MCQs (with clinical case) on Monkeypox virus, infection, diagnosis and treatment - Medical microbiology

1)The first 2022 monkeypox virus outbreak occurred in Nigeria.
What are the common possible routes of transmission of the virus to humans?
Select all the correct answers:
a) Humans to humans
b) Animals to humans
c) Humans to animals
d) Animals to animals

2) Monkeypox infection has been declared a public health emergency in 2022 by the World health organization due to the worldwide spread of the virus.
According to health agencies in the USA which of the following age group are at higher risk?
a)Children 5 to 10 years old
b)Males 18 years and above     
d)Pregnant women

3)Which of the following are the common symptoms related to monkeypox infection?
a) High fever, raised skin lesions, swollen lymph nodes       
b) High fever, diarrhea, and vomiting
c) High fever, flat skin lesions, vomiting
d) High fever, seizures, and loss of appetite

4) Smallpox and monkeypox viruses come under the same genus of viruses known as orthopoxvirus.
When was the monkeypox virus first isolated and identified?
a) 1938
b) 2022
c) 1958    

5) Monkeypox virus is most prevalent in the African continent and the first case in the USA was reported in 2003. 
What was the identified source of virus transmission during the outbreak?
a) Ticks      
b) Birds
c) Contaminated water and food
d) Rodents

6) Human to human monkeypox virus transmission can occur by which of the following routes?
Select all the correct answers:
a) Respiratory droplets        
b) Exposure to skin rashes     
c) Mosquito bites
d) Overuse of drugs

7) What is the typical timeframe for the skin blisters or nodules to start diminishing during Monkeypox infection?
a) 2- 5 days
b) 2- 3 weeks     
c) 1 week
d) 3- 5 weeks

8) All of the following are the primary characteristics of the monkeypox virus, Except?
a) It is a double-stranded DNA virus
b) The infection by the virus is a zoonotic infection
c) Human transmission occurs only through close contact with infected monkeys     
d) The smallpox vaccine is effective against the monkeypox virus

9) Which of the following antiviral drug regimen has been found to be effective and was approved by the FDA in 2018 for the monkeypox virus?
a) Remdesivir for 10 days
b) Tamiflu for 5 weeks
c) Brincidofoir for 4 weeks
d) Ticovarimat for 2 weeks    

10) Which of the following specimen is frequently collected for the diagnosis of the monkeypox virus infection?
a) Blood specimen  
b) Lesion swab specimen 
c) Sputum specimen
d) Urine specimen

11) A 37 year old forest ranger visits a local healthcare facility with fever, rash, and swollen lymph nodes. He has been exposed to wildlife for the past 6 months in tropical rainforest region.The patient reports the symptoms first started about a week ago with with high fever (101.5°F) chills that was followed by rashes on his face and extremities which first started as raised papules. 
He complains of severe pain in the axillary (armpit) lymph nodes, which have become visibly swollen.

Upon examination, skin rashes with pustules on the face, arms, and legs, some of the rashes have become ulcerated. Lymph nodes are enlarged, and tender, no other significant physical findings are reported.Vesicular rash with pustules is consistent with a poxvirus infection. 
For the diagnosis of Monkeypox virus infection, Polymerase Chain Reaction (PCR) testing of a skin lesion sample is conducted to detect the presence of monkeypox virus DNA.

Which of the following symptoms is NOT commonly associated with monkeypox infection?
a) Fever
b) Enlarged and tender lymph nodes
c) Respiratory distress
d) Vesicular rash with pustules

12) What is the incubation period of monkeypox in humans?
a) 1-2 days
b) 1-2 weeks
c) 2-4 weeks
d) 4-6 months

Multiple choice answers:
1. a) Humans to humans, b) Animals to humans, c) Humans to animals, and d) animals to animals
2. b)Males 18 years and above  
3. a) High fever, raised skin lesions, swollen lymph nodes   
4. c)1958
5. d)Rodents
6. a) Respiratory droplets, and b) Exposure to skin rashes     
7. b) 2-3 weeks
8. c) Human transmission occurs only through close contact with infected monkeys  
9. d) Ticovarimat for 2 weeks  
10. b) Lesion swab specimen  
11. c) Respiratory distress
12. b) 1-2 weeks

May 2022 Global Outbreak

"In May 2022, an unprecedented global outbreak of mpox (formerly known as monkeypox) was detected. Cases in the United States increased rapidly, peaking in August 2022. This outbreak of mpox is still ongoing and is different from past outbreaks because it is primarily spread through sexual contact.

CDC lab experts have found at least two variants of mpox virus circulating in this outbreak. Both variants share common ancestors with strains present in Nigeria since 2017. It is likely that there were at least two separate events where the mpox virus spread from animals to people in Nigeria, and then began to spread person-to-person through close contact." (Reference: