Bacterial diseases

MCQs

101
1. Which of the following is characteristic of a lesion of cutaneous anthrax?

A. Pain.

B. Pustules.
C. Edema.

D. Pseudovesiculation.
E. Sporotrichoid spread.

The CORRECT answer is C

Cutaneous anthrax is most common after inoculation into the skin. The bacillus has an
edema toxin, which causes a characteristic gelatinous edema at the site of the local
lesion and a lethal toxin, which causes shock and death in disseminated disease.
Following a one- to three-day incubation period, patients develop fever, malaise, and a
painless papule at the site of inoculation. The lesion enlarges ("malignant pustule") and
develops into a vesicle with surrounding gelatinous edema. The vesicle then becomes
hemorrhagic with eschar formation. Regional lymph nodes may be enlarged.
Ciprofloxacin is the treatment of choice.

2. Scrub typhus is caused by which of the following organisms?

A. Rickettsia burnetti.

B. Rickettsia tsutsugamushi.

C. Rickettsia quintana.
D. Rickettsia conorii.
E. Rickettsia prowazekii.

The CORRECT answer is B

Scrub typhus is caused by Rickettsia tsutsugamushi, transmitted by the chigger (red mite
or Leptotrombidium). Patients present with a black eschar at the site of the chigger bite
with fever, chills, headache, and a truncal eruption. Pneumonitis has also been
associated with the disease.
3. The etiologic agent of glanders is which of the following?

A. Treponema pallidum.

B. Burkholderia mallei.
C. Borrelia recurrentis.

D. Prototheca wickerhamii.
E. Yersinia pestis.

The CORRECT answer is B

Burkholderia (Pseudomonas) mallei is the etiologic agent of glanders.

Normally a disease of horses (farcy), it manifests in two forms in humans.
The first is an acute febrile disseminated disease. The other is an indolent,
chronic condition with cutaneous and subcutaneous abscesses with sinus
formation.

4. In utero infection with which of the following organisms can cause

widespread granulomas, hepatosplenomegaly, and failure to thrive in
neonates?

A. Leptospira interrogans.
B. Pasturella multocida.
C. Corynebacterium diphtheriae.

D. Listeria monocytogenes.

E. Group B streptococcus.

. The CORRECT answer is D

Early-onset neonatal listeriosis ("granulomatosis infantiseptica") develops in

utero and is characterized by widespread granulomas in the placenta, skin,
liver, spleen, lung, and other tissues. Meconium staining of the skin,
hepatosplenomegaly, and failure to thrive are common. Late-onset neonatal
listeriosis occurs several weeks after birth, presumably from postpartum
acquisition. Meningitis is characteristic.
 6. Distal blistering dactylitis is associated with which causative organism?

A. Pseudomonas.

B. Staphylococcus..
C. Pityrosporum.
D. Streptococcus.

E. Candida albicans.

The CORRECT answer is D

Distal blistering dactylitis is most often associated with streptococcus

pyogenes infection and presents as a painful bullous cellulitis on a distal
finger or toe.

7. The treatment of choice for erythema nodosum leprosum is which of the following?

A. Thalidomide.
B. Prednisone.

C. Dapsone.

D. Cyclosporine.
E. Cyclophosphamide.

You CORRECTLY answered A

Erythema nodosum leprosum occurs most commonly in lepromatous leprosy either before,
during, or after therapy. The reaction is characterized by fever, anorexia, malaise, and crops
of tender, bright pink nodules arising in clinically normal skin. Involvement of both upper and
lower extremities is the rule, and facial lesions occur in 50%. The treatment of choice is
thalidomide.

8. Erythema nodosum is most commonly associated with which infection?

A. Tuberculosis.

B. Histoplasmosis.
C. Alpha-hemolytic streptococcus.

D. Beta-hemolytic streptococcus.

E. Salmonella.

The CORRECT answer is D

The most common cause of erythema nodosum in the United States in a preceding
streptococcal infection, particularly in children. Other infectious causative agents include
tuberculosis, syphilis, deep fungal infections, mycoplasma, Chlamydia, yersinia, Neisseria,
and Pseudomonas.
9. Corynebacterium species cause all of the following disorders EXCEPT:

A. Trichomycosis axillaris.

B. Piedra.
C. Pitted keratolysis.

D. Trichomycosis pubis.
E. Erythrasma.

You CORRECTLY answered B

Trichomycosis axillaris and pubis are most commonly caused by Corynebacterium tenuis,
erythrasma by C. minutissimum, and pitted keratolysis by C. sedentarius. White piedra is
caused by Trichosporon beigelii and black piedra is caused by Piedraia hortae.

10. Which of the following disorders is characterized by painful genital ulcers?

A. Chlamydia trachomatis.
B. Neisseria gonorrhoeae.

C. Calymmatobacterium granulomatis.

D. Haemophilus ducreyi.
E. Treponema pallidum.

The CORRECT answer is D

Haemophilus ducreyi is a gram-negative bacillus that causes painful ulcerations on the

anogenital region of infected individuals. The ulcers are often friable and malodorous with a
ragged border. A smear of the ulcer base characteristically reveals bacilli in a "school of fish"
pattern. Two weeks after the primary chancroid appears, painful, purulent inguinal
lymphadenopathy develops. Treatment includes a single dose of intramuscular ceftriaxone or
a week of oral erythromycin.

11. The house mouse mite (Allodermanyssus sanguineus) is a vector for which disease?

A. Endemic typhus.

B. Rickettsialpox.

C. Scrub typhus.
D. Boutonneuse fever.
E. Trench fever.

The CORRECT answer is B

Allodermanyssus sanguineus is the mite of the house mouse (mus musculus). It carries the
bacterium Rickettsia akari, which causes rickettsialpox and Russian vesicular rickettsiosis.
12. Bartonella quintana is the etiologic agent of which infectious disease?

A. Relapsing fever.

B. Mediterranean fever.
C. Epidemic typhus.

D. Trench fever.
E. Scrub typhus.

. The CORRECT answer is D

Bartonella organisms are aerobic, gram-negative bacteria of the Rickettsiaceae family.

Bartonella quintana causes bacillary angiomatosus, peliosis, trench fever, and cat scratch
disease. It has also been associated with endocarditis. In the case of trench fever the
arthropod vector is the human body louse Pediculus humanus corporis and is spread by
humans living closely in unsanitary conditions.

13. Which organism is most commonly associated with botryomycosis?

A. Staphylococcus.

B. Streptococcus.
C. Pseudomonas.

D. Klebsiella.

E. Proteus.

You CORRECTLY answered A

Botryomycosis is a granulomatous bacterial infection most commonly caused by

Staphylococcus aureus. Other causative organisms include Streptococcus, Proteus, E. coli,
and Pseudomonas. Lesions typically occur as nodules, ulcers or draining sinuses on the
extremities.

14. Malakoplakia is most often caused by which of the following organisms?

A. Staphylococcus species.

B. Streptococcus species.

C. Corynebacterium species.
D. Proteus species.
E. Klebsiella species.

The CORRECT answer is A

Malakoplakia is most commonly found in the urinary and gastrointestinal tract. Lesions are the
result of defective macrophage phagocytosis of bacteria, most commonly S. aureus and E.
coli. The characteristic histologic finding is the Michaelis-Gutmann bodies, which are thought
to be phagolysosomes within histiocytes.
15. The treatment of choice for bacillary angiomatosis is which of the following?

A. Penicillin.

B. Gentamycin.
C. Clarithromycin.

D. Vancomycin.
E. Erythromycin.

You CORRECTLY answered E

Bacillary angiomatosis is caused by Bartonella henselae, the agent of cat scratch disease.
Clinically the condition is associated with widespread pyogenic granuloma-like lesions with or
without involvement of the lymphoreticular system. The treatment of choice is erythromycin
250 to 500 mg QID for 4 weeks.

16. Bacterial overgrowth largely contributes to which oral condition?

A. Smooth tongue.
B. Black hairy tongue.
C. Geographic tongue.
D. Fissured tongue.

E. Scrotal tongue.

You CORRECTLY answered B

Bacterial overgrowth is associated with black hairy tongue. The filiform papillae become
hypertrophied and discoloration results from both the bacteria themselves and environmental
influences such as smoking, coffee or tea. Brushing the tongue and use of a tongue scraper
will improve the condition.
17. Weil disease is associated with which bacterial infection?

A. Vibrio parahaemolyticus.
B. Corynebacterium diphtheriae.
C. Francisella tularensis.

D. Pasturella multocida.

E. Leptospira interrogans.

The CORRECT answer is E

Leptospirosis is caused by the spirochete Leptospira interrogans. Infection typically has a

biphasic course. The initial leptospiremic phase is characterized by nonspecific fever,
headache, chills, nausea, vomiting, abdominal pain. and myalgias. Less than half of patients
will have skin lesions. The immune phase begins after about a week with low-grade fever,
meningitis, uveitis, and a macular skin eruption. Weil disease is due to the serovariant
icterohaemorrhagiae and has prominent hepatic and renal involvement. Pretibial (Fort Bragg)
fever is due to the serovariant autumnalis and has a distinctive pretibial eruption occurring on
the fourth or fifth day of illness.

18. Which species of Mycobacterium causes most cases of skin infection in the United
States?

A. Tuberculosis.

B. Chelonae.

C. Fortuitum.
D. Avium intracellulare.

E. Marinum.

The CORRECT answer is E

Mycobacterium marinum is responsible for most cases of cutaneous mycobacterial infection

in the United States and has been associated with pools and fish tanks. Mycobacterium
fortuitum is the most common cause of postsurgical wound infection, particularly in sternal
wounds after cardiac surgery. Mycobacterium avium cellulare is associated with pulmonary
and bone infection in the immunocompromised population.
19. The drug of choice for the treatment of erythema nodosum leprosum is which of the
following?

A. Prednisone.

B. Hydroxychloroquine.
C. Cyclosporine.

D. Dapsone.
E. Thalidomide.

You CORRECTLY answered E

Erythema nodosum leprosum is a type 2 reaction seen in Hansen disease and characterized
by tender, bright pink dermal and subcutaneous nodules arising in clinically normal skin.
Patients may have accompanying fever, arthralgias, and malaise. The drug of choice is
thalidomide, but systemic prednisone may also be used.

20. "Hot tub" folliculitis is most closely associated with which causative organism?

A. Pseudomonas.
B. Staphylococcus.

C. Pityrosporum.
D. Streptococcus.
E. Candida albicans.

The CORRECT answer is A

Hot tub folliculitis is most commonly associated with Pseudomonas aeruginosa infection. It
presents 24 to 48 hours after whirlpool or hot tub use as perifollicular papules in a bathing suit
distribution.

21. Which rickettsial bacterium is not transmitted by a vector?

A. Rickettsia burnetti.

B. Rickettsia tsutsugamushi.
C. Rickettsia quintana.

D. Rickettsia conorii.
E. Rickettsia prowazekii.

The CORRECT answer is A

Rickettsia burnetti is the causative agent of Q fever. There is no vector involved as the
disease is transmitted primarily by the inhalation of tick feces.
22. Cultures of ecthyma gangrenosum most commonly grow which of the following:

A. Pseudomonas.

B. Staphylococcus.
C. Pityrosporum.

D. Streptococcus.
E. Candida albicans.

The CORRECT answer is A

Ecthyma gangrenosum appears as a vesicle or necrotic ulcer, often with a central eschar in
patients with septicemia. The most common causative organism is Pseudomonas aeruginosa.

23. The most appropriate antibiotic therapy for lymphogranuloma venereum is which of the
following?

A. Doxycycline.
B. Amoxicillin.

C. Penicillin G.

D. Ceftriaxone.
E. Ciprofloxacin.

You CORRECTLY answered A

Lymphogranuloma venereum is caused by Chlamydia trachomatis and results in painful

inguinal lymphadenitis or proctocolitis. The treatment of choice is doxycycline 100 mg PO bid
for 3 weeks.

24. Early congenital syphilis may include which of the following?

A. Pseudoparalysis of Parrot.
B. Higoumenaki sign.
C. Generalized paresis.

D. Clutton joints.
E. Saber shins.

The CORRECT answer is A

Early congenital syphilis manifests in children less than two years old. Symptoms may include
low birthweight, hepatosplenomegaly, thrombocytopenia, bullae, rhinitis/snuffles, rhagades,
encephalitis, generalized rash, condyloma lata, and osteochondritis (pseudoparalysis of
Parrot). Late congenital syphilis may be characterized by Hutchinson triad (keratitis, eighth
nerve hearing loss, Hutchinson teeth), osteitis, Higoumenaki sign (unilateral hyperostosis of
the inner third of the clavicle), tabes dorsalis, generalized paresis, mulberry molars, saddle
nose, saber shins,
gummas, Clutton joints (painless perisynovitis of the knees), and paroxysmal cold
hemoglobinuria
25. A butcher develops a tender, purple-red plaque on his right hand. The most likely
causative organism is which of the following?

A. Erysipelothrix rhusiopathiae

B. Mycobacterium marinum.
C. Bacillus anthracis

D. Pseudomonas mallei.
E. Yersinia pestis.

You CORRECTLY answered A

Erysipeloid is an acute cellulitis caused by the organism Erysipelothrix rhusiopathiae. It

occurs most commonly on the hands from inoculation in persons exposed to raw animal
products such as fishermen, butchers, and bone button makers. Associated findings include
regional lymphadenopathy and lymphangitis. Penicillin is the treatment of choice

26. The first serologic test to become positive in syphilis infection is which of the following?

A. VDRL.

B. RPR.
C. FTA-ABS.

D. MHA-TP.

E. TPPA.

The CORRECT answer is C

Serologic tests for syphilis can be divided into treponemal and nontreponemal serologies.
Treponemal serologies include FTA-ABS, MHA-TP, and TPPA. These are positive or
negative and do not have a titer. They detect actual antibodies to T. pallidum and cannot
distinguish active from past infection. FTA-ABS is the first to be positive at 3 weeks after
infection. Nontreponemal serologies include VDRL and RPR. These have a "titer" and are
positive at approximately 4 weeks. They detect antibodies to cardiolipin, which forms
aggregates with T. pallidum and can be used to monitor successful therapy.
27. A fisherman from the Gulf of Mexico develops large hemorrhagic bullae on the lower legs.
What is the most likely causative organism?

A. Streptococcus iniae.

B. Group A streptococcus.
C. Staphylococcus aureus.

D. Vibrio vulnificus.
E. Aeromonas hydrophilia.

You CORRECTLY answered D

Vibrio species are endemic to the Gulf of Mexico, and to a lesser extent the Atlantic and
Pacific coasts. Vibrio vulnificus produces collagenolytic, proteolytic, and elastolytic enzymes.
Infection typically follows trauma or exposure of broken down skin to seawater. Local infection
reveals pustules, lymphangitis, and cellulitis. Extensive necrosis and gangrene may also
occur. Septicemia causes large hemorrhagic bullae on the extremities or trunk.

28. A sushi chef develops fever, lymphangitis, and a tender red plaque on the hand after
preparing tilapia. What is the most likely causative organism?

A. Streptococcus iniae.

B. Group A streptococcus.
C. Staphylococcus aureus.

D. Streptobacillus moniliformis.
E. Aeromonas hydrophilia.

The CORRECT answer is A

Streptococcus iniae colonizes fresh aquacultured fish, particularly tilapia (the Hawaiian
sunfish). It is reported to cause a cellulitis in Asian cuisine workers, particularly sushi chefs.
Bacteremia, lymphangitis, septic arthritis, meningitis, or endocarditis may also occur.
29. Which anatomic area is most commonly affected by actinomycosis?

A. Lower extremities.

B. Peritoneum.
C. Cervicofacial region.

D. Trunk.
E. Dorsal hands.

You CORRECTLY answered C

Actinomycosis is an anaerobic infection caused by Actinomyces or Propionibacterium

species. Infection is characterized by purulent draining sinuses with "sulfur granules."
Cervicofacial infection is the most common presentation, occurring as a painful, indurated soft
tissue mass often at the angle of the jaw ("lumpy jaw"). Infection may also involve the lung,
gastrointestinal or genitourinary tracts.

30. Which of the following forms of mycobacterial infection is characterized by inoculation of

the organism into a previously sensitized individual?

A. Tuberculous chancre.
B. Scrofuloderma.
C. Miliary tuberculosis.
D. Lupus vulgaris.

E. Tuberculosis verrucosa cutis.

The CORRECT answer is E

Tuberculosis verrucosa cutis appears as a warty plaque at the site of inoculation in a patient
who already has a strong immunity to Mycobacterium tuberculosis. Lesions typically occur on
the hands or lower extremities
31. Mickulicz cells are characteristic of what infection?

A. Glanders.

B. Erysipeloid.
C. Erlichiosis.

D. Rhinoscleroma.
E. Granuloma inguinale.

. The CORRECT answer is D

Rhinoscleroma is a bacterial infection caused by Klebsiella rhinoscleromatis. It frequently

involves the nasal mucosa causing rhinitis, granulomatous masses, and fibrosis. Histology is
characterized by Mikulicz cells (vacuolated histiocytes), plasma cells, and abundant bacterial
forms. Ciprofloxacin is the treatment of choice.