230 PART III Immunologic Manifestations of Infectious 10.

____ Streptokinase
Diseases 11. ____ Erythrogenic toxin
REVIEW QUESTIONS a. Degrades DNA
1. S. pyogenes is the most common causative agent of b. Also called spreading factor
all the c. Responsible for characteristic scarlet fever rash
following disorders and complications except: d. Dissolves clots by converting plasminogen to plasmin
a. Pharyngitis 12. All the following characteristics of S. pyogenes are
b. Gastroenteritis correct
c. Scarlet fever except:
d. Impetigo a. It is an uncommon pathogen.
2. All the following characteristics are descriptive of M b. It occurs most frequently in school-age children.
protein except: c. It is spread by contact with large droplets produced
a. No known biological role in the upper respiratory tract.
b. Found in association with the hyaluronic capsule d. It has been known to cause foodborne and
c. Inhibits phagocytosis milkborne epidemics.
d. Antibody against M protein provides type-specific 13. The clinical manifestations of S. pyogenes–
immunity associated
3. Substances produced by S. pyogenes include all the upper respiratory infection are:
following except: a. Mild and usually unnoticeable
a. Hyaluronidase b. Age dependent
b. DNAses (A, B, C, D) c. Associated with cold sores
c. Erythrogenic toxin d. Difficult to detect
d. Interferon 14. The most reliable immunologic test for recent S.
4. Laboratory diagnosis of S. pyogenes can be made by pyogenes
all the skin infection is:
following except: a. ASO
a. Culturing of throat or nasal specimens b. Anti–DNAse B
b. Febrile agglutinins c. Anti-NADase
c. ASO procedure d. Antibody to erythrogenic toxin
d. Anti–DNase B 15-17. Match each ASO titer situation to the appropriate
5. False ASO results may be caused by all the following description. (An answer may be used twice.)
except: 15. ____ Rising titer
a. Room temperature reagents and specimens at the 16. ____ Declining titer
time of testing 17. ____ Constant (low) titer
b. The presence of beta-lipoprotein a. Increase in severity of infection
c. Bacterial contamination of the serum specimen b. Not a current infection, but indicates a past infection
d. Oxidation of ASO reagent caused by shaking or c. Trend toward recovery
aeration of the reagent vial d. No clinical significance
6. Members of the S. pyogenes species are almost 18. If a streptococcal infection is suspected, but the ASO
always titer does not exceed the reference range, a(n)
_____ hemolytic. _________________ should be performed.
a. Alphab. a. Repeat titer
Betac. b. Anti–DNAse B test
gammad. c. Anti-NADase test
Alpha- or beta- d. Throat culture
7. Long-term complications of S. pyogenes infection can 19. The classic tests to demonstrate the presence of
include: streptococcal
a. Acute rheumatic fever infection are:
b. Poststreptococcal glomerulonephritis a. ASO and anti-NADase
c. Rheumatoid arthritis b. ASO and anti–DNAse B
d. Both a and b c. Anti-NADase and anti-DNAse
8. Particularly virulent serotypes of S. pyogenes produce d. Both a and b
proteolytic enzymes that cause __________________ in
a wound or lesion on an extremity. 20. The highest reported levels of sensitivity testing for
a. Necrotizing fasciitis group
b. Bone degeneration A streptococci are in:
c. Burning and itching a. ASO titers
d. Severe inflammation b. Direct latex agglutination tests
9-11. Match the substances produced by group A c. Surface (optical) immunoassay
streptococci d. Both a and b, which are equivalent
with the appropriate description.
9. ____ Hyaluronidase
1-4. Match the Treponema-associated diseases (a-d) with consistency in artificial laboratory media.
with the a. Are
respective causative organism. b. Are not
1. ____ T. pallidum 18. In infected blood, T. pallidum does not appear to
2. ____ T. pallidum (variant) survive
3. ____ T. pertenue at 4° C (39 ° F) for longer than:
4. ____ T. carateum a. 1 day
a. Yaws b. 2 days
b. Syphilis c. 3 days
c. Pinta d. 5 days
d. Bejel 19. The primary incubation period for syphilis (T.
5-8. Match the following stages of syphilis with the pallidum)
appropriate is usually about:
signs and symptoms. a. 1 week
5. ____ Primary syphilis b. 2 weeks
6. ____ Secondary syphilis c. 3 weeks
7. ____ Latent syphilis d. 4 weeks
8. ____ Late (tertiary) syphilis 20. The stage of syphilis that can be diagnosed only by
a. Diagnosis only by serologic methods serologic (laboratory) methods is the:
b. Presence of gummas a. Incubation phase
c. Development of a chancre b. Primary phase
d. Hutchinsonian triad c. Secondary phase
e. Generalized illness followed by macular lesions in d. Latent phase
most patients 21. Immunocompetent patients infected with T. pallidum
9. Which of the following is a term for nontreponemal produce:
antibodies produced by an infected patient against a. Specific antibodies against T. pallidum
components of their own or other mammalian cells? b. Nonspecific antibodies against the protein antigen
a. Autoagglutinins group common to pathogenic spirochetes
b. Reagin antibodies c. Reagin antibodies
c. Alloantibodies d. All of the above
d. Nonsyphilis antibodies
10-12. Match the following: 1. Common vectors of Lyme disease include all the
10. ____ FTA-ABS test following except:
11. ____ TP-PA test a. I. pacificus
12. ____ RPR test b. I. scapularis
a. Treponemal method c. I. ricinus
b. Nontreponemal method d. D. variabilis
13. In the RPR procedure, a false-positive reaction can 2. The only continent without Lyme disease is:
result a. Asia
from all the following except: b. Europe
a. Infectious mononucleosis c. Africa
b. Leprosy d. Antarctica
c. Rheumatoid arthritis 3. The primary reservoir in nature for B. burgdorferi is
d. Streptococcal pharyngitis the:
14. The first diagnostic blood test for syphilis was the: a. White-tailed deer
a. VDRL b. White-footed mouse
b. Wassermann c. Lizard
c. RPR d. Meadowlark
d. Colloidal gold 4. The first B. burgdorferi antigen to elicit an antibody
15. Syphilis was initially treated with: response is:
a. Fuller’s earth a. Outer surface protein A
b. Heavy metals (e.g., arsenic) b. Outer surface protein B
c. Sulfonamides (e.g., triple sulfa) c. Flagellar 41-kDa polypeptide
d. Antibiotics (e.g., penicillin) d. 60-kDa polypeptide
16. Direct examination of the treponemes is most often 5. On average, the incidence of infection following an
performed by: I. scapularis tick bite in an endemic area is:
a. Light microscopy a. 1%
b. Darkfield microscopy b. 3%
c. VDRL testing c. 5%
d. RPR testing d. 10%
17. Pathogenic treponemes _______________ 6. Erythema migrans:
cultivatable a. Occurs in all patients
b. Harbors B. burgdorferi in the advancing edge question 16:
c. Is easily distinguished from other erythemas Possible answers for
d. Is more common in the winter months question 17:
7. The predominant symptoms of Lyme meningitis are: a. 3 days a. Neurologic
a. Severe headache and mild neck stiffness b. 1 week b. Rheumatoid
b. Aseptic meningitis and double vision c. 4 weeks
c. Cranial nerve palsies and blurred vision d. 3 months
d. Peripheral radiculoneuritis and peripheral c. Cutaneous
neuropathy (e.g., erythema
8. Cardiac involvement in Lyme disease may include: migrans)
a. Murmurs d. Cardiac
b. Conduction abnormalities Possible answers for
c. Congestive heart failure question 18:
d. Vasculitis Possible answers for
9. Ocular involvement in Lyme disease includes all the question 19:
following except: a. Hours to weeks a. Arthritis
a. Cranial nerve palsies b. Days to weeks b. Lyme carditis
b. Conjunctivitis c. Weeks to months
c. Panophthalmitis with loss of vision d. Weeks to years
d. Choroiditis with retinal detachment c. Transplacental
transmission
10. Pregnancy in Lyme disease: d. Lymphocytoma
a. Does not result in high fetal mortality 16-19. Fill in the blanks: Clinical features of Lyme
b. Has been associated with transplacental disease
infection Stage Length of Time
c. Should be terminated because of maternal risk Common Signs and
d. Is not associated with congenital abnormalities Symptoms
11. The most useful test for distinguishing between I 16. ________ (median) 17. ________ manifestation
truepositive after infection
and false-positive serologic test results is: II Follows a variable
a. Enzyme-linked immunosorbent assay latent period
b. Immunofluorescence assay Target organs and
c. Polymerase chain reaction systems can manifest
d. T cell assay abnormalities.
12. Preventive methods include all the following except: III 18. ________ after
a. Wearing light-colored clothes infection
b. Tucking pants into socks 19. _______, late neurologic
c. Applying insect repellent to skin and clothes complications
d. All of the above 20. Unlike some procedures, the polymerase chain
13. Lyme disease, the most common tickborne disease reaction
in the (PCR) assay can be used to detect Lyme disease–
United States, is a major health hazard for: causing
a. Dogs organisms in:
b. Horses and cattle a. Urine
c. Humans b. Cerebrospinal fluid
d. All of the above c. Synovial fluid
14. Lyme disease is a ________ type of infection. d. Blood
a. Bacterial 21 and 22. Fill in the blanks, choosing from the possible
b. Parasitic answers (a-d).
c. Viral Antigen detection systems in Lyme disease testing
d. Fungal screen
15. The first Native American case of what would later for _______ (21) rather than for _______ (22)
be associated
called Lyme disease occurred in: with the infection.
a. Connecticut a. Antibody
b. Wisconsin b. Microorganisms
c. Florida c. Antigenic products
d. New York d. An infected tick
16-19. Fill in the blanks in the chart below, choosing 23. A patient who has a specific Lyme disease–
from associated
the following answers. manifestation may be treated with:
Possible answers for a. Vaccination
b. Interferon 7. Which of the following stages of infectious
c. Antibiotic mononucleosis
d. Analgesic infection is (are) characterized by heterophile antibody?
24. Ehrlichia spp. belong to the same family as the a. Recent (acute) infection
organism b. Past infection (convalescent) period
that causes: c. Reactivation of latent infection
a. Lyme disease d. Both a and c
b. Rocky Mountain spotted fever 8. What percentage of the world’s population is exposed
c. Toxoplasmosis to
d. Infectious mononucleosis EBV?
25. One of the most common physical findings in adults a. 25%
with b. 50%
ehrlichiosis is: c. 75%
a. Hives d. 95%
b. Fever 9. Infectious mononucleosis postperfusion syndrome is a
c. Erythema migrans primary infection resulting from a blood transfusion from
d. Nausea a(n) _______ to a(n) _______ recipient.
26. Definitive diagnosis of ehrlichiosis requires: a. Immune; nonimmune
a. A complete blood count b. Nonimmune; immune
b. Detection of the presence of lymphocytopenia c. Infected; nonimmune
c. Acute and convalescent serum antibody titers d. Infected; immune
d. Direct microscopic observation of inclusions in 10. In infectious mononucleosis, there is no:
leukocytes a. Acute state
b. Latent state
REVIEW QUESTIONS c. Carrier state
1. The Epstein-Barr virus can cause all the following d. Reactivation
except: 11. The incubation period of infectious mononucleosis is:
a. Infectious mononucleosis a. 2 to 4 days
b. Burkitt’s lymphoma b. 10 to 15 days
c. Nasopharyngeal carcinoma c. 10 to 50 days
d. Neoplasms of the bone marrow d. 51 to 90 days
2. The primary mode of EBV transmission is: 12. The use of horse erythrocytes in rapid slide tests for
a. Exposure to blood infectious mononucleosis increases their:
b. Exposure to oral-pharyngeal secretions a. Cost
c. Congenital transmission b. Sensitivity
d. Fecal contamination of drinking water c. Specificity
3. Infants infected with EBV are more likely to d. Both b and c
experience
symptomatic infection than EBV-infected adolescents. 13. EBV-infected B lymphocytes express all the following
a. True new antigens except:
b. False a. Viral capsid antigen VCA
4. IgM heterophile antibody is characterized by all the b. Early antigen EA
following features except: c. Cytoplasmic antigen (CA)
a. Reacts with horse, ox, and sheep RBCs d. Nuclear antigen NA
b. Absorbed by beef erythrocytes 14. Anti-EBNA IgG does not appear until a patient has
c. Absorbed by guinea pig kidney cells entered the:
d. Does not react with EBV-specific antigens a. Initial phase of infection
5. Characteristics of EBV-infected lymphocytes include b. Primary infection phase
all c. Convalescent period
the following except: d. Reactivation of infectious stage
a. B type 15-17. Match each procedure to the appropriate
b. Expression of viral capsid antigen description.
c. Expression of early antigen 15. ______ Paul-Bunnell screening test
d. Expression of EBV genome 16. ______ Davidsohn differential test
6. Which of the following stages of infectious 17. ______ MonoSlide agglutination test
mononucleosis a. Distinguishes between heterophile antibodies; uses
infection is characterized by antibody to Epstein-Barr beef erythrocytes, guinea pig kidney cells, and sheep
nuclear antigen (EBNA)? erythrocytes
a. Recent (acute) infection b. Detects heterophile antibodies and uses horse
b. Past infection (convalescent) period erythrocytes
c. Reactivation of latent infection c. Detects heterophile antibodies and uses sheep
d. Both b and c erythrocytes