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microB.txt

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MicroB questions

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1. The class of antibiotics known as the quinolones is bactericidal.


Which of the following is the best characterization of their mode of
action on growing bacteria?
o a. Inactivation of penicillin-binding protein II
o b. Inhibition of beta -lactamase
o c. Inhibition of DNA gyrase
o d. Inhibition of reverse transcriptase

o e. Prevention of the cross-linking of glycine

2. Vancomycin-indeterminate S. aureus (VISA) has recently been


reported in the United States. Which of the following statements
concerning VISA is correct?
o a. Patients with VISA isolates need not be isolated
o b. Minimum inhibitory concentration (MIC) for vancomycin is at least 1.0 mcg/mL
o c. VISAs have emerged because of the extended use of vancomycin for
methicillin-resistant S. aureus (MRSAs)
o d. VISA isolates are infrequent, so surveillance at the present time is not warranted
o e. VISA isolates are usually methicillin susceptible

3. A 55-year-old male develops malaise, fever up to 103.5C, nonproductive cough, headache, and shortness of breath, a few days after
he repaired the cooling system of an old hotel. A chest x-ray reveals
fluid in his lungs. From a sputum sample, a gram-negative rod grew
slowly on a buffered cysteine containing charcoal-yeast agar. Which
of the following antibiotic therapies is most appropriate for treating
this patient?
o a. Ampicillin
o b. Ceftriaxone
o c. Erythromycin
o d. Penicillin
o e. Vancomycin

4. A 60-year-old male resident from a nursing home presents to the


emergency room with a fever of 41C, shaking chills, severe pain to
the right side of his chest that worsens with breathing, and a
productive cough with blood-tinged sputum. During the previous 3
days, he noted cold-like symptoms. Gram stain evaluation of the
sputum reveals gram-positive diplococcic that grow into a-hemolytic

colonies on blood agar. Which of the following antibiotic therapies is


the most appropiate treatment for this patient?
o a. Ampicillin
o b. Ceftriaxone
o c. Erythromycin
o d. Penicillin
o e. Vancomycin

5. A 12-year-old boy, after a camping trip near a wooded area in


Northern California, is taken to the emergency room after
complaining of a headache. He has an erythema migrans rash around
what appears to be a tick bite.Which of the following is the antibiotic
of choice for treating this patient?
o a. Ampicillin
o b. Ceftriaxone
o c. Erythromycin
o d. Penicillin
o e. Vancomycin

6. A 6-year-old girl presents to her pediatrician with fever, headache and


a sore throat. She has swollen tender cervical lymph nodes, and her
oropharynx is red with a gray-white exudate covering both her
tonsils.A rapid strep test of her throat swab is positive, and the culture
subsequently shows beta hemolytic Streptococcus. Which of the
following antibiotic therapies is most appropiate for treating this
patient?
o a. Ampicillin
o b. Ceftriaxone
o c. Erythromycin

o d. Penicillin
o e. Vancomycin

7. A young woman being treated with a broad-spectrum antimicrobial


develops endoscopically observed microabscesses and diarrhea.
Which of the following is the therapy of choice for this form of
enterocolitis?
o a. Ampicillin
o b. Ceftriaxone
o c. Erythromycin
o d. Penicillin
o e. Vancomycin

8. Antibiotic therapy may be a critical step in the management of


patients infected with the following microorganisms. Which organism
listed below would not benefit from prompt antibiotic treatment?
o a. anthracis
o b. botulinum
o c. difficile
o d. perfringens
o e. tetani

9. A 75-year-old African American male with neurogenic bladder


presents to the emergency room with hypertension, fever up to
104.6F, and nausea and vomiting. The urine from his foley catheter
gives a positive culture for Enterococcusfaecalis. Which of the
following antibiotics inhibits the final peptide bond between dalanine and glycine and is the most appropriate treatment for this
patient?
o a. Amdinocillin

o b. Amphotericin
o c. Chloramphenicol
o d. Penicillin
o e. Trimethoprim

10.
A patient with leukemia has a chest CT finding that suggests
aspergillosis. Which of the following antimicrobial binds sterols and
alters membrane permeability, and would most likely be used in this
patients treatment?
o a. Amdinocillin
o b. Amphotericin
o c. Chloramphenicol
o d. Penicillin
o e. Trimethoprim

11.
A 10-week-old infant is diagnosed with meningitis. A lumbar
puncture reveals numerous neutrophils and gram-positive rods. She is
admitted to the hospital and is thought to be allergic to beta-lactams.
Which of the following antibiotics attaches to 505 ribosome, inhibits
peptidyl transferase, and would most likely be used to treat this
patient?
o a. Amdinocillin
o b. Amphotericin
o c. Chloramphenicol
o d. Penicillin
o e. Trimethoprim

12.
A patient presents to the emergency room with vomiting,
diarrhea, high fever, and delirium. Upon physical exam, you notice

large, painful buboes, and disseminated intravascular coagulation.


Laboratory diagnosis of aspirate taken from the bubo reveals a gramnegative rod with bipolar staining resembling a safety pin. Which of
the following antibiotics is most appropiate as part of your immediate
treatment?
o a. Ceftazidine
o b. Ceftriaxone
o c. Penicillin
o d. Streptomycin
o e. Vancomycin

13.
A 3-year-old girl who has missed several scheduled
immunizations presents to the emergency room with a high fever. She
is irritable and has a stiff neck. Fluid from a spinal tap reveals 20,000
white blood cells per milliliter with 85% polymorphonuclear cells.
Which of the following is the preferred third-generation
cephalosporin with good activity against organisms of childhood
meningitis?
o a. Ceftazidine
o b. Ceftriaxone
o c. Penicillin
o d. Streptomycin
o e. Vancomycin

14.
A 28-year-old female just returned from a 1-week cruise with
stops along the coast of Mexico. Forty-eight hours after her return she
is reported to have headache, fever, abdominal cramps, and
constipation. Over the next 5 days her fever increases with continued
complaints of myalgias, malaise, and anorexia. A blood culture is
positive for S. typhi. Her condition improves with a treatment course

of a cephalosporin. Which of the following is the function of porins


that would prevent the effective use of other antimicrobials ?
o a. Hydrolysis of hydrophilic antimicrobials
o b. Metabolism of phosphorylated intermediates
o c. Serologic stabilization of the O antigen
o d. Inactivation of hydrophobic antimicrobials
o e. Transfer of small molecules through the outer membrane

15.
A patient presents to the emergency room with a progressive
fever, cough, and general malaise. History determines that he works
with sheep on a farm and had just been involved in wool harvesting.
Which of the following antibiotics is most appropriate as part of your
immediate treatment?
o a. Ceftazidine
o b. Ceftriaxone
o c. Penicillin
o d. Streptomycin
o e. Vancomycin

16.
During the course of his hospital stay, a severely burned 60year-old male develops a rapidly disseminating bacterial infection.
Small gram-negative rods that are oxidase positive are cultured from
green pus taken from the burn tissue. Which of the following thirdgeneration cephalosporin will most likely have the best primary
activity against this etiologic agent?
o a. Ceftazidine
o b. Ceftriaxone
o c. Penicillin

o d. Streptomycin
o e. Vancomycin

17.
Laboratory results of a clinical specimen from a patient with
hospital-acquired pneumonia reveal the presence of Staphylococcus
aureus with a methicillin-resistant plasmid. Which of the following
drugs is the best immediate treatment?
o a. Ceftazidine
o b. Ceftriaxone
o c. Penicillin
o d. Streptomycin
o e. Vancomycin

18.
Antibiotics that inhibit dihydrofolic acid reductase in bacteria up
to 50,000 times more than in mammalian cells is represented by
which of the following agents?
o a. Amdmocillin
o b. Amphotericin
o c. Chloramphenicol
o d. Penicillin
o e. Trimethoprim

19.
An 18-year-old college freshman presents with fever of 103F,
headache, right flank pain, nausea and vomiting, and urinary
frequency with hematuria and dysuria. Renal ultrasound demonstrates
a right urinary stone with right hydronephrosis. Which of the
following antibiotics binds to PBP-2 and is the most appropriate
treatment option?
o a. Amdinocillin

o b. Amphotericin
o c. Chloramphenicol
o d. Penicillin
o e. Trimethoprim

20.
A patient presents to the emergency room with vomiting,
diarrhea, high fever, and delirium. Upon physical exam, you notice
large, painful buboes, and disseminated intravascular coagulation.
Laboratory diagnosis of aspirate taken from the bubo reveals a gramnegative rod with bipolar staining resembling a safety pin. Which of
the following antibiotics is most appropriate as part of your
immediate treatment?
o a. Ceftazidine
o b. Ceftriaxone
o c. Penicillin
o d. Streptomycin
o e. Vancomycin

21.
Regarding antimicrobial drugs that act by inhibiting nucleic acid
synthesis in bacteria, which one of the following is the MOST
accurate?
o a. Quinolones, such as ciprofloxacin, inhibit the RNA poly-merase in bacteria by
acting as nucleic acid analogues
o b. Rifampin inhibits the RNA polymerase in bacteria by binding to the enzyme
and inhibiting messenger RNA synthesis
o c. Sulfonamides inhibit the DNA polymerase in bacteria by causing chain termination
of the elongating strand
o d. Trimethoprim inhibits the DNA polymerase in bacteria by preventing the
unwinding of double-stranded DNA

22.
Endotoxin is an important underlying cause of septic shock and
death, especially in hospitalized patients. Regarding endotoxin, which
one of the following is the MOST accurate?
o a. It acts by phosphorylating the G stimulating protein
o b. It is a polypeptide with an A-B subunit configuration
o c. It induces the synthesis of tumor necrosis factor
o d. It is found primarily in gram-positive rods
o e. It can be treated with formaldehyde to form an effective toxoid vaccine

23.
A family routinely consumed unpasteurized milk, claiming
"better taste." Several members experienced a sudden onset of
crampy abdominal pain, fever, and bloody, profuse diarrhea. C. jejuni
was isolated and identified from all patients. Which of the following
is the treatment of choice for this type of enterocolitis?
o a. Ampicillin
o b. Campylobacter antitoxin
o c. Ciprofloxacin
o d. Erythromycin
o e. Pepto-Bismol

24.
An outbreak of postsurgical wound infections caused by
staphylococcu aureus has occurred. The infection control team wsa
asked to determine whether the organism could be carried by one of
the operating room personnel. Using your knowledge of normal flora,
which on eof the following body sites is the MOST likely location for
this organism?
o Colon
o Gingival crevice
o Nose

o Throat
o Vagina

25.
Several Neisseria species are a part of the normal flora
(commensals) of the human upper respiratory tract. Which of the
following statements accurately describes the significance of these
bacteria?
o a. As a part of the normal flora, Neisseriae provide a natural immunity in local
host defense
o b. As a part of the respiratory flora, they are the most common cause of acute
bronchitis and pneumonia
o c. Commensal bacteria stimulate a cell-mediated immunity (CMI)
o d. Commensal Neisseriae in the upper respiratory tract impede phagocytosis by means
of lipoteichoic acid
o e. Normal flora such as nonpathogenic Neisseriae provide effective nonspecific Bcell-mediated humoral immunity

26.
A 60-year-old female complains of tenderness and pain around a
peritoneal catheter. Blood cultures reveal gram-positive, catalasepositive cocci. Which of the following is the most likely organism
which is also considered a predominant organism on skin?
o a. a-hemolytic streptococci
o b. B. ragtlis
o c. E. coli
o d. Lactobacillus
o e. S, epidermidis

27.
A 60-year-old female complains of tenderness and pain around a
peritoneal catheter. Blood cultures reveal gram-positive, catalasepositive cocci. Which of the following is the most likely organism
which is also considered a predominant organism on skin?

o a. a-hemolytic streptococci
o b. B. ragtlis
o c. E. coli
o d. Lactobacillus
o e. S, epidermidis

28.
A 65-year-old woman had symptoms of dementia. An MRI
revealed significant cortical atrophy. It was determined that her
intraventricular pressure was very high, and a ventriculoperitoneal
shunt (from the brain, tunneling under the skin into the peritoneal
cavity) was placed to relieve the pressure. Three weeks later she
developed a fever to 38C, malaise, and anorexia but no other
symptoms. Of the following, which one BEST describes MOST
likely organism causing her current symptoms?
o a. A gram-positive coccus that does not clot plasma
o b. A curved gram-negative rod that produces urease
o c. An acid-fast rod that does not grow on bacteriologic media
o d. An obligate intracellular parasite that forms a cytoplasmic inclusion body
o e. A spirochete that induces an antibody that agglutinates a lipid from a cow's heart

29.
A 25-year-old man was in a motorcycle accident 3 days ago, in
which he sustained severe head trauma. He has had spinal fluid
leaking from his nose since the accident and now develops a severe
headache. His temperature is 39C, and on examination you find
nuchal rigidity. You do a lumbar puncture and find that the spinal
fluid is cloudy and contains 5000 WBC/|o,L, 90% of which are polys.
Of the following, which one is the MOST likely result observed in
the laboratory analysis of the spinal fluid?
o a. Gram-negative rods that grew only anaerobically
o b. A motile spirochete that formed p-hemolytic colonies on blood agar

o c. Gram-positive cocci that formed a-hemolytic colonies on blood agar


o d. Gram-positive cocci that grew only in the presence of 6.5% sodium chloride
o e. Gram-positive rods that grew only on chocolate agar supplemented with X and V
factors
o f. No organism was seen using Gram stain, but tissue stains revealed cytoplasmic
inclusion bodies

30.
Your patient is a 10-year-old girl who has leukemia and is
receiving chemotherapy through an indwelling venous catheter. She
now has a fever of 39C but is otherwise asymptomatic. You do a
blood culture, and the laboratory reports growth of Staphylococcus
epidermidis. Which one of the following results is LEAST likely to
be found by the clinical laboratory?
o a. Gram-positive cocci in clusters were seen on Gram stain of the blood culture
o b. Subculture of the blood culture onto blood agar revealed non-hemolytic colonies
o c. A coagulase test on the colonies was negative
o d. A catalase test on the colonies was negative

31.
A 60-year-old woman had surgery for ovarian carcinoma 4 days
ago and has an indwelling urinary catheter in place. She now spikes a
fever to 39C and has cloudy urine in the collection bottle. Gram
stain of the urine shows many polys and gram-positive cocci in
chains. Which one of the following would be the MOST likely
findings in the urine culture?
o a. Hemolytic colonies on the blood agar plate that are optochin-sensitive
o b. Hemolytic colonies on the blood agar plate that are bacitracin-sensitive
o c. Nonhemolytic colonies on the blood agar plate that hydrolyze hippurate
o d. Nonhemolytic colonies on the blood agar plate that grow in 6.5% sodium
chloride

32.
A 40-year-old male had been in good health until he began
experiencing a chronic cough. Over the following 6 weeks the cough
gradually worsened and became productive. He also noted weight
loss, fever, night sweats, and coughing blood. A sputum sample was
positive for acid-fast bacilli. Which of the following pathogenic
mechanisms can be primarily attributed to the etiologic agent
involved in this disease?
o a. Cell-mediated hypersensitivity
o b. Clogging of alveoli by large numbers of acid-fast mycobacteria
o c. Humoral immunity
o d. Specific cell adhesion sites
o e. Toxin production by the mycobacteria

33.
Your patient is a 6-year-old boy with papular and pustular skin
lesions on his face. A serous, "honey-colored" fluid exudes from the
lesions. You suspect impetigo. A Gram stain of the pus reveals many
neutrophils and gram-positive cocci in chains.If you cultured the pus
on blood agar, which one of the followingwould you be MOST likely
to see?
o a. Small B-hemolytic colonies containing bacteria that are bacitracin-sensitive
o b. Small a-hemolytic colonies containing bacteria that are resistant to optochin
o c. Large nonhemolytic colonies containing bacteria that are oxidase-positive
o d. Small nonhemolytic colonies containing bacteria that grow in 6.5% NaCl

34.
Your patient is a 3-year-old girl with fever and pain in her right
ear. On physical examination, the drum is found to be perforated and
a bloody exudate is seen. A Gram stain of the exudate reveals grampositive diplococci. Of the following, which one is the MOST likely
cause?
o a. Streptococcus pyogenes

o b. Staphylococcus aureus
o c. Corynebacterium diphtheriae
o d. Streptococcus pneumoniae

35.
Your patient is a 15-year-old boy with migratory polyarthritis,
fever, and a new, loud cardiac murmur. You make a clinical diagnosis
of rheumatic fever. Which one of the following laboratory results is
MOST likely to be found in this patient?
o a. A blood culture is positive for Streptococcus pyogenes at this time
o b. A throat culture is positive for Streptococcus pyogenes at this time
o c. A Gram stain of the joint fluid shows gram-positive cocci in chains at this time
o d. An anti-streptolysin O assay is positive at this time

36.
Your patient is a 20-year-old man who was in a fist fight and
suffered a broken jaw and lost two teeth. Several weeks later, he
developed an abscess at the site of the trauma that drained to the
surface of the skin, and yellowish granules were seen in the pus.
Regarding this disease, which one of the following is MOST
accurate?
o a. The causative organism is a gram-positive rod that forms long filaments
o b. The causative organism is a comma-shaped gram-negative rod that produces an
exotoxin which increasescyclic AMP
o c. The causative organism cannot be seen in the Gram stain but can be seen in an acidfast stain
o d. A combination of gram-negative cocci and spirochetes cause this disease

37.
Your patient is a 70-year-old woman who had a hysterectomy
for carcinoma of the uterus 3 days ago. She has an indwelling urinary
catheter in place and now has a fever to 39C, and the urine in the
collection bottle is cloudy. A Gram stain of the urine specimen shows
many neutrophils and gram-positive cocci in chains. You also do a

urine culture. Which one of the following is the MOST likely set of
findings on the urine culture?
o a. b-Hemolytic colonies that are bacitracin-sensitive
o b. b-Hemolytic colonies that are optochin-sensitive
o c. Nonhemolytic colonies that grow in 6.5% sodium chloride
o d. Nonhemolytic colonies that grow only anaerobically

38.
Your patient is a 10-year-old girl who has had pain in her left
arm for the past 5 days. On physical examination, her temperature is
38C and there is tenderness of the humerus near her deltoid. On Xray of the humerus, an area of raised periosteum and erosion or bone
is seen. You do a blood culture. Which one of the following is the
MOST likely set of findings'
o a. Gram-negative rods that grow on EMB agar, forming purple colonies and a green
sheen
o b. Gram-positive cocci that grow on blood agar, causing a clear zone of
hemolysis, and are coagulase-positive
o c. Gram-positive rods that grow only anaerobically and form a double zone of
hemolysis on blood agar
o d. Gram-negative diplococci that grow on blood agar, are oxidase-positive, and
ferment maltose

39.
Your patient is a 10-year-old boy who is receiving chemotherapy
for acute leukemia. He develops fever, headache, and stiff neck, and
you make a presumptive diagnosis of meningitis i~-do a lumbar
puncture. A Gram stain reveals a small gram-positive rod, and culture
of the spinal fluid grows a beta-hemolytic colony of blood agar.
Regarding this organism, which one of the following is MOST
accurate?
o a. It has more than 100 serologic types
o b. It produces an exotoxin that inhibits elongation factor 2

o c. It is commonly acquired by eating unpasteurized dairy products


o d. There is a toxoid vaccine available against this organism

40.
Ms. Jones calls to say that she, her husband, and their child have
had nausea and vomiting for the past hour or so. Also, they have had
some nonbloody diarrhea. You ask when their last meal together was,
and she says they had a picnic lunch in the park about 3 hours ago.
They have no fever. Which one of the following is the MOST likely
finding?
o a. Gram stain of the leftover food would show many gram-positive cocci in
clusters
o b. Gram stain of the stool would show many gram-negative diplococci
o c. KOH prep of the leftover food would show many budding yeasts
o d. Acid-fast stain of the stool would show many acid-fast rods

41.
A 4-week-old newborn develops meningitis. Short, grampositive rods are isolated. History reveals that the mother had eaten
unpasteurized cheese from Mexico during the pregnancy, and she
recalled having a flu like illness. Which of the following is the most
likely etiologic microorganism?
o a. C. diphtheriae
o b. E. coli
o c. Group B streptococci
o d. Listeria monocytogenes
o e. S. pneumnoniae

42.
A patient appears in the emergency room with a submandibular
mass. A smear is made of the drainage and a bewildering variety of
bacteria are seen, including branched, gram-positive rods. Which of
the following is the most clinically appropriate action?

o a. Consider vancomycin as an alternative drug


o b. Determine if fluorescent microscopy is available for the diagnosis of
actinomycosis
o c. Do no further clinical workup
o d. Suggest to the laboratory that low colony counts may reflect infection
o e. Suggest a repeat antibiotic susceptibility test

43.
A patient complains to his dentist about a draining lesion in his
mouth. A Gram stain of the pus shows a few gram-positive cocci,
leukocytes, and many-branched gram-positive rods. Branched yellow
sulfur granules are observed by microscopy. Which of the following
is the most likely cause of the disease?
o a. Actinomyces israelii
o b. Actinomyces viscosus
o c. C. diphtheriae
o d. Propionibacterium acnes
o e. S. aureus

44.
A 2-year-old child has a high fever and is irritable. He has a stiff
neck. ( i ram stain smear of spinal fluid reveals gram-negative, small
pleomorphic coccobacillary organisms. What is the most appropriate
procedure to follow in order to reach an etiological diagnosis?
o a. Culture the spinal fluid in chocolate agar, and identify the organism by growth
factors
o b. Culture the spinal fluid in mannitol-salt agar
o c. Perform a catalase test of the isolated organism
o d. Perform a coagulase test with the isolate
o e. Perform a latex agglutination (LA) test to detect the specific antibody in the spinal
fluid

45.
A severely burned firefighter develops a rapidly disseminating
bacterial infection while hospitalized. "Green pus" is noted in the
burned tissue, and cultures of both the tissue and blood yield small,
oxidase-positive, gram-negative rods. Which of the following
statements about this organism is correct?
o a. Endotoxin is the only virulence factor known to be produced by these bacteria
o b. Humans are the only known reservoir hosts for these bacteria
o c. The bacteria are difficult to culture because they have numerous growth
requirements
o d. These are among the most antibiotic resistant of all clinically relevant bacteria
o e. These highly motile bacteria can "swarm" over the surface of culture media

46.
Several days after an unprotected sexual encounter, a healthy 21
year-old male develops pain and pus on urination. A Gram stain
revealed gram-negative diplococci. Which of the following structures
is responsible for adherence of the offending microbe to the urethral
mucosa?
o a. Capsule
o b. Fimbriae
o c. Flagella
o d. The F pili
o e. The peptidoglycan
o f. The lipopolysaccharide (LPS)

47.
A 2-year-old boy who missed several scheduled immunizations
presents to the emergency room with a high fever, irritability, and a
stiff neck. Fluid from a spinal tap reveals 20,000 white blood cells
WBCs per mL with 85% polymorphonuclear cells. Gram stain
evaluation of the fluid reveals small pleomorphic gram-negative rods
that grow on chocolate agar. If an inhibitor is designed to block its

major virulence, which of the following would be the most likely


target?
o a. Capsule formation
o b. Endotoxin assembly
o c. Exotoxin liberator
o d. Flagella synthesis
o e. IgA protease synthesis
o f. H influenzae

48.
Your patient is a 70-year-old man with a long history of smoking
who now has a fever and a cough productive of greenish sputum. You
suspect pneumonia, and a chest X-ray confirms your suspicion. If a
Gram stain of the sputum reveals very small gram-negative rods and
there is no growth on a blood agar but colonies dogrow on chocolate
agar supplemented with NAD and heme, which one of the following
bacteria is the MOST likely cause?
o a. Chlamydia pneumoniae
o b. Legionella pneumophila
o c. Mycoplasma pneumoniae
o d. Haemophilus influenzae

49.
Your patient is a 20-year-old woman with the sudden onset of
fever to 104F and a severe headache. Physical examination reveals
nuchal rigidity. You suspect meningitis and do a spinal tap. Gram
stain of the spinal fluid reveals many neutrophils and many gramnegative diplococci. Of the following bacteria, which one is MOST
likely to be the cause?
o a. Haemophilus influenzae
o b. Neisseria meningitidis

o c. Streptococcus pneumoniae
o d. Pseudomonas aeruginosa

50.
Your patient is a 6-year-old boy with a history of several
episodes of pneumonia. A sweat test revealed an increased amount of
chloride, indicating that he has cystic fibrosis. He now has a fever
and is coughing up a thick, greenish sputum. A Gram stain of the
sputum reveals gram-negative rods. Of the following, which one is
the MOST likely organism to cause this infection?
o a. Pseudomonas aeruginosa
o b. Haemophilus influenzae
o c. Legionella pneumophila
o d. Bordetella pertussis

51.
Your patient is a 28-year-old man with third-degree burns over a
large area of his back and left leg. This morning, he spiked a fever to
40C and had two teeth-chattering chills. A blood culture grows a
gram-negative rod that is oxidase-positive and produces a blue-green
pigment. Of the following, which one is the MOST likely organism to
cause this infection?
o a. Prevotella melaninogenica
o b. Pseudomonas aeruginosa
o c. Proteus mirabilis
o d. Haemophilus influenza

52.
A 70-year-old woman has sustained third-degree bums over a
Significant area of her body. Despite appropriate burn care in the
hospital, she spiked a fever to 39C, and the nurse reports blue-green
pus on the dressing covering the burned area. Gram stain of the pus
reveals gram-negative rods, and antibiotic sensitivity tests show

resistance to most antibiotics. Which one of the following organisms


is MOST likely to cause this disease?
o a. Nocardia astemides
o b. Vibrio vulnificus
o c. Bacteroidesfragilis
o d. Haemophilus influenzas
o e. Pseudomonas aeruginosa

53.
Your patient is a 30-year-old man with acute onset of fever to
40C and a swollen, very tender right femoral node. His blood
pressure is 90/50, and his pulse is 110. As you examine him, he has a
teeth-chattering shaking chill. He returned from a camping trip in the
Southern California desert 2 days ago. Regarding this disease, which
one of the following is MOST accurate?
o a. An aspirate of the node will reveal a small gram-negative rod
o b. The organism was probably acquired by eating food contaminated with rodent
excrement
o c. The aspirate of the node should be cultured on Lowenstein-Jensen agar and an acidfast stain performed
o d. The organism causes disease primarily in people with impaired cell-mediated
immunity

54.
A 55-year-old man who is being treated for adenocarcinoma of
the lung is admitted to a hospital because of a temperature of 38.9C
(102F), chest pain, and a dry cough. Sputum is collected. Gram stain
of the sputum is unremarkable, and culture reveals many small, gramnegative rods able to grow only on a charcoal yeast extract agar.
Which of the following is the most likely organism?
o a. Chlamydia trachomatis
o b. Klebsiella pneumonias

o c. Legionella pneumophila
o d. M. pneumoniae
o e. S. aureus

55.
A severely burned firefighter develops a rapidly disseminating
bacterial infection while hospitalized. "Green pus" is noted in the
burned tissue, and cultures of both the tissue and blood yield small,
oxidase-positive, gram-negative rods. Which of the following
statements about this organism is correct?
o a. Endotoxin is the only virulence factor known to be produced by these bacteria
o b. Humans are the only known reservoir hosts for these bacteria
o c. The bacteria are difficult to culture because they have numerous growth
requirements
o d. These are among the most antibiotic resistant of all clinically relevant bacteria
o e. These highly motile bacteria can "swarm" over the surface of culture media

56.
A 16-year-old Hispanic female with poor oral hygiene and
severe gingivitis presents with a temperature of 103.5F and
hypotension. Blood culture is positive for Capnocytophaga. Which of
the following statements best characterizes Capnocytophaga?
o a. A gram-negative, pleomorphic rod that can cause endocarditis
o b. A gram-negative rod, fusiform-shaped, that is associated with periodontal
disease but may cause sepsis
o c. The causative agent of rat-bite fever
o d. The causative agent of sinusitis, bronchitis, and pneumonia
o e. The causative agent of trench fever

57.
A 6-year-old boy fell and sustained a deep wound from a rusty
nail that penetrated his thigh. His mother removed the nail and
cleaned the wound with soap and water. The next morning, he had a

temperature of 102F, and his thigh was very painful and swollen. In
the emergency room, crepitus (gas in the tissue)was noted. A Gram
stain of exudate from the wound area revealed large gram-positive
rods. Which one of the following is the MOST likely cause?
o a. Actinomyces israelii
o b. Clostridium perfringens
o c. Clostridium tetani
o d. Listeria monocytogenes
o e. Mycobacterium fortuitum-chelonei complex
o f. Nocardia asteroides
o g. Pseudomonas aeruginosa

58.
A 70-year-old woman has the rapid onset of fever to 39C and a
cough productive of greenish sputum. She is not hospitalized and not
immunocompromised. A chest X-ray reveals a left lower lobe
infiltrate. Of the following, which set of findings describes the MOST
likely causative organism found in the sputum culture?
o a. Gram-positive diplococci that form an a-hemolytic colony
o b. Gram-negative diplococci that form an oxidase-positive colony
o c. Gram-positive rods that form a 3-hemolytic colony
o d. Gram-negative rods that form an oxidase-positive colony
o e. Gram-negative cocci that grow only anaerobically

59.
A 25-year-old pregnant woman in the third trimester comes to
the emergency room saying that about 12 hours ago she began to feel
feverish and weak. On examination, she has a temperature of 40C
but no other pertinent findings. A blood culture grows small grampositive rods that cause (3-hemolysis on a bloodagar plate incubated

in room air. Which one of the following bacteria is the MOST likely
cause?
o a. Clostridium perfringens
o b. Streptococcus pyogenes
o c. Bacillus cereus
o d. Listeria monocytogenes
o e. Brucella abortus

60.
Streptococcus mutans is best described by which of the
following statements?
o a. An anaerobic, filamentous bacterium that often causes cervicofacial osteomyelitis
o b. A beta hemolytic organism that causes a diffuse, rapidly spreading cellulitis
o c. A facultative anaerobe that is highly cariogenic and sticks to teeth by synthesis
of a dextran
o d. A facultative anaerobe that often inhabits the buccal mucosa early in a neonate's life
and can cause bacterial endocarditis
o e. A facultatively anaerobic, rod-shaped bacterium that sticks to teeth and is cariogenic

61.
Streptococcus salivarius, a common isolate in the clinical
laboratory, is best described by which of the following statements?
o a. An anaerobic, filamentous bacterium that often causes cervicofacial osteomyelitis
o b. A beta-hemolytic organism that causes a diffuse, rapidly spreading cellulitis
o c. A facultative anaerobe that is highly cariogenic and sticks to teeth by synthesis of a
dextran
o d. A facultative anaerobe that often inhabits the buccal mucosa early in a
neonate's life and can cause bacterial endocarditis
o e. A facultatively anaerobic, rod-shaped bacterium that sticks to teeth and is cariogenic

62.
A patient was hospitalized after an automobile accident. The
wounds became infected, and the patient was treated with
tobramycin, carbenicillin, and clindamycin. Five days after antibiotic
therapy was initiated, the patient developed severe diarrhea and
pseudomembranous enterocolitis. Antibiotic-associated diarrhea and
the more serious pseudomembranous enterocolitis can be caused by
which of the following organisms?
o a. B.fragilis
o b. Clostridium difficile
o c. Clostridium perfringens
o d. Clostridium sordellii
o e. S. aureus

63.
Your patient is a 27-year-old woman who was treated with oral
ampicillin for cellulitis caused by Streptococcus pyogenes. Several
days later, she developed bloody diarrhea. You suspect that she may
have pseudomembranous colitis. Regarding the causative organism of
pseudomembranous colitis, which one of the following is the MOST
accurate?
o a. It is an anaerobic gram-positive rod that produces exotoxins
o b. It is a comma-shaped gram-negative rod that grows best at 41C
o c. It is an obligate intracellular parasite that grows in cell culture but not on blood agar
o d. It is a yeast that forms germ tubes when incubated in human serum at 37C

64.
Your patient is a 70-year-old man with a fever of 40C and a
very painful cellulitis of the right buttock. The skin appears necrotic,
and there are several fluid-filled bullae. Crepitus can be felt,
indicating gas in the tissue. A Gram stain of the exudate reveals large
gram-positive rods. Of the following, which one is the MOST likely
cause?

o a. Clostridium perfringens
o b. Bacillus anthracis
o c. Corynebacterium diphtheriae
o d. Actinomyces israelii

65.
Several hours after dining on sweet and sour chicken and pork
fried rice at the home of an Asian friend, a 34-year-old car salesman
exhibits abdominal discomfort, nausea, and vomiting. In the middle
of the night he awakens with watery diarrhea. Which of the following
pairs of organisms is routinely responsible for food poisoning?
o a. Clostridium botulinum and Bacillus anthracis
o b. C. difficile and C. botulinum
o c. C. perfringens and Bacillus cereus
o d. C. tetani and B. anthracis
o e. Clostridium t. and B. cereus

66.
One of the bacteria isolated from the foul-smelling exudates
taken from an abscess is missing superoxide dismutase, catalase, and
a peroxidase.Which of the following statements best describes this
microorganism?
o a. Aminoglycoside antibiotics will be effective against this bacterium
o b. This bacterium is a facultative aerobe
o c. This bacterium is an anaerobe
o d. This bacterium is more virulent than one containing the three enzymes
o e. This bacterium will survive in an O2 environment

67.
A 25-year-old medical student presented with a ruptured
appendix. A peritoneal infection developed, despite prompt removal
of the organ and extensive flushing of the peritoneal cavity. An

isolate from a pus culture was a gram-negative rod identified as


Bacteroides fragilis. Anaerobic infection with B. fragilis is best
characterized by which of the following?
o a. A black exudate in the wound
o b. A foul-smelling discharge
o c. A heme-pigmented colony formation
o d. An exquisite susceptibility to penicillin
o e. Severe neurologic symptoms

68.
A 17-year-old man is hospitalized with trauma to the abdomen
following a gang-related fight. He develops an intra-abdominal
abscess, which is drained and sent to the laboratory. A mixture of
gram-negative anaerobes are detected. Which of the following
microorganisms is the most likely and is also the most prevalent
bacterium in the gut?
o a. a-Hemolytic Streptococci
o b. B.fragilis
o c. E. coli
o d. Lactobacillus
o e. S. epidermidis

69.
Your patient is a 62-year-old woman with a history of carcinoma
of the sigmoid colon that was removed 5 days ago. The surgery was
complicated by the escape of bowel contents into the peritoneal
cavity. She now has fever and pain in the perineum and left buttock.
On physical examination, her temperature is 39C and myonecrosis
with a foul-smelling discharge is found. A Gram stain of the exudate
reveals gram-negative rods. Of the following, which one is the
MOST likely organism to cause this infection?
o a. Helicobacter pylori

o b. Bacteroides fmgilis
o c. Salmonella typhi
o d. Vibrio parahaemolyticus

70.
Your patient is a 30-year-old woman who was part of a tour
group visiting a Central American country. The day before leaving,
several members of the group developed fever, abdominal cramps,
and bloody diarrhea.Of the following, which one is the LEAST likely
organism to cause this infection?
o a. Shigella dysenteriae
o b. Salmonella enteritidis
o c. Vibrio cholerae
o d. Campylobacter jejuni

71.
A stool culture reveals no lactose-negative colonies on the EMB
agar. Which one of the following is the MOST likely organism to
cause this infection?
o a. Shigella dysenteriae
o b. Salmonella enteritidis
o c. Vibrio cholerae
o d. Campylobacter jejuni

72.
Your patient is a 55-year-old man with severe cellulitis of the
right leg, high fever, and a teeth-chattering chill. He is a fisherman
who was working on his boat in the waters off the Texas coast
yesterday.Which one of the following organisms is MOST likely to
be the cause of his disease?
o a. Yersinia pestis
o b. Vibrio vulnificus

o c. Pasteurella multocida
o d. Brucella melitensi

73.
Your patient is a 5-year-old girl with bloody diarrhea and no
vomiting. There is no history of travel outside of San Francisco. Stool
culture grows both lactose-positive and lactose-negative colonies on
EMB agar.Of the following organisms, which one is MOST likely to
be the cause?
o a. Shigella sonnei
o b. Salmonella typhi
o c. Campylobacter jejuni
o d. Helicobacter pylori

74.
Your patient is a 50-year-old woman who returned yesterday
from a vacation in Peru, where there is an epidemic of cholera. She
now has multiple episodes of diarrhea. Of the following, which one is
MOST compatible with cholera?
o a. Watery diarrhea without blood, no polys in the stool, and growth of curved gramnegative rods in the blood culture
o b. Watery diarrhea without blood, no polys in the stool, and no organisms in the
blood culture
o c. Bloody diarrhea, polys in the stool, and growth of curved gram-negative rods in the
blood culture
o d. Bloody diarrhea, polys in the stool, and no organisms in the blood culture

75.
Your patient is a 40-year-old woman with a severe attack of
diarrhea that began on the airplane while she was returning from a
vacation in the Middle East. She had had multiple episodes of watery.
nonbloody diarrhea and little vomiting. She is afebrile. A stool culture
reveals only lactose-fermenting colonies on EMB agar. Of the
following, which one is the MOST likely cause?

o a. Shigella sonnei
o b. Helicobacter pylori
o c. Escherichia coli
o d. Pseudomonas aeruginosa

76.
Ten boy scouts are hospitalized with bloody diarrhea and severe
hematological abnormalities. An investigation establishes that all of
the boys developed symptoms following consumption of hamburgers
from the same fast-food restaurant chain. Which of the following best
describes E. coli 0157/H7, the etiologic bacterium responsible for the
outbreak?
o a. It produces at least one protein toxin consisting of two subunits, A and B, that cause
severe spasmodic cough, usually in children
o b. It produces a toxin that blocks protein synthesis in an infected cell and carries a
lytic bacteriophage that produces the genetic information for toxin production
o c. It secretes an erythrogenic toxin that causes the characteristic signs of scarlet fever
o d. It secretes an exotoxin that has been called "verotoxin" and "Shiga-like
toxin"; infection is mediated by specific attachment to mucosal membranes It
requires cysteine for growth

77.
A 65-year-old healthy retired former executive female went on
her yearly vacation to Mexico. Unlike her previous trips she decided
to use the local water to make her favorite punch. Thirty-six hours
later she developed profused watery diarrhea, severe cramping, and
abdominal pain. She was diagnosed with E. coli related diarrhea.
Which of the following E. coli types is characterized by the presence
of heat-labile (LT) and heat-stable (ST) proteins?
o a. Enteroinvasive (EIEC)
o b. Enterotoxigenic (ETEC)
o c. Enterohemorrhagic (EHEC)
o d. Enteropathogenic (EPEC)

o e. Enterohemolytic (EHEEC)

78.
Your patient is a 20-year-old woman with severe diarrhea that
began yesterday. She has just returned from a 3 week trip to Peru,
where she ate some raw shellfish at the farewell party. She now has
watery diarrhea, perhaps 20 bowel movements a day, and is feeling
quite weak and dizzy. Her stool is guaiac-negative, a test that
determines whether there is blood in the stool. A Gram stain of the
stool reveals curved gram-negative rods. Of the following organisms,
which one is MOST likely to be the cause of her diarrhea?
o a. Bacteroidesfragilis
o b. Campylobacterjejuni
o c. Entamoeba histolytica
o d. Helicobacterpylori
o e. Shigella dysenteriae
o f. Vibrio cholerae
o g. Yersinia enterocolitica

79.
Several hours after dining on sweet and sour chicken and pork
fried rice at the home of an Asian friend, a 34-year-old car salesman
exhibits abdominal discomfort, nausea, and vomiting. In the middle
of the night he awakens with watery diarrhea. Which of the following
pairs of organisms is routinely responsible for food poisoning?
o a. Clostridium botulinum and Bacillus anthracis
o b. C. difficile and C. botulinum
o c. C. perfringens and Bacillus cereus
o d. C. tetani and B. anthracis
o e. Clostridium t. and B. cereus

80.
A 40-year-old female reports chronic gastritis. She tests positive
for H. pylori. After a course of the appropriate antibiotic therapy her
symptoms subside. Which of the following is the most effective
noninvasive test for the diagnosis of Helicobacter -associated gastric
ulcers?
o a. Culture of stomach contents for H. pylon
o b. Detection of H. pylori antigen in stool
o c. Growth of H. pylori from a stomach biopsy
o d. Growth of H. pylori in the stool
o e. IgM antibodies to H. pylori

81.
Although cholera, a Vibrio infection, has rarely been seen in the
USA , there have been recent outbreaks of classic cholera associated
with shellfish harvested from the Gulf of Mexico. Vibrios are shaped
like curved rods, and infections more common than cholera may be
caused by a variety of curved-rod bacteria. Which of the following
best describes C jejuni?
o a. Cause of gastroenteritis; reservoir in birds and mammals, optimal growth at
42 degree C
o b. Human pathogen, halophihc, lactose-negative, sucrose-negative; causes
gastrointestinal diseases primarily from ingestion of under-cooked seafood
o c. Human pathogen, halophilic, lactose-positive; produces heat-labile,toxin
o d. "String-test"positive isolate; three serotypesOgawa (AB), Inaba (AC)Hikojima
(ABC) Urease-positive; cause of fetal distress in cattle

82.
A box of ham sandwiches with mayonnaise, prepared by a
person with a boil on his neck, was left out of the refrigerator for the
on-call interns. Three doctors became violently ill approximately 2
hours after eating the sandwiches. Which of the following is the most
likely cause?
o a. C. perfringens toxin

o b. Coagulase from S. aureus in the ham


o c. Penicillinase given to inactivate penicillin in the pork
o d. S. aureus enterotoxin
o e. S. aureus leukocidin

83.
An 80-year-old man had a carcinoma of the colon removed 3
days ago. He was doing well until this morning, when he spiked a
fever to 39C and complained of severe abdominal pain. Examination
revealed a "boardlike" abdomen indicative of peritonitis. He was
taken to the operating room, where it was discovered that his
anastomosis had broken down and bowel contents had spilled into the
peritoneal cavity. A foul-smelling exudate was observed. A Gram
stain of the peritoneal exudate revealed many gram-negative rods.
Which one of the following sets of bacteria is the MOST likely cause
of this infection?
o a. Escherichia coli and Brucella melitensis
o b. Enterobacter cloacae and Salmonella enteritidis
o c. Fusobacterium nudeatum and Bacteroides fragilis
o d. Haemophilus influenzae and Actinomyces israelii
o e. Shigella dysenteriae and Serratia marcescens

84.
A patient with a burning epigastric pain was admitted to the
hospital, and a gastric biopsy was performed. The tissue was cultured
on chocolate agar incubated in a microaerophilic environment at
37C for 5-7 days. At 5 days of incubation, colonies appeared on the
plate and curved, gram-negative rods, oxidase-positive, were
observed. Which of the following is the most likely identity of this
organism?
o a. Campylobacterfetus,
o b. Campylobacterjejuni

o c. Haemophilus influenzae
o d. Helicobacter pylori
o e. Vibrio parahaemolyticus

85.
A patient was hospitalized after an automobile accident. The
wounds became infected, and the patient was treated with
tobramycin, carbenicillin, and clindamycin. Five days after antibiotic
therapy was initiated, the patient developed severe diarrhea and
pseudomembranous enterocolitis. Antibiotic-associated diarrhea and
the more serious pseudomembranous enterocolitis can be caused by
which of the following organisms?
o a. B.fragilis
o b. Clostridium difficile
o c. Clostridium perfringens
o d. Clostridium sordellii
o e. S. aureus

86.
An outbreak occurred in a community where the water supply
was contaminated. Multiple patients experienced nausea and
vomiting, as well as profuse diarrhea with abdominal cramps. Stools
were described as "rice water." Curved, gram-negative rods were
isolated on this sulfate-citrate-bile-sucrose agar. In the treatment of
patients who have cholera, the use of a drug that inhibits adenyl
cyclase would be expected to have which of the following
characteristics?
o a. Block the action of cholera toxin
o b. Eradicate the organism
o c. Increase fluid secretion
o d. Kill the patient immediately

o e. Reduce intestinal motility

87.
Two of three family members had dinner at a local restaurant
and, within 48 hours, experienced double vision, difficulty in
swallowing and speaking, and breathing problems. These symptoms
are consistent with which of the following?
o a. Activation of cyclic AMP
o b. Endotoxin shock
o c. Ingestion of a neurotoxin
o d. Invasion of the gut epithelium by an organism
o e. Secretion of an enterotoxin

88.
Testing of an isolate possesses the group D antigen, and is not
beta -lactamase-positive, but is resistant to vancomycin. Which of the
following is the most likely identification of this isolate?
o a. Enterococcus cassiflavus
o b. Enterococcus durans
o c. Enterococcus faecalis
o d. Enterococcus faecium
o e. S. pneumonia

89.
Which of the following is the treatment of choice for the isolate
in question 216?
o a. Ciprofloxacin
o b. Gentamicin
o c. Gentamicin and ampicillin
o d. Rifampin
o e. No available treatment

90.
A family routinely consumed unpasteurized milk, claiming
"better taste." Several members experienced a sudden onset of
crampy abdominal pain, fever, and bloody, profuse diarrhea. C. jejuni
was isolated and identified from all patients. Which of the following
is the treatment of choice for this type of enterocolitis?
o a. Ampicillin
o b. Campylobacter antitoxin
o c. Ciprofloxacin
o d. Erythromycin
o e. Pepto-Bismol

91.
V cholerae, the causative agent of cholera, is best described by
which of the following statements?
o a. Cause of gastroenteritis; reservoir in birds and mammals, optimal growth at 42
o b. Human pathogen, halophilic, lactose-negative, sucrose-negative; causes
gastrointestinal diseases primarily from ingestion of under-cooked seafood
o c. Human pathogen, halophilic, lactose-positive; produces heat-labile, extracellular
toxin
o d. "String-test"positive isolate; three erotypesOgawa (AB), Inaba
(AC),Hikojima (ABC)
o e. Urease-positive; cause of fetal distress in cattle

92.
A 20-year-old female in post-Katerina New Orleans eats poorly
cooked seafood (oysters, clams, and mollusks) for her birthday
dinner. Twenty-four hours later, she develops explosive watery
diarrhea and abdominal cramps. She is positive for V
parahaemolyticus. Which of the following statements best describes
this organism?
o a. Cause of gastroenteritis; reservoir in birds and mammals, optimal growth at 42 C

o b. Human pathogen, halophilic, lactose-negative, sucrose-negative; causes


gastrointestinal diseases primarily from ingestion of under-cooked seafood
o c. Human pathogen, halophilic, lactose-positive; produces heat-labile, extracellular
toxin
o d. "String-test"positive isolate; three serotypesOgawa (AB), Inaba
(AC),Hikojima (ABC)
o e. Urease-positive; cause of fetal distress in cattle

93.
Twenty-four hours after returning from a short trip to Asia, a 35year-old female has a sudden onset of vomiting and massive watery
diarrhea that is colorless, odorless, and contains flecks of mucus.
Which of the following mediums would most likely be used for
isolating V cholerae, the suspected organism?
o a. A Lofflers medium
o b. B Lowenstein-Johnson medium
o c. C Sheep blood agar
o d. D Thayer Martin
o e. E Thiosulfate citrate bile salts sucrose medium

94.
A 31-year-old school teacher returns from foreign travel and
experiences a sudden (1-2 days) onset of abdominal pain, fever, and
watery diarrhea, caused by a heat-labile exotoxin that affects both the
gut and the NS. This infection is caused by an etiologic agent
commonly acquired through which of the following routes?
o a. Gastrointestinal tract
o b. Genital tract
o c. Nasal tract
o d. Respiratory tract Skin

95.
An HIV-positive patient has progressed from fatigue, rash,
nausea, and night sweats symptoms to occasional but defined
opportunistic infections. I k inquires as to what can be done to predict
his chances of developing I) Diplomatic AIDS. Which of the
following tests would be most useful?
o a. CD4 lymphocyte count
o b. HIV antibody test
o c. HIV p24 antigen
o d. HIVRTPCR
o e. Neopterin

96.
A 9-year-old male presents with fever and nonspecific
symptoms followed by a distiinctive rash on the cheeks (slapped
cheek). Which of the following viruses is the most likely cause of this
disease and has been associated with transient aplastic crises in
persons with sickle cell disease? a. Herpes simplex
o a. Parvovirus B19
o b. Rubella
o c. Rubeola
o d. Varicella-zoster

97.
A 20-year-old female presents to her physician with a low-grade
fever, headache, and painful genital lesions. Culture detects herpes
simplex virus (HSV). Which of the following statements best
describes infection with this common human pathogen?
o a. Infection with type 1 virus is most common
o b. Initial infection usually occurs by intestinal absorption of the virus
o c. It can be reactivated by emotional disturbances or prolonged exposure to
sunlight

o d. It rarely recurs in a host who has a high antibody titer


o e. The central nervous system (CNS) and visceral organs are usually involved

98.
An HIV-positive patient, prior to being treated with AZT, DDI,
and saquinavir, has a CD4 lymphocyte count and an HIV RNA viral
load test done. Results are as follows:CD4: 50 CD4 lymphocytes per
JJ.L HIV RNA: 100,000 copies per ml Which of the following
statements best describes this patient?
o a. This patient is no longer in danger of opportunistic infection
o b. The 5-year prognosis is excellent
o c. The patient's HIV screening test is most likely negative
o d. The patient is not infectious
o e. The viral load of 100,000 copies per milliliter suggests that the patient will respond
to triple therapy

99.
An HIV-positive patient with a viral load of 100,000 copies of
HIV RNA/milliliter and a total CD4 count of 50 is at increased risk
for a number of infectious diseases. For which of the following
diseases is the patient at no more added risk than an
immunocompetent host?
o a. Herpes simplex virus
o b. Kaposi sarcoma
o c. Mycobacterial disease
o d. Pneumococcal pneumonia
o e. Pneumocystic pneumonia

100. Which of the following antiviral agents is a purine nucleoside


analogue that has shown promise with Lassa fever, influenza A and
B, and respiratory syncytial virus (RSV)?
o a. Amantadine

o b. Acyclovir
o c. Ribavirin
o d. Rimantadine
o e. Vidarabine

101. Enteric cytopathogenic human orphan viruses (echo-viruses)


appear worldwide and are more apt to be found in young patients.
Family studies demonstrated the ease and high frequency of
transmission. Which of the following body systems is the main target
of echoviruses?
o a. Bladder and urinary tract
o b. Blood and lymphatic systems
o c. Central nervous system
o d. Intestinal tract
o e. Respiratory system

102. Meningitis is characterized by the acute onset of fever and stiff


neck. Aseptic meningitis may be caused by a variety of microbial
agents. During the initial 24 hours of the course of aseptic meningitis,
an affected person's CSF is characterized by which of the following
laboratory findings?
o a. Decreased protein content
o b. Elevated glucose concentration
o c. Eosinophilia
o d. Lymphocytosis
o e. Polymorphonuclear leukocytosis

103. A 62-year-old Florida fisherman forgot his insect repellent on a


recent sporting trip. A week later, he presented to his physician with

fever, chills, headache, and flu-like symptoms that progressed to


possible CNS involvement. Control of the etiologic agent, associated
with a high (50-70%) fatality rate, could be possible by eradication of
which of the following?
o a. Birds
o b. Fleas
o c. Horses
o d. Mosquitoes
o e. Ticks

104. A patient who works in an industrial setting presents to his


ophthalmologist with acute conjunctivitis, enlarged and tender
preauricular nodes, and early stages of keratitis. The differential
diagnosis should include infection with which of the following
viruses?
o a. Adenovirus
o b. Epstein-Barr virus
o c. Parvovirus
o d. Respiratory syncytial virus
o e. Varicella-zoster virus

105. Several antiviral compounds have been developed during the


last decade. One such compound is ribavirin, a synthetic nucleoside
structurally related to guanosine. Ribavirin therapy is FDA-approved
for use against which of the following?
o a. Group A coxsackievirus
o b. Hepatitis B
o c. Herpes simplex virus

o d. Parvovirus
o e. Respiratory syncytial virus

106. An immune compromised person with a history of seizures has


an MRI that reveals a temporal lobe lesion. Brain biopsy results show
multinucleated giant cells with intranuclear inclusions. Which of the
following is the most probable cause of the lesion?
o a. Coxsackievirus
o b. Hepatitis C virus
o c. Herpes simplex virus
o d. Listens monocytogenes
o e. Parvovirus

107. A 70-year-old nursing home patient refused the influenza


vaccine and subsequently developed influenza. She died of acute
pneumonia 1 week after contracting the flu. Which of the following is
the most common cause of acute post influenzal pneumonia?
o a. Escherichia coli
o b. Klebsidla pneumoniae
o c. Legionella pneumophilia
o d. Listeria monocytogenes
o e. Staphylococcus aureus

108. A 5-year-old boy was sent home from kindergarten because his
left eye was red with a watery, nonpurulent discharge. Several of his
classmates recently had mild sore throat but no fever. Conjunctivitis
lasted 1 week with complete recovery. Which of the following
organisms was the most likely cause of his infection?
o a. Adenovirus

o b. Herpes simplex virus


o c. Staphylococcus aureus
o d. Chlamydiae trachomatis
o e. Hemophilus aegypticus

109. A husband and wife performed the yearly spring cleaning of


their mountain cabin, located in the southwestern part of the United
States. The wife presented to her physician 2 weeks later with fever,
myalgia, headache, and nausea, followed by progressive pulmonary
edema. Which of the following statements best describes the
pathogen or disease progression in this patient?
o a. Hemolysis is common in infected patients
o b. Influenza-like symptoms are followed rapidly by acute respiratory failure
o c. It is acquired by inhalation of aerosols of the urine and feces of deer
o d. Transmission from human to human is common
o e. There is effective antiviral therapy available

110. Parvovirus infection, the cause of a mild exanthem in children,


can also cause which of the following?
o a. Aplastic crisis in chronic anemia
o b. Epidemic acute respiratory disease
o c. Gastroenteritis
o d. Keratoconjunctivitis
o e. Whooping cough-like disease

111. Within the first year of life, an infant exhibited severe hearing
loss, ocular abnormalities, and apparent mental retardation. Standard
peripheral blood smears demonstrated multinucleated cells with giant

nuclei and intranuclear inclusions. Which of the following statements


best describes the etiologic agent?
o a. It can be transmitted across the placental barrier
o b. While a common infection, CMV is almost always symptomatic
o c. The CMV can be cultured from red blood cells of infected patients
o d. Unlike other viral infections, CMV is not activated by immunosuppressive therapy
o e. There is no specific therapy for CMV

112. Subacute sclerosing panencephalitis (SSPE) is characterized by


inflammatory lesions and begins with mild changes in personality,
ending with dementia and death. Which of the following statements
best describes the disease characteristics?
o a. Demyelination is characteristic
o b. It is a common event occurring in 1 of 300,000 cases of mumps
o c. It is a late CNS manifestation of mumps
o d. It is a progressive disease involving both white and gray matter
o e. Viral DNA can be demonstrated in brain cells

113. The virus shown below contains double-stranded RNA within a


double-walled capsid. Which of the following statements best
describes this agent?
o a. Early breast-feeding offers no protection to neonates against it
o b. It is a major cause of neonatal diarrhea
o c. It is readily cultured from the stool of infected persons
o d. Maternal antibody does not appear to be protective
o e. There are no related animal viruses

114. Helical viruses containing negative sense linear RNA genomes


and an outer lipid envelope are most commonly associated with
which of the following diseases?
o a. Croup
o b. Fifth disease
o c. Otitis media
o d. Rubella
o e. Tonsillitis

115. A transplant patient taking high levels of immunosuppressive


medications becomes infected with EBV and develops a lymphoma.
The dosage of immunosuppressive drugs given to the patient is
decreased, and the tumor regresses. Which of the following
properties of EBV infection is related to the patient's tumor
development?
o a. Immortalization of B cells
o b. Increased white blood cell count
o c. Presence of atypical lymphocytes
o d. Production of heterophile antibodie

116. Reverse transcriptase is an enzyme found in retroviruses and


hepad-naviruses. Which of the following is a function of the enzyme
reverse transcriptase?
o a. DNAse activity
o b. DNA-dependent RNA polymerase activity
o c. RNA-dependent DNA polymerase activity
o d. RNA-dependent RNA polymerase activity
o e. RNA isomerase activity

117. Several young adults camped in a wilderness area and received


multiple mosquito bites. Ten days later, one had a sudden onset of
headache, chills, and fever, and became stuporous 48 hours later. He
was diagnosed with Saint Louis encephalitis (SLE) and recovered
completely. Which of the following best describes SLE?
o a. It is transmitted to humans by the bite of an infected tick
o b. It is caused by a togavirus
o c. It is the major arboviral cause of central nervous system infection in the United
States
o d. It may present initially with symptoms similar to influenza
o e. Laboratory diagnosis is routinely made by cultural methods

118. There is considerable overlap of signs and symptoms seen in


congenital and perinatal infections. In a neonate with classic
symptoms of congenital CMV infection, which of the following tests
would be most useful in establishing a diagnosis?
o a. CMV IgG titer on neonate's serum at birth
o b. CMV IgG titer on mother's serum at birth of infant
o c. CMV IgM titer on neonate's serum at birth and at 1 month of age
o d. Culture of mother's urine
o e. Total IgM on neonate's serum at birth

119. A 35-year-old man presents with symptoms of jaundice, right


upper quadrant pain, and vomiting. His ALT is elevated. He is
diagnosed with HAV infection after eating at a restaurant where
others were also infected. Which of the following should be done to
protect his family members?
o a. A series of three vaccinations at 0, 1, and 6 months
o b. Administer alpha interferon

o c. Quarantine household contacts and observe


o d. No treatment is necessary
o e. One dose of gamma globulin administered intramuscularly

120. A 17-year-old girl presents with cervical lymphadenopathy,


fever, and pharyngitis. Which of the following is the most rapid and
clinically useful test to make a diagnosis?
o a. Antibody to Epstein-Barr nuclear antigen (EBNA)
o b. C-reactive protein (CRP)
o c. Culture
o d. IgG antibody to viral core antigen (VCA)
o e. IgM antibody to VCA

121. Atypical lymphocytosis is most likely to be found in which one


of the following diseases?
o a. Encephalitis caused by herpes simplex virus (HSV)
o b. Chronic hepatitis C
o c. Mononucleosis induced by Epstein-Barr virus
o d. Parvovirus infection
o e. Rotavirus gastroenteritis

122. A 30-year-old female with a recent history of serious illness


requiring surgery developed fever, nausea, and jaundice. Her
condition continued as a clinically mild disease, with AST=552,
ALT=712, and the HBV panel was negative. Which one of the
following statements best characterizes the illness?
o a. Blood products are not tested for antibody to HCV
o b. Few cases progress to chronic liver disease

o c. HBV but not HCV infections occur in IV drug abusers


o d. HCV is a DNA virus
o e. HCV is the most common cause of posttransfusion hepatitis

123. Which of the following markers is usually the first viral marker
detected after hepatitis B infection?
o a. HBcAg
o b. HBeAg
o c. HBsAg
o d. HBeAb
o e. Anti-HBc

124. Which of the following may be the only detectable serological


marker during the early convalescent phase of HBV infection
(window phase)?
o a. HBcAg
o b. HBeAg
o c. HBsAg
o d. HBeAb
o e. Anti-HBc

125. Which of the following is found within the nuclei of infected


hepa-tocytes and not usually in the peripheral circulation?
o a. HBcAg
o b. HBeAg
o c. HBsAg
o d. HBeAb

o e. Anti-HBc

126. An infant was born and presented with intrauterine growth


retardation, jaundice, hepatosplenomegaly, microcephaly, and
retinitis. Which one of the following viruses most likely caused these
congenital malformations?
o a. Cytomegalovirus
o b. Mumps
o c. HIV
o d. Respiratory syncytial virus
o e. Rubeola

127. Which of the following specimens is best for detection of


cytomegalovirus (CMV)?
o a. Blood
o b. Cerebrospinal fluid
o c. Cervical tissue
o d. Skin
o e. Synovial fluid

128. Which of the following specimens is best for detection of


enterovirus?
o a. Blood
o b. Cerebrospinal fluid
o c. Cervical tissue
o d. Skin
o e. Synovial fluid

129. Which of the following specimens is best for detection of


varicella-zoster virus (VZV)?
o a. Blood
o b. Cerebrospinal fluid
o c. Cervical tissue
o d. Skin
o e. Synovial fluid

130. Which of the following specimens is best for detection of


adenovirus 40/41?
o a. Blood
o b. Cerebrospinal fluid
o c. Cervical tissue
o d. Stool
o e. Synovial fluid

131. Which of the following viruses causes only gastroenteritis and is


the second most common cause of pediatric gastroenteritis?
o a. Adenovirus 40/41
o b. Astrovirus
o c. Hepatitis A virus
o d. Norwalk virusc. Rotavirus

132. Which of the following may be detected by ELISA methods or


electron microscopy and is a common cause of epidemic
gastroenteritis, particularly aboard cruise ships and in summer
camps?
o a. Adenovirus 40/41

o b. Astrovirus
o c. Hepatitis A virus
o d. Norwalk virus
o c. Rotavirus

133. Unlike other similar viruses, this agent appears to account for 515% of the gastroenteritis in young children. Which of the following
etiologic agents causes these infections and is difficult to isolate in
the diagnosticlaboratory?
o a. Adenovirus 40/41
o b. Astrovirus
o c. Hepatitis A virus
o d. Norwalk virus
o e. Rotavirus

134. A flavivirus recently appeared in the United States with birds as


the primary hosts. The virus produces viremia in humans and
possible fatal encephalitis in older patients. Which of the following is
this virus?
o a. Human papillomavirus
o b. Polyomavims
o c. Subacute sclerosing panencephalitis (SSPE) virus
o d. Tick-borne encephalitis virus
o e. West Nile virus

135. An irritable 18-month-old toddler with fever and blister-like


ulcera(itions on mucous membranes of the oral cavity refuses to eat.
The symptoms worsen and then slowly resolve over a period of 2

weeks. Assuming that the etiological agent was HSV type 1, which of
the following statements is true?
o a. Antivirals do not provide any benefit
o b. The virus remains latent in the trigeminal ganglia
o c. Recurrence is likely to result in a generalized rash
o d. Polyclonal B cell activation is a prominent feature
o e. The child is at high risk for developing cancer later in life

136. A sexually active 17-year-old man presents to the local free


clinic to check some small papules that appeard on his penis. The
papules are small, white lesions with a central depression. There is no
discharge or pain on urination. What group listed below does this
etiologic agent belong to?
o A) Adenoviridae
o B) Arenaviridae
o C) Papovaviridae
o D) Parvoviridae
o E) Poxviridae

137. Hepatitis B virus (HBV; Hepadnaviridae), the only known


gapped DNA virus to infect humans, absolutely needs which of the
following polymerases in order to complete their replication cycle?
o A) A cellular RNA-dependent RNA polymerase and reverse transcriptase
o B) A cellular DNA-dependent RNA polymerase and reverse transcriptase
o C) A viral RNA-dependent RNA polymerase and reverse transcriptase
o D) A viral DNA-dependent RNA polymerase and reverse transcriptaseE) A viral
RNA-dependent DNA polymerase and reverse transcriptase

138. Retroviruses such as the Human Immunodeficiency Virus Type


1 (HIV-1) absolutely need which of the following polymerases in
order to complete their replication cycle?
o A) Reverse transcriptase and a cellular RNA-dependent RNA polymerase.
o B) Reverse transcriptase and a viral RNA-dependent RNA polymerase.
o C) Reverse transcriptase and a cellular DNA-dependent RNA polymerase.
o D) Reverse transcriptase and a viral DNA-dependent RNA polymerase.
o E) Reverse transcriptase and a viral RNA-dependent DNA polymerase.

139. A virology research lab (Dead End Empirical Technologies Inc.)


engineers a composite virus with the following characteristics: The
virion possesses a capsid derived from simian virus 40 (SV40;
Polyomaviridae) containing HBV (hepatitis B virus; Hepadnaviridae)
gapped dsDNA, HAV (hepatitis A virus; Picornaviridae) RNAdependent RNA polymerase, and human immunodeficiency virus
type 1 (HIV-1; Retroviridae) reverse transcriptase. The nucleocapsid
is surrounded by an envelope derived from HEK 293 cells (human
embryonic kidney 293 cells) containing murine VSV (murine
vesicular stomatitis virus; Rhabdoviridae) G proteins. If this virion
were to infect permissive cells, which kind of virus would be
generated?
o A) Simian virus 40 (SV40)
o B) Hepatitis B virus (HBV)
o C) Hepatitis A virus (HAV)
o D) Human immunodeficiency virus type 1 (HIV-1)
o E) Murine vesicular stomatitis virus (VSV)

140.

Which statement best applies to virions?


o A) Virions are the vessels that protect and deliver viral self replicating proteins from
susceptible host cells to other susceptible host cells.

o B) Virions are the vessels that protect and deliver viral self replicating proteins from
permissive host cells to other permissive host cells.
o C) Virions are vessels that protect and deliver viral genomes from susceptible host
cells to other susceptible host cells.
o D) Virions are vessels that protect and deliver viral genomes from permissive
host cells to other permissive host cells.
o E) Virions are vessels that need to be processed by viral proteases in order to become
fully infectious viruses.

141. 9) Under natural conditions (i.e. not in laboratory or


immunization settings), which of the following viruses would be the
simplest virus capable of completing its infectious cycle?
o A) A virus that would consist of its nucleic acid and its capsid
o B) A virus that would consist of its nucleic acid, its corresponding polymerase and its
capsid
o C) A virus that would consist of its nucleic acid, its corresponding polymerase, its
capsid and its envelope
o D) A virus that would consist of its nucleic acid, its corresponding polymerase, its
capsid, its matrix and its envelope
o E) A virus that would consist of its nucleic acid, its corresponding polymerase, its
capsid, its matrix, its tegument and its envelope

142.

Viral replication proceeds as follows:


o A) Attachment-Entry-Uncoating-Genome replication-Assembly-ReleaseMaturation
o B) Attachment-Entry-Genome replication-Uncoating-Assembly-Release-Maturation
o C) Attachment-Entry-Uncoating-Genome replication-Release-Assembly-Maturation
o D) Attachment-Uncoating-Entry-Genome replication-Assembly-Release-Maturation
o E) Attachment-Entry-Uncoating-Assembly-Genome replication-Release-Maturation

143. Maraviroc is a recently FDA (Food and Drug Administration)


approved chemokine receptor antagonist that binds to human
chemokine receptor CCR5. Given the function of CCR5 in the
replication cycle of human immunodeficiency virus type 1 (HIV-1),
which event is affected by this drug?
o A) HIV-1 attachment to the cell
o B) HIV-1 entry into the cell
o C) HIV-1 uncoating
o D) HIV-1 release from the cell
o E) HIV-1 maturation

144. The national regulatory body overseeing the transport of


biohazard material in your country has asked you to provide an
expert opinion concerning the safety level of an engineered
composite virus that needs to be shipped from one laboratory to
another. The virion in question possesses a capsid derived from HPV
(Human Papilloma Virus) that contains rhinovirus (+) ssRNA and
HAV (Hepatitis A Virus) RNA-dependent RNA polymerase. The
nucleocapsid is surrounded with an envelope containing Ebola virus
GP peplomer spikes. If this virion were to infect permissive cells,
which kind of virus would be generated?
o A) A human papillomavirus
o B) A rhinovirus
o C) A hepatitis A virus
o D) An Ebola virus
o E) A papirhinohepbolavirus

145. In the previous example, which virion component would


intervene in cell susceptibility?
o A) The HPV capsid protein

o B) The rhinovirus RNA


o C) The RNA-dependent RNA polymerase
o D) The GP peplomer spikes
o E) None of the above

146. Virulence factors play an important role in the pathogenesis of


viral infections and include gene products (1) that alter viral
replication, (2) that alter host defense mechanisms, (3) that facilitate
viral spread, and (4) that are toxic to the host. Which of the following
mechanisms generally favours viral spread?
o A) Apoptosis
o B) Autophagy
o C) Virokines
o D) Viroceptors
o E) Antigenic drift

147. Virulence factors play an important role in the pathogenesis of


viral infections and include gene products (1) that alter viral
replication, (2) that alter host defense mechanisms, (3) that facilitate
viral spread, and (4) that are toxic to the host. Which of the following
mechanisms favours viral replication?
o A) Apoptosis.
o B) Virally-encoded proteins that increase cell cycling.
o C) Virokines.
o D) Viroceptors.
o E) The tandem action of the double-stranded RNA (dsRNA) binding proteins 2-5oligo(A) synthetase and RNase L.

148. Virulence factors play an important role in the pathogenesis of


viral infections, and some of these factors alter host defence
mechanisms. One such factor is the HCMV (human cytomegalovirus)
US6 protein that inhibits TAP proteins (transporters associated with
antigen processing). By inhibiting TAP, which host defence
mechanism is affected by US6?
o A) B-cell-mediated antigen presentation to nave CD4+ cells
o B) CD4+-mediated B-cell activation
o C) Dendritic cell-mediated antigen presentation to nave CD4+ cells
o D) Somatic cell-mediated antigen presentation to activated CD8+ cells
o E) CD4+-mediated CD8+ cell activation

149. Virulence factors play an important role in the pathogenesis of


viral infections. Such virulence factors include gene products that (1)
alter viral replication, (2) host defence mechanisms, (3) facilitate
viral spread, and (4) are toxic to the host. Which of the following
virulence factors alters host immune defence mechanisms?
o A) Human cytomegalovirus viroceptor expression
o B) Rotavirus nsP4 protein expression
o C) Influenza virus HA (hemagglutinin) protein expression
o D) Human immunodeficiency virus-1 TM protein expression
o E) Human immunodeficiency virus-1 reverse transcriptase proof-reading

150. The hallmarks of antiviral immunity are type-I IFN-dependent


defense mechanisms (IFN- and IFN-) and CD8+ T lymphocyte
cytotoxicity (CTL). The CD8+ T lymphocyte cytotoxicity response is
orchestrated by which of these cell types?
o A) Natural Killer cells (NK cells)
o B) Macrophages

o C) CD4+ Thelper1 lymphocytes


o D) CD4+ Thelper2 lymphocytes
o E) B-lymphocytes

151. As a means of virulence, some viruses down-modulate class I


major histocompatibility complex (MHC-I) cell surface expression of
the cells they infect, thereby sharply diminishing CD8+ T
lymphocyte-mediated cytoxicity efficiency. Yet, viral populations can
still be kept in check despite the lack of CD8+ T lymphocytesmediated cytotoxicity. Which of the following cells are the most
likely to be responsible for killing infected cells that express very low
levels of MHC-I?
o A) Natural Killer cells (NK cells)
o B) Macrophages
o C) Dendritic cells
o D) Neutrophils
o E) B-lymphocytes

152. Why is class I-restricted major histocompatibility complex


(MHC-I) antigen presentation so important for viral clearance?
o A) Because MHC-I restricted antigen presentation is the first step in the production of
neutralizing antibodies
o B) Because MHC-I restricted antigen presentation is the first step in the activation of
both Thelper1 and Thelper2 responses
o C) Because MHC-I restricted antigen presentation is the main pathway through
which virus-infected cells are killed
o D) Because MHC-I restricted antigen presentation is the main pathway of antibodydependent cell-mediated cytotoxicity (ADCC)
o E) Because MHC-I restricted antigen presentation is required for B-cell clonal
expansion

153. Viral cell transformation can result from (1) the insertion of viral
oncogenes into host cell genomes, (2) the integration of proviruses
into host cell genomes near proto-oncogene regulatory sequences, (3)
the permanent activation by viruses of host cell signalling pathways,
and (4) the alteration of host cell cycling regulation by viruses.
Which viruses are responsible for cell transformation due to
integration of proviruses in the vicinity of proto-oncogenes
(nontransducing viruses)?
o A) Adenoviruses
o B) Hepadnaviruses (Hepatitis B Virus)
o C) Papillomaviruses
o D) Herpesviruses
o E) Retroviruses

154. Trypanosoma brucei gambiense and T. b. rhodesiense, both


responsible for African sleeping sickness, express pre-programmed
VSG (Variant Surface Glycoproteins) molecule sequences on their
surface. This mechanism allows these trypanosomes to avoid immune
clearance by
o A) having a fraction of the infecting population switching their surface coat in
order to escape the immune response mounted by the host.
o B) having a mixed population of infecting variants so that the host cannot mount an
efficient immune response to all variants at one time.
o C) having variants that differ in time so that infection with one variant does not confer
immunity to the previously encountered variants.

155.

How does acyclovir slow down Herpesviridae replication?


o A) By inhibiting viral protein synthesis
o B) By inhibiting viral mRNA transcription
o C) By inhibiting viral DNA replication

o D) By inhibiting viral RNA replication

156.

How does ganciclovir slow down HCMV replication?


o A) By inhibiting viral protein synthesis
o B) By inhibiting viral mRNA transcription
o C) By inhibiting viral DNA replication
o D) By inhibiting viral RNA replication

157. Virus shedding during acute EBV infection can be diminished


by using acyclovir, a nucleoside analogue. Which polymerase would
be inhibited by acyclovir?
o A) RNA-dependent RNA polymerase
o B) RNA-dependent DNA polymerase
o C) DNA-dependent RNA polymerase
o D) DNA-dependent DNA polymerase
o E) Reverse transcriptase

158.

Ototoxicity and nephrotoxicity associated with this antibiotic:


o a) cefotaxime (Claforan)
o b) amikacin (Amikin)
o c) aztreonam (Azactan)
o d) ceftriaxone (Rocephin)

159. Antibiotic's clearance from the body most likely influenced by


severe hepatic disease:
o a) penicillins
o b) clindamycin (Cleocin)
o c) rifampin (Rimactane)

o d) B & C

160. A sixty-year old male was recovering from bowel resection. The
initial recovery period was unremarkable. Late on the third postoperative day the patient began hyperventilating with respiratory
alkalosis. On the fourth post-operative day, the patient's condition
rapidly worsened with a significant elevation of temperature (104.9
F), profound hypotension (65/38 mm Hg) and tachycardia. Urine
output was very low with BUN and serum creatinine (5 mg%, which
had increased from normal levels at admission) were elevated. . Gram
staining of sputum, which was purulent, indicated gram-negative
rods. WBC was 17000/mmseptic shock with a shift to the left. The
diagnosis was fulminant bacteremia and septic shock. What
mechanism is most likely responsible for this patient's tachycardia?
o a) Direct effects of bacterial endotoxins on the SA node
o b) Significant hypotension associated with low systemic vascular resistance.
o c) Bacterial endotoxins bind to muscarinic cholinergic receptors, thus removing the
dominating cholinergic tone in the heart.
o d) Patient anxiety

161.

FALSE statement about penicillin G


o a) Treatment of choice for viridans group streptococcal endocarditis.
o b) Pen G and Pen V are the two natural penicillins.
o c) Pen G can be combined with procaine, extending drug half-life
o d) Pen G most effective when given orally

162. A 92 year-old female was brought to the emergency room


following an episode of low blood pressure and disorientation at the
nursing home. She had been refusing food and drank little. She was
provided i.v glucose and was rehydrated. Over the next few days her
condition worsened with increasing periods of incoherence. She
exhibited hyperventilation with respiratory alkalosis and pulmonary

congestion. Her body temperature was slightly subnormal and she


was hypotensive (75/40 mm Hg) and tachycardic. Her pulmonary
congestion worsened as did her blood gases. Digoxin was
administered. Blood cultures indicated the present of E. coli, leading
to a definitive diagnosis of E. coli septicemia. Which drug(s) would
be appropriate to treat the septicemia?
o a) cefotaxime (Claforan)
o b) ceftriaxone (Rocephin)
o c) aztreonam (Azactan)
o d) all of the above

163. Antimicrobial treatment of this severely immune-depressed


patient should not be initiated before
o (A) The pathogen has been identified by the microbiology laboratory
o (B) Specimens have been taken for laboratory tests and examinations
o (C) The results of a Gram stain are available
o (D) Antipyretic drugs have been given to reduce body temperature
o (E) The results of antibacterial drug susceptibility tests are available

164. If gentamicin is used systemically in the treatment of this


patient, monitoring of serum drug level may be advised because
o (A) The drug is unstable in gastric acid
o (B) The antibacterial action is antagonized by beta-lactam antibiotics
o (C) Gentamicin is hematotoxic
o (D) The drug does not readily penetrate into the cerebrospinal fluid
o (E) Gentamicin has a narrow therapeutic window

165. A combination of drugs might be given to this patient to provide


coverage against multiple organisms or to obtain a synergistic action.

Examples of antimicrobial drug synergism established at the clinical


level do not include
o (A) Amphotericin B and flucytosine in cryptococ-cal meningitis
o (B) Carbenicillin and gentamicin in pseudomonal infections
o (C) Penicillin and tetracycline in bacterial meningitis
o (D) Rifampin and vancomycin in enterococcal infections
o (E) Trimethoprim and sulfamethoxazole in coliform infections

166. Assuming that the physician is concerned about the effects of


renal impairment on drug dosage in this patient, which of the
following drugs is LEAST likely to require dosage reduction in renal
dysfunction?
o (A) Amikacin
o (B) Ciprofloxacin
o (C) Clindamycin
o (D) Trimethoprim-sulfamethoxazole
o (E) Vancomycin

167. Which of the following antibacterial agents appears to be quite


safe for the treatment of infections in the pregnant patient?
o (A) Azithromycin
o (B) Clarithromycin
o (C) Erythromycin
o (D) Sulfadiazine
o (E) Tetracycline

168. A common drug interaction that occurs with the use of


antimicrobial drugs, particularly drugs that have a wide antibacterial
spectrum of activity, is
o (A) Disulfiram-like reactions when ethanol is ingested
o (B) Increased ototoxicity if administered to a patient on furosemide
o (C) Enhancement of the anticoagulant effects of warfarin
o (D) Increased adverse effects if acetaminophen is administered as an antipyretic
o (E) Hypertension with ingestion of red wine and cheese

169. There is no evidence that antimicrobial prophylaxis is of


established benefit in
o (A) Contacts of the index case in mycoplasmal pneumonia
o (B) "Traveler's diarrhea"
o (C) Contacts of the index case in gonorrhea
o (D) Recurrent urinary tract infection
o (E) Tuberculin convenors

170. All of the following drugs are anticipated to be of value in a


bioterrorist attack that utilizes anthrax EXCEPT
o (A) Cefazolin
o (B) Ciprofloxacin
o (C) Clindamycin
o (D) Doxycycline
o (E) Rifampin

171. A 48-year-old patient is scheduled for a vaginal hysterectomy.


An antimicrobial drug will be used for prophylaxis against
postoperative infection. It is proposed that cefazolin, a first-

generation cephalosporin, be given intravenously at the normal


therapeutic dose immediately before surgery and continued until the
patient is released from the hospital. Which of the following
statements about the proposed drug management of this patient is
LEAST accurate?
o (A) Without prophylaxis, the infection rate following this procedure exceeds 5%
under optimal conditions
o (B) This drug will not be effective against anaerobes
o (C) Probable pathogens do not become rapidly resistant to this drug
o (D) Nosocomial (hospital-acquired) infection will be prevented by treatment
throughout the period of hospitalization
o (E) Prophylaxis has documented efficacy in this type of surgical procedure

172. If the patient had been scheduled for elective colonic surgery,
optimal prophylaxis against infection would be achieved by
mechanical bowel preparation and the use of
o (A) Intravenous cefotetan
o (B) Oral ampicillin
o (C) Oral neomycin and erythromycin
o (D) Intravenous third-generation cephalosporin
o (E) Oral fluoroquinolone

173. Which of the following antimicrobial drugs is LEAST likely to


affect the hepatic metabolism of other drugs?
o (A) Ampicillin
o (B) Clarithromycin
o (C) Erythromycin
o (D) Ketoconazole

o (E) Rifampin

174. Which of the following antimicrobial drugs does not require


supplementation of dosage following hemodialysis?
o (A) Ampicillin
o (B) Cefazolin
o (C) Ganciclovir
o (D) Tobramycin
o (E) Vancomycin

175. The persistent suppression of bacterial growth that may occur


after limited exposure to some antimicrobial drugs is called
o (A) Time-dependent killing
o (B) The postantibiotic effect
o (C) Clinical synergy
o (D) Concentration-dependent killing
o (E) Sequential blockade

176. If ampicillin and piperacillin are used in combination in the


treatment of infections resulting from Pseudomonas aeruginosa,
antagonism may occur. The most likely explanation is that
o (A) The 2 drugs form an insoluble complex
o (B) Piperacillin blocks the attachment of ampicillin to penicillin-binding proteins
o (C) Ampicillin induces beta-lactamase production
o (D) Autolytic enzymes are inhibited by piperacillin
o (E) Ampicillin is bacteriostati