TEST BANK For Textbook of Diagnostic Microbiology, 7th Edition by Connie R. Mahon, Verified Chapters 1 - 41, Complete Newest Version

Test Bank For Textbook Of Diagnostic Microbiology
7th Edition By Connie R. Mahon

Chapters 1 - 41
Mahon: Textbook of Diagnostic Microbiology, 7th Edition Test Bank
Table of contents
Part 1: Introduction to Clinical Microbiology
Chapter 1. Bacterial Cell Structure, Physiology, Metabolism, and Genetics
Chapter 2. Host-Parasite Interaction
Chapter 3. The Laboratory Role in Infection Control
Chapter 4. Control of Microorganisms: Disinfection, Sterilization, and Microbiology Safety
Chapter 5. Performance Improvement in the Microbiology Laboratory
Chapter 6. Specimen Collection and Processing
Chapter 7. Microscopic Examination of Materials from Infected Sites
Chapter 8. Use of Colony Morphology for the Presumptive Identification of Microorganisms
Chapter 9. Biochemical Identification of Gram-Negative Bacteria
Chapter 10. Immunodiagnosis of Infectious Diseases
Chapter 11. Applications of Molecular Diagnostics
Chapter 12. Antibacterial Mechanisms of Action and Bacterial Resistance Mechanisms
Chapter 13. Antimicrobial Susceptibility Testing
Part 2: Laboratory Identification of Significant Isolates
Chapter 14. Staphylococci
Chapter 15. Streptococcus, Enterococcus, and Other Catalase-Negative, Gram-Positive Cocci
Chapter 16. Aerobic Gram-Positive Bacilli
Chapter 17. Neisseria Species and Moraxella catarrhalis
Chapter 18. Haemophilus, HACEK, Legionella and Other Fastidious Gram-Negative Bacilli
Chapter 19. Enterobacteriaceae
Chapter 20. Vibrio, Aeromonas, and Campylobacter Species
Chapter 21. Nonfermenting and Miscellaneous Gram-Negative Bacilli
Chapter 22. Anaerobes of Clinical Importance
Chapter 23. The Spirochetes
Chapter 24. Chlamydia, Rickettsia, and Similar Organisms
Chapter 25. Mycoplasma and Ureaplasma
Chapter 26. Mycobacterium tuberculosis and Nontuberculous Mycobacteria
Chapter 27. Medically Significant Fungi
Chapter 28. Diagnostic Parasitology
Chapter 29. Clinical Virology
Chapter 30. Agents of Bioterror and Forensic Microbiology
Chapter 31. Biofilms: Architects of Disease
Part 3: Laboratory Diagnosis of Infectious Diseases: and Organ System Approach to Diagnostic
Microbiology
Chapter 32. Upper and Lower Respiratory Tract Infections
Chapter 33. Skin and Soft Tissue Infections
Chapter 34. Gastrointestinal Infections and Food Poisoning
Chapter 35. Infections of the Central Nervous System
Chapter 36. Bacteremia and Sepsis
Chapter 37. Urinary Tract Infections
Chapter 38. Genital Infections and Sexually Transmitted Infections
Chapter 39. Infections in Special Populations
Chapter 40. Zoonotic Diseases
Chapter 41. Ocular Infections
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Chapter 01: Bacterial Cell Structure, Physiology, Metabolism, and Genetics Mahon:
Textbook of Diagnostic Microbiology, 7th Edition Test Bank
MULTIPLE CHOICE
1. To survive, microbial inhabitants have learned to adapt by varying all of the following, except
a. growth rate.
b. growth in all atmospheric conditions.
c. growth at particular temperatures.
d. bacterial shape.
ANSWER: D
The chapter begins by discussing the way microbial inhabitants have had to evolve to survive in
many different niches and habitats. It discusses slow growers, rapid growers, and replication
with scarce or abundant nutrients, under different atmospheric conditions, temperature
requirements, and cell structure. Bacterial shape as a form of evolution is not discussed.
OBJ: Level 2: Interpretation
2. Who was considered the father of protozoology and bacteriology?

a. Anton van Leeuwenhoek
b. Louis Pasteur
c. Carl Landsteiner
d. Michael Douglas
ANSWER: A
The book discusses Anton van Leeuwenhoek as the inventor of the microscope and the first
person to see the “beasties.” So they dubbed him the father of protozoology and bacteriology.
The other three individuals were not discussed.
OBJ: Level 1: Recall
3. Prokaryotic cells have which of the following structures in their cytoplasm?

a. Golgi apparatus
b. Ribosomes
c. Mitochondria
d. Endoplasmic reticulum
ANSWER: B
All the structures listed are found in eukaryotic cells, but ribosomes are the only ones that
apply to prokaryotic cells.
4. This form of DNA is commonly found in eukaryotic cells.

a. Linear
b. Circular
c. Plasmid
d. Colloid
.
.
ANSWER: A
Circular and plasmid DNA are usually found only in bacteria, not eukaryotic cells. Colloid is a
property of protein molecules and is not associated with nucleotides.
5. The nuclear membrane in prokaryotes is

a. missing.
b. impenetrable.
c. a classic membrane.
d. a lipid bilayer membrane.
ANSWER: A
Prokaryotic cells do not have any membrane-bound structures in the cytoplasm including a
structured nucleus.
6. A microorganism that is a unicellular organism and lacks a nuclear membrane and true
nucleus belongs to which classification?
a. Fungi
b. Bacteria
c. Algae
d. Parasite
ANSWER: B
Fungi, algae, and parasites are unicellular eukaryotic organisms that contain a true nucleus.
Bacteria are prokaryotic and do not contain a true nucleus or nuclear membrane.
7. In the laboratory, the clinical microbiologist is responsible for all the following, except
a. isolating microorganisms.
b. selecting treatment for patients.
c. identifying microorganisms.
d. analyzing bacteria that cause disease.
ANSWER: B
Clinical microbiologists do not select the treatment for patients. They provide the doctor with
the name of the organism and the antibiotics that can kill the bacteria, but not in the final
selection of treatment protocols.
8. What enables the microbiologist to select the correct media for primary culture and optimize
the chance of isolating a pathogenic organism?
a. Determining staining characteristics
b. Understanding the cell structure and biochemical pathways of an organism
c. Understanding the growth requirements of potential pathogens at specific body site
d. Knowing the differences in cell walls of particular bacteria
ANSWER: C
By understanding growth requirements, a microbiologist can maximize the chance of the
organism being isolated from a culture. The other three choices are used to identify a
bacterium once it has grown on media.
9. A clinical laboratory scientist is working on the bench, reading plates, and notices that a
culture has both a unicellular form and a filamentous form. What type of organism exhibits
these forms?
a. Virus
b. Fungi
c. Bacteria
d. Parasite
ANSWER: B
Viruses typically only have one form and would not grow on plate media. Bacteria have two
forms: a vegetative cell and spore form. Parasites may have trophozoite, cysts, egg, etc. Fungi are
the organism classification that may have both unicellular yeast forms and filamentous hyphal
forms in the same culture plate.
10. All of the following statements are true about viruses, except:
a. Viruses consist of DNA or RNA but not both.
b. Viruses are acellular but are surrounded by a protein coat.
c. Viruses can infect bacteria, plants, and animals.
d. Viruses do not need host cells to survive and grow.
ANSWER: D
Viruses need to have a host cell because they do not have the ability to reproduce or nourish
themselves without the host’s cellular mechanisms.
11. Diagnostic microbiologists apply placement and naming of bacterial organisms into all the
following categories, except
a. order.
b. family.
c. genus.
d. species.
ANSWER: A
Clinical microbiologists use the family, genus, and species taxonomic categories to identify
species that are important for diagnostic diseases.
12. Bacterial species that exhibit phenotypic differences are considered

a. biovarieties.
b. serovarieties.
c. phagevarieties.
d. subspecies.
.
.
ANSWER: D
Biovarieties vary based on biochemical test results, serovarieties vary based on serologic test
results, and phagevarieties is a fictitious word.
13. What structure is described as a phospholipid bilayer embedded with proteins and sterols that
regulates the type and amount of chemicals that pass in and out of a cell?
a. Cell wall
b. Mitochondria
c. Endoplasmic reticulum
d. Plasma membrane
ANSWER: D
The cell wall is the outer covering made up of lipids. The mitochondria is a cellular organelle
that is considered the powerhouse of the cell (electron transport and oxidative phosphorylation
occur here). The endoplasmic reticulum is a cellular organelle where protein synthesis occurs.
14. What makes the interior of the plasma membrane potentially impermeable to water-soluble
molecules?
a. The hydrophobic tails of the phospholipid molecules are found there.
b. The hydrophilic tails of the phospholipid molecules are found there.
c. The ion channels are found there.
d. The cholesterol molecules in the plasma membrane are found solely in the interior
of the membrane.
ANSWER: A
The plasma membrane is designed so that the hydrophilic heads of the phospholipid molecules
are positioned to make contact with the intracellular and extracellular fluids. The hydrophobic
tails of the phospholipid molecules face away from the fluids and form the interior of the
plasma membrane. The tails of the phospholipid molecules are hydrophobic, not hydrophilic.
The ion channels extend through the cellular membrane. The cholesterol molecules also extend
through the plasma membrane.
15. The function of a cell wall is to

a. regulate the transport of macromolecules in and out of the cell.
b. provide rigidity and strength to the exterior of the cell.
c. provide reserve energy to the eukaryotic cell.
d. protect the eukaryote from predators.
ANSWER: B
The plasma membrane regulates the transport of macromolecules in and out of the cell, not the
cell wall. The mitochondria provide energy to the eukaryotic cell. Cell walls are not able to
protect a eukaryotic cell from predators.
.
.
16. Name the numerous short (3 to 10 μm) projections that extend from the cell surface and are
used for cellular locomotion.
a. Flagella
b. Mitochondria
c. Cilia
d. Phospholipid
ANSWER: C
By definition, cilia are short projections extending from the cell surface and are used for
locomotion, whereas flagella are longer projections used for locomotion. Mitochondria are
cellular organelles responsible for electron transport and oxidative phosphorylation.
Phospholipids are polar molecules that form the plasma membrane.
17. A microbiology technologist performs a traditional bacterial stain on a colony from a wound
culture that is suspected to contain bacteria from the genus Clostridium. The unstained areas in
the bacterial cell observed by the technologist are called
a. cilia.
b. ribosomes.
c. endospores.
d. mitochondria.
ANSWER: C
Ribosomes are small circular areas used for protein synthesis that are not visible on a traditional
stain. Cilia are short projections on the outside of the plasma membrane used for locomotion.
Mitochondria are cellular organelles used for energy production.
18. This constituent of a gram-positive cell wall absorbs crystal violet but is not dissolved by
alcohol, thus giving the gram-positive cell its characteristic purple color.
a. Mycolic acid
b. Cholesterol
c. Carbolfuchsin
d. Peptidoglycan
ANSWER: D
Mycolic acid is part of the cell wall of the Mycobacterium and Nocardia spp., but does not play a
part in the Gram stain. Cholesterol is also part of the cell membrane, not the cell wall, so it does
not play a part in the Gram stain. Carbolfuchsin is a stain used in bacteriology.
19. Mycobacteria have a gram-positive cell wall structure with a waxy layer containing these two
compounds.
a. Glycolipids and mycolic acid
b. Glycolipids and phospholipids
c. Mycolic acid and lipopolysaccharides
d. Lipopolysaccharides and phospholipids
ANSWER: A
Glycolipids are a part of the waxy layer, but phospholipids are part of the plasma membrane.
Mycolic acid is a part of the waxy layer, but lipopolysaccharides are part of a gram-negative cell
wall. Lipopolysaccharides are part of a gram-negative wall, and phospholipids are part of a
plasma membrane.
20. When performing a Gram stain on a gram-negative organism, the crystal violet is absorbed
into this outer cell wall layer, and then washed away with the acetone alcohol. What is the
main component of the outer layer of the cell wall?
a. Peptidoglycan
b. Mycolic acid
c. N-acetyl-D-muramic acid
d. Lipopolysaccharide
ANSWER: D
Peptidoglycan is a thinner layer under the lipopolysaccharide in a gram-negative organism,
whereas mycolic acid is the waxy layer present in a mycobacterium’s outer cell wall, and N-
acetyl-D-muramic acid is part of the peptidoglycan.
21. The three regions of the lipopolysaccharide include all the following, except
a. antigenic O-specific polysaccharide.
b. mycolic acid.
c. core polysaccharide.
d. endotoxin (inner lipid A).
ANSWER: B
Antigenic O-specific polysaccharide, core polysaccharide, and endotoxin are all part of the
lipopolysaccharide layer.
22. The outer cell wall of the gram-negative bacteria serves three important functions, which
includes all the following, except:
a. It provides an attachment site for the flagella, which will act in locomotion.
b. It acts as a barrier to hydrophobic compounds and harmful substances.
c. It acts as a sieve.
d. It provides attachment sites that enhance adhesion to host cells.
ANSWER: A
The outer cell wall of gram-negative bacteria acts as a barrier to hydrophobic compounds and
harmful substances, acts as a sieve, and provides attachment sites that enhance adhesion to host
cells. Flagella attach to the cell membrane, not to the cell wall.
23. Mycoplasma and Ureaplasma spp. must have media supplemented with serum or sugar as
nutrients and because
a. their cell walls contain only peptidoglycan.
b. they lack cell walls.
.
.
c. the sterols in their cell walls are soluble in normal bacterial media.
d. their cell walls contain detoxifying enzymes.
ANSWER: B
These two genera have no cell walls, so the other choices are not appropriate. Serum and sugar
are needed nutrients and assist with osmotic balance of the media.
24. What is the purpose of a capsule?

a. Prevent osmotic rupture of the cell membrane
b. Make up the periplasmic space
c. Act as a virulence factor in helping the pathogen evade phagocytosis
d. Provide an attachment site for somatic antigens
ANSWER: C
The capsule acts as a virulence factor in helping the pathogen evade phagocytosis because
antibodies have difficulty attaching to the capsule of bacteria and therefore are unable to
prepare the organism for ingestion. The cell membrane is not prone to osmotic rupture when
inside a host; the periplasmic space is found between the peptidoglycan and the
lipopolysaccharide layers of the cell wall in gram-negative organisms; and somatic antigens are
found below the capsule.
25. The three basic shapes of bacteria include all the following, except
a. spirochetes.
b. cell wall deficient.
c. cocci.
d. bacilli.
ANSWER: B
Cell wall deficient is not one of the basic shapes of bacteria. It refers to the cell wall
composition, not the bacterial shape.
26. The Gram stain is a routine stain used in bacteriology to determine gram-positive and
gram-negative bacteria based on the
a. phenotypic characteristics of the organism.
b. composition of the bacterial cell wall.
c. composition of the bacterial cell membrane.
d. composition of the bacterial pili.
ANSWER: B
The composition of the bacterial cell wall is routinely used in bacteriology. The peptidoglycan
cell walls of the gram-positive bacteria retain the crystal violet (purple) stain, whereas crystal
violet stain is washed away because of the lipopolysaccharide (outer membrane) present in the
cell walls of the gram-negative cells. The outer membrane retains the Safranin (pink) with the
counter stain.

27. In what staining procedure does carbolfuchsin penetrate the bacterial cell wall through heat or
detergent treatment?
a. Gram stain
b. Acridine orange stain
c. Endospore stain
d. Acid-fast stain
ANSWER: D
Of all the stains listed, the acid-fast stain is the only one that requires heating or detergent
treatment so that the carbolfuchsin stain can penetrate the waxy wall of acid-fast bacteria. Gram
staining uses crystal violet stain; acridine orange is used in acridine orange stain; and the
endospore stain uses malachite green.
28. What stain is used for medically important fungi?

a. Methylene blue
b. Acridine orange
c. Acid-fast
d. Lactophenol cotton blue
ANSWER: D
Lactophenol cotton blue is the only fungi stain listed. Methylene blue is used to stain
Corynebacterium spp.; acridine orange is used to stain all types of bacteria, living or dead; and
acid-fast is used to stain Mycobacterium spp.
29. All the following are types of media, except

a. selective.
b. differential.
c. fastidious.
d. transport.
ANSWER: C
Fastidious refers to the nutrient requirements of bacteria, not a type of media. Selective media
have ingredients added to grow only selected bacteria. Differential media have chemicals added
to allow visualization of metabolic differences of bacteria. Transport media are used to keep
bacteria alive during transport to the laboratory.
30. Which of the following environmental factors influence the growth of bacteria in the
laboratory?
a. pH
b. Temperature
c. Gaseous composition of the atmosphere
d. All of the above
ANSWER: D
.
.
Most bacteria grow best at a pH between 7.0 and 7.5, at 35 C, with a requirement for the
gaseous composition of the atmosphere. Some bacteria require higher than atmospheric
moisture (humidity) levels for optimal growth (Neisseria sp.).
31. Some bacteria grow at 25 C or 42 C, but diagnostic laboratories routinely grow

pathogenic bacteria at what temperature?
a. 30 C
b. 60 C
c. 35 C
d. 10 C
ANSWER: C
Most pathogenic bacteria grow well at 35 C because it is close to body temperature; 30 C
is the temperature at which most medically important fungi grow well; 60 C is too hot for
pathogenic bacteria to grow, and 10 C is too cold for pathogenic bacteria to grow.
32. Which of these bacteria cannot grow in the presence of oxygen?

a. Obligate aerobes
b. Capnophilic organisms
c. Facultative anaerobes
d. Obligate anaerobe
ANSWER: D
An obligate anaerobe is a bacterium that is killed when exposed to normal atmospheric
conditions of oxygen and requires strict absence of oxygen. An obligate aerobe is a bacterium
that grows only in the presence of oxygen, and a capnophilic bacterium grows only in the
presence of 5% to 10% carbon dioxide.
33. What class of organisms, such as the Streptococcus sp., can survive in the presence of oxygen but
do not use oxygen in its metabolic processes?
a. Microaerophilic
b. Aerotolerant anaerobe
c. Obligate anaerobe
d. Facultative anaerobe
ANSWER: B
An aerotolerant anaerobe is one that can live in the presence of oxygen but does not use
oxygen in its metabolic processes. A microaerophilic bacterium requires a reduced level of
oxygen to grow. An obligate anaerobe cannot survive in the presence of oxygen, and a
facultative anaerobe can grow either with or without oxygen.

34. The laboratory receives a specimen in which the doctor suspects that the infecting organism is
Haemophilus influenzae. This organism grows best in an atmosphere that contains 5% to 10%
carbon dioxide. It is therefore classified as what type of bacteria?
a. Obligate aerobe
b. Capnophilic
c. Facultative anaerobe
d. Obligate anaerobe
ANSWER: B
Capnophilic bacteria need increased carbon dioxide in the atmosphere to grow; obligate aerobes
can grow only in the presence of oxygen; facultative anaerobes can grow in the presence or
absence of air; and obligate anaerobes need an atmosphere without oxygen to grow.
35. The following describes the log phase of bacterial growth:

a. Preparing to divide
b. Limited nutrients with bacteria count remaining constant
c. Number of nonviable bacterial cells exceeds the number of viable cells
d. Bacteria doubling with each generation time
ANSWER: D
As a bacterium is immersed in an environment with favorable conditions for growth, the
bacterium starts dividing; soon their numbers increase logarithmically. The growth tapers off as
the nutrients become limited; then the bacteria will begin to die as the nutrients are exhausted.
36. Diagnostic schemes in the microbiology laboratory typically analyze each unknown
bacterium’s metabolic processes for all the following, except
a. utilization of a variety of substrates as carbon sources.
b. energy utilization for metabolic processes.
c. production of specific end products from specific substrates.
d. production of an acid or alkaline pH in the test medium.
ANSWER: B
The microbiologist examines production of specific end products, production of an acid or
alkaline pH in the test medium, and utilization of various carbon sources for energy to identify
bacteria. Identification schemes are based on the percentages of bacterial species that exhibit
particular metabolic processes in vitro.
37. Which is a biochemical process carried out by both obligate and facultative anaerobes?
a. Fermentation
b. Respiration
c. Oxidation
d. Reduction
ANSWER: A
Fermentation takes place without oxygen. Respiration and oxidation need oxygen to occur.
Reduction is a chemical reaction that can occur independent of bacteria.
38. What type of fermentation produces lactic, acetic, succinic, and formic acids as the end
products?
a. Butanediol
b. Propionic
c. Mixed acid
d. Homolactic
ANSWER: C
Most of the fermentative processes produce only a single acid as a metabolic by-product. Mixed
acid fermentation produces several different acids: lactic, acetic, succinic, and formic.
39. If bacteria utilize various carbohydrates for growth, they are usually detected by
a. alkaline production and change of color from the pH indicator.
b. production of carbon dioxide.
c. production of keto acids.
d. acid production and change of color from the pH indicator.
ANSWER: D
Most bacterial identification systems examine the ability of bacteria to utilize several different
carbohydrates. The medium contains the specific carbohydrate being examined and a pH
indicator that can produce a color change: blue to yellow or red to yellow
40. In the medical microbiology laboratory, the ability of a gram-negative bacterium to ferment
this sugar is the first step in its identification.
a. Sucrose
b. Mannitol
c. Trehalose
d. Lactose
ANSWER: D
Media used for gram-negative bacillus that contain this sugar allow for the differentiation into
lactose fermenters and nonlactose fermenters. With this characteristic, organisms can be placed
into these two large groupings. This aids in the identification of gram-negative organisms.
41. A is a single, closed, circular piece of DNA that is supercoiled to fit inside a bacterial
cell.
a. phenotype
b. chromosome
c. frame-shift mutation
d. transposon
.
.
ANSWER: B
Chromosomes contain the genome of a bacterial cell. The DNA in the genome must be
compacted and wrapped around protein molecules to fit inside the cell nucleus. This
compacting, wrapping, and supercoiling makes up the chromosome.
42. Genes that code for antibiotic resistance are often found on small, circular pieces of DNA.
These DNA pieces are called
a. plasmids.
b. phenotypes.
c. chromosomes.
d. genomes.
ANSWER: A
Plasmids found in bacteria are small, extrachromosomal DNA. Plasmids are found in the
cytoplasm and can be replicated and passed on to daughter cells. Plasmids contain the antibiotic
resistance genes for some antibiotics.
43. What process involves transferring or exchanging genes between similar regions on two
separate DNA molecules?
a. IS element
b. Replication
c. Recombination
d. Transcription
ANSWER: C
Recombination is the process described. Transcription occurs when a DNA molecule makes an
RNA molecule. Replication occurs when DNA is used to make another DNA molecule. An IS
element is a type of mutation that occurs when a small piece of DNA jumps from one area in a
chromosome to another.
44. A microbiologist is working with two separate cultures of the same organism. The bacteria in
one culture are resistant to penicillin, whereas the bacteria in the other culture are susceptible to
penicillin. The bacteria from both cultures are mixed together, and all the resulting bacteria are
resistant to penicillin. What caused this phenomenon?
a. The plasmid carrying the resistance gene was transferred to the susceptible
population of bacteria.
b. The plasmid carrying the susceptibility gene was transferred to the resistant
population of bacteria.
c. An IS element was inserted into the genome of the susceptible bacterial
population.
d. A frame-shift mutation occurred that allowed the susceptible population of bacteria
to develop resistance to penicillin.
ANSWER: A
.
.
Antibiotic resistance is carried by plasmids, which can easily be transferred from one bacterium to
another. The receiving bacterium then displays the characteristics contained in the plasmid. IS
elements and frame-shift mutations occur on the chromosomes and take longer to manifest than
do plasmid transfers.
45. Diphtheria is a disease produced by Corynebacterium diphtheriae. However, not all C. diphtheriae
bacteria produce the toxin that causes this disease. To produce the toxin, the bacteria must
first become infected with a bacteriophage. The process by which bacterial genes are
transferred to new bacteria by the bacteriophage is called
a. conjugation.
b. transduction.
c. replication.
d. transformation.
ANSWER: B
Conjugation occurs when genetic material is passed from one bacterium to another through the
use of a sex pilus or similar appendages. Replication is when DNA makes a copy of itself.
Transformation occurs when naked DNA or plasmids are taken up and incorporated into a
bacteria’s genome.
46. Lysogeny occurs when

a. genes present in the IS element are expressed in the bacterial cell.
b. genetic material is transferred from one bacterium to another through a sex pilus.
c. competent bacteria cells take up naked DNA
d. genes present in the bacteriophage DNA are incorporated into the bacteria’s
genome.
ANSWER: D
IS elements are small pieces of bacterial DNA that jumped from one area in a chromosome to
another area in the same chromosome. When using a sex pilus to transfer DNA, the process is
called conjugation. Competent cells taking up DNA into their genomes represent transduction.
47. These are enzymes that cut the bacterial DNA at specific locations.
a. Bacteriophage enzymes
b. Restriction enzymes
c. Temperate lysogeny enzymes
d. Conjugation enzymes
ANSWER: B
Restriction enzymes allow bacteria to cut a place in its genome and insert specific sequences of
foreign DNA. Researchers also use the resulting fragments to identify identical genomes.
Bacteriophage enzymes do not cut the host bacteria DNA. Temperate lyosgeny enzymes are
associated with bacteriophage activation and conjugation enzymes assist in transfer of DNA
from one bacterial cell to another.
.
.
Chapter 02: Host–Parasite Interaction
Mahon: Textbook of Diagnostic Microbiology, 7th Edition
MULTIPLE CHOICE
1. Organisms that participate in a biological relationship where both benefit from one another are
called
a. parasites.
b. symbionts.
c. hosts.
d. flora.
ANSWER: B
Symbiosis is a relationship where two organisms live together and their association benefits both
organisms. Organisms that live in symbiosis are said to be symbionts. Parasites are organisms
that live off a host and harm the host. The host is the organism that provides the nutrients to the
other organisms. Flora are described as microorganisms that inhabit the body sites of healthy
individuals.
2. Parasitism is
a. a biological relationship between two or more organisms in which both benefit
from one another.
b. a biological relationship between only two organisms in which there are no
beneficial or harmful effects to the host
c. a biological relationship in which one species gains benefits at the expense of the
host.
d. a synonym for mutualism.
ANSWER: C
When both organisms live together and one organism benefits at the expense of the host, this is
parasitism. When both organisms live together and both benefit, this is symbiosis. When both
organisms live together and neither benefits, this is commensalism. Mutualism and symbiosis are
synonyms.
3. This bacterial state occurs when a host harbors a disease-causing organism, but does not show
signs of disease.
a. Carrier
b. Transient
c. Resident
d. Indigenous
ANSWER: A
Transient, resident, and indigenous refer to particular types of flora associated with the human
body, whereas carrier refers to the state in which pathogenic organisms establish themselves in a
host without causing disease, but the host can still transmit the infection.
4. Healthy people are colonized by many different bacteria in many different sites. These
bacteria are referred to as
a. transient flora.
b. carrier flora.
c. maintenance flora.
d. indigenous flora.
ANSWER: D
Indigenous flora are usual or normal flora, whereas transient flora are microbial flora that are
present at a site temporarily. Carrier and maintenance flora are not types of microbial flora found
on the human body.
5. Diabetics may sometimes be infected with their own resident flora. This type of infection is
called
a. an opportunistic infection.
b. a carrier state.
c. symbiosis.
d. a parasitic infection.
ANSWER: A
Opportunistic infections occur when the host has changes in body chemistry associated with age,
disease states, and drug or antibiotic effects. Carrier states are those in which a host does not
show symptoms of a disease, but it can infect other hosts with pathogenic organisms.
Symbiosis is a biological relationship that benefits the host and the organism. A parasitic
infection is one in which the parasite receives benefits, but at the expense of the host.
6. Mechanisms used by the skin to prevent infection and protect the underlying tissue from
invasion by potential pathogens include all the following, except
a. desquamation of the epithelium.
b. excretion of lysozyme by sweat glands.
c. antibiotics that inhibit many microorganisms.
d. mechanical separation of microorganisms from the tissues.
ANSWER: C
The skin produces fatty acids that inhibit microorganisms, not antibiotics. The remaining three
mechanisms are described in the text on page 25.
7. A laboratory professional is testing a new antimicrobial soap. The tech washes her forearm
then does a culture of the skin. Which organisms should she most likely expect to find
growing in the culture?
a. Diphtheroids and Bacillus spp.
b. Staphylococcus epidermidis and Propionibacterium
c. S. aureus and Propionibacterium
d. Diphtheroids and Propionibacterium
e. None of these organisms should be found.
ANSWER: B
Superficial antisepsis of the skin does not kill the Propionibacterium and S. epidermidis that live in
the hair follicles and sebaceous glands. Diphtheroids are found in moist areas such as the
axillae and toes. S. aureus is typically a pathogen but can be found on healthy skin.
Handwashing does not remove all bacteria from the skin.
8. What mechanism allows strict anaerobes to grow in the cervices and areas between the teeth
when plaque is present?
a. A low oxidation-reduction potential occurs at the tooth surface under the plaque.
b. The bacteria secrete sugar to nourish the strict anaerobes.
c. The normal flora secrete antibiotics to kill all the other bacteria and allow the strict
anaerobes to thrive.
d. The plaque-causing bacteria secrete an alkaline fluid and change the pH around the
tooth.
ANSWER: A
The growth of the plaque-causing bacteria on the tooth’s surface contain as many as 1011
streptococci per gram, and this amount of bacteria lowers the oxidation-reduction potential at
the tooth surface. Strict anaerobes cannot grow in the presence of oxygen, and lowering the
oxidation-reduction potential lowers the amount of oxygen at the tooth surface. Normal oral
flora organisms do not secrete sugar, antibiotics, or alkaline fluid.
9. The stomach can be considered a first line of defense against microbial infections because
a. most microorganisms are susceptible to the antibiotics and alkaline pH present in
the stomach.
b. most microorganisms are killed by the liver enzymes that are emptied into the
stomach during a meal.
c. the stomach produces proteases, which attack the lipopolysaccharide cell wall of
the organisms.
d. most microorganisms are susceptible to the acid pH of the stomach.
ANSWER: D
The stomach cells secrete enough acid to create an environment with a pH of approximately 1.
Bacteria that are enmeshed in food, spore-forming bacterial species in their spore phase, and the
cysts of parasites can survive the extreme pH present in the stomach. The stomach does not
produce antibiotics, and liver enzymes do not empty into the stomach during digestion.
10. This type of bacteria is able to live in the colon with little to no oxygen and is the predominant
organism.
a. Anaerobes
b. Facultative anaerobes
c. Facultative gram-negative rods
d. Gram-positive cocci
ANSWER: A
Anaerobes make up over 90% of the microbial flora of the large intestine. The facultative
anaerobes, facultative gram-negative rods, and gram-positive cocci are present in the colon in
much smaller numbers than the anaerobes.
11. After perforation of the colon, surgeons must guard against infection in the because of
leakage of the contents of the colon.
a. peritoneal cavity
b. urinary bladder
c. vaginal flora
d. renal vein
ANSWER: A
The peritoneal cavity is the space between the internal organs and the abdominal wall—a
normally sterile space. The colon contains lots of bacteria that can cause an infection in this
normally sterile space because there are no normal flora or immune system cells here to fight
off an infection. The organisms would have no natural defenses to overcome before causing an
infection.
12. The human body is constantly challenged by pathogens in the environment. It is not infected
by every pathogen it encounters because the microbial flora
a. engulf the pathogenic bacteria
b. produce conditions at the microenvironmental level that block colonization.
c. prime our immune system.
d. activate and support the action of antigen-presenting cells, cytokines, and
cell-mediated immunity.
ANSWER: B
Several mechanisms are used by microbial flora to ensure that colonization of pathogenic
organisms is blocked, such as lowering the reduction-oxidation potential, lowering the pH,
producing antimicrobials, and depleting the nutrients present in a particular environment.
13. The ability of an organism to produce disease in an individual is called

a. pathogenicity.
b. iatrogenic infection.
c. parasitic infection.
d. opportunistic infection.
ANSWER: A
An iatrogenic infection occurs as the result of medical treatment or procedure. A parasitic
infection occurs when an organism invades a host and only the organism benefits from the
biological relationship. An opportunistic infection occurs when the condition of the host
changes and the resident flora cause an infection.
14. A patient with an indwelling catheter develops a fever and lethargy. In addition, the urine in
the catheter bag has turned a brownish color and smells foul, which suggests an infection is
present. What type of infection does this describe?
a. Opportunistic
b. Iatrogenic
c. Pathogenic
d. Parasitic
ANSWER: B
An iatrogenic infection occurs as the result of medical treatment or procedures. In this case, the
use of an indwelling catheter to treat a medical condition has resulted in an infection. An
opportunistic infection occurs when a host’s condition changes and resident flora are able to
cause disease. Pathogenic describes the types of organisms that cause disease, but not a type of
infection. A parasitic infection occurs when an organism invades a host and only the organism
benefits from the biological relationship.
15. The smaller the number of microorganisms necessary to cause infection in a competent host,
the more the microorganism.
a. opportunistic
b. parasitic
c. invasive
d. virulent
ANSWER: D
Virulence refers to the relative ability of a microorganism to cause disease; more virulent
organisms need fewer organisms to cause disease in a host. Opportunistic refers to a type of
resident flora that causes infection when the conditions in a host change. A parasitic infection
occurs when an organism invades a host and only the organism benefits from the biological
relationship. Invasive refers to entering tissue, not the degree of ease with which an organism
can cause disease.
16. Factors that determine the pathogenicity and increase the virulence of organisms include all
the following, except
a. an organism’s ability to avoid phagocytosis.
b. an organism’s ability to produce exotoxins and extracellular enzymes.
c. an organism’s ability to produce infection when host conditions change.
d. an organism’s ability to survive intracellularly when phagocytized.
ANSWER: C
An organism’s ability to produce infection when the host conditions change is referred to as an
opportunistic pathogen. The other three statements refer to ways that a microorganism can
survive the attack of a host’s immune system and produce disease.
.
.
17. The most common bacterial characteristic that allows for evasion of phagocytosis by the host is
called
a. exotoxin production.
b. extracellular enzyme production.
c. pili.
d. polysaccharide capsule.
ANSWER: D
Organisms possessing a polysaccharide capsule are considered highly virulent because they can
evade phagocytosis. Exotoxin and extracellular enzyme production and pili are factors that can
increase an organism’s virulence. The exotoxins and extracellular enzymes may be used to
survive phagocytosis, but these do not help an organism evade phagocytosis. Pili are used to
transfer plasmids that may contain the genes for antimicrobial resistance and, therefore, help an
organism survive in the host.
18. This is a leukocidin that is lethal to leukocytes and produced by staphylococci.

a. Panton-Valentine
b. Lancefield
c. Hemolysin
d. Adhesins
ANSWER: A
The Panton-Valentine leukocidin is lethal to leukocytes and contributes to the invasiveness of
staphylococci. Lancefield deals with classifying -hemolytic streptococci on the basis of
antigens found on their outer covering. Hemolysins are produced by streptococci, and these lyse
red blood cells. Adhesins are cell-surface structures that mediate attachment to other cells.
19. Changes in these host structures can result in lower virulence of a microorganism.
a. Pili
b. Adhesin receptors
c. Surface polysaccharides
d. Phagocytes
ANSWER: B
Adhesin receptors are structures found on the host cell that are necessary for attachment of
bacterial adhesins and the beginnings of an infection. Pili and surface polysaccharides are the
main bacterial structures of attachments called adhesins. Phagocytes are white blood cells
(WBCs) that engulf invading microorganisms.
20. After attachment to host cells, a pathogen may use the following mechanisms to establish
itself and cause disease, except:
a. Uses lactoferrin for iron
b. Produces an IgA protease that degrades the IgA at mucosal surfaces
c. Produces lysozyme to kill the host cell
d. Circumvents host antibodies by shifting key cell-surface antigens
ANSWER: C
After engulfing bacteria, the host cell releases lysosomal contents that kill the organism. The
bacteria do not produce lysozyme.
21. Dissemination of a pathogen is

a. when a pathogen penetrates and grows in tissues.
b. when a pathogen multiplies intracellularly.
c. when a pathogen circumvents host antibodies by shifting key cell-surface antigens.
d. when infection with a pathogen spreads from the initial infection site to distant
sites such as organs and tissues.
ANSWER: D
Invasion of a pathogen allows the microbe to take advantage of the host’s transport system (the
blood) and seek out other areas that can be infected. This occurs only if the pathogen can elude
the host’s immune system during this journey. Invasion is when a pathogen penetrates and
grows in tissues. Intracellular multiplication of a pathogen occurs when an organism can survive
phagocytosis. When a pathogen shifts key cell-surface antigens, it is evading a host’s immune
system.
22. A physician notices that several patients are infected with Clostridium difficile, but only a few of the
patients are symptomatic for disease. The reason for this discrepancy is
a. only those strains of the organisms carrying the extrachromosomal DNA coding for
the toxin gene will produce toxin and cause the individuals to be symptomatic.
b. only those strains of the organism carrying DNA coding for the toxin within its
main DNA molecule will produce toxin and cause the individuals to be
symptomatic.
c. the exotoxin produced contains only the nontoxic portion.
d. the exotoxin must be produced in conjunction with extracellular enzymes to cause
problems.
ANSWER: A
The exotoxin gene is commonly encoded for by phages, plasmids, or transposons and does not
normally reside within an organism’s main DNA molecule. Exotoxins are highly characterized
molecules that are composed of a nontoxic subunit that binds the toxin to the host cells,
allowing attachment of the toxin. Exotoxins exhibit their effects without the aid of extracellular
enzymes. Extracellular enzymes are another factor that contributes to the virulence and
invasiveness of organisms.
23. The effects of endotoxins consist of dramatic changes in all the following, except
a. blood pressure.
b. fluid imbalance.
c. clotting.
d. body temperature.
ANSWER: B
Unlike shock caused by fluid loss, such as that seen in severe bleeding, septic shock is
unaffected by fluid administration. An increase in body temperature occurs within an hour after
exposure. Severe hypotension occurs within 30 minutes after exposure. The endotoxin also
initiates coagulation, which can result in intravascular coagulation.
24. A patient is brought to the emergency room with the following symptoms: body temperature
of 102° F, low blood pressure, elevated WBC, and disseminated intravascular coagulation. This
person has gram-negative rods growing in the blood. What is responsible for these symptoms?
a. Exotoxin
b. Extracellular enzymes
c. Endotoxin
d. Exfoliating toxin
ANSWER: C
Effects of the lipid A portion of the lipopolysaccharide present in the cell walls of gram-
negative bacteria include increased body temperature, hypotension, intravascular
clotting, neutropenia, metabolic changes, changes in humoral and cellular immunity, and
changes resistance to infection.
OBJ: Level 3: Synthesis
25. Healthy skin secretes these substances to help prevent colonization by transient and possibly
pathogenic organisms.
a. Long-chain fatty acids
b. Sebaceous glands
c. Carbohydrates
d. Antibodies
ANSWER: A
Long-chain fatty acids produced by the sebaceous glands allow the skin environment to be
acidic, leading to a low pH environment. Many pathogens prefer the near-neutral environment in
the body to produce disease. Bacteriocidal substances are produced by the microbial flora that
colonize the skin, and antibodies are produced by lymphocytes.
26. Lysozyme is
a. an antibody produced by the skin.
b. a low-molecular-weight enzyme that hydrolyzes the peptidoglycan layer of
bacterial cell walls.
c. an exotoxin that digests the lipopolysaccharide layer of the bacterial cell wall.
d. a radical similar to hydrogen peroxide.
ANSWER: B
Antibodies are produced only by the lymphocytes. Exotoxins are produced by bacteria and are
toxic to the host. Lysozyme is a low-molecular-weight enzyme that hydrolyzes the peptidoglycan
layer of bacterial cell walls.
27. Interferon is a substance produced by the body that inhibits viral replication. Interferon
accomplishes this task by
a. digesting the virus that is attempting to attach to the host cell.
b. destroying the host cell before the virus can attach and replicate.
c. binding to surface receptors that stimulate the cell to synthesize enzymes that
inhibit viral replication over several days.
d. stimulating platelets to produce -lysins.
ANSWER: C
Interferon is produced by eukaryotic cells in response to a viral infection, and it stimulates the
cell to synthesize enzymes that inhibit viral replication over several days. Interferons are not
enzymes and cannot digest viruses. Destroying the host cell before the virus can attach would be
counterproductive, because the purpose is to keep the host cells viable and free of infection.
The -lysin’s cationic proteins are produced by platelets during coagulation and are active
against gram-positive bacteria, not viruses.
28. All the following activities must occur for phagocytosis to take place and be effective in host
defense, except
a. attachment of the particle to the phagocyte.
b. ingestion.
c. killing.
d. migration of lymphocytes to the area of infection (chemotaxis).
ANSWER: D
Phagocytes are neutrophils or macrophages. Lymphocytes are not phagocytic and cannot engulf
bacteria.
29. This process results in enhanced phagocytosis by neutrophils.

a. Opsonization
b. Chemotaxis
c. Digestion
d. Glycolysis
ANSWER: A
Chemotaxis is the process of phagocytes migrating toward the site of the infection. Digestion is
when the contents of the lysozyme are mixed with the phagocytized bacteria. Glycolysis is a
metabolic process where glucose is broken down and energy is generated.
30. One of the most effective defenses bacteria have against phagocytosis is
a. enzymes.
b. the capsule.
c. plasmids.
d. lipopolysaccharide layer.
ANSWER: B
Enzymes facilitate host cell destruction but do not have any effect on phagocytosis. Plasmids
carry small pieces of DNA that can code for toxins, enzymes, and antibiotic resistance. The
lipopolysaccharide layer acts as an endotoxin that causes septic shock.
31. Innate immunity consists of which of the following components?

a. Physical and chemical barriers such as the skin and mucous membranes
b. Blood proteins that act as mediators of infection
c. Cells capable of phagocytosis
d. All of the above are part of the innate immune system
ANSWER: D
Innate immunity includes (1) physical and chemical barriers, such as the skin and mucous
membranes; (2) blood proteins that act as mediators of infection; and (3) a cellular mechanism
capable of phagocytosis, such as neutrophils and macrophages, and other leukocytes such as
natural killer cells.
32. The major constituents of the adaptive or specific immune response are
a. neutrophils.
b. macrophages.
c. monocytes.
d. lymphocytes.
ANSWER: D
Lymphocytes produce antibodies in response to specific antigens present in the blood.
Neutrophils, macrophages, and monocytes are all phagocytic cells that function in innate
immunity, not the specific immune response.
33. This class of antibodies is usually found as a pentamer.

a. IgM
b. IgG
c. IgA
d. IgE
ANSWER: A
IgM is made up of five basic immunoglobulin subunits and is considered a pentamer. IgG is a
monomer, IgA is a dimer, and IgE is a monomer.
34. A subsequent exposure to the same antigen elicits a(n) , characterized by a rapid
increase in IgG antibody associated with higher levels, a prolonged elevation, and a more
gradual decline in antibody levels.
a. primary immune response
b. anamnestic immune response
c. opsonin immune response
d. innate immune response
ANSWER: B
The primary immune response consists of production of IgM antibodies. The innate immune
response does not consist of antibody production but rather physical and chemical barriers to
infection and phagocytosis.
35. These are low-molecular-weight proteins secreted by T cells.

a. Antibodies
b. Opsonins
c. Lymphokines
d. Lysozyme
ANSWER: C
Antibodies are produced by B cells. Opsonins are antibodies or pieces of complement that help
make a pathogen ready to be phagocytized. Lysozyme is the enzyme present in host cell vacuoles
that assist in killing a phagocytized microorganism. Lymphokines are produced by T cells as a
result of antigen binding, activation, cell division, and differentiation.
36. Immunity to intracellular bacterial pathogens, such as Mycobacterium tuberculosis, is

primarily cell mediated, through the activities of
a. interferons and macrophages
b. antibodies and lymphokines.
c. lysozyme, T lymphocytes, and antibodies.
d. T lymphocytes, lymphokines, and macrophages.
ANSWER: D
T lymphocytes, lymphokines, and macrophages are used by the immune system to battle
intracellular pathogens most effectively. Interferons are useful against viruses, not bacteria.
Macrophages are effective against intracellular pathogens because they are phagocytes.
Antibodies are not useful against intracellular pathogens because they cannot reach the pathogen
that lives inside the cell. Lysozyme is an enzyme that is used to kill bacteria once they are
phagocytized.
37. Pathogens can be transmitted through all the following routes, except
a. ingestion.
b. handwashing.
c. sexual contact.
d. air.
ANSWER: B
Handwashing is a major method to prevent spread of infections. Pathogens can be transmitted
by ingestion, sexual contact, and air.
38. Because infections can be encountered via the air, can cause transmission of some
pathogens.
a. cuts
b. eyes
c. coughing
d. eating
ANSWER: C
Airborne infections are the most commonly encountered infections. They are transmitted by
droplets in the air that can be generated by coughing or sneezing. Cuts, eyes, and children are
not usual pathways for airborne transmission of a pathogen.
39. The resulting disease from this route of transmission is a disease of animals that is transmitted to
humans.
a. Sexual contact
b. Zoonotic
c. Airborne
d. Ingestion
ANSWER: B
Sexual contact, airborne, and ingestion are all routes of transmission for diseases of humans that
are passed from person to person. Zoonotic describes diseases of animals that infect humans.
.
.
Chapter 03: The Laboratory Role in Infection Control Mahon:
Textbook of Diagnostic Microbiology, 7th Edition
MULTIPLE CHOICE
1. In acute care hospitals, transmission of pathogens as a result of treatment occurs as all the
following “classifications” of infections, except
a. hand hygiene-acquired infections.
b. surgical site infections.
c. catheter-related bloodstream infections.
d. ventilator-associated pneumonias.
ANSWER: A
Although infections can be transmitted through improper hand hygiene, it is not a classification
of infection acquired in a hospital. Good handwashing technique is essential for preventing the
spread of pathogens in a health care setting, but infections are not classified as hand hygiene-
acquired infections. Surgical site infections, catheter-related bloodstream infections, and
ventilator-associated pneumonias are acquired from a treatment rendered to the patient. For
example, catheter-related bloodstream infections usually occur when patients have sterile
catheter devices implanted into their bloodstream. Because of the invasive nature of the catheter,
bacteria can colonize on the catheter and cause sepsis. The patient did not enter the hospital
with this infection, but acquired the infection as a result of medical treatment.
2. An iatrogenic infection is one that

a. is caused by gram-negative bacteria.
b. occurs as a result of medical treatment.
c. is found in urinary tract infections.
d. is not subject to outbreak investigation.
ANSWER: B
The definition of an iatrogenic infection is one that is acquired in a health care setting. Iatrogenic
infections can be caused by gram-negative bacteria, but other types of bacteria may also cause
these types of infections (i.e., methicillin-resistant Staphylococcus aureus, MRSA). Urinary tract
infections can be a type of iatrogenic infection, but other types of infections are also iatrogenic.
Because an iatrogenic infection is acquired in a health care setting, outbreak investigations are
routinely conducted to determine the source of the infection so that the bacteria can be killed
and the spread of infection stopped.
3. This ongoing process helps public health and health care officials recognize outbreaks,
upward trends of infections, and positive effects of interventions.
a. Handwashing techniques
b. Intervention
c. Surveillance
d. Antimicrobial resistance
ANSWER: C
Handwashing techniques help to prevent the spread of pathogens, and antimicrobial resistance
identifies organisms that are resistant to particular antibiotics, but these do not identify
outbreaks, upward trends of infections, or positive effects of interventions. Intervention is an
action taken to kill pathogenic bacteria-causing disease. Surveillance, collection, and analysis of
data about infections help public health officials recognize outbreaks, upward trends of
infections, and positive effects of interventions.
4. Iatrogenic infections are commonly associated with

a. breaks in aseptic technique.
b. preexisting infections.
c. food-borne illness.
d. respiratory aerosol transmission.
ANSWER: A
Health care-associated (nosocomial) infections occur after the patient arrives (generally not
within the first 48 hours) and were not incubating in the community before the patient arrived.
They occur because of instrumentation, increased use of antimicrobial agents, breaks in aseptic
techniques, and lack of hand hygiene.
5. When reviewing surgical site infections, the infection control practitioner must determine if
the patient’s infection is health care–associated by considering all the following, except
a. whether an endotracheal tube was present during surgery.
b. the length of surgery.
c. the degree of contamination of the surgical site (gunshot wound to the abdomen
versus a hernia repair).
d. whether any breaks in surgical technique occurred.
ANSWER: A
During surgery, there is a chance that bacteria present in the environment (including
instruments) can be transferred to the surgical site and cause an infection. When put under
general anesthesia, patients usually have a tube inserted to keep their airway open. This is not
unique to any particular surgery and therefore will probably not contribute to a nosocomial
infection. The length of surgery could contribute to an infection—the longer a person’s inner
tissue is exposed to the air, the more chance there is for bacteria or fungi to get into that wound.
The degree of contamination of the surgical site may contribute to a surgical site infection
because the gut contains lots of bacteria. When it is opened up, bacteria can leak into the sterile
abdominal cavity. If there were breaks in surgical technique and a contaminated object was
introduced into the sterile area, bacteria may have transferred to the wound, and an infection
would follow.
6. To keep abreast of all infections that occur in the hospital, infection control practitioners set
up surveillance programs. These surveillance programs look at this parameter to determine if
there are more or fewer infections in a given period.
a. Antimicrobial susceptibility reports
b. Infection rates
c. Handwashing rates
d. Glove usage
ANSWER: B
Antimicrobial susceptibility reports inform practitioners about the organisms that are resistant to
particular drugs. They do not address the number of infections in a health care facility.
Handwashing is an important part of preventing the spread of pathogens, but there is no one
who goes around and counts the number of times someone washes his or her hands. So this is
not a parameter. Glove usage is assumed to be 100%, and it does not tell the practitioner how
many infections were in the health care setting.
7. This program involves a close watch of only specific, high-risk, high-volume procedures for
nosocomial infections.
a. Baseline data
b. Total surveillance program
c. Targeted surveillance program
d. Data mining
ANSWER: C
Targeted surveillance programs look at particular programs for increases or decreases in infection
rates. Baseline data are used in a surveillance program and offer a marker for comparison of
subsequent data. Total surveillance programs look at all procedures for increases or decreases in
infection rates. Data mining uses sophisticated tools to analyze data.
8. The counties surrounding yours are seeing an increase in the number of whooping cough
cases. This is important for the microbiology laboratory because
a. physicians may start sending these cases to you.
b. you will need to advise physicians to suspect such cases and to send them to the
hospitals in the surrounding counties.
c. you need to make sure that the infection control practitioners in those counties
have baseline data.
d. you need to educate health care providers on specimen collection and transportation,
and have the specialized media ready so you can detect any cases in your county.
ANSWER: D
The laboratory can be proactive in educating health care providers on specimen collection and
transportation if those are unique to a specific public health concern. Awareness of infection
control activities within the public health setting allows the laboratory to acquire the necessary
media or reagents to meet emerging needs.
9. Information that the microbiology laboratory can provide to infection control practitioners
includes
a. the prevalence of a particular pathogen.
b. data on the effectiveness of handwashing techniques.
c. information about the outbreak of meningitis cases in the surrounding counties.
d. the antibiotic ordering patterns of particular physicians.
ANSWER: A
The prevalence of a particular pathogen is another piece of information that the microbiology
laboratory can provide to the infection control practitioner. Prevalence is the number of cases of
disease that occurs in a given moment in time or specific time period in a given population.
Therefore, knowing what pathogens are isolated from a given body site and being familiar with
what pathogens are frequently isolated from a given location within a health care facility are
important to the infection control practitioner.
10. A microbiology technologist is working at the bench and notices that a patient from the
cardiac intensive care unit (CICU) grows a Klebsiella pneumoniae bacterium that is an
extended-spectrum -lactamase-producing isolate. This technologist would advise the
physician to
a. order any antimicrobial that is effective against gram-negative rods in general.
b. limit the use of antimicrobial agents that tend to induce the formation of
extended-spectrum -lactamases.
c. draw more blood cultures, because the ones that grew that organism are
contaminated.
d. be on the lookout for diarrhea.
ANSWER: B
Being able to recognize what pathogens are isolated from patients in a cardiac CICU may
provide the opportunity for the infection control practitioner to inform health care providers of
the effects of antibiotic preTssEuS
reTBA
.A sN
a nKeS
xEamLpLleE, R
if.eC
xtO
enMded-spectrum -lactamase-producing
Klebsiella pneumoniae isolates were seen in that MICU, the physicians may be advised to limit the
use of antimicrobial agents that tend to induce the formation of extended-spectrum
-lactamases.
11. Organisms that represent public health concerns can be recovered from patients in an acute
care hospital. All of the following isolates are considered significant or major public health
concerns that are reportable to public health jurisdictions to follow up as a potential outbreak,
except
a. Neisseria meningitis.
b. West Nile virus.
c. MRSA.
d. encephalitis viruses.
ANSWER: C
Although MRSA can be an infection control issue within a health care facility, it is not yet
considered a significant public health concern. Methicillin-resistant S. aureus is usually born and
bred in a health care setting, but more cases of community-acquired MRSA are being seen. The
other organisms are spread by mosquitoes and close contact.

12. Organisms that are frequently encountered as causes of health care-associated infections in
acute care settings include all the following organisms, except
a. MRSA.
b. enterococci.
c. Clostridium difficile.
d. Neisseria meningitis.
ANSWER: D
N. meningitis is usually not implicated in health care-associated infections. These infections are
usually outbreaks that occur in the community, especially in schools.
13. Patients in both extended care facilities and home care settings are frequently
immunosuppressed by disease or therapy and often need intravascular or other device-related
care. The microbes identified in these patients are often opportunistic pathogens and include all
a. Pseudomonas aeruginosa.
b. Neisseria meningitis.
c. Candida.
d. Acinetobacter.
ANSWER: B
Infectious etiologic agents of infection control significance identified in these patients include
P. aeruginosa, Candida, Staphylococcus aureus, Acinetobacter, Clostridium difficile,
methicillin-resistant Staphylococcus, and vancomycin-resistant enterococci.
14. Prisoners or people housed in behavioral health facilities are more likely to contract infections
with pathogens from their intimate contact with blood and body fluids. A likely pathogen may be
a. Pseudomonas aeruginosa.
b. Hepatitis C.
c. Methicillin-resistant Staphylococcus aureus (MRSA).
d. Clostridium difficile.
ANSWER: B
People who are housed together in some form of communal living, such as prisons or
behavioral health facilities, have infection control-related infections similar to the other settings
previously described. The infectious diseases are more likely related to the activities of the
persons within the facility. As an example, MRSA is recovered from prisoners who practice illicit
tattooing with nonsterile, shared equipment, whereas lice and hepatitis C are more frequently
seen in behavioral health settings because of the community source of the clients and their
intimate contact with blood and body fluids.
15. An outbreak occurs when

a. numbers of isolates or infection rates increase significantly above the baseline.
b. numbers of isolates or infection rates decrease significantly below the baseline.
c. many people in a community are infected with a particular organism.
d. the mortality rate from a particular organism increases above 2%.
ANSWER: A
When numbers of isolates or infection rates increase above the baseline or when an isolate of a
rare or potential bioterrorism agent is recovered, an “outbreak” may have occurred. The
microbiology laboratory may be the first to recognize that event and will likely participate in the
investigation of that outbreak.
16. An index case is

a. an epidemiologic curve for a particular pathogen.
b. the last case described in an outbreak.
c. the first case described in an outbreak.
d. the case where the number of infections with a particular organism rises above the
baseline.
ANSWER: C
The first case described is the index case, and the other infections that followed were to be
determined if they were related to that first case.
17. When an outbreak is suspected, all the following steps are taken in investigating that event,
except
a. establishing a case definition.
b. confirming that an outbreak exists.
c. immediately treating all persons involved with appropriate antibiotic.
d. establishing an epidemiologic curve.
ANSWER: C
First establish a case definition, and then confirm that an outbreak exists. One must be certain
that all the suspected cases match the definition and that there are more than an expected
number of cases. Additional cases may be added to the initial number of cases. Next, pull
together as much information about the cases as possible, related to person, place, or time, then
draw an epidemiologic curve. Then form a hypothesis about the likely reservoir, source, and
means of transmission. At any point along the timeline, establish interventions to stop the
outbreak.
18. In an outbreak investigation and in the collection of routine surveillance data, what sorts of
activities are critical?
a. Microbiologists’ awareness of the processes that occur in a routine investigation
b. Alerting the public health department about potential outbreaks
c. Analyzing data on antimicrobial susceptibility from pathogens in the hospital so
the health care providers understand the type of antimicrobials that must be used
d. Collecting, processing, reporting, and reviewing pertinent cultures
ANSWER: D
In an outbreak investigation and in the collection of routine surveillance data, the collection,
processing, reporting, and reviewing of pertinent cultures become critical. The availability of
culture reviews that may result in the initiation or termination of an outbreak investigation
cannot be overlooked in importance. These data form the basis for the decisions made at each
step of the investigation of an outbreak.
19. If a large statewide or worldwide epidemic occurs, one of the major difficulties is
a. collecting and transporting specimens from people who live out of state or around
the world.
b. determining what organism is causing the outbreak.
c. arranging to get all the people with the infections to come back to the main area of
the outbreak for an extended period.
d. making sure enough media and technologists are available to process the large
amount of cultures associated with the outbreak investigation.
ANSWER: A
One of the major difficulties in a large outbreak is the ability to collect and transport specimens
from patients who live out of the area. Some of the individuals may have had their cultures
processed in their home state or country so that results from those cultures are difficult to
retrieve.
20. What is pulsed-field gel electrophoresis?

a. The process of performing various environmental cultures to aid in infection
control investigations
b. A strain-typing technique that can be an important adjunct to epidemiologic
investigations
c. A culture technique that compares the two antibiograms of an isolate with the
index case
d. A technique that checks for water quality
ANSWER: B
Pulsed-field gel electrophoresis enables a microbiology technologist to determine the strain of an
organism. Knowing the strain is important because, in an outbreak, the same strain of organism
is causing the problem. If the strain can be identified, the index case can be found, and the
outbreak can be stopped. This strain typing technique is more sensitive than comparing
antibiograms.
21. Although environmental cultures are not usually performed because the environment is rarely
implicated in disease transmission, they occasionally are useful. Samples will be taken from all of
a. air.
b. water.
c. hands.
d. surfaces.
ANSWER: C
Recommendations surrounding environmental infection control have been extensively discussed
in a Centers for Disease Control and Prevention (CDC) document. The environment is rarely
implicated in disease transmission, except with immunosuppressed patients. The air, water, and
surfaces are cultured when appropriate. Hands may transmit pathogens, but they are not
considered part of the environment.
22. Waterborne illnesses that may be associated with contaminated drinking water or recreation
water include all the following, except
a. legionellosis.
b. hepatitis A.
c. Pseudomonas skin infection.
d. hepatitis B.
ANSWER: D
Hepatitis B is a blood-borne pathogen and cannot be contracted from contaminated water.
Waterborne diseases include respiratory illnesses (such as legionellosis), hepatitis (hepatitis A or
hepatitis E), skin infections (from Pseudomonas or mycobacteria), and central nervous system
infections (Naegleria).
23. In the United States, 46 outbreaks annually owing to waterborne pathogens cause this illness
and affect several thousand people.
a. Diarrhea
b. Hepatitis C
c. Naegleria
d. Legionnaires’ disease
ANSWER: A
These outbreaks can be due to Giardia lamblia, Escherichia coli, the Norwalk virus, Norwalk-like
viruses, and other viruses associated with diarrhea. Hepatitis C is a blood-borne pathogen.
Infection with Naegleria affects the brain and is relatively rare. Legionnaires’ disease is a
respiratory illness.
24. The role of the microbiology laboratory is to perform cultures and provide culture results to
health care providers. The microbiology laboratory also has the responsibility to
a. report the identification or suspicion of certain infectious diseases to local, state,
and federal public health entities.
b. report any bioterrorism findings to the news media.
c. report odd infectious diseases to the CDC.
d. report any bioterrorism finding to the police.
ANSWER: A
Because of the escalation of terrorism in the United States and the distinct possibility of a
widespread bioterrorism attack, it is imperative that the laboratory technologist knows what
infectious diseases are reportable, to what agency they are to be reported, and in what time
frame they are to be reported. The identification or suspicion of certain infectious diseases will
need to be reported to particular government agencies to begin an investigation. If these reports
are not made, no one will know of the possibility of an outbreak or a bioterrorism attack.
Laboratory technologists need to follow the policies of their laboratory for notification.
25. The hospital infection control committee will expect reports from the laboratory that deal with
all the following, except
a. antibiograms.
b. water contamination rates.
c. blood culture contamination rates.
d. pathogens recovered in certain hospital units.
ANSWER: B
Committees review the results and note any trends that may be occurring. This is important so
that outbreaks may be caught early while they are still manageable. Water contamination rates are
never included in these periodic reports because routine environmental cultures are not
performed in the hospital. Antibiograms, blood culture contamination rates, and pathogens
recovered in certain hospital units are extremely important when looking for outbreaks.
26. Laboratory technologists must not only keep themselves educated in their contribution to the
infection control team,they must keep
a. housekeeping alerted as to the nature of the microbiology laboratory’s
biohazardous waste.
b. laboratory management aware of equipment needs.
c. the infection control personnel educated regarding the laboratory’s contribution to
the team.
d. the Centers for CDC informed of the continuing education needs of the
microbiology laboratory’s staff.
ANSWER: C
The infection control team needs to know the types of contributions the microbiology laboratory
can make. When new procedures or new equipment are added to the laboratory, personnel need
to know what new type of information is now available to the infection control team. New
information may make discovering outbreaks easier and quicker. Housekeeping knows that the
microbiology laboratory’s waste is biohazardous and treats it as such. The housekeeping team has
no need to know exactly what is in the bags. Laboratory management monitors workload and
new equipment, so the supervisory team would keep track of the equipment needs of the
department. The CDC does not need to be notified of the microbiology laboratory staff’s
continuing education needs.
27. This is practiced throughout the hospital and mandates safety for all personnel when handling
blood and body fluids.
a. Biosafety level 2
b. Handwashing
c. Wearing of respirators
d. Standard Precautions
ANSWER: D
Standard Precautions are used by all hospital personnel to prevent infection with blood-borne
pathogens. This is mandated by the Occupational Safety and Health Administration (OSHA).
Handwashing is also practiced throughout the hospital when hands become soiled, but this is
used for everything, not just when handling blood and body fluids. Biosafety level 2 precautions
are practiced only in the laboratory, not throughout the hospital. Wearing of respirators is used
in biosafety level 3 and level 4 precautions. Respirators are usually only worn in the laboratory
and not throughout the hospital.
28. What types of activities have led to the emergence of the microbiology laboratory as the
forefront in keeping Americans safe?
a. Terrorist
b. Research
c. Military
d. Educational
ANSWER: A
With the advent of terrorist activities in the world, the microbiology laboratory has become an
integral part of that area of the infection control program. Whether dealing with emerging
diseases, such as severe acute respiratory syndrome (SARS), or reemerging disease, such as
anthrax, the laboratory must stay closely aligned with the infection control activities in the
setting that the laboratory serves. Hospital laboratories will be the first point of contact for
cultures of infected people.
29. An example of an emerging disease is

a. influenza.
b. West Nile virus.
c. malaria.
d. chicken pox.
ANSWER: B
West Nile virus is a zoonotic virus that is slowly beginning to infect humans. This disease has
been diagnosed in humans since the late 1990s. Influenza has been around for many years—
one of the worse outbreaks was in 1916. Malaria has been around in the tropics since the
Europeans began invading South America and Africa. Chicken pox is a common virus, so
common that a vaccine was developed to ward off infection in the 1960s.

.
.
Chapter 04: Control of Microorganisms
Mahon: Textbook of Diagnostic Microbiology, 7th Edition
MULTIPLE CHOICE
1. The chemical or physical method that destroys all forms of life is called
a. sterilization.
b. disinfection.
c. bacteriostatic.
d. bactericidal.
ANSWER: A
Sterilization is the destruction of all forms of life, including bacterial spores. Disinfection is a
process that eliminates a defined scope of microorganisms, including in some cases spores.
Bacteriostatic inhibits the growth of microorganisms. Bactericidal kills bacteria.
2. Organisms that are the most resistant to heat, chemicals, and radiation are
a. parasites.
b. prions.
c. bacteria.
d. viruses.
ANSWER: B
Prions are naked pieces of protein, so they are harder to kill than any other organism. Viruses
usually contain a nucleic acid and all the mentioned formsof killing can effectively disrupt their
nucleic acid. Bacteria and parasites are complete organisms that are killed by disinfection and
sterilization, even in the spore and cyst stages.
3. After using the phone, the laboratory tech sprayed the receiver with a chemical spray. This
process will kill a defined scope of microorganisms. What is this process called?
a. Sterilization
b. Bacteriostatic
c. Disinfection
d. Bactericidal
ANSWER: C
Disinfection kills a defined scope of microorganisms. Sterilization kills all organisms and spores
at a site. Bacteriostatic and bactericidal are adjectives that describe the particular action of
chemical agents: to inhibit bacterial growth or kill bacteria.
4. Before performing a phlebotomy, the phlebotomist will clean the area on a patient’s arm with a
substance before inserting the needle. This substance is called a(n)
a. disinfectant.
b. sterilizer.
c. antiseptic.
d. bactericidal.
ANSWER: C
An antiseptic is a substance applied to the skin for the purpose of eliminating or reducing the
number of bacteria present. A disinfectant is a chemical agent used to kill microorganisms on an
inanimate object. To sterilize is to kill all life; skin will still have organisms growing after wiping.
Bactericidal is the process of killing bacteria.
5. All the following factors play a significant role in the selection and implementation of the
appropriate method of disinfection, except
a. temperature.
b. contact time.
c. biofilms.
d. humidity.
ANSWER: D
Humidity is not important when attempting to disinfect or kill organisms. Temperature, contact
time, and biofilms all play a role in selection and implementation of the appropriate method of
disinfection.
6. When eliminating organisms from inanimate objects, higher numbers of organisms require
longer exposure times because
a. all disinfecting agentsare not alike and some require shorter times.
b. the chemical composition of the disinfecting agent varies.
c. disinfecting agents containing carbon tetrachloride require longer times to act.
d. it takes longer to eliminate 99% of microorganisms.
ANSWER: D
When there are higher numbers of microorganisms, it takes longer to kill 99% of the
microorganisms present. Although disinfectants are different, it still takes longer to kill more
organisms. The chemical composition of a disinfecting agent may affect the time required to kill
microorganisms, but microbial load is a determining factor.
7. If this is present on a surface to be disinfected, it can shield microorganisms from the

disinfectant or inactivate the disinfectant. What is this substance?
a. Bleach (sodium hypochlorite)
b. Organic material
c. Hydrochloric acid
d. Water
ANSWER: B
Organic matter (e.g., blood, pus) can keep the disinfectant from reaching and killing the
microorganism. Bleach, hydrochloric acid, and water can counteract another disinfectant, but
they cannot shield microorganisms from a disinfectant.
8. Disinfectants are usually used at this temperature.

a. 50° C to 100° C
b. 0° C to 10° C
c. 25° C to 50° C
d. 20° C to 22° C
ANSWER: D
Disinfectants are usually used at room temperature (20° C to 22° C). Too high or too low a
temperature can actually inactivate a disinfectant.
9. Pasteurization achieves _ .
a. disinfection
b. sterilization
c. asepsis
d. filtration
ANSWER: A
Pasteurization kills food-borne pathogens, but not microbial spores present in a liquid. Because
sterilization is killing of all microorganisms plus spores and cysts, pasteurization only disinfects.
Asepsis describes no bacteria present. Filtration describes another method of disinfection where
microorganisms are removed from a liquid by a physical device—a filter.
10. Chemosterilizers exert their killing effect through all the following mechanisms, except
a. denaturation of cellular proteins.
b. damage of RNA and DNA.
c. inactivating enzyme substrates.
d. reactions with components of the cytoplasmic membrane.
ANSWER: C
Inactivating an enzyme substrate may or may not have an effect on cellular function. If a
chemical can denature proteins that are used by the cell, damage RNA or DNA, or react with
components of the cell membrane, they can damage the cell.
11. Alcohols use this mechanism to inactivate microorganisms.

a. Denature proteins
b. Destroy DNA
c. Denature RNA
d. Inhibit cell wall synthesis
ANSWER: A
Alcohols disrupt the tertiary and quaternary structure of the cell wall proteins to destroy
microorganisms. They do not have the capability to destroy DNA, denature RNA, or inhibit cell
wall synthesis.
12. The tech needs to sterilize a piece of equipment that cannot be autoclaved or gas sterilized
because the equipment contains lenses, metal, and rubber components. What solution should
be used to sterilize this piece of equipment?
a. 10% bleach
b. 37% formalin
c. Glutaraldehyde
d. 90% alcohol
ANSWER: C
Glutaraldehyde is the sterilant of choice, because it is not inactivated by organic material, and it
can kill both microbes and spores, depending on contact time. Ten percent bleach cannot be
used because it is a corrosive and can corrode metal; 37% formalin cannot be used because it is
a carcinogen, and the Occupational Safety and Health Administration (OSHA) does not
recommend it for routine sterilizing or disinfecting; 90% alcohol can be corrosive, but it is also
inactivated with any organic material that may be present on the instrument.
13. For the most effective microbial killing, all iodophors must be properly diluted because
a. they stain the skin if too concentrated.
b. this decreases contact time for adequate killing.
c. there must be enough free iodine to kill the microorganisms.
d. this increases contact time for adequate killing.
ANSWER: C
The reason for diluting iodophors properly is that the dilution ratio is important to ensure there is
enough free iodine to kill microorganisms. When iodophors are used as skin preparations, contact
time is essential for killing microorganisms. Contact time does not depend on dilution. Iodophors
are considered nonstaining.
14. Even though hypochlorites are inexpensive and have a broad range of microbes that they kill,
they are not used as sterilants because of
a. the corrosive nature of the compound.
b. the activation required by organic matter.
c. short exposure time for sporicidal action.
d. long exposure time for sporicidal action.
ANSWER: D
Hypochlorites require a long exposure time to kill spores, and they are inactivated by organic
material present on an object. They are not used as a disinfectant because they are corrosive.
15. Many materials in hospitals that must be sterilized cannot withstand steam sterilization. Gas
sterilization is used instead, using this gas.
a. Nitrous oxide
b. Oxygen
c. Ethylene oxide
d. Carbon dioxide
ANSWER: C
Ethylene oxide is usually mixed with nitrogen or carbon dioxide before use because it is
explosive in its pure form. It is used in hospitals and in the manufacturing industry for
sterilizing thermoplastic products. Nitrous oxide, oxygen, and carbon dioxide are all gases, but
they do not kill microbes or their spores.
16. Why should health care workers wash their hands after coming into contact with a patient?
a. To reduce the amount of red blood cells transmitted from one patient to the next
b. To reduce the occurrence of hemolytic transfusion reactions
c. To reduce the need for antiseptics and disinfectants
d. To reduce the spread of pathogenic bacteria from one individual to another
ANSWER: D
Any pathogenic bacteria present on the hands of one individual will be passed on to the next
individual unless the hands are washed to remove the pathogens. Hands visibly contaminated
with red blood cells are always washed after becoming soiled. Hemolytic transfusion reactions are
caused by the intravenous administration of red blood cells. Antiseptics and disinfectants will
always be needed to cleanse skin and inanimate objects to free them of pathogenic bacteria.
17. High-level disinfectants are active against all the following, except
a. parasites.
b. spores.
c. fungi.
d. tubercle bacilli.
ANSWER: A
High-level disinfectants are active against vegetative cells, tubercle bacilli, spores, fungi, and
viruses. These disinfectants may have no activity against parasite cysts or egg forms.
18. This agency regulates the use, sale, and distribution of antimicrobial pesticide products for
certain inanimate, hard, nonporous surfaces, or incorporates into substances under the
pesticide law.
a. Antimicrobial Division of Environmental Protection Agency (EPA)
b. Centers for Disease Control and Prevention (CDC)
c. U.S. Army Medical Research Institute for Infectious Diseases (USAMRIID)
d. U.S. Food and Drug Administration (FDA)
ANSWER: A
The Antimicrobial Division of the EPA regulates the use of antimicrobials on inanimate,
nonporous surfaces. The CDC acts as a clearinghouse for information of medically important
bacteria and houses one of two biosafety level 4 (BSL-4) laboratories. The other (BSL-4)
laboratory is found at the Army infectious disease research facility, USAMRIID. The FDA
regulates substances that are put into the body.
19. These two alcohols are effective in killing enveloped viruses such as hepatitis B virus (HBV).
a. 50% isopropyl and 50% butanol
b. 95% propanol and 70% ethanol
c. 70% isopropyl and 95% ethanol
d. 70% pentanol and 70% isopropyl
ANSWER: C
The only two alcohols used in U.S. hospitals that kill HBV are 70% isopropyl and 95% ethanol.
20. This chemical is a saturated 5-carbon dialdehyde that has broad-spectrum activity, rapid
killing action, and remains active in the presence of organic matter.
a. Formalin
b. Formaldehyde
c. Haloaldehyde
d. Glutaraldehyde
ANSWER: D
Glutaraldehyde is a good killing agent because it has broad-spectrum activity and rapid killing
action, remains active in the presence of organic matter, and can be used on sensitive equipment.
Formalin is designated as a carcinogen by the OSHA, and worker exposure limits have been set.
These adverse effects limit its usefulness. Formaldehyde is a gas that is usually known as formalin.
Haloaldehyde is not used as a disinfectant.
21. These disinfectants are cationic, surface-activated agents that work by reducing the surface
tension of molecules in a liquid, resulting in the disruption of the cellular membrane of
microbes.
a. Quaternary ammonium compounds
b. Heavy metals
c. Chlorines
d. Iodophors
ANSWER: A
Quaternary ammonium compounds are disinfectants that are cationic, surface-activated agents
that disrupt the cellular membrane of microbes. Heavy metals are bacteriostatic. The mechanism,
by which chlorines kill microorganisms, is the oxidative effects of hypochlorous acid. Iodophors
kill through the action of periodic acid.

22. This organization regulates chemical skin antiseptics.
a. EPA
b. FDA
c. CDC
d. National Institutes of Health (NIH)
ANSWER: B
The FDA regulates chemical skin antiseptics. The Antimicrobial Division of the EPA regulates
disinfectants. The CDC is the nation’s clearinghouse on infectious diseases. The NIH is a
conglomerate of special federal agencies that award research grants to further knowledge in a
particular area.
23. The main goal of handwashing is to

a. sterilize a person’s hand.
b. increase the risk of passing on pathogens.
c. eliminate transient flora.
d. disinfect a person’s hands.
ANSWER: C
A person’s hands are never sterile; therefore, the best handwashing scenario would be to
cleanse the hands of transient flora. Sterilizing someone’s hands would also strip the hands of
essential oils that would contribute to drying and cracking of the skin. Washing would eliminate
most pathogens, thereby decreasing, not increasing, a person’s ability to transmit pathogens.
Disinfection occurs when microorganisms are killed on inanimate objects.
24. Routine handwashing in health care settings mandates washing at all the following times,
except
a. in high-risk areas such as ICU and burn units.
b. on entering protective isolation units.
c. before and after routine patient contact.
d. when gloves become soiled during a procedure or dressing change on the same
patient.
ANSWER: D
Soiled gloves are changed during a procedure or dressing change on a single patient, but the
hands are not washed until contact with that patient terminates.
25. The purpose of surgical hand scrubs and waterless hand rubs is to
a. eliminate the transient flora and most of the resident flora on the skin.
b. remove all physical dirt and some residential flora.
c. remove all resident flora.
d. remove all transient flora.
ANSWER: A
.
.
Surgical scrubs try to eliminate as much bacteria from the surgeon’s hand as possible. In case the
surgeon’s glove is torn or punctured, very little bacteria will enter the surgical wound.
Transient and resident flora must be removed by the surgical hand scrubs and waterless hand
rubs.
26. The most common iodophor used in the United States for preoperative skin preparation is
a. calcium iodophor.
b. 95% ethanol and iodine.
c. tincture of iodine.
d. povidone-iodine.
ANSWER: D
Povidone-iodine contains a low amount of free molecular iodine, reducing toxic effects,
staining, and irritation. It also provides slow and continuous release of iodine. Tincture of
iodine is not used frequently. Ca iodophor and 95% ethanol and iodine are not used for
preoperative surgical skin preparation.
27. This topical antiseptic disrupts the microbial cell membrane and precipitates the cellular
contents.
a. Chlorhexidine gluconate
b. Povidone-iodine
c. 95% ethanol
d. 60% isopropyl alcohol
ANSWER: A
The bactericidal mechanism for chlorhexidine gluconate is to disrupt the microbial cell
membrane and precipitate the cellular contents. Povidone-iodine uses hypoiodonic acid and free
iodine to disrupt the cell and eventually kill it. The bactericidal mechanism for alcohols is
denaturing proteins.
28. This compound is a diphenyl ether and it exerts its bactericidal effects by disrupting the cell
wall. It has good activity against gram-positive cocci, but poor activity against fungi. What is its
name?
a. 95% ethanol
b. Triclosan
c. Chlorhexidine gluconate
d. Povidone-iodine
ANSWER: B
Triclosan is a diphenyl ether, and it exerts its bactericidal effects by disrupting the cell wall.
Ninety-five percent ethanol denatures the cellular proteins. Chlorhexidine gluconate disrupts
the cellular membrane and spills the cell’s contents. Povidone-iodine kills the bacteria with free
iodine and hypoiodonic acid.

29. Laboratory safety includes all the following areas, except
a. radioactivity.
b. chemical.
c. isolation.
d. fire.
ANSWER: C
Isolation safety and precautions are usually practiced in conjunction with the patient on the
floor or outpatient setting. In the laboratory, there are few patients, so safety focuses on areas
like radioactivity, chemical safety, and fire safety.
30. Why is laboratory-acquired infection an obvious hazard for personnel working in a

microbiology laboratory?
a. Microbiology personnel do not always adhere to safety practices.
b. Safety practices are not applicable for the microbiology laboratory.
c. In-service education is not provided for microbiology staff.
d. Personnel deal with a variety of infectious agents: viral, fungal, parasitic, and
bacterial.
ANSWER: D
All specimens handled by laboratory techs are considered to be potentially infectious. Therefore,
if a person is careless, a laboratory-acquired infection can occur. Microbiology personnel should
follow safety procedures for their own safety. Safety procedures do apply to the microbiology
laboratory, and training is provided to each employee.
31. The comprehensive safety program for the microbiology laboratory needs to fulfill all the
following provision, except:
a. It is specific to the hospital and does not need to conform to state, local, and
federal regulations.
b. It must address biological hazards.
c. It must teach correct techniques for lifting and moving heavy objects and patients
(where applicable).
d. It must describe the safe handling, storage, and disposal of chemicals.
ANSWER: A
The safety program must comply with federal and state regulations, hospital procedures, and
good laboratory practice. It needs to address all safety hazards (fire, chemical, radiologic, and
biological) and be uniformly applied. Procedures need to be written, and employees need to
take responsibility for keeping their workplace safe.
32. Processing of patient specimens and handling of actively growing cultures of microorganisms
put an employee at risk of potential contact with the infectious agent through all the following
routes, except
a. mucous membranes.
b. blood splashed onto intact skin.
c. inhalation of aerosols.
d. accidental ingestion.
ANSWER: B
When working with specimens and culture plates, there is little chance of contracting an
infection if blood is splashed onto intact skin. Infection—through the mucous membranes by
rubbing eyes with contaminated hands, from inhaling aerosolized microorganisms, or by
accidental ingestion—is possible when handling specimens and actively growing culture plates.
33. All of the following organisms can typically cause infection from aerosolization of specimens,
except
a. Mycobacterium tuberculosis.
b. Brucella spp.
c. Staphylococcus aureus.
d. Francisella tularensis.
ANSWER: C
Cases of S. aureus infection of laboratory workers occur often, but not usually through aerosol
inhalation. Many reported cases of laboratory workers being infected with M. tuberculosis after
being exposed to aerosols when processing sputum specimens fill the literature. Brucella and F.
tularensis are very infectious organisms and several cases a year are reported of laboratory workers
who contract the disease after processing culture specimens.
34. What protective measures can a laboratory worker take when working with actively growing
cultures to ensure that they do not become infected?
a. Ensure that fungal cultures are sealed and worked in a biosafety cabinet.
b. Wash their hands at the end of their shift.
c. Handle specimens routinely, using extra care for HIV and HBV cultures.
d. Take off bandages on fingers when reading plates.
ANSWER: A
Fungal cultures produce many infectious spores that can disseminate rapidly via the ventilation
system if a plate is opened on the bench in a laboratory. These cultures should always be
handled in a biosafety cabinet. Bench technicians should wash their hands frequently to ensure
the number of pathogenic microorganisms on their hands is always low. All specimens should
be handled as though they are HBV and HIV positive—with extreme care. Cuts on the hand
should always be covered by finger cots or gloves.
35. The laboratory exposure control plan should contain all the following, except
a. engineer and work practice controls.
b. review of control plan every 5 years.
c. methods of compliance for Standard Precautions.
d. guidelines for handling and disposal of regulated waste.
ANSWER: B
The exposure control plan is mandated by the OSHA to protect workers against blood-borne
pathogens. This plan must be reviewed and updated annually. It must contain a determination
of tasks and procedures that may result in an occupational hazard, a plan to investigate all
exposure incidents, and a plan to prevent these from reoccurring, methods of compliance for
Standard Precautions, engineering and work practice controls, personal protective equipment
(PPE), guidelines for ensuring that the work site is maintained in a clean and sanitary manner,
guidelines for handling and disposal of regulated waste, and a training program for all employees
(OSHA Bloodborne Standards).
36. Universal/Standard Precautions require that

a. only some body fluids be considered infectious and capable of transmitting
disease.
b. body fluids with visible blood be treated as noninfectious.
c. blood and body fluids from all patients be considered infectious and capable of
transmitting disease.
d. urine and feces be considered noninfectious.
ANSWER: C
Anything that comes from a patient is capable of transmitting disease. Blood and all body fluids,
including secretions and excretions, except sweat, regardless of whether visible blood is present,
are considered infectious.
37. Engineering controls and work practice controls to ensure Standard Precautions are followed
include all the following, except
a. eyewash stations.
b. the use of safety needles.
c. plastic shield barriers.
d. fire blankets.
ANSWER: D
The OSHA defines engineering controls as controls that isolate or remove the hazard from the
workplace. Some examples of engineering controls are the use of closed tube sampling by
laboratory equipment, the use of safety needles and single-use holders, eyewash stations,
emergency showers, and plastic shield barriers. Ideally laboratories should have negative air
pressure, access to the laboratory should be limited, and there should be a plan to prevent insect
infestation.
38. Standard Precautions do not address which of the following?

a. Handwashing
b. Gloves
c. Laboratory coats
d. Respirators
ANSWER: D
Respirators are not included in the items addressed by Standard Precautions because they are
used in a biosafety level 3 (BSL-3) laboratory. To ensure the guidelines required in Standard
Precautions are followed within the laboratory, engineering controls and work practice controls
are instituted, and employers must provide PPE.
39. Safety program and work practice controls consist of all of the following, except
a. ensuring written procedures are in place for a task.
b. altering the manner in which a task is performed to reduce exposure to infectious
agents.
c. allowing workers to eat at the bench if it gets busy and they do not have time to
take a lunch break.
d. reviewing the procedure manual annually.
ANSWER: C
Safety programs and work practice controls consist of altering the manner in which a task is
performed to reduce the likelihood of exposure to infectious agents. This is accomplished by no
mouth pipetting; no eating, drinking, or applying cosmetics in the laboratory; disinfecting
workstations at the end of each shift and after any spill of infectious material; no recapping or
breaking of contaminated needles; disposal of needles in an appropriate puncture-resistant
container; performing procedures in a manner to minimize splashing and the generation of air
droplets; placing specimens for transport in well-constructed containers with secure lids to
prevent leakage of infectious materials; and frequent handwashing.

40. All of the following are examples of PPE, except
a. gloves.
b. laboratory coats.
c. safety glasses.
d. prescription glasses.
ANSWER: D
PPE must be protective and appropriate. Blood and body fluids must not be able to penetrate
the PPE material. Prescription glasses are not considered PPE because splashes of blood and
body fluids can get to the eye by coming in around the sides, top, and bottom of the glasses.
Safety glasses form a barrier where body fluids cannot come in around the sides, top, or
bottom.
41. Technicians are doing the morning chemistry run. Once they load the specimens onto the
instrument, they remove their gloves to do paperwork in a clean area of the laboratory. What
should the technicians do after removing their gloves?
a. Reposition the tubes in the racks.
b. Take a break and eat a snack.
c. Call any critical values.
d. Wash their hands.
ANSWER: D
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TEST BANK For Textbook of Diagnostic Microbiology, 7th Edition by Connie R. Mahon, Verified Chapters 1 - 41, Complete Newest Version

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Test Bank For Textbook Of Diagnostic Microbiology

7th Edition By Connie R. Mahon

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2. Who was considered the father of protozoology and bacteriology?

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3. Prokaryotic cells have which of the following structures in their cytoplasm?

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4. This form of DNA is commonly found in eukaryotic cells.

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5. The nuclear membrane in prokaryotes is

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12. Bacterial species that exhibit phenotypic differences are considered

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15. The function of a cell wall is to

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24. What is the purpose of a capsule?

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28. What stain is used for medically important fungi?

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29. All the following are types of media, except

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31. Some bacteria grow at 25 C or 42 C, but diagnostic laboratories routinely grow

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32. Which of these bacteria cannot grow in the presence of oxygen?

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35. The following describes the log phase of bacterial growth:

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46. Lysogeny occurs when