1.

A 24-year-old woman in New York City is admitted to the hospital

because of jaundice. On workup, she is found to have HCV
infection. The major risk factor for HCV infection in the United
States is
(A) Tattoos
(B) Injecting drug use
(C) Blood transfusion
(D) Sexual activity
(E) Working in health care occupations
2. Which of the following exposures poses a risk for hepatitis
infection?
(A) A nurse sustains a needlestick while drawing up insulin to
administer to an HBV-infected patient with diabetes.
(B) While cleaning the bathroom, a housekeeper’s intact skin
has contact with feces.
(C) An operating room technician with chapped and abraded
hands notices blood under his gloves after assisting in an
operation on a patient with HCV infection.
(D) A child drinks out of the same cup as her mother, who has
an HAV infection.
(E) A shopper eats a sandwich prepared by a worker with an
asymptomatic HBV infection.
3. An epidemic of jaundice caused by HEV occurred in New
Delhi. HEV is
(A) Found in rodents and pigs
(B) A major cause of bloodborne hepatitis
(C) The cause of a disease that resembles hepatitis C
(D) Capable of establishing chronic infections
(E) Associated with an increased risk of liver cancer
4. HDV (delta agent) is found only in patients who have either acute
or chronic infection with HBV. The following is most correct
(A) HDV is a defective mutant of HBV.
(B) HDV depends on HBV surface antigen for virion formation.
(C) HDV induces an immune response indistinguishable from
that induced by HBV.
(D) HDV is related to HCV.
(E) HDV contains a circular DNA genome.
5. A 23-year-old woman is planning a 1-year trip through Europe,
Egypt, and the Indian subcontinent and receives a vaccine for
hepatitis A. The current hepatitis A vaccine is
(A) A live attenuated virus vaccine
(B) A recombinant DNA vaccine
(C) A formalin-inactivated virus vaccine
(D) An envelope glycoprotein subunit vaccine
(E) A chimeric poliovirus that expresses HAV neutralizing
epitopes
6. The following statements about HCV infection and associated
chronic liver disease in the United States are correct except
(A) HCV is responsible for 40% of chronic liver disease.
(B) Chronic infection develops in most (70–90%) HCVinfected
persons.
(C) HCV-associated liver disease is the major cause for liver
transplantation.
(D) HCV viremia occurs transiently during early stages of
infection.
(E) HCV-infected patients are at high risk (5–20%) for liver
cancer.
7. A middle-aged man complained of acute onset of fever, nausea,
and pain in the right upper abdominal quadrant. There was
jaundice, and dark urine had been observed several days earlier.
A laboratory test was positive for HAV IgM antibody. The physician
can tell the patient that
(A) He probably acquired the infection from a recent blood
transfusion.
(B) He will probably develop chronic hepatitis.
(C) He will be at high risk of developing hepatocellular carcinoma.
(D) He will be resistant to infection with hepatitis E.
(E) He may transmit the infection to family members by person-
to-person spread for up to 2 weeks.
8. Several different viruses can cause hepatitis. One of the following
statements applies to all four viruses: HAV, HCV, HDV, and HEV.
(A) Contains a single-stranded RNA genome
(B) Is transmitted primarily by the parenteral route
(C) Is transmitted primarily by the fecal–oral route
(D) Is associated with fulminant hepatitis
(E) Undergoes sequence variation during chronic infection
9. A 30-year-old student goes to the emergency room because
of fever and anorexia for the past 3 days. She appears jaundiced.
Her liver is enlarged and tender. A laboratory test shows
elevated aminotransferases. She reports a history of having
received hepatitis B vaccine 2 years ago but has not had hepatitis A vaccine. The results
of her hepatitis serologic tests are as follows:
HAV IgM-negative, HAV IgG-positive, HBsAg-negative,
HBsAb-positive, HBcAb-negative, HCV Ab-positive. The most
accurate conclusion is that she probably
(A) Has hepatitis A now, has not been infected with HBV, and
had hepatitis C in the past
(B) Has hepatitis A now and has been infected with both HBV
and HCV in the past
(C) Has been infected with HAV and HCV in the past and has
hepatitis B now
(D) Has been infected with HAV in the past, has not been
infected with HBV, and has hepatitis C now
(E) Has been infected with HAV and HCV in the past, has not
been infected with HBV, and has hepatitis E now
10. A 36-year-old nurse is found to be both HBsAg positive and
HBeAg positive. The nurse most likely
(A) Has acute hepatitis and is infectious
(B) Has both HBV and HEV infections
(C) Has a chronic HBV infection
(D) Has cleared a past HBV infection
(E) Was previously immunized with HBV vaccine prepared
from healthy HBsAg-positive carriers
11. The following persons are at increased risk for HAV infection
and should be routinely vaccinated except for which group?
(A) Persons traveling to or working in countries that have high
levels of HAV infection
(B) Men who have sex with men
(C) Users of illegal drugs (both injecting and noninjecting)
(D) Persons who have an occupational risk for infection
(E) Persons who have a clotting factor disorder
(F) Susceptible persons who have chronic liver disease
(G) Teachers in elementary schools
12. There is global variation in the prevalence of HBV infection.
Which of the following geographic areas has low endemicity
(HBsAg prevalence of <2%)?
(A) Southeast Asia
(B) The Pacific Islands
(C) Eastern Europe
(D) Australia
(E) Sub-Saharan Africa
13. Which of the following persons are not recommended to
receive hepatitis B vaccine because they have a risk factor for
HBV infection?
(A) Sexually active persons who are not in long-term, mutually
monogamous relationships
(B) Injection drug users
(C) Pregnant women
(D) Persons who live in a household with a person who is
HBsAg positive
(E) Persons seeking treatment for a sexually transmitted disease
14. Which of the following statements regarding HBIG is not true?
(A) HBIG provides temporary protection when administered
in standard doses.
(B) HBIG typically is used instead of hepatitis B vaccine
for postexposure immunoprophylaxis to prevent HBV
infection.
(C) No evidence exists that HBV, HCV, or HIV have ever been
transmitted by HBIG in the United States.
(D) HBIG is not used as protection against HCV infection.
15. Each of the following statements concerning HAV is correct
except
(A) The hepatitis A vaccine contains inactivated HAV as the
immunogen.
(B) HAV commonly causes asymptomatic infection in children.
(C) The diagnosis of hepatitis A is usually made by isolating
HAV in cell culture.
(D) Gamma globulin is used to prevent hepatitis A in exposed
persons.
16. Which one of the following is the most reasonable explanation
for the ability of HBV to cause chronic infection?
(A) Infection does not elicit the production of antibody.
(B) The liver is an “immunologically sheltered” site.
(C) Viral DNA can persist within the host cell.
(D) Many humans are immunologically tolerant to HBsAg.
17. A 35-year-old man addicted to intravenous drugs has been a
carrier of HBsAg for 10 years. He suddenly develops acute fulminant
hepatitis and dies within 10 days. Which of the following
laboratory tests would contribute most to diagnosis?
(A) Anti-HBs antibody
(B) HBeAg
(C) Anti-HBc antibody
(D) Anti-delta virus antibody
18. Each of the following statements concerning HCV and HDV is
correct except
(A) HCV is an RNA virus that causes posttransfusion
hepatitis.
(B) HDV is transmitted primarily by the fecal–oral route
(C) HDV is a defective virus that can replicate only in a cell
that is also infected with HBV.
(D) People infected with HCV commonly become chronic
carriers of HCV and are predisposed to hepatocellular
carcinoma.
19. Which of the following statements about HBV is false?
(A) Replication involves reverse transcriptase.
(B) Infected persons may have large numbers of noninfectious
viral particles circulating in their bloodstream.
(C) Infection can result in cirrhosis.
(D) Asymptomatic infections can last for years.
(E) In the United States, the incidence of infection has been
steadily increasing over the past few years.
1. Which of the following statements about rhinoviruses is
correct?
(A) There are three antigenic types.
(B) Amantadine protects against infection.
(C) They do not survive on environmental surfaces.
(D) They are the most frequent causative agent of the common
cold.
(E) They share physicochemical similarities with coronaviruses.
2. A 26-year-old man develops myopericarditis with mild congestive
heart failure that increases over several weeks. Coxsackievirus
B5 infection is diagnosed. Which of the following clinical
syndromes is not associated with coxsackievirus infections?
(A) Herpangina
(B) Myocarditis or pericarditis
(C) Aseptic meningitis
(D) Acute hemorrhagic conjunctivitis
(E) Progressive postpolio muscle atrophy
3. A 3-month-old child develops fever, restlessness, and unusual
crying. These are followed by apparent lethargy. Physical
examination shows a normal-appearing infant who is minimally
responsive to stimuli. A lumbar puncture yields cerebrospinal
fluid with 200 white blood cells per microliter,
predominantly lymphocytes. Acute aseptic meningitis is diagnosed,
probably caused by an enterovirus. Enteroviruses are
characterized by
(A) Latency in sensory ganglia and reactivation primarily in
immunocompromised patients
(B) Transmission primarily by the fecal–oral route
(C) The presence of a DNA polymerase enzyme
(D) The entry of cells following binding to the intercellular
adhesion molecule-1 (ICAM-1) receptor
(E) Undergoing antigenic shift and drift
4. Picornavirus vaccines have been used for several decades in
the prevention of human disease. Which of the following statements
is correct?
(A) The live, attenuated poliovirus vaccine produces gastrointestinal
tract resistance.
(B) There is an effective killed vaccine against the three major
types of rhinoviruses.
(C) The live, attenuated poliovirus vaccine induces protective
immunity against the closely related coxsackie B viruses.
(D) None of the available echovirus vaccines should be given to
immunocompromised patients.
(E) Only the live attenuated poliovirus vaccine is currently
recommended for use in the United States.
5. One month after school has been let out for the summer, a
16-year-old girl develops fever, myalgia, and headache. An outbreak
of an illness with similar symptoms caused by an echovirus
is known to be occurring in the community. The primary
anatomic site of echovirus multiplication in the human host is
(A) The muscular system
(B) The central nervous system
(C) The alimentary tract
(D) The blood and lymph system
(E) The respiratory system
6. Which of the following properties of enteroviruses is not shared
by rhinoviruses?
(A) Single-stranded RNA genome
(B) Production by cleavage of viral proteins from a polyprotein
precursor
(C) Resistance to lipid solvents
(D) Stability at acid pH (pH 3.0)
(E) Icosahedral symmetry
7. A person with asthma has an acute exacerbation with increased
lower respiratory illness. A virus is recovered. The isolate is
most likely to be which of the following virus types?
(A) Parainfluenza virus
(B) Parechovirus
(C) Rhinovirus
(D) Respiratory syncytial virus
(E) Echovirus
8. The use of live oral polio vaccine has been replaced by inactivated
polio vaccine in many countries. Which of the following
is the primary reason?
(A) It is more cost effective to use the inactivated vaccine.
(B) There is a greater risk of vaccine-induced disease than wild
virus-induced disease in areas where poliovirus has been
eradicated.
(C) Only a single dose of inactivated vaccine is necessary compared
with multiple doses of the oral vaccine.
(D) Circulating poliovirus strains have changed and the live
vaccine is no longer effective in many countries.
9. Outbreaks of hand-foot-and-mouth disease, characterized by
oral ulcerations and vesicular rashes, occur and may result in
infant deaths. The disease is caused by
(A) Foot-and-mouth disease virus
(B) Chickenpox virus
(C) Nonpolio enteroviruses
(D) Rhinoviruses
(E) Rubella virus
10. Epidemiologic studies indicate that a core group of enteroviruses
is consistently circulating in the United States. Which of
the following statements is most accurate?
(A) Members of the core group all display an epidemic pattern
of outbreaks of disease.
(B) The group includes about half of the known enteroviruses.
(C) Disease occurs predominantly in adolescents and adults.
(D) Members of the group are all classified as coxsackie A and
B viruses.
(E) This core group determines the majority of enterovirus disease.
11. Each of the following statements concerning rhinoviruses is
correct except
(A) Rhinoviruses are one of the most frequent causes of the
common cold.
(B) Rhinoviruses grow better at 33°C than at 37°C; thus, they
tend to cause disease in the upper respiratory tract rather
than the lower respiratory tract.
(C) Rhinoviruses are members of the picornavirus family and
resemble poliovirus in their structure and replication.
(D) The immunity provided by the rhinovirus vaccine is excellent
because there is only one serotype.
12. Live, attenuated oral polio vaccine (OPV) and inactivated polio
vaccine (IPV) are both available. In which one of the following
situations is the use of OPV preferred?
(A) Routine infant vaccination
(B) Mass immunization programs in areas of high poliomyelitis
endemicity
(C) Adult immunization
(D) Patients who are receiving immunosuppressive therapy
(E) Family contacts of immunocompromised patients
13. Which of the following statements about enteroviral meningitis
is true?
(A) Vaccines are generally available to protect against the disease.
(B) The main symptom is muscle paralysis.
(C) Transmission is usually by the fecal–oral route.
(D) The causative agents do not survive well in the environment.
(E) Recovery is rarely complete.
14. The major barrier to the control of rhinovirus upper respiratory
infections by immunization is
(A) The poor local and systemic immune response to these viruses
(B) The large number of rhinovirus serotypes
(C) The side effects of the vaccine
(D) The inability to grow the viruses in cell culture
15. Each of the following clinical syndromes is associated with
infection by picornaviruses except
(A) Myocarditis or pericarditis
(B) Hepatitis
(C) Mononucleosis
(D) Meningitis
1. A 36-year-old man enjoyed a meal of raw oysters. Twenty-four
hours later, he became ill, with a sudden onset of vomiting,
diarrhea, and headache. The most likely cause of his gastroenteritis
is
(A) Astrovirus
(B) Hepatitis A virus
(C) Norwalk virus
(D) Rotavirus, group A
(E) Echovirus
2. This virus is the most important cause of gastroenteritis in
infants and young children. It causes infections that are often
severe and may be life threatening, especially in infants.
(A) Echovirus
(B) Norwalk virus
(C) Rotavirus, group A
(D) Orbivirus
(E) Parvovirus
3. An outbreak of epidemic gastroenteritis occurred at a wooded
summer camp 24 hours after a party for visiting families. Some
of the visiting parents also became ill. Samples taken 2 weeks
later from the well that was the source of drinking water at the
camp were negative for fecal coliforms. The most likely source
of the outbreak was
(A) Mosquitoes or ticks, present in high numbers in the area
(B) Contaminated food served at the party
(C) A nearby stream used for fishing
(D) A visiting parent who was developing pneumonia
(E) The swimming pool
4. This viral gastroenteritis agent has a segmented, doublestranded
RNA genome and a double-shelled capsid. It is a member
of which virus family?
(A) Adenoviridae
(B) Astroviridae
(C) Caliciviridae
(D) Reoviridae
(E) Coronaviridae
5. Rotavirus and Norwalk virus are distinctly different viruses.
However, they share which one of the following characteristics?
(A) Fecal–oral mode of transmission.
(B) They mainly cause disease in infants and young children.
(C) They induce generally mild disease in young children.
(D) Infection patterns show no seasonal variation.
(E) A double-stranded RNA genome
6. Because rotavirus infections can be serious, a vaccine would be
beneficial. Which of the following is most correct regarding a
rotavirus vaccine?
(A) A killed human rotavirus group A vaccine is licensed for
use in the United States.
(B) Live attenuated vaccines are licensed for use in the United
States.
(C) Vaccine development is complicated by rapid antigenic
variation by the virus.
(D) Available antiviral drugs make a vaccine unnecessary.
(E) Vaccine development is complicated because the virus cannot
be grown in cell culture.
7. Rotaviruses and astroviruses share a number of characteristics.
Which of the following is not shared?
(A) Multiple serotypes exist
(B) Can cause gastroenteritis in infants and children
(C) Can cause gastroenteritis in elderly institutionalized patients
(D) Live vaccine available
(E) Fecal–oral route of transmission
8. A 20-year-old man was on a 3-week tour of Italy with other
college students. One day he abruptly became ill with nausea
and vomiting followed 5 hours later by abdominal cramps and
watery diarrhea. No fever was noted. Which of these viruses is
the most likely cause of the man’s illness?
(A) Calicivirus
(B) Rotavirus
(C) Reovirus
(D) Adenovirus
(E) Astrovirus
9. Which statement about rotaviral gastroenteritis is false?
(A) The name of the causative agent was suggested by its
appearance.
(B) Most of the estimated 600,000 deaths occurring worldwide
from this disease are from dehydration.
(C) Most cases of the disease occur in infants and children.
(D) The causative agent infects mainly the stomach.
(E) The disease is transmitted by the fecal–oral route.
10. Norwalk virus illness might be prevented by any of the following
except
(A) Avoidance of raw fruits
(B) Live, reassortant vaccine
(C) Careful handwashing
(D) Avoidance of local drinking water
(E) Avoidance of raw oysters
11. Which of the following statements about noroviruses is false?
(A) They cause almost half the cases of viral gastroenteritis in
the United States.
(B) They can be responsible for epidemics of gastroenteritis.
(C) They generally produce an illness lasting 1–2 weeks.
(D) Similar viruses are widespread among marine animals.
(E) They typically cause disease in children and adults rather
than infants.
12. Each of the following statements regarding rotaviruses is
correct except
(A) The rotavirus vaccine contains recombinant RNA
polymerase as the immunogen.
(B) Rotaviruses are a leading cause of diarrhea in young
children.
(C) Rotaviruses are transmitted primarily by the fecal–oral
route.
(D) Rotaviruses belong to the reovirus family, which has a
double-stranded segmented RNA genome.
1. A 74-year-old man develops fever, malaise, and a sore throat
followed shortly thereafter by nausea, vomiting, and then stupor.
Eastern equine encephalitis is diagnosed. Control of this
disease in humans could be accomplished by eradication of
which of the following?
(A) Horses
(B) Birds
(C) Sandflies
(D) Mosquitoes
(E) Ticks
2. An arbovirus common in the Middle East, Africa, and Southwest
Asia first appeared in New York in 1999. By 2002 the virus
had spread throughout the continental United States. This
arbovirus, a member of the Japanese B encephalitis antigenic
complex, is which of the following?
(A) Japanese B encephalitis virus
(B) Tick-borne encephalitis virus
(C) West Nile virus
(D) Dengue virus
(E) Rift Valley fever virus
3. Which of the following descriptions of or statements about
Lassa fever is correct?
(A) It is found in eastern Africa.
(B) Human-to-human transmission does not occur.
(C) It seldom causes death or complications.
(D) It occurs from contact with the house rat Mastomys
natalensis.
(E) There is no drug that is effective in treating Lassa
fever.
4. Arboviruses are transmitted by bloodsucking arthropods from
one vertebrate host to another. Arboviruses are found in the
following virus families except which of the following?
(A) Togaviridae
(B) Flaviviridae
(C) Bunyaviridae
(D) Reoviridae
(E) Arenaviridae
5. A 27-year-old man develops fever, chills, headache, and backache.
Four days later he develops a high fever and jaundice. Yellow
fever is diagnosed. Which of the following statements concerning
yellow fever is correct?
(A) The virus is transmitted by culicine mosquitoes in the
urban form of disease.
(B) Monkeys in the jungle are a major reservoir of yellow fever
virus.
(C) Yellow fever often has long-term complications.
(D) All infections lead to apparent disease.
(E) Ribavirin is specific therapy.
6. Regarding the patient in Question 5, yellow fever occurs in
which region or regions of the world?
(A) Asia
(B) Africa and South America
(C) North America
(D) Africa and Middle East
(E) Throughout the world
7. African hemorrhagic fevers, Marburg and Ebola, are severe
diseases often ending in death. Which of the following is most
accurate about Ebola virus?
(A) Is spread by contact with blood or other body fluids
(B) Is transmitted by mosquitoes
(C) Is a flavivirus
(D) Causes infections but no disease in nonhuman primates
(E) Is antigenically related to Lassa fever virus
8. Which of the following groups can be vaccinated routinely with
yellow fever vaccine without special safety considerations?
(A) Children younger than 9 months old
(B) Pregnant women
(C) Persons with compromised immune systems
(D) All of the above
(E) None of the above
9. Hantaviruses, which are emerging pathogens in the United
States, can be described by which of the following?
(A) They are arenaviruses.
(B) They are readily transmitted human to human.
(C) They cause influenza-like symptoms followed rapidly by
acute respiratory failure.
(D) They are acquired by inhalation of aerosols of deer urine.
(E) They show a high frequency of antigenic variation.
10. A microbiologist was performing a necropsy in a laminar flow
biosafety cabinet on a blue-jay submitted as part of a state’s
arbovirus surveillance program. He lacerated his thumb while
using a scalpel to remove the bird’s brain. Four days later, he
developed a headache, myalgia, and malaise followed by chills,
sweats, and lymph node swelling. Two days later, a rash began
on his face and spread to the trunk, arms, and legs, persisting
for about 3 days. He sought medical care and reported a history
of dengue fever and vaccinations with yellow fever and Japanese
B encephalitis vaccines. A serum sample taken the day of the
injury contained anti-flavivirus immunoglobulin G (IgG) antibody
by enzyme-linked immunosorbent assay. A serum sample
collected 13 days after the onset of illness showed an increased
titer of antiflavivirus IgG antibody and the presence of West Nile
virus IgM antibody. The physician could conclude that the most
likely cause of the microbiologist’s illness was which virus?
(A) Dengue virus
(B) Yellow fever virus
(C) West Nile virus
(D) St. Louis encephalitis
(E) Not identifiable until neutralizing antibody titers from
paired sera could be assessed against a panel of arboviruses
11. Which of the following statements about dengue virus is not true?
(A) It is the most important mosquito-borne viral disease
affecting humans.
(B) It is distributed worldwide in tropical regions.
(C) It can cause a severe hemorrhagic fever.
(D) There is a single antigenic type.
(E) One form of disease is characterized by increased vascular
permeability.
12. Which of the following diseases occurring in the United States
lacks a known vector?
(A) Hantavirus pulmonary syndrome
(B) West Nile fever
(C) La Crosse encephalitis
(D) Colorado tick fever
(E) St. Louis encephalitis
13. Each of the following statements concerning arboviruses is correct
except
(A) The pathogenesis of dengue hemorrhagic shock syndrome
is associated with the heterotypic anamnestic response.
(B) Wild birds are the reservoir for encephalitis viruses but not
for yellow fever virus.
(C) Ticks are the main mode of transmission for both encephalitis
viruses and yellow fever virus.
(D) There is a live, attenuated vaccine that effectively prevents
yellow fever.
14. Which of the following statements about yellow fever is false?
(A) There is no animal reservoir.
(B) The name “yellow” comes from the fact that many victims
have jaundice.
(C) Certain mosquitoes are biological hosts for the causative agent.
(D) Outbreaks of the disease could occur in the United States
because a suitable vector is present.
(E) An attenuated vaccine is widely used to prevent the disease.
15. Which of the following statements about hantaviruses in the
United States is correct?
(A) Are limited in range to southwestern states
(B) Are carried only by deer mice
(C) Infect human beings with a fatality rate that can be above 30%
(D) Were first identified in the early 1970s
(E) Are contracted mainly in bat caves
1. Which of the following statements regarding the prevention
and treatment of influenza is correct?
(A) Booster doses of vaccine are not recommended.
(B) Drugs that inhibit neuraminidase are active only against
influenza A.
(C) As with some other live vaccines, the influenza vaccine
should not be given to pregnant women.
(D) The influenza vaccine contains several serotypes of virus.
(E) The virus strains in the influenza vaccine do not vary from
year to year.
2. Which of the following statements about the neuraminidase of
influenza virus is not correct?
(A) Is embedded in the outer surface of the viral envelope
(B) Forms a spike structure composed of four identical monomers,
each with enzyme activity
(C) Facilitates release of virus particles from infected cells
(D) Lowers the viscosity of the mucous film in the respiratory
tract
(E) Is antigenically similar among all mammalian influenza
viruses
3. Which of the following statements reflects the pathogenesis of
influenza?
(A) The virus enters the host in airborne droplets.
(B) Viremia is common.
(C) The virus frequently establishes persistent infections in the
lung.
(D) Pneumonia is not associated with secondary bacterial
infections.
(E) Viral infection does not kill cells in the respiratory tract.
4. Which of the following symptoms is not typical of influenza?
(A) Fever
(B) Muscular aches
(C) Malaise
(D) Dry cough
(E) Rash
5. The type-specific antigen (A, B, or C) of influenza viruses is
found on which viral constituent?
(A) Hemagglutinin
(B) Neuraminidase
(C) Nucleocapsid
(D) Polymerase complex
(E) Major nonstructural protein
(F) Lipid in the viral envelope
6. A 70-year-old nursing home patient refused the influenza vaccine
and subsequently developed influenza. She died of acute pneumonia
1 week after contracting the flu. The most common cause
of acute postinfluenza pneumonia is which of the following?
(A) Legionella
(B) Staphylococcus aureus
(C) Measles
(D) Cytomegalovirus
(E) Listeria
7. Which of the following statements concerning antigenic drift in
influenza viruses is correct?
(A) It results in major antigenic changes.
(B) It is exhibited only by influenza A viruses.
(C) It is caused by frameshift mutations in viral genes.
(D) It results in new subtypes over time.
(E) It affects predominantly the matrix protein.
8. A 32-year-old male physician developed a “flu-like” syndrome
with fever, sore throat, headache, and myalgia. To provide laboratory
confirmation of influenza, a culture for the virus was
ordered. Which of the following would be the best specimen for
isolating the virus responsible for this infection?
(A) Stool
(B) Nasopharyngeal washing
(C) Vesicle fluid
(D) Blood
(E) Saliva
9. Which of the following statements about isolation of influenza
viruses is correct?
(A) Diagnosis of an influenza virus infection can only be made
by isolating the virus.
(B) Isolation of influenza virus is done using newborn mice.
(C) Isolation of virus can help determine the epidemiology of
the disease.
(D) Primary influenza virus isolates grow readily in cell culture.
10. The principal reservoir for the antigenic shift variants of influenza
virus appears to be which of the following?
(A) Chronic human carriers of the virus
(B) Sewage
(C) Pigs, horses, and fowl
(D) Mosquitoes
(E) Rodents
11. Highly pathogenic H5N1 avian influenza (HPAI) can infect
humans with a high mortality rate, but it has not yet resulted in
a pandemic. The following are characteristics of HPAI, except
for one. Which one is not?
(A) Efficient human-to-human transmission
(B) Presence of avian influenza genes
(C) Efficient infection of domestic poultry
(D) Contains segmented RNA genome
12. Which of the following statements about diagnostic testing for
influenza is true?
(A) Clinical symptoms reliably distinguish influenza from
other respiratory illnesses.
(B) Viral culture is the “gold standard” diagnostic test because
it is the most rapid assay.
(C) Patient antibody responses are highly specific for the strain
of infecting influenza virus.
(D) Reverse transcription polymerase chain reaction is preferred
for its speed, sensitivity, and specificity.
13. The mechanism of “antigenic drift” in influenza viruses includes
all but one of the following
(A) Can involve either hemagglutinin or neuraminidase
antigens
(B) Mutations caused by viral RNA polymerase
(C) Can predominate under selective host population immune Pressures
(D) Reassortment between human and animal or avian
reservoirs
(E) Can involve genes encoding structural or nonstructural
proteins
14. Each of the following statements concerning the prevention and
treatment of influenza is correct except
(A) The inactivated influenza vaccine contains H1N1 virus but
the live, attenuated influenza vaccine contains H3N2 virus.
(B) The vaccine is recommended to be given each year because
the antigenicity of the virus drifts.
(C) Oseltamivir is effective against both influenza A and influenza
B viruses.
(D) The main antigen in the vaccine that induces protective
antibody is the hemagglutinin.
15. Each of the following statements concerning the antigenicity of
influenza A virus is correct except
(A) Antigenic shifts, which represent major changes in antigenicity,
occur infrequently and are caused by the reassortment
of segments of the viral genome.
(B) Antigenic shifts affect both the hemagglutinin and the
neuraminidase.
(C) The worldwide epidemics caused by influenza A virus are
caused by antigenic shifts.
(D) The protein involved in antigenic drift is primarily the
internal ribonucleoprotein.
16. Which of the following infectious agents is most likely to cause
a pandemic?
(A) Influenza A virus
(B) Streptococcus pyogenes
(C) Influenza B virus
(D) Respiratory syncytial virus
(E) Influenza C virus
1. A 4-year-old boy develops an acute febrile illness. His pediatrician
diagnoses mumps. The organ most commonly exhibiting
signs of mumps is the
(A) Lungs
(B) Ovary
(C) Parotid glands
(D) Skin
(E) Testes
2. The paramyxoviruses include the most important causes of
respiratory infections in infants and young children. Which of
the following is not characteristic of paramyxoviruses?
(A) Genome is negative-sense RNA.
(B) Envelope contains a glycoprotein with fusion activity.
(C) Paramyxoviruses do not undergo genetic reassortment.
(D) Replication cycle occurs in cytoplasm of susceptible cells.
(E) Genome is segmented.
3. A 2-month-old infant developed a respiratory illness that the
pediatrician diagnosed as bronchiolitis. The most likely cause
of the disease is
(A) Parainfluenza virus type 4
(B) Respiratory syncytial virus
(C) Influenza virus
(D) Metapneumovirus
(E) Measles virus
4. Several paramyxoviruses can cause pneumonia in infants or
children. For which of the following paramyxoviruses is there
an effective vaccine available that would prevent pneumonia?
(A) Parainfluenza virus type 1
(B) Measles virus
(C) Respiratory syncytial virus
(D) Mumps virus
(E) Metapneumovirus
5. A 27-year-old woman who is 2 months’ pregnant develops fever,
malaise, and arthralgia. A fine maculopapular rash appears on
her face, trunk, and extremities. Rubella is diagnosed, and there
is concern that the fetus will be infected, resulting in the congenital
rubella syndrome. Which of the following statements
about this syndrome is correct?
(A) The disease can be prevented by vaccination of school-age
children with measles vaccine.
(B) Congenital abnormalities occur when a nonimmune pregnant
woman is infected at any time during pregnancy.
(C) Deafness is a common defect associated with congenital
rubella syndrome.
(D) Only rare strains of rubella virus are teratogenic.
(E) None of the above
6. A 5-year-old child develops a low-grade fever, coryza, conjunctivitis,
and Koplik spots. The physician can conclude that
(A) The child has probably not been successfully vaccinated
with the MMR vaccine.
(B) The child’s pregnant mother is at risk of becoming infected
and her unborn child developing congenital abnormalities,
including mental retardation.
(C) A rash will soon develop on the child’s face and will last
only 2–3 days.
(D) Treatment of the child with the antiviral drug ribavirin
should be initiated immediately to minimize the chance of
development of acute encephalitis.
7. Parainfluenza viruses are ubiquitous and cause respiratory illnesses
in people of all ages. However, reinfections with parainfluenza
viruses are common because
(A) Many antigenic types of parainfluenza viruses exist, and
exposure to new strains results in new infections.
(B) Infections in the respiratory tract do not elicit a systemic immune response.
(C) Limited virus replication occurs, which fails to stimulate antibody production.
(D) Secretory immunoglobulin A antibody in the nose is short
lived, disappearing a few months after infection.
8. A 20-month-old boy had an illness characterized by fever,
irritability, conjunctivitis, and a brick-red rash initially on the face
but spreading downward and outward. At age 9 years, the boy had
a gradual onset of severe, generalized neurologic deterioration.
Subacute sclerosing panencephalitis (SSPE) was diagnosed. Which
of the following statements about SSPE is correct?
(A) Defective varicella-zoster virus is present in brain cells.
(B) High titers of measles antibody are found in cerebrospinal fluid.
(C) The incidence of the disease is rising since the introduction of MMR vaccine.
(D) Rapidly progressive deterioration of brain function occurs.
(E) The disease is a rare, late complication of rubella infection.
9. Which of the following paramyxoviruses has an HN surface
glycoprotein lacking hemagglutinin activity?
(A) Measles virus
(B) Mumps virus
(C) Parainfluenza virus type 1
(D) Respiratory syncytial virus
(E) Rubella virus
10. A 3-year-old girl develops an acute respiratory virus infection that
requires hospitalization. Ribavirin therapy is considered. Ribavirin
is approved for treatment of which of the following situations?
(A) Lower respiratory tract disease caused by respiratory syncytial
virus in infants
(B) Congenital rubella syndrome
(C) Aseptic meningitis caused by mumps infection
(D) Pneumonia caused by measles virus in adults
(E) Encephalitis related to Nipah virus
(F) All of the above
11. Reverse transcription polymerase chain reaction (RT-PCR) assays
are useful in diagnosis of paramyxovirus infections. Which of the
following statements about RT-PCR is not accurate?
(A) More sensitive assay than virus isolation
(B) Can identify virus strains
(C) More rapid assay than antigen detection
(D) Can provide data about genetic variation for molecular
epidemiology studies
(E) More specific assay for parainfluenza viruses than serology
12. Each of the following statements concerning measles vaccine is
correct except
(A) The vaccine contains live, attenuated virus.
(B) The vaccine should not be given at the same time as the
mumps vaccine because the immune system cannot
respond to two viral antigens given simultaneously.
(C) Virus in the vaccine contains only one serotype.
(D) The vaccine should not be given before 15 months of age
because maternal antibodies can prevent an immune response.
13. Each of the following statements concerning rubella is correct
except
(A) Congenital abnormalities occur primarily when a pregnant
woman is infected during the first trimester.
(B) Women who say that they have never had rubella can, nevertheless,
have neutralizing antibody in their serum.
(C) In a 6-year-old child, rubella is a mild, self-limited disease
with few complications.
(D) Acyclovir is effective in the treatment of congenital rubella
syndrome.
14. Each of the following statements concerning rubella vaccine is
correct except
(A) The vaccine prevents reinfection, thereby limiting the
spread of virulent virus.
(B) The immunogen in the vaccine is killed rubella virus.
(C) The vaccine induces antibodies that prevent dissemination
of the virus by neutralizing it during the viremic stage.
(D) The incidence of both childhood rubella and congenital
rubella syndrome has decreased significantly since the
advent of the vaccine.
15. Each of the following statements concerning mumps is correct
except
(A) Mumps virus is a paramyxovirus and hence has a singlestranded
RNA genome.
(B) Meningitis is a recognized complication of mumps.
(C) Mumps orchitis in children before puberty often causes
sterility.
(D) During mumps, the virus spreads through the bloodstream
(viremia) to various internal organs.
16. Each of the following statements concerning subacute sclerosing
panencephalitis is correct except
(A) Immunosuppression is a frequent predisposing factor.
(B) Aggregates of helical nucleocapsids are found in infected cells.
(C) High titers of measles antibody are found in cerebrospinal
fluid.
(D) Slowly progressive deterioration of brain function occurs.
17. Which one of the following is the best evidence on which to base
a decisive diagnosis of acute mumps disease?
(A) A positive skin test result
(B) A fourfold rise in antibody titer to mumps antigen
(C) A history of exposure to a child with mumps
(D) Orchitis in young adult man
18. Which one of the following statements concerning mumps is
correct?
(A) Although the salivary glands are the most obvious sites of
infection, the testes, ovaries, and pancreas can be involved
as well.
(B) Because there is no vaccine against mumps, passive immunization
is the only means of preventing the disease.
(C) The diagnosis of mumps is made on clinical grounds
because the virus cannot be grown in cell culture and serologic
tests are inaccurate.
(D) Second episodes of mumps can occur because there are
two serotypes of the virus, and protection is type specific.
19. Which of the following statements is more likely to be true of
measles (rubeola) than German measles (rubella)?
(A) Koplik spots are present.
(B) It causes birth defects.
(C) It causes only a mild illness.
(D) Human beings are the only natural host.
(E) Attenuated virus vaccine is available for prevention.