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BMD 210 (Infectious Disease)

Exam 3 Study Guide (Chapters 15-17, 20-21)

Testing Rules:

1. No electronic devices (e.g. cell phones, blue tooth earpieces, ear buds, etc.) are permitted
during examinations. Any student seen with these devices will be considered to be cheating
and his/her exam will be taken and given a grade of zero.
2. Cell phones must be “turned off” during the exam (no vibrate mode).
3. You are only allowed to sit in a seat where an exam has been placed.
4. All personal items must fit under your seat or left up front.
5. Exam scores will only be posted at MasteringMicrobiology® web site being found @ Score.
6. Exams will not be returned but you may review them during scheduled office hours.

Test Format:

1. Fifty multiple choice & matching questions total (50 minutes)


2. Each question is worth 2 points.
3. Exam is worth 22% of your final grade.
4. Answers must be recorded on the “bubble” answer sheet within the allotted exam time.
5. Testing will begin promptly and exams/answer sheets will be collected 50 minutes later.
6. Makeup tests are only offered for bona fide (real) emergencies and require written
documentation (refer to syllabus for criteria on acceptable documentation).

Exam Template (questions per chapter)

 Chapter 15 = 13 questions
 Chapter 16 = 6 questions
 Chapter 17 = 6 questions
 Chapter 20 = 12 questions
 Chapter 21 = 13 questions

Learning Objectives

Chapter 15

1. Describe the relationship between pathogenicity and virulence.


2. Recall four portals of entry for microbes.
3. Describe how intact skin and mucous membranes function as an effective barrier to
microbes.
4. Define the term parenteral and recall six mechanisms of infectious agent parental entry.
5. Discuss the concept of preferred portal of entry.
6. Define the terms infectious dose & lethal dose.
7. Differentiate between an ID50 & LD50.
8. Recall five effects enabled by virulence factors.
9. Define the terms adhesins & host cell receptors and list examples of each one.
10. Discuss how bacterial capsules contribute to virulence. Recall three bacteria expressing
capsules.
11. Recall cell wall virulence components, along with its effect, for Streptococcus pyogenes
(group A), Neisseria gonorrhoeae, & Mycobacterium tuberculosis.
12. Recollect the effects of extracellular enzymes coagulase, kinases, hyaluronidase,
collagenase, & IgA proteases.
13. Describe how antigenic (phase) variation contributes to microbe virulence.
14. Recall four microorganisms that demonstrate antigenic (phase) variation.
15. Define the term invasins and recall its effect on a change in host cell membranes.
16. Recall the names of five intracellular pathogens.
17. Recall four mechanisms of host cell damage.
18. List two mechanisms used by bacteria to disrupt host cell iron metabolism.
19. Define the terms toxin, toxigenicity, toxemia, toxoids, & antitoxins.
20. Differentiate between an exotoxin & endotoxin based upon differences in source, location,
chemical makeup, fever induction, antitoxin neutralization, & LD50.
21. List three types of exotoxins.
22. Recall four effects of cytokine release caused by endotoxins.
23. Recollect two endotoxin-induced cytokines and their effects.
24. Describe the utility of the Limulus amebocyte lysate (LAL) assay.
25. Recall exotoxin type and lysogeny potential for Corynebacterium diphtheriae, Streptococcus
pyogenes, Clostridium botulinum, C. tetani, Vibrio cholerae, & Staphylococcus aureus.
26. List three CPE associated with pathogenic viruses.
27. List three fungi associated with chronic infections that provoke an allergic response.
28. Recall two mechanisms that allow protozoans to evade host immune response.
29. List three host damaging effects of helminths.
30. Recall the reason for an infectious agent portal of exit.

Chapter 16

1. Define the terms immunity, susceptibility, immunocompromised, & immunosuppressed.


2. Describe innate immunity, including its two-level defense system.
3. Discuss the relationship between pathogen-associated molecular patterns (PAMPS) & Toll-
like receptors.
4. List four body secretions helpful in removing microbes from potentially infective sites.
5. Recall four chemical factors and their antimicrobial actions.
6. Discuss how normal microbiota help prevent disease.
7. Describe how opportunistic pathogens cause disease.
8. Recall the functions of phagocytic macrophages & neutrophils.
9. Recall the functions of nonphagocytic eosinophils, basophils, & dendritic cells
10. Discuss the four main phases of the phagocytic process.
11. Recall the role of the lymphatic system.
12. List the four cardinal signs of inflammation.
13. Recall substances acting as acute phase proteins or blood vessel dilators.
14. Describe the process producing fever, including involved cells, cytokine released, & brain
area affected.
15. Describe what is occurring during a fever crisis.
16. Recall four major categories of antimicrobial substances and their associated actions.

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Chapter 17

1. Describe adaptive immunity, including its two divisions.


2. Differentiate between active & passive adaptive immunity.
3. Recall the origins, roles, and body location of T & B lymphocytes.
4. Differentiate between humoral and cellular immunity, including cell types associated with
each one.
5. Discuss cell mediated immunity and associated cell types.
6. Define the terms antigen, epitope, antigenic determinant.
7. Define the term immunoglobulin.
8. Recognize the components of an antibody, including light/heavy chain, constant/variable
chain regions, & Fc/Fab fragments.
9. Recall the five antibody classes, their individual valances, blood plasma concentrations, &
associated properties.
10. Recall the Ab classes expressed on B cell surfaces.
11. Discuss the process of B cell activation through plasma cell generation & Ab production
12. State the purpose of the major histocompatibility complex (MHC).
13. Describe how T-independent & T-dependent antigens stimulate B-cells.
14. Define the terms memory B cells, anamnestic response, & clonal deletion.
15. Differentiate between Ab affinity & Ab avidity.
16. Recall four mechanisms of Ag-Ab binding.
17. Describe the process of thymic selection.
18. Describe how macrophages & dendritic cells act as antigen presenting cells (APCs).
19. Recall the functions of each T cell subset.
20. Distinguish between naturally acquired active immunity, naturally acquired passive immunity,
artificially acquired active immunity, & artificially acquired passive immunity.

Chapter 20

1. Define the terms chemotherapy, antimicrobial drugs, antibiotic, selective toxicity, antibiosis,
superinfection, & therapeutic index.
2. Recall the name of the microbe that is a major source of natural antibiotics.
3. List six desirable characteristics of an antibiotic.
4. Distinguish between antibiotic bacteriocidal and bacteriostatic actions & also broad and
narrow spectrum activities.
5. Recall five actions of antimicrobials.
6. Recall two major classes of antibiotics inhibiting cell wall synthesis, modes of action, and
individual antibiotics associated with each class.
7. Describe penicillin binding proteins (PBP) and state their relationship to penicillin.
8. Define the terms natural penicillins, semisynthetic penicillins, & extended-spectrum
penicillins.
9. Describe the mechanism of beta lactamase resistance to penicillin.
10. Describe why MRSA, VRSA & VRE bacteria pose an increased patient threat.

11. Recall the source, mechanisms of action, & bacterial coverage for polypeptide antibiotics:

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 bacitracin
 vancomycin
 chloramphenicol
 aminoglycosides
 tetracyclines
 glycylcyclines
 macrolides
12. Recall two major classes of antimicrobials affecting bacterial fatty acid synthesis, antibiotic
names, mechanisms of action, and coverage.
13. Recall two major classes of antimicrobials affecting RNA/DNA synthesis, mechanisms of
action, antibiotic names, and coverage.
14. Describe the mechanism of action and coverage of the sulfonamides sulfamethoxazole &
trimethoprim.
15. List three reasons that fungal infections are harder to treat than bacterial infections.
16. Recall three antifungals interfering with ergosterol synthesis, antibiotic names, and
coverage.
17. Recall the fungal target of echinocandins along with three organisms for treatment.
18. Recall two antifungals interfering with nucleic acid synthesis, antibiotic names, and
coverage.
19. Recall fungal diseases treated with griseofulvin & tolnaftate.
20. Recall the mode of action for the following antitubucular drugs:
 isoniazid (INH)
 ethambutol
 rifampin
 pyrazinamide
21. Discuss why viruses are generally harder to treat than bacteria.
22. Recall four major classes of antiviral drugs, drug names, and target organisms.
23. Recall three major classes of antiprotozoan drugs, drug names, and target organisms.
24. Recall four major classes of antihelminthic and target organisms.
25. Differentiate between empiric therapy & definitive therapy.
26. List two types of antimicrobial sensitivity testing (AST).
27. Describe how the disk-diffusion (Kirby-Bauer) method is used to determine antimicrobial
sensitivity.
28. Describe how sensitive, intermediate, & resistant zones of inhibition affect antibiotic
selection.
29. Discuss what an antibiogram is, how it is used, and why each institution produces one.
30. Describe how misuse of antibiotics leads to increased organism resistance.

Chapter 21

1. Recall four antibacterial substances produced by skin and their individual effects.
2. Recognize five antibacterial properties of mucous membranes.
3. Define the terms lesions & superantigen.
4. Differentiate between the following lesion types:
 vesicle
 papules
 pustules
 macules
 bullae

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 exanthem
 enanthem
5. Recall characteristics of S. epidermidis & S.aureus skin infections, including gram reaction,
coagulase test result, infection sites, & virulence factors, if given.
6. Recall four properties of a “superbug” infection.
7. Describe what is meant by a superantigen
8. Differentiate between the following staphylococcal skin infections:
 folliculitis
 furuncle
 carbuncle
 impetigo
 cellulitis
9. Describe impetigo contagiosa.
10. Recall the stages of progression from a folliculitis to a carbuncle.
11. Describe staphylococcal scalded skin syndrome (SSSS), including toxins, symptoms, skin
pathology, source & types (bullous impetigo, newborn impetigo).
12. Recall how the infection source of newborn impetigo (pemphigus neonatorum) is revealed.
13. Describe staphylococcal toxic shock syndrome (TSS), including toxins, symptoms, skin
pathology, & source.
14. Define the term cytokine storm and explain its relationship to TSS.
15. Recall characteristics of S. pyogenes skin infections, including gram reaction, hemolytic
pattern, infection sites, produced toxins, & virulence factors.
16. Describe the following streptococcal skin infections:
 streptococcal toxic shock syndrome
 streptococcal impetigo
 erysipelas
 necrotizing fasciitis
17. Recall characteristics of P. aeruginosa skin infections, including gram reaction, oxidase test
result, sources, produced toxins, & soluble pigments.
18. Recall characteristics of skin infections caused by Mycobacterium ulcerans, Mycobacterium
leprae, & Mycobacterium tuberculosis.
19. Differentiate between comedonal acne, inflammatory acne, & nodular cystic acne based on
severity, pathology & treatment.
20. Recall the causative agent of human warts & three types of treatment.
21. Recall characteristics of viral skin infections including, causative agent, alternate names,
type of transmission, associated skin lesion, type of vaccine, & post-infection complication, if
given, for:
 smallpox
 chicken pox
 shingles
 herpes simplex
 measles
 rubella
 fifth disease
 roseola
22. Define the term “breakthrough varicella”.
23. Identify the causative agent and body locations for cold sores (fever blisters), herpes
gladiatorum, & herpetic whitlow.
24. Recall how HSV-1 & HSV-2 gain access to the brain to cause encephalitis.

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25. Describe features of postherpetic neuralgia.
26. Describes features of congenital rubella syndrome.
27. Describe Koplik’s spots and recall its associate virus.
28. Describe features of cutaneous mycoses & identify three fungal genera causing most
dermatomycoses.
29. Associate a tinea infection with its corresponding body location (e.g., tinea corporis - body)
30. Describe features of subcutaneous mycoses.
31. Recall sporotrichosis eitiology & treatment.
32. Recall characteristics of candidiasis including, causative agent, affected tissues, &
treatment.
33. Define the term oral thrush & state its relationship to AIDS.
34. Recall characteristics of parasitic skin infections including, causative agent, affected tissues,
& treatment.
35. Associate body location with the three main species of human lice.
36. Define the terms conjunctivitis & keratitis.
37. Recall characteristics of conjunctivitis including, causative agent, alternate names, route of
transmission, associated eye lesion, for:
 ophthalmia neonatorum
 inclusion conjunctivitis
 trachoma
38. Recall four types of keratitis and the causative agent of each one.

Sample Questions

1. Which of the following produces a large anti-phagocytic polysaccharide capsule?


a. Streptococcus pneumoniae *
b. Eschericia coli
c. Salmonella enterica
d. Yersinia pestis

2. Which of the following is considered an intracellular pathogen?


a. Streptococcus pyogenes
b. Enterobacter aerogenes
c. Listeria monocytogenes *
d. Proteus mirabilis

3. What phase of phagocytosis involves Toll-like receptors (TLR)?


a. digestion
b. adherence *
c. chemotaxis
d. ingestion

4. What immunoglobulin (Ig) dimer is associated with mucous membranes, found in secretions,
and expresses a secretory component (hint: 13% of Ig)?
a. IgA*
b. IgD

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c. IgE
d. IgM

5. What T cell subset destroys infected target cells?


a. Natural killer T (NKT) cells
b. Treg (CD4/CD25+) cells
c. Tcytotoxic (CD8+) cells *
d. TH (CD4+) cells

6. What antibiotic structure would a penicillinase producing bacteria disrupt?


a. -glucan
b. ergosterol
c. β-lactam ring *
d. dihydrofolate

7. An antibiotic that is only active against a select group of bacteria exhibits a(n):
a. selective toxicity
b. antibiosis
c. narrow spectrum *
d. empiric capability

8. Which of the following is an antibiotic that acts as a nucleic acid synthesis inhibitor?
a. polymixin B
b. riphampin *
c. tetracycline
d. sulfonamides

9. What organism is responsible for producing measles?


a. papilloma virus
b. herpes zoster
c. herpes simplex
d. rubeola *

10. Which of the following would indicate a fungal nail infection caused by a Trichophyton spp.?
a. tinea barbae
b. tinea unguium *
c. tinea capitis
d. tinea cruris

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