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151799
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microB.txt
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2012-05-02 22:20:22
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Microbiology
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MicroB questions
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3. A 55-year-old male develops malaise, fever up to 103.5C, nonproductive cough, headache, and shortness of breath, a few days after
he repaired the cooling system of an old hotel. A chest x-ray reveals
fluid in his lungs. From a sputum sample, a gram-negative rod grew
slowly on a buffered cysteine containing charcoal-yeast agar. Which
of the following antibiotic therapies is most appropriate for treating
this patient?
o a. Ampicillin
o b. Ceftriaxone
o c. Erythromycin
o d. Penicillin
o e. Vancomycin
o d. Penicillin
o e. Vancomycin
o b. Amphotericin
o c. Chloramphenicol
o d. Penicillin
o e. Trimethoprim
10.
A patient with leukemia has a chest CT finding that suggests
aspergillosis. Which of the following antimicrobial binds sterols and
alters membrane permeability, and would most likely be used in this
patients treatment?
o a. Amdinocillin
o b. Amphotericin
o c. Chloramphenicol
o d. Penicillin
o e. Trimethoprim
11.
A 10-week-old infant is diagnosed with meningitis. A lumbar
puncture reveals numerous neutrophils and gram-positive rods. She is
admitted to the hospital and is thought to be allergic to beta-lactams.
Which of the following antibiotics attaches to 505 ribosome, inhibits
peptidyl transferase, and would most likely be used to treat this
patient?
o a. Amdinocillin
o b. Amphotericin
o c. Chloramphenicol
o d. Penicillin
o e. Trimethoprim
12.
A patient presents to the emergency room with vomiting,
diarrhea, high fever, and delirium. Upon physical exam, you notice
13.
A 3-year-old girl who has missed several scheduled
immunizations presents to the emergency room with a high fever. She
is irritable and has a stiff neck. Fluid from a spinal tap reveals 20,000
white blood cells per milliliter with 85% polymorphonuclear cells.
Which of the following is the preferred third-generation
cephalosporin with good activity against organisms of childhood
meningitis?
o a. Ceftazidine
o b. Ceftriaxone
o c. Penicillin
o d. Streptomycin
o e. Vancomycin
14.
A 28-year-old female just returned from a 1-week cruise with
stops along the coast of Mexico. Forty-eight hours after her return she
is reported to have headache, fever, abdominal cramps, and
constipation. Over the next 5 days her fever increases with continued
complaints of myalgias, malaise, and anorexia. A blood culture is
positive for S. typhi. Her condition improves with a treatment course
15.
A patient presents to the emergency room with a progressive
fever, cough, and general malaise. History determines that he works
with sheep on a farm and had just been involved in wool harvesting.
Which of the following antibiotics is most appropriate as part of your
immediate treatment?
o a. Ceftazidine
o b. Ceftriaxone
o c. Penicillin
o d. Streptomycin
o e. Vancomycin
16.
During the course of his hospital stay, a severely burned 60year-old male develops a rapidly disseminating bacterial infection.
Small gram-negative rods that are oxidase positive are cultured from
green pus taken from the burn tissue. Which of the following thirdgeneration cephalosporin will most likely have the best primary
activity against this etiologic agent?
o a. Ceftazidine
o b. Ceftriaxone
o c. Penicillin
o d. Streptomycin
o e. Vancomycin
17.
Laboratory results of a clinical specimen from a patient with
hospital-acquired pneumonia reveal the presence of Staphylococcus
aureus with a methicillin-resistant plasmid. Which of the following
drugs is the best immediate treatment?
o a. Ceftazidine
o b. Ceftriaxone
o c. Penicillin
o d. Streptomycin
o e. Vancomycin
18.
Antibiotics that inhibit dihydrofolic acid reductase in bacteria up
to 50,000 times more than in mammalian cells is represented by
which of the following agents?
o a. Amdmocillin
o b. Amphotericin
o c. Chloramphenicol
o d. Penicillin
o e. Trimethoprim
19.
An 18-year-old college freshman presents with fever of 103F,
headache, right flank pain, nausea and vomiting, and urinary
frequency with hematuria and dysuria. Renal ultrasound demonstrates
a right urinary stone with right hydronephrosis. Which of the
following antibiotics binds to PBP-2 and is the most appropriate
treatment option?
o a. Amdinocillin
o b. Amphotericin
o c. Chloramphenicol
o d. Penicillin
o e. Trimethoprim
20.
A patient presents to the emergency room with vomiting,
diarrhea, high fever, and delirium. Upon physical exam, you notice
large, painful buboes, and disseminated intravascular coagulation.
Laboratory diagnosis of aspirate taken from the bubo reveals a gramnegative rod with bipolar staining resembling a safety pin. Which of
the following antibiotics is most appropriate as part of your
immediate treatment?
o a. Ceftazidine
o b. Ceftriaxone
o c. Penicillin
o d. Streptomycin
o e. Vancomycin
21.
Regarding antimicrobial drugs that act by inhibiting nucleic acid
synthesis in bacteria, which one of the following is the MOST
accurate?
o a. Quinolones, such as ciprofloxacin, inhibit the RNA poly-merase in bacteria by
acting as nucleic acid analogues
o b. Rifampin inhibits the RNA polymerase in bacteria by binding to the enzyme
and inhibiting messenger RNA synthesis
o c. Sulfonamides inhibit the DNA polymerase in bacteria by causing chain termination
of the elongating strand
o d. Trimethoprim inhibits the DNA polymerase in bacteria by preventing the
unwinding of double-stranded DNA
22.
Endotoxin is an important underlying cause of septic shock and
death, especially in hospitalized patients. Regarding endotoxin, which
one of the following is the MOST accurate?
o a. It acts by phosphorylating the G stimulating protein
o b. It is a polypeptide with an A-B subunit configuration
o c. It induces the synthesis of tumor necrosis factor
o d. It is found primarily in gram-positive rods
o e. It can be treated with formaldehyde to form an effective toxoid vaccine
23.
A family routinely consumed unpasteurized milk, claiming
"better taste." Several members experienced a sudden onset of
crampy abdominal pain, fever, and bloody, profuse diarrhea. C. jejuni
was isolated and identified from all patients. Which of the following
is the treatment of choice for this type of enterocolitis?
o a. Ampicillin
o b. Campylobacter antitoxin
o c. Ciprofloxacin
o d. Erythromycin
o e. Pepto-Bismol
24.
An outbreak of postsurgical wound infections caused by
staphylococcu aureus has occurred. The infection control team wsa
asked to determine whether the organism could be carried by one of
the operating room personnel. Using your knowledge of normal flora,
which on eof the following body sites is the MOST likely location for
this organism?
o Colon
o Gingival crevice
o Nose
o Throat
o Vagina
25.
Several Neisseria species are a part of the normal flora
(commensals) of the human upper respiratory tract. Which of the
following statements accurately describes the significance of these
bacteria?
o a. As a part of the normal flora, Neisseriae provide a natural immunity in local
host defense
o b. As a part of the respiratory flora, they are the most common cause of acute
bronchitis and pneumonia
o c. Commensal bacteria stimulate a cell-mediated immunity (CMI)
o d. Commensal Neisseriae in the upper respiratory tract impede phagocytosis by means
of lipoteichoic acid
o e. Normal flora such as nonpathogenic Neisseriae provide effective nonspecific Bcell-mediated humoral immunity
26.
A 60-year-old female complains of tenderness and pain around a
peritoneal catheter. Blood cultures reveal gram-positive, catalasepositive cocci. Which of the following is the most likely organism
which is also considered a predominant organism on skin?
o a. a-hemolytic streptococci
o b. B. ragtlis
o c. E. coli
o d. Lactobacillus
o e. S, epidermidis
27.
A 60-year-old female complains of tenderness and pain around a
peritoneal catheter. Blood cultures reveal gram-positive, catalasepositive cocci. Which of the following is the most likely organism
which is also considered a predominant organism on skin?
o a. a-hemolytic streptococci
o b. B. ragtlis
o c. E. coli
o d. Lactobacillus
o e. S, epidermidis
28.
A 65-year-old woman had symptoms of dementia. An MRI
revealed significant cortical atrophy. It was determined that her
intraventricular pressure was very high, and a ventriculoperitoneal
shunt (from the brain, tunneling under the skin into the peritoneal
cavity) was placed to relieve the pressure. Three weeks later she
developed a fever to 38C, malaise, and anorexia but no other
symptoms. Of the following, which one BEST describes MOST
likely organism causing her current symptoms?
o a. A gram-positive coccus that does not clot plasma
o b. A curved gram-negative rod that produces urease
o c. An acid-fast rod that does not grow on bacteriologic media
o d. An obligate intracellular parasite that forms a cytoplasmic inclusion body
o e. A spirochete that induces an antibody that agglutinates a lipid from a cow's heart
29.
A 25-year-old man was in a motorcycle accident 3 days ago, in
which he sustained severe head trauma. He has had spinal fluid
leaking from his nose since the accident and now develops a severe
headache. His temperature is 39C, and on examination you find
nuchal rigidity. You do a lumbar puncture and find that the spinal
fluid is cloudy and contains 5000 WBC/|o,L, 90% of which are polys.
Of the following, which one is the MOST likely result observed in
the laboratory analysis of the spinal fluid?
o a. Gram-negative rods that grew only anaerobically
o b. A motile spirochete that formed p-hemolytic colonies on blood agar
30.
Your patient is a 10-year-old girl who has leukemia and is
receiving chemotherapy through an indwelling venous catheter. She
now has a fever of 39C but is otherwise asymptomatic. You do a
blood culture, and the laboratory reports growth of Staphylococcus
epidermidis. Which one of the following results is LEAST likely to
be found by the clinical laboratory?
o a. Gram-positive cocci in clusters were seen on Gram stain of the blood culture
o b. Subculture of the blood culture onto blood agar revealed non-hemolytic colonies
o c. A coagulase test on the colonies was negative
o d. A catalase test on the colonies was negative
31.
A 60-year-old woman had surgery for ovarian carcinoma 4 days
ago and has an indwelling urinary catheter in place. She now spikes a
fever to 39C and has cloudy urine in the collection bottle. Gram
stain of the urine shows many polys and gram-positive cocci in
chains. Which one of the following would be the MOST likely
findings in the urine culture?
o a. Hemolytic colonies on the blood agar plate that are optochin-sensitive
o b. Hemolytic colonies on the blood agar plate that are bacitracin-sensitive
o c. Nonhemolytic colonies on the blood agar plate that hydrolyze hippurate
o d. Nonhemolytic colonies on the blood agar plate that grow in 6.5% sodium
chloride
32.
A 40-year-old male had been in good health until he began
experiencing a chronic cough. Over the following 6 weeks the cough
gradually worsened and became productive. He also noted weight
loss, fever, night sweats, and coughing blood. A sputum sample was
positive for acid-fast bacilli. Which of the following pathogenic
mechanisms can be primarily attributed to the etiologic agent
involved in this disease?
o a. Cell-mediated hypersensitivity
o b. Clogging of alveoli by large numbers of acid-fast mycobacteria
o c. Humoral immunity
o d. Specific cell adhesion sites
o e. Toxin production by the mycobacteria
33.
Your patient is a 6-year-old boy with papular and pustular skin
lesions on his face. A serous, "honey-colored" fluid exudes from the
lesions. You suspect impetigo. A Gram stain of the pus reveals many
neutrophils and gram-positive cocci in chains.If you cultured the pus
on blood agar, which one of the followingwould you be MOST likely
to see?
o a. Small B-hemolytic colonies containing bacteria that are bacitracin-sensitive
o b. Small a-hemolytic colonies containing bacteria that are resistant to optochin
o c. Large nonhemolytic colonies containing bacteria that are oxidase-positive
o d. Small nonhemolytic colonies containing bacteria that grow in 6.5% NaCl
34.
Your patient is a 3-year-old girl with fever and pain in her right
ear. On physical examination, the drum is found to be perforated and
a bloody exudate is seen. A Gram stain of the exudate reveals grampositive diplococci. Of the following, which one is the MOST likely
cause?
o a. Streptococcus pyogenes
o b. Staphylococcus aureus
o c. Corynebacterium diphtheriae
o d. Streptococcus pneumoniae
35.
Your patient is a 15-year-old boy with migratory polyarthritis,
fever, and a new, loud cardiac murmur. You make a clinical diagnosis
of rheumatic fever. Which one of the following laboratory results is
MOST likely to be found in this patient?
o a. A blood culture is positive for Streptococcus pyogenes at this time
o b. A throat culture is positive for Streptococcus pyogenes at this time
o c. A Gram stain of the joint fluid shows gram-positive cocci in chains at this time
o d. An anti-streptolysin O assay is positive at this time
36.
Your patient is a 20-year-old man who was in a fist fight and
suffered a broken jaw and lost two teeth. Several weeks later, he
developed an abscess at the site of the trauma that drained to the
surface of the skin, and yellowish granules were seen in the pus.
Regarding this disease, which one of the following is MOST
accurate?
o a. The causative organism is a gram-positive rod that forms long filaments
o b. The causative organism is a comma-shaped gram-negative rod that produces an
exotoxin which increasescyclic AMP
o c. The causative organism cannot be seen in the Gram stain but can be seen in an acidfast stain
o d. A combination of gram-negative cocci and spirochetes cause this disease
37.
Your patient is a 70-year-old woman who had a hysterectomy
for carcinoma of the uterus 3 days ago. She has an indwelling urinary
catheter in place and now has a fever to 39C, and the urine in the
collection bottle is cloudy. A Gram stain of the urine specimen shows
many neutrophils and gram-positive cocci in chains. You also do a
urine culture. Which one of the following is the MOST likely set of
findings on the urine culture?
o a. b-Hemolytic colonies that are bacitracin-sensitive
o b. b-Hemolytic colonies that are optochin-sensitive
o c. Nonhemolytic colonies that grow in 6.5% sodium chloride
o d. Nonhemolytic colonies that grow only anaerobically
38.
Your patient is a 10-year-old girl who has had pain in her left
arm for the past 5 days. On physical examination, her temperature is
38C and there is tenderness of the humerus near her deltoid. On Xray of the humerus, an area of raised periosteum and erosion or bone
is seen. You do a blood culture. Which one of the following is the
MOST likely set of findings'
o a. Gram-negative rods that grow on EMB agar, forming purple colonies and a green
sheen
o b. Gram-positive cocci that grow on blood agar, causing a clear zone of
hemolysis, and are coagulase-positive
o c. Gram-positive rods that grow only anaerobically and form a double zone of
hemolysis on blood agar
o d. Gram-negative diplococci that grow on blood agar, are oxidase-positive, and
ferment maltose
39.
Your patient is a 10-year-old boy who is receiving chemotherapy
for acute leukemia. He develops fever, headache, and stiff neck, and
you make a presumptive diagnosis of meningitis i~-do a lumbar
puncture. A Gram stain reveals a small gram-positive rod, and culture
of the spinal fluid grows a beta-hemolytic colony of blood agar.
Regarding this organism, which one of the following is MOST
accurate?
o a. It has more than 100 serologic types
o b. It produces an exotoxin that inhibits elongation factor 2
40.
Ms. Jones calls to say that she, her husband, and their child have
had nausea and vomiting for the past hour or so. Also, they have had
some nonbloody diarrhea. You ask when their last meal together was,
and she says they had a picnic lunch in the park about 3 hours ago.
They have no fever. Which one of the following is the MOST likely
finding?
o a. Gram stain of the leftover food would show many gram-positive cocci in
clusters
o b. Gram stain of the stool would show many gram-negative diplococci
o c. KOH prep of the leftover food would show many budding yeasts
o d. Acid-fast stain of the stool would show many acid-fast rods
41.
A 4-week-old newborn develops meningitis. Short, grampositive rods are isolated. History reveals that the mother had eaten
unpasteurized cheese from Mexico during the pregnancy, and she
recalled having a flu like illness. Which of the following is the most
likely etiologic microorganism?
o a. C. diphtheriae
o b. E. coli
o c. Group B streptococci
o d. Listeria monocytogenes
o e. S. pneumnoniae
42.
A patient appears in the emergency room with a submandibular
mass. A smear is made of the drainage and a bewildering variety of
bacteria are seen, including branched, gram-positive rods. Which of
the following is the most clinically appropriate action?
43.
A patient complains to his dentist about a draining lesion in his
mouth. A Gram stain of the pus shows a few gram-positive cocci,
leukocytes, and many-branched gram-positive rods. Branched yellow
sulfur granules are observed by microscopy. Which of the following
is the most likely cause of the disease?
o a. Actinomyces israelii
o b. Actinomyces viscosus
o c. C. diphtheriae
o d. Propionibacterium acnes
o e. S. aureus
44.
A 2-year-old child has a high fever and is irritable. He has a stiff
neck. ( i ram stain smear of spinal fluid reveals gram-negative, small
pleomorphic coccobacillary organisms. What is the most appropriate
procedure to follow in order to reach an etiological diagnosis?
o a. Culture the spinal fluid in chocolate agar, and identify the organism by growth
factors
o b. Culture the spinal fluid in mannitol-salt agar
o c. Perform a catalase test of the isolated organism
o d. Perform a coagulase test with the isolate
o e. Perform a latex agglutination (LA) test to detect the specific antibody in the spinal
fluid
45.
A severely burned firefighter develops a rapidly disseminating
bacterial infection while hospitalized. "Green pus" is noted in the
burned tissue, and cultures of both the tissue and blood yield small,
oxidase-positive, gram-negative rods. Which of the following
statements about this organism is correct?
o a. Endotoxin is the only virulence factor known to be produced by these bacteria
o b. Humans are the only known reservoir hosts for these bacteria
o c. The bacteria are difficult to culture because they have numerous growth
requirements
o d. These are among the most antibiotic resistant of all clinically relevant bacteria
o e. These highly motile bacteria can "swarm" over the surface of culture media
46.
Several days after an unprotected sexual encounter, a healthy 21
year-old male develops pain and pus on urination. A Gram stain
revealed gram-negative diplococci. Which of the following structures
is responsible for adherence of the offending microbe to the urethral
mucosa?
o a. Capsule
o b. Fimbriae
o c. Flagella
o d. The F pili
o e. The peptidoglycan
o f. The lipopolysaccharide (LPS)
47.
A 2-year-old boy who missed several scheduled immunizations
presents to the emergency room with a high fever, irritability, and a
stiff neck. Fluid from a spinal tap reveals 20,000 white blood cells
WBCs per mL with 85% polymorphonuclear cells. Gram stain
evaluation of the fluid reveals small pleomorphic gram-negative rods
that grow on chocolate agar. If an inhibitor is designed to block its
48.
Your patient is a 70-year-old man with a long history of smoking
who now has a fever and a cough productive of greenish sputum. You
suspect pneumonia, and a chest X-ray confirms your suspicion. If a
Gram stain of the sputum reveals very small gram-negative rods and
there is no growth on a blood agar but colonies dogrow on chocolate
agar supplemented with NAD and heme, which one of the following
bacteria is the MOST likely cause?
o a. Chlamydia pneumoniae
o b. Legionella pneumophila
o c. Mycoplasma pneumoniae
o d. Haemophilus influenzae
49.
Your patient is a 20-year-old woman with the sudden onset of
fever to 104F and a severe headache. Physical examination reveals
nuchal rigidity. You suspect meningitis and do a spinal tap. Gram
stain of the spinal fluid reveals many neutrophils and many gramnegative diplococci. Of the following bacteria, which one is MOST
likely to be the cause?
o a. Haemophilus influenzae
o b. Neisseria meningitidis
o c. Streptococcus pneumoniae
o d. Pseudomonas aeruginosa
50.
Your patient is a 6-year-old boy with a history of several
episodes of pneumonia. A sweat test revealed an increased amount of
chloride, indicating that he has cystic fibrosis. He now has a fever
and is coughing up a thick, greenish sputum. A Gram stain of the
sputum reveals gram-negative rods. Of the following, which one is
the MOST likely organism to cause this infection?
o a. Pseudomonas aeruginosa
o b. Haemophilus influenzae
o c. Legionella pneumophila
o d. Bordetella pertussis
51.
Your patient is a 28-year-old man with third-degree burns over a
large area of his back and left leg. This morning, he spiked a fever to
40C and had two teeth-chattering chills. A blood culture grows a
gram-negative rod that is oxidase-positive and produces a blue-green
pigment. Of the following, which one is the MOST likely organism to
cause this infection?
o a. Prevotella melaninogenica
o b. Pseudomonas aeruginosa
o c. Proteus mirabilis
o d. Haemophilus influenza
52.
A 70-year-old woman has sustained third-degree bums over a
Significant area of her body. Despite appropriate burn care in the
hospital, she spiked a fever to 39C, and the nurse reports blue-green
pus on the dressing covering the burned area. Gram stain of the pus
reveals gram-negative rods, and antibiotic sensitivity tests show
53.
Your patient is a 30-year-old man with acute onset of fever to
40C and a swollen, very tender right femoral node. His blood
pressure is 90/50, and his pulse is 110. As you examine him, he has a
teeth-chattering shaking chill. He returned from a camping trip in the
Southern California desert 2 days ago. Regarding this disease, which
one of the following is MOST accurate?
o a. An aspirate of the node will reveal a small gram-negative rod
o b. The organism was probably acquired by eating food contaminated with rodent
excrement
o c. The aspirate of the node should be cultured on Lowenstein-Jensen agar and an acidfast stain performed
o d. The organism causes disease primarily in people with impaired cell-mediated
immunity
54.
A 55-year-old man who is being treated for adenocarcinoma of
the lung is admitted to a hospital because of a temperature of 38.9C
(102F), chest pain, and a dry cough. Sputum is collected. Gram stain
of the sputum is unremarkable, and culture reveals many small, gramnegative rods able to grow only on a charcoal yeast extract agar.
Which of the following is the most likely organism?
o a. Chlamydia trachomatis
o b. Klebsiella pneumonias
o c. Legionella pneumophila
o d. M. pneumoniae
o e. S. aureus
55.
A severely burned firefighter develops a rapidly disseminating
bacterial infection while hospitalized. "Green pus" is noted in the
burned tissue, and cultures of both the tissue and blood yield small,
oxidase-positive, gram-negative rods. Which of the following
statements about this organism is correct?
o a. Endotoxin is the only virulence factor known to be produced by these bacteria
o b. Humans are the only known reservoir hosts for these bacteria
o c. The bacteria are difficult to culture because they have numerous growth
requirements
o d. These are among the most antibiotic resistant of all clinically relevant bacteria
o e. These highly motile bacteria can "swarm" over the surface of culture media
56.
A 16-year-old Hispanic female with poor oral hygiene and
severe gingivitis presents with a temperature of 103.5F and
hypotension. Blood culture is positive for Capnocytophaga. Which of
the following statements best characterizes Capnocytophaga?
o a. A gram-negative, pleomorphic rod that can cause endocarditis
o b. A gram-negative rod, fusiform-shaped, that is associated with periodontal
disease but may cause sepsis
o c. The causative agent of rat-bite fever
o d. The causative agent of sinusitis, bronchitis, and pneumonia
o e. The causative agent of trench fever
57.
A 6-year-old boy fell and sustained a deep wound from a rusty
nail that penetrated his thigh. His mother removed the nail and
cleaned the wound with soap and water. The next morning, he had a
temperature of 102F, and his thigh was very painful and swollen. In
the emergency room, crepitus (gas in the tissue)was noted. A Gram
stain of exudate from the wound area revealed large gram-positive
rods. Which one of the following is the MOST likely cause?
o a. Actinomyces israelii
o b. Clostridium perfringens
o c. Clostridium tetani
o d. Listeria monocytogenes
o e. Mycobacterium fortuitum-chelonei complex
o f. Nocardia asteroides
o g. Pseudomonas aeruginosa
58.
A 70-year-old woman has the rapid onset of fever to 39C and a
cough productive of greenish sputum. She is not hospitalized and not
immunocompromised. A chest X-ray reveals a left lower lobe
infiltrate. Of the following, which set of findings describes the MOST
likely causative organism found in the sputum culture?
o a. Gram-positive diplococci that form an a-hemolytic colony
o b. Gram-negative diplococci that form an oxidase-positive colony
o c. Gram-positive rods that form a 3-hemolytic colony
o d. Gram-negative rods that form an oxidase-positive colony
o e. Gram-negative cocci that grow only anaerobically
59.
A 25-year-old pregnant woman in the third trimester comes to
the emergency room saying that about 12 hours ago she began to feel
feverish and weak. On examination, she has a temperature of 40C
but no other pertinent findings. A blood culture grows small grampositive rods that cause (3-hemolysis on a bloodagar plate incubated
in room air. Which one of the following bacteria is the MOST likely
cause?
o a. Clostridium perfringens
o b. Streptococcus pyogenes
o c. Bacillus cereus
o d. Listeria monocytogenes
o e. Brucella abortus
60.
Streptococcus mutans is best described by which of the
following statements?
o a. An anaerobic, filamentous bacterium that often causes cervicofacial osteomyelitis
o b. A beta hemolytic organism that causes a diffuse, rapidly spreading cellulitis
o c. A facultative anaerobe that is highly cariogenic and sticks to teeth by synthesis
of a dextran
o d. A facultative anaerobe that often inhabits the buccal mucosa early in a neonate's life
and can cause bacterial endocarditis
o e. A facultatively anaerobic, rod-shaped bacterium that sticks to teeth and is cariogenic
61.
Streptococcus salivarius, a common isolate in the clinical
laboratory, is best described by which of the following statements?
o a. An anaerobic, filamentous bacterium that often causes cervicofacial osteomyelitis
o b. A beta-hemolytic organism that causes a diffuse, rapidly spreading cellulitis
o c. A facultative anaerobe that is highly cariogenic and sticks to teeth by synthesis of a
dextran
o d. A facultative anaerobe that often inhabits the buccal mucosa early in a
neonate's life and can cause bacterial endocarditis
o e. A facultatively anaerobic, rod-shaped bacterium that sticks to teeth and is cariogenic
62.
A patient was hospitalized after an automobile accident. The
wounds became infected, and the patient was treated with
tobramycin, carbenicillin, and clindamycin. Five days after antibiotic
therapy was initiated, the patient developed severe diarrhea and
pseudomembranous enterocolitis. Antibiotic-associated diarrhea and
the more serious pseudomembranous enterocolitis can be caused by
which of the following organisms?
o a. B.fragilis
o b. Clostridium difficile
o c. Clostridium perfringens
o d. Clostridium sordellii
o e. S. aureus
63.
Your patient is a 27-year-old woman who was treated with oral
ampicillin for cellulitis caused by Streptococcus pyogenes. Several
days later, she developed bloody diarrhea. You suspect that she may
have pseudomembranous colitis. Regarding the causative organism of
pseudomembranous colitis, which one of the following is the MOST
accurate?
o a. It is an anaerobic gram-positive rod that produces exotoxins
o b. It is a comma-shaped gram-negative rod that grows best at 41C
o c. It is an obligate intracellular parasite that grows in cell culture but not on blood agar
o d. It is a yeast that forms germ tubes when incubated in human serum at 37C
64.
Your patient is a 70-year-old man with a fever of 40C and a
very painful cellulitis of the right buttock. The skin appears necrotic,
and there are several fluid-filled bullae. Crepitus can be felt,
indicating gas in the tissue. A Gram stain of the exudate reveals large
gram-positive rods. Of the following, which one is the MOST likely
cause?
o a. Clostridium perfringens
o b. Bacillus anthracis
o c. Corynebacterium diphtheriae
o d. Actinomyces israelii
65.
Several hours after dining on sweet and sour chicken and pork
fried rice at the home of an Asian friend, a 34-year-old car salesman
exhibits abdominal discomfort, nausea, and vomiting. In the middle
of the night he awakens with watery diarrhea. Which of the following
pairs of organisms is routinely responsible for food poisoning?
o a. Clostridium botulinum and Bacillus anthracis
o b. C. difficile and C. botulinum
o c. C. perfringens and Bacillus cereus
o d. C. tetani and B. anthracis
o e. Clostridium t. and B. cereus
66.
One of the bacteria isolated from the foul-smelling exudates
taken from an abscess is missing superoxide dismutase, catalase, and
a peroxidase.Which of the following statements best describes this
microorganism?
o a. Aminoglycoside antibiotics will be effective against this bacterium
o b. This bacterium is a facultative aerobe
o c. This bacterium is an anaerobe
o d. This bacterium is more virulent than one containing the three enzymes
o e. This bacterium will survive in an O2 environment
67.
A 25-year-old medical student presented with a ruptured
appendix. A peritoneal infection developed, despite prompt removal
of the organ and extensive flushing of the peritoneal cavity. An
68.
A 17-year-old man is hospitalized with trauma to the abdomen
following a gang-related fight. He develops an intra-abdominal
abscess, which is drained and sent to the laboratory. A mixture of
gram-negative anaerobes are detected. Which of the following
microorganisms is the most likely and is also the most prevalent
bacterium in the gut?
o a. a-Hemolytic Streptococci
o b. B.fragilis
o c. E. coli
o d. Lactobacillus
o e. S. epidermidis
69.
Your patient is a 62-year-old woman with a history of carcinoma
of the sigmoid colon that was removed 5 days ago. The surgery was
complicated by the escape of bowel contents into the peritoneal
cavity. She now has fever and pain in the perineum and left buttock.
On physical examination, her temperature is 39C and myonecrosis
with a foul-smelling discharge is found. A Gram stain of the exudate
reveals gram-negative rods. Of the following, which one is the
MOST likely organism to cause this infection?
o a. Helicobacter pylori
o b. Bacteroides fmgilis
o c. Salmonella typhi
o d. Vibrio parahaemolyticus
70.
Your patient is a 30-year-old woman who was part of a tour
group visiting a Central American country. The day before leaving,
several members of the group developed fever, abdominal cramps,
and bloody diarrhea.Of the following, which one is the LEAST likely
organism to cause this infection?
o a. Shigella dysenteriae
o b. Salmonella enteritidis
o c. Vibrio cholerae
o d. Campylobacter jejuni
71.
A stool culture reveals no lactose-negative colonies on the EMB
agar. Which one of the following is the MOST likely organism to
cause this infection?
o a. Shigella dysenteriae
o b. Salmonella enteritidis
o c. Vibrio cholerae
o d. Campylobacter jejuni
72.
Your patient is a 55-year-old man with severe cellulitis of the
right leg, high fever, and a teeth-chattering chill. He is a fisherman
who was working on his boat in the waters off the Texas coast
yesterday.Which one of the following organisms is MOST likely to
be the cause of his disease?
o a. Yersinia pestis
o b. Vibrio vulnificus
o c. Pasteurella multocida
o d. Brucella melitensi
73.
Your patient is a 5-year-old girl with bloody diarrhea and no
vomiting. There is no history of travel outside of San Francisco. Stool
culture grows both lactose-positive and lactose-negative colonies on
EMB agar.Of the following organisms, which one is MOST likely to
be the cause?
o a. Shigella sonnei
o b. Salmonella typhi
o c. Campylobacter jejuni
o d. Helicobacter pylori
74.
Your patient is a 50-year-old woman who returned yesterday
from a vacation in Peru, where there is an epidemic of cholera. She
now has multiple episodes of diarrhea. Of the following, which one is
MOST compatible with cholera?
o a. Watery diarrhea without blood, no polys in the stool, and growth of curved gramnegative rods in the blood culture
o b. Watery diarrhea without blood, no polys in the stool, and no organisms in the
blood culture
o c. Bloody diarrhea, polys in the stool, and growth of curved gram-negative rods in the
blood culture
o d. Bloody diarrhea, polys in the stool, and no organisms in the blood culture
75.
Your patient is a 40-year-old woman with a severe attack of
diarrhea that began on the airplane while she was returning from a
vacation in the Middle East. She had had multiple episodes of watery.
nonbloody diarrhea and little vomiting. She is afebrile. A stool culture
reveals only lactose-fermenting colonies on EMB agar. Of the
following, which one is the MOST likely cause?
o a. Shigella sonnei
o b. Helicobacter pylori
o c. Escherichia coli
o d. Pseudomonas aeruginosa
76.
Ten boy scouts are hospitalized with bloody diarrhea and severe
hematological abnormalities. An investigation establishes that all of
the boys developed symptoms following consumption of hamburgers
from the same fast-food restaurant chain. Which of the following best
describes E. coli 0157/H7, the etiologic bacterium responsible for the
outbreak?
o a. It produces at least one protein toxin consisting of two subunits, A and B, that cause
severe spasmodic cough, usually in children
o b. It produces a toxin that blocks protein synthesis in an infected cell and carries a
lytic bacteriophage that produces the genetic information for toxin production
o c. It secretes an erythrogenic toxin that causes the characteristic signs of scarlet fever
o d. It secretes an exotoxin that has been called "verotoxin" and "Shiga-like
toxin"; infection is mediated by specific attachment to mucosal membranes It
requires cysteine for growth
77.
A 65-year-old healthy retired former executive female went on
her yearly vacation to Mexico. Unlike her previous trips she decided
to use the local water to make her favorite punch. Thirty-six hours
later she developed profused watery diarrhea, severe cramping, and
abdominal pain. She was diagnosed with E. coli related diarrhea.
Which of the following E. coli types is characterized by the presence
of heat-labile (LT) and heat-stable (ST) proteins?
o a. Enteroinvasive (EIEC)
o b. Enterotoxigenic (ETEC)
o c. Enterohemorrhagic (EHEC)
o d. Enteropathogenic (EPEC)
o e. Enterohemolytic (EHEEC)
78.
Your patient is a 20-year-old woman with severe diarrhea that
began yesterday. She has just returned from a 3 week trip to Peru,
where she ate some raw shellfish at the farewell party. She now has
watery diarrhea, perhaps 20 bowel movements a day, and is feeling
quite weak and dizzy. Her stool is guaiac-negative, a test that
determines whether there is blood in the stool. A Gram stain of the
stool reveals curved gram-negative rods. Of the following organisms,
which one is MOST likely to be the cause of her diarrhea?
o a. Bacteroidesfragilis
o b. Campylobacterjejuni
o c. Entamoeba histolytica
o d. Helicobacterpylori
o e. Shigella dysenteriae
o f. Vibrio cholerae
o g. Yersinia enterocolitica
79.
Several hours after dining on sweet and sour chicken and pork
fried rice at the home of an Asian friend, a 34-year-old car salesman
exhibits abdominal discomfort, nausea, and vomiting. In the middle
of the night he awakens with watery diarrhea. Which of the following
pairs of organisms is routinely responsible for food poisoning?
o a. Clostridium botulinum and Bacillus anthracis
o b. C. difficile and C. botulinum
o c. C. perfringens and Bacillus cereus
o d. C. tetani and B. anthracis
o e. Clostridium t. and B. cereus
80.
A 40-year-old female reports chronic gastritis. She tests positive
for H. pylori. After a course of the appropriate antibiotic therapy her
symptoms subside. Which of the following is the most effective
noninvasive test for the diagnosis of Helicobacter -associated gastric
ulcers?
o a. Culture of stomach contents for H. pylon
o b. Detection of H. pylori antigen in stool
o c. Growth of H. pylori from a stomach biopsy
o d. Growth of H. pylori in the stool
o e. IgM antibodies to H. pylori
81.
Although cholera, a Vibrio infection, has rarely been seen in the
USA , there have been recent outbreaks of classic cholera associated
with shellfish harvested from the Gulf of Mexico. Vibrios are shaped
like curved rods, and infections more common than cholera may be
caused by a variety of curved-rod bacteria. Which of the following
best describes C jejuni?
o a. Cause of gastroenteritis; reservoir in birds and mammals, optimal growth at
42 degree C
o b. Human pathogen, halophihc, lactose-negative, sucrose-negative; causes
gastrointestinal diseases primarily from ingestion of under-cooked seafood
o c. Human pathogen, halophilic, lactose-positive; produces heat-labile,toxin
o d. "String-test"positive isolate; three serotypesOgawa (AB), Inaba (AC)Hikojima
(ABC) Urease-positive; cause of fetal distress in cattle
82.
A box of ham sandwiches with mayonnaise, prepared by a
person with a boil on his neck, was left out of the refrigerator for the
on-call interns. Three doctors became violently ill approximately 2
hours after eating the sandwiches. Which of the following is the most
likely cause?
o a. C. perfringens toxin
83.
An 80-year-old man had a carcinoma of the colon removed 3
days ago. He was doing well until this morning, when he spiked a
fever to 39C and complained of severe abdominal pain. Examination
revealed a "boardlike" abdomen indicative of peritonitis. He was
taken to the operating room, where it was discovered that his
anastomosis had broken down and bowel contents had spilled into the
peritoneal cavity. A foul-smelling exudate was observed. A Gram
stain of the peritoneal exudate revealed many gram-negative rods.
Which one of the following sets of bacteria is the MOST likely cause
of this infection?
o a. Escherichia coli and Brucella melitensis
o b. Enterobacter cloacae and Salmonella enteritidis
o c. Fusobacterium nudeatum and Bacteroides fragilis
o d. Haemophilus influenzae and Actinomyces israelii
o e. Shigella dysenteriae and Serratia marcescens
84.
A patient with a burning epigastric pain was admitted to the
hospital, and a gastric biopsy was performed. The tissue was cultured
on chocolate agar incubated in a microaerophilic environment at
37C for 5-7 days. At 5 days of incubation, colonies appeared on the
plate and curved, gram-negative rods, oxidase-positive, were
observed. Which of the following is the most likely identity of this
organism?
o a. Campylobacterfetus,
o b. Campylobacterjejuni
o c. Haemophilus influenzae
o d. Helicobacter pylori
o e. Vibrio parahaemolyticus
85.
A patient was hospitalized after an automobile accident. The
wounds became infected, and the patient was treated with
tobramycin, carbenicillin, and clindamycin. Five days after antibiotic
therapy was initiated, the patient developed severe diarrhea and
pseudomembranous enterocolitis. Antibiotic-associated diarrhea and
the more serious pseudomembranous enterocolitis can be caused by
which of the following organisms?
o a. B.fragilis
o b. Clostridium difficile
o c. Clostridium perfringens
o d. Clostridium sordellii
o e. S. aureus
86.
An outbreak occurred in a community where the water supply
was contaminated. Multiple patients experienced nausea and
vomiting, as well as profuse diarrhea with abdominal cramps. Stools
were described as "rice water." Curved, gram-negative rods were
isolated on this sulfate-citrate-bile-sucrose agar. In the treatment of
patients who have cholera, the use of a drug that inhibits adenyl
cyclase would be expected to have which of the following
characteristics?
o a. Block the action of cholera toxin
o b. Eradicate the organism
o c. Increase fluid secretion
o d. Kill the patient immediately
87.
Two of three family members had dinner at a local restaurant
and, within 48 hours, experienced double vision, difficulty in
swallowing and speaking, and breathing problems. These symptoms
are consistent with which of the following?
o a. Activation of cyclic AMP
o b. Endotoxin shock
o c. Ingestion of a neurotoxin
o d. Invasion of the gut epithelium by an organism
o e. Secretion of an enterotoxin
88.
Testing of an isolate possesses the group D antigen, and is not
beta -lactamase-positive, but is resistant to vancomycin. Which of the
following is the most likely identification of this isolate?
o a. Enterococcus cassiflavus
o b. Enterococcus durans
o c. Enterococcus faecalis
o d. Enterococcus faecium
o e. S. pneumonia
89.
Which of the following is the treatment of choice for the isolate
in question 216?
o a. Ciprofloxacin
o b. Gentamicin
o c. Gentamicin and ampicillin
o d. Rifampin
o e. No available treatment
90.
A family routinely consumed unpasteurized milk, claiming
"better taste." Several members experienced a sudden onset of
crampy abdominal pain, fever, and bloody, profuse diarrhea. C. jejuni
was isolated and identified from all patients. Which of the following
is the treatment of choice for this type of enterocolitis?
o a. Ampicillin
o b. Campylobacter antitoxin
o c. Ciprofloxacin
o d. Erythromycin
o e. Pepto-Bismol
91.
V cholerae, the causative agent of cholera, is best described by
which of the following statements?
o a. Cause of gastroenteritis; reservoir in birds and mammals, optimal growth at 42
o b. Human pathogen, halophilic, lactose-negative, sucrose-negative; causes
gastrointestinal diseases primarily from ingestion of under-cooked seafood
o c. Human pathogen, halophilic, lactose-positive; produces heat-labile, extracellular
toxin
o d. "String-test"positive isolate; three erotypesOgawa (AB), Inaba
(AC),Hikojima (ABC)
o e. Urease-positive; cause of fetal distress in cattle
92.
A 20-year-old female in post-Katerina New Orleans eats poorly
cooked seafood (oysters, clams, and mollusks) for her birthday
dinner. Twenty-four hours later, she develops explosive watery
diarrhea and abdominal cramps. She is positive for V
parahaemolyticus. Which of the following statements best describes
this organism?
o a. Cause of gastroenteritis; reservoir in birds and mammals, optimal growth at 42 C
93.
Twenty-four hours after returning from a short trip to Asia, a 35year-old female has a sudden onset of vomiting and massive watery
diarrhea that is colorless, odorless, and contains flecks of mucus.
Which of the following mediums would most likely be used for
isolating V cholerae, the suspected organism?
o a. A Lofflers medium
o b. B Lowenstein-Johnson medium
o c. C Sheep blood agar
o d. D Thayer Martin
o e. E Thiosulfate citrate bile salts sucrose medium
94.
A 31-year-old school teacher returns from foreign travel and
experiences a sudden (1-2 days) onset of abdominal pain, fever, and
watery diarrhea, caused by a heat-labile exotoxin that affects both the
gut and the NS. This infection is caused by an etiologic agent
commonly acquired through which of the following routes?
o a. Gastrointestinal tract
o b. Genital tract
o c. Nasal tract
o d. Respiratory tract Skin
95.
An HIV-positive patient has progressed from fatigue, rash,
nausea, and night sweats symptoms to occasional but defined
opportunistic infections. I k inquires as to what can be done to predict
his chances of developing I) Diplomatic AIDS. Which of the
following tests would be most useful?
o a. CD4 lymphocyte count
o b. HIV antibody test
o c. HIV p24 antigen
o d. HIVRTPCR
o e. Neopterin
96.
A 9-year-old male presents with fever and nonspecific
symptoms followed by a distiinctive rash on the cheeks (slapped
cheek). Which of the following viruses is the most likely cause of this
disease and has been associated with transient aplastic crises in
persons with sickle cell disease? a. Herpes simplex
o a. Parvovirus B19
o b. Rubella
o c. Rubeola
o d. Varicella-zoster
97.
A 20-year-old female presents to her physician with a low-grade
fever, headache, and painful genital lesions. Culture detects herpes
simplex virus (HSV). Which of the following statements best
describes infection with this common human pathogen?
o a. Infection with type 1 virus is most common
o b. Initial infection usually occurs by intestinal absorption of the virus
o c. It can be reactivated by emotional disturbances or prolonged exposure to
sunlight
98.
An HIV-positive patient, prior to being treated with AZT, DDI,
and saquinavir, has a CD4 lymphocyte count and an HIV RNA viral
load test done. Results are as follows:CD4: 50 CD4 lymphocytes per
JJ.L HIV RNA: 100,000 copies per ml Which of the following
statements best describes this patient?
o a. This patient is no longer in danger of opportunistic infection
o b. The 5-year prognosis is excellent
o c. The patient's HIV screening test is most likely negative
o d. The patient is not infectious
o e. The viral load of 100,000 copies per milliliter suggests that the patient will respond
to triple therapy
99.
An HIV-positive patient with a viral load of 100,000 copies of
HIV RNA/milliliter and a total CD4 count of 50 is at increased risk
for a number of infectious diseases. For which of the following
diseases is the patient at no more added risk than an
immunocompetent host?
o a. Herpes simplex virus
o b. Kaposi sarcoma
o c. Mycobacterial disease
o d. Pneumococcal pneumonia
o e. Pneumocystic pneumonia
o b. Acyclovir
o c. Ribavirin
o d. Rimantadine
o e. Vidarabine
o d. Parvovirus
o e. Respiratory syncytial virus
108. A 5-year-old boy was sent home from kindergarten because his
left eye was red with a watery, nonpurulent discharge. Several of his
classmates recently had mild sore throat but no fever. Conjunctivitis
lasted 1 week with complete recovery. Which of the following
organisms was the most likely cause of his infection?
o a. Adenovirus
111. Within the first year of life, an infant exhibited severe hearing
loss, ocular abnormalities, and apparent mental retardation. Standard
peripheral blood smears demonstrated multinucleated cells with giant
123. Which of the following markers is usually the first viral marker
detected after hepatitis B infection?
o a. HBcAg
o b. HBeAg
o c. HBsAg
o d. HBeAb
o e. Anti-HBc
o e. Anti-HBc
o b. Astrovirus
o c. Hepatitis A virus
o d. Norwalk virus
o c. Rotavirus
133. Unlike other similar viruses, this agent appears to account for 515% of the gastroenteritis in young children. Which of the following
etiologic agents causes these infections and is difficult to isolate in
the diagnosticlaboratory?
o a. Adenovirus 40/41
o b. Astrovirus
o c. Hepatitis A virus
o d. Norwalk virus
o e. Rotavirus
weeks. Assuming that the etiological agent was HSV type 1, which of
the following statements is true?
o a. Antivirals do not provide any benefit
o b. The virus remains latent in the trigeminal ganglia
o c. Recurrence is likely to result in a generalized rash
o d. Polyclonal B cell activation is a prominent feature
o e. The child is at high risk for developing cancer later in life
140.
o B) Virions are the vessels that protect and deliver viral self replicating proteins from
permissive host cells to other permissive host cells.
o C) Virions are vessels that protect and deliver viral genomes from susceptible host
cells to other susceptible host cells.
o D) Virions are vessels that protect and deliver viral genomes from permissive
host cells to other permissive host cells.
o E) Virions are vessels that need to be processed by viral proteases in order to become
fully infectious viruses.
142.
153. Viral cell transformation can result from (1) the insertion of viral
oncogenes into host cell genomes, (2) the integration of proviruses
into host cell genomes near proto-oncogene regulatory sequences, (3)
the permanent activation by viruses of host cell signalling pathways,
and (4) the alteration of host cell cycling regulation by viruses.
Which viruses are responsible for cell transformation due to
integration of proviruses in the vicinity of proto-oncogenes
(nontransducing viruses)?
o A) Adenoviruses
o B) Hepadnaviruses (Hepatitis B Virus)
o C) Papillomaviruses
o D) Herpesviruses
o E) Retroviruses
155.
156.
158.
o d) B & C
160. A sixty-year old male was recovering from bowel resection. The
initial recovery period was unremarkable. Late on the third postoperative day the patient began hyperventilating with respiratory
alkalosis. On the fourth post-operative day, the patient's condition
rapidly worsened with a significant elevation of temperature (104.9
F), profound hypotension (65/38 mm Hg) and tachycardia. Urine
output was very low with BUN and serum creatinine (5 mg%, which
had increased from normal levels at admission) were elevated. . Gram
staining of sputum, which was purulent, indicated gram-negative
rods. WBC was 17000/mmseptic shock with a shift to the left. The
diagnosis was fulminant bacteremia and septic shock. What
mechanism is most likely responsible for this patient's tachycardia?
o a) Direct effects of bacterial endotoxins on the SA node
o b) Significant hypotension associated with low systemic vascular resistance.
o c) Bacterial endotoxins bind to muscarinic cholinergic receptors, thus removing the
dominating cholinergic tone in the heart.
o d) Patient anxiety
161.
172. If the patient had been scheduled for elective colonic surgery,
optimal prophylaxis against infection would be achieved by
mechanical bowel preparation and the use of
o (A) Intravenous cefotetan
o (B) Oral ampicillin
o (C) Oral neomycin and erythromycin
o (D) Intravenous third-generation cephalosporin
o (E) Oral fluoroquinolone
o (E) Rifampin