Written revalida Prev med

61. . A 6-year-old child is brought to the emergency room by her parents on a Friday night because they
are concerned about rabies. A bat was present in the childs bedroom when they arrived at their country
home that evening. It started flying around the head of the girl when she entered her room and it ruffled
her hair. The parents heard her scream, ran up to her room, and shooed the bat out the window. Upon
examination, there is no visible bite or scratch marks. Which is the most appropriate intervention at this
time?

a. Reassure the parents that there is no risk of rabies given the history and examination

b. Consult public health authorities to determine the epidemiology of rabies in that area

c. Administer rabies vaccine and rabies immunoglobulin (RIG)

d. Administer rabies immunoglobulin (RIG) only

e. Administer rabies vaccine only

62. Which of the following conditions has been associated with a false-positive Fluorescent Treponemal
Antibody Absorption (FTAABS) test?

a. Tuberculosis

b. Mononucleosis

c. Lyme disease

d. Viral pneumonia

e. HIV infection

63. One of your patients, a 30- year-old developer, tells you he is planning a trip to the Dominican
Republic the following month. He will need to travel in rural areas. Which is the most appropriate
intervention for malaria prophylaxis for this patient?

a. No prophylaxis

b. Chloroquine

c. Mefloquine

d. Doxycycline

e. Primaquine

64. A 20-month-old child presents to your office with a mild viral infection. The results of examination
are normal except for a temperature of 37.2°C (99°F) and clear nasal discharge. Review of her
vaccination records reveals that she received only two doses of polio vaccine and diphtheria-tetanus-
pertussis (DTaP) vaccine, and that she did not receive the measles-mumps-rubella (MMR) vaccine. The
mother is 20 weeks pregnant. Her brother is undergoing chemotherapy for leukemia. Which of the
following is the most appropriate intervention?
. a. Schedule a visit in two weeks for DTaP

b. Administer inactivated polio vaccine (IPV) and DTaP

c. Administer DTaP, oral polio vaccine (OPV), and MMR

d. Administer DTaP, IPV, and MMR

e. Administer DTaP and OPV and schedule a visit in three months for MMR

65. Prevention of human brucellosis depends primarily on

a. Pasteurization of dairy products derived from goats, sheep, or cows

b. Treatment of human cases

c. Control of the insect vector d. Immunization of farmers and slaughterhouse workers

e. Destruction of infected animals

66.. Which of the following vaccines is CONTRAINDICATED during pregnancy?

a. Hepatitis B vaccine

b. Varicella vaccine

c. Influenza vaccine

d. Tetanus toxoid

e. Rabies vaccine

67. A 32-year-old farmer presents to the emergency room with a crushing injury of the index finger and
thumb that occurred while he was working with machinery in his barn. Records show that he received
three doses of Td in the past, and that his last dose was given when he was 25 years old. In addition to
proper wound cleaning and management, which of the following is the most appropriate prevention
intervention?

a. No additional prophylaxis

b. Administration of tetanus toxoid

c. Administration of tetanus immunoglobulin only

d. Administration of tetanus toxoid and immunoglobulin

e. Administration of tetanus and diphtheria toxoid

68. Epidemics of typhus fever have been associated with war and famine for several centuries. What
factor was most important in the control of such epidemics following the end of World War II?
a. Eradication of Anopheles mosquitoes

b. Improved sanitation practices

c. Improved methods for handling food supplies

d. Disinfestation by use of DDT

e. Mass therapy with antibiotics

69. Immunization of preschool children with diphtheria toxoid results in

a. Protection against the diphtheria carrier state

b. Lifelong immunity against diphtheria

c. Detectable antitoxin or immunologic memory for about 10 years

d. Frequent adverse reactions

e. Protection against infection of the respiratory tract by Corynebacterium diphtheriae

70. What is the recommended interval in months between the administration of whole blood
transfusion and the measles-mumps-rubella (MMR) vaccine?

a. 0

b. 1

c. 3

d. 6

e. 10

71. . Professional organizations recommend that all pregnant women be routinely counseled about HIV
infection and be encouraged to be tested. What is the most important reason for early identification of
HIV infection in pregnant women?

a. A cesarean section can be planned to reduce HIV transmission to the newborn

b. Breast feeding can be discouraged to reduce transmission to the newborn

c. Early identification of a newborn at risk of HIV infection will improve survival

d. Counseling on pregnancy options, such as termination, can be offered

e. Antiretroviral therapy can be offered to reduce the chance of transmission of HIV to the newborn

72. A 35-year-old patient comes to your office in early April for a routine examination. In the course of
the history, he tells you that he plans to go turkey hunting in Nantucket, Massachusetts, for one week in
May. He is concerned about Lyme disease. Which is the most appropriate intervention for preventing
Lyme disease?

a. Vaccination
b. Avoidance of bushy areas

c. Tick check at the end of each day

d. Protective clothing and DEET

e. Antibiotic prophylaxis for one week

. Items 73-74 An 18-year-old sexually active college student presents with complaints of lower
abdominal pain and irregular bleeding for five days. She has no fever. She uses oral contraceptives as
method of birth control. Upon examination, the cervix is friable, there is cervical motion tenderness and
adnexal tenderness. The pregnancy test is negative.

73. Which is the most likely etiologic agent responsible for these findings?

a. Neisseria gonorrhoeae

b. Chlamydia trachomatis

c. Treponema pallidum

d. Herpes simplex virus type 2

e. Mycoplasma hominis

74. She tells you that she had a similar episode two years ago. What is her risk of infertility following this
second clinical episode of pelvic inflammatory disease?

a. <1%

b. 5%

c. 10%

d. 20%

e. 40%

75. In the course of investigating a 24-year-old HIV-infected male, the HBsAg is positive. He is currently
asymptomatic, his physical examination is essentially normal, and his CD4 cell count is 800. Which of the
following tests is most helpful in determining whether the patient is in the acute phase of viral hepatitis?
a. ALT levels

b. HBeAg

c. HBsAg

d. IgG anti-HBcAg

e. IgM anti-HBcAg

Items 76-78. You are a newly employed physician at a community hospital and have been given the
responsibility of overseeing the infection control program. You plan to conduct a prospective
surveillance of nosocomial infections of patients, hire infection control personnel, and begin an
educational program for hospital personnel.

76. . Based on national data, you expect that the incidence of nosocomial infections in your facility will
be

a. <1%

b. 1 to 2%

c. 3 to 5%

d. 6 to 8%

e. 9 to 10%

77. You expect the most common site of infection to be

a. Urinary tract

b. Surgical wounds

c. Respiratory tract

d. Bloodstream

e. Gastrointestinal tract

78. . The intervention most likely to decrease the transmission of nosocomial infections in your
institution is

a. Adding proper ventilation systems

b. Disinfecting sheets and towels

c. Decreasing the use of indwelling catheters

d. Enforcing adherence to hand washing

e. Eliminating common sources of infection

79. A 7-year-old girl is brought to your office by her mother because of a rash that appeared three days
ago. Her temperature is 37.2°C (99°F) and her face has an intense rash with a slapped-cheek
appearance. The most likely etiologic agent is

a. Adenovirus

b. Rotavirus

c. Parvovirus

d. Coxsackievirus

e. Echovirus
80. To which patient would the MMR be safe to administer?

a. A 15-month-old HIV-infected child with a CD4 cell count of 700

b. A 25-year-old pregnant woman

c. A 12-year-old asthmatic on 20 mg of oral prednisone daily for the last 20 days

d. An 18-year-old with leukemia in remission whose chemotherapy was terminated 1 month ago

e. A 17-year-old with a life-threatening anaphylactic reaction to egg ingestion

81. The most effective means of preventing trichinosis in humans is

a. Cooking pork to reach a internal temperature of at least 40°C (104°F)

b. Proper disposal of hog feces

c. Prohibiting feeding garbage to hogs

d. Testing hogs with Trichinella antigen prior to slaughter

e. Freezing pork at 10°F

82. Which engineered water purification system is the most effective for the elimination of
Cryptosporidium parvum?

a. Flocculation

b. Sedimentation

c. Disinfection

d. Boiling

e. Filtration

83. 0. The major environmental source of lead absorbed in the human blood stream in adults is

a. Air

b. Water

c. Lead-based paint

d. Food

e. Soil

84. You are asked to evaluate the working environment in a manufacturing plant processing metal parts.
In one area of the mill, where such parts are flattened, the sound level is measured at 85 dB. The
workers responsible for this process are exposed to this sound for the entire 8-hour shift. The most
appropriate intervention for this level of sound is
a. None. This level of sound is below the level at which OSHA regulations apply

b. A hearing conservation program

c. A shutdown of the manufacture until the level of sound is reduced

d. A shutdown only of the process area where the sound is 85 dB or higher

e. Enforcement of hearing protective devices for all exposed workers

85. A 42-year-old welder is brought in the emergency room complaining of a sore throat, headache, and
myalgias. He also started feeling a tightness in the chest and shortness of breath. He works in an
electroplating operation brazing and cutting metals. Pulmonary function tests reveal a reduced forced
expiratory volume. The chest x-ray is normal. Which of the following exposures is the most likely cause
of the workers symptoms?

a. Lead

b. Mercury

c. Chromium

d. Copper

e. Cadmium

86.. Which of the following tests is the most frequently used rapid screening test to assess
mutagenicity/carcinogenicity of a chemical substance?

a. Ames test

b. Mammalian mutation assay

c. Unscheduled DNA assay

d. Cell transformation assay

e. Cytogenetic assay

87. A migrant farm worker is brought to the clinic at 2:00 P.M. complaining of blurred vision, salivation,
nausea, and diarrhea. He had been working in the fields since 6:00 A.M. in hot and humid weather. The
examination reveals the following findings: heart rate of 50 per minute, respiration 20 per minute,
profuse perspiration, and miosis. The most effective initial intervention with this worker is

a. Rapid administration of intravenous

fluid

b. Evaporative cooling

c. Atropine

d. Observation only

e. Epinephrine
88. Which of the following waste management methods is the preferred method of waste control?

a. Waste minimization

b. Incineration

c. Recycling

d. Physical treatment

e. Biological treatment

89. . Commercial airline pilots have higher exposures to which type of radiation compared to the general
population?

a. Alpha particles

b. Beta particles

c. Gamma rays

d. Cosmic rays

e. X-rays

90. Radioactive waste is best disposed by

a. Physical treatment

b. Incineration

c. Landfill

d. Injection wells

e. Chemical treatment

91. Which of the following is responsible for the largest proportion of domestic water use?

a. Bathing

b. Drinking

c. Laundry

d. Toilet flushing

e. Dishwashing

92. A 42-year-old welder presents to employee health services complaining of tearing eye pain and
photophobia. A photokeratoconjunctivitis is diagnosed. The most likely cause of this condition is

a. Infrared radiation

b. Visible radiation
c. Ultraviolet radiation A

d. Magnetic radiation

e. Ultraviolet radiation B

93. . Which of the following physical characteristics of water is the most important impediment to
disinfection?

a. Color

b. Viscosity

c. Turbidity

d. Density

e. Temperature

94. . Which of the following residential environmental pollutants is the leading cause of lung cancer?

a. Radon

b. Tobacco smoke

c. Asbestos

d. Formaldehyde

e. Sulfur oxide

95. Which of the following minerals is responsible for hard water

a. Lead

b. Copper

c. Iron

d. Sulfur

e. Manganese

96. . A 28-year-old woman presents with nausea, vomiting, and diarrhea. She has no fever. Her history
reveals that she attended a reception about six hours ago. She ate roast beef with gravy, salad, and had
cream-filled pastries for dessert. Prevention of this food-borne illness could have been achieved by

a. Freezing the food

b. Heating the food to 140° Fahrenheit

c. Proper hand washing by food handlers

d. Proper cleaning of contaminated

surfaces
e. Control of flies

97. A 50-year-old textile worker presents to your office for his periodic health examination. He has no
complaints. Review of history reveals that he has been working for over 25 years at the same company.
His work consists of preparing dyes. Which of the following tests would be appropriate in this setting?

a. A chest x-ray

b. A brain computed tomography

(CT) scan

c. Liver function tests

d. A complete blood count

e. A urinalysis

98. A 30-year-old patient presents at an evening walk-in clinic after work complaining of chills, fever, and
malaise of acute onset. He started coughing and feeling out of breath late in the afternoon. Inspiratory
crackles are present on chest auscultation. The chest x-ray is normal. The complete blood count reveals
12,000 WBC with 70% PMNs. His past medical history is benign. No one else in the household is sick. He
says some of his coworkers have a cold. He works in a pet shop in the bird section. He is not taking any
medication. He states he had a similar episode a few weeks ago that resolved after a few days of rest at
home. The most appropriate management is to prescribe

a. Rest, fluid, and antipyretics

b. Amantadine

c. Doxycycline

d. Prednisone

e. Erythromycin

99. Biological oxygen demand (BOD) measures the total organic content of water based on the
consumption of oxygen in a sample at 20° Celsius over five days. A consumption of 10 to 20 mg of O2
per liter most likely represents a sample from

a. Treated freshwater

b. Untreated freshwater

c. Treated sewage

d. Domestic sewage

e. Industrial wastewater

100. Which of the following smokers has the highest risk of developing lung cancer?

a. An asbestos worker
b. A uranium miner

c. A coal worker

d. A textile worker

e. A sandblaster
Answer Key

1. C 61.
2. C 62.
3. B 63.
4. D 64.
5. A 65.
6. B 66.
7. E 67.
8. D 68.
9. C 69.
10. D 70.
11. E 71.
12. D 72.
13. B 73.
14. D 74.
15. E 75.
16. C 76.
17. A 77.
18. D 78.
19. C 79.
20. A 80.
21. C 81.
22. E 82.
23. A 83.
24. B 84.
25. E 85.
26. A 86.
27. C 87.
28. A 88.
29. D 89.
30. C 90.
31. D 91.
32. E 92.
33. C 93.
34. B 94.
35. E 95.
36. C 96.
37. E 97.
38. A 98.
39. C 99.
40. A 100.