Exam I: Medical Microbiology 479, Spring 2003.

Name ________________________ Last four numbers of SSN ________________________ 40 questions Read all questions carefully. Choose the most correct answer exists for each question. 1. Which of the following is not an attribute of a eukaryotic cell? A. can undergo mitosis B. lipoteichoic acid C. contain an 80S ribosome D. have linear chromosomes E. can possess a mitochondria 2. A heat-fixed slide with both Gram-positive and Gram-negative bacterial cells is Gram stained. During the staining procedure, the iodine was inadvertently omitted, but all other steps in the procedure were done correctly. Upon examination of the slide by light microscopy, the Grampositive cells would appear _______ and the Gram-negative cells would appear _________. A. purple B. purple C. red D. colorless E. purple red. purple. red. red. colorless.

3. Bacterial fermentation is a process which is best described as A. the incomplete oxidation of organic compounds. B. the complete oxidation of glucose. C. a series of reactions where the terminal electron acceptor is oxygen. D. the production of CO2 and H2O as the result of the glucose metabolism 4. Which of the following Genera is not Gram-positive? A. Actinomyces B. Clostridium C. Klebsiella D. Peptostreptococcus E. Propionibacterium

5. Which of the following Genera looks like a curved/comma-shaped rod under the microscope? A. Streptococcus B. Neisseria C. Corynebacterium D. Campylobacter E. Moraxella 6. Which of the following associations between function and structural component of procaryotic cells is incorrect? A. Protein synthesis B. Prevent osmotic lysis C. Antiphagocytic D. Attachment E. Locomotion tRNA outer membrane capsule pili (fimbriae) flagella

7. Biofilms are a common component of bacterial infections in humans. Biofilms are defined as viable bacterial colonies enmeshed in _______ and are _________ A. the outer membrane B. LPS C. peptidoglycan D. exopolysaccharide adhering to wet surfaces. free floating in bodily fluids. adhering to interior surfaces of blood vessels. adhering to wet surfaces.

8. All of the following are functions of the bacterial cell membrane except A. aerobic respiration. B. secretion of protein, e.g., hydrolytic enzymes. C. cell wall synthesis. D. transport nutrients. E. confers shape to cell. 9. The production of organic acids by bacteria has medical importance for all of the following except A. maintenance of a low pH on the skin surface and in the adult vagina. B. inhibition of antibiotic activity within sequestered sites (e.g. abscesses). C. demineralization of tooth enamel (e.g. tooth decay). D. production of urinary calculi.

10. Which microorganism can grow in a refrigerated vial containing media in only an inert (N2) atmosphere? A. mesophilic aerotolerant anaerobes B. psychrophilic anaerobes C. thermophilic anaerobes D. psychrophilic aerobes E. mesophilic aerobes 11. In peptidoglycan synthesis, bactoprenol (lipid carrier) functions A. to form a linkage between the complete subunit (N-acetylglucosamine-Nacetylmuramic acid-amino acid-side chain/stem peptide) and the peptidoglycan chain in the cell wall. B. to transport the complete peptidoglycansubunit across the cell membrane. C. as a carrier for synthesis of the amino sugar subunits in the cytoplasm. D. to convert L-alanine to D-alanine. 12. The ability of some bacteria to retain crystal violet-iodine complex in the Gram stain depends on the A. amount of outer membrane proteins present. B. shape of the cell. C. the presence of a capsule. D. the binding selectivity of the porins. E. thickness of the peptidoglycan. 13. Which of the following associations is not correct? A. DNA synthesis B. RNA synthesis C. DNA synthesis D. RNA synthesis DNA gyrase DNA-helicase DNA-dependent DNA polymerase topoisomerase IV

14. The mechanical strength of the peptidoglycan layer is due partly to the presence of A. cross-linkage of the amino acid side chains (stem-peptides). B. the anchoring of the peptidoglycan chains to the cell membrane. C. lipoprotein bound to N-acetylmuramic acid. D. acetylated N-acetylmuramic acid or methylated N-acetylmuramic acid.

15. Characteristics/properties of bacterial endotoxin include all of the following except A. broad host specificity and biological action. B. heat stable. C. can activate Hageman factor XII. D. structural component of the cell wall. E. readily forms toxoids. 16. Gram-negative sepsis may result in all of the following, except A. disseminated intravascular coagulopathy. B. production of endogenous mediators, i.e. IL-1 and TNF-alpha. C. Both A and B above are correct. D. Neither A nor B above are correct. 17. Viral host cell and tissue trophism is mediated by A. endocytosis. B. complementary nucleic acid sequences. C. specific host cell receptor and viral structural component interactions. D. the type of nucleic acid making up the viral genome. 18. Which of the following is not used in the classification of animal viruses? A. Capsid symmetry. B. Number of capsomeres in the capsid. C. Specific receptors to which the virus binds. D. Type of nucleic acid. 19. A chronic viral infection is a persistent viral infection in which A. host cells are routinely transformed into malignant cells. B. there is continued presence of virus particles but disease may be present or absent. C. intermittent production of infective virus particles occurs. D. a prolonged incubation period ensues subsequent to infection and prior to the onset of symptoms (usually several years). 20. Syncytia formation is the appearance of A. amassed virions within the infected cell. B. multinucleated giant cells. C. rounded and detached cells. D. perinuclear inclusions.

21. The third step during viral replication in an eukaryotic cell is A. macromolecular synthesis. B. uncoating. C. penetration. D. attachment. 22. Of the viruses, which is not associated with potential neoplasm formation? A. Papilloma B. Epstein-Barr C. Norwalk D. Hepatitis B 23. Which of the following spore types is produced by fragmentation of hyphal filaments? A. blastospores B. macrospores C. microspores D. arthrospores 24. Which of the following is not true with respect to fungi? A. Cell mediated immunity is not required for control of infections. B. Possess a complex cell wall made up of glycoproteins chitin and other materials. C. Generally prefer to grow in aerobic conditions. D. Can be made up of a mycelium. 25. Superficial mycoses involve the _____________________ while subcutaneous mycoses can involve ________________. A. dermis B. hair C. skin D. epidermis fascia respiratory tract regional lymph nodes liver

26. Which of the following are tapeworms representatives of? A. Platyhelminthes B. Trematodes C. Cestodes D. Nematodes

27. Which of the following can be obtained from both the Kirby-Bauer disc susceptibility tests and minimal inhibitory concentration determinations (MICs)? A. The quantity of antibiotic reaching the site of infection. B. If a bacterial isolate is resistant or susceptible to a given antibiotic. C. The exact amount of antibiotic that inhibits bacterial growth. D. The minimal bactericidal concentration (MBC). 28. Which of the following situations is not an example of justified antibiotic chemoprophylaxis. A. To prevent secondary bacterial pneumonia in a patient with the flu. B. Patient recently bitten by a dog. C. Rheumatic heart disease patients before undergoing dental surgery. D. Immunocomprimized patients to prevent potential bacterial infection. 29. Aminoglycosides inhibit bacterial protein synthesis by A. inhibiting isoleucyl-tRNA synthetase B. irreversibly binding to the 50S ribosomal subunit. C. irreversibly binding to the 30S ribosomal subunit. D. irreversibly binding to elongation factor G. 30. Which of the following is not an example of a general bacterial resistance mechanism? A. Antibiotic efflux. B. Alteration of antibiotic target site. C. Prevention of chromosomal mutation. D. Enzymatic modification of the antibiotic. 31. Which of the following classes of antibiotics inhibits bacterial DNA synthesis? A. cephalosporins B. fluoroquinolones C. imidazoles D. tetracyclines

32. Which of the following antifungals does not target fungal sterol synthesis? A. trizoles B. morpholines C. polyenes D. capsofungin 33. Which of the following antimicrobials demonstrates the best selective toxicity? A. cephalosporins B. aminoglycosides C. polymyxins D. polyenes 34. All the following are protein synthesis inhibitors except: A. tetracyclines B. chloramphenicol C. rifampin D. oxazolidinones 35. Which of the following statements is not true for tolerant bacteria? A. Require both an MBC and MIC determination for detection. B. Involves cell wall active antibiotics. C. Can multiply in the presence of the antibiotics that select for them. D. Can cause treatment failures. 36. Which of the following antibiotics is limited to use against anaerobic infections? A. tetracycline B. penicillin C. ciprofloxacin D. metronidazole 37. Therapy with which of the following will not lead to a decrease in the plasma levels of oral contraceptives? A. penicillin B. erythromycin C. tetracyclines D. rifampin

38. Which of the following antibacterials is considered the backbone for treatment of Mycobacterium turberculosis? A. penicillin B. macrolides C. isoniazid D. fluoroquinolones 39. Which of the following antibacterials inhibits peptidoglycan synthesis in Gram-positive bacteria by binding to the terminal D-ala-D-ala of the stem peptide? A. bacitracin B. metronidazole C. mupirocin D. vancomycin 40. Streptogramins act by ___________ while oxazolidinones _______________ A. interfering with formation of the initiation complex - inhibit isoleucyl-tRNA synthetase. B. binding irreversibly to the 50S ribosomal subunit - interfere with formation of the initiation complex. C. damaging DNA in reduced oxygen environments - bind irreversibly to the 50S ribosomal subunit. D. blocking regeneration of bactoprenol - bind irreversibly to the 50S ribosomal subunit.

Exam II: Medical Microbiology 479, Spring 2003. Name ________________________ Last four numbers of SSN ________________________ 42 questions Read all questions carefully. Choose the most correct answer exists for each question. 1. The class of antiviral drugs that are referred to as "pro-drugs" because they require virally-encoded or host-encoded kinase activity to become activated are the A. neuraminidase inhibitors B. protease inhibitors C. synthetic amines D. nucleoside analogues 2. Novel influenza drugs (amantidine, rimantadine, zanamir and oseltamivir) have recently been introduced into the market. These drugs function by inhibiting viral A. RNA replication and viral protein synthesis. B. uncoating and neuraminidase activity. C. DNA synthesis and protease activity. D. binding specificity and interferon production. 3. Which of the following is not a reason why viral diseases are difficult to treat? A. latent or integrated (proviral) viruses are resistant to antivirals B. immunoprophylaxis cannot be used to treat viral disease C. viruses are obligate intracellular parasites D. antivirals in general are toxic. 4. Which of the antiprotozoal agents below directly targets only DNA synthesis? A. aminoquinolone analogues B. arsenical and antimonial compounds C. metronidazole D. folate synthesis inhibitors

5. The mode of action of chloroquine is complex and not completely understood. The antiprotozoal effects of chloroquine include all the following except, A. forms a toxic complex with ferriprotoporphyrin IX. B. inhibits protozoan protein synthesis. C. raises pH in pathogen intracellular acid vesicles. D. interferes with pathogen hemoglobin degradation. 6. Which of the following agents is not used in therapies to treat malaria caused by chloroquine-resistant Plasmodium falciparum? A. quinine B. tetracycline C. ivermectin D. mefloquine 7. Which of the following agents has good tissue penetration, is relatively non-toxic and is used in therapy targeting the etiologic agent of disseminated amebiasis? A. diamidines B. metronidazole C. piperazine D. ivermectin 8. Antihelmenthics generally target adult nonproliferating helmiths. The physiological mechanisms that antihelminthics target include all the following except, A. carbohydrate metabolism. B. neuromuscular coordination. C. protein synthesis. D. microtubule integrity. 9. Ivermectin can be used to treat river blindness (onchocerciasis) caused by Onchocerca volvulus. Benefits associated with treatment include A. amelioration of ocular damage caused by organism. B. reduction of pathogen transmission. C. Both A and B above are correct. D. Neither A nor B above are correct.

10

10. The drug(s) used to treat giardiasis and microsporidiosis in AIDS patients is A. albendazole. B. tetracycline. C. tetrahydropyrimidines. D. piperazine. 11. The benzimidazoles are broad spectrum antihelminthics. The action(s) of these drugs on helminthes include all of the following except A. ATP depletion. B. inhibition of glucose transport. C. destruction of helminth integument. D. reduction of mobility. 12. Which of the following drugs acts as a gamma-aminobutyric acid agonist leading to flaccid paralysis in helminthes? A. piperazine B. melarsoprol C. clindamycin D. ivermectin 13. Which of the following is not a known role for normal flora in host defenses? A. occupation of potential pathogen receptor sites B. competition with pathogens for nutrients C. enhancement of innate defense by the induction of interferons D. production of substances that are toxic to pathogens E. induction of adaptive immunity which is cross protective against pathogens 14. The centers for disease control suggests that hands should be washed in all the following instances except A. between contacts with different patients in high risk units. B. before and after touching wounds. C. after touching inanimate objects that are likely to be contaminated. D. before performing invasive procedures. E. All the instances above require handwashing.

11

15. Normally, which of the following is sterile? A. bladder urine B. the skin C. oropharynx D. the stomach contents 16. Which of the following is an example of a disease that is not normally caused by misplaced normal flora? A. endocarditis B. vaginal thrush C. urinary tract infection D. suture wound infection 17. Clostridium difficile is considered normal flora, although it must be said that it is not carried by everyone. Where can Clostridium difficile be found? A. skin B. colon C. mouth D. nasopharynx 18. Critical items enter sterile tissue (e.g. blood stream) and must be sterilized. Examples of critical items include all of the following except A. surgical instruments. B. urinary catheters. C. IV fluids. D. respiratory equipment. 19. In general which of the following infectious agents is most resistant to the action of biocides? A. Pseudomonas spp. B. Mycobacterium spp. C. prions D. enveloped viruses

12

20. Of the following chemicals, which is not routinely used for sterilization procedures? A. ethylene oxide B. chlorine C. glutarldehyde D. hydrogen peroxide 21. After appropriate detergent cleansing, endoscopic disinfection is generally accomplished by immersion in A. glutaraldehyde solutions. B. chlorine solutions. C. iodophores. D. hydrogen peroxide. 22. Which of the following biocides is found in many household soaps, even though its presence is not required? A. phenol B. triclosan C. iodophores D. hydrogen peroxide 23. Which of the following produces free hydroxyl radicals that cause DNA strand breakage and disruption of thiol groups in proteins? A. alcohol B. glutaraldehyde C. peracetic acid D. ethylene oxide 24. Which of the following terms best describes infections that occur suddenly and are rapidly progressive (e.g. infection with Yersinia pestis, [plague])? A. acute B. fulminant C. chronic D. pyogenic

13

25. Infectious disease which occurs at a site other than the primary site and after treatment of the primary infection, are referred to as A. secondary infections. B. superinfections. C. fulminant infections. D. inapparent infections. 26. Disease incidence indicates A. how rapidly a disease is developing in a population. B. the total number (new and old cases) of persons infected at any one period of time. C. Both A and B above are correct. D. Neither A nor B above is correct. 27. Disease can spread among humans by a number of mechanisms. The least common mode of human infectious disease spread is via A. contact with contaminated animals or animal products. B. biological vectors. C. contact with contaminated fomites. D. ingestion of contaminated food. 28. All of the following measures are effective in halting and eradicating infectious disease except A. quarantine (when appropriate). B. elimination of insect vectors. C. examination of food and water. D. therapy to eliminate carrier state. 29. In order to determine the etiologic agent of sepsis in a patient you should do all the following except A. culture 20 ml of blood, instead of 10 ml. B. take blood samples 2-3 times over a 24 hour period at different sites. C. carefully disinfect skin at site where blood is taken. D. take blood samples when patient spikes a fever.

14

30. During the investigation of cerebrospinal fluid in suspected meningitis cases, the specimen A. can be refrigerated. B. should be Gram-stained (following concentration procedures). C. A and B above are correct. D. Neither A nor B above is correct. 31. Of the following organisms, which is not an expected agent of bacterial pharyngitis? A. Pseudomonas aeruginosa B. Streptococcus pyogenes C. Bordetella pertussis D. Neisseria gonorrhoeae 32. Which of the following samples is most commonly cultured for etiologic agents of infectious disease in the clinical environment? A. sputum (expectorate). B. blood C. feces D. urine E. lung aspirates 33. Urine can be used to determine if a patient is infected with certain parasites. Examination of urine specimens is commonly used to diagnose infection with A. Entamoeba histolytica. B. Schistosoma haematobium . C. Plasmodium falcipirum. D. Enterobius vermicularis. 34. Which of the following pathogens is a primary fungal pathogen? A. Histoplasma capsulatum B. Asperigillus nigers C. Candida albicans D. Penicillium notatum

15

35. Inappropriate procedures for culturing fungal pathogens include all the following except A. culturing specimens directly onto blood agar. B. culturing at 37C. C. using selective media with a pH of 7. D. media prepared with cycloheximide to slow saprobic fungi growth. 36. A parent presents complaining of a child that has trouble sleeping due to an itchy rear-end. On investigation of the child you note a filthy appearance and decide to perform a scotch tape test of the childs perianal region. The etiologic agent you are looking for is A. Wuchereria bancrofti. B. Ascaris lumbricoides. C. Entamoeba histolytica. D. Enterobius vermicularis. 37. Acute otitis media and sinusitis are similar with respect to all of the following except A. allergic rhinitis and viral rhinitis are predisposing factors. B. both viruses and bacteria are etiologic agents of these diseases. C. drainage of the site is blocked. D. treatment of these diseases are major contributing factors to the increasing incidence of community-acquired antibiotic resistant strains. 38. A two and half-year old male presents within 2 days of acute onset of fever, irritability, bilateral otalgia, otorrhea, and hearing loss. Examination with a pneumatic otoscope reveals both tympanic membranes are opaque, bulging and lack of mobility. All of the following are appropriate treatments and/or preventive measures except A. administration of amoxicillin. B. tympanocentesis. C. administration of antihistamines, decongestant and local administration of corticosteroids. D. transfer of child from his large group setting to a family day-care center environment. E. insertion of tympanostomy tube(s).

16

39. A newborn child presents on the 10th day with severe inclusion conjunctivitis. The most likely etiologic agent causing this disease is A. Neisseria gonorrhoeae B. Chlamydia trachomatis C. Haemophilus influenzae D. Coxsackie virus A24 40. An adult presents with red eyes, moderate to severe ocular pain, photophobia, tearing, and decreased vision. She is presently wearing soft contact lenses. The most likely etiologic agent of this case of keratitis is A. Staphylococcus aureus B. Streptococcus pneumoniae C. Chlamydia trachomatis D. Pseudomonas aeruginosa 41. A child presents in July with fever, ulcerative pharyngitis, red macules on the soft palate and tonsils of 4 days duration. The causitive agent of this disease is most likely A. a paramyxovirus. B. coxsackie A virus. C. enterovirus 71. D. parainfluenzavirus. 42. A homeless patient that cannot speak presents with inflammation of the oral mucosal membranes which exhibit a cottage cheese -like appearance. The most likely etiologic agent of this case is A. Prevotella intermedia. B. Porphyromonas gingivalis. C. Herpes simplex virus. D. Candida albicans.

17

Exam III: Medical Microbiology 479, Spring 2003 (L12-L17). Name ________________________ Last four numbers of SSN ________________________ 43 questions 1. Which of the following is not true with regards to diphtheria? A. humans are the sole reservoir for the etiological agent of this disease B. exotoxin-mediated disease C. etiological agent transmitted via the fecal-oral route D. antitoxin is available for treatment 2. A six month old child presents with a low grade fever, a bull neck appearance and upon examination a grayish pseudomembrane is apparent in the oropharynx. Microscopic examination of an appropriately Gram-stained sample from the pseudomembrane will reveal A. Gram-negative diplococci. B. Gram-positive coccobacilli. C. Gram-positive, club shaped rods. D. Nothing, since the agent causing this disease is a virus. 3. All of the following are true with regards to Haemophilus influenzae type B (as of 2003) except A. is a Gram-negative, short, coccobacilli B. commonly causes otitis media and sinusitis. C. can cause acute epiglottis in adults. D. has a capsule composed of polyribosphosphate 4. Which of the following is true for both coronoviruses and rhinoviruses? A. immunity is life long following infections with single serotypes. B. transmission is via fecal-oral route. C. infection predisposes individuals for otitis media or sinusitis. D. primarily cause infections in the early summer season.

18

5. An 8 year old swimmer presents in July with pharyngitis, conjunctivitis and exhibits periauricular (around the ear) lymphadenopathy (swollen lymph nodes). Based on this presentation as a trained physician you would suspect that this child is infected with A. Streptococcus pyogenes B. Heamophilus influenzae non-typeable C. Coronavirus D. Adenovirus Use the following case for the next 2 questions. A patient presents with pharyngitis in winter. A throat swab, blood plate culture and Gram stain demonstrate the presence of bhemolytic Gram-positive cocci in chains. 6. Which of the following is not true with regards to this case? A. Organism causing disease produces a protein that protects against phagocytosis. B. Classification of organism causing disease can be based on cell wall carbohydrate. C. Disease progresses to systemic infection and requires antibiotic therapy for cure. D. Crowding increases the likelihood of becoming infected with the etiologic agent of this disease. 7. Which of the following is true of non-suppurative sequelae that may follow this case of pharyngitis? A. Caused by growth of the b-hemolytic Gram-positive cocci at sites other than the pharynx. B. Commonly associated with secondary adenovirus pneumonia. C. Mediated by antibodies to the pathogen that cross react with heart tissue. D. Can be prevented by antibiotic treatment following resolution of pharyngitis. 8. A patient presents in winter complaining of previously having a headache, sore throat, and coryza, which has now progressed to bronchospasms and fever. The most appropriate therapy for this patient is A. supportive therapy including fluids and bed-rest. B. antibiotic therapy until the fever defervesces. C. Both A and B above are correct. D. Neither A nor B above are correct. 9. Chronic bronchitis is rapidly rising in persons 18 to 44 years old, and those over 65 years old. Chronic bronchitis is diagnosed in individuals who have all the following symptoms except A. prolonged cough ( 3 months). B. excessive sputum production. C. infection of bronchioles. D. dyspnea (shortness of breath, difficult or labored breathing).

19

10. The most commonly reported vaccine-preventable disease of children in the US is A. diptheria. B. tetanus. C. whooping cough. D. otitis media. 11. Which of the following is/are the etiological agent(s) most often associated with pneumonia in both community acquired and hospital acquired populations? A. Streptococcus pneumoniae B. Influenza virus C. Gram-negative rods D. Mycoplasma pneumoniae 12. Following hospitalization of a patient, which of the following shifts in pharyngeal flora can normally be expected? A. decrease in the total number of organisms B. increase in Gram-negative organisms C. increase in Gram-positive organisms D. None of the above are correct. No overall change in pharyngeal flora will be observed. 13. Antigenic drift differs from antigenic shift in that antigenic drift A. involves only the influenza A virus. B. has no impact with regard to herd immunity. C. involves only small changes in the primary structure of the envelope glycoproteins. D. requires development of altered vaccines for protection. 14. The first concern of clinicians when a patient presents with acute epiglottitis is A. toxin neutralization. B. administration of antibiotics. C. maintenance of the airway. D. chemoprophylaxis of contacts.

20

15. An afebrile 2-year old presents with prolonged upper respiratory disease that evolved into a paroxysmal cough of more than 2 weeks duration and post-cough vomiting. Which of the following agents is most likely responsible for this illness? A. Haemophilus influenzae, non-typeable B. Bordatella pertussis C. Moraxella catarrhalis D. Haemophilus influenzae, type b 16. The primary reason for the excess mortality occurring during influenza epidemics is from ______ which occurs as a result of _______. A. primary influenza virus pneumonia - increased virulence of the virus. B. secondary bacterial pneumonia - viral destruction of ciliated cells. C. Reye's syndrome - administration of aspirin. D. myocardial infarction - release of atherosclerotic plaques. 17. The pathology due to infection with respiratory syncytial virus is the result of A. respiratory epithelial desquamation. B. exaggerated IgE response. C. Both A and B above are correct D. Neither A nor B above is correct. 18. For patients with confirmed bacterial pneumonia, a common early indication of successful antibiotic therapy is A. a negative blood culture. B. defervescence. C. a negative sputum culture. D. a chest X-ray reveals a change from consolidation to lacy appearence. 19. Of the following agents that cause pneumonia, which is not acquired directly by inhalation of aerosols? A. Mycobacterium tuberculosis B. viral agents C. Legionella pneumophilia D. Klebsiella pneumoniae

21

20. Which of the following risk factors is least often associated with an increased risk of acquiring pneumococcal pneumonia? A. Antecedent infection. B. Chronic obstructive pulmonary disease. C. Impaired splenic function. D. Age and debilitating disease. E. Exposure to a person with a case of pneumococcal pneumonia. 21. A 65-year old male presented to the emergency room with acute onset of fever, chest pain, a purulent sputum with a predominance of polymorphonuclear leukocytes (PMNs, indicative of bacterial infection) and consolidation on chest X-ray. Gram-positive, lancetshaped diplococci were cultured from the blood, but attempts to culture the organism from the sputum were not successful. Of the following organisms, which one is the most likely cause of these symptoms? A. Haemophilus influenzae, type b B. Streptococcus pneumoniae C. Staphylococcus aureus D. Pseudomonas aeruginosa 22. A severely ill middle-aged man who is a known alcoholic presents with a lower respiratory tract infection. A consolidated pneumonia is seen on X-ray examination. A Gram-stained film from a thick, mucoid sputum contained PMNs and Gram-negative bacilli that produce mucoid colonies on culture. Of the following organisms, which one is the most likely cause of these symptoms? A. Pneumocystis carinii B. Staphylococcus aureus C. Pseudomonas aeruginosa D. Klebsiella pneumoniae 23. A 30-year old hospitalized cystic fibrosis patient manifests with low-grade fever, nonproductive cough, dyspnea, and pleuritic chest pains. A lobar pneumonia is seen on X-ray examination. Gram-negative bacilli that colored the agar blue-green were cultured from a blood specimen. Of the following organisms, which one is the most likely cause of these symptoms? A. Streptococcus pneumoniae B. Staphylococcus aureus C. Pseudomonas aeruginosa D. Pneumocystis carinii

22

24. The source of the infectious form of ________________ is commonly contaminated, aerosolized water. A. Ureaplasma urealyticum B. Mycoplasma pneumoniae C. Legionella pneumophila D. Chlamydia pneumoniae 25. The agent of atypical pneumonia that sucks-out nutrients from host cells and commonly causes outbreaks of pneumonia in closed populations of young adults, (e.g. college students and military recruits) has which of the following characteristics? A. obligate intracellular parasitism B. absence of a cell wall C. pili for attachment D. antiphagocytic capsule 26. The elementary body of Chlamydia pneumoniae refers to the A. metabolically active form. B. infectious form. C. antigens expressed on the cell surface. D. cytoplasmic location of the organism. 27. Histoplasma capsulatum differs from Mycobacterium tuberculosis with regards to A. clinical presentation. B. reservoir. C. ability to cause disseminated disease. D. ability to reactivate. E. portal of entry. 28. Which of the following is not true of Mycobacterium turberculosis? A. cell wall contains mycolic acids/waxy lipids B. obligate aerobe (requires high oxygen tension) C. digested readily by macrophages D. facultative intracellular pathogen

23

29. All the following are true for Mycobacterium avium and Pneumocystis carinii except A. rarely cause disease in immunocompentent individuals. B. commonly cause pneumonia in AIDs patients. C. are transmitted readily person-to-person. D. are controlled by cell-mediated immunity. Use the following case for the next two questions. A 35 year old male has a two week history of night sweats, loss of appetite, fever and hemoptysis (T h e expectoration [spitting up] of blood or of blood stained sputum). A history reveals he gleefully traveled to California three weeks previously for business meetings in several rural towns. 30. In addition to the most likely agent, your differential diagnosis must also include A. Histoplasma capsulatum B. Blastomyces dermatitidis C. Mycobacterium turberculosis D. Cryptocococcus neoformans 31. Microscopic examination of the sputum sample taken from this patient reveals the presence of spherules, which confirms the causative agent to be A. Histoplasma capsulatum B. Blastomyces dermatitidis C. Coccidioides immitis D. Cryptocococcus neoformans 32. The most common cause of active tuberculosis in the United States today is due to reactivation pulmonary tuberculosis. A. TRUE B. FALSE 33. Which of the following organisms does not have a specific geographical distribution? A. Pneumocystis carinii B. Histoplasma capsulatum C. Blastomyces dermatitidis D. Coccidioides immitis

24

34. Which of the following statements concerning treatment of bacterial meningitis is incorrect? A. Antibiotic concentrations should exceed the minimum bactericidal concentration if possible. B. Steroids should always be administered before antibiotic therapy is initiated. C. Antibiotic susceptibilities should be determined if agent responsible for disease is isolated. D. Antibiotics utilized should be secreted in tears. 35. Which of the following associations of an etiologic agent and age-dependent incidence of central nervous system disease is incorrect? A. Listeria monocytogenes B. Streptococcus agalactiae C. S. pneumoniae D. Haemophilus influenzae, type b neonates and elderly young adults children (<4-y-o-age) and elderly children (<6-y-o-age)

36. Overall, which of the following etiologic agents leads to the highest meningitis case-related mortalities and is responsible for most meningitis cases in children? A. Streptococcus agalactiae B. Streptococcus pneumoniae. C. Neisseria meningitides D. Haemophilus influenzae, type b. 37. The human nasopharynx can be a reservoir for all of the following agents of bacterial meningitis except: A. Streptococcus pneumoniae B. Neisseria meningitidis C. Listeria monocytogenes D. Haemophilus influenzae, type b. 38. It is currently recommended that gravid (pregnant) females should be screened for infection with ________________ to significantly reduce in utero infection and those acquired during parturition. A. Klebsiella pneumoniae B. Streptococcus agalactiae C. Listeria monocytogenes D. Mycoplasma pneumoniae

25

39. Vaccines exist for each of the following agents except A. Haemophilus influenzae, type b. B. Streptococcus pneumoniae. C. Listeria monocytogenes. D. Neisseria meningitides, serotype C. 40. An otherwise healthy 18-year old college student living in a dormitory manifests with rapid onset of signs and symptoms including a fever, failure to respond to anything but the simplest commands and "staring off into space", as well as a stiff neck, and a non-blanching rash on his ankles and trunk. Of the following agents, which is the most likely cause of these symptoms? A. Streptococcus agalactiae B. Haemophilus influenzae, type b C. Neisseria meningitides D. Streptococcus pyogenes 41. The commonly accepted method of preparation of centrifuge-concentrated CSF specimens for microscopic examination for Cryptococcus neoformans is A. a modified Gram-stain (10 minutes on the safranin counter stain). B. direct fluorescent microscopic examination C. a modification of the acid fast stain. D. negative staining of a wet-mount with India ink. 42. In a patient with the constitutional signs and symptoms of meningitis, a finding of Gram-positive diplococci in a CSF specimen is pathognomonic for A. Streptococcus pneumoniae. B. Streptococcus agalactiae. C. Neisseria meningitidis. D. Haemophilus influenzae, type b. 43. Which of the following bacterial agents of meningitis possess a Gram-positive cell wall architecture, is easily decolorized during Gram-staining (not in notes, newinformation), and appears as a coccobacilli or club-shaped rods? A. Listeria monocytogenes B. Neisseria meningitides C. Streptococcus pneumoniae D. Staphylococcus aureus

26

Exam IV: Medical Microbiology 479, Spring 2003 (L18-L23). Name ________________________ Last four numbers of SSN ________________________ 50 questions. 1. The most common etiological agent of viral meningitis in the United States is/are A. non-polio enteroviruses. B. herpes viruses 6 and 7. C. polio virus. D. West Nile virus. 2. The most common outcome of infection with arboviruses in the USA is A. arthralgias accompanied by a rash. B. asymptomatic with seroconversion. C. encephalitis. D. fever and malaise. 3. Worldwide, most cases of rabies occur following interactions with which of the following animals? A. Bats B. Rats C. Cats D. Dogs 4. All of the following can be acquired via fecal contamination of food or water except A. polio virus. B. Taenia solium. C. enteroviruses 68 to 71. D. herpes viruses. 5. A neonate (6 months old) presents in the emergency room with abrupt onset of high fever, lethargy (sluggishness), irritability, and malaise, but no rash. Spinal taps demonstrate the absence of bacteria (aseptic meningitis). These symptoms are mostly likely caused by A. polio virus. B. Taenia solium. C. arboviruses. D. herpes viruses 6 or 7.

27

6. All of the following are true of viral encephalitis except A. associated with low mortality. B. arboviruses and herpes are most frequent agents. C. vaccination against mumps and measles has significantly reduced morbidity and mortality. D. caused by viral replication in brain parenchyma. 7. An outbreak of 5 cases (geographically and personally unrelated patients) of diffuse encephalitis occurs in Las Cruces during the summer. The patients symptoms range from an acute flu-like illness to a fulminant encephalitis. Which of the following is true with regards to the etiological agent of this outbreak? A. Reservoir is horses. B. Agents of this type, are found only west of the Mississippi river. C. Vector is the mosquito. D. Common cause of recurring skin infections. 8. All the following are true for polio except A. rarely, can lead to a flaccid, ascending asymmetrical paralysis. B. can cause a viremia (virus in the blood). C. is caused by a lytic virus D. the attenuated vaccine is safe for immunocomprimised patients. 9. A patient presents exhibiting insomnia, photophobia (fear of light), hydrophobia (fear of water), excess motor activity and is foaming at the mouth. His mother explains how the patient recently cared for a sick skunk that died shortly after capture. Of the following, the only beneficial course of action for this patient is to A. administer vaccine and antisera. B. treat with antivirals. C. keep patient as comfortable as possible. D. perform a brain biopsy and identify etiological agent of disease. 10. In infants suffering from infant botulism, treatment consists of A. antibiotics. B. horse antitoxin. C. both A and B above are correct. D. Neither A nor B above are correct.

28

THE FOLLOWING CASE SHOULD BE USED TO ANSWER THE NEXT TWO QUESTIONS. A 65-year old presents in the winter manifesting with fever, bizarre behavior, slurred speech, and difficulty with short-term memory of two days duration. Minimal nuchal rigidity is observed. Bacteriologic culture of the blood and sedimented cerebral spinal fluid specimens are negative. 11. Which of the following etiological agents is most likely the cause of these symptoms? A. Rabies virus B. West Nile virus C. Herpes virus D. Polio virus 12. This illness has probably resulted from reactivation of a latent infection. A. TRUE B. FALSE 13. All of the following diseases can involve access to the central nervous system via retrograde axoplasmic flow except A. polio. B. rabies. C. tetanus. D. toxoplasmosis. 14. An immigrant from Guatemala presents with a head trauma due to a car accident. The CT-scan with contrast reveals the presence of 2 small (<1cm in diameter) non-contrast enhancing cysts without surrounding edema. All concerns about the head trauma have been satisfactorily resolved. With regards to the 2 cysts, as this patient's physician, you recommend to A. do nothing, the cysts may remain viable and your patient asymptomatic for the remainder of your patient's life. B. do nothing until the cysts begin to calcify and your patient manifests with signs and symptoms, i.e., seizures. C. initiate appropriate treatment now to prevent possible clinical manifestations in the future.

29

15. Toxoplasmosis can result from all the following except A. ingestion of undercooked meat contaminated with the etiologic agent (pseudocysts). B. inhalation or ingestion of mature oocysts of the etiologic agent. C. reactivation of latent toxoplasmosis. D. All of the above can result in toxoplasmosis. 16. The definitive host of Toxoplasma gondii is the A. cat. B. human. C. dog. D. hamster. 17. A 10-day old neonate manifests with a foul smelling discharge from his umbilical cord, irritability, muscle spasms and failure to nurse that rapidly progresses (within one day) to opisthotonos. A spinal tap is unrevealing (no bacteria). History reveals the child delivered by the local midwife (no professional training) in a rural area. The mother has had no vaccinations. This infant is most likely suffering from which of the following? A. Tetanus B. Polio C. Botulism D. Herpes encephalitis 18. Guillian Barre syndrome is most often the sequella of which of the following diseases? A. Salmonellosis B. Shigellosis C. Amoebiasis D. Campylobacteriosis 19. All the following are true of Guillain Barre syndrome except A. fever is present. B. most common cause of generalized paralysis in the US. C. due to production of cross-reactive antibodies against infectious agent. D. most patients have good recovery. 20. All the following are true of tetanus and botulism except A. etiological agents are obligate anaerobes. B. antitoxin therapy exists for both diseases. C. are both toxin mediated diseases. D. both commonly result from food poisoning.

30

21. The major reason why facial muscles are involved early during tetanus is because their nerves have longer axons. A. TRUE B. FALSE 22. Tetanus toxin __________________________________ while botulism toxin _________________________________. A. inhibits muscle contractions - inhibits g-aminobutyric acid release B. inhibits acetylcholine release - increases muscle contractions C. inhibits the action of inhibitory neurons - acts on myoneural junctions D. always acts within the peripheral nervous system - acts on the central nervous system 23. A person who has recently been to China in 2003 (returned in the past 5 days), presents with a temperature of 101.4F (~39C) and is having difficulty breathing (pneumonia). Of the etiological agents below which one is most likely causing this patient's illness? A. rotavirus B. coronavirus C. influenza virus D. rhinovirus 24. All the following are true of prions except A. can cause a transmissible spongiform encephalitis. B. are susceptible to UV radiation. C. do not generate inflammatory response. D. can cause chronic progressive pathology without remission. 25. Humans are the sole reservoir for which of the following? A. Giardia lamblia B. Canpylobacter jejuni C. Salmonella enteritidis D. Helicobacter pylori 26. All the following are capable of causing diarrheal diseases in humans. Of the following which does not cause diarrhea via intoxication? A. Staphylococcus aureus B. Bacillus cereus C. Clostridium perfringens D. Canpylobacter jejuni

31

27. The most common bacterial cause of diarrhea in the US is A. Campylobacter jejuni. B. Salmonella enteriditis. C. Shigella flexneri. D. enterotoxigenic Escherichia coli (ETEC). 28. All of the following organisms have a low infection dose, except A. Shigella spp. B. enterotoxigenic Escherichia coli (ETEC). C. Giardia lamblia. D. Entamoeba. 29. Which of the following is an obligate intracellular pathogen? A. Norwalk virus B. Campylobacter jejuni C. Salmonella enteritidis D. All of the above are correct. 30. Which of the following causes prolonged severe disease (watery diarrhea) in AIDS patients and has no FDA approved antimicrobial therapy? A. Cryptosporidium parvum B. Campylobacter jejuni C. Norwalk virus D. Helicobacter pylori 31. In general, etiologic agents that cause diarrheal disease as a result of toxemia are nontransmissible (e.g. fecal-oral route) and the toxemias that result, do not cause fever A. TRUE B. FALSE 32. During diagnosis of a diarrheal disease you notice white blood cells in a fecal sample. The presence of white blood cells is indicative of an A. invasive bacterial infection. B. antibiotic-induced diarrhea. C. Both A and B above could be correct. D. Neither A nor B above is correct.

32

33. Which of the following is not a common feature of Vibrio cholerae and enterotoxigenic Escherichia coli? A. Gram-negative B. non-invasive C. lactose fermentation D. cause afebrile, watery diarrhea 34. Which of the following two organisms can cause hemolytic uremic syndrome? A. Escherichia coli O157H7 and Campylobacter jejuni B. Salmonella enteriditis and Shigella dysenteriae C. Salmonella enteriditis and Campylobacter jejuni D. Escherichia coli O157H7 and Shigella dysenteriae 35. A patients presents that has been taking ciprofloxacin because he is scared of a potential terrorist anthrax attack. He is complaining of diarrhea, severe abdominal pain and fever. On endoscopic exam you observe elevated yellowish plaques scattered over inflamed areas of the colon mucosa. The most likely etiological agent of this disease is A. Campylobacter jejuni. B. Shigella dysenteriae. C. Clostridium difficile. D. Staphylococcus aureus. 36. Which of the following agents is most likely to cause bacteremia, after causing diarrhea? A. Shigella spp. B. Campylobacter B. Yersinia D. Salmonella 37. A patient, who has just returned from a trip to Calcutta India, presents with an afebrile bloody diarrhea and tender abdomen. Fecal smears reveals RBCs, scarce leukocytes, and some cysts. The most likely etiologic agent is A. shiga toxin producing Escherichia coli (STEC). B. Cryptosporidium parvum. C. enterohemorrhagic E. coli (EHEC). D. Entamoeba histolytica.

33

38. A patient from an appropriate endemic area presents with blood and mucous in his stool. In addition to bacillary (Shigella) and amoebic dysentery, the differential diagnoses should include parasitic infestation with A. Taenia spp. B. Enterobius vermicularis. C. Ascaris lumbricoides. D. Trichuris trichiura. 39. A four year-old is a thumb sucker who has anal pruritis and a history of sleep disturbances. Microscopically examined samples collected from his anus show the presence of eggs. Your diagnosis should be A. trichuriasis. B. ascariasis. C. enterobiasis. D. tape worm infestation. 40. A young man complains of feeling exhausted and occasionally has epigastric pain (stomach ache). Laboratory findings indicate he is anemic. Upon questioning, he states that he has always been healthy. He eats no red meat or fowl but confesses that he is quite partial to sushi and often prepares if from fresh salmon at home. Of the following, which is the most likely cause of Richard's illness? A. Taenia solium. B. Taenia saginata. C. Diphyllobothrium latum. D. Enterobius vermicularis 41. As a whole, urinary tract infections are most often caused by A. Staphylococcus aureus. B. Escherichia coli. C. Proteus mirabilis. D. Klebsiella pneumoniae. 42. Of the following genera of normal vaginal flora, which plays the greatest role in killing or suppressing the growth of potential pathogens? A. Lactobacilli B. Bacteriodes C. Streptococcus D. Candida

34

43. Which of the following is not recognized as an etiologic agent of bacterial vaginosis? A. Mobiluncus spp. B. Gardnerella vaginalis C. Escherichia coli D. Prevotella spp. 44. From a public health perspective, in which of the following stages of syphilis can a person be considered not infectious? A. Primary B. Secondary C. Early latent D. Reactivated latent E. Tertiary 45. Which of the following sexually transmitted agents of genital ulcer disease are known to initiate a latent infection that remains locally restricted to the site of the primary infection? A. Herpes simplex virus, type 2. B. Treponema pallidum C. Chlamydia trachomatis, serotypes L1-L3 D. None of the above are correct. 46. Which of the following agents of sexually transmitted disease can be seen readily on routine Gram-staining and microscopy? A. Neisseria gonorrhoeae B. Chlamydia trachomatis C. Treponema pallidum D. All of the above are correct. 47. Most commonly, Chlamydia trachomatis infection in females occurs as a/an A. symptomatic pelvic inflammatory disease. B. cottage-cheese vaginal discharge. C. asymptomatic cervical infection. D. inflammation of the anus.

35

48. Which of the following diseases manifests as: an intense vulvovaginal pruritis, foamy vaginal discharge, vaginal pH of 6.0, inflammatory cells with highly motile organisms on microscopy. A. Bacterial vaginosis B. Toxic shock syndrome C. Trichomoniasis D. Candida vaginitis 49. Which of the following diseases often begins as a painless papule that progresses to inguinal lymphadenopathy and scarring obstruction of the lymphatics that drain the genitalia. A. Lymphogranuloma B. Genital herpes C. Syphilis D. Chancroid 50. Which of the following diseases is characterized by painful, non-indurated ulcerative lesions with a ragged edge. A. Lymphogranuloma B. Genital herpes C. Syphilis D. Chancroid

36