REVIEW QUESTIONS

MICRO PARA LEC

PAGE 183-Spore-forming gram positive
bacilli- bacillus and clostridium
1. A housewife who lives on a small farm is brought to the emergency dept.
complaining of double vision and difficulty talking. On the examination ,
there is symmetrical descending paralysis of thr cranial nerves, upper
extremities and trunk.
C- BOTULISM

2. Which of the following is an important virulence factor of Bacillus

antracis?

A- PROTECTIVE ANTIGEN
3. A young man sustains major soft tissue injury and open- fractures of
his right leg after a motocyle accident. One day later, he has a temp of
38 deg.

E- CLOSTRIDIUM PERFRINGENS

4. For the patient, in question 3, which of he following is likely to

happen?
C- LECITHINASE
5. The reported incubation period for inhalational anthrax can be up to

D- 6 WEEKS

6. A food commonly associated with Bacillus cerrus food poisoning is

A- Fried rice
7. Tetanus toxin (tetanospasmin) diffuses to terminals of inhitory cells
in the spinal cord and brainstem and blocks which of the following?

C- RELEASE OF INHIBITORY GLYCINE AND Y-AMINOBUTYRIC ACID

8. A 45 year old man who immigrated to the US 5 years ago sustained a

punchture injury to the lower part of his right leg when his rotary lawn
mowers threw a small stick into his leg.
D- TETANUS
9. Which of the following statements about tetanus and tetanus toxoid
is correct?

E- Tetanus toxin acts on inhibitory interneuron synapse.

10. A 67 year old man had a surgery for a ruptured sigmoid colon
diverticulum wit an abscess was drained.
C- CLOSTRIDIUM PERFRINGENS TOXIN
11. Infant botulinum has been associated with all of the ff except?

B- CLOSTRIDIUM SEPTICUM

12. Which of the ff food items is most frequently associated with infant
botulism?

D- HONEY
• 13. All of the ff are properties characteristic of Bacils anthracis,
expect?

A- motility on wet mount examination

14. Which of the ff statements regarding vaccination FOR bacillus

anthracis is correct?

B- Recombinant vaccine trials have shown good safety and efficacy.

15. All of the following statementd regarding clostridium perfringens
are correct, except?

D- It is the most common cause of antibiotic-associated diarrhea.

PAGE 195-Aerobic non-spore-forming-gram-
positive bacilli
1. Three moths ago , a 53 year old woman had surgery and
chemotherapy for breast cancer.

D- NORCARDIA FARCINICA

2. The drug choice to treat this patient in question 1 is

B- Trimethoprim-sulfamethozaxole
3. It is practicularly difficult to differentiate Erysipelothrix rhusiopathiae
from
E- Lactobacillus species

4. Movement of Listeria monocytogenes inside the host cells is caused

by

A- INDUCING HOST CELLACTIN POLYMERIZATION

5. An 8 year old boy develops a severe throat. On example , grayish
exudate is seen over.

D- A CLUB-SHAPED GRAM POSITIVE BACILLUS

6. The primary mechanism in the pathogenesis of the boy's disease

E- INACTIVATION OF ACETYLCHOLINE ESTERASE

7. Corynebacterium jeikeium is

C- OFTEN MULTIDRUG RESISTANT

8. Which of the ff aerobic gram positive bacilli is modified acid-fast

positive?

A- NOCARDIA BRASILIENSIS
9. Skin diptheria as occurs in children in tropical areas typically

D- results in protective antitoxin levels in most children by the time

they are 6-8 years old.

10. A 45 year old fisherman imbedded a fishhook into his right

forefinger. He removed it and did not seek immediate ,edical theraphy.

B- ERYSIPELOTHRIX RHUSIOPATHIAE
11. A biochemical reaction that is useful identification of the causitive
agent of the infection in question 10 as

E- PRODUCTION OF H2S

12. Listeria monocytogenes is frequently a foodborne pathogen

because

D- all of the above are correct.

13. After the recovery on laboratory media

D- MOLECULAR METHODS SUCH AS 16SrRNA gene sequencing

14. Which of the following statements regarding Rhodococcus equi is

correct?

C- IT IS A RARE CAUSE OF PULMONARY INFECTION IN HUMANS.

15. A hospitalized patient who had an indwelling urinary tract catheter
develops fever, chills, suprapubic pain and difficulty in voiding 48 hours
after the catheter is removed.

A- CORYNEBACTERIUM UREALYTICUM
Page 206- Stapyloccoci
1. A 54 year old woman develops a right should abcess with strain of
Staphylococcus aureus that is resistant to nafcillin.

D- INCREASED CELL WALL SYNTHESIS AND ALTERATIONS IN THE CELL

WALL STRUCTURE.

2. An 11 year old boy develops a mild fever and pain in his upper arm.

E- CATALASE POSITIVE
3. A 36 year old male patient has an abscess with the strain of S.
aureus that is b-lactamase positive. This indicates that the organism is
resistanty to

A- PENICILLIN G, AMPICILLIN AND PIPERACILLIN

4. Seven days ago, a 27 year old medical student returned from

central america, where she had spend the summer working in a clinic
for indigenous people.
C- A toxin that binds to the class II major histocompatibility complex
(MHC) of an antigen-presenting cell and the Vb region of the T cell.
5. Over the period of 3 weeks, a total of five newborns in the hospital
nursey developed S aureus infection with S aureus bacterimia.

E- Culture using mannitol salt'agar of the anterior nares of the physicians

6. The exfoliative toxins, TSST-1, and the enterotoxins are all superantigens.

D- On the staphylococcus chromosomes in a pathogenicity island.

7. A 16 year old bone marrow transplant patient has a central venous line that
has been in place for 2 weeks.

E- The S epidermidis organisms are likely to bein a biofilm obn the central
venous catheter surface.

8. A 65 year old man develops an abcess on the back of his neck. Culture
yields S aureus.

D- The isolate is resistant to nafcillin.

9. Antimicrobial resistance has become a significant problem. Whivh of
the following is the major concern?

D- Vancomycin resistance in Escherichia coli

10. A group of 6 children younger than 8 years of age live n semitropical

country.

C- S aureus
11. Which of the following statements regarding the role of protein A in
the pathogenesis of infection

E- It is bacterial surface protein that binds to the Fc portion of IgG1.

12. Which of the following staphylococcus organisms produces

coagulase and has been implicated in infections:

A- Staphylococcus intermedius
13. All of the following statements regarding Panton-Valentine leukocidin are
correct except?

D- iT IS IDENTICAL TO ONE OF THE STAPHYLOCOCCAL ENTEROTOXINS

14. Which of the following statements best describe the function of the
accessory gene?

C- IT CONTROLS THE PREFERENTIAL EXPRESSION OF THE SURFACE ADHESINS.

15. All of the following are important infection control strategies in
containing spread of MRSA in hos[itals except:

D- Routine antimicrobial prophylaxis for all the patients hospitalized for

more than 48hours.
Page 225
 PAGE 241-Enteric gram-negative rods
1. A 20 year old college students goes to student health center because
of dysuria, frequently and urgency on urination for 24 hours. She has
recently become sexually active. On urinalysis, many
polymorphonuclear cells are seen.

E- ESCHERICHIA COLI
2. A 27 year old woman is admitted to the hospital because of fever,
with increasing anorexia, headache, weakness and altered mental
status of 2 days duration. She works for an airline. Her temp is 39, heart
rate is 68, blood pressure is 120/80 Hg. She knows she is and where she
is but does not know the date.

D- SALMONELLA ENTERICA SUBSPECIES ENTERICA SEROTYPE typi

(SALMONELLA TYPHI)
3. Blood cultures from the patient in question 2 grow non lactose fermenting
gram negative bacillus. Which is the constituent of hthis organism?

B- Vi antigen (capsule; virulence antigen)

4. A 37 year old women with historyb of urinary tract infection comes to the
emergency department with burning on urination along with frequency and
urgency. She says her urine smells like ammonia.

B- PROTEUS MIRABILIS
5. An 18 year old student has abdominal cramps and diarrhea. A plate
of MacConkey agar is inoculated and grows gram negative rods. Triple
sugar ion is used for the isolates for salmonellae and shigella.

C-INABILITY TO FERMENT LACTOSE AND SUCROSE

6. An uncommon serotype of SALMONELLA ENTERICA subspecies
enterica was found by laboratories in the health dept. The isolates were
all from small. By what method did the laboratories determine the
isolates were the same?

B- O ANTIGEN and H antigen typing

7. A 43 year old man with diabetes has a 4 cm nonhealing foot ulcer. Culture of
the ulcer yields Staphylacoccus aureus. The gram negative is a member of genus.

E- PROTEUS

8. A 4 year old boy from Kansas City who recently started attending preschool
brought to his pediatrician for diarrheal illness by fever to 38.2 Which of the
foolowing is the most likely pathogen causing the llness?

C- SHIGELLA SONNEI
9. A 5 year old girl attended a party at local fast food restaurant. About 48 hrs, se
developed cramping abdominal pain and low grade fever. a serum 8 mg ./dl. What
most likely pathogen causing child?

A- ESCHERICHIA COLI O157: H7

10. a 55 year old homeless man wth alcolohism presents severe multilobar
pneumonia. The organism is a lac tose fermenter MacConkey agar and very much
mucoid.

D- KLEBSIELLA PNEUMONIAE
11. Which of the following statements reagarding o antigen is correct/

C- THEY HAVE COVALENTLY LINKED TO A POLYSACCHARIDE CORE.

12. Which of the following test methods is the least sensitive procedure
for diagnosis of colitis caused by Shiga toxin- producing E COLI?

A- CULTURE ON SORBITOL MACCONKEY AGAR

13 An HIV positive man recently travelled to Caribbean. He developed
acute watery diarrhea and abdominal pain without fever during the
secon week of his vacation.

E- ENTROAGGREGATIVE E COLI

14. Heat- labile toxin of ETEC acts by which of the following mechanism?

B- ACTIVATION OF ADENYLYL CYCLASE

15. A young woman presents with recurrent urinary tract infection
caused by same PROTEUS MIRABILIS STRAIN. What is the major
concern?

C- SHE HAS A BLADDER OR KIDNEY STONES

 PAGE 251- Pseudomonads, Acinetobacters and Uncommon
Gram-negative bacteria
1. A sputum culture of a patient with cystic fibrosis grows Pseudomonas
aeruginosa that form very mucoid colonies. The implication of this
observation is whuch?

E- THE P AERUGINOSA HAVE FORMED A BIOFILM IN THE PATIENT'S AIRWAY.

2. An environmental gram -negative bacillus that is resistant to
cephalosporins, aminoglycosides, and quinolones has become a very
important pathogen largely because it is selected by use of those antibiotics.
must be differentiated BURKHOLDERIA CEPACIA.

E- STENOTROPHOMONAS MALTOPHILIA
3. This gram negative bacillus, which is oxidase positive and does not ferment
carbohydrates

D- EIKENELLA CORRODENS

4. A 17 year old girl with cystic fibrosis has a slight increase in her frequently
cough and production of mucoid sputum. A sputum specimen is obtained and
plated on routine cultre media.

B- PSEUDOMONAS AEROGINOSA
5. The sputum from a 17 year old patient with cystic fibrosis in question
4 also plated on mannitol salt agar, which turns

D- STAPHYLOCOCCUS AUREUS

6. The sputum from a 17 year old patient with cystic fibrosis also plated
on a colistin-containing agar. After 72 hours of incubation, the colistin-
containing agar grows.
B- BURKHOLDERIA CEPACIA
7. When Burkholderia cepacia complex organism is isolated from a patients
with cystic fibrosis, great care must.

B- THE PRESENCE OF B CEPACIA COMPLEX IN A CF patient's airway has major

implication for the patient long term prognosis and therapeutic options.

8. Which of the following statements about ACINETOBACTER SPECIES is or are

true?

F- All of the above

9. A 37 year old fire fighter sustain smoke inhalation and is hospitalized
for ventilatory support. He has severe cough and begins to expectorate
purulent sputum. the organism causing the patient infection is?

A- PSEUDOMONAS AEROGINOSA

10. The pigment produced by the microorganism is question 9?

D- PYOVERDIN
11. Burkholderia cepacia is infrequently found in or

A- SWIMMING POOL

12. Which of the following statements about PSEUDOMOAS

AERUGINOSA IS correct?

E- P AERUGINOSA HAS FIMBRAE, WICH PROMOTE ATTATCHEMENT TO

EPITHELIAL CELLS.
13. The mechanism of action of exotocin A of Pseudomonas aeroginosa
is:

B- TO BLOCK ELONGATION FACTOR 2

14. The HACKER bacteria sometimes cause indolent endocarditis or

other infection. This acronym represents which of the following?

E- KINGELLA KINGAE
15. A 30 year old man , a dog owner presents a fever of 39
hypotension and early signs of dismented intravascular coagulation.
Sepsis is suspected. The most likely pathogen is

B- CAPNOCYTOPHAGA CANIMORSUS
PAGE 263- Vibrios, Camylobacters,
Helicobacter and Associated Bacteria
1. Long term carriage and shedding is most likely to occur after
gastrointestinal infection With which of the following?

E- SALMONELLA TYPHI
2. A 63 year old man visited his fav oyster restaurant. He ate 2 dozen of
oyster/. Two days later, he was admitted to the hospital because of absurpt
onset of chills. A microorganism of major concern for this patient is:

A- VIBRIO VULNIFICUS
3. A 10 year old boy was playing in a slowly moving stream which he cut his foot
on a shrap object. Three days later he was brought to the emergency
department because of the pain.

C- AEROMONAS HYDROPHILA

4. A family of four persons ate a meal that included undercooked chicken. Within
3 days, three members develpoed an illness characterized by fever, headache,
myalgia. Which of the following culture was most likely used to islate C jejun?

E- A medium containing vancomycin, polymyxin B, and trimenthoprim incubated

at 42 in 5% oxygen and 10% co2
5. Bacteremia associated with gastrointestinal infection is most likely to
occur with?

A- SALMONELLA TYPHI
6. During the El Nino years in the mid 90, the waters of the Puget
sounds between washington state and british columbia. The micro
oraganism of concern is:

D- VIBRIO PARAHAEMOLYTICUS
7. A patient presents to the emergency dept. with nonbloddy diarrhea
for 12 hrs. The patient lives and has not recently traveled out of the
area. Which of the folloswing is unlikely the cause?

D- VIBRIO CHOLERAE
8. An 18 year old woman in rural Bangladesh develops profuse 8L/d
diarrhea. She has no symptoms other than the diarrhea and the
manifestation of the fluids and electrolytes.
D- SHIGELLA DYSENTERIAE
9. Age and geography are major factors in the prevalence of colonization by
Helicobacter pylori. In the developing countries, the prevalence of colonization
may be greater than 80% in adults.

D- 40-60%
10. A 59 year old man comes to the emergency dept in the afternoon because of
acute swelling and pain in his right leg. Earlier that morning, he had been working
on a small sport fishing boat in an estuary.Near the wound , bullae were forming-
the largest approx 2.5 cm in diameter.

E- VIBRIO VULNIFICUS
11. The vibrio cholerae factor responsible for diarrhea is a toxin that

B- YIELDS INCREASED INTRACELLULAR LEVELS OF cAMP

12. In september 1854, a severe epidemic of cholera occured in the

Soho/Golden Square area of London.

B- REMOVINGTHE HANDLE F THE BROAD STREET WATER PUMP.

13. A 45 year old man develops a gastric ulcer that can be visualized on
a contrast medium-enchanced radiographs of his stomach. A biopsy
specimen is taken.

A- A medium used to detect urease incubated at 37 deg.

14. Which of the following is useful in differentiating Vibrio species
from Aeromonas species?

A- GROWTH OR NO GROWTH ON A MEDIUM CONTAINING NaCl

15. In the US, public health officials often warn people to thoroughly
cook chicken commercially obtained from supermarkets and stores.
What percentage?

E- GREATER THAN 50%

PAGE 275- Haemophilus, Bordetella, Brucella and
Francisella
1. A 68 year old woman was seen in the clinic because she had felt feverish and had
been experiencing increasing pain and swelling in her left knee during the past weeks.
A urea slant was inoculated and positive for urease activity after overnight incubation.

D- BRUCELLA SPECIES

2. After the culture test in question 1 turned positive, additional history was obtained.
Approx 4 weeks before the onset of her knee pain.

B- UNPASTEURIZED GOAT'S CHEESE

3. A 55 ear old game warden in Vermont found a dead muskrat on the bank
of the stream. He picked up the animal, thinking it might have been illegally
trapped or shot. Physical examination was revealed right axillary
lymphadenopathy.

E- FRANCISELLA TULARENSIS
4. An 18 year old boy has been playing with ach

B- Infants 2 months to 2 years of age do not immunically respond to

polysaccharides vaccines that are not conjuated to a protein.
5. An 11 year old boy from Peru was reffered to the Brain tumor
institute. Three months earlier he had developed headaches and
then slowly progressive right side weakness.

A- BRUCELLA SPECIES

6. A 3 year old child develops HAEMOPHILUS INFLUENZAE meningitis.

Therapy is begun with cefotaxime. Why it is third generation
cephalosporin rather than ampicillin?
E- About 20% of H influenza organisms have a plasmid that encodes
for the beta-lactamase.
7. A 55 year old man with severe dental caries presented with 1 month
of fever, malaise, and back pain and now presents with moderately
severe shortness of breath. The most likely causitive pathogen is:

C- AGGREGATIBACTER APHROPHILUS

8. All of the following statements regarding acellular pertussis vaccines

are correct except?
D- The vaccine is approved only for young children and adolescents.
9. Which of the following subspecies of FRANCISELLA TURARENSISis the
most virulent for humans?

A- TULARENSIS

10. All of the following statements regarding the etiologic agent

chancroid are correct expect?

C- The organism grows well on standard chocolate agar.

11. A 3 month old infant is brought to the pediatric emergency department in
severe respiratory distress. The child appears dehydrated, and the is
prominent peripheral lymphocytosis.

B- BORDETELLA PERTUSSIS

12. In question 11, the factor that is responsible fr the profound

lymphocytosis?

C- An A/B structured toxin.

13. All of the following cause zoonotic infections expect?

C- BORDETELLA PERTUSSIS

14. Which of the following is not recognized virulence factor of

Bardetella pertussis?

A-HEAT -LABEL TOXIN

15. Which of following pathogens discussed in this chapter is on the
select agent list?

D- ALL OF THE ABOVE

PAGE 282-Yersinia and Pasteurella
1. An 18 year old male resident of Arizoan came to the emergency
department (ED) complaining of fever, pain in his left groin, and
diarrhea for the past 2 days.

A- Y PESTIS PRODUCES A COAGULASE WHEN INCUBATED AT 28 DEG.

2. The drug choice to treat the patient in question 1?

E-STREPTOMYCIN
3. Yersinia pestis entered North America through SAN fRANCISCO in the
1890s, carried by rats on ships that had sailed from HK, where a plague
epidemic occurred.

E- RURAL WILD RODENTS

4. Which of the following is generally not considered a potential agent of

bioterrorism and biological warfare?

C- STREPTOCOCCUS PYOGENES
5. An 8 year old boy was bitten by a stray cat. Two days later, the wound was
red and swollen and drained purulent fluid. Pasteurel multocida was cultured
from the wound. the drug?

D- PENICILLIN G

6. Intimate contacts of patients with suspected plague pneumonia should

receive which ogf the following agents as chemoprophylaxis?

E- DOXYCYCLINE
7. In a patient who has the bubonic form of plague, all the following
specimens are acceptable except?

A- STOOL CULTURE ON HEKTON ENTERIC AGAR

8. All of the following statements regarding the pFra/plasmid of Yersinia pestis

are true, except?

B- It contains genes that yield plasminogen-activating protease that has

temperature-dependent coagulase activity.
9. All of the following statements regarding the epidemiology of
infections caused by Yersinia enterocolitica are corre, except?

C- PERSON-TO-PERSON SPREAD IS QUITE COMMON

10. Which of the following Pasteurella species has been associated with
infections of the female genital tract and of the newborn?

D- PASTEURELLA BETTYAE
11. Optimum recovery of Yersinia enterecolitica from the stools of patients
ith gastrointestinal requires which of the following specialized media?

A- CEFSULODIN-IRGASAN-NOVOBIOCIN AGAR

12. Which of the following organisms is likely to cause a transfusion

reaction even if the donor is asymptomatic?

D- YERSINIA ENTEROCOLITICA
13. A 25 year old graduate student is rushed to the operating room for
fever, acute abdominal pain and leukocytosis suggestive of acute
appendicitis. During the surgery, the appendix appears normal,

B- MESENTERIC LYMPHADENTIS caused by Y pseudotuberculosis

14. A typical source of the infection in the case question 13 is

C- Direct contact with another infetal individual

15. An organism suspeted of being Yersinia pestis is recovered from a
patient with sepsis. The isolate has bipolar staining is catalase positive
but is oxidase.

D- Send the isolate to the nearest public health laboratory for

confirmation.
PAGE 293- The Neisseriae
1. The inhabitants of a group of small village in rural sub Sharan Africa
experienced an epidemic of meningtis. 10 % of the people died. The
microorganism that most likely caused this epedimic was?

D- NEISSERIA MENINGITIDIS SEROGROUP A

2. A 19 year old man presented to the clinic with a urethral discharge for the
past 24 hrs. Which of the following statements about these antimicrobial
resistance factor?
A- B-lactamase production and high-level resistance to tetracycline are both
mediated by genes on plasmid.
3. A 6 year old boy develops a fever and headache. He is taken to the
emergency dept, where he is noted to have a stiff neck, suggesting
meningeal irritation.

D- THEY SHOULD BE GIVEN RIFAMPIN PROPHYLAXIS.

4. An 18 year old woman who reports unprotected sex with a new

partner 2 weeks previously develops fever and left lower quadrant
abdominal pain with onset in association with her menstrual period.
D- INFERTILITY
5. A 38 year old vice squad police officer comes to the emergency dept. with
the chief complaint expressed as follows

C- DEFICIENCY OF A LATE-ACTING COMPLEMENT COMPONENT C5, C6, C7 OR

C8

6. Which of the following individuals should routinely receive vaccination with

the conjugate meningococcal vacine.

A- A healthy young adolescent entering high school.

7. A 25 year old sexually active woman presents with purulent vaginal
discharge and dysuria 7 days after having unprotected sexual intercourse with
anew partner?

D- A NUCLEIC ACID AMPLICATION TEST

8. What is the currently recommended treatment for gonococcal urethritis in

men?

C- CEFRIAXONE GIVEN INTRAMASCULARLY AS A SINGLE DOSE.

9. Which of the following cell components prduced by Neisseria
gonorrhoeae is responsible for attachment to host cells?

B- PILI (FIMBRIAE)

10. A 60 year old man with severe chronic lung disease presents with
fever, cough productive of purulent sputum and worsening hypoxemia.

C- MORAXELLA CATARRHALIS
11. One major advantage of the conjugate meningococcal vaccines
compared with the polysaccharides vaccines?

C- A T CELL-DEPENDENT RESPONSE TO VACCINE IS INDUCED.

12. A 25- year-old woman presents with septic arthritis of the knee. The
fluid aspirate grows a gram-negative diplococcus

D- Neisseria gonorrhoeae
13. All of the following are virulence factors associated with N
gonorrhoeae except.

E- A THICK POLYSACCHARIDES CAPSULE

14. The prevalence of gonococcal infections increased between 2009

and 2010.

A- TRUE
15. A useful test to differentiate Moraxella catarrhalis from saprophytic
neisseriae in the respiratory samples is

A- BUTYRATE ESTERASE
 page 302- Infections caused by anaerobic
bacteria
1. A 55 year old man visits his physian complaining of a severe cough and
production of purulent sutum. His breath h a very unpleasant fetid odor.

C- PREVOTELLA MELANINOGENICA, FUSOBACTERIUM SPECIES AND

VIRIDANS STREPTOCOCCI

2. A 23 year old man develops a perirectal abscess, which is drained

surgically. A specimen is cultured and grows anaerobic bacteria.
E- all of the above
3. A 63 year old man with diabetes routinely injects insulin into the
muscles of his left thigh. He is recently developed severe pain with
swelling in his left thigh.

B- SYNERGISTIC NONCLOSTRIADIAL ANEROBIC MYONECROSIS

4. An 18 year old man develops fever with the pain in the right
lower quadrant of his abdomen.

B- CAPSULE
5. Infection caused by bacteroides species can be treated with all of
the following antibiotics except?

D- PENICILLIN

6. A 17 year old high school senior develops infectious

monomucleosis. About 2 weekslater, he develops a significantly
higher fever, a worsening sore throat.

A- Fusobacterium necrophorum
7. Which of the following statements regarding Lactobacilli is correct?

D- THEY RARELY CAUSE DISEASE IN HUMANS.

8. Which of the following statements best describes the pathogenisis of

CLOSTRIDIUM BOTULINUM?

A- It elaborates a toxin that inhibits the release of acetylcholine at

cholinergic synapses.
9. The drug of choice for treatment of infectious caused by
Actinomyces species?

E- PENICILLIN

10. Infections commonly caused by Clostridium perfrigens include a of

the following except

B- LUMPY Jaw
11. All of the following statements regarding anaerobes are true except.

A- THEY POSSESS THE ENZYMES CYTOCHROME OXIDASE.

12. Lemierre's disease is a serious infection of the head and neck

associated with

E- FUSOBACTERIUM NECROPHORUM
13. Definitive identification of an anaerobe is likely best accomplished
by

D- CELL WALL FATTY ACIDS ANALYSIS USING GAS LIQUIDS

CHROMATOGRAPHY
14. A patient who has mainatained good denttition presents with
induration and swelling of the mandibular area.

D- ACTINOMYCES ISRAELII
15. The recommended treatment in the non-allergic patient for the
condition caused by the organism in question 14?

A- AMPICILLIN
PAGE 310- Legionellae, bartonella and unsual
bacterial pathogens.
1. Humans become infected with Legionella pneumophilia by

C- BREATHING AEROSOL FROM ENVIRONMENTAL WATER SOURCES

2. A 11 year old girl developed an acute onset of fever, chills, headache

and vomiting and severe migratory arthralgias (joint pain) and myalgias
(muscle pain). Two days later, she developed

B- STEPTOBACILLUS MONILIFORMIS
3. A 70 year old man presents with bilateral pneumonia. His legionella urinary
antigen test result positive. Which of the ff is likely?

A- Legionella pneumophilia seogroup 1

4. A 70 year old man comes to the emergency dept. feeling feverish and really
tired. He has chronic cigarette cough, but this has dramatically increased in
the past week.

E- ALL OF THE ABOVE

5. Routine sputum cultures for the patient in queston 5 grows
normal flora. Treatment with ampicillin for 2 days yields no
improvement. A diagnosis of Legionnaire's disease is considered.

E- all of the above

6. Charcoal is present in buffered charcoal yeast extract agar used

to isolate Legionella pneumophilia to

E- ACTS AS A DETOXIFYING AGENT

7. A 23 year old woman presents with a 3-day history of low grade fever
and headache. Examination reveals enlarge and slightly tender lymph
nodes near left elbow.

E- ALL OF THE ABOVE

8. Which of the ff statement about bacillary angiomatosis is most correct?

C- The major differential diagnosis is Kaposi sarcoma

9. An important factor in the pathogenesis of Legionnaires disease is that

B- Alveolmacrophages phagocytose Legionella pneumophila using coiled

pseudopods.

10. True statements egarding T whipplei include all of the ff except?

A- iT IS EASY TO CULTIVATE ON CHOCOLATE AGAR AFTER 3 DAYS OF

INCUBATION.
11. All of the ff staements below regarding infection with Legionella except?

B- Human to human transmission is the major mechanism

12. Which of the following best represents the role of the Mip protein in
Legionella pathogenesis?

D- It facilitates adherence to the macrophage and stimulates cellular

invasion.
13. Pontiac fever is a severe form of pneumonia caused by Legionella
pneumophilia serotypes 1 and 6

B- FALSE

14. All of the ff statements regarding Streptobacillus moniliformis are

correct except?

D- THE MORPHOLOGY OF THE ORGANISM IS SPIRAL SHAPED.

15. The diagnosis ofhe Whipple's disease is best made by:

C- NUCLEIC ACID AMPLIFICATION TESTING PERFORMED ON TISSUE

Page 324- Mycobacteria
1. A 60 ye old man has a 5 month history of progressive weakness and a
weight loss of 13kg along with intermittent fever, chills and chronic
cough productive of yellow sputum.
C- ISONIAZID, RIFAMPIN,PYRAZINAMIDE AND ETHAMBUTOL

2. If the patient ;s Mycobacterium tuberculosis isloate in question 1

proves to be resistant to isoniazid.

B- MUTATIONS IN THE CATALASE- PROXIDE GENE.

3. A 47 year old woman presents with a 3 month history of progressive
cough, weight loss and fever. Chest radiography shows bilateral cavity
disease suggestive.

B- MYCOBACTERIUM KANSASII

4. A 31 year old Asian woman is admitted to the hospital with a 7 week

history of increasing malaise, myalgia, nonproductive cough and shortness
of breath.
E- MYOBACTERIUM TUBERCULOSIS
5. It is very important that the patient in question 4 is also evaluated
for:

A- HIV/AIDS

6. Of concern regarding the patient in question 4 is that she could be

infected with a mycobacterium that is:

E- RESISTANT TO ISONIAZID AND RIFAMPIN

7. You observe a 40 year old man begging on a street in a town in
India. He has clawing of the fourth and fifth digits with loss of distal
parts of the digi of both hands, strongly suggesting.

B- GROWS IN PARTS OF THE BODY THAT ARE COOLER THAN 37 DEG.

8. Which of the followng statements about the purified protein

derivatives and the tuberculin skin test is most correct?
D- A positive tuberculin test result indicates that an individual h been
infected with Mycobacterium tuberculosis in the past and may
continue to carry viable mycobacteria.
9. A 72 year old woman has an artificial hip joint placed because of
degenerative joint disease. One week after the procedure , she has fever and
joint pain. The hip is aspirated, and the fluid

B- MYCOBACTERIUM CHELONAE

10. A 10 year old child has a primary pulmonary Mycobacterium tuberculosis

infection. Which of the following features of tuberculosis is most correct?
A- IN PRIMARY TUBERCULOSIS, AN ACTIVE EXUDATIVE LESION DEVELOPSAND
RAPIDLY SPREADS TO LYMPHATICS AND REGIONAL LYMPH NODES.
11. Which of the following statements regarding interferon-gamma release
assays is correct?

E- They are used as alternatives to the tuberculin skin test to evaluate for
latent tuberculosis.

12. Mycobacterium abscessus most often causes pulmonary disease among

which group of individuals?

C- Elderly, nonsmoking white females

13. A newly characterized rapidly growing mycobacterium that has
emerged as an important causes f central venous catheter

B- Mycobacterium mucogenicum

14. The definition of extensively drug resistant (XDR) tuberculosis

includes:

E- all of the above

15. All of the following organisms are rapidly growing mycobacteria
except:

D- MYCOBACTERIUM NONCHROMOGENICUM
PAGE 345- Mycoplasmas and Cell wall-
defecive bacteria
PAGE 338- Spirochetes and other spiral
microorganisms
PAGE 356- Rickettsia and related genera
PAGE 368- Chlamydia spp.
PAGE 403- Antimicrobial Chemotherapy
PAGE 429- General properties of viruses