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Microbiology III

Microbiology III

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Published by: Jaime Sarmiento Zegarra on Jan 04, 2011
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04/27/2012

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Which of the following viruses produce disease or sequelae that is/are more severe if the infectionoccurs at a very young age?A. Epstein-Barr virusB. Hepatitis B virusC. Measles virusD. PoliovirusE. Varicella zoster virusExplanation:The correct answer is B. Infection with Hepatitis B virus (HBV) at birth or a very young age isassociated with chronic HBV infection and the development of hepatocellular carcinoma later inlife. In fact, infants born to Hepatitis B surface antigen (HBsAg)-positive mothers arecommonly infected, and approximately 90% become chronic carriers of the virus. Chronic carrierssuffer from hepatocellular carcinoma at an incidence over 200 times higher than a noncarrier.The current recommendation for infants born of HBsAg-positive mothers is administration of hepatitis B immunoglobulin (HBIg) in the delivery room, with the first dose of the hepatitis Bvaccine given at the same time or within 1 week. The second and third dose of the vaccine arethen given at 1 and 6 months. With this protocol, 94% protection is achieved.The Epstein-Barr virus (EBV; choice A) is the agent of heterophile-positive infectiousmononucleosis. In children, primary EBV infection is often asymptomatic.The measles virus (choice C) often causes a more severe disease in adults. Over the age of 20,the incidence of complications, including pneumonia, bacterial superinfection of therespiratory tract, bronchospasm and hepatitis, is much higher than in children.Poliovirus (choice D) causes asymptomatic or inapparent infections 95% of the time. Frank  paralysis occurs in approximately 0.1% of all poliovirus infections. However, the probabilityof paralysis increases with increasing age.Varicella zoster virus (choice E) is the agent of chickenpox and shingles. In immunocompetentchildren, it is a benign illness with a mortality of less than 2 per 100,000 cases. This risk is increased over 15-fold in adults. Much of the increase is due to varicella pneumonitis, acomplication that occurs more frequently in adults.A 40-year-old otherwise healthy gardener presents with several subcutaneous nodules on his right hand,where he had cut himself on rose thorns. Physical exam reveals several erythematous fluctuantlesions. Which of the following organisms is most likely responsible for his condition?A. AspergillusB. MalasseziaC. OnchocercaD. RhizopusE. SporothrixExplanation:
 
The correct answer is E. Whenever you see a question on a gardener who works with roses, think "Sporothrix schenckii." This organism is responsible for "rose gardener's disease," knowntechnically as sporotrichosis. The organism enters through skin breaks in the fingers or hands,causing a chancre, papule, or subcutaneous nodule with erythema and fluctuance. Ulceratinglesions appear along lymphatic channels, but the lymph nodes are not commonly infected.Potassium iodide is the treatment of choice for the subcutaneous manifestations.Aspergillus (choice A) causes pulmonary aspergillosis–a systemic mycotic infection. Thereis an allergic type that is caused by a hypersensitivity reaction to the organism and aninfectious type that occurs more commonly in the immunocompromised. Hemoptysis is a commonsymptom.Malassezia (choice B), specifically M. furfur, causes tinea versicolor, a superficial mycoticinfection.Onchocerca (choice C), specifically O. volvulus, causes river blindness. This organism is ahelminth that is transmitted by black flies in Africa, Central America, and South America.Rhizopus (choice D) causes rhinocerebral infections in diabetics with ketoacidosis.A 33-year-old man in Arkansas presents to the local clinic with fever, chills, headache, and generalizedmyalgias and arthralgias. On physical examination, an ulcer with a black base is apparent onhis right hand, and epitrochlear lymphadenopathy is noted. A careful history reveals that theman is a hunter and trapper, recently trapping and skinning rabbits. Which of the followingorganisms is the most likely cause of this man's illness?A. BorreliaB. BrucellaC. FrancisellaD. LeptospiraE. ListeriaExplanation:The correct answer is C. The disease is tularemia, which may be spread by handling rabbits or rabbit skins, or by bites from ticks that feed on the blood of wild rabbits. The causativeorganism is Francisella tularensis, a gram-negative coccobacillus. The disease begins as arupturing pustule followed by an ulcer, with involvement of regional lymph nodes. More seriouscases can be complicated by bacteremia, splenomegaly, rash, pneumonia, or endotoxemic shock.Borrelia(choice A) spp. cause relapsing fever (transmitted by ticks and lice) and Lyme disease(transmitted by ticks).Brucella(choice B) causes brucellosis after ingestion of contaminated milk or contact withinfected livestock.Leptospira (choice D) causes leptospirosis and Weil's disease; the organism is acquired byingestion of water contaminated with animal urine.Listeria (choice E) causes listeriosis after contact with contaminated milk, vegetables, or with transplacental transmission.
 
A 28-year-old HIV-positive male complains of pain on swallowing. Physical examination is remarkable for white plaque-like material on his tongue and buccal mucosa, which is scraped and sent to thelaboratory. Based on these findings, and on the laboratory results, the man is diagnosed withacquired immunodeficiency syndrome (AIDS). With which of the following agents is the man mostlikely infected?A. Candida albicansB. CytomegalovirusC. Herpes simplex ID. Human herpesvirus 8E. Human papilloma virusExplanation:The correct answer is A.Candida albicans produces oral thrush, an AIDS-defining lesion, whichis common in acute HIV disease, and becomes increasing common as the CD4 + cell count falls.The lesions are usually painless. Diagnosis is by demonstration of pseudohyphae using a wetsmear with confirmation by culture.Although cytomegalovirus (choice B) is associated with numerous clinical scenarios in the AIDS population, including odynophagia (painful swallowing), it would not produce white plaques onthe oral mucosa.Herpes Simplex I (choice C) produces vesicular lesions occurring in clusters in the oralcavity. There is an increased risk of herpes infections in the AIDS group, but the lesions donot resemble those described in the question.Human herpesvirus 8 (choice D) is the causative agent of Kaposi's sarcoma, a malignancy arisingfrom endothelial cells that appears as hemorrhagic nodules in different organ systems. It isthe most common cancer in the HIV infected population.Human papilloma virus (choice E) is associated with a variety of lesions, including warts andintraepithelial neoplasias of the vulva and cervix. It is associated with anal condyloma, whichcan occur in the AIDS population.A 26-year-old obstetric patient becomes acutely ill during her first trimester with infectiousmononucleosis-like symptoms, but her heterophil antibody test was negative. A careful historyreveals that the family has two cats in the house. The appropriate laboratory tests indicatethe expectant mother is infected with Toxoplasma gondii. Months later, the woman delivers afull term baby with no obvious signs of infection with the protozoan parasite. The best test todiagnose acute infection in the neonate would be a parasite-specific ELISA for which isotype of immunoglobulin?A. IgAB. IgEC. IgG 1D. IgG 4

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