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A student returns from a student teaching assignment in Zimbabwe. On the way home she swam in Lake Malawi. She is found to have schistosomiasis. Four of the following answers are good advice on how to prevent schistosomiasis. Which one is bad advice?
A. in risk areas, don't swim in fresh water rivers or lakes
B. Swimming in chlorinated pools is safe
C. Swimming in ocean salt water is safe
D. Toweling off vigorously after contact with potentially contaminated water decreases your risk
E. Wading in water up to your knees is safe for brief periods of time
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A 22-year old Tibetan female is found to have a large multiloculated cyst of the pelvis that is removed and found to be due to Echinococcus granulosus. This is most unusual since most cysts occur in the liver or lung. Which of the following is false regarding Echinococcus granulosus?
A. The diagnosis in humans can be made by looking for the eggs in human stool
B. Dogs are the definitive host
C. Sheep are intermediate hosts
D. Humans are incidental hosts
E. Humans contract disease from eating the eggs excreted in dog feces
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Taenia saginata and Taenia solium are similar in many ways, but Taenia solium is more dangerous. Which of the following makes T. solium more dangerous?
A. It has an armed scolex
B. It has fewer uterine branches than T. saginata
C. Man can be infected as an intermediate host by eating the eggs from T. solium
D. The cyst or larvae form ingested from pork is more potent than the cyst from beef
E. It produces more eggs than T. saginata
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Humans are the definitive host for Diphyllobothrium latum or the fish tapeworm which competes for Vitamin B12 with its human host. Vitamin B12 deficiency can result in an anemia with production of very large red blood cells, called macrocytic anemia. All of the following would prevent the spread of this disease but one. Which one would not be a method of prevention?
A. Avoid swimming in fresh waters that are endemic for Diphyllobothrium latum
B. Cook freshwater fish well before eating
C. Freeze fish that is going to be consumed raw which will kill the parasite
D. Provide sewage treatment plants that treat raw sewage before dumping it into fresh water
E. Avoid eating fresh water fish
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A physician calls from an outlying hospital to report that his patient has passed a large, white, round worm with pointed ends that is about 8 inches long. He is concerned this could be Echinococcus but the only parasite that matches this description is Ascaris lumbricoides. Which of the following is false regarding Ascaris lumbricoides?
A. Most infected humans are asymptomatic
B. Large numbers of larvae passing through the lung can cause asthma type symptoms
C. Large numbers of adult worms in the gut can cause obstruction
D. The fertilized unembryonated egg passed in the stool requires a period of time to embryonate before it becomes infectious
E. Heavy infection has been associated with rectal prolapse
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An elderly Tongan male was diagnosed with multiple myeloma (a form of cancer) and has been treated with chemotherapy agents for two months. He was then admitted to the hospital with new-onset asthma symptoms that became worse when he was treated with steroids. Many small larvae were found in his sputum and he was found to have a hyper-infection with Strongyloides stercoralis. Which statement is false regarding Strongyloides?
A. Strongyloides is a common cause of iron deficiency anemia just like hookworm
B. The initial infection occurs when larvae penetrate the skin from the soil
C. Auto infection occurs when the ova hatch and mature in the intestinal tract and then penetrate the intestine to establish a persistent infection
D. Eosinophilia is present during the migrating phase of the life cycle
E. Recurrent bacterial infections can develop when bacteria are carried by the larvae into sterile areas of the body
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In the 1920s, the Rockefeller Foundation funded a physician to go throughout the Pacific Islands to decrease the incidence of hookworm. Each of the following but one would help decrease the incidence of this disease. Which one would not make any change in incidence of Ancylostoma duodenale or Necator americanus?
A. Wearing shoes
B. Washing hands after using the bathroom
C. Using latrines for defecation
D. Treating those found to be infected
E. Establishing sewage treatment facilities
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Itching around the rectum is commonly caused by the pinworm, Enterobius vermicularis. Which of the following is false regarding pinworms?
A. It has a simple rectum to mouth life cycle (do not scratch your bum and suck your thumb)
B. Diagnosis is best made by a stool O&P exam
C. It is highly contagious infecting a number of members of a family at the same time
D. Spread can be prevented by good hygiene
E. The egg is oval, flat on one side and contains a single larvae folded over like a safety pin
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Trichuris trichiura or whipworm is a frequent parasite found in humans. Which of the following is false for Trichuris trichiura?
A. Heavy infestations may result in diarrhea sometimes associated with blood
B. Light infections may be asymptomatic
C. The eggs have a barrel-like appearance with bipolar plugs
D. After ingestion the eggs hatch into larvae that migrate through the lung before maturing in the duodenum
E. Eggs passed in stool are unembryonated, so they require a time to mature in the soil before they become infectious
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An ophthalmologist from Cameroon, Africa describes the microfilaria seen in the eye of patients with Onchocerciasis. He states that he treats only after finding 30+ microfilaria because of the toxicity of Diethyl-Carbamazine that was used for treatment. Now with a less toxic agent, (Ivermectin) a major attempt is being made to eradicate Onchocerca volvulus. Which statement is false regarding Onchocerca volvulus?
A. It is transmitted by the Simulian Black fly that reproduces in rapidly moving water
B. Itching of the skin is a prominent feature of this disease
C. The adults live in a nodule on the skin with the female producing large numbers of microfilaria that migrate under the skin
D. Diagnosis can sometimes be made by finding the microfilaria in a skin snip or skin biopsy
E. The microfilaria mates in the human skin and develop into the adult parasite
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A 74-year old World War II Veteran who was a prisoner of war in the Philippines is admitted to the VAH with a Group A-Streptococcal cellulitis resulting from massive swelling of both lower legs from elephantiasis. Which of the following is false regarding elephantiasis caused by Wuchereria bancrofti?
A. If these infections are not treated early they rapidly progress to massive swelling of the involved lymphatic drainage area
B. It is transmitted to humans by the mosquito
C. Humans are the definitive host
D. The microfilaria in the blood stream of man can be transfused to another person without establishing a new infection
E. The adult organisms live in the lymphatic channels of man and can result in scarring of the Lymphatic channels
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A 74-year old World War II Veteran who was a prisoner of war in the Philippines is admitted to the VAH with a Group A-Streptococcal cellulitis resulting from massive swelling of both lower legs from elephantiasis. Which of the following is false regarding elephantiasis caused by Wuchereria bancrofti?
A. If these infections are not treated early they rapidly progress to massive swelling of the involved lymphatic drainage area
B. It is transmitted to humans by the mosquito
C. Humans are the definitive host
D. The microfilaria in the blood stream of man can be transfused to another person without establishing a new infection
E. The adult organisms live in the lymphatic channels of man and can result in scarring of the Lymphatic channels
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A 4th year medical student from the UofU traveled to Northern Ghana during an international rotation to Accra. He was fortunate enough to see a patient with Dracunculus medinensis in which they were extracting a worm from his leg onto a pencil. This parasite is being eradicated from the world. Which of the following is least likely to help rid the world of Dracunculus medinensis?
A. Boiling surface water before drinking it
B. Using a coffee filter or shirt to filter out copepods before drinking surface water
C. Treating of sewage before it enters fresh surface water
D. Preventing persons suspected of having Dracunculus from wading in the drinking water
E. Treating ponds used for drinking water with insecticide
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You see a young child for evaluation of fever, abdominal pain, enlarged liver and eosinophilia. You suspect toxocariasis from Toxacara canis or cati. Which of the following statements is false about Toxocara?
A. It can result in retinal lesions that can impair vision
B. It is caused by the larvae of the "dog or cat ascaris" that wander through the body unable to find the lung to complete their life cycle
C. It is associated with persons who eat dirt
D. It can be spread by contact with human feces
E. It is often found in young puppies or kittens
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Several years ago there was an outbreak of Trichinosis among a group of Vietnam immigrants in New York that had made their own pork sausage. About 30 people who ate the sausage all become ill. Which of the following statements is false about Trichinella spiralis?
A. It can be spread by eggs passed in the stool
B. It is a tissue nematode that induces a high eosinophil response
C. It is a disease of meat eating animals
D. It is usually self limiting
E. Heavy infection causes symptoms of diarrhea and abdominal pain that progresses to fever, facial and periorbital edema and myalgias
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You have just examined a patient from Brazil who has a chronic ulcer of his ear that has been present for 6 months. You are concerned that he has Leishmaniasis and want to differentiate L. mexicana from L. braziliensis. Which of the following statements about these 2 organisms is false?
A. They are both transmitted by the sand fly
B. Both appear as amastigotes in macrophages on biopsy
C. Both can start as a cutaneous ulcer that eventually heals on its own
D. Both heal with a residual scar
E. Both will eventually cause lesions of the mucous membranes
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This year a report from India indicates that a single dose of Amphotericin B can result in the cure of Leishmania donovani rather than prolonged treatment by fairly toxic medication. If confirmed this will be a major advance in the treatment of Kala-azar. Which of the following statements is false regarding systemic Leishmaniasis?
A. It is spread by the bite of the sand fly
B. Macrophages ingest the organism and move about the body facilitating its spread
C. Diagnosis can often be made by identifying amastigotes in cells aspirated from the spleen or bone marrow
D. Untreated patients frequently recover themselves
E. Kala-azar should be considered as one of the possibilities in someone who has lived in an endemic area and has an enlarged spleen
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Blood banks in Southern California and Texas have done studies to evaluate how often blood containing Trypansoma cruzi is found in their blood donor pool. They have found that the incidence varies between 1:8,000 and 1:40,000 donors. If you were making up a list of questions to ask blood donors, which of the following questions would be least helpful in screening to exclude this organism from persons that have grown up in an endemic area?
A. Have you ever been bitten by a reduvid bug?
B. Have you ever eaten pigs, dogs, or other animals that are reservoir hosts for Chaga's diseas
C. Have you lived in an adobe hut with a thatched roof?
D. Have you ever had swelling of your eye that lasted more than 3 days?
E. Have you ever had a blood test positive for Chaga's disease?
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This year there have been 7 travelers to eastern Africa that have contracted Trypanosoma brucei rhodesiense. They have all presented in the early stage of the disease with a chancre of the skin associated with cellulitis (red hot swelling) around the chancre. Which of the following is false regarding Trypanosoma brucei?
A. Progression of the disease is more rapid in rhodesiense than in gambiense
B. Early diagnosis allows for a more effective, safer medication that can be used before the parasite reaches the brain
C. Rhodesiense has multiple hosts while in gambiense, humans are the only host
D. Epidemics of African sleeping sickness have occurred by person to person spread
E. Both are transmitted by the Tsetse fly
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This year there have been 7 travelers to eastern Africa that have contracted Trypanosoma brucei rhodesiense. They have all presented in the early stage of the disease with a chancre of the skin associated with cellulitis (red hot swelling) around the chancre. Which of the following is false regarding Trypanosoma brucei?
A. Progression of the disease is more rapid in rhodesiense than in gambiense
B. Early diagnosis allows for a more effective, safer medication that can be used before the parasite reaches the brain
C. Rhodesiense has multiple hosts while in gambiense, humans are the only host
D. Epidemics of African sleeping sickness have occurred by person to person spread
E. Both are transmitted by the Tsetse fly
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Question: A Chinese male has had right upper quadrant pain for the past 10 years. Workup for gallbladder disease with an ultrasound shows small linear organisms. O&P exam reveals the ovoid, flask shaped egg of Clonorchis sinensis. Which of the following statements is false regarding Clonorchis sinensis?
Answer: C. This infection can best be treated with surgical removal of the gallbladde
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Payment of time- barred debt is:
(a) Valid
(b) Void
(c) Illegal
(d) Voidable