Medicine 2nd Long Exam Batch 2013

MEDICINE 2nd LONG EXAM BATCH 2013 1. A 23 year old male, complained of urethral discharge 3 days after sexual contact with a prostitute. This is associated with dysuria and scrotal pain. He took trimethoprim sulfamethoxazole forte twice daily for 3 days but afforded no relief: Your next plan is: A. treat with Cefixime and Azithromycin B. urinalysis C. do gram stain of urethral discharge D. gram stain and culture of urethral discharge 2. This is characteristic of non gonococcal etiology of urethritis: A. symptoms usually appear within 5 days after sexual contact B. discharge is purulent C. majority of women are asymptomatic D. absence of gram negative diplococcic on gram stain 3. A 34 year old male, seafarer, complained of genital sore of the penile shaft. This is characterized as solitary, with regular border, indurated margin and slightly tender. (+) for inguinal lymphadenopathy. He diagnosis require: A. Serologic testing B. Biopsy of ulcer C. Gram stain and culture of swab from ulcer base D. Blood culture 4. A diagnosed case of latent syphilis with an RPR titer of 1:64 came to your clinic to seek consult with regards to his partner. Your recommendation is: A. Treat partner with 3 doses of benzathine penicillin G B. Screen the partner for RPR and TPHA before deciding on giving treatment C. Treat partner with single dose of benzathine penicillin G D. Observe only and treat once symptomatic 5. Which among the following choices of etiologic agent and recommended treatment is correct? A. Gardnerella vaginalis and fluconazole B. Herpes simplex and penicillin C. Chlamydia trachomatis and doxycycline D. Neisseria gonorrhea and azithromycin

6. The ability of Mycobacterium tuberculosis to evade effects of host immune response: A. Granuloma formation B. Antigenic changes C. Ability to become latent D. Destroys T cells 7. The pathogenicity of Haemophilus influenza that enables them to pass thru normal host defense is attributed to: A. iron sequestration mechanism B. anti phagocytic capsule C. toxins and enzymes D. immune specific proteases such as lgA proteases 8. Motility and release of chemotactic factors are specific attributes of microorganisms to: A. breach normal host barriers B. multiply upon reaching tissue C. promote interaction in the host cell D. pass thru normal host defense 9. This can facilitate acquisition and development of hospital acquired infections: A. use of antibiotics after surgical operations B. insertion of intravenous devices on peripheral sites C. treatment with immunosuppressive drugs D. failure to comply with infection control policy such as hand washing* 10. microbial factors produced by gram-negative bacteria that will directly interact with host phagocytes: A. fili or fimbriae B. lipopolysaccharide toxins C. lipoteichoic acid D. antioxidants 11. The difficulty of identifying specific etiologic agents causing infections in an immunocompromised is primarily due to the following factors, except: A. microbiologic confirmation is rarely positive B. mostly involved difficult to treat and unusual pathogens C. organisms are virulent and fastidious D. signs and symptoms are often muted

12. the most appropriate method of blood culture set at initial assessment of patients with infections: A. 2 sets of blood cultures same venipuncture site if no central catheter is present B. 1 set of blood culture taken at the lumen of central vein catheter, if present C. 2 sets of blood cultures taken at separate venipuncture sites D. 3 sets of blood culture at 3 separate venipuncture sites if antibiotic has been given 13. The presence of the following finding in febrile neutropenia entails empiric antibiotic monotherapy with an anti-pseudomonal beta lactam agent given intravenously A. Anticipated brief (