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Multiple Choice Questions - Paper 1

Instructions for candidates

The examination consists of 30 multiple choice questions, each divided into 5
different parts. Each part contains a statement which could be true or false. Each
question will have at least one part which is true. For each part, you should indicate
whether you think it is true (T), false (F), or dont know (DN). You must fill in the
relevant square with a black pen. One mark will be given for each correct answer and
one mark deducted for each incorrect answer. You will not be marked for those
questions for which you have indicated "dont know".

1. Viruses
Contain both DNA and RNA
May have an envelope
Have their own metabolism
May contain enzymes for replication
Cell wall

2. The following are DNA viruses

Herpesviruses
Orthomyxoviruses
Enteroviruses
Hepadnaviruses
Parvoviruses

3. The following are RNA viruses

Picornaviruses
Adenoviruses

Papillomaviruses
Rhabdoviruses
Rotaviruses

4. Live attenuated vaccines are available against the following viruses

Influenza A Virus
Hepatitis B Virus
Rubella Virus
Yellow Fever Virus
Varicella-Zoster Virus

5. The following antiviral agents is active against the following virus

Lamivudine and HIV
Lamivudine and HBV
Amantidine and Influenza B virus
Ribavirin and RSV
Acyclovir and HSV

6. Herpes Simplex Encephalitis

Commonly affect the temporal lobe
Is usually diagnosed by culture of the CSF
May be diagnosed by PCR of the CSF

Should be treated with IV ganciclovir

May be diagnosed by the finding of specific antibody in the CSF

7. The following statements are true of Varicella-Zoster Virus

Causes a maculopapular rash

Respond to AZT therapy
Remains latent in sensory ganglia following primary infection
Recurrent episodes of Shingles usually occur
Patients with shingles are not infectious

8. Cytomegalovirus (CMV)
Primary infection is usually symptomatic
An infectious mononucleosis-like syndrome may occur during primary infection.
May cause severe infection in immunocompromised individuals
Is teratogenic
Causes Kawasaki's Disease

9. Epstein-Barr Virus (EBV) is associated with

Infectious Mononucleosis
Hepatitis
Burkitt's lymphoma
Nasopharyngeal carcinoma
Oral leukoplakia

10. HHV-6 is associated with

Fifth disease
Roseala Infantum
Kaposi's Sarcoma
Infectious Mononucleosis-like illness
Oral leukoplakia

11. Adenoviruses
Are associated with genital cancers
May cause gastroenteritis
May cause conjunctivitis
May cause pneumonia
May cause warts

12. Papillomaviruses
HPV-6 and HPV-11 are associated with genital cancers
HPV-16 and HPV-18 are associated with genital cancers
Warts caused by papillomaviruses may respond to interferon therapy
Papillomavirus infection is commonly diagnosed by viral culture
Are associated with progressive multifocal leucoencephalopathy (PML)

13. Coxsackie B Virus is associated with the following

Paralytic illness
Myocarditis

Bornholm's disease
Severe congenital infection
Meningitis

14. Influenza A Virus

May undergo antigenic shift and antigenic drift
May cause pandemics
Respond to rimantidine
Respond to neuraminidase inhibitors
Vaccination confers lifelong protection

15. Paramyxoviruses may cause

Croup
Maculopapular rash
Pneumonia
Bronchiolitis
Diarrhoea

16. Respiratory Syncytial Virus (RSV)

Respond to Amantidine
May cause bronchiolitis
May cause croup
May cause pneumonia

May be prevented by vaccination

17. Parvoviruses
Causes Roseola Infantum
Causes Erythema Infectiousum
Is teratogenic
May cause abortion
May cause aplastic crisis in persons with haemolytic anaemias

18. Measles Virus Infection

Causes a vesicular rash
May cause encephalitis
May respond to acyclovir
May be prevented by HNIG
May be prevented by vaccination

19. Rubella Virus

The rash of rubella is similar to that caused by parvo and enteroviruses
Is teratogenic
Congenital rubella is charaterised by eye, ear and heart defects
Congenital rubella is diagnosed by the finding of rubella-specific antibody in the cord blood of infants
Infants with congenital rubella poses a great infectious risk.

20. Human T-lymphotropic virus 1 (HTLV-1) is associated with

Burkitt's lymphoma
Adult T-cell lymphoma

Tropical Spastic Paraparesis

Multiple Sclerosis
Hodgkin's lymphoma

21. HIV Infection may lead to

Dementia
Chronic Diarrhoea
CMV retinitis
Oesophageal candidiasis
Non-Hodgkin's lymphoma

22. The following may be useful for prognostic purposes in HIV-infected individuals
HIV envelope antibody
HIV-p24 antigen
CD4 count
HIV pro-viral DNA in leucocytes
HIV plasma RNA

23. A chronic carrier state may occur in the following:

Hantavirus Infection
Hepatitis A
Hepatitis B
Hepatitis C

Smallpox Infection

24. The following markers are usually present in a hepatitis B carrier with chronic active hepati
HbeAg
Anti-HBc IgG
Anti-HBc IgM
HBV-DNA
HbsAg

25. The following statements are true

Chronic HBV infection may respond to interferon therapy
Chronic HCV infection may respond to interferon therapy
Chronic HCV infection may respond to ribavirin therapy
Hepatitis Delta infection may be prevented by vaccination against HBV
Hepatitis E Infection may be prevented by vaccination

26. The following viruses can be transmitted by blood

Hepatitis A
HIV
HTLV-1
HBV
HCV

27. Regarding viral infection of the central nervous system (CNS)

Meningitis may occur together with encephalitis

Enteroviruses are one of the commonest causes of CNS infections in childhood
HSV encephalitis is a postinfectious encephalomyelitis
Measles encephalitis is a postinfectious encephalomyelitis
The detection of antibody in the CSF is a useful diagnostic marker

28. The following viruses are associated with gastroenteritis

Astroviruses
Norwalk-like viruses
Caliviruses
Adenoviruses
Rotaviruses

29. The following viruses are transmitted from animals to humans

Rabies Virus
Polioviruses
CMV
Hantaviruses
Lassa Fever Virus

30. The following is true of rabies virus

The majority of cases worldwide result from bat bites
Infection may be prevented by active and passive immunisation
Rabies vaccine is a live attenuated vaccine
The animal reservoir differ from country to country
May be diagnosed by serology

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Answers to Mulitple Choice Questions - Paper 1

1. Viruses
Contain both DNA and RNA
May have an envelope

nts

nts

nts

11

Have their own metabolism

May contain enzymes for replication
Cell wall

Viruses contain either DNA or RNA but not both. Some may have an envelope. Unlike bacteria, they do not have a cell w
their own metabolism. They may contain enzymes for replication.

2. The following are DNA viruses

Herpesviruses
Orthomyxoviruses
Enteroviruses
Hepadnaviruses
Parvoviruses

Herpesvirus and Hepadnaviruses are double stranded DNA viruses. Parvovirus is a single stranded DNA virus. Orthomyx
and enteroviruses are singles stranded RNA viruses.

3. The following are RNA viruses

Picornaviruses
Adenoviruses
Papillomaviruses
Rhabdoviruses
Rotaviruses

Adenoviruses and papillomaviruses are double standed DNA viruses. Picornaviruses and rhabdoviruses are single stranded
viruses. Rotaviruses are double stranded RNA viruses.

4. Live attenuated vaccines are available against the following viruses

Influenza A Virus
Hepatitis B Virus

nts

ts

12

Rubella Virus
Yellow Fever Virus
Varicella-Zoster Virus

Live attenuated vaccines are available against rubella, yellow fever, and varicella-zoster viruses. Influenza A viral vaccine
either inactivated split or subunit vaccines. The vaccines in current use against hepatitis B are recombinant subunit vaccine

5. The following antiviral agents is active against the following virus

Lamivudine and HIV
Lamivudine and HBV
Amantidine and influenza B virus
Ribavirin and RSV
Acyclovir and HSV

Lamivudine is a reverse transcriptase inhibitor active against both HIV and HBV. Amantidine is active against influenza A
Ribavirin is active against RSV and acyclovir against HSV

6. Herpes Simplex Encephalitis

True

Commonly affect the temporal lobe

False

Is usually diagnosed by culture of the CSF

True

May be diagnosed by PCR of the CSF

False

Should be treated with IV ganciclovir

True

May be diagnosed by the finding of specific antibody in the CSF

Comments

Herpes Simplex Encephalitis commonly affect the temporal lobe. Culture of the CSF is usually un
is a much better choice. A diagnosis can also be made by the detection of HSV-specific antibodies
Encephalitis should be treated with IV acyclovir.

7. The following statements are true of Varicella-Zoster Virus

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False

Causes a maculopapular rash

False

Respond to AZT therapy

True

Remains latent in sensory ganglia following primary infection

False

Recurrent episodes of Shingles usually occur

False

Patients with shingles are not infectious

Comments

VZV causes a vesicular rash. It does not respond to AZT as it does not possess reverse transcripta
sensory ganglia following primary infection. It is rare for more than one episode of shingles to occ
infectious.

8. Cytomegalovirus (CMV)
True

Primary infection is usually symptomatic

True

An infectious mononucleosis-like syndrome may occur during primary infection.

True

May cause severe infection in immunocompromised individuals

False

Is teratogenic

False

Causes Kawasaki's Disease

Comments

Primary CMV infection is usually asymptomatic. Occasionally, an infectious mononucleosis-like

primary infection. CMV is well known to cause severe disease in immunocompromised individual
recipients and patients with AIDS. Although it may cause severe congenital infection, it is not tera
formed fetal organs. It is not associated with Kawaski's disease.

9. Epstein-Barr Virus (EBV) is associated with

True

Infectious Mononucleosis

True

Hepatitis

True

Burkitt's lymphoma

True

Nasopharyngeal carcinoma

True

Oral leukoplakia

Comments

All the above

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10. HHV-6 is associated with

False

Fifth disease (erythema infectiosum)

True

Roseala Infantum

False

Kaposi's Sarcoma

True

Infectious Mononucleosis-like illness

False

Oral leukoplakia

Comments

Parvovirus is associated with Fifth disease (erythema infectiosum). HHV-6 is associated with Sixth
HHV-8 is associated with Kaposi's sarcoma. Rarely, in adults, primary HHV-6 infection may resul
mononucleosis-like illness. EBV is associated with oral leukoplakia

11. Adenoviruses
False

Are associated with genital cancers

True

May cause gastroenteritis

True

May cause conjunctivitis

True

May cause pneumonia

False

May cause warts

Comments

Human papillomaviruses are associated with genital cancers. Adenoviruses type 40 and 41 are ass
Adenoviruses may also cause conjunctivitis and pneumonia. Human papillomaviruses are associat

12. Human Papillomaviruses

False

HPV-6 and HPV-11 are associated with genital cancers

True

HPV-16 and HPV-18 are associated with genital cancers

True

Warts caused by papillomaviruses may respond to interferon therapy

False

Papillomavirus infection is commonly diagnosed by viral culture

False

Are associated with progressive multifocal leucoencephalopathy (PML)

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Comments

HPV-16 and HPV-18 are associated with genital cancers. Warts caused by papillomaviruses may r
although it is rarely used. Huamn Papillomaviruses cannot be grown in cell culture. Polyomavirus

13. Coxsackie B Virus is associated with the following

True

Paralytic illness

True

Myocarditis

True

Bornholm's disease

True

Severe congenital infection

True

Meningitis

Comments

All the above

14. Influenza A Virus

True

May undergo antigenic shift and antigenic drift

True

May cause pandemics

True

Respond to rimantidine

True

Respond to neuraminidase inhibitors

False

Vaccination confers lifelong protection

Comments

Influenza A Virus may undergo antigenic shift and antigenic drift. Antigenic shifts result in pandem
respond to rimantidine, which is a similar compound to amantidine. It will also respond to newly a
inhibitors. Because of constant antigenic changes, vaccination will not confer lifelong immunity; i

15. Paramyxoviruses may cause

True

Croup

False

Maculopapular rash

True

Pneumonia

True

Bronchiolitis

False

Diarrhoea

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Comments

Paramyxoviruses most commonly cause croup. They may occasionally cause bronchiolitis and pn

16. Respiratory Syncytial Virus (RSV)

False

Respond to Amantidine

True

May cause bronchiolitis

True

May cause croup

True

May cause pneumonia

False

May be prevented by vaccination

Comments

RSV will not respond to amantidine. It most commonly cause bronchiolitis and pneumonia. Occas
There is no vaccine available.

17. Parvoviruses
False

Causes Roseola Infantum

True

Causes Erythema Infectiousum

False

Is teratogenic

True

May cause abortion

True

May cause aplastic crisis in persons with haemolytic anaemias

Comments

Parvovirus causes erythema infectiousum. Although it may cause abortion and stillbirths, it is not t
aplastic crisis in persons with haemolytic anaemias

18. Measles Virus Infection

False

Causes a vesicular rash

True

May cause encephalitis

False

May respond to acyclovir

True

May be prevented by HNIG

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True

May be prevented by vaccination

Comments

Measles causes a maculopapular rash. It may cause encephalitis. It does not respond to acyclovir.
be protected by HNIG. A live attenuated vaccine is now given as part of universal vaccination in m

19. Rubella Virus

True

The rash of rubella is similar to that caused by parvo and enteroviruses

True

Is teratogenic

True

Congenital rubella is charaterised by eye, ear and heart defects

True

Congenital rubella is diagnosed by the finding of rubella-specific antibody in the cord blood of inf

True

Infants with congenital rubella poses a great infectious risk.

Comments

The rash of rubella is similar to that caused by parvo and enteroviruses. It is teratogenic, the classi
rubella consists of eye, ear and heart defects. Congenital rubella can be diagnosed by the finding o
the cord blood of infants.Infants with congenital rubella poses a great infectious risk since they ma
1 year.

20. Human T-lymphotropic virus 1 (HTLV-1) is associated with

False

Burkitt's lymphoma

True

Adult T-cell lymphoma

True

Tropical Spastic Paraparesis

False

Multiple Sclerosis

False

Hodgkin's lymphoma

Comments

Human T-lymphotropic virus 1 (HTLV-1) is associated with Adult T-cell lymphoma and Tropical

21. HIV Infection may lead to

True

Dementia

True

Chronic Diarrhoea

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True

CMV retinitis

True

Oesophageal candidiasis

True

Non-Hodgkin's lymphoma

Comments

All the above

22. The following may be useful for prognostic purposes in HIV-infected individua
False

HIV envelope antibody level

True

HIV-p24 antigen

True

CD4 count

False

HIV pro-viral DNA in leucocytes

True

HIV plasma RNA

Comments

HIV envelope antibody remains high at a constant level throughout the period of infection and is t
marker. HIV-p24 antigen had been widely used as a prognostic marker in the past but has now bee
RNA (viral load). The CD4 count provides important information on the stage of the disease.

23. A chronic carrier state may occur in the following:

False

Hantavirus Infection

False

Hepatitis A

True

Hepatitis B

True

Hepatitis C

False

Smallpox Infection

Comments

A chronic carrier state may occur with HBV and HCV infection.

24. The following markers are usually present in a hepatitis B carrier with chronic
True

HbeAg

True

Anti-HBc IgG

False

Anti-HBc IgM

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True

HBV-DNA

True

HbsAg

Comments

In patients with chronic active hepatitis, HBV replication is present and hence HBV-DNA and Hbe
HbcIgM is normally absent although it may occasionally be detected during periods of exacerbatio

25. The following statements are true

True

Chronic HBV infection may respond to interferon therapy

True

Chronic HCV infection may respond to interferon therapy

True

Chronic HCV infection may respond to ribavirin therapy

True

Hepatitis Delta infection may be prevented by vaccination against HBV

False

Hepatitis E Infection may be prevented by vaccination

Comments

Chronic HBV and HCV infection may respond to interferon therapy. Chronic HCV infection may
however ribavirin is usually given with interferon. Hepatitis Delta infection may be prevented by v
There is no vaccine available against HEV.

26. The following viruses can be transmitted by blood

True

Hepatitis A

True

HIV

True

HTLV-1

True

HBV

True

HCV

Comments

All the above viruses may be transmitted by blood

27. Regarding viral infection of the central nervous system (CNS)

True

Meningitis may occur together with encephalitis

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True

Enteroviruses are one of the commonest causes of CNS infections in childhood

False

HSV encephalitis is a postinfectious encephalomyelitis

True

Measles encephalitis is a postinfectious encephalomyelitis

True

The detection of antibody in the CSF is a useful diagnostic marker

Comments

Meningitis usually occurs with encephalitis. Enteroviruses are one of the commonest causes of CN
HSV encephalitis result from invasion of the virus rather than an allergic postinfectious event as in
detection of antibody in the CSF is a useful diagnostic marker

28. The following viruses are associated with gastroenteritis

True

Astroviruses

True

Norwalk-like viruses

False

Picornviruses

True

Adenoviruses

True

Rotaviruses

Comments

Although enteroviruses may be found in faeces, they are not associated with gastroenteritis

29. The following viruses are transmitted from animals to humans

True

Rabies Virus

False

Polioviruses

False

CMV

True

Hantaviruses

True

Lassa Fever Virus

Comments

Rabies may be transmitted to humans from a variety of mammals. Hantaviruses and Lassa Fever V
humans by rodents.

30. The following is true of rabies virus

False

The majority of cases world-wide result from bat bites

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True

Infection may be prevented by active and passive immunisation

False

Human Rabies vaccine is a live attenuated vaccine

True

The animal reservoir differ from country to country

True

May be diagnosed by serology

Comments

The majority of human rabies cases world-wide result from dog bites. Infection may be prevented
immunisation. Although live attenuated vaccines are available for vaccinating animals, inactivated
for safety reasons. May be diagnosed by serology.