MINISTRY OF HEALTH OF UKRAINE

Kharkiv National Medical University

D.P. GRYNYOV DEPARTMENT OF MICROBIOLOGY,
VIROLOGY AND IMMUNOLOGY

MATERIALSFOR PREPARING TO LICENSE

EXAMINATION «KROK-1» ON
MICROBIOLOGY, VIROLOGY AND
IMMUNOLOGY
FOR ENGLISH-MEDIUM STUDENTS OF THE
FACULTIESOF MEDICINE AND DENTISTRY

Part 2

Kharkiv 2018
 Standard protocols to laboratory classes in special virology for the II and III
year English media students of medical and dentistry faculties / M.M. Mishyna,
N.I.Kovalenko, Yu.A.Mozgova, T.M. Zamaziy, O.O. Vovk. – Kharkiv: KNMU,
2018. – 84 p.
 Introduction.
«Materials for preparing to license examination “KROK-1” on
microbiology, virology and immunology for English-medium students of the
faculties of medicine and dentistry (guidelines for students)» were prepared
according to the Program on microbiology, virology and immunology for students
of medical and dentistry faculties of medical universities of 3-4 accreditation
levels.
These materials were made that to help students to remember tests and be
prepared to “KROK-1” examination on special virology. This book contains tests
that were in “KROK” buklets for English-medium students of medical, dentistry
and pharmacy facultaties (http://testcentr.org.ua). According to tendence of last
years when in “KROK-1” appear tests on infectious diseases we also add such
tests.
The book deals with the viruses that can cause infectious diseases in
humans. Particular attention is paid to prophylaxis and treatment of various
infectious diseases, modern methods of laboratory diagnostics also are discussed.
The book is structured in two parts: I – especially tests where for students
correct answer is marked, and it is necessary to write a key words at right side, and
II – where schemes and schedules are present that to make the process of answer
easily and may help to remember key words for longer time.
 Influenza viruses
1. Ambulace brought to the hospital a patient with acute respiratory viral
0
infection. The illness began suddenly with temperature rise up to 39,9 C. He
complains of headache in frontotemporal lobes, pain in eyeballs, aching of the
whole body, nose
stuffiness, sore throat, dry
cough. At home he had a
nasal hemorrhage twice.
What type of acute
respiratory viral infection
is it?
A. Influenza
B. Adenoviral infection
C. Parainfluenza
D. RS-infection
E. Enterovirus infection

2. Material taken from a patient with provisional diagnosis "influenza"was

referred to a laboratory. For virological examination the hemadsorption
reaction was applied. This reaction can be applied for detection of the
following viruses:
A. Viruses containing hemagglutinins
B. All the complex viruses
C. All the simple viruses
D. DNA-genomic viruses
E. Any viruses

3. During the breakout of acute respiratory infection in order to diagnose

influenza the express-diagnosis, based on revealing of specific viral antigen
in the examined material (nasopharyngial lavage), is carried out. Which
reaction is used for this?
A. Immunofluorescence
B. Agglutination
C. Precipitation
D. Opsonization
E. Complement binding

2
4. A virological laboratory obtained pathological material (mucous
discharges from nasal meatuses) taken from a patient with provisional
diagnosis "influenza". What quick test will allow to reveal specific viral
antigen in the material under examination?
A. Direct and indirect
immunofluorescence test
B. Direct and indirect
fluorescence immunoassay
C. Hemagglutination inhibition
assay D. Radioimmunoassay
E. –

5. Pathological material (mucosal excretion from the nasal passages) taken

obtained from a patient provisionally diagnosed with influenza was delivered
to the virological laboratory. What quick test allows detecting specific viral
antigen in the investigated material?
A. Direct and indirect immunofluorescence (IF)
B. Reverse indirect haemagglutination (RIHA)
C. Radioimmunoassay (RIA)
D. Direct and indirect enzyme-linked immunosorbent assay
(ELISA) E. Hemagglutination inhibition assay (HAI)

6. Virological laboratory has received patient’s nasopharyngeal lavage. What

can be used to single out influenza virus from the patient’s lavage?

A. Chick embryo
B. Endo’s medium
C. Meat infusion agar
D. Meat infusion broth
E. Lowenstein–
Jensen medium

3
7. Inoculation of hen’s embryos is the main method of detection of influenza
virus. In order in the material under examination (nasopharyngeal lavage) it is
necessary to add beforehand:
A. Antibiotics B. Anti-influenza gamma globulin
C. Fluorescent serum
D. Leukocytic interferon
E. Eubiotics

8. A patient has been diagnosed with ARVI. Blood serum contains

immunoglobulin M. What is the stage of infection in this case?
A. Acute
B. Prodromal
C. Incubation
D. Reconvalescence
E. Carriage

9. A patient fell ill the day before, the disease is acute with a predominance of
general toxic symptoms. With an account for the epidemic situation in the
city, the doctor diagnosed the patient with influenza A. What emergency
etiotropic treatment must be administered to this patient?
A. Rimantadine
B. Oxolinic ointment
C. Gentamicin
D. Inactivated
influenza vaccine
E. Human gamma globulin

4
10. Pharmacy has received viricidal drugs. Choose the one used for influenza
treatment from the list given below.
A. Rimantadine
B. Metisazone C.
Levamisole D.
Azidothimidine E.
Acyclovir

11. Epidemic of influenza was announced in a town. Which drug can be

recommended for the nonspecific prophylaxis of influenza?
A. Leukocytic
interferon B. Antibiotics
C. Anti-influenza
immunoglobulin
D. Anti-influenza vaccine
E. Anti-influenza serum

12. A drugstore received a supply of a drug that is widely used for treatment
of many virus diseases since it is not virus specific. What drug is it?
A. Interferon
B. Remantadin
C. Metisazone
D. Immunoglobulin
E. Vaccine

5
13. To prevent the seasonal influenza epidemics in the city hospitals, sanitary
epidemic station gave orders to immunize health care workers. Which of the
following preparations should be used for immunization?
A. Subunit vaccine
B. Interferon
C. Amantadine
D. Rimantadine
E. Gamma-globulin

14. For the specific prevention of influenza, the employees of an enterprise

were vaccinated with "Influvac". What type of immunity will develop in the
body of the vaccinated?
A. Artificial
active B. Innate
congenital
C. Natural active
D. Artificial
passive
E. Natural passive

15. A person has been in contact with influenza patient. What drug should be
administered for specific passive influenza prophylaxis?
A. Antigrippal
immunoglobulin
B. Amizon
C. Anaferon D.
Vaccine
influenza virus
inactivated E.
Leukocytic
interferon

6
 Poxviruses
1. The contents of vesicles that appeared on the mucous membrane of a
patient with variola were sent to a virological laboratory. Which of the listed
changes were revealed during the smear microscopy?
A. Paschen bodies
B. Babes-Negri bodies
C. Guarnieri bodies D.
Babes-Ernst bodies E.
Syncytium

Picornaviruses
1. A 3-year-old child has been taken to a pediatrician. He has no recent
history of any diseases. Objective examination revealed no pathology of the
internal organs. The child needs the routine immunization against the
following disease:
A. Poliomyelitis
B. Diphtheria and
tetanus C. Measles,
rubella, parotitis
D. Pertussis
E. Type B hepatitis

7
 0
2. A 1,5 y.o. child fell ill acutely with high temperature 38 C, headache,
fatigue. The temperature declined on the fifth day, muscular pain in the right
leg occured in the morning, there were no movements and tendon reflexes,
sensitivity was reserved. What is the initial diagnosis?
A. Polyomyelitis
B. Viral encephalitis
C. Polyartropathy D.
Osteomyelitis E. Hip
joint arthritis

o
3. A child is 9 months old. The patient’s body temperature is 36,7 C, the skin
is pale, humid, there is pain in leg muscles. There is no extremities mobility,
sensitivity is present. The child has been diagnosed with poliomyelitis. The
causative agent of this disease relates to the following family:
A. Picornavirus
B. Paramyxovirus
C. Tohovirus
D. Adenovirus
E. Rotavirus

8
4. In our country, routine preventive vaccinations against poliomyelitis
involve using live vaccine that is administered orally. What immunoglobulins
are responsible for the development of local post-vaccination immunity in
this case?
A. Secretory
IgA B. IgM
C. IgG
D. Serum
IgA E. IgE

o
5. An 8-year-old child was hospitalized for fever up to 39,8 C, inertness,
moderate headache, vomiting. Examination revealed meningeal symptoms.
Lumbar puncture was performed. The obtained fluid had raised opening
pressure, it was transparent, with the cell count of 450 cells per 1 mcL
(mainly lymphocytes - 90%), glucose level of 2,6 mmol/l. What causative
agent might have caused the disease in the child?
A. Enterovirus B.
Meningococcus
C. Koch’s bacillus
D. Staphylococcus
E. Pneumococcus

9
6. A culture of monkey cells (Vero) and a group of mouse sucklings were
infected with an inoculum taken from a child with provisional diagnosis
"enterovirus infection". There was no cytopathic effect on the cell culture but
mouse sucklings died. What enteric viruses might have caused disease of this
child?
A. Coxsackie A
B. Coxsackie B
C. ECHO virus
D. Polioviruses
E. Unclassified enteric viruses 68-71

7. A laboratory received a sample of water used in drug production for

sanitary and virusological analysis. What group of viruses will indicate fecal
contamination of water and thus the need for its additional purification?
A. Picornaviridae
B. Herpesviridae
C. Orthomyxoviridae
D. Retroviridae
E. Flaviviridae

10
8. A paitent, who works as a milkmaid, has made an appointment with a
dentist with complaints of aphtha-shaped rash on the mucosa of oral cavity.
The doctor detected rash on her hands in the area of nail plates. What agent
causes this disease?
A. Foot-and-mouth
disease virus
B. Cytomegalovirus
C. Vesicular
stomatitis
D. Herpesvirus
E. Coxsackie
B virus

Rotaviruses
1. A three-year-old child has had marked diarrhea for three days. Immune
electron microscopy of his excrements revealed bilayer pseudocovered capsid
viruses that looked like small spoke wheels. What viruses have been
revealed?
A. Rotaviruses
B. Coxsackie viruses
C. ECHO viruses D.
Coronaviruse
E. Reoviruses

2. An outbreak of an intestinal infection occurred in a kindergarten on the eve

of New Year holidays. Bacteriological examination of patients’ feces didn’t
reveal any pathogenic bacteria. Electron microscopy revealed roundish
structures with clear outer edges and a thick core resembling a wheel. Specify
the most likely causative agent of this infection:
A. Rotavirus
B. Adenovirus C. Coxsackivirus
D. E.coli E. P.vulgaris

11
 Rabies viruses
1. A hospitalized patient bitten by a rabid animal has an abusive wound of
shin. What kind of vaccine must be given to prevent rabies?
A. Anti-rabies
vaccine B. DTaP
C. Td D.
BCG E.
TABte

2. In the area being the epicenter of the registered rabies cases among wild
animals a 43-year-old man presented to a clinic and claimed to have been
bitten by a stray dog. He was given a course of anti-rabies vaccine. This
preparation relates to the following type of vaccines:
A. Attenuated
B. Inactivated
C. Molecular
D. Toxoids E.
Synthetic

3. In the area that is the epicenter of the registered rabies cases among wild
animals a 43-year-old man arrived at a clinic and claimed to have been bitten
by a stray dog. He was given a course of anti-rabies vaccine. This preparation
belongs to the following type of vaccines:
A. Attenuated
B. Inactivated
C. Molecular
D. Toxoids E.
Synthetic

12
4. A female patient bitten by a stray dog came to a surgery. Wide lacerated
wounds were localized on the patient’s face. What treatment-and prevention
aid should be rendered in order to prevent rabies?
A. Immunization with the
antirabic vaccine
B. Combined antibiotic therapy
C. Hospitalization, injection of DTP
D. Hospitalization, medical surveillance
E. Urgent injection of normal gammaglobulin

5. A man who was bitten by the unknown dog applied to the surgeon. Wide
ragged wounds were localized on the face. What curative-prophylactic aid
should be given to prevent rabies?
A. Start immunization with rabies vaccine
B. Prescribe combined antibiotic therapy C.
Immediate injection of DPT vaccine
D. Hospitalize the patient and keep under the doctor’s supervision
E. Immediately inject normal gamma globulin

13
6. Brain autopsy revealed an edema, hyperemia, and small hemorrhages in
the medulla oblongata. Microscopically chromatolysis, hydropia and nerve
cell necrosis are observed; within the cytoplasm of hippocampal nerve cells
there are eosinophilic structures (Negri bodies) detected. What diagnosis
corresponds with the described morphological signs?
A. Rabies
B. Encephalomyelitis
C. Meningococcal
meningitis D. Brucellosis
E. Encephalitis

Vesicular stomatitis virus

1. A patient has some vesicles on the mucous membrane of the oral cavity,
lips and nose. A dentist suspected vesicular stomatitis. What analysis will
allow to confirm the diagnosis?
A. Recovery of virus from the vesicular fluid
B. Allergy test
C. Recovery of bacteria from the vesicular fluid
D. Contamination of animals with the vesicular
fluid E. Microscopy of the vesicular fluid

14
 Herpesviruses
1. A patient consulted a dentist about pains, reddening and swelling of gums.
The dentist assumed herpetic gingivostomatitis. What virus might have
caused this disease?
A. Herpes simplex virus type
1 B. HSV type 2
C. Herpes zoster
D. Cytomegalic virus
E. Epstein-
Barr virus

2. A 26-year-old male patient complains of a rash on the upper lip skin, which
arose on a background of influenza with high-grade fever and is accompanied by
pain and burning. The rash has been present for 3 days. Objectively: the skin of
the upper lip is edematic and erythematous, grouped vesicles are filled with
serous fluid and have a rough surface. What is the most likely diagnosis?
A. Herpetic vesicular
dermatitis B. Eczema
C. Contact dermatitis
D. Dermatitis herpetiformis
E. Erythema multiforme

15
3. A 27-year-old sexually active female complains of numerous vesicles on
the right sex lip, itch and burning. Eruptions regularly turn up before
menstruation and disappear 8-10 days later. What is the most likely
diagnosis?
A. Herpes simplex
virus B. Bartholinitis
C. Primary syphilis
D. Cytomegalovirus infection
E. Genital condylomata

4. A 7 y.o. girl has mild form of varicella. Headache, weakness, vertigo,

tremor of her limbs, ataxia, then mental confusion appeared on the 5th day of
illness. Meningeal signs are negative. Cerebrospinal fluid examination is
normal. How can you explain these signs?
A. Encephalitis
B. Meningitis
C. Meningoencephalitis
D. Myelitis
E. Neurotoxic syndrome

16
5. On the 21 day after appearance of vesiculous chickenpox rash a 7-year-old
child developed ataxia, nystagmus, intention tremor, muscle hypotonia.
Liquor analysis shows insignificant lymphocytic pleocytosis, slightly
increased protein rate. What complication is it?
A. Encephalitis B. Acute nephritis C. Pneumonitis
D. Purulent meningitis E. Postherpetic neuralgia
6. A 50-year-old woman is being treated for shingles in a neurology unit.
What reactivated virus causes this disease?
A. Varicella zoster virus
(chickenpox virus)
B. Herpes simplex virus type
1 C. HSV type 2
D. Measles virus E.
Cytomegalovirus

7. A patient complained about general weakness, fever, painful rash on his

trunk skin. He has been suffering from this for 3 days. Objectively: lateral
surface of trunk on the left is hyperemic and edematic, there are some groups
of vesicles with serous and haemorrhagic contents. What is the most probable
diagnosis?
A. Herpes zoster B. Contact dermatitis simplex
C. Contact allergic dermatitis
D. Microbial eczema E. Herpetiform Duhring’s dermatosis

17
8. A 67-year-old male patient complains of rash, severe pain in the
subscapular region on the right. Objectively: skin in the right subscapular
region is covered with linearly arranged pink-red edematous lesions that are
somewhat infiltrated, and have clear boundaries. On the lesion surface there
are vesicles with transparent exudate. What is the most likely diagnosis?
A. Herpes zoster B. Duhring dermatitis
C. Erysipelas D. Atopic dermatitis
E. Impetigo

9. 2 days ago a patient presented with acute pain in the left half of chest,
general weakness, fever and headache. Objectively: between the 4 and 5 rib
on the left the skin is erythematous, there are multiple groups of vesicles 2-4
mm in diameter filled with transparent liquid. What diease are these
symptoms typical for?
A. Herpes zoster B. Pemphigus
C. Herpes simplex
D. Streptococcal impetigo E. Herpetiform Duhring’s dermatosis

10. A 3-year-old child has continuous fever, lymph nodes are enlarged, the
amount of lymphocytes in blood is significantly increased. Enzymelinked
immunosorbent assay (ELISA) revealed antigen of Epstein-Barr virus. What
diagnosis can be made based on the information given above?
A. Infectious mononucleosis
B. Burkitt’s lymphoma
C. Herpetic lymphadenopathy
D. Cytomegalovirus infection
E. Generalized infection caused by herpes-zoster

11. A doctor examines a 17-year-old girl. The following is detected:

pharyngitis, cervical lymphadenopathy, fever. The preliminary diagnosis
is infectious mononucleosis. What method of investigation allows to
confirm this diagnosis at the disease onset?
A. Determining antibodies IgМ to Epstein-Barr virus B.
Microscopy of blood smear according to Giemsa method
C. Determining antibodies IgG to Epstein-Barr virus
D. Sabin-Feldman dye test
E. Determining the amount of C-reactive Protein

18
12. An 18 year old patient was admitted to a hospital with complaints of
headache, weakness, high temperature, sore throat. Objectively: enlargement
of all groups of lymph nodes was revealed. The liver is enlarged by 3 cm,
spleen - by 1 cm. In blood: leukocytosis, atypical lymphocytes - 15%. What
is the most probable diagnosis?
A. Infectious mononucleosis
B. Acute lymphoid leukosis C.
Adenoviral infection
D. Angina E.
Diphtheria

13. Often the cause of secondary immunodeficiency is an infectious affection

of an organism, when agents reproduce directly in the cells of immune
system and destroy them. Specify the diseases, during which the described
above occurs:
A. Poliomyelitis, viral hepatitis A
B. Q fever, typhus
C. Tuberculosis, mycobacteriosis
D. Infectious mononucleosis,
AIDS E .Dysentery,cholera

19
14. An HIV-positive patient’s cause of death is acute pulmonary
insufficiency resulting from pneumonia. Pathohistological investigation of
lungs has revealed transformed cells resemble owl’s eye. Name the
pneumonia causative agent:
A. Cytomegalovirus
B. Pneumococcus C.
Influenza virus D.
Candida fungi
E. Toxoplasma

15. What chemotherapeutic agent is a drug of choice for treatment of herpes?

A. Acyclovir
B. Rifampicin
C. Chingamin
D. Doxycycline hydrochloride
E. Metronidazole

16. A patient has herpetic rash. What medication should be administered?

A. Acyclovir B. Gentamycin C. Clotrimazole
D. Benzylpenicillin sodium salt E. Biseptol
17. A patient is ill with herpetic stomatitis provoked by immunosuppression.
What preparation introduced intravenously, internally and locally can provide
antiviral and immunopotentiating effect?
A. Acyclovir B. Remantadinum C. Levamisole
D. Methisazonum E. Amoxicillin
18. A patient consulted a dentist about a lesion of his oral mucosa. He was
diagnosed with herpetic stomatitis. Which of the following drugs will have an
effect on etiotropic factor?
A. Acyclovir B. Dimedrol C. Paracetamol
D. Levamisole E. Furacilinum

20
19. A patient has herpetic conjunctivitis. What etiotropic drug should be
administered?
A. Acyclovir B. Ampicillin C. Methisazonum
D. Furagin E. Tetracycline
20. A patient with herpetic stomatitis was prescribed acyclovir for topical
application. What is its mechanism of action?
A. It inhibits synthesis of nucleic acids of viruses
B. It increases the resistance of macroorganism cells to the viruses
C. It inhibits virus maturation
D. It inhibits virus penetration into
cells E. It inhibits virion assembly

Arboviruses
1. A patient with clinical signs of encephalitis was delivered to the infectious
diseases hospital. Anamnesis registers a tick bite. Hemagglutination-
inhibition reaction helped to reveal antibodies to the causative agent of tick-
borne encephalitis in the dilution 1:20 which is not diagnostic. What actions
should the doctor take after he had got such result?
A. To repeat the examination with serum taken 10 days
later B. To examine the same serum
C. To apply more sensitive reaction
D. To repeat examination with another diagnosticum
E. To deny diagnosis of tick-borne encephalitis

21
2. After a thorough examination the patient who had returned from Central
Asia to Ukraine was diagnosed with spring-summer encephalitis. Its pathogen
might have entered the body through the bite of the following arthropod:
A. Dog-louse
B. Taiga tick
C. Mosquito
D. Itch mite
E. Argasid tick (ornithodorus papillipes)

Measles virus
1. A 4-year-old girl died suddenly with symptoms of asphyxia. Autopsy
revealed white spots on the buccal mucosa; large blotches of rash on the skin
of face, trunk and extremities; conjunctivitis, edema with foci of necrosis on
the laryngeal mucosa; giant-cell pneumonia on microscopy. What is the most
likely diagnosis?
A. Measles
B. Scarlet fever
C. Influenza
D. Meningococcal
infection E. Typhus

22
2. A child is 4 years old, has been ill for 5 days. There are complaints of
o
cough, skin rash, to- 38,2 C, face puffiness, photophobia, conjunctivitis.
Objectively: there is bright, maculo-papulous, in some areas confluent rash
on the face, neck, upper chest. The pharynx is hyperemic. There are
seropurulent discharges from the nose. Auscultation revealed dry rales in
lungs. What is the most likely diagnosis?
A. Measles
B. Rubella C. Scarlet fever
D. Adenoviral infection E. Enterovirus exanthema

3. A child, aged 4, has being ill for 5 days, suffers from cough, skin rash, t0-
38,2 °C, facial hydropy, photosensitivity, conjunctivitis. On the face, neck,
upper part of the chest there is bright maculopapular rash with areas of
merging. Hyperemic throat. Seropurulent nasal discharge. In lungs there are
dry crackles. What is the most probable preliminary diagnosis?
A. Measles
B. Rubella C. Scarlet fever
D. Adenovirus infection E. Enterovirus exanthema

4. Such presentations as catarrhal conjunctivitis, pharyngitis, laryngotracheo-

bronchitis, white spots on the buccal mucosa in the region of lower premolar
teeth, maculopapular rash on face, body and extremities are typical for the
following disease:
A. Measles
B. Spotted fever C. Scarlet fever
D. Meningococcal infection
E. Influenza

5. A 7 year old child had an acute onset of disease. Pediatrician stated that
mucous membrane of face is hyperemic and covered with a lot of mucus.
Mucous membrane of cheeks has whitish stains. Next day the child’s skin of
face, neck, body was covered with coarsely-papular rash. What disease may
be presumed?
A. Measles
B. Scarlet fever C. Diphteria
D. Meningococcemia E. Allergic dermatitis

6. There is a 7-year-old child with complains of cough, lacrimation, rhinitis,

o
skin rash, photophobia and three-day-long fever as high as 38 C. Physical
examination has revealed the following: conjunctivitis; bright red
maculopapular rash covering the skin of face, neck and torso; hyperemic
pharynx; serous purulent secretions from the nose; dry rales in the lungs.
What is the most probable diagnosis?
A. Measles
B. Scarlet fever C. Rubella
D. Adenovirus infection
E. Chicken pox
23
7. A 5-year-old child developed an acute disease starting from body
o
temperature rise up to 38,5 C, running nose, cough and conjunctivitis. On the
4th day the child presented with maculo-papular rash on face. Body
o
temparature rose again up to 39,2 C. Over the next few days the rash spread
over the whole body and extremities. Mucous membrane of palate was
hyperemic, there was whitish deposition on cheek mucous membrane next to
molars. What is your provisional diagnosis?
A. Measles B. Acute viral respiratory infection
C. Yersinia D. Rubella E. Enterovirus diseases

8. A 3 year old child has been suffering from fever, cough, coryza,
conjunctivitis for 4 days. He has been taking sulfadimethoxine. Today it has
o
fever up to 39 C and maculopapular rash on its face. Except of rash the
child’s skin has no changes. What is your diagnosis?
A. Measles
B. Allergic rash C. Rubella
D. Scarlet fever E. Pseudotuberculosis
9. Blood serum of a newborn contains antibodies to measles virus. What kind
of immunity is this indicative of?
A. Natural passive
B. Natural active C. Artificial passive
D. Artificial active E. Heredoimmunity

24
10. Examination of a child who has recently recovered from measles revealed
in the soft tissues of cheeks and perineum some inaccurate, edematic, red-
and-black, slightly fluctuating areas. What complication is it?
A. Humid gangrene B. Dry gangrene
C. Gas gangrene D. Pressure sore E. Trophic ulcer
11. A 6 year old child was delivered to the hospital because of measles
pneumonia. On the mucous membrane of a cheek a dentist revealed an ill-
defined greish area 2х2,5 cm large. Soft tissues are edematic and foul-
smelling. The most probable diagnosis of the dentist should be:
A. Noma B. Gangrenous stomatitis
C. Pustular stomatitis D. Phlegmonous stomatitis
E. Ulcerous stomatitis
Rubella virus
1. A 2 y.o. girl has been ill for 3 days. Today she has low–grade fever, severe
catarrhal symptoms, non-abundant maculopapular rash on her buttocks and
enlarged occipital glands. What is your diagnosis?
A. Rubella
B. Scarlet fever
C. Measles
D. Adenoviral infection
E. Pseudotuberculosis

25
2. A pregnant woman was registered in an antenatal clinic and underwent
complex examination for a number of infections. Blood serum contained IgM
to the rubella virus. What is this result indicative of?
A. Of primary infection
B. Of a chronic process
C. The woman is healthy
D. Of exacerbation of a chronic disease
E. Of recurring infection with rubella virus

3. A pregnant woman was detected with IgM to rubella virus. An

obstetrician-gynecologist recommended therapeutic abortion due to the high
risk of teratogenic affection of the fetus. Detection of IgM was of great
importance as it is these specific immunoglobulins that:
A. Indicate recent infection
B. Penetrate placental barrier
C. Have the largest molecular weight
D. Are associated with anaphylactic reactions
E. Are the main factor of antiviral protection

4. A 36 y.o. woman is in the 12-th week of her first pregnancy. She was
treated for infertility in the past. She contacted a child who fell ill with rubella
2 days after their meeting. Woman doesn’t know if she has ever been infected
with rubella. What is the adequate tactics?
A. Monitoring of the specific IgG, IgM with the ELISA
B. Fetus wastage C. Immunoglobulin injection
D. Cyclovin prescription E. Interferon prescription

26
 Hepatitis viruses
1. A 20 y.o. patient was admitted to the hospital with complaints of having
skin and sclera icteritiousness, dark urine, single vomiting, appetite loss, body
0
temperature rise up to 38 C for 2 days. Three weeks ago he went in for
fishing and shared his dishes with friends. Objectively: the patient is flabby, t
0
- 36, 8 C, skin and scleras are icteritious, liver sticks from under the costal
margin by 3 cm, it is sensitive; spleen isn’t palpable. Urine is dark, stool is
partly acholic. What is the most probable diagnosis?
A. Virus A hepatitis
B. Leptospirosis
C. Infectious mononucleosis
D. Hemolytic anemia
E. Intestinal yersiniosis

2. A hepatitis outbreak was registered in a settlement. This episode is

connected with water factor. What hepatitis virus could have caused the
infective
outbreak in
this
settlement?
A. E
B. C
C. D
D. G
E. B

3. In a township there were registered an outbreak of hepatitis, which was

attributed to water supply. What hepatitis virus could be the cause of the
outbreak in this township?
A. Hepatitis E virus B. Hepatitis C virus C. Hepatitis D virus
D. Hepatitis G virus E. Hepatitis B virus

27
4. A patient has been admitted to the infectious diseases department for
o
malaise, fever up to 38 C, jaundice. A few months ago, the patient underwent
blood transfusion. The doctor suspected viral hepatitis B. What are the
principal methods of laboratory diagnosis of hepatitis B?
A. Serological and gene diagnostics
B. Virus isolation in cell culture and its identification by
CPE C. Detection of virions in blood by electron microscopy
D. Isolation of the virus in laboratory animals
(Nt) E. Isolation of the virus in chicken embryos

5. The donor who for a long time didn't donate the blood was investigated
with IFA method. Anti-HBs antibodies were revealed. What does positive
result of IFA in this case mean?
A. Chronic hepatitis
В B. Acute hepatitis B
C. Acute hepatitis C
D. Chronic hepatitis С E. Previous hepatitis B
6. Examination of a 27-year-old donor who had not donated blood for a long
time revealed HBs antibodies detected by ELISA method. In this case, the
positive ELISA results indicate that the donor:
A. Had hepatitis B
B. Has acute hepatitis B C.
Has acute hepatitis C D.
Has chronic hepatitis B E.
Has chronic hepatitis C
7. Immune-enzyme reaction revealed in blood serum HBs-antigen. What
disease is this antigene associated with?
A. Viral hepatitis type
B B. Viral hepatitis A
C. AIDS D. Tuberculosis E. Syphilis
8. Immune-enzyme assay has detected HBs antigen in blood serum.
What disease is it characteristic of?
A. Viral hepatitis type
B B. AIDS
C. Tuberculosis
D.Viral hepatitis type
A E. Syphilis
28
9. During surgical operation a blood transfusion was made. The blood must
be checked to find antigens of some disease. What disease is expected to be
found?
A. Viral hepatitis
B B. Viral hepatitis
A C. Adenovirus
D. Enterovirus
E. Viral hepatitis E

10. Hepatitis B is diagnosed through laboratory tests that determine the

presence of HBA-DNA in blood serum of the patient. What reference method
is applied for this purpose?
A. Polymerase chain reaction
B. Hybridization method
C. Hybridization signal amplification
method D. Ligase chain reaction method
E. ELISA
diagnostic
method

29
11. A patient has been hospitalized with provisional diagnosis of virus B
hepatitis. Serological reaction based on complementation of antigen with
antibody chemically bound to peroxidase or alkaline phosphatase has been
used for disease diagnostics. What is the name of the applied serological
reaction?
A. Immune-enzyme analysis B.
Radioimmunoassay technique C.
Immunofluorescence test
D. Bordet-Gengou test

E. Antigen-binding assay

12. Professional dentists belong to the risk group concerning professional

infection with viral hepatitis type B. Name an effective method for active
prevention of this disease among the dentists:
A. Vaccination with recombinant vaccine
B. Secure sterilization of medical
instruments C. Working with gum gloves on
D. Introduction of specific immunoglobuline
E. Introduction of interferonogenes

30
13. Dentists are at increased risk of being infected with the type B hepatitis.
What preparation should be used for reliable active prevention of this
disease?
A. Recombinant vaccine of HBsAg proteins
B. Live type B hepatitis vaccine
C. Specific immunoglobulin
D. Monoclonal HBsAg antibodies
E. Antihepatitis serum

14. In order to eliminate occupational risks dental workers underwent

vaccination. The vaccine should protect them from a viral infection, whose
pathogen may be found in blood of dental patients who had had this infection
or who are its chronic carriers. What vaccine was used?
A. Genetically engineered HBs
antigen B. Live measles vaccine
C. Inactivated hepatitis A vaccine
D. Subunit influenza vaccine
E. Anti-rabies vaccine
15. A 32 year old patient suffering from chronic viral hepatitis complains
about dull pain in the right subcostal area, nausea, dry mouth. Objectively:
liver dimensions are 13-21-11 cm (according to Kurlov), spleen is by 2 cm
enlarged, aspartate aminotransferase is 3,2 micromole/l·h, alanine
aminotransferase - 4,8 millimole/l·h. Serological study revealed HBeAg, high
concentration of DNA HBV. What drug should be chosen for treatment of
this patient?
A. α-interferon B. Acyclovir C. Remantadinum
D. Arabinoside monophosphate E. Essentiale-forte
16. It is known that infectious type B hepatitis is a systemic disease caused by
the type B hepatitis virus and characterized by a predominant liver affection.
Choose from the below given list the drugs for the etiotropic therapy of this
infection:
A. Acyclovir B. Penicillin C. Tetracycline
D. Sulfanilamides E. Fluoroquinolones

31
 HIV
1. RNA that contains AIDS virus penetrated into a leukocyte and by means of
reverse transcriptase forced a cell to synthesize a viral DNA. This process is
based upon:
A. Reverse transcription
B. Operon repression
C. Reverse translation D.
Operon depression E.
Convariant replication

2. During reproduction of some RNA-containing viruses that cause tumors in

animals, genetic information can be transmitted in the opposite direction from
the RNA to the DNA via a specific enzyme. The enzyme of reverse
transcription is called:
A. Reverse transcriptase B. DNA polymerase
C. Ligase D. Primase E. Topoisomerase
3. The examination of blood serum of a patient with immunodeficiency signs
revealed antybodies to gP120 and gP41 proteins. The presence of what
infection of this patient does it confirm?
A. НLTV-1-infection
B. TORCH-infection
C. ЕСНО-infection
D. НВV-infection
E. HIV-infection

32
4. Blood analysis of a patient showed signs of HIVinfection (human
immunodeficiency virus). Which cells does HIV-virus primarily affect?
A. Cells that contain receptor T4 (T-helpers)
B. Cells that contain receptor IgM (B-lymphocytes)
C. Specialized nervous cells (neurons)
D. Mast cells
E. Proliferating cells

5. A patient consulted an immunologist about diarrhea, weight loss within

several months, low-grade fever, enlarged lymph nodes. The doctor suspected
HIV infection. What immunocompetent cells must be studied in the first
place?
A. Helper T-lymphocytes B. Suppressor T-lymphocytes
C. B-lymphocytes D. Monocytes E. Plasma cells
6. HIV displays the highest tropism towards the following blood cells:
A. T-helpers B. T-suppressors C. T-killers
D. Thrombocytes E. Erythrocytes
7. Examination of a young man in the AIDS centre produced a positive result
of immune-enzyme assay with HIV antigens. Patient’s complaints about state
of his health were absent. What can the positive result of immune-enzyme
assay be evidence of?
A. HIV infection
B. Being ill with AIDS C. Being infected with HBV
D. Having had AIDS recently E. HBV persistence

33
8. It was revealed that T-lymphocytes were affected by HIV. Virus enzyme -
reverse transcriptase (RNA-dependent DNA polymerase) - catalyzes the
synthesis of:
A. DNA on the matrix of virus mRNA
B. Virus informational RNA on the matrix of
DNA C. DNA on virus ribosomal RNA
D. Viral DNA on DNA matrix
E. mRNA on the matrix of virus protein

9. T-lymphocytes are determined to be affected with HIV. In this case viral

enzyme reverse transcriptase (RNA-dependent DNA polymerase) catalyzes
the synthesis of:
A. DNA based on the viral RNA matrix
B.Viral DNA based on DNA matrix
C.Viral RNA based on DNA matrix
D. Viral protein based on RNA matrix
E. Informational RNA based on viral protein matrix
10. Quite often the cause of secondary immunodeficiency is an infection
involvement, when the causative agents propagate directly in the cells of
immune system and destroy it. The following diseases are characterized by:
A. Infectious mononucleosis, AIDS
B. Tuberculosis, mycobacteriosis C.
Poliomyelitis, type A hepatitis D.
Dysentery, cholera
E. Q-febris, epidemic typhus

34
11. Often the cause of secondary immunodeficiency is an infectious affection
of an organism, when agents reproduce directly in the cells of immune
system and destroy them. Specify the diseases, during which the described
above occurs:
A. Poliomyelitis, viral hepatitis A B. Q fever, typhus
C. Tuberculosis, mycobacteriosis
D. Infectious mononucleosis, AIDS E. Dysentery, cholera
12. The immunoblot detected gp120 protein in the blood serum. This protein
is typical for the following disease:
A. HIV-infectionB. Virus B hepatitisC. Tuberculosis
D. Syphilis E. Poliomyelitis
13. HIV has gp41 and gp120 on its surface interacts with target cells of an
organism. Which of the following human lymphocyte antigens is gp120
complementary bound with?
A. CD 4
B. CD 3
C. CD 8
D. CD 19
E. CD 28

14. A 26 year old manual worker complained of 3 weeks history of fevers and
fatigue, weight loss with no other symptoms. Physical findings: Temperature
o
37,6 C, Ps- 88 bpm, blood pressure 115/70mmHg, superficial lymph nodes
(occipital, submental, cervical, axillary) are enlarged, neither tender nor
painful. Rubella-like rash on the trunk and extremities. Herpes simplex
lesions on the lips. Candidosis of oral cavity. What infectious disease would
you suspect?
A. HIV infection
B. Influenza
C. Rubella D.
Infectious
mononucleosis
E. Tuberculosis

35
15. A 24 y.o. woman presents with prolonged fever, nocturnal sweating.
She’s lost weight for 7 kg during the last 3 months. She had irregular
intercourses. On examination: enlargement of all lymphaden groups,
9
hepatolienal syndrom. In blood: WBC – 2,2 x 10 /L. What is the most likely
diagnosis?
A. HIV-infectionB. Lymphogranulomatosis C. Tuberculosis
D. ChroniosepsisE. Infectious mononucleosis
16. A 35-year-old female patient has HIV at the AIDS stage. On the skin of
the lower extremities and palatine mucosa there appeared rusty red spots,
bright red nodules of various sizes. One of the nodules was taken for
histological study. It revealed a lot of randomly distributed thin-walled
vessels lined with endothelium, the bundles of spindle cells containing
hemosiderin. What kind of tumor developed in the patient?
A. Kaposi’s sarcoma
B. Hemangioma
C. Burkitt’s lymphoma
D. Lymphangioma
E. Fibrosarcoma

17. An HIV-positive patient’s cause of death is acute pulmonary

insufficiency resulting from pneumonia. Pathohistological investigation of
lungs has revealed transformed cells resemble owl’s eye. Name the
pneumonia causative agent:
A. Cytomegalovirus
B. Pneumococcus C.
Influenza virus D.
Candida fungi
E. Toxoplasma

36
18. A doctor examined a patient with recurrent aphthous stomatitis with
concominant candidosis and decided to eliminate a possibility of HIV-
infection. What examination can help to clear the situation up and make a
provisional diagnosis?
A. Immune-enzyme analysis
B. Gel precipitation reaction
C. Reaction of hemagglutination
inhibition D. Phase-contrasr microscopy
E. Reaction of hemagglutination

19. Medical examination of a 19-year-old worker revealed generalized

lymphadenopathy mainly affecting the posterior cervical, axillary and ulnar
lymph nodes. There are multiple injection marks on the elbow bend skin. The
man denies taking drugs, the presence of injection marks ascribes to influenza
12 9
treatment. Blood count: RBCs - 3,2x10 /l, Hb- 100 g/l, WBCs - 3,1x10 /l,
moderate lymphopenia. What study is required in the first place?
A. ELISA for HIV
B. Immunogram C. Sternal puncture
D. X-ray of lungs E. Lymph node biopsy
20. The 28 y.o. woman applied to doctor because of limited loss of the hair.
In the anamnesis - she had frequent headache indisposition, arthromyalgia,
fever, irregular casual sexual life, drug user. RW is negative. What
examination must be done first?
A. Examination for HIV
B. Examination for neuropathology
C. Examination for gonorrhea
D. Examination for fungi E. Examination for trichomoniasis
21. Mass serological diagnosis of HIV infection is made by means of
enzyme-linked immunosorbent assay techniques. What standard component
of the reaction must be adsorbed on the solid phase of the test system?
A. HIV antigens B. Monoclonal HIV antibodies
C. Specific immunoglobulins D. Enzyme-marked HIV antibodies
E. Substrates to determine enzyme activity
22. A doctor was addressed by a 30-year old man. There is a probability of
the patient being HIV-positive. To clarify the diagnosis the doctor proposed
to perform polymerase chain reaction. The basic process in this kind of
investigation is:
A. Gene amplification B. Transcription
C. Genetic recombination D. Genomic mutation
E. Chromosome mutation
37
Special virilogy

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FOR NOTES

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References:
1. https://testkrok.org.ua
2. https://testcentr.org.ua
3. https://www.google.com
4. www.microbiologybook.org
5. http://www.eurolab.ua
6. http://sigmadiagnosticsinc.com
7. www.who.int
8. www.medportal.ru
9. http://encephalitis.ru
10. www.infectology.ru
11. https://en.wikipedia.org

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