1. Treatment of choice for late cardiovascular syphilis is?
- Benzathine penicillin 7.2 million units in three divided doses for three weeks
- Benzathine penicillin 2.4 million units single dose
- Benzylpenicillin 12-24 million units for 21 days
- Tetracycline 2 g daily
Answer. (1) (Benzathine penicillin 7.2 million units in three divided doses)
- Treatment of choice for late cardiovascular syphilis
- CSF normal or not examined: Penicillin G benzathine (2.4 mU IM weekly for 3 weeks)
- CSF abnormal: Treat as neurosyphilis i.Aqueous crystalline penicillin G (18–24 mU/d IV) for 10–14 days
Read And Learn More: Micro Biology And Immunology Multiple Choice Question And Answers
2. Which of the following diseases are caused by Spirochetes?
- Syphilis
- Yaws
- Pinta
- Legionnaires disease
- Lyme disease
Answer. (1, 2, 3, 5) (Syphilis, Yaws, Pinta, Lymedisease)
- Spirochetes include Treponema, Borrelia and Leptospira.
- Agent of Syphilis- Treponema pallidum
- Agent of Yaws- Treponema pertenue
- Agent of Pinta- Treponema carateum
- Agent of Lyme disease- Borrelia burgdorferi
- Agent of Legionnaires disease- Legionella pneumophila (it is not a spirochete).
3. Which is true about Syphilis?
- VDRL test detects antibodies
- Jarisch-Herxheimer—IgE mediated
- In Primary and secondary syphilis, treatment preferred is penicillin
- RPR is done for CSF
- T.pallidum can be easily cultivated in artificial culture medi
Answer. (1, 2, 3) (VDRL test detects antibodies, Jarisch-Herxheimer – IgE mediated, In
- Primary and secondary syphilis treatment preferred is penicillin)
- VDRL is a non-treponemal test, detects antibody against cardiolipin antigen.
- Jarisch–Herxheimer reaction is a IgE-mediated reaction to the products released by the death of T.pallidum during antibiotic (penicillin) treatment in syphilis.
- Penicillin is the DOC for all stages of syphilis.
- VDRL test can be done on CSF not RPR.
- T.pallidum cannot be cultivated in artificial culture media.
4. A patient is presented with rashes, mucosal patches and condyloma lata at mucocutaneous junction. What screening test you would like to perform?
- VDRL
- TPI
- TPA
Answer. (1) (VDRL)
Most widely used screening test in patients with history of secondary syphilis- VDRL or RPR.
5. Centripetal rash is seen in all except:
- Measles
- Typhoid
- Epidemic typhus
- Secondary syphilis
Answer. (4) (Secondary syphilis)
6. Which stage of syphilis is known as great imitator?
- Primary syphilis
- Secondary syphilis
- Tertiary syphilis
Answer. (3) (Tertiary syphilis )
Syphilis was referred to as “the great imitator” by Sir William Osler due to its varied presentations (Gummas, neurological and cardiac) seen in its tertiary stage.
7. T.pallidum can be grown in:
- Mice
- Armadillo
- Rodent
- Cannot be grown
Answer. (4) (Cannot be grown)
8. Non-treponemal test includes:
- RPR
- VDRL
- FTA-ABS
- TPHA
- TPI
Answer: (1, 2) (RPR, VDRL)
9. Which of the following is/are NOT spirochete(s)?
- Borrelia
- Fusobacterium
- Lactobacillus
- Leptospira
- Leptotrichia
Answer. (2, 3,5) (Fusobacterium, Lactobacillus, Leptotrichia)
- Spirochetes include Treponema, Borrelia and Leptospira
- Feature Syphilis Herpes Chancroid LGV Donovanosis
- Incubation period 9–90 days 2–7 days 1–14 days 3 days–6 weeks 1–4 weeks (up to 6 months)
Biological false positive (BPF) is defined as positive reaction obtained in nontreponemal test with negative treponemal test in absence of past or present treponemal infection.
10. A 25-year-old man with painless ulcer on penis. He has h/o contact with commercials sex worker. Dark ground microscopy of the discharge from the lesion has be shown in the picturIdentify the disease.
- Chancre
- Chancroid
- Herpes
- Granuloma inguinale
Answer. (1) (Chancre)
Clue for diagnosis:
- Painless ulcer on penis, h/o contact with commercial sex worker, Dark ground microscopy showing spirally coiled bacilli……… Suggestive of Treponema pallidum
11. Syphilis was first identified by:
- Fraenkel
- Nicolaicu
- Schaudinn & Hoffman
- Ogston
Answer. (3) (Schaudinn & Hoffman)
- Schaudinn and Hoffman were the first to identify Treponema pallidum.
12. In a syphilis patient, site which does not help in isolation of organism:
- Gumma
- Primary chancre
- Mucosal patch
- Maculopapular rash
13. Stain for treponema:
- Fontana’s
- Acid-fast
- Methenamine-silver
- PAS
Answer. (1) (Fontana’s)
- Sliver impregnation stains like Fontana and Levaditi stains are used for T.pallidum.
14. In a pregnant lady of 8 weeks, allergic to penicillin, VDRL was done which found to be positive drug of choice for treatment is:
- Erythromycin
- Penicillin
- Tetracycline
- Desensitization
Answer. (4) (Desensitization)
- DOC of syphilis in pregnancy: Penicillin
- DOC of syphilis in pregnancy allergic to Penicillin: Desensitization followed by penicillin
15. False +ve VDRL test is/are seen in:
- Leprosy
- Malaria
- Relapsing fever
- IV drug user
- HIV infection
Answer. (1, 2, 3, 4, 5) (Leprosy, Malaria, Relapsing fever, IV drug user, HIV infection)
16. Correct combination of incubation period is:
- Syphilis: 9–90 days
- Herpes genitalis: 4–5 week
- LGV: 3 d –6 week
- Donovanosis: 1–4 week
- Chancroid: 2–3 week
Answer. (1, 3, 4) (Syphilis: 9 90 days, LGV : 3 d 6 week, Donovanosis: 14 week)
17. A newborn premature baby presented with bullous lesions on skin and a shin on knee.
- X-ray shows periostitis. Best investigation for diagnosis is:
- VDRL from mother and baby
- PCR for tuberculosis
- HBsAg detection
- ELISA for HIV
Answer. (1) (VDRL from mother and baby)
Clinical clue: Newborn with bullous lesions on skin and a shin on knee with periostits on X-ray is pointing towards congenital syphilis.
- Among the options: Only option a is lab method used for of syphilis. (Other option can easily be ruled out).
- However, even ‘VDRL from mother and baby’ is not a satisfactory answer. Because: VDRL detects IgG antibodies, hence cannot differentiate between congenital syphilis and maternal transfer.
- However, there are certain guideline to for screening of congenital syphilis based on VDRL test.
18. In India, syndromic management is applicable for:
- Chancroid and chancre
- Chancroid and herpes genitalis
- Chancroid, chancre, herpes genitalis
- Chancre and herpes genitalis
Answer. (3) (Chancroid, chancre, herpes genitalis)
Immediate syndrome-based treatment is recommended for the usual causes of acute genital ulcerations like syphilis, chancroid and herpes.
19. VDRL is most sensitive in the diagnosis of which stage of syphilis?
- Primary
- Secondary
- Tertiary
- Reactivation
Answer. (2) (Secondary)
VDRL is 100% sensitive in Secondary syphilis.
20. A 25-year-old laborer 3 years back presented with penile ulcer not treateLater he presented with neurological symptoms for which he got treateTest to monitor response to treatment is:
- VDRL
- FTA-ABS
- TPI
- RPR
Answer. (1) (VDRL)
- History of ‘present neurological symptoms with penile ulcer 3 years back’ is suggestive of tertiary Syphilis.
- Test to monitor response to treatment for Syphilis VDRL followed by RPR.
21. True about primary chancre:
- Painless ulcer
- Painless lymphadenopathy
- Covered with exudates
- Indurated lesion
- Organism can be cultured from exudative fluid
Answer. (1, 2, 3, 4) (Painless ulcer, Painless lymphadenopathy, Covered with exudates, Indurated lesion)
22. A VDRL-reactive mother gave birth to an infant. All of the following would help in determining the risk of transmission to the infant except:
- TPHA test on the serum sample of the mother
- TPHA test on the serum sample of the infant
- VDRL on the paired serum sample of the infant and mother
- Time interval between the treatment of the mother and her delivery
Answer. (1) (TPHA test on the serum sample of the mother)
- TPHA test on the serum sample of the mother:
- Indicates mother has syphilis. But it doesn’t say about the congenital syphilis. Moreover,
- TPHA remains elevated even after treatment. So, an adequately treated mother before 4th month of gestation has a very less risk of transmission but can still have an elevated TPHA.
About Other Options:
- Since all the nontreponemal tests like VDRL mainly detects IgG, so they cannot be used to detect congenital syphilis as maternally transferred IgG will be there till 12-18 months of birth.
- However, VDRL is used for screening in India, and the interpretation should be done as follows…
- Simultaneous VDRL test of mother and baby:
- If mother’s titer > baby’s titer → Indicates maternal transfer
- If baby’s titer > mother’s titer → Indicates congenital infection
- TPHA test on the serum sample of the infant—suggestive of established congenital syphilis
- Adequate treatment of the mother before the 16th week of pregnancy should prevent fetal damage.
23. A 23-year-old guy with painless penile ulcer and painless lymphadenopathy. What is the diagnosis?
- Chancroid
- Donovanosis
- Syphilis
- Herpes
Answer. (3) (Syphilis)
24. A 23-year-old male had unprotected sexual intercourse with a commercial sex worker. Two weeks later, he developed a painless, indurated ulcer on the glans that exuded clear serum on pressurInguinal lymph nodes in both groins were enlarged and not tender. The most appropriate diagnostic test is:
- Gram’s stain of ulcer discharge
- Darkfield microscopy of ulcer discharge
- Giemsa stain of lymph node aspirate
- ELISA for HIV infection
Answer. (2) (Darkfield microscopy of ulcer discharge)
- History of unprotected sexual intercourse with a commercial sex worker followed by:
- Painless, indurated ulcer on the glans
- Enlarged and not tender Inguinal lymph nodes
- Suggestive of primary Syphilis.
- Diagnosis of primary Syphilis can be done by Dark field microscopy of ulcer discharge.
25. Hutchinson’s triad a feature of:
- Primary Syphilis
- Secondary Syphilis
- Tertiary Syphilis
- Late Congenital Syphilis
Answer. (4) (Late Congenital Syphilis)
Hutchinson’s triad, which consists of Hutchinson’s teeth (notched incisors), keratitis and deafness and occurs in 63% of cases of late congenital syphilis.
26. Yaws is caused by:
T. pertunae
T. pallidum
T. caraetum
Hemophilus
Answer. (1) (T. pertunae)
27. Bejel is caused by:
- Trepnema pertenue
- Treponema caratenum
- Treponema pallidum
- Treponema endemicum
Answer. (4) (T. endemicum)
- Bejel or endemic syphilis is caused by Treponema endemicum
28. Causative agent of Yaws is:
- Trepnema pertenue
- Treponema caratenum
- Treponema pallidum
- Treponema endemicum
Answer. (1) (T. pertenue)
- Trepnema pertenue is the causative agent of yaws.
29. Nonvenereal treponemes are:
- T. pertenue
- T. Carateum
- T. pallidum
- T. cuniculi
Answer. (1, 2) (T. Pertenue, T. Carateum)
- T.cuniculi is pathogenic to rabbit but mostly nonpathogenic to human.
30. True about Yaws:
- Sexually transmitted disease
- Transmitted by fomites
- Mother-child transmission
- Periostitis occurs
- Caused by T. pallidum subspecies endemicum
Answer. (2, 4) (Transmitted by fomites, Periostitis occurs)
Yaws is caused by T.pertenue, transmitted by nonsexual mode such as direct or indirect contact through fomites/files feeding on to lesions.
31. Infective organism causing AV block:
- Treponema pallidum
- Borrelia burgdorferi
- Cryptococcus
- Listeria monocytogenes
Answer. (2) (Borrelia burgdorferi)
In Borrelia burgdorferi infection (Lyme disease), Cardiac involvement occurs in 8% of cases, including atrioventricular block.
32. Infecting organism causing AV block is transmitted by:
- Ixodid tick
- Aedes aegypti
- Phlebotomus argentipes
- Tunga penetrans
33. True about recurrentis:
- Causes leptospirosis
- Waterborne disease
- Transmitted by louse
- Transmitted by flea
Answer. (3) (Transmitted by louse)
Epidemic relapsing fever is transmitted by louse, endemic relapsing fever is transmitted by tick.
34. Which of the following is associated with Borrelia burgdorferi?
- Relapsing fever
- Lyme disease
- Vincent’s angina
- Transmitted by ixodid tick bite
- Culture in BSK medium
Answer. (2, 4, 5) (Lyme.., Transmitted by ixodid …..,BSK..)
- Borrelia burgdorferi causes Lyme disease, transmitted by tick and ideal culture medium is BSK medium (Barbour-Stoenner-Kelly)
- Relapsing fever is caused by Borrelia recurrentis
- Vincent’s angina is caused by Borrelia vincenti
35. Lyme’s disease is caused by:
- Borrelia parkeri
- Borellia burgdorferi
- Borrelia recurrentis
- Borrelia hermsii
Answer. (2) (burgdorferi)
Lyme’s disease is caused by Borellia burgdorferi
36. Which one of the following microorganisms uses antigenic variation as a major means of evading host?
- Streptococcus pneumoniae
- Borrelia recurrentis
- Mycobacterium tuberculosis
- Listeria monocytogenes
Answer. (2) (recurrentis)
- Borrelia recurrentis shows antigenic variation due to DNA rearrangement in the linear plasmid of Borrelia.
- This explains the reason for relapse of fever in relapsing fever.
37. Which bacterium best exemplifies the information provided in the image?
- Helicobacter pylori
- Mycobacterium tuberculosis
- Leptospira icterohaemmorrhagiae
- Vibrio cholerae
Answer. (3) (Leptospira icterohaemmorrhagiae)
- Spirochete such as Treponema, Borrelia and Leptospira are motile with typical endoflagella.
38. What Treponema is seen in the silver impregnation micrograph below:
- Borrelia burgdorferi
- Leptospira interrogans
- Treponema pallidum
- Ehrlichia chaffeensis
Answer. (2) (Leptospira interrogans)
- Spirally coiled bacilli with hooked ends and more no. of spirals (tightly coiled spirals)-suggestive of Leptospira.
39. A, patient was suffering from hepatorenal syndrome urinsample was obtained from the patient and was examined under the microscopWhich of the following technique is being used to make the organism visible?
- Darkfield microscopy
- Routine microscopy with negatively stained background
- Phase contrast microscopy
- Compound light microscopy
Answer. (1) (Dark field microscopy)
- Spirally coiled bacilli with hooked end is suggestive of Leptospira, which is demonstrated by performing dark field microscopy.
40. Selective culture medium to grow Leptospira:
- Thayer Martin medium
- Mc Conkey agar
- TCBS medium
- EMJH
Answer. (4) (EMJH)
41. Weil’s disease is caused by:
- Leptospira
- Plague
- Yersinia
- Rickettsial Fever
Answer. (1) (Leptospira)
- Weil’s disease is caused by- Leptospira
42. A sewer worker comes with high grade fever, neck rigidity and signs of meningismus.
Lab findings suggestive of renal failure and elevated liver enzymes. Most appropriate drug:
- Benzylpenicillin
- Ciprofloxacin
- Doxycycline
- Cotrimoxazole
Answer. (1) (Benzylpenicillin)
- The history is suggestive of Weil’s disease
Points in favor:
- Sewer worker
- High-grade fever, neck rigidity, and signs of meningismus.
- Lab findings suggestive of renal failure and elevated liver enzymes.
- DOC for Weil’s disease – IV Penicillin
43. Which one of these is true regarding Leptospirosis?
- Rat is the principal animal reservoir
- Transmission is orofecal
- Renal and hepatic involvement is seen in half of the affected children
- Fluoroquinolones are the drugs of choice
Answer. (1) (Rat is the principal animal reservoir)
- Transmission is contact with animal
- Renal and hepatic involvement is seen in 10% of the affected cases
- Penicillin: DOC in severe cases, doxycycline is DOC in milder cases.
44. Which of the following is not used to diagnose Leptospirosis?
- Microscopic agglutination test
- Darkfield microscopy
- Macroscopic agglutination test
- Weil-Felix reaction
Answer. (4) (Weil-Felix reaction)
- Weil-Felix test is used for the diagnosis of rickettsiosis.
45. Culture media of Leptospira:
- Korthoff
- Perkin
- Tinsdale
- Baker’s
Answer. (1) (Korthoff)
Culture media for Leptospira- EMJH (Ellinghausen-McCullough-Johnson-Harris), Korthoff and Fletcher media
46. Which human infection spreads through urine?
- Leptospira
- Legionella
- Plague
- Diphtheria
Answer. (1) (Leptospira)
- Transmission of leptospira to humans may follow direct contact with urine, blood, or tissue from an infected animal or exposure to a contaminated environment;
- Human-to-human transmission is rare.
- Legionella antigen detection test is done in urine sample but it spreads through inhalational route
47. A bacterial disease that has been associated with the 3 “R” i.e rats, rice fields, and rainfall is:
- Leptospirosis
- More common in tropics
- Plague
- Melioidosis
- Rodent bite fever
Answer. (1) (Leptospirosis)
Leptospirosis
More common in tropics
- During the summer (Western) and during the rainy season in the tropics
- Rodents, especially rats, are the most important reservoir
- High-risk occupational exposures include: Veterinarians, agricultural workers, sewage workers, slaughterhouse employees, and workers in the fishing industry
48. A 25-year-old farmer presented with history of high-grade fever for 7 days and altered sensorium for 2 days. On examination, he was comatosed and had conjunctival hemorrhagUrgent investigations showed hemoglobin of 11 gm/dl, serum bilirubin 8 mg/dl and urea 78 mg/dl. Peripheral blood smear was negative for malarial parasitWhat is the most likely diagnosis?
- Brucellosis
- Weil’s disease
- Acute viral hepatitis
- Q-fever
Answer. (2) (Weil’s disease)
- Farmer with high-grade fever, altered sensorium and conjunctival hemorrhage with hepatic (raised bilirubin) and renal (raised creatinine) involvement is suggestive of Leptospirosis with hepatorenal syndrome (Weil’s disease).
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