General+ Bacteriology Microbiology MCQs
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Apr 17, 2020
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About This Presentation
Chapter Wise MCQs
Slide Content
REVIEW QUESTIONS
1. Which one of the following terms characterizes the interaction
between herpes simplex virus and a human?
(A) Parasitism
(B) Symbiosis
(C) Endosymbiosis
(D) Endoparasitism
(E) Consortia
2. Which one of the following agents lacks nucleic acid?
(A) Bacteria
(B) Viruses
(C) Viroids
(D) Prions
(E) Protozoa
3. Which one of the following is a prokaryote?
(A) Bacteria
(B) Algae
(C) Protozoa
(D) Fungi
(E) Slime molds
4. Which one of the following agents simultaneously contains
both DNA and RNA?
(A) Bacteria
(B) Viruses
(C) Viroids
(D) Prions
(E) Plasmids
5. Which of the following cannot be infected by viruses?
(A) Bacteria
(B) Protozoa
C) Human cells
D) Viruses
E) None of the above
(
(
(
1. Which one of the following terms characterizes the interaction
between herpes simplex virus and a human?
(A) Parasitism
(B) Symbiosis
(C) Endosymbiosis
(D) Endoparasitism
(E) Consortia
2. Which one of the following agents lacks nucleic acid?
(A) Bacteria
(B) Viruses
(C) Viroids
(D) Prions
(E) Protozoa
3. Which one of the following is a prokaryote?
(A) Bacteria
(B) Algae
(C) Protozoa
(D) Fungi
(E) Slime molds
4. Which one of the following agents simultaneously contains
both DNA and RNA?
(A) Bacteria
(B) Viruses
(C) Viroids
(D) Prions
(E) Plasmids
5. Which of the following cannot be infected by viruses?
(A) Bacteria
(B) Protozoa
C) Human cells
D) Viruses
E) None of the above
(
(
(
6. Viruses, bacteria, and protists are uniquely characterized by
heir respective size, True or false?
A) True
(B) False
Quorum sensing in prokaryotes involves
A) Cell-cell communication
B) Production of molecules such as AHI
(C) An example of multicellular behavior
tion of genes involved in diverse physiologic
processes
E) All of the above
A 16-year-old female patient presented to her family physi
a complaint of an abnormal vaginal discharge and
pruritus (itching). The patient denied having sexual activity
and recently completed a course of doxycycline for the treat:
ment of her acne. An examination of a Gram-stained vaginal
smear revealed the presence of Gram-positive oval cells about
4-8 um in diameter. Her vaginitis is caused by which of the
following agents?
(A) Bacterium
(B) Virus
(©) Protozoa
(D) Fungus
(E) P
A 65-year-old man develops dementia, progressive over several
months, along with ataxia and somnolence. An electroencepha-
lographic pattern shows paroxysms with high voltages and slow
waves, suggestive of CJD. By which of the following agents is
this disease caused?
(A) Bac
(8) Virus
(C) Viroid
(D) Prion
(E) Plasmid
Twenty minutes after ingesting a raw clam, a 35-year-old man
experiences paresthesias of the mouth and extremities, head:
che, and ataxia, These symptoms are the result ofa neurotoxin
produced by algae called
Ay Amos
(B) Blue-green algae
(©) Dinoflagellates
(D) Kelp
(E) None of the above
heir respective size, True or false?
A) True
(B) False
Quorum sensing in prokaryotes involves
A) Cell-cell communication
B) Production of molecules such as AHI
(C) An example of multicellular behavior
tion of genes involved in diverse physiologic
processes
E) All of the above
A 16-year-old female patient presented to her family physi
a complaint of an abnormal vaginal discharge and
pruritus (itching). The patient denied having sexual activity
and recently completed a course of doxycycline for the treat:
ment of her acne. An examination of a Gram-stained vaginal
smear revealed the presence of Gram-positive oval cells about
4-8 um in diameter. Her vaginitis is caused by which of the
following agents?
(A) Bacterium
(B) Virus
(©) Protozoa
(D) Fungus
(E) P
A 65-year-old man develops dementia, progressive over several
months, along with ataxia and somnolence. An electroencepha-
lographic pattern shows paroxysms with high voltages and slow
waves, suggestive of CJD. By which of the following agents is
this disease caused?
(A) Bac
(8) Virus
(C) Viroid
(D) Prion
(E) Plasmid
Twenty minutes after ingesting a raw clam, a 35-year-old man
experiences paresthesias of the mouth and extremities, head:
che, and ataxia, These symptoms are the result ofa neurotoxin
produced by algae called
Ay Amos
(B) Blue-green algae
(©) Dinoflagellates
(D) Kelp
(E) None of the above
Answers
REVIEW QUESTIONS
1. A 22-year-old man presents with a painle
shaft of his penis. Inguinal lymphadenopathy is
ding drugs for sex and has several sexual part
1-cm ulcer on the
present. The
patient admits t
ners. An RPR test result is positive, and syphilis is suspected;
however, a Gram-stain of a swab specimen from the ulcer shows
no bacteria. T. pallidum, the causative agent of syphilis, cannot
be visualized by light microscopy because
(A) It is transparent.
(B) It cannot be stained by ordinary stains.
(C) It has a diameter of less than 0.2 pm
(D) The wavelength of white light is too long
(E) Rapid movement of the organism prevents visualization.
1. A 22-year-old man presents with a painle
shaft of his penis. Inguinal lymphadenopathy is
ding drugs for sex and has several sexual part
1-cm ulcer on the
present. The
patient admits t
ners. An RPR test result is positive, and syphilis is suspected;
however, a Gram-stain of a swab specimen from the ulcer shows
no bacteria. T. pallidum, the causative agent of syphilis, cannot
be visualized by light microscopy because
(A) It is transparent.
(B) It cannot be stained by ordinary stains.
(C) It has a diameter of less than 0.2 pm
(D) The wavelength of white light is too long
(E) Rapid movement of the organism prevents visualization.
Chloramphenisol, a anubioti that inhibits bacterial protein
rss, wil also affect which of the following eukaryotic
organi
(A) Mitochond
B) Gol complex
(E) Nuclear membrane
Which ofthe following structures isnot part of the bacterial
callenneop
roup of tenagers became il with nausea, vomiting, se
hospitalized with hemolyic-uremic syndrome oli O15
‘rat olted for the patients tos as well from unco
Thamburges. The 157 refer to which bacterial structure?
(A) Lipoplysacchard
(© Flag
Which of he following components is present in Gram-negative
bacteria but aot in Gram postive bacteria
Group A strptococ ae the most common bacterial cause of
important cell component involved in adherence ofthis bac
(A) Capsute
(©) Flgal
In the fall of 2001, a series of les containing spores of
amas, party ateibutable to ther dehydrated sae and
(8) Glutamic aid
Silthydeyt containing proteins
ipid A
(a) Haplol
8) Diplo
rss, wil also affect which of the following eukaryotic
organi
(A) Mitochond
B) Gol complex
(E) Nuclear membrane
Which ofthe following structures isnot part of the bacterial
callenneop
roup of tenagers became il with nausea, vomiting, se
hospitalized with hemolyic-uremic syndrome oli O15
‘rat olted for the patients tos as well from unco
Thamburges. The 157 refer to which bacterial structure?
(A) Lipoplysacchard
(© Flag
Which of he following components is present in Gram-negative
bacteria but aot in Gram postive bacteria
Group A strptococ ae the most common bacterial cause of
important cell component involved in adherence ofthis bac
(A) Capsute
(©) Flgal
In the fall of 2001, a series of les containing spores of
amas, party ateibutable to ther dehydrated sae and
(8) Glutamic aid
Silthydeyt containing proteins
ipid A
(a) Haplol
8) Diplo
(C) Circular
(D) Nucleoid
(E) Feulgen positive
9. Lysozyme cleaves the B1->4 linkage between
(A) p-Alanine and the pentaglycine bridge
(B) N-Acetylmuramic acid and p-alanine
(C) Lipid A and KDO
(D) N-Acetylmuramic acid and N-acetylglucosamine
(E) D-Alanine and p-alanine
10
Mycoplasma species lack which of the following components?
(A) Ribosomes
(B) Plasma membrane
(C) Both DNA and RNA
(D) Lipids
(E) Peptidoglycan
Puan
wow
Ss
‘canned with CamScann
(D) Nucleoid
(E) Feulgen positive
9. Lysozyme cleaves the B1->4 linkage between
(A) p-Alanine and the pentaglycine bridge
(B) N-Acetylmuramic acid and p-alanine
(C) Lipid A and KDO
(D) N-Acetylmuramic acid and N-acetylglucosamine
(E) D-Alanine and p-alanine
10
Mycoplasma species lack which of the following components?
(A) Ribosomes
(B) Plasma membrane
(C) Both DNA and RNA
(D) Lipids
(E) Peptidoglycan
Puan
wow
Ss
‘canned with CamScann
REVIEW QUESTIONS
. Eubacteria that lack cell walls and do not synthesize the precur-
sors of peptidoglycan are called
(A) Gram-negative bacteria
(B) Virus
(C) Mycoplasmas
(D) Serovar
(E) Bacilli
. Eubacteria that lack cell walls and do not synthesize the precur-
sors of peptidoglycan are called
(A) Gram-negative bacteria
(B) Virus
(C) Mycoplasmas
(D) Serovar
(E) Bacilli
Archaebacteria can be distinguished from eubacteria by thei
lack of
(5) RNA
Ribosomes
(D) Peptidoglycan
(E) Nucleus
À 16-year-old eystic fibrosis patient is admitted to the hospital. A
spatum culture yields Burkholder cepacia, Subsequently, there are
two other patients with R cepacia bacteremia, and the organism cul
tured from the sputum of four addtional patients During this oso
mia outbreak of B cepacia, 50 environmental and 7 patient isolates
arebeing subtyped to identify the source ofthe outbreak, Which ofthe
following techniques would be mos useful inthis endeavor
1) Ribotyping
(©) 16S RNA sequencing
Antimicrobial susceptibility testing
E) Nucleicacid sequencing
An unculturable Gram-positive microorganism has been visu
alized in issue specimens obtained from patients with a previ
‘ously undescribed disease. Which of the following techniques
would be most useful in identifying this organism
A) Serology
(5) PCR amplification and sequencing of RNA genes
(C) Multilocus VNTR analysis
(D) SDS. polyacrylamide gel electrophoresis
E) PEGI
The DNA polymerase from T aguaticus is an important compo
nent of DNA amplification methods suchas the PCR, This organ
ism can grow at temperatures above 100°C, Organisms that are
capable of growth at these temperatures are referred to as
(6) Psjchrophiles
philes
(D) Thermophiles
E) Chemolihotroph
A bacterium with a genome having a G + C content of 45% har
bors a plasmid encoding a gene with a G + C content of
Which one ofthe following conclusions could be drawn?
(A) This gene codes for a cell wall peptidyl tra
(B) This gene codes for a critical bacterial eytochr
(C) This gene codes fora unique transfer RNA,
(D) ‘Thisgene codes foraphsmid RNA-dependent DNA-polymerase
(E) This gene codes for an antigenically diverse capsular
polysaccharide
lack of
(5) RNA
Ribosomes
(D) Peptidoglycan
(E) Nucleus
À 16-year-old eystic fibrosis patient is admitted to the hospital. A
spatum culture yields Burkholder cepacia, Subsequently, there are
two other patients with R cepacia bacteremia, and the organism cul
tured from the sputum of four addtional patients During this oso
mia outbreak of B cepacia, 50 environmental and 7 patient isolates
arebeing subtyped to identify the source ofthe outbreak, Which ofthe
following techniques would be mos useful inthis endeavor
1) Ribotyping
(©) 16S RNA sequencing
Antimicrobial susceptibility testing
E) Nucleicacid sequencing
An unculturable Gram-positive microorganism has been visu
alized in issue specimens obtained from patients with a previ
‘ously undescribed disease. Which of the following techniques
would be most useful in identifying this organism
A) Serology
(5) PCR amplification and sequencing of RNA genes
(C) Multilocus VNTR analysis
(D) SDS. polyacrylamide gel electrophoresis
E) PEGI
The DNA polymerase from T aguaticus is an important compo
nent of DNA amplification methods suchas the PCR, This organ
ism can grow at temperatures above 100°C, Organisms that are
capable of growth at these temperatures are referred to as
(6) Psjchrophiles
philes
(D) Thermophiles
E) Chemolihotroph
A bacterium with a genome having a G + C content of 45% har
bors a plasmid encoding a gene with a G + C content of
Which one ofthe following conclusions could be drawn?
(A) This gene codes for a cell wall peptidyl tra
(B) This gene codes for a critical bacterial eytochr
(C) This gene codes fora unique transfer RNA,
(D) ‘Thisgene codes foraphsmid RNA-dependent DNA-polymerase
(E) This gene codes for an antigenically diverse capsular
polysaccharide
REVIEW QUESTIONS
1
A 23-year-old woman has 10 E. coli introduced into her blad-
der while having sex. This organism has a generation time
of 20 minutes. After a lag of 20 minutes, the E. coli enter the
logarithmic phase of growth. After 3 hours, the total number
of cells is
(A) 2056
(B) 5012
(©) 90
(D) 1028
(E) 1,000,000
A 73-year-old woman is admitted to the hospital for intrave-
nous treatment of an abscess caused by Staphylococcus aureus.
Subsequent to her treatment and discharge from the hospital, it
is necessary to disinfect the hospital room. One thousand of the
S. aureus cells are exposed to a disinfectant. After 10 minutes,
90% of the cells are killed. How many cells remain viable after
20 minutes?
(A) 500
(B) 100
©) 10
(D) 1
(E) 0
The action of which of the following agents or processes on
non-spore forming bacteria can be reversed?
(A) A disinfectant
(B) A bactericidal agent
(C) Abacteriostatic agent
(D) Autoclaving at 121°C for 15 minutes
(E) Dry heat at 160-170°C for I hour
The growth rate of bacteria during the exponential phase of
growth is
(A) Zero
(B) Increasing
(C) Constant
(D) Decreasing
(E) Negative
1
A 23-year-old woman has 10 E. coli introduced into her blad-
der while having sex. This organism has a generation time
of 20 minutes. After a lag of 20 minutes, the E. coli enter the
logarithmic phase of growth. After 3 hours, the total number
of cells is
(A) 2056
(B) 5012
(©) 90
(D) 1028
(E) 1,000,000
A 73-year-old woman is admitted to the hospital for intrave-
nous treatment of an abscess caused by Staphylococcus aureus.
Subsequent to her treatment and discharge from the hospital, it
is necessary to disinfect the hospital room. One thousand of the
S. aureus cells are exposed to a disinfectant. After 10 minutes,
90% of the cells are killed. How many cells remain viable after
20 minutes?
(A) 500
(B) 100
©) 10
(D) 1
(E) 0
The action of which of the following agents or processes on
non-spore forming bacteria can be reversed?
(A) A disinfectant
(B) A bactericidal agent
(C) Abacteriostatic agent
(D) Autoclaving at 121°C for 15 minutes
(E) Dry heat at 160-170°C for I hour
The growth rate of bacteria during the exponential phase of
growth is
(A) Zero
(B) Increasing
(C) Constant
(D) Decreasing
(E) Negative
A physician obtains a sputum specimen from a patient sue
Mycobacterium tuberculosis, an organiem with a
ig ive in vitro o 48 hours which coresponds toa growth
rate constant (4) in vitro of 0.04. Estimating that the bio
mas of this single myeobacterial organism is 2.3 10" and
ascuming that this organism Is immediately going to enter
phase growth, how many hours wll it tke to produce 10* gf
400 hours
A specinen of pasteurized goat's milk i culture forthe pre
A) Bacteria the milk were ible but nt culivatabl
0) Incomplete pasterization ofthe milk
(©) The organisms inthe milk were in the lag phase when
1) The milk contained a high concentration of bactericidal
antibiotic when ested
0) There was post-test contamination ofthe milk
Working asa medical missionary in rural India you spray the
umbilicus ofa newly born infaa witha solution containing the
‘chemical structure in he associated figure to prevent tl
aus infection, Which class chemical agent does this structure
(0) Aleohl class
B) Aldehyde class
(©) Bisphenol clas
(9) Quaternary ammonium cs
Your superior requests that you tele some surgical instr
ments. Which one ofthe following agents would you use?
(A) Benzoic acid 2%)
(8) Isoprapylalchal 2
(©) Giutarldehyde (2
(D) Hydrogen peroxide 0%)
(E) Quaternary ammonium compound (2%)
The growth rate of bacteria during the maximum stationary
phaseof growth is
(a) ze
Decrcsing
Mycobacterium tuberculosis, an organiem with a
ig ive in vitro o 48 hours which coresponds toa growth
rate constant (4) in vitro of 0.04. Estimating that the bio
mas of this single myeobacterial organism is 2.3 10" and
ascuming that this organism Is immediately going to enter
phase growth, how many hours wll it tke to produce 10* gf
400 hours
A specinen of pasteurized goat's milk i culture forthe pre
A) Bacteria the milk were ible but nt culivatabl
0) Incomplete pasterization ofthe milk
(©) The organisms inthe milk were in the lag phase when
1) The milk contained a high concentration of bactericidal
antibiotic when ested
0) There was post-test contamination ofthe milk
Working asa medical missionary in rural India you spray the
umbilicus ofa newly born infaa witha solution containing the
‘chemical structure in he associated figure to prevent tl
aus infection, Which class chemical agent does this structure
(0) Aleohl class
B) Aldehyde class
(©) Bisphenol clas
(9) Quaternary ammonium cs
Your superior requests that you tele some surgical instr
ments. Which one ofthe following agents would you use?
(A) Benzoic acid 2%)
(8) Isoprapylalchal 2
(©) Giutarldehyde (2
(D) Hydrogen peroxide 0%)
(E) Quaternary ammonium compound (2%)
The growth rate of bacteria during the maximum stationary
phaseof growth is
(a) ze
Decrcsing
10. Chemical agents can interfere with the normal reaction between a
specific enzyme and its substrate (chemical antagonism). Which
one of the following inhibits energy-yielding cellular processes?
A)
B)
)
)
5-Methyltryptophan
nide
Hydrogen peroxide
Ethanol
) Lysozyme
(a
€
(€
(D
(E)
11. Which of the following is the most resistant to destruction by
chemicals and heat?
(A) Spores of Aspergillus fumigatus
(B) Mycobacterium tuberculosis
(C) Ebola virus
(D) E. coli
(E) Spores of Bacillus anthrac
Answers
LA 5. C 9.
2. C 6. À 10.
3. FA 11.
4. 8.
specific enzyme and its substrate (chemical antagonism). Which
one of the following inhibits energy-yielding cellular processes?
A)
B)
)
)
5-Methyltryptophan
nide
Hydrogen peroxide
Ethanol
) Lysozyme
(a
€
(€
(D
(E)
11. Which of the following is the most resistant to destruction by
chemicals and heat?
(A) Spores of Aspergillus fumigatus
(B) Mycobacterium tuberculosis
(C) Ebola virus
(D) E. coli
(E) Spores of Bacillus anthrac
Answers
LA 5. C 9.
2. C 6. À 10.
3. FA 11.
4. 8.
QUESTIONS
¡ol ATP production withthe transfer o electrons
The reduction of oxygen
Substrate phosphorylation
major elect ofa temperature of 60°C on the growth
Destroy Ihe
Denatare proteins
merization of bling blocks e
ieee le prota) sache
A) Delydrati:
(6) Reduction
(D) Asimilation
©) Hydrobas
A sra of E.coli does not require vitamins when grown
provided in the media
Which of the following is NOT a mechanism for generating
() Protein synthesis
(©) Photosynthesis
‘Which ofthe following terms best describes am
A) Neutraop
(8) Payehrotroph
(©) Mesophile
(©) Osmophie
ability to asii N, eductively via NH, call
(8) Anammox
¡ol ATP production withthe transfer o electrons
The reduction of oxygen
Substrate phosphorylation
major elect ofa temperature of 60°C on the growth
Destroy Ihe
Denatare proteins
merization of bling blocks e
ieee le prota) sache
A) Delydrati:
(6) Reduction
(D) Asimilation
©) Hydrobas
A sra of E.coli does not require vitamins when grown
provided in the media
Which of the following is NOT a mechanism for generating
() Protein synthesis
(©) Photosynthesis
‘Which ofthe following terms best describes am
A) Neutraop
(8) Payehrotroph
(©) Mesophile
(©) Osmophie
ability to asii N, eductively via NH, call
(8) Anammox
10.
(D) Deamination
(E) Nitrogen fixation
. Which of the following is NOT assimilated by eukaryotic cells?
(A) Glucos:
(B) Lactate
(©) Sulfate (SO?)
(D) Nitrogen (N,)
(E) Phosphate (PO *-)
Bacteria that are obligate intracellular pathogens of humans
(eg, Chlamydia trachomatis) are considered to be
(A) Autotrophs
(B) Photosynthetic
(C) Chemolithotrophs
(D) Hyperthermophiles
(E) Heterotrophs
‘canned with CamScann
(D) Deamination
(E) Nitrogen fixation
. Which of the following is NOT assimilated by eukaryotic cells?
(A) Glucos:
(B) Lactate
(©) Sulfate (SO?)
(D) Nitrogen (N,)
(E) Phosphate (PO *-)
Bacteria that are obligate intracellular pathogens of humans
(eg, Chlamydia trachomatis) are considered to be
(A) Autotrophs
(B) Photosynthetic
(C) Chemolithotrophs
(D) Hyperthermophiles
(E) Heterotrophs
‘canned with CamScann
/ QU
1. The synthesis of which of the following cell components is
dependent on a template?
(A) Lipopolysaccharide
(B) Peptidoglycan
(C) Capsular polysaccharide
(D) Deoxyribonucleic acid
(E) Phospholipids
»
. The synthesis of which of the following cell components is
determined entirely by enzyme specificities?
(A) DNA
(B) Ribosomal RNA
(C) Flagella
(D) Lipopolysaccharide
(E) Protein
‘canned with CamScann
1. The synthesis of which of the following cell components is
dependent on a template?
(A) Lipopolysaccharide
(B) Peptidoglycan
(C) Capsular polysaccharide
(D) Deoxyribonucleic acid
(E) Phospholipids
»
. The synthesis of which of the following cell components is
determined entirely by enzyme specificities?
(A) DNA
(B) Ribosomal RNA
(C) Flagella
(D) Lipopolysaccharide
(E) Protein
‘canned with CamScann
Amino acid are found i the protein peptidoglycan, and cap
ule of bacteria, Which ofthe flowing amino acids is fou
18) None ofthe above
he abit to use compounds and ions other than oxygen at
his capaciy called
(©) Anserblerspraion
he primary route of carbon assimilation used by organismo
ha an use CO, asa sol source of carbon is
A) Hesse monophosphate shun
(©) Embden-Meyerhof pathway
(D) Glyoryiae cyte
he pepidogycan bosynthti pathway isof particular impor
ance in medicine because provides a basis for selective ant
sceial action of several chemotherapeutic agents, All ofthe
allowing anubioucs inhib steps in pepedoglyean bosynthe
() Vancomycin
1 regulation of enzyme activity provides fine contro of
aboli pathways. Which ofthe following regulatory mecha
A) Catabolte represion
(©) Feedback inhibition
he biosynthetic origin of building blocks and cocnzymes can
traced back orate called focal mtb
(B) Onaloacetate
(©) Phosphoenaippru
ule of bacteria, Which ofthe flowing amino acids is fou
18) None ofthe above
he abit to use compounds and ions other than oxygen at
his capaciy called
(©) Anserblerspraion
he primary route of carbon assimilation used by organismo
ha an use CO, asa sol source of carbon is
A) Hesse monophosphate shun
(©) Embden-Meyerhof pathway
(D) Glyoryiae cyte
he pepidogycan bosynthti pathway isof particular impor
ance in medicine because provides a basis for selective ant
sceial action of several chemotherapeutic agents, All ofthe
allowing anubioucs inhib steps in pepedoglyean bosynthe
() Vancomycin
1 regulation of enzyme activity provides fine contro of
aboli pathways. Which ofthe following regulatory mecha
A) Catabolte represion
(©) Feedback inhibition
he biosynthetic origin of building blocks and cocnzymes can
traced back orate called focal mtb
(B) Onaloacetate
(©) Phosphoenaippru
10. Which of the following is NOT a component of peptidoglycan?
(A) N-Acetyl muramic acid
(B) N-Acetyl glucosamine
(C) Lipid A
(D) Pentaglycine
(E) Diaminopimelic acid
11. Which of these pathways gives a cell the potential to produce
TP?
the most /
(A) TCA cycle
(B) Pentose phosphate pathway
(C) Glycolysis
(D) Lactic acid fermentation
(E) Entner-Doudoroff pathway
12. During the process of oxidative phosphorylation, the energy of
the proton motive force is used to generate
(A) NADH
(B) ADP
(C) NADPH
(D) Acetyl CoA
¢
E) ATP
Answers
1. D 2G 3. E
2.D 6. E 10. €
3. C 7 D 1..A
4. B 8. C 12. E
carnes with canscomer
(A) N-Acetyl muramic acid
(B) N-Acetyl glucosamine
(C) Lipid A
(D) Pentaglycine
(E) Diaminopimelic acid
11. Which of these pathways gives a cell the potential to produce
TP?
the most /
(A) TCA cycle
(B) Pentose phosphate pathway
(C) Glycolysis
(D) Lactic acid fermentation
(E) Entner-Doudoroff pathway
12. During the process of oxidative phosphorylation, the energy of
the proton motive force is used to generate
(A) NADH
(B) ADP
(C) NADPH
(D) Acetyl CoA
¢
E) ATP
Answers
1. D 2G 3. E
2.D 6. E 10. €
3. C 7 D 1..A
4. B 8. C 12. E
carnes with canscomer
STIONS
Mutations in bacteria can occur by which of the following
mechanisms?
(A) Base substitutions
(B) Deletions
(©) Insertions
(D) Rearrangements
(E) All of the above
he form of genetic exchange in which donor DNA is introduced
1o the recipient by a bacterial virus is
(A) Transformation
(8) Conjugation
(C) Transfection
(D) ‘Transduction
(E) Horizontal transfer
he enzyme DNAse degrades naked DNA. If two strains of
bacteria from the same species were mixed in the presence of
DNAse, which method of gene transfer would be the most likely
hibited?
(A) Conjugation
(B) Transduction
(C) Transformation
(D) Transposition
(E) Allof the above
Replication of which of the following requires physical integra:
tion with a bacterial replicon?
(A) Single-stranded DNA bacteriopha
(B) Double-stranded DNA bacterioph
(C) Single-stranded RNA bacteriophage
(D) Plasm
(E) ‘Transposon
he formation ofa mating pair during the process of conjugation
n En coli requires
(A) Lysis of the done:
(B) A sex pilus
(C) Transfer of both strands of DNA
(D) A restriction endonuclease
(E) Integration of a transposon
Why do bacteria contain restriction enzymes?
(A) To cleave RNA for incorporation into ribosome
(8) To extend the length of bacterial chromosomes
(©) To prevent foreign DNA from incorporating into a bacterial
(D) To process the exons from prokaryotic mRNA
(E) To proteolytically cleave nuclear promoters
Mutations in bacteria can occur by which of the following
mechanisms?
(A) Base substitutions
(B) Deletions
(©) Insertions
(D) Rearrangements
(E) All of the above
he form of genetic exchange in which donor DNA is introduced
1o the recipient by a bacterial virus is
(A) Transformation
(8) Conjugation
(C) Transfection
(D) ‘Transduction
(E) Horizontal transfer
he enzyme DNAse degrades naked DNA. If two strains of
bacteria from the same species were mixed in the presence of
DNAse, which method of gene transfer would be the most likely
hibited?
(A) Conjugation
(B) Transduction
(C) Transformation
(D) Transposition
(E) Allof the above
Replication of which of the following requires physical integra:
tion with a bacterial replicon?
(A) Single-stranded DNA bacteriopha
(B) Double-stranded DNA bacterioph
(C) Single-stranded RNA bacteriophage
(D) Plasm
(E) ‘Transposon
he formation ofa mating pair during the process of conjugation
n En coli requires
(A) Lysis of the done:
(B) A sex pilus
(C) Transfer of both strands of DNA
(D) A restriction endonuclease
(E) Integration of a transposon
Why do bacteria contain restriction enzymes?
(A) To cleave RNA for incorporation into ribosome
(8) To extend the length of bacterial chromosomes
(©) To prevent foreign DNA from incorporating into a bacterial
(D) To process the exons from prokaryotic mRNA
(E) To proteolytically cleave nuclear promoters
7. If the arrangement of bases on the coding D strand is
“CATTAG”, then a corresponding strand of mRNA will be
(A)
(B) SC
(C) *
“CATTAG”, then a corresponding strand of mRNA will be
(A)
(B) SC
(C) *
REVIEW QUESTIONS
1. Which of the following characteristics does not apply to adap-
tive immunity?
(A) Highly antigen specific
(B) Induces memory
(C) Rapid, immediate response
(D) Induces cytokine production
NK cells contribute to innate immunity in all of the following
ways except:
(A) Killing virus infected cells
(B) Killing tumor cells
(C) Inducing IFN-gamma production
(D) Participate in antibody-dependent cellular cytotoxicity
(ADCO)
(E) Initiating antigen presentation
3. As part of the innate immune response, which cells participate
in phagocytosis?
(A) Macrophages and mast cells
(B) Macrophages and plasma cells
(C) NK cells and neutrophils
(D) Macrophages and neutrophils
(E) T cells and mast cells
4. The immunoglobulin class most frequently responsible for
inhibition of bacteria on mucosal surfaces is:
(A) IgG
(B) IgM
(©) IgA
(D) IgE
(E) IgD
5. Which of the following properties is associated with MHC?
(A) Binds peptide antigen and presents it to T cells
(B) Binds virus particles and neutralizes the virus
(C) Binds LPS and interferes with bacterial phagocytosis
(D) Binds self-antigens and presents them to NK cells
‘Scanned with CamScanner
1. Which of the following characteristics does not apply to adap-
tive immunity?
(A) Highly antigen specific
(B) Induces memory
(C) Rapid, immediate response
(D) Induces cytokine production
NK cells contribute to innate immunity in all of the following
ways except:
(A) Killing virus infected cells
(B) Killing tumor cells
(C) Inducing IFN-gamma production
(D) Participate in antibody-dependent cellular cytotoxicity
(ADCO)
(E) Initiating antigen presentation
3. As part of the innate immune response, which cells participate
in phagocytosis?
(A) Macrophages and mast cells
(B) Macrophages and plasma cells
(C) NK cells and neutrophils
(D) Macrophages and neutrophils
(E) T cells and mast cells
4. The immunoglobulin class most frequently responsible for
inhibition of bacteria on mucosal surfaces is:
(A) IgG
(B) IgM
(©) IgA
(D) IgE
(E) IgD
5. Which of the following properties is associated with MHC?
(A) Binds peptide antigen and presents it to T cells
(B) Binds virus particles and neutralizes the virus
(C) Binds LPS and interferes with bacterial phagocytosis
(D) Binds self-antigens and presents them to NK cells
‘Scanned with CamScanner
Which of he following tems regarding 1 cell located in Iymph
node follies participate in D ell help with isotype switeaing
nd antibody production?
A) Thi cele
Th ces
D) Treg
Which ofthe following functional properties are not associa
with EN puma
A) Induces production of ether pro-inflammatory cytokines
5) Anti proliferative activity
D) Trigger plasma cel formation and antibody production
Which ofthe following cytokines can inhib or downregulate
A) IPN beta and IL-0
1) LEN gamma and I-10
© TEN beta and 2
D) IL and IL-2
ne intial step in antibody formation begins withthe binding
of anligen tothe B cll surface immunoglobulin vi
A) MHC cass molecu
(© Bell recep
Which of the cytokines attracts neutrophils and inhibit
1) IL-A(CXCIS
D) 16
E) TOES
MHC dass I molecules are critical importan in bat sm
solo proc
B) Phagocytoss
D) CDS" Fell got
E) Opsonization
he host response tothe interaction afa
ic LL generates which ofthe fl
A) IgG production
1) Cell activation and production of ‘cytok
(©) Immunoglobulin cles switching
D) Phagocytosts
E) Presentation of pathogen to helper T cel
The imersction of two IgG molecules binding to antigen fl
ced by the binding of CI tothe Fe portion ofthe antibod
results in wich ofthe following?
A) Initiation of antigen presenation
Initiation of casal complement pathway
(©) Initiation of alternative complement pahway
node follies participate in D ell help with isotype switeaing
nd antibody production?
A) Thi cele
Th ces
D) Treg
Which ofthe following functional properties are not associa
with EN puma
A) Induces production of ether pro-inflammatory cytokines
5) Anti proliferative activity
D) Trigger plasma cel formation and antibody production
Which ofthe following cytokines can inhib or downregulate
A) IPN beta and IL-0
1) LEN gamma and I-10
© TEN beta and 2
D) IL and IL-2
ne intial step in antibody formation begins withthe binding
of anligen tothe B cll surface immunoglobulin vi
A) MHC cass molecu
(© Bell recep
Which of the cytokines attracts neutrophils and inhibit
1) IL-A(CXCIS
D) 16
E) TOES
MHC dass I molecules are critical importan in bat sm
solo proc
B) Phagocytoss
D) CDS" Fell got
E) Opsonization
he host response tothe interaction afa
ic LL generates which ofthe fl
A) IgG production
1) Cell activation and production of ‘cytok
(©) Immunoglobulin cles switching
D) Phagocytosts
E) Presentation of pathogen to helper T cel
The imersction of two IgG molecules binding to antigen fl
ced by the binding of CI tothe Fe portion ofthe antibod
results in wich ofthe following?
A) Initiation of antigen presenation
Initiation of casal complement pathway
(©) Initiation of alternative complement pahway
specifiy but different immunoglobulin classes?
0) Clase itching
(C) Somatic hypermutation
D) Junctonal variability due to imprecise Y, D and
1) Gene duplication, le, multiple V, D, and] gene segments
Which major antibody molecule has the ability to ros the
placenta?
DEN
shortness of breath and fatigue, He is also very pale. Two days
le he was given pencllin for an infcton, He had pen
lin previously without problems and stated that he had “nc
allergy” o pencil, Laboratory esting shows that antibodies
16 penicilin are present inthe patients seram and tha be is
raking down his own red blood cells He is diagnosed wi
immune hemelytic anemia. The patient has which type of
hypersensitivity ration?
(a) ‘ype
B) Type
(©) Type it
D) Type IV (OTH)
Which one of the following cll types expresses receptors fo
(a) Teall
(C) NK cells
E) Dendritic cells
IgE-mediated histamine release is
pe
pel
ype it
D) Type IV
Which two cytokines play an important ole in attracting new
twophilsto the ste ofan infection?
(A) TEN alpha and IFN-gamma
IL 2and IL
he following laboratory assays considered tobe
cunterpartofthetypelV hyperseastvity rections
the TR kin tes?
(&) Immunoblot for TS antigen
B) EIA analysis of ea from TR patin
(©) Immunofluorescence assy for TH antibod
(D) TEN gamma prod
0) Clase itching
(C) Somatic hypermutation
D) Junctonal variability due to imprecise Y, D and
1) Gene duplication, le, multiple V, D, and] gene segments
Which major antibody molecule has the ability to ros the
placenta?
DEN
shortness of breath and fatigue, He is also very pale. Two days
le he was given pencllin for an infcton, He had pen
lin previously without problems and stated that he had “nc
allergy” o pencil, Laboratory esting shows that antibodies
16 penicilin are present inthe patients seram and tha be is
raking down his own red blood cells He is diagnosed wi
immune hemelytic anemia. The patient has which type of
hypersensitivity ration?
(a) ‘ype
B) Type
(©) Type it
D) Type IV (OTH)
Which one of the following cll types expresses receptors fo
(a) Teall
(C) NK cells
E) Dendritic cells
IgE-mediated histamine release is
pe
pel
ype it
D) Type IV
Which two cytokines play an important ole in attracting new
twophilsto the ste ofan infection?
(A) TEN alpha and IFN-gamma
IL 2and IL
he following laboratory assays considered tobe
cunterpartofthetypelV hyperseastvity rections
the TR kin tes?
(&) Immunoblot for TS antigen
B) EIA analysis of ea from TR patin
(©) Immunofluorescence assy for TH antibod
(D) TEN gamma prod
21. Which of the following laboratory assays can be used to detect
the number and types of immune cells in the peripheral blood?
(A) Immunofixation electrophoresis
(B) EIA
(C) Flow cytometry
(D) Immunoblot
22. PD-1 and CTLA-4 are targets for cancer immune therapy and
are both expressed on what cell type:
(A) Plasma cells
(B) Mast cells
(C) Neutrophils
(D) Activated T cells
(E) Tumor cells
Answers
1 C 4 € 17 D
2. E 10. B 18. A
3. D 11. D 19. B
4. € 12. B 20. D
5. A 13. B 21. C
6. E 14. B 22. D
7. D 15. A
8. A 16. B
carnes with canscomer
the number and types of immune cells in the peripheral blood?
(A) Immunofixation electrophoresis
(B) EIA
(C) Flow cytometry
(D) Immunoblot
22. PD-1 and CTLA-4 are targets for cancer immune therapy and
are both expressed on what cell type:
(A) Plasma cells
(B) Mast cells
(C) Neutrophils
(D) Activated T cells
(E) Tumor cells
Answers
1 C 4 € 17 D
2. E 10. B 18. A
3. D 11. D 19. B
4. € 12. B 20. D
5. A 13. B 21. C
6. E 14. B 22. D
7. D 15. A
8. A 16. B
carnes with canscomer
REVIEW QUESTIONS
1. A 22-year-old woman who works in a plant nursery presents
with a history of fever and cough for 2 months. Over this period
of time she has lost 5 kg. Chest radiography shows bilateral
upper lobe infiltrates with cavities. A stain of her sputum shows
acid-fast bacilli. The likely means by which the patient acquired
her infection is
(A) Sexual activity
(B) Ingesting the microorganisms in her food
(C) Holding onto contaminated hand rails when she takes
public transportation
(D) Handling potting soil
(E) Breathing aerosolized droplets containing the microorganism
During a pandemic of a well-characterized disease, a group of
175 airline passengers flew from Lima, Peru, to Los Angeles.
Lunch on the plane included crab salad, which was eaten by
about two-thirds of the passengers. After landing in Los Ange-
les, many of the passengers transferred to other flights with des-
tinations in other parts of California and other Western states.
Two of the passengers who stayed in Los Angeles developed
severe watery diarrhea. The status of the other passengers was
unknown. The likely cause of the diarrhea in the two passen-
gers is
(A) E. coli O157:H7 (lipopolysaccharide O antigen 157; flagel-
lar antigen 7)
(B) V. cholerae type 0139 (lipopolysaccharide O antigen 139)
(©) Shigella dysenteriae type |
(D) Campylobacter jejuni
(E) Entamoeba histolytica
3. A 65-year-old woman has a long-term central venous catheter
for intravenous therapy. She develops fever and subsequently
has multiple blood cultures positive for S. epidermidis. All of
the S. epidermidis isolates have the same colony morphology
‘Scanned with CamScanner
1. A 22-year-old woman who works in a plant nursery presents
with a history of fever and cough for 2 months. Over this period
of time she has lost 5 kg. Chest radiography shows bilateral
upper lobe infiltrates with cavities. A stain of her sputum shows
acid-fast bacilli. The likely means by which the patient acquired
her infection is
(A) Sexual activity
(B) Ingesting the microorganisms in her food
(C) Holding onto contaminated hand rails when she takes
public transportation
(D) Handling potting soil
(E) Breathing aerosolized droplets containing the microorganism
During a pandemic of a well-characterized disease, a group of
175 airline passengers flew from Lima, Peru, to Los Angeles.
Lunch on the plane included crab salad, which was eaten by
about two-thirds of the passengers. After landing in Los Ange-
les, many of the passengers transferred to other flights with des-
tinations in other parts of California and other Western states.
Two of the passengers who stayed in Los Angeles developed
severe watery diarrhea. The status of the other passengers was
unknown. The likely cause of the diarrhea in the two passen-
gers is
(A) E. coli O157:H7 (lipopolysaccharide O antigen 157; flagel-
lar antigen 7)
(B) V. cholerae type 0139 (lipopolysaccharide O antigen 139)
(©) Shigella dysenteriae type |
(D) Campylobacter jejuni
(E) Entamoeba histolytica
3. A 65-year-old woman has a long-term central venous catheter
for intravenous therapy. She develops fever and subsequently
has multiple blood cultures positive for S. epidermidis. All of
the S. epidermidis isolates have the same colony morphology
‘Scanned with CamScanner
al um
D) They dirty inject.
bacterial and hos
(2) Mutations that prevent tl
man presents with gradually increasing
I pain arthropathy. Dur
‘Scanned with CamScanner
D) They dirty inject.
bacterial and hos
(2) Mutations that prevent tl
man presents with gradually increasing
I pain arthropathy. Dur
‘Scanned with CamScanner
yee
na
(A) Culture on agar media
(B) Polymerase chain reaction amplification and sequencing
ofan appropriate segment of DNA
(C) Cocultivation with E. coli
(D) In situ hybridization
(E) Direct fluorescent antibody test
Which of the following best describes the mechanism of action
of diphtheria toxin?
(A) Forms pores in red blood cells causing hemolysis
(B) Degrades lecithin in eukaryotic cell membranes
(C) Causes release of tumor necrosis factor
(D) Inhibits elongation factor 2
(E) Causes increased adenylate cyclase activity
swers
E 6. C ll. B
B 7. E 12. D
E 8. A 13. D
D 9. D 14. B
A 10. A 15. D
na
(A) Culture on agar media
(B) Polymerase chain reaction amplification and sequencing
ofan appropriate segment of DNA
(C) Cocultivation with E. coli
(D) In situ hybridization
(E) Direct fluorescent antibody test
Which of the following best describes the mechanism of action
of diphtheria toxin?
(A) Forms pores in red blood cells causing hemolysis
(B) Degrades lecithin in eukaryotic cell membranes
(C) Causes release of tumor necrosis factor
(D) Inhibits elongation factor 2
(E) Causes increased adenylate cyclase activity
swers
E 6. C ll. B
B 7. E 12. D
E 8. A 13. D
D 9. D 14. B
A 10. A 15. D
VIEW QUE
A 26-year-old woman visits her physician because of an unusual
vaginal discharge. On examination, the physician observes a thin,
homogeneous, white-gray discharge that adheres to the vaginal
wall. The pH of the discharge is 5.5 (normal, <4.3). On Gram-
stain, many epithelial cells covered with Gram-variable rods are
seen. Bacterial vaginosis is diagnosed. Which one of the follow-
ing normal genital flora microorganisms is greatly decreased in
a
STIONS
bacterial vaginos
(A) Corynebacterium species
(B) Staphylococcus epidermidis
(C) Prevotella species
(D) Candida albicans
(E) Lactobacillus species
Certain microorganisms are never considered to be members of
the normal flora. The:
are always considered to be pathogens.
Which one of the following organisms fits into that category?
A 26-year-old woman visits her physician because of an unusual
vaginal discharge. On examination, the physician observes a thin,
homogeneous, white-gray discharge that adheres to the vaginal
wall. The pH of the discharge is 5.5 (normal, <4.3). On Gram-
stain, many epithelial cells covered with Gram-variable rods are
seen. Bacterial vaginosis is diagnosed. Which one of the follow-
ing normal genital flora microorganisms is greatly decreased in
a
STIONS
bacterial vaginos
(A) Corynebacterium species
(B) Staphylococcus epidermidis
(C) Prevotella species
(D) Candida albicans
(E) Lactobacillus species
Certain microorganisms are never considered to be members of
the normal flora. The:
are always considered to be pathogens.
Which one of the following organisms fits into that category?
senc The mas ch organ a De cle rm th
pericos u suchen or scree I Immer Quint
sbdomiml pain. Fever devops. The severe pain prada
subsides und ls eplaced by u Constan! aching pa and shed
Deus mde, an the paint taken othe operating o
The diagnosis of ruptured diverticulum is confirmed, and a
abs net tothe gold colon I found. The most kl ac
[Which one ofthe following microorganisms can be part ofthe
pericos u suchen or scree I Immer Quint
sbdomiml pain. Fever devops. The severe pain prada
subsides und ls eplaced by u Constan! aching pa and shed
Deus mde, an the paint taken othe operating o
The diagnosis of ruptured diverticulum is confirmed, and a
abs net tothe gold colon I found. The most kl ac
[Which one ofthe following microorganisms can be part ofthe
occus pneumoniae can be port of the normal ora of
(of people At what anatomic nec nit
Hundrdsotphylotypshase ben ented in he human stom
Tower, he only microorganism that has ben shown to
(©) Kidn
(D) Salivary glands
3. Resident
(2) Pax
(8) Lange
4. A.65-yearold woran vas admited with squamous cl caro
gery and was maintained podoperatively on broad-spectrum
venous antics, The patient had central venous catheter
ame febrile, On day & cultures of Bond and of
he most Ukely portal of entry for the organi
(D) During placement of V line for admin
(of people At what anatomic nec nit
Hundrdsotphylotypshase ben ented in he human stom
Tower, he only microorganism that has ben shown to
(©) Kidn
(D) Salivary glands
3. Resident
(2) Pax
(8) Lange
4. A.65-yearold woran vas admited with squamous cl caro
gery and was maintained podoperatively on broad-spectrum
venous antics, The patient had central venous catheter
ame febrile, On day & cultures of Bond and of
he most Ukely portal of entry for the organi
(D) During placement of V line for admin
Answers
STION
1. A housewife who lives on a small farm is brought to the emer-
gency department complaining of double vision and difficulty
talking. Within the past 2 hours, she noted a dry mouth and
generalized weakness. Last night she served home-canned
green beans as part of the meal. She tasted the beans before
they were boiled. None of the other family members are ill. On
examination, there is symmetrical descending paralysis of the
cranial nerves, upper extremities, and trunk. The correct diag-
nosis is which one of the following?
(A) Tetanus
(B) Strychnine poisoning
(C) Botulism
(D) Morphine overdose
(E) Ricin intoxication
2. Which one of the following is an important virulence factor of
Bacillus anthracis?
1. A housewife who lives on a small farm is brought to the emer-
gency department complaining of double vision and difficulty
talking. Within the past 2 hours, she noted a dry mouth and
generalized weakness. Last night she served home-canned
green beans as part of the meal. She tasted the beans before
they were boiled. None of the other family members are ill. On
examination, there is symmetrical descending paralysis of the
cranial nerves, upper extremities, and trunk. The correct diag-
nosis is which one of the following?
(A) Tetanus
(B) Strychnine poisoning
(C) Botulism
(D) Morphine overdose
(E) Ricin intoxication
2. Which one of the following is an important virulence factor of
Bacillus anthracis?
8) Lipopolpsaccharid
) Pi
ars of his right Ig after a motorcycle accident. One day ner,
and restesness, On examination, the lg is swollen and tense
ith thin. dark serous lud dratning from the wounds. The
tin the le. is hematocrit is 20% (-30% of normal) and his
Jobin. Which of the following microorganisms i the most
ely cause of his infection?
D) Bact
he patient described in Question 3, which of the fol
à food commonly associated with Bails cereus food pos
D) Green beans
ry cells in the pial coed and brainstem and blocks which o
A) Release of acetylcholine
®) Cleavage of SNARE proteins
Release of inhibitory glycine and y-aminobutyricacld
D) Release of protect antigen
E) Activation of acetylcholine esterase
ago sustained a puncture injury to the lower part of his right
dosel spasas particoady notable in th much
Separtcen (ED) In the ED, you sce a man who ds alert and
) Pi
ars of his right Ig after a motorcycle accident. One day ner,
and restesness, On examination, the lg is swollen and tense
ith thin. dark serous lud dratning from the wounds. The
tin the le. is hematocrit is 20% (-30% of normal) and his
Jobin. Which of the following microorganisms i the most
ely cause of his infection?
D) Bact
he patient described in Question 3, which of the fol
à food commonly associated with Bails cereus food pos
D) Green beans
ry cells in the pial coed and brainstem and blocks which o
A) Release of acetylcholine
®) Cleavage of SNARE proteins
Release of inhibitory glycine and y-aminobutyricacld
D) Release of protect antigen
E) Activation of acetylcholine esterase
ago sustained a puncture injury to the lower part of his right
dosel spasas particoady notable in th much
Separtcen (ED) In the ED, you sce a man who ds alert and
he has general muscle spasm with arching of his back. The cor
rect diagnosis is which of the followin
) Botulism
(8) Anthrax
(C) Gas gangrene
D) Tetanus
) Toxic shock syndrome
Which of the following statements about tetanus and tetanus
toxoid is correct?
A) Tetanus toxin kills neurons,
(B) Tetanus toxoid immunization has a 10% failure rate
(©) The mortality rate of generalized tetanus is less than 196
(D) Double vision is commonly the first sign of tetanus,
(E) Tetanus toxin acts on inhibitor interneuron synapses.
A 67-year-old man had surgery for a ruptured sigmoid colon
diverticulum with an abscess. A repair was done, and the
abscess was drained. He was treated with intravenous gen
tamicin and ampicillin. Ten days later and 4 days after bein
discharged from the hospital, the patient developed malaise,
fever, and cramping abdominal pain, He had multiple episodes
of diarrhea, His stool was positive for occult blood and t
presence of polymorphonuclear cells. On sigmoidoscopy, the
mucosa was erythematous and appeared to be inflamed, and
there were many raised white to yellowish plaques 4-8 mm
in diameter. Which of the following is the likely cause of the
patients problem?
A) Staphylococcus aureus enterotoxin
(B), Bacillus cereus toxin
(©) Clostridium diffcitetoxins
D) Clostridium perfringens toxin
(E) Enterohemorrhagic Escherichia coli
Which of the following food items is most frequently associated
with infant botulism?
(A) Corn syrup
B) Canned infant formula
(C) Liquid multivitamins
(D) Honey
E) Jarred baby food
Which of the following statements regarding vaccina
Bacillus anthracisis correct?
A) Itis routinely available forall citizens of the United States.
(8) Recombinant vaccine trials have shown good safety and
efficacy
(©) The current vaccine is well tolerated.
(D) A single dose is adequate after exposure to spores.
(E) Vaccination of animals is not useful
rect diagnosis is which of the followin
) Botulism
(8) Anthrax
(C) Gas gangrene
D) Tetanus
) Toxic shock syndrome
Which of the following statements about tetanus and tetanus
toxoid is correct?
A) Tetanus toxin kills neurons,
(B) Tetanus toxoid immunization has a 10% failure rate
(©) The mortality rate of generalized tetanus is less than 196
(D) Double vision is commonly the first sign of tetanus,
(E) Tetanus toxin acts on inhibitor interneuron synapses.
A 67-year-old man had surgery for a ruptured sigmoid colon
diverticulum with an abscess. A repair was done, and the
abscess was drained. He was treated with intravenous gen
tamicin and ampicillin. Ten days later and 4 days after bein
discharged from the hospital, the patient developed malaise,
fever, and cramping abdominal pain, He had multiple episodes
of diarrhea, His stool was positive for occult blood and t
presence of polymorphonuclear cells. On sigmoidoscopy, the
mucosa was erythematous and appeared to be inflamed, and
there were many raised white to yellowish plaques 4-8 mm
in diameter. Which of the following is the likely cause of the
patients problem?
A) Staphylococcus aureus enterotoxin
(B), Bacillus cereus toxin
(©) Clostridium diffcitetoxins
D) Clostridium perfringens toxin
(E) Enterohemorrhagic Escherichia coli
Which of the following food items is most frequently associated
with infant botulism?
(A) Corn syrup
B) Canned infant formula
(C) Liquid multivitamins
(D) Honey
E) Jarred baby food
Which of the following statements regarding vaccina
Bacillus anthracisis correct?
A) Itis routinely available forall citizens of the United States.
(8) Recombinant vaccine trials have shown good safety and
efficacy
(©) The current vaccine is well tolerated.
(D) A single dose is adequate after exposure to spores.
(E) Vaccination of animals is not useful
Answers
REVIEW QUESTIONS
1. Three months ago, a 53-year-old woman had surgery and che
motherapy for breast cancer. Four weeks ago, she de
leveloped
à cough occasionally productive of purulent sputum. Abou
2 weeks ago she noted a slight but progressive weakness of her
left arm and leg. On chest examination, rales were heard over
the left upper back when the patient breathed deeply. Neuro
logic examination confirmed weakness ofthe left arm and leg
Chest radiography showed a left upper lobe inflate. Cor
trastenhanced computed tomography showed two lesions in
the right hemisphere. Gram-stain ofa purulent sputum spec
men shoved branching Gram-positive rods that were part
aci fast, Which ofthe following organisms isthe cause ofthis
patients curren illness?
(D) Necantia spec
(E) Ensipelothri rhusiopathine
Thedrugofchoice to teat his patients infection (Question is
(A) Penicillin
(0) Trimethoprim-sulfamethoxazo
(D) Amphotericin B
(E) A third-generation cephalospe
(4) Indacing host cell actin polymerization
(8) The formation of pl (imbrie) on the isteriae surface
(©) Pseudopod formation
(D) The motion afliserie flagella
(E) Tumbling motility
An 8-year-ld boy, who recently arrived in the United Stats,
develops a severe sore throst
date (pseudomembrane) is seen over the tonsils and pharynx
The differential diagnosis of severe pharyngitis such as this
includes group A streptococcal infection, Epstein-Barr virus
(EBV) infection, Netseriagonorshoeae pharyngitis, and diph
theria, The case ofthe boy’ pharyngitis fs most likely
(A) A Gram-negative bacillus
(8) single-stranded postve-sense RNA virus
(©) A catalasepositive, Gram postive coccus that grows in
(E) A doublesstranded RNA virus
The primary mechanism inthe pathogenesis of the boys dis
ase (Question ) is
(A) A met increase in intracellular cycle adenosine
monophosphate
(0) Action of pyrogenic exotoxin (a superantigen)
(©) Inactivation of acetylcholine esterase
(D) Action of enterotoxin A
(E) Inactivation of elongation factor 2
1. Three months ago, a 53-year-old woman had surgery and che
motherapy for breast cancer. Four weeks ago, she de
leveloped
à cough occasionally productive of purulent sputum. Abou
2 weeks ago she noted a slight but progressive weakness of her
left arm and leg. On chest examination, rales were heard over
the left upper back when the patient breathed deeply. Neuro
logic examination confirmed weakness ofthe left arm and leg
Chest radiography showed a left upper lobe inflate. Cor
trastenhanced computed tomography showed two lesions in
the right hemisphere. Gram-stain ofa purulent sputum spec
men shoved branching Gram-positive rods that were part
aci fast, Which ofthe following organisms isthe cause ofthis
patients curren illness?
(D) Necantia spec
(E) Ensipelothri rhusiopathine
Thedrugofchoice to teat his patients infection (Question is
(A) Penicillin
(0) Trimethoprim-sulfamethoxazo
(D) Amphotericin B
(E) A third-generation cephalospe
(4) Indacing host cell actin polymerization
(8) The formation of pl (imbrie) on the isteriae surface
(©) Pseudopod formation
(D) The motion afliserie flagella
(E) Tumbling motility
An 8-year-ld boy, who recently arrived in the United Stats,
develops a severe sore throst
date (pseudomembrane) is seen over the tonsils and pharynx
The differential diagnosis of severe pharyngitis such as this
includes group A streptococcal infection, Epstein-Barr virus
(EBV) infection, Netseriagonorshoeae pharyngitis, and diph
theria, The case ofthe boy’ pharyngitis fs most likely
(A) A Gram-negative bacillus
(8) single-stranded postve-sense RNA virus
(©) A catalasepositive, Gram postive coccus that grows in
(E) A doublesstranded RNA virus
The primary mechanism inthe pathogenesis of the boys dis
ase (Question ) is
(A) A met increase in intracellular cycle adenosine
monophosphate
(0) Action of pyrogenic exotoxin (a superantigen)
(©) Inactivation of acetylcholine esterase
(D) Action of enterotoxin A
(E) Inactivation of elongation factor 2
Which of the following aerobic Gram-positive bacill is modi
fied acid-fast positive?
A) Nocardia brasiliensis
B) Lactobacillus acidophilus
(©) Erysipelothrix rhusiopath
D) Listeria monocytogenes
Skin diphtheria as occurs in children in tropical areas
typically
A) Docs not occur in children who have been immunized
with diphtheria toxoid
B) Is clinically distinct from skin infections (pyoderma,
impetigo) caused by Streptococcus pyogenes and Staphylo
(©) Is also common in northern latitudes
D) Results in protective antitoxin levels in most children by
the time they are 6-8 years old
E) Yields toxin-mediated cardiomyopathy
A 45-year-old fisherman imbedded a fishhook into his right
forefinger. He removed it and did not seek immediate m
cal therapy. Five days later, he noted fever, severe pain, and
nodular-type swelling of the finger. He sought medical the
apy. The violaceous nodule was aspirated, and after 48 hours
of incubation, colonies of a Gram-positive bacillus that caused
greenish discoloration of the agar and formed long filaments
in the broth culture were noted. The most likely cause ofthis
A) Lactobacillus a
1) Erysipelothrix shusiopathiae
(C) Listeria monocytogenes
D) Rhodococcus equ
E) Nocardia brasiliensis
A biochemical reaction that is useful in the identification ofthe
causative agent of the infection in Question 8 is
A) Catalase postivity
B) Acid fastness using modified Kinyoun stain
(©) Esculin hydrolysis
D) Tumbling motility
E) Production of H,S
Listeria monocytogenes is frequently a foodborne pathoge
A) lean survive at 4°C
1), It survives under conditions of low pH
(©) 1 survives in the presence of high-salt concentrations
1D) All of the above are correct
Which of the following statements regarding Rhodococcus equ
A) It is transmitted person to person,
B) lt causes tuberculosisin e
(©) isa rare cause of pulmonary infection in humans.
D) It produces a black pigment on sheep blood agar,
fied acid-fast positive?
A) Nocardia brasiliensis
B) Lactobacillus acidophilus
(©) Erysipelothrix rhusiopath
D) Listeria monocytogenes
Skin diphtheria as occurs in children in tropical areas
typically
A) Docs not occur in children who have been immunized
with diphtheria toxoid
B) Is clinically distinct from skin infections (pyoderma,
impetigo) caused by Streptococcus pyogenes and Staphylo
(©) Is also common in northern latitudes
D) Results in protective antitoxin levels in most children by
the time they are 6-8 years old
E) Yields toxin-mediated cardiomyopathy
A 45-year-old fisherman imbedded a fishhook into his right
forefinger. He removed it and did not seek immediate m
cal therapy. Five days later, he noted fever, severe pain, and
nodular-type swelling of the finger. He sought medical the
apy. The violaceous nodule was aspirated, and after 48 hours
of incubation, colonies of a Gram-positive bacillus that caused
greenish discoloration of the agar and formed long filaments
in the broth culture were noted. The most likely cause ofthis
A) Lactobacillus a
1) Erysipelothrix shusiopathiae
(C) Listeria monocytogenes
D) Rhodococcus equ
E) Nocardia brasiliensis
A biochemical reaction that is useful in the identification ofthe
causative agent of the infection in Question 8 is
A) Catalase postivity
B) Acid fastness using modified Kinyoun stain
(©) Esculin hydrolysis
D) Tumbling motility
E) Production of H,S
Listeria monocytogenes is frequently a foodborne pathoge
A) lean survive at 4°C
1), It survives under conditions of low pH
(©) 1 survives in the presence of high-salt concentrations
1D) All of the above are correct
Which of the following statements regarding Rhodococcus equ
A) It is transmitted person to person,
B) lt causes tuberculosisin e
(©) isa rare cause of pulmonary infection in humans.
D) It produces a black pigment on sheep blood agar,
Answers
strain of $. aureus tht I resistant to afin. She was treated
improved. our weks later (week 11). the infection recured and
the patient was agan started on intravenous vancomycin, The
MICs for vancomycin forthe S aureus ots were as follows:
3 ml. The patent fled to improve withthe third course of
at best explains the elatv resistance of the patients strain of
A) Acquisition ofthe nan gene fom another microorganis
Increased cell wall synthesis and alterations inthe cell al
0 Pos an inectivation ofthe
url boy develops mid eve and pain in is upper
A radiograph of hs arm shows a ti lesion (solu
‚per par ofthe humerus with periosteal elevation ove
he lesion. The patient is taken to surgery where the lesion ls
ebrided (dead bone and pus removed). Culture from the ess
ds Gram-positive coca. A es shows thatthe organism i
63) lactamase postive
(0) Encapsulated
E) Catalase post
A 36-pear-old male pasen has an abscess with a stain of
Benicilin G ampicillin, and piperailin
GB) Trimethoprim slfamethorazc
D) Vancomycin
E) Celazolin and ceftrlaxo
Seren days ago, 27-year-old medical student returned fro
lini for indigenous people: Four days ago she develop
y erythematous sunburn-ke ash. She alo has had head
y ber menıteu period with» lampoa in placa other
st (scrum ura nitrogen and creatinine) rests ae abnor
mal indising mild renal fllre. A blood smear for malaria,
I negative. Her less i ky to be cased by which ofthe
A toxin that esuls in greatly increase levels of intrace
0) A toxin that degrades sphingomyelin,
improved. our weks later (week 11). the infection recured and
the patient was agan started on intravenous vancomycin, The
MICs for vancomycin forthe S aureus ots were as follows:
3 ml. The patent fled to improve withthe third course of
at best explains the elatv resistance of the patients strain of
A) Acquisition ofthe nan gene fom another microorganis
Increased cell wall synthesis and alterations inthe cell al
0 Pos an inectivation ofthe
url boy develops mid eve and pain in is upper
A radiograph of hs arm shows a ti lesion (solu
‚per par ofthe humerus with periosteal elevation ove
he lesion. The patient is taken to surgery where the lesion ls
ebrided (dead bone and pus removed). Culture from the ess
ds Gram-positive coca. A es shows thatthe organism i
63) lactamase postive
(0) Encapsulated
E) Catalase post
A 36-pear-old male pasen has an abscess with a stain of
Benicilin G ampicillin, and piperailin
GB) Trimethoprim slfamethorazc
D) Vancomycin
E) Celazolin and ceftrlaxo
Seren days ago, 27-year-old medical student returned fro
lini for indigenous people: Four days ago she develop
y erythematous sunburn-ke ash. She alo has had head
y ber menıteu period with» lampoa in placa other
st (scrum ura nitrogen and creatinine) rests ae abnor
mal indising mild renal fllre. A blood smear for malaria,
I negative. Her less i ky to be cased by which ofthe
A toxin that esuls in greatly increase levels of intrace
0) A toxin that degrades sphingomyelin,
0) Aton that blocks.
Over a period of 3 weeks, total of five newborns inthe hosp
bowing should be done now?
A) Prophylactic treatment of al newborns wit
(Protective isolation fall newborns
(©) Closing the nursery and refering pregnant some:
soother hospital
(0) Hiring all new sat for the hospital nurery
() Culture using mannitol salt agar of the anterior nares of the
cias, nues, and others who cared forthe infected
The exfoliative toxins, TSSTA, and the ene
(3) Widely distributed onthe staphyloccesl chromosome
) On both the staphylococcal chromosome (TSST-1 an
A 1636 ne marrow transplant patient as à central
nd before the ransplan ha engrafted ros blo cultures are
A) Thes. dic organisms are likely e susceptible to
pen
(@ Fes. epidermidis organisms are likely to be from the sur
face ofthe urinary tract cat
The S epidermidi organisms ae likely to be resistant to
) The Sp re likely tobe f
E) The S. epidermidis onganisms are lik
nthe central venous catheter src
A 65-year-old man develops an abscess on the ack of his neck.
Culture yields S aureus. The isolate i tested and found to be
positive forthe meca gene, which means tha
A) The slates susceptible to vancomyein
(C) The lola susceptible o nain.
(D) The isolates resstan
0 The isolates suscepti
Over a period of 3 weeks, total of five newborns inthe hosp
bowing should be done now?
A) Prophylactic treatment of al newborns wit
(Protective isolation fall newborns
(©) Closing the nursery and refering pregnant some:
soother hospital
(0) Hiring all new sat for the hospital nurery
() Culture using mannitol salt agar of the anterior nares of the
cias, nues, and others who cared forthe infected
The exfoliative toxins, TSSTA, and the ene
(3) Widely distributed onthe staphyloccesl chromosome
) On both the staphylococcal chromosome (TSST-1 an
A 1636 ne marrow transplant patient as à central
nd before the ransplan ha engrafted ros blo cultures are
A) Thes. dic organisms are likely e susceptible to
pen
(@ Fes. epidermidis organisms are likely to be from the sur
face ofthe urinary tract cat
The S epidermidi organisms ae likely to be resistant to
) The Sp re likely tobe f
E) The S. epidermidis onganisms are lik
nthe central venous catheter src
A 65-year-old man develops an abscess on the ack of his neck.
Culture yields S aureus. The isolate i tested and found to be
positive forthe meca gene, which means tha
A) The slates susceptible to vancomyein
(C) The lola susceptible o nain.
(D) The isolates resstan
0 The isolates suscepti
Antimicrobial resistance has become a significant problem.
(D) Vancomycin resistance in. are
A group ofsxchildren younger than 8 yeaslivein asem
al country, Each ofthe children has several crusted wecpin
anis isa key case ofthe lesions?
(5) Chlamydia
(D) $ pneumoniae
(A) Ris responsible or the rash in tate shock syndrome
(ED Tkeomwerts hydrogen peroxide lato water and exygen.
(D) Ris directly responshle for lysis of neutrophil
(E) Iisa bacterial surface protein that binds to the Fe pation
Which ofthe lowing staphylococcal organians produces cong
(ms.
Al ofthe following statements eg
ve-component toxin
A) Itregulates production of hemolysns
(8) tis influenced by environmental oxygen.
{©) ltcontols the preferential expresion of surface adhesns
(D) Ris important In the contol of autolysis.
All ofthe following are important infection control strategies in
(D) Vancomycin resistance in. are
A group ofsxchildren younger than 8 yeaslivein asem
al country, Each ofthe children has several crusted wecpin
anis isa key case ofthe lesions?
(5) Chlamydia
(D) $ pneumoniae
(A) Ris responsible or the rash in tate shock syndrome
(ED Tkeomwerts hydrogen peroxide lato water and exygen.
(D) Ris directly responshle for lysis of neutrophil
(E) Iisa bacterial surface protein that binds to the Fe pation
Which ofthe lowing staphylococcal organians produces cong
(ms.
Al ofthe following statements eg
ve-component toxin
A) Itregulates production of hemolysns
(8) tis influenced by environmental oxygen.
{©) ltcontols the preferential expresion of surface adhesns
(D) Ris important In the contol of autolysis.
All ofthe following are important infection control strategies in
Answers
L D
L D
A 48a. ol alcohol mani admite toa hospital because
when he cold nt be cal roused. His temperature le 8 °C
nh blood pressure 125/80 mm Hg. He moans when ltempta
re made o arouse him. He has postive Kerig and Brodrinal
<oliénion. An endotracheal aspirate yields rus colored sputum,
Shaped dplocoect On limber puntue, he cerebrospinal Quid
poste diplococs Based on this information, the ker dig
A) Pneumonie and meningitis cased by aue
(8) Poeumonia and meningitis assed by S prugener
(D) Pocumonia and meningitis caused by E fi
(F) Pacumonia and. meningitis caused
hisnfecton (Questia 1) might have been prevented
(©) A vaccine against seroproups A, C, % and WI35 capsular
polysaccharide
(0) À vaccine of polyiborytbitel capsular polysccharide
ovalen inked oa protein
(09 Resistance to phagneytosis mediated by M proteins
(© Migration to mediastinal ymph nodes where hemorthag
(6) Inhibition of phagocosi by a polaccharide cape
A 13-vale capsular polysaccharide protein conjugate vacine
forthe pathogen in Question 1 is recommended
A) For children upto age I year and for selected adults
(9) Only on exposure toa patiné with disease caused by the
when he cold nt be cal roused. His temperature le 8 °C
nh blood pressure 125/80 mm Hg. He moans when ltempta
re made o arouse him. He has postive Kerig and Brodrinal
<oliénion. An endotracheal aspirate yields rus colored sputum,
Shaped dplocoect On limber puntue, he cerebrospinal Quid
poste diplococs Based on this information, the ker dig
A) Pneumonie and meningitis cased by aue
(8) Poeumonia and meningitis assed by S prugener
(D) Pocumonia and meningitis caused by E fi
(F) Pacumonia and. meningitis caused
hisnfecton (Questia 1) might have been prevented
(©) A vaccine against seroproups A, C, % and WI35 capsular
polysaccharide
(0) À vaccine of polyiborytbitel capsular polysccharide
ovalen inked oa protein
(09 Resistance to phagneytosis mediated by M proteins
(© Migration to mediastinal ymph nodes where hemorthag
(6) Inhibition of phagocosi by a polaccharide cape
A 13-vale capsular polysaccharide protein conjugate vacine
forthe pathogen in Question 1 is recommended
A) For children upto age I year and for selected adults
(9) Only on exposure toa patiné with disease caused by the
or all chile Ih plus selected oler
(0) Forchildren ages 2
An 8 year ld bay develops a severe sore throat. On examina
tion grayish white exudates sen on the tonsils and pharyox
Theifferemial diagnosis includes group A streptococcal infec
und diphtheria, (Netseria gonerchoeae pharyogilis would als
be included, but the patient has not been sexually abused) The
cae ofthe boys pharyngitis mos Ike
(O) A eaalesporive Gram-posiive coceus tit grows in
(D) A ctalase negative Gram postive bacilos
(E) A double-stranded RNA virus
A primary mechanism responsible forthe pathogenesis of the
boys disease (Question 6) 6
phosphate
Action of GAL protease
neurologic examination findings are normal. À brain san shows
à ring enhancing lesion ofthe left hemisphere. During surgery,
à brain abscess found. Culture ofthe abcess id grows
thought smell ike buterscotch 1taglitinaes with group F
antiker. The organism mos ll is
US pyogenes group
Aggutintion using antisera against the cll wall group
specific substance
(0) Blochemical testing
(©) Hemolytic properties (a monbemalyi
(©) Capsular swelling quelling) reaction
(E) Allofthe
An Syear-<ld gir develops Sydenhanis chorea (St. Vitus
dance”) with rapid uncoordinated fall tes and involuntary
(0) Forchildren ages 2
An 8 year ld bay develops a severe sore throat. On examina
tion grayish white exudates sen on the tonsils and pharyox
Theifferemial diagnosis includes group A streptococcal infec
und diphtheria, (Netseria gonerchoeae pharyogilis would als
be included, but the patient has not been sexually abused) The
cae ofthe boys pharyngitis mos Ike
(O) A eaalesporive Gram-posiive coceus tit grows in
(D) A ctalase negative Gram postive bacilos
(E) A double-stranded RNA virus
A primary mechanism responsible forthe pathogenesis of the
boys disease (Question 6) 6
phosphate
Action of GAL protease
neurologic examination findings are normal. À brain san shows
à ring enhancing lesion ofthe left hemisphere. During surgery,
à brain abscess found. Culture ofthe abcess id grows
thought smell ike buterscotch 1taglitinaes with group F
antiker. The organism mos ll is
US pyogenes group
Aggutintion using antisera against the cll wall group
specific substance
(0) Blochemical testing
(©) Hemolytic properties (a monbemalyi
(©) Capsular swelling quelling) reaction
(E) Allofthe
An Syear-<ld gir develops Sydenhanis chorea (St. Vitus
dance”) with rapid uncoordinated fall tes and involuntary
and her mother all had sore throats 2 months ago À test that if
positive would indicate recent S. pyogenes infections is
(A) Antstreptolysin $ antibody titer
(8) Polymerase chain reaction for antibodies against M protein
(©) ASO antibody iter
(D) Esculin hydrolysis
(E) Antihyaluronie acid antibody titer
All of the following statements regarding the hyaluronic acid
capsule of. pyugenes are correct except
(A) Kris responsible for the mucoid appearance ofthe cl
(8) Ieisantiphagocytic,
(©) Itbinds to CDAS on human epithelial cells,
(D) Risan important virulence facto
(8) A vaccine against the capsule is currently available
interocosei can be distinguished from nonenterococcal
group D streptococ on the bass of which of the following
characteristics?
(4) y Hemolysis
(8) Esculinhydrolysis
(©) Growthin6.5% NaCl
(D) Growth in the presence of bile
(E) Gram-stain morphology
Which ofthe following statements regarding the S, bovis group
(A) They possess Lancefield group D antigen
(8) Some strains ae vancomycin resistant.
(©) Infections caused by these organisms are benign.
(D) All subspecies are PYR past
(E) All subspecies are hemoytic
Which of the following genera requires pyridoxal for growth?
(8) Granulica
(D) Leuconostoc
(E) Pediococcus
Which of the following genera is typically resistant to
(A) Aerococcus
(D) Streptococcus
(E) Abo
positive would indicate recent S. pyogenes infections is
(A) Antstreptolysin $ antibody titer
(8) Polymerase chain reaction for antibodies against M protein
(©) ASO antibody iter
(D) Esculin hydrolysis
(E) Antihyaluronie acid antibody titer
All of the following statements regarding the hyaluronic acid
capsule of. pyugenes are correct except
(A) Kris responsible for the mucoid appearance ofthe cl
(8) Ieisantiphagocytic,
(©) Itbinds to CDAS on human epithelial cells,
(D) Risan important virulence facto
(8) A vaccine against the capsule is currently available
interocosei can be distinguished from nonenterococcal
group D streptococ on the bass of which of the following
characteristics?
(4) y Hemolysis
(8) Esculinhydrolysis
(©) Growthin6.5% NaCl
(D) Growth in the presence of bile
(E) Gram-stain morphology
Which ofthe following statements regarding the S, bovis group
(A) They possess Lancefield group D antigen
(8) Some strains ae vancomycin resistant.
(©) Infections caused by these organisms are benign.
(D) All subspecies are PYR past
(E) All subspecies are hemoytic
Which of the following genera requires pyridoxal for growth?
(8) Granulica
(D) Leuconostoc
(E) Pediococcus
Which of the following genera is typically resistant to
(A) Aerococcus
(D) Streptococcus
(E) Abo
1. A 20-year-old college student goes to the student health cen-
ter because of dysuria, frequency, and urgency on urination fc
24 hours. She has recently become sexually active. On urinalysis,
ter because of dysuria, frequency, and urgency on urination fc
24 hours. She has recently become sexually active. On urinalysis,
line va cain attendant, ing between the Ida sabcon
nent and other place in Southeast Asia and the West Coat of
the United States Ten days before admission, she had à dar
Speed forthe past 3 days Her temperature 39°C, hear rte
à 68 beatin, Boo pressure ls 12010 mm Hg, and epi
is ut doesnot know the date She e picking at he bedcothes.
Rose spots are seen on her trunk. The remsiader ofthe physical
‘enous lines placed. The most likly cause of he inc is
lod cultures fom the paient in Question 2 gro
An I-year-ld student has abdominal camps and dares
negative rods, Triple sugar iron agar Is used to Went
isolates ssalmonclla or hielo. A result suggesting
vas found by laboratories in the health departments of ad
nent and other place in Southeast Asia and the West Coat of
the United States Ten days before admission, she had à dar
Speed forthe past 3 days Her temperature 39°C, hear rte
à 68 beatin, Boo pressure ls 12010 mm Hg, and epi
is ut doesnot know the date She e picking at he bedcothes.
Rose spots are seen on her trunk. The remsiader ofthe physical
‘enous lines placed. The most likly cause of he inc is
lod cultures fom the paient in Question 2 gro
An I-year-ld student has abdominal camps and dares
negative rods, Triple sugar iron agar Is used to Went
isolates ssalmonclla or hielo. A result suggesting
vas found by laboratories in the health departments of ad
Young adults who smoked marian: th
Juana) By what method dil the public he
determine tha these lates wer the sam
Capsular (K antigen
ar old man with dibet
Aer. Culture of the uk
negative bails
land afterschool dayare is rough to his ped
«lominal pin, snd instal watery darts. Hi
and the chil appear qu
lien wi tend th
had darrheal dies
Which ofthe follow
hens in es hl
surat. About 48 hours late, abe developed cramping
abdominal pan and lowe ad had five episodes
‘Scanned with CamScanner
Juana) By what method dil the public he
determine tha these lates wer the sam
Capsular (K antigen
ar old man with dibet
Aer. Culture of the uk
negative bails
land afterschool dayare is rough to his ped
«lominal pin, snd instal watery darts. Hi
and the chil appear qu
lien wi tend th
had darrheal dies
Which ofthe follow
hens in es hl
surat. About 48 hours late, abe developed cramping
abdominal pan and lowe ad had five episodes
‘Scanned with CamScanner
and lysine decarboxylase postive, What is the most like
‘organism causing this man’s illness?
(8) El aerogenes
(D) Kle
(E) M.mon
Which ofthe following statements regarding O anges is correct?
A) All Enterobacteriacese possess identical O anti
(B) They are found in the polysaccharide capsules of enteric
bacteria
(©) They are covalently linked toa polysaccharide core
(D) They do not stimulate an immune response in the host.
() They are not important in the pathogenesis of infection
caused by enteric bacteria
Which of the est methods is the leat sensitive pro
A) Culture on sorbitol MacConkey a
(B) Toxin testing using an enzyme immunoassay
(©) Cell culture eytotoxin assay using Vero
(D) Polymerase chain reaction for detection of the genes that
3. An HIV-positive man recently traveled to the Caribbean for
a 2-weck vacation. He developed acute watery diarrhea and
abdominal pain without fever during the second week of his
vacation, Three weeks later, he is seen in clini for persistent
symptoms, and he is concerned because he is beginning to lose
weight. Given this history, you suspect
A) Enteroinvasive E. col
(8) Salmonella Typhi
(©) Enteropathogenie Es coi
(D) Shigelaflexner
(E) Enterosggregativ E
Heatabile toxin of ETEC acts by which of the followin
mechanisms?
(A) Attachment and effacement
(8) Activation of adenylyl cyclase
(©) Aggregaive adherence
(D) Ribosomal dysfunction
(E) None ofthe above
A young woman presents with recurrent urinary tract infec
tions caused by the same Proteus mirabilis strain. What is
(4) She does not take her medication.
(8) Sheis pregnant because pregnant patients are more sus
tible to UTIs
(©) She has a bladder or kidney stone
(D) Her partner is infected
(E) Shehas occult diabetes and should havea gluc
‘organism causing this man’s illness?
(8) El aerogenes
(D) Kle
(E) M.mon
Which ofthe following statements regarding O anges is correct?
A) All Enterobacteriacese possess identical O anti
(B) They are found in the polysaccharide capsules of enteric
bacteria
(©) They are covalently linked toa polysaccharide core
(D) They do not stimulate an immune response in the host.
() They are not important in the pathogenesis of infection
caused by enteric bacteria
Which of the est methods is the leat sensitive pro
A) Culture on sorbitol MacConkey a
(B) Toxin testing using an enzyme immunoassay
(©) Cell culture eytotoxin assay using Vero
(D) Polymerase chain reaction for detection of the genes that
3. An HIV-positive man recently traveled to the Caribbean for
a 2-weck vacation. He developed acute watery diarrhea and
abdominal pain without fever during the second week of his
vacation, Three weeks later, he is seen in clini for persistent
symptoms, and he is concerned because he is beginning to lose
weight. Given this history, you suspect
A) Enteroinvasive E. col
(8) Salmonella Typhi
(©) Enteropathogenie Es coi
(D) Shigelaflexner
(E) Enterosggregativ E
Heatabile toxin of ETEC acts by which of the followin
mechanisms?
(A) Attachment and effacement
(8) Activation of adenylyl cyclase
(©) Aggregaive adherence
(D) Ribosomal dysfunction
(E) None ofthe above
A young woman presents with recurrent urinary tract infec
tions caused by the same Proteus mirabilis strain. What is
(4) She does not take her medication.
(8) Sheis pregnant because pregnant patients are more sus
tible to UTIs
(©) She has a bladder or kidney stone
(D) Her partner is infected
(E) Shehas occult diabetes and should havea gluc
Answers
m culture of a patient with cystic fibrosis grows
inosa that forms very mucoid colonies. The implication
(@) The. aeruginosa infected with a pyocin (a bacteriocin,
(©) The colonies are mucoid because they hae polysaccharide
capsule of hyalaroni aci
(©) Theexotoxin A genehas been disabledand he P aeruginosa
isn longer able to black host cell protein synthesis
cephalosporins, minoglycodes, and quinolones hs become
selected by use of hose antbitics. This Gram-negative baci
Tuscan take 2-3 days to grow and must be differentiated from
Bcepucia is
(©) Alcaligenes sox
(©) Klebsiella preumoniae
A 17-year-old gir with et fibrosis has sigh increase in her
mucod colonies after 8 hours of incubation, These bail ae
base positive growat 42°C, and havea grape odor. These
Gram negative cil are which ofthe following?
(8) E aeruginosa
© Beepacia
rule out which ofthe following?
@ B.cspaca
(E) & pseudomalle
inosa that forms very mucoid colonies. The implication
(@) The. aeruginosa infected with a pyocin (a bacteriocin,
(©) The colonies are mucoid because they hae polysaccharide
capsule of hyalaroni aci
(©) Theexotoxin A genehas been disabledand he P aeruginosa
isn longer able to black host cell protein synthesis
cephalosporins, minoglycodes, and quinolones hs become
selected by use of hose antbitics. This Gram-negative baci
Tuscan take 2-3 days to grow and must be differentiated from
Bcepucia is
(©) Alcaligenes sox
(©) Klebsiella preumoniae
A 17-year-old gir with et fibrosis has sigh increase in her
mucod colonies after 8 hours of incubation, These bail ae
base positive growat 42°C, and havea grape odor. These
Gram negative cil are which ofthe following?
(8) E aeruginosa
© Beepacia
rule out which ofthe following?
@ B.cspaca
(E) & pseudomalle
Acinetobacter species:
(A) are only found in a hospital environment
(8) May appear as Gram: postive rods
Gram-stains of endocervical secretions
(D) Can be a significant cause of ventilator-associated pneu
monia in intensive care unit patients
(E) Are susceptible to most antibiotics
A 37-year-old firefighter sustains smoke inhalation and is hos
pitalized for ventilatory support, He has a severe cough and
begins to expectorate purulent sputum, Gram-stain of his sp:
tum specimen shows numerous polymorphonuclear cells and
numerous Gram-negative rods, Sputum culture grows numer
ous Gram-negative rods that are oxidase postive. They grow
well at 42°C. On clear agar medium, they produce a green colo
inthe agar. The agar where the green color is located fluoresces
when exposed to ultraviolet lig n causing the
aient infection is
(A) P.aeruginos
(8) K pneumoniae
(©) Escherichia col
(D) Bo cepacio
(E) B. pseudomallei
The mechanism of action of exotoxin A of P aeruginosa i
(A) To activate acetylcholine esterase
(8) To block elongation factor 2
(©) To form pores in white blood cells and increase cation
permeability
(D) To increase intracellular cyelic adenosine monophosp
(E) To split lecithin into phosphorylcholine and diacylglycerol
Patients deficient in these cells are particularly at high risk fo
developing serious systemic infections with P. aeruginosa:
(A) Eosinophils
(®) Neutrophils
(©) Macrophages
(D) Natural killer cells
(E) CD44 Teells
A marine wounded in Afghanistan returns to her home a para
plegic. Her past medical history included surgery to amputat
both her legs below the knee and the placement of Suprapu:
bic tube to repair damage to her bladder. She is now at the VA.
outpatient clinic with a recurrent urinary tract infection that
has not responded to conventional antibiotic regimens for com
munity-acquired cystitis, Her urine is positive for small, plamp
Gram-negative coccobacili, When cultured, this organism
does not ferment carbohydrates, does not hydrolyze urea, does
not reduce nitrates, and does not make hydrogen sulfide. Th
organism most likely causing this marine infection is
(A) Klebsiela oxytoca
@ E col
(A) are only found in a hospital environment
(8) May appear as Gram: postive rods
Gram-stains of endocervical secretions
(D) Can be a significant cause of ventilator-associated pneu
monia in intensive care unit patients
(E) Are susceptible to most antibiotics
A 37-year-old firefighter sustains smoke inhalation and is hos
pitalized for ventilatory support, He has a severe cough and
begins to expectorate purulent sputum, Gram-stain of his sp:
tum specimen shows numerous polymorphonuclear cells and
numerous Gram-negative rods, Sputum culture grows numer
ous Gram-negative rods that are oxidase postive. They grow
well at 42°C. On clear agar medium, they produce a green colo
inthe agar. The agar where the green color is located fluoresces
when exposed to ultraviolet lig n causing the
aient infection is
(A) P.aeruginos
(8) K pneumoniae
(©) Escherichia col
(D) Bo cepacio
(E) B. pseudomallei
The mechanism of action of exotoxin A of P aeruginosa i
(A) To activate acetylcholine esterase
(8) To block elongation factor 2
(©) To form pores in white blood cells and increase cation
permeability
(D) To increase intracellular cyelic adenosine monophosp
(E) To split lecithin into phosphorylcholine and diacylglycerol
Patients deficient in these cells are particularly at high risk fo
developing serious systemic infections with P. aeruginosa:
(A) Eosinophils
(®) Neutrophils
(©) Macrophages
(D) Natural killer cells
(E) CD44 Teells
A marine wounded in Afghanistan returns to her home a para
plegic. Her past medical history included surgery to amputat
both her legs below the knee and the placement of Suprapu:
bic tube to repair damage to her bladder. She is now at the VA.
outpatient clinic with a recurrent urinary tract infection that
has not responded to conventional antibiotic regimens for com
munity-acquired cystitis, Her urine is positive for small, plamp
Gram-negative coccobacili, When cultured, this organism
does not ferment carbohydrates, does not hydrolyze urea, does
not reduce nitrates, and does not make hydrogen sulfide. Th
organism most likely causing this marine infection is
(A) Klebsiela oxytoca
@ E col
(C) Staphylococcus saprophyticus
(D) Proteus mirabilis
(E) Acinetobacter baumannii
10. A 70-year-old neutropenic patient was diagnosed with ecthyma
gangrenosum 3 days after he developed a fever of 39°C. Blood
cultures drawn the day his fever started grew out overnight a
strictly aerobic, Gram-negative rod that was oxidase positive
and did not ferment lactose. Which of the following antibiotic
regimens would be most appropriate for treating this patient?
(A) Tobramycin + piperacillin/tazobactam
(B) Vancomycin + metronidazole
(C) Cefazolin
(D) Tigecycline
(E) Oxacillin
Answers
1 E 5. D 9. E
2. E 6. À 10. A
3. B 7. B
4. B 8. B
[brane in cansconn
(D) Proteus mirabilis
(E) Acinetobacter baumannii
10. A 70-year-old neutropenic patient was diagnosed with ecthyma
gangrenosum 3 days after he developed a fever of 39°C. Blood
cultures drawn the day his fever started grew out overnight a
strictly aerobic, Gram-negative rod that was oxidase positive
and did not ferment lactose. Which of the following antibiotic
regimens would be most appropriate for treating this patient?
(A) Tobramycin + piperacillin/tazobactam
(B) Vancomycin + metronidazole
(C) Cefazolin
(D) Tigecycline
(E) Oxacillin
Answers
1 E 5. D 9. E
2. E 6. À 10. A
3. B 7. B
4. B 8. B
[brane in cansconn
REVIEW QUESTIONS
1
Long-term carriage and shedding is most likely to occur after
gastrointestinal infection with which of the following species
(A) E. coli O157:H7
(B) Shigella dysenteriae
© Y. cholerae
(D) C jejuni
(E) Salmonella typhi
A 63-year-old man visited his favorite oyster restaurant in a
small town on the eastern shore of the Gulf Coast of Texas. He
ate two dozen oysters. Two days later, he was admitted to the
hospital because of an abrupt onset of chills, fever, and light
headedness when he stood up. (In the emergency department
[ED], his blood pressure was 60/40 mm Hg) While in the ED,
he developed erythematous skin lesions. These rapidly evolved
into hemorrhagic bullae, which then formed ulcers. The man
drank a six-pack of beer and one half-bottle of whisky each day.
A microorganism of major concern for this patient is
(A) V. vulnificus
(B) E. coli
(© S. typhi
(D) Clostridium perfringens
(E) Streptococcus pyogenes (group A streptococci)
A family of four persons ate a meal that included undercooked
chicken. Within 3 days, three members developed an illness
characterized by fever, headache, myalgia, and malaise. Two of
the patients had concomitant diarrhea and abdominal pain. The
third person developed diarrhea after the systemic symptoms
had cleared. Stool cultures grew C. jejuni. Which of the following
culture conditions was most likely used to isolate C. jejuni?
(A) Thiosulfate-citrate-bile-sucrose medium incubated at
37°C in 5% oxygen and 10% CO,
(B) Salmonella-Shigella selective medium incubated at 37°C in
ambient air
1
Long-term carriage and shedding is most likely to occur after
gastrointestinal infection with which of the following species
(A) E. coli O157:H7
(B) Shigella dysenteriae
© Y. cholerae
(D) C jejuni
(E) Salmonella typhi
A 63-year-old man visited his favorite oyster restaurant in a
small town on the eastern shore of the Gulf Coast of Texas. He
ate two dozen oysters. Two days later, he was admitted to the
hospital because of an abrupt onset of chills, fever, and light
headedness when he stood up. (In the emergency department
[ED], his blood pressure was 60/40 mm Hg) While in the ED,
he developed erythematous skin lesions. These rapidly evolved
into hemorrhagic bullae, which then formed ulcers. The man
drank a six-pack of beer and one half-bottle of whisky each day.
A microorganism of major concern for this patient is
(A) V. vulnificus
(B) E. coli
(© S. typhi
(D) Clostridium perfringens
(E) Streptococcus pyogenes (group A streptococci)
A family of four persons ate a meal that included undercooked
chicken. Within 3 days, three members developed an illness
characterized by fever, headache, myalgia, and malaise. Two of
the patients had concomitant diarrhea and abdominal pain. The
third person developed diarrhea after the systemic symptoms
had cleared. Stool cultures grew C. jejuni. Which of the following
culture conditions was most likely used to isolate C. jejuni?
(A) Thiosulfate-citrate-bile-sucrose medium incubated at
37°C in 5% oxygen and 10% CO,
(B) Salmonella-Shigella selective medium incubated at 37°C in
ambient air
acConkey agar and Hektoen enteric gar incubated a
D) St shee Blood agar incubated a 37°C in ambient air
ame and oysters rom these water became il with dis
Some patients, he dira usual ad an
À hour after eating the shellfish, Sol altres typ
ofthe flowing is amie to be the cause oF your patient
An 18 year. woman in rural Bangladesh develops pr
and the manifestations ofthe hid and locals lus cased
Age and geography ee major fctorsin the prevalence of clo
als older han age 60 years is
D) St shee Blood agar incubated a 37°C in ambient air
ame and oysters rom these water became il with dis
Some patients, he dira usual ad an
À hour after eating the shellfish, Sol altres typ
ofthe flowing is amie to be the cause oF your patient
An 18 year. woman in rural Bangladesh develops pr
and the manifestations ofthe hid and locals lus cased
Age and geography ee major fctorsin the prevalence of clo
als older han age 60 years is
fishing boat in an estuary on the Gulf Coast of Texas. While
walking around the boat in shallow water, he scratched his leg
breaking the skin atthe ste of the current pain and swelling
He was not wearing boots. About 1 hour after the injury, the
scratch became red and painful. Swelling developed. Within
hours, the leg below the knee had become markedly swollen
he skin was red and tender, There was serous drainage from
the wound, which had uleerated and was now much enlarged
Near the wound, bullae were forming—the largest approxi
mately 2.5 cm in diameter. The most likely cause ofthis med
m lococeus aureus
B) 5. pyogenes
oc
D) E.coli
(A) Blocks E
1) Vids increased intracellular evel of AMP
©) Cleves SNARE
D) Blocks EF dependent binding of emino-cplARNA
o Gene VAMP
In September 1854, asevreopldend of cher occared athe
epidemicogy studied the epidemic and helped stop by which
(A) Banning the sale of apple at he local markets
raid by inoclating part ofthe Specimen on which ofthe
slowing?
(© MacConkey apr medium incubaeda 37°C
walking around the boat in shallow water, he scratched his leg
breaking the skin atthe ste of the current pain and swelling
He was not wearing boots. About 1 hour after the injury, the
scratch became red and painful. Swelling developed. Within
hours, the leg below the knee had become markedly swollen
he skin was red and tender, There was serous drainage from
the wound, which had uleerated and was now much enlarged
Near the wound, bullae were forming—the largest approxi
mately 2.5 cm in diameter. The most likely cause ofthis med
m lococeus aureus
B) 5. pyogenes
oc
D) E.coli
(A) Blocks E
1) Vids increased intracellular evel of AMP
©) Cleves SNARE
D) Blocks EF dependent binding of emino-cplARNA
o Gene VAMP
In September 1854, asevreopldend of cher occared athe
epidemicogy studied the epidemic and helped stop by which
(A) Banning the sale of apple at he local markets
raid by inoclating part ofthe Specimen on which ofthe
slowing?
(© MacConkey apr medium incubaeda 37°C
€
REVIEW QUESTIONS
1. A 68-year-old woman was seen in the clinic because she had
felt feverish and had been experiencing increasing pain and
swelling in her left knee during the past 3 weeks. Four years
earlier, a prosthetic joint had been placed in her left knee. On
examination, the knee was swollen, and fluid could be detected.
An aspirate of the fluid was obtained. There were 15,000 poly-
morphonuclear cells/mL in the fluid. No organisms were seen
on Gram-stain. A routine culture was done. On the fourth day
of incubation, colorless colonies smaller than 1 mm in diameter
were seen on the blood and chocolate agar plates. The organ-
ism was a tiny Gram-negative coccobacillus that was catalase
positive and oxidase positive. A urea slant was inoculated and
was positive for urease activity after overnight incubation.
The patient was probably infected with which of the following
microorganisms?
(A) H. influenzae
(B) H. ducreyi
(©) F tularensis
(D) Brucella species
(E) Staphylococcus aureus
2. After the culture (Question 1) turned positive, additional his-
tory was obtained. Approximately 4 weeks before the onset of
her Knee pain, the patient had visited relatives in Israel and trav-
eled to other countries in the Mediterranean area. She had a
particular fondness for one food product that was the probable
vehicle for her infection. The product most likely was
(A) Bananas
(B) Unpasteurized goat's cheese
REVIEW QUESTIONS
1. A 68-year-old woman was seen in the clinic because she had
felt feverish and had been experiencing increasing pain and
swelling in her left knee during the past 3 weeks. Four years
earlier, a prosthetic joint had been placed in her left knee. On
examination, the knee was swollen, and fluid could be detected.
An aspirate of the fluid was obtained. There were 15,000 poly-
morphonuclear cells/mL in the fluid. No organisms were seen
on Gram-stain. A routine culture was done. On the fourth day
of incubation, colorless colonies smaller than 1 mm in diameter
were seen on the blood and chocolate agar plates. The organ-
ism was a tiny Gram-negative coccobacillus that was catalase
positive and oxidase positive. A urea slant was inoculated and
was positive for urease activity after overnight incubation.
The patient was probably infected with which of the following
microorganisms?
(A) H. influenzae
(B) H. ducreyi
(©) F tularensis
(D) Brucella species
(E) Staphylococcus aureus
2. After the culture (Question 1) turned positive, additional his-
tory was obtained. Approximately 4 weeks before the onset of
her Knee pain, the patient had visited relatives in Israel and trav-
eled to other countries in the Mediterranean area. She had a
particular fondness for one food product that was the probable
vehicle for her infection. The product most likely was
(A) Bananas
(B) Unpasteurized goat's cheese
ght have been legally tapped or aha; was not, and the
ce om his ight forehead and pain in his eight ail. Phys
cal examination also revealed right axillary Iaphadenopaty
This patiente most Likely infected with
D) HE duce
An 18-month-o boy has een playing wi
dti, we says she is comfortable tht the
be fine because has Been fully immunized wth the poly
itl ribose phosphate (PRE) protein conjugate vaccine, For
A) The conjugate polen is diphtheria toxcid and the gu
Aiphern
alas 2 monts 102 cars of age donot immunological
respond to polysaccharide vacines tha are ot conjugated
(C) The conjugate vaccine is designed for oder children und
dl as well as infants
(D) Maternal ransplacental) antibodies aginst infer:
re gone from the Infants circulation by 2 months of
showed a mass ei inthe eft hemisphere He was though to
havea brain tumor. A lumbar puncte was not done because
tion through the tmtorum cerebell, During surgery, mass
este were dane while the patient was in Ihe operating room,
Microscopy of the sections showed a granulomatous ina
cure for AL tuberculosis Middlebrook 7119 broth medium
was used. Six dye after he culture was setup, the automated
ne detectas the culture result was postie. Resuls of
an acid fs ain and a Grant stain were bath negative. Subcul
gave coccbacils that was catala positive and oxide
re showed urease activity after 2 hours of incubation
on uses containing medi. This child had infection with
E) Moras catorrh
ce om his ight forehead and pain in his eight ail. Phys
cal examination also revealed right axillary Iaphadenopaty
This patiente most Likely infected with
D) HE duce
An 18-month-o boy has een playing wi
dti, we says she is comfortable tht the
be fine because has Been fully immunized wth the poly
itl ribose phosphate (PRE) protein conjugate vaccine, For
A) The conjugate polen is diphtheria toxcid and the gu
Aiphern
alas 2 monts 102 cars of age donot immunological
respond to polysaccharide vacines tha are ot conjugated
(C) The conjugate vaccine is designed for oder children und
dl as well as infants
(D) Maternal ransplacental) antibodies aginst infer:
re gone from the Infants circulation by 2 months of
showed a mass ei inthe eft hemisphere He was though to
havea brain tumor. A lumbar puncte was not done because
tion through the tmtorum cerebell, During surgery, mass
este were dane while the patient was in Ihe operating room,
Microscopy of the sections showed a granulomatous ina
cure for AL tuberculosis Middlebrook 7119 broth medium
was used. Six dye after he culture was setup, the automated
ne detectas the culture result was postie. Resuls of
an acid fs ain and a Grant stain were bath negative. Subcul
gave coccbacils that was catala positive and oxide
re showed urease activity after 2 hours of incubation
on uses containing medi. This child had infection with
E) Moras catorrh
e hoe, timethopeim.slfasethosazale can
ec because the chil is allengie to sulfonamile
thatthe child wi
liars
sas, and back p
indings include conjunctival petech
eomorphic Gram negative rod tha is not hemolytc and th
‘Scanned with CamScanner
ec because the chil is allengie to sulfonamile
thatthe child wi
liars
sas, and back p
indings include conjunctival petech
eomorphic Gram negative rod tha is not hemolytc and th
‘Scanned with CamScanner
(A) H influenzae type b
(8) B. pertussis
(©) Streptococcus agalactiae
(D) C. pneumoniae
(E) B. bronchiseptica
12. In Question 11, the factor responsible for the profound lympho
cytosis is
(A) A hemagglutinin
(B) A polysaccharide capsule
(©) AnA/B structured toxin
(D) A heat-labile toxin
(E) A neuraminidase
13. All of the following cause zoonotic infections except
(A) E tularensis
(8) B. melitensis
(C) B pertussis
(D) Bacillus anthracis
(E) Leptospira interrogans
14, Which of the following is not a recognized virulence factor of
B. pertussis
(A) Heat-labile toxin
(B) Filamentous hemagglutinin
(C) Tracheal cytotoxin
(D) Pertussis toxin
(E) Dermonecrotic toxin
15, Which of the following pathogens discussed in this chapter is
on the select agent list?
(A) H. influenzae
(B) A. aphrophilus
(©) B pertussis
(D) E tularensis
(E) Allof the above
Answers
(8) B. pertussis
(©) Streptococcus agalactiae
(D) C. pneumoniae
(E) B. bronchiseptica
12. In Question 11, the factor responsible for the profound lympho
cytosis is
(A) A hemagglutinin
(B) A polysaccharide capsule
(©) AnA/B structured toxin
(D) A heat-labile toxin
(E) A neuraminidase
13. All of the following cause zoonotic infections except
(A) E tularensis
(8) B. melitensis
(C) B pertussis
(D) Bacillus anthracis
(E) Leptospira interrogans
14, Which of the following is not a recognized virulence factor of
B. pertussis
(A) Heat-labile toxin
(B) Filamentous hemagglutinin
(C) Tracheal cytotoxin
(D) Pertussis toxin
(E) Dermonecrotic toxin
15, Which of the following pathogens discussed in this chapter is
on the select agent list?
(A) H. influenzae
(B) A. aphrophilus
(©) B pertussis
(D) E tularensis
(E) Allof the above
Answers
REVIEW QUESTIONS
1. An 18-year-old male resident of Arizona came to the emergency
department (ED) complaining of fever, pain in his left groin, and
diarrhea for the past 2 days. On examination, he was afebrile,
had a pulse rate of 126 beats/min, a respiratory rate of 20 breaths/
min, and a blood pressure of 130/80 mm Hg. Left groin swelling
and tenderness were noted. A groin muscle strain was diagnosed,
attributed to a fall 2 days earlier. He was treated with nonsteroidal
anti-inflammatory drugs and released. The next day, the patient
reported feeling weak, had difficulty breathing, and collapsed
while taking a shower. He was transported to a hospital ED and
pronounced dead shortly after arrival. Cultures of blood samples
obtained in the ED were positive for Y. pestis. An epidemiologic
investigation indicated that the patient most likely became infected
as a result of bites by Y. pestis-infected fleas while walking through
aprairie dog colony (see Chapter 48). Which of the following state-
ments about the pathogenesis of plague is correct?
(A) Y. pestis produces a coagulase when incubated at 28°
(B) There is no risk for pneumonia caused by person-to-person
transmission of Y. pestis.
(C) Y. pestis organisms multiply in polymorphonuclear cells.
(D) After the bite of an infected flea, Y. pestis infection seldom,
if ever, disseminates beyond the site of the flea bite and the
regional lymph nodes.
(E) Y. pestis is transmitted to animals (and humans) in flea
feces excreted when the flea is feeding.
The drug of choice to treat the patient in Question 1 would have
been
(A) Ampicillin
(B) Cefotaxime
(C) Levofloxacin
(D)
(
) Erythromycin
E) Streptomycin
1. An 18-year-old male resident of Arizona came to the emergency
department (ED) complaining of fever, pain in his left groin, and
diarrhea for the past 2 days. On examination, he was afebrile,
had a pulse rate of 126 beats/min, a respiratory rate of 20 breaths/
min, and a blood pressure of 130/80 mm Hg. Left groin swelling
and tenderness were noted. A groin muscle strain was diagnosed,
attributed to a fall 2 days earlier. He was treated with nonsteroidal
anti-inflammatory drugs and released. The next day, the patient
reported feeling weak, had difficulty breathing, and collapsed
while taking a shower. He was transported to a hospital ED and
pronounced dead shortly after arrival. Cultures of blood samples
obtained in the ED were positive for Y. pestis. An epidemiologic
investigation indicated that the patient most likely became infected
as a result of bites by Y. pestis-infected fleas while walking through
aprairie dog colony (see Chapter 48). Which of the following state-
ments about the pathogenesis of plague is correct?
(A) Y. pestis produces a coagulase when incubated at 28°
(B) There is no risk for pneumonia caused by person-to-person
transmission of Y. pestis.
(C) Y. pestis organisms multiply in polymorphonuclear cells.
(D) After the bite of an infected flea, Y. pestis infection seldom,
if ever, disseminates beyond the site of the flea bite and the
regional lymph nodes.
(E) Y. pestis is transmitted to animals (and humans) in flea
feces excreted when the flea is feeding.
The drug of choice to treat the patient in Question 1 would have
been
(A) Ampicillin
(B) Cefotaxime
(C) Levofloxacin
(D)
(
) Erythromycin
E) Streptomycin
1990s, carried by rats on ships that had sald from HG
a pagos eee worum, The current tse
Y pests in the United Stats sare
A) Urban fra cats
B) Urban rats
agent of bioterrorism and bo
wound was red and swollen and drained purulent fluid. mu
0) Erytheomyc
ln
chemoprophyloxst
0) Cana
D) Penicilin
In a patent who hast bo
(©) Culture ofa lymph node aspirate on blood and MacConke
) ltnsiunchistochenicl staining of lymph node tise
antiphagocytic properties.
contains genes ha yield plsminogen-at
hat has temperatue-dependent compas ati
contains genes that encode phospalipse D, which I
unique to Y pet,
encodes factors that are important for survival
drink contaminated by animals or animal products,
a pagos eee worum, The current tse
Y pests in the United Stats sare
A) Urban fra cats
B) Urban rats
agent of bioterrorism and bo
wound was red and swollen and drained purulent fluid. mu
0) Erytheomyc
ln
chemoprophyloxst
0) Cana
D) Penicilin
In a patent who hast bo
(©) Culture ofa lymph node aspirate on blood and MacConke
) ltnsiunchistochenicl staining of lymph node tise
antiphagocytic properties.
contains genes ha yield plsminogen-at
hat has temperatue-dependent compas ati
contains genes that encode phospalipse D, which I
unique to Y pet,
encodes factors that are important for survival
drink contaminated by animals or animal products,
(D) A large inoculum is required to cause infection.
(E) Infection is more prevalent in persons with histocompat-
ibility antigen HLA-B27.
10. Optimum recovery of Y. enterocolitica from the stools of
patients with gastroenteritis requires which of the following
specialized media?
(A) Cefsulodin-irgasan-novobiocin agar
(B) Xylose-lysine decarboxylase agar
(C) Hektoen-enteric agar
(D) Regan-Lowe medium
(E) MacConkey agar
11. An organism suspected of being Y. pestis is recovered from a
patient with sepsis. The isolate has bipolar staining and is cata-
lase positive but is oxidase and urease negative and is nonmo-
tile. At this point, what should be done?
(A) Nothing; the laboratory has confirmed the diagnosis.
(B) Inoculate the isolate to an identification kit or automated
system for confirmation.
(C) Call the police because there is a possible bioterrorism
event.
(D) Send the isolate to the nearest public health laboratory for
confirmation,
(E) Send the isolate to the hospital across town for sequencing.
Answers
1...A: 5. D 9. C
2.E 6. E 10. A
Se. B 7. A 1. D
4. C 8. B
(E) Infection is more prevalent in persons with histocompat-
ibility antigen HLA-B27.
10. Optimum recovery of Y. enterocolitica from the stools of
patients with gastroenteritis requires which of the following
specialized media?
(A) Cefsulodin-irgasan-novobiocin agar
(B) Xylose-lysine decarboxylase agar
(C) Hektoen-enteric agar
(D) Regan-Lowe medium
(E) MacConkey agar
11. An organism suspected of being Y. pestis is recovered from a
patient with sepsis. The isolate has bipolar staining and is cata-
lase positive but is oxidase and urease negative and is nonmo-
tile. At this point, what should be done?
(A) Nothing; the laboratory has confirmed the diagnosis.
(B) Inoculate the isolate to an identification kit or automated
system for confirmation.
(C) Call the police because there is a possible bioterrorism
event.
(D) Send the isolate to the nearest public health laboratory for
confirmation,
(E) Send the isolate to the hospital across town for sequencing.
Answers
1...A: 5. D 9. C
2.E 6. E 10. A
Se. B 7. A 1. D
4. C 8. B
REVIEW QUESTIONS
1. The inhabitants of a group of small villages in rural sub-Saharan
Africa experienced an epidemic of meningitis. Ten percent of the
people died, most of them younger than the age of 15 years. The
microorganism that most likely caused this epidemic was
(A) Streptococcus agalactiae (group B)
(B) Escherichia coli Kl (capsular type 1)
(C) H. influenzae serotype b
(D) meningitidis serogroup A
(E) West Nile virus
1. The inhabitants of a group of small villages in rural sub-Saharan
Africa experienced an epidemic of meningitis. Ten percent of the
people died, most of them younger than the age of 15 years. The
microorganism that most likely caused this epidemic was
(A) Streptococcus agalactiae (group B)
(B) Escherichia coli Kl (capsular type 1)
(C) H. influenzae serotype b
(D) meningitidis serogroup A
(E) West Nile virus
past our, N gonorrhoeae vas cultured fom the spe
imen and found to be lactamase postie and resistant o high
kvl (232 pg) of tetracycline, Which ofthe following stat
A) f-Lactamase production and high-level resistance to tetra
edite by genes on plasmid
08) Whereas lactamase production is mediated by a gene 0
he bacterial chromosome, high-level tetracycline resis
) Wheres -lctamase production is mediated by a gene
00) lactamase production and high-level resistance 1 1
6-yerold boy develops a fever and headache, He tae
f neck, suggesting meningcal irritation. A lumbar puns:
ve is done, and culture of the cercrospinal fluid grows
N meningitis serogroup B. Which ofthe following shold be
GB) They should be given N
(©) They shouldbe given N mening
D) They shoul be given iampin
E) They should be given slfonamide prop
An 183 old woman who reports unprotected ex with anew
artnet 2 weeks previously develops fever ade quadrant
period. On pelvic examination in the emergency department
che has altera tenderness when the ters pated. À mass
non sequel ofthi infection is
nal-recal fistula
on The patent shoul be eau la
0) Aan ymphocye adenosine dain
GA Sh enteng Linder
(©) Ao year lá man with mali dependent bees
imen and found to be lactamase postie and resistant o high
kvl (232 pg) of tetracycline, Which ofthe following stat
A) f-Lactamase production and high-level resistance to tetra
edite by genes on plasmid
08) Whereas lactamase production is mediated by a gene 0
he bacterial chromosome, high-level tetracycline resis
) Wheres -lctamase production is mediated by a gene
00) lactamase production and high-level resistance 1 1
6-yerold boy develops a fever and headache, He tae
f neck, suggesting meningcal irritation. A lumbar puns:
ve is done, and culture of the cercrospinal fluid grows
N meningitis serogroup B. Which ofthe following shold be
GB) They should be given N
(©) They shouldbe given N mening
D) They shoul be given iampin
E) They should be given slfonamide prop
An 183 old woman who reports unprotected ex with anew
artnet 2 weeks previously develops fever ade quadrant
period. On pelvic examination in the emergency department
che has altera tenderness when the ters pated. À mass
non sequel ofthi infection is
nal-recal fistula
on The patent shoul be eau la
0) Aan ymphocye adenosine dain
GA Sh enteng Linder
(©) Ao year lá man with mali dependent bees
(D) A eal 40 year old technician who works
A 25-year-old sexually ative woman presents with parlent
vaginal charge and dysuria 7 days afer having unprotected
thelial log agent?
(C) Bacterial culture on selective media
) Serology
What ithe curently recommended reten for gonococcal
ng cell componente produced by N. gn
saccharide
i imbrie
(D) Outer membrane porn protein
0 rom binding protein
Sesa Hype. A sputum sample 1 collected
the specimen lo sent promptly to the laboratory, Microscopie
‘old woman presents with septic arthrits of the
nce. The Hi gprate grows a Gram negativ diplococcus on
hocolate gar after 8 hours of incubation, The late is om
‘dase postive and oxidaes glucose but not malos, lactose, 0
A 25-year-old sexually ative woman presents with parlent
vaginal charge and dysuria 7 days afer having unprotected
thelial log agent?
(C) Bacterial culture on selective media
) Serology
What ithe curently recommended reten for gonococcal
ng cell componente produced by N. gn
saccharide
i imbrie
(D) Outer membrane porn protein
0 rom binding protein
Sesa Hype. A sputum sample 1 collected
the specimen lo sent promptly to the laboratory, Microscopie
‘old woman presents with septic arthrits of the
nce. The Hi gprate grows a Gram negativ diplococcus on
hocolate gar after 8 hours of incubation, The late is om
‘dase postive and oxidaes glucose but not malos, lactose, 0
. A useful test to differentiate M. catarrhalis from saprophytic
neisseriae in respiratory samples is
(A) Butyrate esterase
am-stain
(C) Growth on 5% sheep blood agar
(D) PYR
(E) Oxidase
Answers
1D
A
D
D
neisseriae in respiratory samples is
(A) Butyrate esterase
am-stain
(C) Growth on 5% sheep blood agar
(D) PYR
(E) Oxidase
Answers
1D
A
D
D
R
1
EVIEW QUESTIONS
A 55-year-old man visits his physician complaining of a severe
cough and production of purulent sputum. His breath has a very
unpleasant fetid odor. Chest radiography shows a large amount of
fluid in the left pleural space and a 5-cm lung cavity with an air-
fluid level. A needle is inserted through the chest wall, and some of
the fluid in the pleural space is removed; it is thick, yellow-gray in
color, and malodorous. Which of the following organisms or sets
of organisms are most likely to be cultured from the pleural fluid?
(A) B. fragilis, E. coli, and enterococci
(8) P. bivia, peptostreptococci, and Staphylococcus epidermidis
(©) P. melaninogenica, Fusobacterium species, and viridans
streptococci
(D) Propionibacterium species, peptostreptococ
Staphylococcus aureus
(E) $. pneumoniae
. An 18-year-old man develops fever with pain in the right lower
quadrant of his abdomen, After initial evaluation, he is taken to
the operating room. During surgery, a ruptured appendix with an
abscess is found. B. fragilisis cultured from the abscess fluid. Which
of the following factors promote abscess formation by B. fragilis?
(A) Lipopolysaccharide
(B) Capsule
(C) Superoxide dismutase
(D) Pili
(E) Leukocidin toxin
Infections caused by Bacteroides species can be treated with all of
the following antibiotics except
(A) Ampicillin-sulbactam
(B) Clindamycin
(C) Metronidazole
(D) Penicillin
(E) Cefoxitin
A 17-year-old high school senior develops infectious mononucleo
sis. About 2 weeks later, he develops a significantly higher fever, a
‘worsening sore throat, an inability to swallow, and severe neck and
‘Scanned with CamScanner
1
EVIEW QUESTIONS
A 55-year-old man visits his physician complaining of a severe
cough and production of purulent sputum. His breath has a very
unpleasant fetid odor. Chest radiography shows a large amount of
fluid in the left pleural space and a 5-cm lung cavity with an air-
fluid level. A needle is inserted through the chest wall, and some of
the fluid in the pleural space is removed; it is thick, yellow-gray in
color, and malodorous. Which of the following organisms or sets
of organisms are most likely to be cultured from the pleural fluid?
(A) B. fragilis, E. coli, and enterococci
(8) P. bivia, peptostreptococci, and Staphylococcus epidermidis
(©) P. melaninogenica, Fusobacterium species, and viridans
streptococci
(D) Propionibacterium species, peptostreptococ
Staphylococcus aureus
(E) $. pneumoniae
. An 18-year-old man develops fever with pain in the right lower
quadrant of his abdomen, After initial evaluation, he is taken to
the operating room. During surgery, a ruptured appendix with an
abscess is found. B. fragilisis cultured from the abscess fluid. Which
of the following factors promote abscess formation by B. fragilis?
(A) Lipopolysaccharide
(B) Capsule
(C) Superoxide dismutase
(D) Pili
(E) Leukocidin toxin
Infections caused by Bacteroides species can be treated with all of
the following antibiotics except
(A) Ampicillin-sulbactam
(B) Clindamycin
(C) Metronidazole
(D) Penicillin
(E) Cefoxitin
A 17-year-old high school senior develops infectious mononucleo
sis. About 2 weeks later, he develops a significantly higher fever, a
‘worsening sore throat, an inability to swallow, and severe neck and
‘Scanned with CamScanner
chest pain, Upon admission, he has signs of sepsis and respiratory
distress, What isthe most kely organism causing this complication?
(A) E necrophorun
E) B ovatus
D) Clostridium ı
E) À israel
The drug of choice for treatment of infections caused by Actino
myces species is
(A) Tigecycline
B) Cefoxits
(C) Metronidazole
D) Imipenem
E) Penicillin
Allofthe following statements regardinganacrobes are true excep
A) They possess the enzyme cytochrome oxidase
B) Many species are part ofthe normal human microbiota,
(©) They are often found along with aerobes in complicated
(D) Special techniques are required to ensure their recovery
Some species are more tolerant of exposure to oxygen tha
Lemierres disease is a serious infection of the head and neck
ssaciated with which ofthe following anaerobes?
À) Pe melan
(8) Bactero
(©) Porphyromonas gingiv
mr
(E) Enecrophorum
Definitive identification of an anaerobe is likely best accom
plished by
(A) Colony morphology on anaerobic media
(B) The presence of pigment
(©) Susceptibility to a variety of antimicrobial dis
(D) Cell wall fatty acid analysis using gas liquid chromatography
(E) Gram-stain morphology
A patient who has not maintained good dentition presents ws
nduration and swelling of the mandibular area. On examination,
y note purulent material draining from a small opening. The
naterial appears yellowish, and there are some visible granules.
You perform a Gramstain, and pleomorphic Gram-positive rods
with short branches are noted along with cells suggestive of acute
1d chronic inflammation. You suspect which of the following
organisms?
(A) 8 feagilis
(B) Lactobac
(©) Clostridium perfringens
(D) A israel
© Sauren
distress, What isthe most kely organism causing this complication?
(A) E necrophorun
E) B ovatus
D) Clostridium ı
E) À israel
The drug of choice for treatment of infections caused by Actino
myces species is
(A) Tigecycline
B) Cefoxits
(C) Metronidazole
D) Imipenem
E) Penicillin
Allofthe following statements regardinganacrobes are true excep
A) They possess the enzyme cytochrome oxidase
B) Many species are part ofthe normal human microbiota,
(©) They are often found along with aerobes in complicated
(D) Special techniques are required to ensure their recovery
Some species are more tolerant of exposure to oxygen tha
Lemierres disease is a serious infection of the head and neck
ssaciated with which ofthe following anaerobes?
À) Pe melan
(8) Bactero
(©) Porphyromonas gingiv
mr
(E) Enecrophorum
Definitive identification of an anaerobe is likely best accom
plished by
(A) Colony morphology on anaerobic media
(B) The presence of pigment
(©) Susceptibility to a variety of antimicrobial dis
(D) Cell wall fatty acid analysis using gas liquid chromatography
(E) Gram-stain morphology
A patient who has not maintained good dentition presents ws
nduration and swelling of the mandibular area. On examination,
y note purulent material draining from a small opening. The
naterial appears yellowish, and there are some visible granules.
You perform a Gramstain, and pleomorphic Gram-positive rods
with short branches are noted along with cells suggestive of acute
1d chronic inflammation. You suspect which of the following
organisms?
(A) 8 feagilis
(B) Lactobac
(©) Clostridium perfringens
(D) A israel
© Sauren
1. Humans become infected with L. pneumophila by
(A) Kissing a person who is a legionella carrier
(B) Breathing acrosols from environmental water sources
(©) Receiving a mosquito bite
(D) Consuming undercooked pork
An LL year-old girl developed an acute onset of fever, chills, head.
ache, vomiting, and severe migratory arthralgias (joint pain) and
myalgias (muscle pain). Two days later, she developed a maculo.
papular rash over her palms, soles, and extremities. At the same
time, her left knee became extremely painful and swollen. On
examination, fluid was demonstrated in the knee. Further history
disclosed that the patient had a pet rat. Culture of the fluid from
her knee on 5% sheep blood agar showed 2-mm colonies afte
3 days of incubation. Broth culture showed small puffball-like
growth. Gram-staining showed a Gram-negative bacillus 0.5 um
wide and 1-4 ym long. Some extremely long forms (up to 150 pm)
with beadlike chains, fusiform swellings, and large round bodies
were seen. The microbiologist who observed the Gram-stained
smear immediately knew the cause of the girls infection to be
(A) Pasteurella multocida
(8) Streptobacillus moniliformis
(© Francisella tularensis
(D) B. bacilliformis
(E) Yersinia pestis
A 70-year-old man presents with bilateral pneumonia. His
Legionella urinary antigen test result is positive. Which of the
following is the likely cause of his pneumonia?
(A) L. pneumophila serogroup 1
(8) L. micdadei serogroup 4
(©) Legionella bozemanii serogroup
(D) L. longbeachae serogroup 2
(E) All of the above because the urinary antigen test is genus
specific and not species or serotype specific.
A 65-year-old man comes to the emergency department feeling
feverish and “really tired.” He has a chronic cigarette cough, but
this has dramatically increased in the past week and he has been
producing whitish sputum. ‘The previous day he had a tempera
ture of 38°C and watery diarrhea. Physical examination reveals
inspiratory and expiratory wheezes and rales over the right lower
(A) Kissing a person who is a legionella carrier
(B) Breathing acrosols from environmental water sources
(©) Receiving a mosquito bite
(D) Consuming undercooked pork
An LL year-old girl developed an acute onset of fever, chills, head.
ache, vomiting, and severe migratory arthralgias (joint pain) and
myalgias (muscle pain). Two days later, she developed a maculo.
papular rash over her palms, soles, and extremities. At the same
time, her left knee became extremely painful and swollen. On
examination, fluid was demonstrated in the knee. Further history
disclosed that the patient had a pet rat. Culture of the fluid from
her knee on 5% sheep blood agar showed 2-mm colonies afte
3 days of incubation. Broth culture showed small puffball-like
growth. Gram-staining showed a Gram-negative bacillus 0.5 um
wide and 1-4 ym long. Some extremely long forms (up to 150 pm)
with beadlike chains, fusiform swellings, and large round bodies
were seen. The microbiologist who observed the Gram-stained
smear immediately knew the cause of the girls infection to be
(A) Pasteurella multocida
(8) Streptobacillus moniliformis
(© Francisella tularensis
(D) B. bacilliformis
(E) Yersinia pestis
A 70-year-old man presents with bilateral pneumonia. His
Legionella urinary antigen test result is positive. Which of the
following is the likely cause of his pneumonia?
(A) L. pneumophila serogroup 1
(8) L. micdadei serogroup 4
(©) Legionella bozemanii serogroup
(D) L. longbeachae serogroup 2
(E) All of the above because the urinary antigen test is genus
specific and not species or serotype specific.
A 65-year-old man comes to the emergency department feeling
feverish and “really tired.” He has a chronic cigarette cough, but
this has dramatically increased in the past week and he has been
producing whitish sputum. ‘The previous day he had a tempera
ture of 38°C and watery diarrhea. Physical examination reveals
inspiratory and expiratory wheezes and rales over the right lower
and would sgt
lavage
(©) Culture ofthe
ofthe abo
aon source forthe gro
event hemolysis af the ed boo
thology in
Lactan lactamase inhibitor combination
gets of choice or treatment.
aspirated rom involved mph
disease pid leads to
‘Scanned with CamScanner
lavage
(©) Culture ofthe
ofthe abo
aon source forthe gro
event hemolysis af the ed boo
thology in
Lactan lactamase inhibitor combination
gets of choice or treatment.
aspirated rom involved mph
disease pid leads to
‘Scanned with CamScanner
(©) L. pneumophila invades pulmonary capillaries, leading to
dissemination and systemic illness.
D) L. pneumophila induces alveolar macrophage phagosomes
Lo fuse with lysosomes,
E) L. pneumophila outer surface protein A (OspA) is impor
tant for invasion of alveolar macrophages.
10, True statements regarding 7: whipplei include all ofthe follow
A) It is easy to cultivate on chocolate agar after 3 di
incubation,
(8) It isa Gram positive actinomycete
(C) It causes fever, abdominal pain, diarrhea, weight loss, and
migratory polyarthralgia
D) Itstains with PAS.
All ofthe statements below regarding infections with Legionella
are correct except
A) Hospitals that care for patients at risk for Legionella infec
tions should know if their potable water systems contain
Human-to-human transmission is the major mech
of transmission of Legionella infection.
Legionella species can be visualized with Gram stain if
carbolfuchsin is used for the counter stain,
he chest radiograph of a patient who has Legionella pneu
‘monia is indistinguishable from that of patients with pres
monia caused by other pathogens,
E) A macrolide or quinolone are the drugs of first choice for
treatment of Legionella infections.
Which of the following best represents the role of the Mip pro.
ionella pathogenesis?
A) It prevents phagosome-Iysosome fusion.
B) acts asa siderophore to capture iron,
(©) It prevents phagocytosis
D) It facilitates adherence to the macrophage and stimulates
cellular invasion,
E) None of the above.
Pontiac fever is a severe form of pneumonia caused by
L. pneumophila serotypes 1 and 6
A) True
B) False
All of the following statements regarding S. moniliformis are
correct except
A) is susceptible to penicilln
B) It causes the disease rat-bite fever
(C) It causes Haverhill fever from ingestion of contaminated
food.
D) The morphology of the organism is spiral shaped.
dissemination and systemic illness.
D) L. pneumophila induces alveolar macrophage phagosomes
Lo fuse with lysosomes,
E) L. pneumophila outer surface protein A (OspA) is impor
tant for invasion of alveolar macrophages.
10, True statements regarding 7: whipplei include all ofthe follow
A) It is easy to cultivate on chocolate agar after 3 di
incubation,
(8) It isa Gram positive actinomycete
(C) It causes fever, abdominal pain, diarrhea, weight loss, and
migratory polyarthralgia
D) Itstains with PAS.
All ofthe statements below regarding infections with Legionella
are correct except
A) Hospitals that care for patients at risk for Legionella infec
tions should know if their potable water systems contain
Human-to-human transmission is the major mech
of transmission of Legionella infection.
Legionella species can be visualized with Gram stain if
carbolfuchsin is used for the counter stain,
he chest radiograph of a patient who has Legionella pneu
‘monia is indistinguishable from that of patients with pres
monia caused by other pathogens,
E) A macrolide or quinolone are the drugs of first choice for
treatment of Legionella infections.
Which of the following best represents the role of the Mip pro.
ionella pathogenesis?
A) It prevents phagosome-Iysosome fusion.
B) acts asa siderophore to capture iron,
(©) It prevents phagocytosis
D) It facilitates adherence to the macrophage and stimulates
cellular invasion,
E) None of the above.
Pontiac fever is a severe form of pneumonia caused by
L. pneumophila serotypes 1 and 6
A) True
B) False
All of the following statements regarding S. moniliformis are
correct except
A) is susceptible to penicilln
B) It causes the disease rat-bite fever
(C) It causes Haverhill fever from ingestion of contaminated
food.
D) The morphology of the organism is spiral shaped.
15. The diagnosis of Whipple's disease is best made by
(A) Paired serum obtained 8 weeks apart
(B) Prolonged culture on mycobacterial media
(C) Nucleic acid amplification testing performed on tissue
(D) Histopathology
(E) None of the above
Answers
1 B
B
(A) Paired serum obtained 8 weeks apart
(B) Prolonged culture on mycobacterial media
(C) Nucleic acid amplification testing performed on tissue
(D) Histopathology
(E) None of the above
Answers
1 B
B
REVIEW QUESTIONS
1
A 60-year-old man has a 5-month history of progressive weak-
ness and a weight loss of 13 kg along with intermittent fever,
chills, and a chronic cough productive of yellow sputum, occa-
sionally streaked with blood. A sputum specimen is obtained,
and numerous acid-fast bacteria are seen on the smear. Culture
of the sputum is positive for M. tuberculosis. Which treatment
regimen is most appropriate for initial therapy
1
A 60-year-old man has a 5-month history of progressive weak-
ness and a weight loss of 13 kg along with intermittent fever,
chills, and a chronic cough productive of yellow sputum, occa-
sionally streaked with blood. A sputum specimen is obtained,
and numerous acid-fast bacteria are seen on the smear. Culture
of the sputum is positive for M. tuberculosis. Which treatment
regimen is most appropriate for initial therapy
A) Isoniazid and rifampin
08) Sulfamethaxazole-rimethoprim and septenych
(©) Ionia, rfampan,pyrazinamide, and thambutel
E) Rifampin and sreptomyc
resistant Lo isoniazid the Ukely mechanism for esstance is,
A) lactamase
GB) Mutations in the ctalas-peroxkase gene
(©) Alterations inthe subunit of RNA polymerase
D) Mutations inthe DNA gyrase gene
À card woman presents wth a 3 month history ofp
tive cough weight os and eve Cheat rdicgraphy shows aera
‘aviary das sugges of ubecalos Sputum culture grows
ac fs acosa a photochomogen (makes an orange i
en ben exposed ga. The organi most lay
A Bear Asian woman is admitted 6 the hospital with à
Zeck history of increasing, malas, mula, nonproducie
ough, and shortness al breath She has daily overs °C
en she entered the United Stats 7 yeas ago. The patients
grandmother ded oftubercalosis whe the patient was an nf
écrase hematocrit and ver function test abnormalities, Liver
as ba, Sheis probably infected with
E) M tuberculosis
Ius very important thatthe p
0) Typhoid fever
D) Lymphoma
6) Malaria
Of concern regarding the patient in Question 4 isthat she cou
be infected with Meobactriun tats
0) Resistant to streptomyc
nda, He has clawing ofthe fourth and fit digits with loss
Y distal parts of the digs of both hands, strongly suggesting
A) le susceptible o isnizid and rifampin
1B) Growsin part ofthe by tat are cooler than 37°C
08) Sulfamethaxazole-rimethoprim and septenych
(©) Ionia, rfampan,pyrazinamide, and thambutel
E) Rifampin and sreptomyc
resistant Lo isoniazid the Ukely mechanism for esstance is,
A) lactamase
GB) Mutations in the ctalas-peroxkase gene
(©) Alterations inthe subunit of RNA polymerase
D) Mutations inthe DNA gyrase gene
À card woman presents wth a 3 month history ofp
tive cough weight os and eve Cheat rdicgraphy shows aera
‘aviary das sugges of ubecalos Sputum culture grows
ac fs acosa a photochomogen (makes an orange i
en ben exposed ga. The organi most lay
A Bear Asian woman is admitted 6 the hospital with à
Zeck history of increasing, malas, mula, nonproducie
ough, and shortness al breath She has daily overs °C
en she entered the United Stats 7 yeas ago. The patients
grandmother ded oftubercalosis whe the patient was an nf
écrase hematocrit and ver function test abnormalities, Liver
as ba, Sheis probably infected with
E) M tuberculosis
Ius very important thatthe p
0) Typhoid fever
D) Lymphoma
6) Malaria
Of concern regarding the patient in Question 4 isthat she cou
be infected with Meobactriun tats
0) Resistant to streptomyc
nda, He has clawing ofthe fourth and fit digits with loss
Y distal parts of the digs of both hands, strongly suggesting
A) le susceptible o isnizid and rifampin
1B) Growsin part ofthe by tat are cooler than 37°C
(©) Canbeculturedinthelaboratry using Middlebrook 7111
is seen in high numbers in lapses of eaberealoid leprosy
PPD) and the tuberculin skin tests mos
sitive PPD skin est results.
(©) The intradermal skin test Is usualy ead 4 hours after
gapped
pose tuberculin test resul indicates tht an individ
as ben infected with M uberufsiin the past and
A postive PPD skin test vlt implies that person is
A72 year ld woman has an artificial hip joint placed because
is submited for routine culture and for culture for acid
ing onthe shep blood agar plate, and similar apparing aid
patients most kel infected with
is seen in high numbers in lapses of eaberealoid leprosy
PPD) and the tuberculin skin tests mos
sitive PPD skin est results.
(©) The intradermal skin test Is usualy ead 4 hours after
gapped
pose tuberculin test resul indicates tht an individ
as ben infected with M uberufsiin the past and
A postive PPD skin test vlt implies that person is
A72 year ld woman has an artificial hip joint placed because
is submited for routine culture and for culture for acid
ing onthe shep blood agar plate, and similar apparing aid
patients most kel infected with
12. M. abscessus most often causes pulmonary disease among
which group of individuals?
(A) Young children exposed to dirt
(B) African American smokers
(©) Elderly, nonsmoking white females
(D) Hispanic men who work outdoors
(E) Persons living in the Northwestern United States
A newly characterized rapidly growing Mycobacterium that has
emerged as an important cause of central venous catheter asso
ciated infections is
(A) M phlei
(B) M. mucogenicum
(©) M. xenopi
(D) M. smegmatis
(E) M. terrae
The definition of extensively drug-resistant (XDR) tuberculosis
includes
(A) Resistance to isoniazid
(8) Resistance to a fluoroquinolone
(© Resistance to capreomycin, amikacin, or kanamycin
(D) Resistance to rifampin
(E) All of the above
All of the following organisms are rapidly growing mycobac
teria except
(A) M. fortuitum
(B) M. abscessus
(© M. mucogenicum
(D) M. nonchromogenicum
(E) M. chelonae
Answers
1
2.
3
4.
5.
which group of individuals?
(A) Young children exposed to dirt
(B) African American smokers
(©) Elderly, nonsmoking white females
(D) Hispanic men who work outdoors
(E) Persons living in the Northwestern United States
A newly characterized rapidly growing Mycobacterium that has
emerged as an important cause of central venous catheter asso
ciated infections is
(A) M phlei
(B) M. mucogenicum
(©) M. xenopi
(D) M. smegmatis
(E) M. terrae
The definition of extensively drug-resistant (XDR) tuberculosis
includes
(A) Resistance to isoniazid
(8) Resistance to a fluoroquinolone
(© Resistance to capreomycin, amikacin, or kanamycin
(D) Resistance to rifampin
(E) All of the above
All of the following organisms are rapidly growing mycobac
teria except
(A) M. fortuitum
(B) M. abscessus
(© M. mucogenicum
(D) M. nonchromogenicum
(E) M. chelonae
Answers
1
2.
3
4.
5.
REVIEW QUESTIONS
1. A 28-year-old woman who is 10 weeks pregnant presents to the
obstetrics clinic for prenatal care. She has a history of treatment
for syphilis 7 years previously. ‘The results of serologic tests for
syphilis are as follows: nontreponemal test, RPR, nonreactive;
treponemal test (TP-PA), reactive. Which of the following state:
ments is most correct?
(A) The mother’s previous treatment for syphilis was effective.
(B) The baby is at high risk for congenital syphilis.
(©) The mother needs to be treated again for syphilis.
(D) The mother needs a lumbar puncture and a VDRL test of
her CSF for neurosyphilis.
A 12-year-old Boy Scout went to summer camp for 2 weeks
in late August at a site located just outside Mystic, Connecti
cut, When he returned home, his mother noticed a bull’s-eye-
shaped rash on the back of her son's left calf, Shortly after Labor
Day, the boy developed a flulike illness that resolved after 4 days
ofbed rest. Three weeks later, the boy complained to his mother
that his body hurt all over whenever he moved. ‘This prompted
a visit to the pediatrician, who ordered an infectious dis
workup. What is the most likely source of the boy’s infect
(A) Respiratory transmission from another sick camper
(Bj Ingestion of urine-contaminated water from a stream
(C) The bite of a mosquito harboring a parasite
(D) Ingestion of fecally contaminated food
(E) The bite ofa spirochete infected tick
Nontreponemal serological tests:
(A) Are useful in definitively identifying a T. pallidum
infection
(B) Measure antibodies against T pallidum
(C) Can be used to monitor antibiotic treatment of primary or
secondary syphilis,
(D) Measure antibodies against lipids released from damaged
cells.
Are useful in diagnosing a disseminated gonococcal
infection.
A 42-year-old woman went camping in the Sierra Nevada
Mountains, where she slept for two nights in an abandoned log
‘Scanned with CamScanner
1. A 28-year-old woman who is 10 weeks pregnant presents to the
obstetrics clinic for prenatal care. She has a history of treatment
for syphilis 7 years previously. ‘The results of serologic tests for
syphilis are as follows: nontreponemal test, RPR, nonreactive;
treponemal test (TP-PA), reactive. Which of the following state:
ments is most correct?
(A) The mother’s previous treatment for syphilis was effective.
(B) The baby is at high risk for congenital syphilis.
(©) The mother needs to be treated again for syphilis.
(D) The mother needs a lumbar puncture and a VDRL test of
her CSF for neurosyphilis.
A 12-year-old Boy Scout went to summer camp for 2 weeks
in late August at a site located just outside Mystic, Connecti
cut, When he returned home, his mother noticed a bull’s-eye-
shaped rash on the back of her son's left calf, Shortly after Labor
Day, the boy developed a flulike illness that resolved after 4 days
ofbed rest. Three weeks later, the boy complained to his mother
that his body hurt all over whenever he moved. ‘This prompted
a visit to the pediatrician, who ordered an infectious dis
workup. What is the most likely source of the boy’s infect
(A) Respiratory transmission from another sick camper
(Bj Ingestion of urine-contaminated water from a stream
(C) The bite of a mosquito harboring a parasite
(D) Ingestion of fecally contaminated food
(E) The bite ofa spirochete infected tick
Nontreponemal serological tests:
(A) Are useful in definitively identifying a T. pallidum
infection
(B) Measure antibodies against T pallidum
(C) Can be used to monitor antibiotic treatment of primary or
secondary syphilis,
(D) Measure antibodies against lipids released from damaged
cells.
Are useful in diagnosing a disseminated gonococcal
infection.
A 42-year-old woman went camping in the Sierra Nevada
Mountains, where she slept for two nights in an abandoned log
‘Scanned with CamScanner
ach relapse is associated with an antigenically distinct
nthe p
relic donot passa rom one generation
00) The main reservoir fo the
Boreas resistant to pen
datysyphils was considered in the diferent dign
and convalescent pase sera for aie
ar old man presente with sony
enon (considered ow),
‘Scanned with CamScanner
nthe p
relic donot passa rom one generation
00) The main reservoir fo the
Boreas resistant to pen
datysyphils was considered in the diferent dign
and convalescent pase sera for aie
ar old man presente with sony
enon (considered ow),
‘Scanned with CamScanner
(C) PCR on the patient’s plasma should be done to detect
B. burgdorferi.
(D) A serum specimen should be submitted for immunob-
lot assay to detect antibodies reactive with B. burgdorferi
antigens.
(E) Culture of synovial fluid on blood and chocolate agar.
9. Which of the following organisms principally infects the liver
and kidneys?
(A) L. interrogans
(B) Staphylococcus aureus
(C) Escherichia coli
(D) Enterococcus faecalis
(E) T. pallidum
10. All of the following statements regarding relapsing fever are
correct except
(A) Epidemic disease carries a higher mortality rate than
endemic disease.
(B) Endemic
B. recurrentis.
he recurrent febrile episodes are caused by antigenic vari-
ation among the spirochetes.
(D) Penicillin is the drug of choice.
(E) Crushing a tick could transmit the spirochetes.
e in North America is caused by
©
Answers
1 A 5. A 9. A
2. E 6. E 10. B
3. D 7. D
4. A 8. D
[Scanned with CamScanner
B. burgdorferi.
(D) A serum specimen should be submitted for immunob-
lot assay to detect antibodies reactive with B. burgdorferi
antigens.
(E) Culture of synovial fluid on blood and chocolate agar.
9. Which of the following organisms principally infects the liver
and kidneys?
(A) L. interrogans
(B) Staphylococcus aureus
(C) Escherichia coli
(D) Enterococcus faecalis
(E) T. pallidum
10. All of the following statements regarding relapsing fever are
correct except
(A) Epidemic disease carries a higher mortality rate than
endemic disease.
(B) Endemic
B. recurrentis.
he recurrent febrile episodes are caused by antigenic vari-
ation among the spirochetes.
(D) Penicillin is the drug of choice.
(E) Crushing a tick could transmit the spirochetes.
e in North America is caused by
©
Answers
1 A 5. A 9. A
2. E 6. E 10. B
3. D 7. D
4. A 8. D
[Scanned with CamScanner
U. urealyticum is so named because
(A) It thrives in the upper urinary tract
(B) It requires urea asa growth substrate.
(©) Itisa frequent cause of symptomatic urinary bladder infec-
tions in young women.
(D) It causes chronic urinary tract infections in premature
babies born to mothers with ureaplasmas as part of the
genital flora,
An 18-year-old sexually active woman develops left lower
quadrant pain and fever. On pelvic examination, she has ten
derness in the left adnexa, and a mass suggestive of a uterine
tube abscess is palpated. The patient is diagnosed with pelvic
inflammatory disease. Which of the following bacteria is con-
sidered to be a common cause of pelvic inflammatory disease?
(A) Bacillus cereus
GB) H. influenzae
(©) Neisseria subflava
(D) M. pneumoniae
(E) Chlamydia trachomatis
Which of the following is important in the pathogenesis of
mycoplasmal infections?
(A) The peptidoglycan in the mycoplasmal cell wall
(B) The presence of lacto-N-neotetraose with a terminal galac
tosamine as the host cell receptor
(C) The structures and the interactive proteins that mediate
adhesion to host cells
(D) The absence of cilia on the surface of the host cells
(E) Growth in an anatomic site where anaerobic organisms
thrive
A 25-year-old woman is referred to the sexually transmitted
diseases clinic because of contact with a male partner with gon-
orrhea. The woman has had 15 male sex partners since becom:
ing sexually active. The likelihood that she also has genital
M. hominis infection is
(A) 1%
(8) 5%
© 15%
(D) 40%
(E) 90%
(A) It thrives in the upper urinary tract
(B) It requires urea asa growth substrate.
(©) Itisa frequent cause of symptomatic urinary bladder infec-
tions in young women.
(D) It causes chronic urinary tract infections in premature
babies born to mothers with ureaplasmas as part of the
genital flora,
An 18-year-old sexually active woman develops left lower
quadrant pain and fever. On pelvic examination, she has ten
derness in the left adnexa, and a mass suggestive of a uterine
tube abscess is palpated. The patient is diagnosed with pelvic
inflammatory disease. Which of the following bacteria is con-
sidered to be a common cause of pelvic inflammatory disease?
(A) Bacillus cereus
GB) H. influenzae
(©) Neisseria subflava
(D) M. pneumoniae
(E) Chlamydia trachomatis
Which of the following is important in the pathogenesis of
mycoplasmal infections?
(A) The peptidoglycan in the mycoplasmal cell wall
(B) The presence of lacto-N-neotetraose with a terminal galac
tosamine as the host cell receptor
(C) The structures and the interactive proteins that mediate
adhesion to host cells
(D) The absence of cilia on the surface of the host cells
(E) Growth in an anatomic site where anaerobic organisms
thrive
A 25-year-old woman is referred to the sexually transmitted
diseases clinic because of contact with a male partner with gon-
orrhea. The woman has had 15 male sex partners since becom:
ing sexually active. The likelihood that she also has genital
M. hominis infection is
(A) 1%
(8) 5%
© 15%
(D) 40%
(E) 90%
A 25-year-old medical student has contact with a patient who
has pneumonia with fever and cough. Four days later, the medi
al student develops fever and cough, and chest radiographs
show consolidation of the right lower lobe, Routine bacterial
sputum culture results are negative, Pneumonia caused by
M. pneumoniae is considered. AÑ ofthe following are methods
to confirm the clinical suspicion except
(A) PCR amplification of M pnewmoniae DNA in sputun
3) Culture of sputum for M. pneumonia
(C) Gram-stain of sputum smear
D) Culture ofa lung aspirate for M. pneumoniae
E) Enzyme immunoassay tes of acute and convalescent sera
Which type of testis most readily used to obtain labora
confirmation of M. pneumoniae infection?
(A) Culture in broth containing serum, glucose, and a penicil
in (to inhibit other flora
m PCR
(C) Electron microse
(D) EIA tests on acute and convalescent phase sera
A 13-year-old boy develops infection with Ml. pneumoniae
Whatisthe risk for infection in other membersofhishousehold?
(A) None; itis sexually transanited
© 10-15
D) 20-40%
Y) 50-90%
A 19-year-old man develops cough and fever. A chest radio
graph shows consolidation of the left lower lobe, A diagnosis
of pncumonia is made, Which ofthe following bacteria isa fre
quent cause of community-acquired pneumonia?
D) Mycoplasma pneumoniae
F) Kiehtela pneu
Initiation ofinfection by M. pneumoniae begins with
(A) Elaboration of polysaccharide capsule that inhibits
phagocytosis
B) Secretion of apotent exotoxin
(C) Endocytosis by ciliated respiratory epithelial cells
D) Adherence to respiratory epithelial cells mediated by PI
.dhesin
E) Phagocytic uplakeby alveolar macrophages
Infection with M. genitlium
(A) is not restricted tothe genitourinary tract
B) results in inflammation causing urethritis
cervicitisin females
(C) is best treated with a frst generation cephalosporin.
D) is associated only with no
Y) is asymptomatic unless a o-infectio
chomatiss presen
has pneumonia with fever and cough. Four days later, the medi
al student develops fever and cough, and chest radiographs
show consolidation of the right lower lobe, Routine bacterial
sputum culture results are negative, Pneumonia caused by
M. pneumoniae is considered. AÑ ofthe following are methods
to confirm the clinical suspicion except
(A) PCR amplification of M pnewmoniae DNA in sputun
3) Culture of sputum for M. pneumonia
(C) Gram-stain of sputum smear
D) Culture ofa lung aspirate for M. pneumoniae
E) Enzyme immunoassay tes of acute and convalescent sera
Which type of testis most readily used to obtain labora
confirmation of M. pneumoniae infection?
(A) Culture in broth containing serum, glucose, and a penicil
in (to inhibit other flora
m PCR
(C) Electron microse
(D) EIA tests on acute and convalescent phase sera
A 13-year-old boy develops infection with Ml. pneumoniae
Whatisthe risk for infection in other membersofhishousehold?
(A) None; itis sexually transanited
© 10-15
D) 20-40%
Y) 50-90%
A 19-year-old man develops cough and fever. A chest radio
graph shows consolidation of the left lower lobe, A diagnosis
of pncumonia is made, Which ofthe following bacteria isa fre
quent cause of community-acquired pneumonia?
D) Mycoplasma pneumoniae
F) Kiehtela pneu
Initiation ofinfection by M. pneumoniae begins with
(A) Elaboration of polysaccharide capsule that inhibits
phagocytosis
B) Secretion of apotent exotoxin
(C) Endocytosis by ciliated respiratory epithelial cells
D) Adherence to respiratory epithelial cells mediated by PI
.dhesin
E) Phagocytic uplakeby alveolar macrophages
Infection with M. genitlium
(A) is not restricted tothe genitourinary tract
B) results in inflammation causing urethritis
cervicitisin females
(C) is best treated with a frst generation cephalosporin.
D) is associated only with no
Y) is asymptomatic unless a o-infectio
chomatiss presen
3) Ehlchie ine
A) The diese occurs primary in sub-Saharan Africa
3) Ils transmited by teks,
) Recrudescence can occur many years aller the initial
The mos useful drugto treat hlihiosiis
(C) Trimethop
One elderly person, although ic was much ls ick than othe
alts The eoplchuddledtogeiherto kp warms body ce wer
Common, Which fhe fing statements I most corre
A) The disease that these people hadis common in the Rock
3) The ler person may have had acute epdemic typhus
(©) Plea Grom vents in the house were spreading R yp
D) Culture is good method to confirm the diagnosis
) Elicia are typical found in Iymphosytn
A group of urban teenagers vised sheep ranch in a large
‘Western stat fora 2 week experience. While they wer bee
many ofthe pregnant ewes delivered lambs tothe light ofthe
teenagers developed lie ices eharactried by mal
cough, and fever One had an inflrte on chet radiography
indicating pucumonia. The three teenagers had diferent do
determine that al of the comer Ind ben o bbc
A) The diese occurs primary in sub-Saharan Africa
3) Ils transmited by teks,
) Recrudescence can occur many years aller the initial
The mos useful drugto treat hlihiosiis
(C) Trimethop
One elderly person, although ic was much ls ick than othe
alts The eoplchuddledtogeiherto kp warms body ce wer
Common, Which fhe fing statements I most corre
A) The disease that these people hadis common in the Rock
3) The ler person may have had acute epdemic typhus
(©) Plea Grom vents in the house were spreading R yp
D) Culture is good method to confirm the diagnosis
) Elicia are typical found in Iymphosytn
A group of urban teenagers vised sheep ranch in a large
‘Western stat fora 2 week experience. While they wer bee
many ofthe pregnant ewes delivered lambs tothe light ofthe
teenagers developed lie ices eharactried by mal
cough, and fever One had an inflrte on chet radiography
indicating pucumonia. The three teenagers had diferent do
determine that al of the comer Ind ben o bbc
the ranch had ben sick, The mos ely explana
teenager ilinesses and the ak flee tthe ranch 5
(©) Tretoeagers acquired Qfeverattheranch andthe pope
The publ heal laborstory bade
A) Dengue
(8) Rocky Mountain poid ver
© Malai
A) Timeboprin-sllamebozaole
(1) Chlorampheni
One week ter deerhantingina wooded arcs, 33-year man
developed fever to 39°C with headache and malaise, Over th
debvequet 24 hours he developed nauses, vonsling néon
tal pala, and dia. On day 4. he developed arch. ial
round the wrist and anes, which then progresveyevaved
involving the arms, trunk, palms and sols nal the al
bout Rocky Mountain spoted fevers correct?
A) The vectors o rickets ae tick ofthe gems sede
(D) The patients antibody response may not occur unt after
he recommended treatment for Q fever endocardit
A) Emergent surgery; antibiotics are not effective
(8) Levofloxacin monotherapy for 6 weeks
teenager ilinesses and the ak flee tthe ranch 5
(©) Tretoeagers acquired Qfeverattheranch andthe pope
The publ heal laborstory bade
A) Dengue
(8) Rocky Mountain poid ver
© Malai
A) Timeboprin-sllamebozaole
(1) Chlorampheni
One week ter deerhantingina wooded arcs, 33-year man
developed fever to 39°C with headache and malaise, Over th
debvequet 24 hours he developed nauses, vonsling néon
tal pala, and dia. On day 4. he developed arch. ial
round the wrist and anes, which then progresveyevaved
involving the arms, trunk, palms and sols nal the al
bout Rocky Mountain spoted fevers correct?
A) The vectors o rickets ae tick ofthe gems sede
(D) The patients antibody response may not occur unt after
he recommended treatment for Q fever endocardit
A) Emergent surgery; antibiotics are not effective
(8) Levofloxacin monotherapy for 6 weeks
14.
(C) 18 months of combination therapy with doxycycline and
hydroxychloroquine
(D) Penicillin and gentamicin combination therapy using IgG
titers to determine duration
C. burnetii can be transmitted by milk when animals such as
goats and cows are infected. The presently recommended con-
ditions of “high-temperature, short-time” pasteurization are
adequate to destroy viable Coxiella organisms.
(A) True
(B) False
The histopathological hallmark of infection caused by
R. rickettsii is
(A) Morulae within granulocytes
(B) Morulae within monocytes
(C) Granulomatous inflammation
(D) Intracellular vacuoles
(E) Perivascular lymphocytes
All of the following statements regarding Rickettsialpox are
correct except
(A) The cause of the disease is R. akari.
(B) Ticks of the genus Amblyomma are responsible for
transmission.
(C) The disease is mild.
(D) Disease is more common in urban than rural areas.
Reasons why C. burnetii could be a potential agent of bioterror-
ism include
(A) It is acquired by the inhalation.
(B) It is highly infectious.
(C) It can be difficult to treat depending on the phase of
infection.
(D) Pneumonia may be severe.
(E) Allofthe above.
(C) 18 months of combination therapy with doxycycline and
hydroxychloroquine
(D) Penicillin and gentamicin combination therapy using IgG
titers to determine duration
C. burnetii can be transmitted by milk when animals such as
goats and cows are infected. The presently recommended con-
ditions of “high-temperature, short-time” pasteurization are
adequate to destroy viable Coxiella organisms.
(A) True
(B) False
The histopathological hallmark of infection caused by
R. rickettsii is
(A) Morulae within granulocytes
(B) Morulae within monocytes
(C) Granulomatous inflammation
(D) Intracellular vacuoles
(E) Perivascular lymphocytes
All of the following statements regarding Rickettsialpox are
correct except
(A) The cause of the disease is R. akari.
(B) Ticks of the genus Amblyomma are responsible for
transmission.
(C) The disease is mild.
(D) Disease is more common in urban than rural areas.
Reasons why C. burnetii could be a potential agent of bioterror-
ism include
(A) It is acquired by the inhalation.
(B) It is highly infectious.
(C) It can be difficult to treat depending on the phase of
infection.
(D) Pneumonia may be severe.
(E) Allofthe above.
Answers
EVIEW QUE
Which of the following statements about chlamydial antigens
A) Chlamydiac have shared group or genus-specific antigens
0) There is no cross-reaction between C. trachomatis and
D) One serovar of C, trachomatis causes eye infections, and
he second serovar causes genital infections.
0) Chamydiae frequently vary the epitopes oftheir antigens
As part ofthe control of C. psittaci and pttacosis in birds:
A) All psittacine birds imported into the United States ar
st vaccinated
B) Pstacin birds hatched in the United States are preferred
(©) Allbirás are tested for €. psitaci infection.
D) The shipment ofall birds between states highly regulated
2) Psitacine bird ae fed penicillin G prophylactically.
Perinatal C trachomatis infections frequently manifest as:
necrotic pneumoni
(©) inclusion conjunctivitis
D) a pustular rash
E) endophthalmitis.
An adolescent girl came to the clinic because afa vaginal ds
charge. She had recently become sexually active and had (wo
new partners during the previous month. On pelvic examina
don, a purulent discharge was sen atthe opening of her endo-
cal canal. Which of the following statements about this
A) A serologic test for syphilis is not indicated because her
symptoms are not those of syphilis
0) A Gram-sain of her endocervical specimen would show
.trachomatisinsde polymorphonuclear cells
(©) The diferential diagnosis includes infection with N. gonor
rhoeae, C. trachomatis or both
D) The endocervical specimen should be analyzed for herpes
simplex.
ment is with ampicillin
Which of following statementsabout trachoma ismost accurate?
A) It follows an acute eye infection with C. trachomatis.
(8) Millions of people in the United States have trachoma.
(C) There is nachlamydial vaccine to prevent trachoma,
ression of trachoma is accelerated by intermitten
reatment with azithromycin
(E) Trachoma involves direct damage to corneal epithe!
Which of the following statements about chlamydial antigens
A) Chlamydiac have shared group or genus-specific antigens
0) There is no cross-reaction between C. trachomatis and
D) One serovar of C, trachomatis causes eye infections, and
he second serovar causes genital infections.
0) Chamydiae frequently vary the epitopes oftheir antigens
As part ofthe control of C. psittaci and pttacosis in birds:
A) All psittacine birds imported into the United States ar
st vaccinated
B) Pstacin birds hatched in the United States are preferred
(©) Allbirás are tested for €. psitaci infection.
D) The shipment ofall birds between states highly regulated
2) Psitacine bird ae fed penicillin G prophylactically.
Perinatal C trachomatis infections frequently manifest as:
necrotic pneumoni
(©) inclusion conjunctivitis
D) a pustular rash
E) endophthalmitis.
An adolescent girl came to the clinic because afa vaginal ds
charge. She had recently become sexually active and had (wo
new partners during the previous month. On pelvic examina
don, a purulent discharge was sen atthe opening of her endo-
cal canal. Which of the following statements about this
A) A serologic test for syphilis is not indicated because her
symptoms are not those of syphilis
0) A Gram-sain of her endocervical specimen would show
.trachomatisinsde polymorphonuclear cells
(©) The diferential diagnosis includes infection with N. gonor
rhoeae, C. trachomatis or both
D) The endocervical specimen should be analyzed for herpes
simplex.
ment is with ampicillin
Which of following statementsabout trachoma ismost accurate?
A) It follows an acute eye infection with C. trachomatis.
(8) Millions of people in the United States have trachoma.
(C) There is nachlamydial vaccine to prevent trachoma,
ression of trachoma is accelerated by intermitten
reatment with azithromycin
(E) Trachoma involves direct damage to corneal epithe!
Which ofthe following is not eff
(8) Face washing and hygen
Which one ofthe following statements about Cp
A) Transmis spe
(8) 1 makes lycoge-rich inclusions hat stain with iodine
(© There ae multiple serovars, including thre that cause a
(0) They ae resistant to macrolides,
(8) Serovars Li, 12, and L are associated wit ymphogran:
Binding trachoma and sexually transmitted infections
(0) The antibody tier ise sen beginning around 6-8 y
J che United States, it has ong been known that the pose
jui the primary school years ages 6-10 eus), kyr
0) Increaeed incidence of infections with €. rachomati
(©) Cross reactive amibodies with M poten of grup A strep
Which of the following statements ab
nereum (LGV) Is most acurate?
(©) Thereare fev este eymptams of nection
(D) Acute inflammation with LGV willed to Iymy
(E) Inguinal lymph nodes are unaffeted
Which sing mods ae considered the dis
(A) Serology using complement ati
(8) Cel culture wing cyloheximide containing MeCoy cells
I specimens,
(0) Nude acid amplifation methods
(1 Espe inmuntenes prefered 06 pail ti
(8) Face washing and hygen
Which one ofthe following statements about Cp
A) Transmis spe
(8) 1 makes lycoge-rich inclusions hat stain with iodine
(© There ae multiple serovars, including thre that cause a
(0) They ae resistant to macrolides,
(8) Serovars Li, 12, and L are associated wit ymphogran:
Binding trachoma and sexually transmitted infections
(0) The antibody tier ise sen beginning around 6-8 y
J che United States, it has ong been known that the pose
jui the primary school years ages 6-10 eus), kyr
0) Increaeed incidence of infections with €. rachomati
(©) Cross reactive amibodies with M poten of grup A strep
Which of the following statements ab
nereum (LGV) Is most acurate?
(©) Thereare fev este eymptams of nection
(D) Acute inflammation with LGV willed to Iymy
(E) Inguinal lymph nodes are unaffeted
Which sing mods ae considered the dis
(A) Serology using complement ati
(8) Cel culture wing cyloheximide containing MeCoy cells
I specimens,
(0) Nude acid amplifation methods
(1 Espe inmuntenes prefered 06 pail ti
12. Which of the following specimens is not acceptable for nucleic
acid amplification testing for the diagnosis of chlamydial
infections:
(A) Self-collected vaginal swabs in women
(8) First void urine samples obtained from men
(C) Rectal swabs obtained from children 12 years of age or
(D) Urethral swab samples obtained from adult men
(E) Cervical swab samples obtained from adolescent girls
C. pneumoniae pneumonia most resembles infection caused
which of the following organisms?
(A) Streptococcus pneumoniae
(B) Mycoplasma pneumoniae
(C) Haemophilus influenzae
(D) C. trachomatis
(E) Rhinovirus
Inclusion conjunctivitis of the newborn
(A) Is a mucopurulent conjunctivitis that occurs
after delivery
(B) Is caused by
(©) Isa result of exposure to pet birds in the home
(D) Is treated with systemic penicillin because it may progress
to pneumonia
(E) None of the above
The diagnostic method of choice for C. trachomatis pneumonia
in the newborn is
(A) A nucleic acid amplification test that targets the ompA gene
(B) Culture of respiratory secretions in McCoy cells or other
cell lines
(C) Enzyme immunoassay testing of respiratory secretions
(D) IgG antibodies detected by complement fixation
Answers
1
acid amplification testing for the diagnosis of chlamydial
infections:
(A) Self-collected vaginal swabs in women
(8) First void urine samples obtained from men
(C) Rectal swabs obtained from children 12 years of age or
(D) Urethral swab samples obtained from adult men
(E) Cervical swab samples obtained from adolescent girls
C. pneumoniae pneumonia most resembles infection caused
which of the following organisms?
(A) Streptococcus pneumoniae
(B) Mycoplasma pneumoniae
(C) Haemophilus influenzae
(D) C. trachomatis
(E) Rhinovirus
Inclusion conjunctivitis of the newborn
(A) Is a mucopurulent conjunctivitis that occurs
after delivery
(B) Is caused by
(©) Isa result of exposure to pet birds in the home
(D) Is treated with systemic penicillin because it may progress
to pneumonia
(E) None of the above
The diagnostic method of choice for C. trachomatis pneumonia
in the newborn is
(A) A nucleic acid amplification test that targets the ompA gene
(B) Culture of respiratory secretions in McCoy cells or other
cell lines
(C) Enzyme immunoassay testing of respiratory secretions
(D) IgG antibodies detected by complement fixation
Answers
1
REVIEW QUESTIONS
1. The antimicrobial agent whose structure is shown below is con-
sidered the drug of choice to treat infections caused by which
one of the following microorganisms?
ou
out en- cer
H—G—N—CH—
J | I 1 ITCH,
H ¢—N—cH—cooH
Il
o
(A) Bacteroides fragilis
(B) P. aeruginosa
(C) Herpes simplex virus
(D) Streptococcus pyogenes (group A streptococci)
(E) Mycobacterium tuberculosis
Resistance of Staphylococcus aureus to the drug shown in
Question 1 is caused by
(A) The action of acetyltransferase
(B) The action of B-lactamase
(©) Substitution of the p-Ala-p-Ala dipeptide with the D-Ala-
D-Lac dipeptide in the cell wall peptidoglycan
(D) Decreased permeability of the bacterial cell wall to the drug
(E) S. aureus being an intracellular pathogen
S. pneumoniae resistance to the drug shown in Question 1 is
caused by
(A) The action of acetyltransferase
(B) The action of B-lactamase
(©) Substitution of the p-Ala-p-Ala dipeptide with p-Ala
D-Lac dipeptide in the cell wall peptidoglycan
(D) Decreased permeability of the bacterial cell wall
(E) Genetically modified binding proteins in the bacterial cell wall
All of the following statements about antimicrobial resistance
of enterococci are correct except
(A) Enterococci are resistant to sulfamethoxazole
trimethoprim in vivo.
(B) Cephalosporins are not active against enterococci
‘Scanned with CamScanner
1. The antimicrobial agent whose structure is shown below is con-
sidered the drug of choice to treat infections caused by which
one of the following microorganisms?
ou
out en- cer
H—G—N—CH—
J | I 1 ITCH,
H ¢—N—cH—cooH
Il
o
(A) Bacteroides fragilis
(B) P. aeruginosa
(C) Herpes simplex virus
(D) Streptococcus pyogenes (group A streptococci)
(E) Mycobacterium tuberculosis
Resistance of Staphylococcus aureus to the drug shown in
Question 1 is caused by
(A) The action of acetyltransferase
(B) The action of B-lactamase
(©) Substitution of the p-Ala-p-Ala dipeptide with the D-Ala-
D-Lac dipeptide in the cell wall peptidoglycan
(D) Decreased permeability of the bacterial cell wall to the drug
(E) S. aureus being an intracellular pathogen
S. pneumoniae resistance to the drug shown in Question 1 is
caused by
(A) The action of acetyltransferase
(B) The action of B-lactamase
(©) Substitution of the p-Ala-p-Ala dipeptide with p-Ala
D-Lac dipeptide in the cell wall peptidoglycan
(D) Decreased permeability of the bacterial cell wall
(E) Genetically modified binding proteins in the bacterial cell wall
All of the following statements about antimicrobial resistance
of enterococci are correct except
(A) Enterococci are resistant to sulfamethoxazole
trimethoprim in vivo.
(B) Cephalosporins are not active against enterococci
‘Scanned with CamScanner
(C) Resistance to the reptogramins (quinupritin-dalfapeitin)
States, develops fever and a cough productive of blood stecaked
Her cheat radiograph shows bilateral uppe lobe infiltrates wit
vehich ofthe following drug regimens would be the best app
Prise initial therapy while wating culture results?
A) Isoniazid, rifampin, pycazinamido, and ethamburo
(8) Penicilin G and nfampin
sulfamethoxazole
E) Vane cand clindamycin
(A) They case aplastic anemia
(B) They cause nonspecific stimulation of cells
(©) They cause ororxiciy and nephrotorcy
Which on ofthe fllowing groups of antimicrobial.
(8) Aminoglyosides
(D) Glycopeptdes eg, vancomycin)
E) Polymyxins
tions. Which one of the following is of major internation
3) Exylhrompein resistance in $. p
selecting intial animicroblal therapy fora infection?
) Anatomie st of he infection (eg meningitis or wen
(©) Whether or mot the patio is immunocompromised
(D) Whether or not the patient has implanted devices in place
(eg artifical hip join, artical heart valve
10. All ofthe following agents have good activity against Gram
A) Daptomyst
States, develops fever and a cough productive of blood stecaked
Her cheat radiograph shows bilateral uppe lobe infiltrates wit
vehich ofthe following drug regimens would be the best app
Prise initial therapy while wating culture results?
A) Isoniazid, rifampin, pycazinamido, and ethamburo
(8) Penicilin G and nfampin
sulfamethoxazole
E) Vane cand clindamycin
(A) They case aplastic anemia
(B) They cause nonspecific stimulation of cells
(©) They cause ororxiciy and nephrotorcy
Which on ofthe fllowing groups of antimicrobial.
(8) Aminoglyosides
(D) Glycopeptdes eg, vancomycin)
E) Polymyxins
tions. Which one of the following is of major internation
3) Exylhrompein resistance in $. p
selecting intial animicroblal therapy fora infection?
) Anatomie st of he infection (eg meningitis or wen
(©) Whether or mot the patio is immunocompromised
(D) Whether or not the patient has implanted devices in place
(eg artifical hip join, artical heart valve
10. All ofthe following agents have good activity against Gram
A) Daptomyst
1
Tigecycline, a new glycyleycline antibiotic with good activity
against a variety of pathogens, is best used for treatment of
which of the following infections?
(A) Meningitis
(B) Intra-abdominal infections caused by mixed aerobic and
anaerobic bacteria
(©) Neonatal sepsis
(D) Urethritis caused by C. trachomatis
(E) As monotherapy for bacteremia caused by A. baumannii
Which of the following carbapenem antibiotics has no activity
against P. aeruginosa?
(A) Imipenem
(B) Meropenem
(C) Doripenem
(D) Ertapenem
Which of the following agents would not be expected to demon-
strate postantibiotic affect against Gram-negative bacilli?
(A) imipenem
(B) Ciprofloxacin
(C) Gentamicin
(D) Ampicillin
All of the following are common mechanisms of resistance to
the penicillins except
(A) Production of B-lactamases
(B) Alterations in target receptors (PBPs)
(©) Inability to activate autolytic enzymes
(D) Failure to synthesize peptidoglycans
(E) Methylation of ribosomal RNA
The drug of first choice for the treatment of serious anaerobic
infections caused by B. fragilis is
(A) Clindamycin
(B) Ampicillin
(C) Cefoxitin
(D) Metronidazole
(E) Amoxicillin-clavulanate
Tigecycline, a new glycyleycline antibiotic with good activity
against a variety of pathogens, is best used for treatment of
which of the following infections?
(A) Meningitis
(B) Intra-abdominal infections caused by mixed aerobic and
anaerobic bacteria
(©) Neonatal sepsis
(D) Urethritis caused by C. trachomatis
(E) As monotherapy for bacteremia caused by A. baumannii
Which of the following carbapenem antibiotics has no activity
against P. aeruginosa?
(A) Imipenem
(B) Meropenem
(C) Doripenem
(D) Ertapenem
Which of the following agents would not be expected to demon-
strate postantibiotic affect against Gram-negative bacilli?
(A) imipenem
(B) Ciprofloxacin
(C) Gentamicin
(D) Ampicillin
All of the following are common mechanisms of resistance to
the penicillins except
(A) Production of B-lactamases
(B) Alterations in target receptors (PBPs)
(©) Inability to activate autolytic enzymes
(D) Failure to synthesize peptidoglycans
(E) Methylation of ribosomal RNA
The drug of first choice for the treatment of serious anaerobic
infections caused by B. fragilis is
(A) Clindamycin
(B) Ampicillin
(C) Cefoxitin
(D) Metronidazole
(E) Amoxicillin-clavulanate
Answers
D
. B
. E
. D
A
D
. B
. E
. D
A
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