lesion shown in the image suggest a diagnosis of erysipeloid, caused by
Erysipelothrix rhusiopathiae. The treatment of choice is penicillin
24) The treatment of choice of cat-scratch disease is:
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7. A. Itraconazole
B. Mebendazole
C. Ceftriaxone
D. Trimethoprim-sulfamethoxazole
E. ErythromycinCorrect Choice
Cat-scratch disease is caused by Bartonella henselae, which is spread among cats by fleas. The
hallmark of the disease is unilateral and regional lymphadenopathy. The treatment of choice for cat-
scratch disease is erythromycin
25) Pretibial fever is caused by:
A. Listeriosis
B. Rickettsiae spp.
C. LeptospirosisCorrect Choice
D. Rickettsiae spp.
E. Ehlichiosis
Leptospira autumnalis causes pretibial fever (“Fort Bragg fever” or anicteric leptospirosis), an acute
exanthematous infectious erythema, generally most prominent on the shins. Leptospira interrogans,
serotype icterohaemorrhagiae, is the most common cause of Weil’s disease or icteric leptospirosis
26) Guarneri bodies are associated with:
A. Smallpox Correct Choice
B. Anthrax
C. Measles
D. Orf
E. CMV
Guarnieri’s bodies are cytoplasmic eosinophillic inclusions found on light microscopy
27) Petechial lesions at the junction of the hard and soft palate are characteristically seen in which
disease?
A. Kawasaki’s disease
B. Infectious mononucleosisCorrect Choice
C. Scarlet fever
D. Rocky Mountain spotted Fever
E. Rickettsialpox infection
Forsheimer spots are distinctive pinhead size petechiae found at the junction of the hard and soft
palate. They may be seen in infectious mononucleosis
28) Congenital Varicella Syndrome occurs after maternal varicella infection during which stage of
pregnancy?
A. Third trimester
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8. B. First 20 weeks Correct Choice
C. 20-24 weeks
D. 5 days before and 2 days after delivery
E. None of these answers are correct
Congenital Varicella Syndrome occurs after maternal varicella-zoster virus infection early in
pregnancy (up to 20 weeks gestation)
29) Of the choices listed, which antiobiotic is the best to treat a 7-year old child with erythema
migrans?
A. Tetracycline
B. Azithromycin
C. AmoxicillinCorrect Choice
D. Doxycycline
E. Rifampin
Doxycycline is the usual treatment for erythema migrans in adults in the absence of neurologic or
cardiovascular complications. In children less than 8, all tetracyclines are relatively contraindicated
because of they can cause tooth discoloration. Therefore amoxicillin should be used as the first line
therapy for children less than 8. Note: Changes have been made to the treatment of RMSF. Children
of any age should be treated with doxycycline for that disease
30) A 48 year-old woman presents to the Emergency Room with a 2 day history of fever and a well
demarcated erythematous plaque on her right cheek. What is the treatment of choice?
A. Potent topical corticosteroid
B. Fluconazole
C. Intravenous penicillinCorrect Choice
D. Prednisone
E. Cephelexin
The most likely diagnosis is Erysipelas which is caused by beta-hemolytic group A streptococcus.
The treatment of choice is intravenous penicillin
31) Herpes simplex virus infection and this condition has been linked to which HLA type?
A. HLA B15Correct Choice
B. HLA B51
C. HLA DR3
D. HLA Cw6
E. HLA B27
HSV related erythema multiforme has been associated with an increased frequency of HLA-B15
32) Milker’s nodule is caused by infection with which of the following viruses?
A. Orf virus
8

9. B. Human herpesvirus-8 (HHV-8)
C. Paravaccinia virusCorrect Choice
D. Human herpesvirus-6 (HHV-6)
E. Vaccinia virus
Milker’s nodule is caused by paravaccinia virus, a poxvirus of the genus Parapoxvirus. It is
transmitted to humans from infected cows
33) Which porphyrin is responsible for the fluorescence under Wood's lamp examination of
erythrasma?
A. Protoporphyrin IX
B. Porphobilinogen
C. Coproporphyrin IIICorrect Choice
D. Coproporphyrinogen
E. Uroporphobilinogen
Erythrasma is caused by corynebacterium minutissimum. The presence of coprophyrinogen III
created by the bacteria is responsible for the characteristic coral-red fluorescence under Wood's
lamp
34) Epithelioma cuniculatum is an HPV-associated verrucous carcinoma involving the:
A. Trunk
B. Scalp
C. Penis
D. Oral mucosa
E. SoleCorrect Choice
Epithelioma cuniculatum is a form of verrucous carcinoma involving the sole
35) A 28 year-old man presents with fever, chills, arthralgias and the cutaneous lesions shown. The
most likely diagnosis is:
A. Gonoccemia Correct Choice
B. Rickettsialpox
C. Primary herpes simplex infection
D. Anthrax
E. Purpura fulminans
The image shows sparsely distributed hemorrhagic vesiculopustules with erythematous bases on an
acral surface. These features are characteristic of gonococcemia
36) Blueberry Muffin Baby can be a feature of all of the following EXCEPT:
A. Rhabdomyosarcoma
B. Langerhans’ cell histiocytosis
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10. C. TORCH
D. Hemolytic disease of the newborn
E. Klippel-Trenaunay-Weber syndrome Correct Choice
Blueberry muffin lesions can be seen in the setting of prenatal infections (e.g. TORCH), severe
anemia (e.g. Hemolytic Disease of the newborn) and neoplastic diseases (e.g. rhabdomyosarcoma).
It is not associated with the Klippel-Trenaunay-Weber syndrome
37) The treatment of choice for Oroya Fever is:
A. ChloramphenicolCorrect Choice
B. Erythromycin
C. Penicillin
D. Minocycline
E. Doxycycline
The treatment of choice for Oroya Fever is chloramphenicol
because of frequent superinfection with
Salmonella
38) A 10 year-old with a 3-day history of fever and headache presents to the clinic with multiple
erythematous papulopustules on his extremities, many of which have central eschars. The most
likely diagnosis is:
A. Erlichiosis
B. RickettsialpoxCorrect Choice
C. Meningococcemia
D. Lyme disease
E. Rocky mountain spotted fever
Rickettsialpox is an acute febrile illness caused by the bacteria Rickettsia akari, a member of the
spotted fever group. R. akari is transmitted by the house mouse mite, Liponyssus sangineus.
Clinically, patients have an eschar at the inoculation site with a subsequent papulovesicular rash,
fevers, headache, chills, diaphoresis, myalgia, and anorexia
39) A 35 year-old woman presents with a painful vaginal erosion and tender left-sided inguinal
lymphadenopathy. Gram stain reveals clusters of coccobacilli in a “school of fish” pattern. What is
the most likely diagnosis?
A. Granuloma inguinale
B. ChancroidCorrect Choice
C. Primary syphilis
D. Secondary syphilis
E. Lymphogranuloma venereum
Chancroid classically presents with a soft, tender chancre with ragged edges and unilateral, tender
inguinal adenopathy (bubo). A “school of fish” pattern on Gram or Giemsa stain is diagnostic
40) All of the following are features of scarlet fever except:
10

11. A. S. aureus infectionCorrect Choice
B. Pastia’s lines
C. Pharyngitis
D. Circumoral pallor
E. Sandpaper-like texture
Scarlet fever is primarily a disease of children with most cases occurring between the ages of 1 and
10 years of age. Streptococcus pyogenes is the causative organism. It produces the streptococcus
pyrogenic exotoxin which elicits the cutaneous manifestations by enhancing delayed type
hypersensitivity to streptococcal products. Clinical findings include fever, sore throat, headache,
chills, sandpaper rash on the trunks, strawberry tongue, and Pastia’s lines (linear petechial streaks
found in flexural locations
41) Hebra nose deformity is characteristic of infection with which organism?
A. Serratia marcesens
B. Haemophilus influenzae
C. Streptococcus pyogenes
D. E. coli
E. Klebsiella pneumoniaeCorrect Choice
Hebra nose deformity is seen in Rhinoscleroma which is caused by Klebsiella pneumoniae
42) Pediculus humanus corporis can transmit:
A. Scrub typhus
B. Oriental typhus
C. Epidemic typhusCorrect Choice
D. Endemic typhus
E. Murine typhus
The body louse or Pediculus humanus corporis transmits Rickettsia prowasekii the organism
responsible for epidemic typhus. Endemic typhus or murine typhus is caused by R. typhi that is
transmited by the rat flea/Xenopsylla cheopis. Scrub typhus is caused by R. tsutsugamushi and is
transmitted by chiggers or trombiculid mite larvae
43) Xenopsylla cheopis transmits:
A. Rickettsia akari
B. Epidemic typhus
C. Scrub typhus
D. Murine typhusCorrect Choice
E. Rickettsia prowazekii
Xenopsylla cheopis along with Ctenocephalides felis are fleas that transmit R. typhi, the organism
responsible for murine or endemic typhus. The body louse or Pediculus humanus corporis transmits
Rickettsia prowasekii the organism responsible for epidemic typhus. Scrub typhus is caused by R.
tsutsugamushi and is transmitted by chiggers or trombiculid mite larvae
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12. 44) A 4 year-old boy is diagnosed with Staphylococcal Scalded-Skin Syndrome. Vesiculation in this
disease is secondary to exfoliative toxins binding what target protein?
A. Desmoglein 1Correct Choice
B. Bullous Pemphigoid antigen 1
C. Bullous pemphigoid antigen 2
D. Desmoglein 3
E. Plectin
Staphylococcus Scalded-Skin Syndrome (SSSS) is caused by Staphylococcus exfoliative toxins A
and B binding desmoglein A. This results in the intraepidermal split at the granular layer seen in this
illness. Targeting of desmoglein 3 would result in a suprabasilar split. Targetting of plectin, BPAG1,
or BPAG2 would result in a subepidermal split. This is not seen in SSSS
45) Streptococcus Iniae has been shown to cause:
A. Perianal dermatitis in neonates
B. Bullous impetigo
C. Perineal erysipelas in postpartum women
D. Necrotizing fasciitis
E. Hand cellulitis in fish handlersCorrect Choice
Streptococcus iniae has been demonstrated to cause hand cellulitis from puncture wounds sustained
form the dorsal fin, fish bone or knife of usually a tilapia. Treatment with PCN is curative. Group A
Streptococci are the most common cause of perianal dermatitis. Many different bacteria have been
implicated in necrotizing fasciitis. Bullous impetigo is most frequently caused by phage type 71 S.
aureus or a related group 2 phage type. Group B streptococcus is most often responsible for
perineal erysipelas in postpartum women.
46) What is the most common site of infection from Streptococcus Iniae?
A. Face
B. HandCorrect Choice
C. Lower leg
D. Foot
E. Nails
Streptococcus iniae most commonly causes bacteremic cellulitis of the hand in persons who have
recently handled fresh fish. S. iniae is a fish pathogen that causes sporadic infection in tilapia,
yellowtail, rainbow trout, and coho salmon. Treatment of choice is with penicillin antibiotics
47) The vector of New World Leishmaniasis is the:
A. Deer fly (Chrysops spp.)
B. Tsteste fly
C. Phlebotomus sandfly
D. Lutzomyia sandflyCorrect Choice
E. Simulium black fly
12

13. The sandfly belonging to the genus Lutzomyia is the vector of New World Leishmaniasis. Sandflies
of the genus Phlebotomus are the vectors of Old World Leishmaniasis
48) How long is the life cycle for the mite that causes this infestation?
A. 1 day
B. 1 monthCorrect Choice
C. 6 months
D. 1 year
E. 1 week
Scabies is caused by the mite Sarcoptes scabiei var. hominis. The life cycle of the mite is 30 days. A
female mite will lay 60-90 eggs during her life
49) Herpes-associated erythema mutliforme is most commonly associated with which HLA type?
A. HLA DR2
B. HLA DR3
C. HLA B15Correct Choice
D. HLA B8
E. HLA B27
Recurrent erythema multiforme (EM minor) is usually caused by recurrent herpes simplex, most
commonly HSV-1 orolabial disease. This is more correctly now called herpes-associated erythema
multiforme(HAEM) and has been more commonly associated with people with HLA type B15
50) All of the following are features of the Ramsay Hunt Syndrome EXCEPT:
A. Infection of the geniculate ganglion
B. Vesicles on the external ear
C. Tinnitus
D. Facial paresis
E. Herpes simplex infectionCorrect Choice
Ramsay Hunt syndrome results from varicella zoster virus infection of the geniculate ganglion of the
seventh cranial nerve (CN VII). It is characterized by vesicles on the external ear or ear canal,
tinnitus and/or other auditory symptoms, and ipsilateral facial paresis
51) Exanthem Subitum is caused by which of the following?
A. Group A Steptococcus
B. Coxsackie virus
C. Human Herpes Virus-6 (HHV-6) Correct Choice
D. Parvovirus B19
E. Epstein-Barr Virus
Exanthem Subitum (Roseola Infantum, Sixth Disease) is caused by human herpesvirus 6, and 7
(HHV-6, HHV-7
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14. 52) Carrion's disease is characterized by fevers, headaches and arthralgias and is accompanied by
severe hemolytic anemia. Superinfection with which organism is the most frequent cause of death?
A. Shigella
B. Bartonella henselae
C. SalmonellaCorrect Choice
D. Bartonella bacilliformis
E. Bartonella Quintana
Carrion's disease (Oroya fever) is characterized by fevers, headaches and arthralgias and is
accompanied by severe hemolytic anemia. Superinfection with Salmonella is the most frequent
cause of death. Protection from sandfly bites is all-important
53) Dracunculiasis is typically acquired from:
A. Soil
B. Salt water
C. Black flies
D. Drinking water Correct Choice
E. Chiggers
Dracunculiasis, which is caused by Dracunculus medinensis, is acquired by ingestion of copepod-
infested water
54) Which subtype of the human papilloma virus is most likely to have caused this infection?
A. HPV, type 3
B. HPV, type 6Correct Choice
C. HPV, type 1
D. HPV, type 5
E. HPV, type 2
The human papilloma virus is a member of the Papovavirus family, a double-stranded DNA virus.
HPV, type 6 has been implicated in giant conduloma of Buschke and Lowenstein and anogenital
condyloma
55) Which of the following diseases is caused by a virus?
A. Boutonneuse spotted fever
B. Colorado tick feverCorrect Choice
C. Q fever
D. Rocky Mountain spotted fever
E. Human monicytic ehrlichiosis
Rocky Mountain spotted fever is caused by Rickettsia rickettsii. Human monicytic ehrlichiosis is
caused by Ehrlichia chaffeensis. Colorado tick fever is caused by Reoviiridae. Boutonneuse fever is
caused by Rickettsia conorii. Q fever is caused by Coxiella burnetti
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15. 56) Epidermodysplasia verruciformis is caused by which human papilloma virus (HPV) types?
A. 3 and 10
B. 6 and 11
C. 5, 8, and 9Correct Choice
D. 13 and 32
E. 16 and 18
Epidermodysplasia verruciformis is caused by HPV types 5, 8, 9, 12, 14, 15, 17, 19-26
57) Verruga peruana is transmitted by:
A. Fecal oral contact
B. Blackfly
C. SandflyCorrect Choice
D. Tick
E. Fecal fecal contact
Verruga peruana, a disease endemic to Peru and a few neighboring countries, is caused by
Bartonella bacilliformis. It is transmitted by the sandfly, Lutzomyia verrucarum. It is preceded by an
acute febrile stage called Oroyo fever or Carrion’s disease. The treatment of choice is
chloramphenicol
58) Each of the following is true regarding leishmaniasis except:
A. Arthropod vector is the sand fly
B. Mazzotti’s test is diagnosticCorrect Choice
C. Cutaneous disease is the most common form
D. Pentavalent antimony used for visceral disease
E. Espundia seen mucocutaneous disease
Leishmaniasis is a parasitic infection born by a sandfly vector. No treatment is necessary for
cutaneous leishmaniasis, pentavalent antimony for visceral leishmaniasis. Mazzotti reaction is used
to test for onchocerciasis in which a single dose of dimethycarbamazine is given for reaction
59) What is the principal vector of Lyme Disease in the Northeastern U.S.?
A. Lxodes ricinus
B. Dermacentor variabilis
C. Lxodes damminiCorrect Choice
D. Ambylomma americanum
E. Soft-bodied ticks (Ornithodoros)
The proncipal vector of Lyme Disease in the Northeastern U.S. is Ixodes dammini (Ixodes scapularis
60) Which of the following mycobacterial organisms is classified as a photochromogen?
15

16. A. M. tuberculosis
B. M. grodonae
C. M. KansasiiCorrect Choice
D. M. ulcerans
E. M. fortuitum
M. Kansasii, M. marinum, and M. simiae are photochromogens. They form pigment when exposed to
light
61) The vector of Trench Fever is the:
A. Cat flea (Ctenocephalides felis)
B. Human body louse (Pediculus humanus corporis)Correct Choice
C. Trombiculid mite
D. Sandfly (Phlebotamus perniciosus)
E. Rat flea (Xenopsylla cheopis)
The human body louse (Pediculus humanus corporis)is the vector of Trench Fever, Epidemic Typhus,
and Relapsing Fever
62) Pediculus humanus var. corporis (human body louse) is the vector in which of the following
diseases:
A. Q fever (C. burnetii)
B. Endemic typhus (R. typhus)
C. Rickettsialpox (R. akari)
D. Epidemic typhus (R. prowazekii)Correct Choice
E. Rocky Mountain Spotted Fever (R. rickettsii)
The human body louse is the implicated Trench fever, epidemic typhus, and relapsing fever. Trench
fever usually affects alcoholic men and is manifested by fevers. Treatment is with ceftriaxone,
erythromycin, or doxycycline. Epidemic typhus is manifested by fevers, chills, malaise, and a pink
macular eruption beginning in the axilla and trunk. Treatment is with tetracycline or
chloramphenicol. Relapsing fever is manifested by paroxysmal fevers, headache, lymphocytoma,
and erythematous/petechial macules on trunk/extremities. Treatment is with doxycycline
63) A 27 year-old man with a 1-month history of bilateral inguinal lymphadenopathy and a positive
“groove sign.” What is the most likely diagnosis?
A. Gonorrhea
B. Lymphogranuloma venereumCorrect Choice
C. Syphilis
D. Chancroid
E. Herpes simplex
Inguinal adenopathy with fluctuant, tender nodes above and below Poupart’s ligament - referred to
as “groove sign” - is a characteristic clinical feature of lymphogranuloma venereum
16

17. 64) The most common location of herpes gladiatorum is the:
A. FaceCorrect Choice
B. Anterior thigh
C. Groin
D. Hand
E. Chest
The face is the most common location for Herpes Gladiatorum
65) Which of the following is the vector of lymphatic filariasis caused by Wuchereria bancrofti?
A. Black fly
B. Deerfly
C. Mosquito Correct Choice
D. Botfly
E. Tsteste fly
Lymphatic filariasis is spread by mosquitoes belonging to genera Aedes, Anopheles, Culex, or
Mansonia
66) What is the classic CXR finding of a patient with inhalational anthrax?
A. Pleural effusions
B. Increased interstitial markings
C. Widened mediastinumCorrect Choice
D. Alveolar infiltrates
E. Normal x-ray
Inhalation anthrax is the most lethal form of anthrax. Other forms include cutaneous anthrax and GI
anthrax. The classic radiographic finding is a widened mediastinum
67) What is the vector for this nematodal infection?
A. Tsetse fly (Glossine morsitans)
B. Mango fly (Chrysops)Correct Choice
C. Black fly (Simulium)
D. Water flea (Cyclops)
E. Reduviid bug
Loiasis is caused by the nematode loa loa. It is transmitted by the mango fly (Chrysops dimidia or
CHrysops silacea). It may manifest with painful, localized subcutaneous nonpitting edema called
calabar swellings. Conjunctival migrations are also common
68) A goatherder develops this painless pustule that subsequently forms a black eschar. What
causes the edema to form in this lesion?
17

18. A. Inhibition of phagocytosis
B. C1 esterase inhibitor
C. Increased levels of cAMPCorrect Choice
D. Release of TNF-alpha
E. Release of IL-1beta
Anthrax is caused by Bacillus anthracis, a gram positive spore-forming rod. Anthrax is primarily
seen in individuals who are in contact with wild or domestic animals. Recent cases have been linked
with bioterrorism. B. anthracis produces edema toxin and lethal toxin. Edema toxin is comprised of
edema factor and protective antigen. Edema factor is a calmodulin dependent adenyl cyclase. The
increased cAMP induces the gelatinous edema of anthrax skin lesions
69) Which human papillo viurs (HPV) type is implicated in papillomatosis cutis carcinoides di
Gottron?
A. 7
B. 11Correct Choice
C. 60
D. 18
E. 57
Papillomatosis cutis carcinoides di Gottron, also know as Gottron's tumor, is a verrucous carcinoma
of the skin. In 1948, Ackerman first described verrucous carcinoma (VC), a low-grade tumor that
generally is considered a clinicopathologic variant of squamous cell carcinoma.
Verrucous carcinomas are caused by HPV types 6 and 11. When they occur on the feet they are
called epithelioma caniculatum. When they occur on the genitals they are refered to as Buschke-
Lowenstein tumors. When they occur in the mouth they are called Ackerman's tumors or oral florid
papillomatosis
70) A 48 year-old man develops headache, myalgias, and high fever 5 days after a hunting trip. On
examination he has a tender ulcer with raised margins and an eschar on his index finger, as well as
tender axillary lymphadenopathy. The most likely diagnosis is:
A. Orf
B. Anthrax
C. Tularemia Correct Choice
D. Glanders
E. Erysipeloid
Tularemia, which is caused by Francisella tularensis, occurs after exposure to infected animals,
including, rabbits, foxes, and squirrels. The clinical description is that of the ulceroglandular form,
which is the most common presentation
71) Which exotoxin(s) are involved in mediating the effects of Bacillus anthracis - the causative
organism for anthrax?
A. Lethal Toxin
B. Edema Toxin and Lethal ToxinCorrect Choice
C. Exotoxin B
18

19. D. Edema Toxin
E. Alpha toxin
B. anthracis has 2 exotoxins: edema toxin and lethal toxin, each comprised of a pair of
noncovalently linked
proteins:
– Edema toxin = Edema Factor (EF) + Protective Antigen (PA)
– Lethal toxin = Lethal Factor (LF) + PA
– EF causes gelatinous edema of anthrax skin lesions by inducing an increase in cyclic adenosine
monophosphate (cAMP) levels
– LF causes shock and death in disseminated anthrax via the release of tumor necrosis factor-alpha
(TNF-a)and interleukin-1b (IL-1b)
– PA is responsible for entry of exotoxins into the cell by receptor-mediated endocytosis
72) A 43 year-old man with uncontrolled HIV disease presents with yellowish, red papules, draining
sinuses and ulcers perianally and periurethrally. Which histopathological or immunohistochemical
stain may aid in diagnosis?
A. Von Gieson (EVG)
B. CD3
C. Steiner
D. CD20
E. Von KossaCorrect Choice
The most likely diagnosis is malakoplakia. Malakoplakia, an infection usually attributed to S. aureus,
P. aeruginosa, or E. coli is characterized histopathologically by Michelis-Gutmann bodies. These are
foamy eosinophilic macrophages containing calcified, laminated, intracytoplasmic bodies. They can
be highlighted by a calcium stain such as von Kossa. CD3 and CD20 are lymphocyte markers, von
Gieson is an elastic tissue stain, and Steiner stain is used to highlight spirochetes. These would not
aid in the diagnosis of malakoplakia
73) A 42 year-old woman presents with a large, vegetating ulcer involving her left labia majora and
groin for over 1 year. A Giemsa’s stained touch preparation reveals bipolar, safety pin-shaped
intracytoplasmic inclusions. What is the most likely diagnosis?
A. Chancroid
B. Lymphogranuloma venereum
C. Gonorrhea
D. Primary herpes simplex
E. Granuloma InguinaleCorrect Choice
Bipolar, safety pin-shaped intracytoplasmic inclusions on Giemsa stain - known as Donovan bodies -
are diagnostic of granuloma inguinale
74) The leading infectious cause of deafness and mental retardation in the U.S. is:
A. Congenital herpes simplex
B. Congenital syphilis
C. Congenital Cytomegalovirus (CMV)Correct Choice
D. Congenital varicella
19

20. E. Congenital Rubella
Congenital CMV is the leading infectious cause of deafness and mental retardation in the U.S.
75) Which human papillomavirus type is associated with giant condylomata of Bushke and
Lowenstein (Bushke-Lowenstein tumor)?
A. 2
B. 31
C. 16
D. 1
E. 6 Correct Choice
The Bushke-Lowenstein tumor is caused by HPV-6 and 11
76) Each of the following species may be involved in necrotizing fasciitis except:
A. MycobacteriumCorrect Choice
B. Pseudomonas
C. Bacteroides
D. Streptococcus
E. Clostridium
Necrotizing fasciitis is a rapidly advancing acute necrotizing infection that may follow trauma,
surgery, or occur spontaneously. It is associated with systemic toxicity and high mortality rate.
Clinically, erythema, edema, and edema progresses to dusky cyanosis, blistering and necrosis.
Many virulent bacteria have been culturesd including Pseudomonas, Bacteroides, streptococci,
staphylococcus, enterococci, and clostridium. Both aerobic and anaerobic cultures should be taken.
Mycobacterium is not associated with necrotizing fasciitis
77) Bacillary angiomatosis is caused by which of the following organisms?
A. B. quintana
B. All of these answers are correct
C. B. quintana and B. henselaeCorrect Choice
D. B. bacilliformis
E. B. henselae
B. quintana or B. henselae are both causative organisms for bacillary angiomatosis
78) A 24 year-old man from New York City develops fever, chills, malaise, and a severe headache.
His apartment has a mouse problem. On examination, multiple, discrete papulovesicles and a single
eschar are found. What is the most likely diagnosis?
A. RickettsialpoxCorrect Choice
B. Rocky Mountain Spotted Fever
C. Q Fever
D. Meningococcemia
20

21. E. Ehrlichiosis
The clinical description is that of rickettsialpox, which is caused by R. akari and spread by
liponyssoides sanguineus - the house mouse mite
79) Nonmenstrual cases of the staphylococcal toxic shock syndrome are mediated by which of the
following toxins?
A. Epidermolytic toxins A and B
B. Edema toxin
C. Pyrogenic exotoxins A, B, C
D. Exfoliative toxins A and B
E. Enterotoxins B and C Correct Choice
Toxic shock syndrome (TSS) is mediated by Enterotoxins B and C (50% of nonmenstrual cases) and
TSS toxin 1 (TSST-1), which is the leading cause of menstrual cases
80) A 27 year-old HIV positive presents with this pruritic eruption? What is the characteristic cell
type found on histopathology?
A. Plasma Cell
B. Lymphocyte
C. Neutrophil
D. EosinophilCorrect Choice
E. Neutrophil
Eosinophilic pustular folliculitis is a pruritic disorder that may be seen in HIV positive patients.
Typically, the CD4 count is < 300. In patients with HIV, pruritus tends to improve after institution of
anti-retroviral therapy
81) Which of the following statements best describes the pathogenesis of scrofuloderma?
A. Autoinoculation of M. tuberculosis from advanced pulmonary tuberculosis
B. Hematogenous spread of M. tuberculosis from a distant site of infection
C. Primary incoculation of M. tuberculosis in a sensitized host
D. An cutaneous manifestation of military tuberculosis
E. Contiguous spread from an underlying focus of tuberculous lymphadenitis Correct Choice
Scrofuloderma is the result of contiguous spread onto skin from an underlying focus of tuberculous
infection. This typically occurs in a sensitized host with low immunity
82) Focal epithelial hyperplasia (Heck’s Disease) is associated with which of the following human
papillomavirus types?
A. 7
B. 13 Correct Choice
C. 10
D. 4
21

22. E. 3
Focal epithelial hyperplasia is caused by HPV-13 and 32
83) Winterbottom’s sign is a characteristic feature of which of the following diseases?
A. Onchocerciasis
B. Leishmaniasis
C. Loaiasis
D. Strongyloidiasis
E. African Trypanosomiasis Correct Choice
Winterbottom’s sign (posterior cervical lymphadenopathy) is a clinical feature of African
trypanosomiasis. Romaña’s sign (eyelid edema and conjunctivitis at site of incoculation) is a
diagnostic finding in American trypanosomiasis (Chagas’ disease)
84) A young patient presents to you after participating in a bar brawl a few nights before with a
painful swollen erythematous right hand. The most likely organism is:
A. Staphylococus aureus
B. Bacteriodes fragilis
C. Eikenella corrodensCorrect Choice
D. Pasturella multocida
E. Streptococcus pyogenes
Eikenella corrodens is a member of normal oral flora, that is commonly the cause of human bite and
fist fight infections. Pasturella multocida is a common organism found in dog and cat bites. Staph
and Strep could be the right answers for a cellulitis, but with this history are not the correct choices.
Baceriodes fragilis is found in normal bowel flora
85) Hutchinson’s teeth are a feature of which stage of syphilis?
A. Primary
B. Secondary
C. Tertiary
D. Early congenital
E. Late congenital Correct Choice
Hutchinson’s teeth (widely-spaced, peg-shaped upper incisors) are a seen in Late Congenital
Syphilis (> 2 years of age
86) The causative organism in Whitmore disease is which of the following?
A. Vibrio vulnificus
B. Pseudomonas aeruginosa
C. Streptobacillus moniliformis
D. Burkholderia pseudomalleiCorrect Choice
E. Klebsiella pneumoniae
22

23. Whitmore disease also known as Meloidosis is characterized by pulmonary disease, septicemia, and
miliary abscesses. It is caused by Burkholderia pseudomallei
87) All of the following are true regarding tularemia except:
A. Potential for use as a biologic weapon
B. Ticks serve as a reservoir
C. No longer one of the CDC's list of reportable diseasesCorrect Choice
D. Presents as an acute febrile illness
E. Caused by the gram negative Francisella tularensis
Tularemia is a zoonotic disease caused by the gram-negative coccobacillus Francisella tularensis. It
is transmitted by arthropods (particularly tick bites) or from contact with infected mammals (usually
rabbits). It characteristically presents as an acute febrile illness with other variable clinical
manifestations depending on the route of inoculation. Possible symptoms could include an ulcer at
the site of inoculation, pharyngitis, ocular lesions, lymphadenopathy, and pneumonia. Diagnosis can
be made by culture or a fourfold titer change. Because of its potential use as a biologic agent,
tularemia is once again a reportable disease
88) All of the following are potential causes of a false positive RPR except:
A. Pregnancy
B. Malaria
C. Malignant MelanomaCorrect Choice
D. Systemic Lupus Erythematosus (SLE)
E. Lepromatous Leprosy
Non-treponemal tests for syphilis measure antibodies against phospholipids released from
treponemes and damaged host cells. False positive non-treponemal tests can occur in the setting of
pregnancy, autoimmune diseases, other spirochete infections, and infectious diseases such as
leprosy and malaria. It does not occur in cases of melanoma
89) Coxsackievirus A16 is implicated in the pathogenesis of which of the following dieases?
A. Fifth disease
B. Exanthem subitum
C. Papular purpuric “gloves and socks” syndrome
D. Hand-Foot-and-Mouth disease Correct Choice
E. Erythema infectiousum
Hand-Foot-and-Mouth disease is caused by coxsackievirus A16. Group A coxsackievirus infection is
also associated with herpangina
90) The most common bacterial cause of purpura fulminans is:
A. Group A streptococcus Correct Choice
B. E. coli
C. P. aeruginosa
23

24. D. S. aureus
E. H. influenzae
Group A streptococcus is the leading bacterial cause of purpura fulminans
91) Which of the following is the causative organism of Tularemia?
A. Orientia tsutsugamushi
B. Klebsiella pneumoniae
C. Burkholderia mallei
D. Francisella tularensisCorrect Choice
E. Streptobacillus moniliformis
Tularemia is caused by infection with Francisella tularensis - most commonly acquired after contact
with infected rabbits (e.g. hunters
92) Roseola infantum is caused by which virus?
A. Pox virus
B. Coxsackie virus A16
C. Parvovirus B19
D. Human herpes virus 6Correct Choice
E. Epstein-Barr virus
Roseola infantum may be cause be either human herpes virus types 6 or 7. It is the sixth of the
traditional exanthems of childhood. A diffuse, maculopapular eruption is typically preceded by a
prodrome of fever and either respiratory or gastrointestinal symptoms. The infection usually occurs
in the spring and the fall and nearly all children are seropositive for the virus by the age of 4
93) Foamy macrophages containing Klebsiella pneumoniae are called:
A. Mikulicz's cellsCorrect Choice
B. Virchow cells
C. Michaelis-Gutman cells
D. Russell cells
E. Hansemann's cells
Mikulicz’s cells are foamy macrophages found in Rhinoscleroma – a chronic, inflammatory,
granulomatous disease of the upper respiratory tract. Virchow cells are found in Hansen’s disease.
Hansemann cells and Michaelis-Gutman bodies are found in Malakoplakia
94) The diagnosis of leishmaniasis can be confirmed by which of the following techniques?
A. Culture in Sabourad's agar
B. Warthin-Starry stain
C. Culture in Michel's medium
D. Weil-Felix test
24

25. E. Culture in Novy-MacNeal-Nicolle (NNN) mediumCorrect Choice
Confirmation of infection with Leishmaniasis is performed by culture in Novy-MacNeal-Nicolle (NNN)
medium
95) What is the most common cause of focal epithelial hyperplasia?
A. Pachyonychia Congenita
B. human immunodeficiency virus(HIV)
C. Dyskeratosis Congenita
D. human papilloma virus(HPV)Correct Choice
E. Ebstein Bar virus(EBV)
Focal epithelia hyperplasia, also known as Heck's disease, is caused by HPV types 13, 32 and 57. It
is most commonly found on the lower lip but also on the buccal mucosa, gums and tongue. It is
mainly a disease of native Americans and Greenlander Eskimos. EBV causes an oral hairy
leukoplakia in patients with AIDS. Pachyonychia Congenita patients commonly develop a benign oral
leukoplakia, while Dykeratosis Congenita patients develop a premalignant oral leukoplakia
96) Which form of cutaneous tuberculosis is associated with the highest level of immunity?
A. Tuberculosis gumma
B. Tuberculosis verrucosa cutis
C. Lupus vulgarisCorrect Choice
D. Miliary tuberculosis
E. Tuberculosis chancre
Lupus vulgaris is an chronic, progressive form which usually occurs around nose, neck and earlobes,
notable for gelatinous "apple-jelly" hue. Tuberculosis chancre and tuberculosis verrucosa cutis cutis
are primary inoculations of tuberculosis infection. Tuberculosis gumma and miliary tuberculosis are
associated with lowered states of immunity
97) Which of the following is the causative organism of cat-scratch disease?
A. B. quintana
B. B. burgdorferi
C. B. bacilliformis
D. B. henselae Correct Choice
E. B. duttonii
B. henselae is the cause of cat-scratch disease. Humans are infected by a cat bite or scratch, while
the cat flea is responsible for cat to cat transmission
98) Herpangina is caused by which of the following?
A. Parvovirus B19
B. Group A coxsackievirusCorrect Choice
C. Human Herpesvirus 6 (HHV-7)
25

26. D. Epstein Barr Virus
E. Human Herpesvirus 6 (HHV-6)
Herpangina is caused by Group A coxsackievirus
99) A patient on the bone marrow transplant service has a fever, neutropenia, hemorrhagic bullae
and erythematous nodules with dusky gray centers. The organism most likely to be responsible is:
A. Streptococcus pyogenes
B. Pseudomonas aeruginosaCorrect Choice
C. Mycobacterium tuberculosis
D. Staphylococcus aureus
E. Candida albicans
Ecthyma gangrenosum is an infection of critically ill or immunocompromised individuals by
Pseudomonas aeruginosa. Clinically, patients develop opalescent, tense vesicles or pustules
surrounded by a narrow pink to violaceous halo. The lesions rapidly become hemorrhagic, then
violaceous and necrotic leaving ulcers. The most common location is on the buttocks and lower
extremities. Treatment is with aminoglycosides
100) What is the treatment of choice in a penicillin allergic individual?
A. Rifampiin
B. Penicillin
C. DoxcycylineCorrect Choice
D. Ceftriaxone
E. Clindamycin
Secondary syphillis is caused by the spirochete, T. pallidum. Penicillin is the treatment of choice for
secondary syphillis. In penicillin allergic individuals, doxycyline may be used
101) A patient presents with this anesthestic plaque. Which cytokines are upregulated in this
disease?
A. IL-2Correct Choice
B. All of these cytokines are upregulated
C. IL-5
D. IL-10
E. IL-4
Leprosy is caused by infections to Mycobacterium leprae. It is a acid fast bacilli. In tuberculoid
leprosy, Th1 cytokines (IL-2, IFN-gamma) are upregulated. Clinically, patients have few, well-
circumscribed anesthetic plaques
102) A 43 year-old man presents with suppurative nodules and sinus tracts over the mandible. He
also is noted to have poor oral hygiene. What is the most likely causative organism?
A. Staphylococcus aureus
B. Nocardia brasilensis
26

27. C. Streptococcus somaliensis
D. Bartonella Henselae
E. Actinomyces israeliiCorrect Choice
Actinomyces israelii is an anaerobic gram-positive rod which causes chronic suppurative nodules
and sinus tracts with an exudate containing sulfur granules. It most commonly effects the
cervicofacial area, especially near the mandible. The abdomen and thoracic areas can also be
affected. The source of infection is endogenous and patients with poor oral hygiene, penetrating
foreign bodies, and recent dental procedures are at increased risk. Treatment of choice is penicillin
103) A 32 year-old woman presents with meningitis and palpable purpura. A diagnosis of
meningococcemia is confirmed via culture of cerebrospinal fluid. Which complement components are
most likely to be deficient in this patient?
A. C3
B. C2
C. C4
D. C5Correct Choice
E. C1
Patients with meningococcemia often demonstrate deficiencies of late complement components
C5-9.
104) A 62 year-old man presents with tinnitus, facial paralysis, and vesicles of the external ear.
What is the most likely diagnosis?
A. Primary Herpes Simplex infection
B. Coxsackievirus A16 infection
C. Cytomegalovirus infection
D. Primary Varicella Infection
E. Herpes Zoster InfectionCorrect Choice
This patient has Ramsay Hunt Syndrome, herpes zoster infection of the geniculate ganglion.
Vesicles can be seen on the tympanic membrane and the external ear. Symptoms include ipsilateral
facial paralysis, tinnitus, or other auditory symptoms. Treatment is with acyclovir and systemic
corticosteroids
105) Calabar swellings are a characteristic feature of which disease?
A. Eumycetoma
B. LoiasisCorrect Choice
C. Carrion's Disease
D. Tertiary Syphilis
E. Onchocerciasis
Calabar swellings are characteristic of Loiasis. They are transient, non-tender soft tissue swellings
found most commonly around joints
106) What is the characteristic body on histopathology for this disease?
27

28. A. Henderson-Patterson
B. Cowdry Type ACorrect Choice
C. Dutcher
D. Guarnieri
E. Cowdry Type B
Herpes simlex virus is characterized by Cowdry type A bodies on histopathology. They appear as
sharply demarcated eosinophilic structures separated by a clear halo from a basophilic rim of the
infected cell's marginated nuclear chromatin. Cowdry B bodies may be seen in polio infections
107) A 10 year-old girl presents to the dermatology clinic with a pruritic eruption on her trunk after
swimming at a beach in Florida. Of note, the lesions are limited to skin that was covered by her
bathing suit. The most likely diagnosis is:
A. Swimmer’s itch
B. Cutaneous larva migrans
C. Cercarial dermatitis
D. Seabather’s eruption Correct Choice
E. Swimming pool granuloma
Seabather’s eruption characteristically involves areas covered by swimwear, as a result of
coelenterate larvae becoming trapped underneath bathing suits. The causative organisms are larval
forms of Edwardsiella lineata (sea anemone) and Linuche unquiculata (thimble jellyfish).
108) The Jarisch-Herxeimer reaction is most closely associated with the release of which of the
following cytokines?
A. IFN-alpha
B. IL-10
C. IL-12
D. IL-4
E. TNF-alpha Correct Choice
TNF-alpha. The Jarisch-Herxheimer reaction is associated with increased plasma concentrations of
TNF-alpha after antibiotic treatment of syphilis. The Jarisch-Herxheimer reaction has also been
described following treatment of louse-borne relapsing fever, lyme disease and leptospirosis
109) The causative organism of epidemic typhus is:
A. Salmonella typhi
B. R. prowazekiiCorrect Choice
C. Francisella tularensis
D. R. typhi
E. R. akari
Epidemic typhus is caused by infection with R. prowazekii
28

29. 110) The expanding annular erythematous patch shown developed in a 25 year-old woman after
returning from a weekend at her summer home in Long Island, New York. The vector of this
infection is:
A. Lutzomyia verrucarum
B. Ixodes dammini Correct Choice
C. Ixodes ricinus
D. Ctenocephalides felis
E. Pediculus humanus corporis
This is an example of erythema migrans, seen in Lyme disease. Ixodes dammini is the principal
vector in the northeastern U.S
111) Streptobacillus moniliformis is the causative organism of which infectious disease?
A. Glanders
B. Rat-bite fever (Haverhill fever)Correct Choice
C. Tularemia
D. Cat scratch disease
E. Scrub typhus
Rat-bite fever (Haverhill fever) is caused by Streptobacillus moniliformis
112) Which antibiotic is best to treat this condition caused by Bartonella hensalae.
A. Ceftriaxone
B. ErythromycinCorrect Choice
C. Clindamycin
D. Fluconazole
E. Trimethoprim/sulfamethoxasole
Bartonella hensalae is the causative agent of bacillary angiomatosis. The differential diagnosis of
bacillary angiomatosis may include pyogenic granulomas and Kaposi's sarcoma. The treatment of
choice is erythromycin
113) The treatment of choice of the tropical infectious disease shown is:
A. Ivermectin
B. Mebendazole
C. Permethrin
D. Pentavalent antimony Correct Choice
E. Diethylcarbamazine
The ulcerated nodule shown here is characteristic of cutaneous leishmaniasis (CL). Leishmaniasis is
treated with pentavalent antimony
114) Tick-borne Relapsing Fever is caused by:
29

30. A. B. duttoniiCorrect Choice
B. B. henselae
C. B. burgdorferi
D. B. recurrentis
E. B. bacilliformis
Relapsing Fever can be either Louse-borne or Tick-borne. Tick-borne Relapsing Fever is caused by
B. duttonii, while Louse-borne Relapsing Fever is caused by B. recurrentis
115) Cat scratch disease is caused by infection with:
A. Bartonella speciesCorrect Choice
B. Gram-positive bacilli
C. Spirochetes
D. Rickettsiae
E. Gram-positive cocci
Cat scratch disease is caused by infection with B. henselae - a gram-negative bacillus of the genus
Bartonella
116) Corynebacterium minuttissimum is responsible for which of the following infections?
A. Erysipeloid
B. Trichomycosis axillarisCorrect Choice
C. Majocchi's granuloma
D. Erysipelas
E. Malakoplakia
Corynebacterium minutissimum is responsible for causing trichomycosis axillaris, a superficial
bacterial overgrowth of axillary hairs characterized by circumferential yellow (most common), red,
or black granular concretions. Majocchi's granuloma is a dermatophyte infection. Erysipelas is
caused by beta-hemolytic group A streptococcus. Malakoplakia is usually caused by S. aureus, P.
aeruginosa, or E. coli. Erysipeloid is caused by Erysipelothrix rhusiopathiae. Corynebacterium is also
the causative organism in erythrasma and pitted keratolysis
117) Measles is caused by which type of virus?
A. ParamyxovirusCorrect Choice
B. Togavirus
C. Parvovirus
D. Picornavirus
E. Rhabdovirus
Measles is caused by an RNA virus known as paramyxovirus. The illness is characterized by high
fever, cough, coryza, conjunctivitis, and Koplik's spots. Viral exanthem characterized by
erythematous macules and papules beginning on the face and spreading caudally 3-4 days after
prodromal symptoms
30

31. 118) A 27 year-old woman who is 30 weeks pregnant presents with erythema migrans. The
treatment of choice for this patient is:
A. Doxycycline
B. AmoxicillinCorrect Choice
C. Erythromycin
D. Clindamycin
E. Chloramphenicol
In the setting of pregnancy, amoxicillin is the treatment of choice for Lyme Disease since
doxycycline is contraindicated
119) The treatment of choice for Loiasis is:
A. Diethylcarbamazine (DEC)Correct Choice
B. Permethrin
C. Ivermectin
D. Malathion
E. Chloramphenicol
The recommended treatment for loiasis is Diethylcarbamazine (DEC
120) The most likely target for exfoliative toxin A in bullous impetigo is:
A. Desmoglein 1Correct Choice
B. BPAG2
C. BPAG1
D. Desmocollin
E. Desmoglein 3
Bullous impetigo is caused primarily by staphylococcus aureus phage type 71. This bacteria
produces exfoliative toxin A binds to desmoglein 1 and produces produces the blisters characteristic
of bullous impetigo
121) The infectious disease shown is most likely caused by which of the following organisms?
A. L. mexicana complex
B. L. infantum
C. L. major
D. Klebsiella pneumoniae rhinoscleromatis Correct Choice
E. L. donovani
The figure is an example of rhinoscleroma, which is caused by Klebsiella pneumoniae
rhinoscleromatis. While the diagnosis of mucocutaneous leishmaniasis (MCL) could be considered,
none of the leismania species listed as possible responses are causes of MCL
122) A 8 year-old girl presents to the pediatrician with a poorly marginated blue-red single
indurated plaque on her right cheek. What is the most likely causative organism?
31

32. A. Klebsiella pneumoniae
B. Staphyloccus aureus
C. Beta-hemolytic group A streptococcus
D. Haemophilus influenzaeCorrect Choice
E. Pseudomonas aeruginosa
The most likely diagnosis is H. flu cellulitis. This infection usually occurs in children and is
characterized by a single indurated plaque with poorly delineated margins. Erysipelas, an infection
caused by beta-hemolytic streptococcus group A, usually presents with well delineated margins in
adult patients
123) A 35 year-old woman who works in the animal product industry presents with a painless
hemorrhagic bulla. A diagnosis of anthrax is suspected. Gram stain of the vesicle fluid should reveal
which of the following?
A. Gram-negative cocci
B. Guarnieri bodies
C. Gram-positive bacilli Correct Choice
D. Gram-negative bacilli
E. Gram-positive cocci
Anthrax is caused by Bacillus anthracis, which is a gram-positive spore-forming rod
124) The mechanism of action of this virulence factor of Bacillus anthracis is via increasing the
activity of tumor necrosis factor alpha:
A. Lethal toxinCorrect Choice
B. All of the above answers are correct
C. Edema toxin
D. Polyglutamate acid capsule
E. None of the above answers are correct
Bacillus anthracis is responsible for causing Anthrax. Anthrax of the skin is characterized by a
painless edematous nodule which rapidly degenerates into an eschar. B. anthracis has 3 virulence
factors: a polyglutamate acid capsule which inhibits phagocytosis of the bacteria, edema toxin
(edema factor and protective factor) which results in edema secondary to induction of cAMP
pathway, and lethal toxin (lethal factor and protective factor) which leads to shock and death via
increasing TNFalpha activity
125) At what rate of speed does this parasite migrate through the skin?
A. 0.1 cm/day
B. 10 cm/day
C. 1 cm/day
D. 2 cm/dayCorrect Choice
E. 100 cm/day
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33. The infection depicted is larva migrans or creeping eruption which is caused by Ancylostoma
braziliense. This nematode is typically a hookworm of cats and dogs. It migrates at a rate of 2
cm/day. Larva currens migrates at a rate of 10 cm/day
126) High doses of which of the following antiviral agents has been associated with thrombotic
thrombocytopenic purpura in immunosuppressed patients?
A. Acyclovir
B. ValcyclovirCorrect Choice
C. Cidofovir
D. Foscarnet
E. Famciclovir
Thrombotic thrombocytopenic purpura has been reported with high doses of valcyclovir in
immunosuppressed patients
127) Orf virus infection is also known as:
A. Ecthyma
B. Pseudocowpox
C. Ecthyma contagiosumCorrect Choice
D. Milker's nodule
E. Echtyma gangrenosum
Orf virus infection is also known as Ecthyma contagiosum. Ecthyma Gangrenosum is caused by
Pseudomonas aeruginosa. Ecthyma is caused by Staphylococcal or streptococcal pyoderma.
Pseudocowpox and Milker's nodule are also known as paravaccinia and caused by udders of infected
cows
128) Botryomycosis is:
A. An acute, disseminated infection involving the genitourinary system
B. A fungal infection caused by T. tonsurans
C. A bacterial infection commonly associated with Staphylococcus aureusCorrect Choice
D. A bacterial infection commonly associated with Clostridium botulinum
E. A fungal infection caused by M. canis
Botryomycosis is an uncommon, chronic, idonlent disorder characterized by nodular, crusted,
purulent lesions. Sinuses that discharge sulfur granules are present. These heal with atrophic scars.
The granules yield most commonly Staphylococcus aureus on culture, although cases caused by
Pseudomonas aeruginosa, E. coli, Proteus, Bacteroides, and Streptococcus have been reported
129) Xenopsylla cheopis is the vector responsible for which infectious disease?
A. Human Granulocytic Ehrlichiosis
B. Scrub typhus
C. Endemic typhusCorrect Choice
D. Human Monocytic Ehrlichiosis
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34. E. Epidemic typhus
Xenopsylla cheopis (rat flea) is the vector of endemic typhus, which is caused by R. typhi
130) Erythema infectiosum is caused by a:
A. None of these answers are correct
B. Single stranded DNA virusCorrect Choice
C. Double stranded DNA virus
D. RNA virus
E. Herpes virus
Erythema infectiosum is caused by parvovirus B19 which is a single stranded DNA virus
131) Which of the following vectors is responsible for transmitting Chagas’ disease?
A. Reduviid bug Correct Choice
B. Sandfly
C. Black fly
D. Tstse fly
E. Mosquito
The reduviid big is the vector of American trypanosomiasis (Chagas disease). The vector of African
trypanosomiasis is the tstse fly
132) All of the following statements are true of Bacillus anthracis infection except:
A. inhalation, GI and cutaneous forms exist
B. ciprofloxacin and doxycycline are first line treatments
C. Spores remain stable for decades
D. 20% mortality rate in untreated cutaneous infectionsCorrect Choice
E. no recommendations from CDC exist on anthrax vaccine
Anthrax can present in three different clinical forms: cutaneous, inhalational, and gastrointestinal.
The cutaneous form appears as a painless vesicle that later forms an eschar (malignant pustule).
The cutaneous form has a mortality rate of less than 1% if treated an up to 20% if untreated
133) Which of the following is the vector responsible for the transmission of Verruga Peruana?
A. Ctenocephalides felis
B. Tsetse fly
C. Lutzomyia verrucarumCorrect Choice
D. Pediculus humanus corporis
E. Simulium slossonae
Verruga Peruana is caused by infection with B. bacilliformis, which is transmitted by the sandfly,
Lutzomyia verrucarum
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