BASIC BACTERIOLOGY MCQS

1. You’re watching a television program that is discussing viruses called bacteriophages that can kill bacteria. Your
roommate says, “Wow, maybe viruses can be used to kill the bacteria that infect people! You’re taking the
Microbiology course now; what’s the difference between viruses and bacteria?” Which one of the following would
be the most accurate statement to make?
(A) Viruses do not have mitochondria, whereas bacteria do.
(B) Viruses do not have a nucleolus, whereas bacteria do.
(C) Viruses do not have ribosomes, whereas bacteria do.
(D) Viruses replicate by binary fission, whereas bacteria replicate by mitosis.
(E) Viruses are prokaryotic, whereas bacteria are eukaryotic.

2. Bacteria, fungi (yeasts and molds), viruses, and protozoa are important causes of human disease. Which one of the
following microbes contains either DNA or RNA but not both?
(A) Bacteria
(B) Molds
(C) Protozoa
(D) Viruses
(E) Yeasts

3. Which one of the following contains DNA that is not surrounded by a nuclear membrane?
(A) Bacteria
(B) Molds
(C) Protozoa
(D) Yeasts

4. The initial step in the process of many bacterial infections is adherence of the organism to mucous membranes.
The bacterial component that mediates adherence is the:
(A) Lipid A
(B) Nucleoid
(C) Peptidoglycan
(D) Pilus
(E) Plasmid

5. In the Gram stain procedure, bacteria are exposed to 95% alcohol or to an acetone/alcohol mixture. The purpose
of this step is:
(A) To adhere the cells to the slide
(B) To retain the purple dye within all the bacteria
(C) To disrupt the outer cell membrane so the purple dye can leave the bacteria
(D) To facilitate the entry of the purple dye into the gram-negative cells
(E) To form a complex with the iodine solution

6. In the process of studying how bacteria cause disease, it was found that a rare mutant of a pathogenic strain failed
to form a capsule. Which one of the following statements is the most accurate in regard to this unencapsulated
mutant strain?
(A) It was nonpathogenic primarily because it was easily phagocytized.
(B) It was nonpathogenic primarily because it could not invade tissue.
(C) It was nonpathogenic primarily because it could only grow anaerobically.
(D) It was highly pathogenic because it could secrete larger amounts of exotoxin.
(E) It was highly pathogenic because it could secrete larger amounts of endotoxin.

7. Mycobacterium tuberculosis stains well with the acid-fast stain, but not with the Gram stain. Which one of the
following is the most likely reason for this observation?
(A) It has a large number of pili that absorb the purple dye.
(B) It has a large amount of lipid that prevents entry of the purple dye.
(C) It has a very thin cell wall that does not retain the purple dye.
(D) It is too thin to be seen in the Gram stain.
(E) It has histones that are highly negatively charged.

8. Of the following bacterial components, which one exhibits the most antigenic variation?
(A) Capsule
(B) Lipid A of endotoxin
(C) Peptidoglycan
(D) Ribosome
(E) Spore

9. β-Lactamases are an important cause of antibiotic resistance. Which one of the following is the most common site
where β-lactamases are located?
(A) Attached to DNA in the nucleoid
(B) Attached to pili on the bacterial surface
(C) Free in the cytoplasm
(D) Within the capsule
(E) Within the periplasmic space

10. Which one of the following is the most accurate description of the structural differences between gram-positive
bacteria and gram-negative bacteria?
(A) Gram-positive bacteria have a thick peptidoglycan layer, whereas gram negative bacteria have a thin layer.
(B) Gram-positive bacteria have an outer lipid-rich membrane, whereas gram negative bacteria do not.
(C) Gram-positive bacteria form a sex pilus that mediates conjugation, whereas gram-negative bacteria do not.
(D) Gram-positive bacteria have plasmids, whereas gram-negative bacteria do not.
(E) Gram-positive bacteria have capsules, whereas gram-negative bacteria do not.

11. Bacteria that cause nosocomial (hospital-acquired) infections often produce extracellular substances that allow
them to stick firmly to medical devices, such as intravenous catheters. Which one of the following is the name of
this extracellular substance?
(A) Axial filament
(B) Endotoxin
(C) Flagella
(D) Glycocalyx
(E) Porin

12. Lysozyme in tears is an effective mechanism for preventing bacterial conjunctivitis. Which one of the following
bacterial structures does lysozyme degrade?
(A) Endotoxin
(B) Nucleoid DNA
(C) Peptidoglycan
(D) Pilus
(E) Plasmid DNA

13. Several bacteria that form spores are important human pathogens. Which one of the following is the most
accurate statement about bacterial spores?
(A) They are killed by boiling for 15 minutes.
(B) They are produced primarily by gram-negative cocci.
(C) They are formed primarily when the bacterium is exposed to antibiotics.
(D) They are produced by anaerobes only in the presence of oxygen.
(E) They are metabolically inactive yet can survive for years in that inactive state.

14. In which one of the phases are antibiotics such as penicillin most likely to kill bacteria?
(A) Lag Phase
(B) Log Phase
(C) Stationary Phase
(D) Death Phase
15. Some bacteria are obligate anaerobes. Which of the following statements best explains this phenomenon?
(A) They can produce energy both by fermentation (i.e., glycolysis) and by respiration using the Krebs cycle and
cytochromes.
(B) They cannot produce their own ATP.
(C) They do not form spores.
(D) They lack superoxide dismutase and catalase.
(E) They do not have a capsule.

16. The emergence of antibiotic-resistant bacteria, especially in enteric gram negative rods, is a medically important
phenomenon. This most commonly occurs by a process that involves a sex pilus and the subsequent transfer of
plasmids carrying one or more transposons. Which one of the following is the name that best describes this process?
(A) Conjugation
(B) Transduction
(C) Transformation
(D) Translocation
(E) Transposition

17. Several important pathogenic bacteria have the ability to translocate pieces of their DNA in a process called
programmed rearrangements. Which one of the following is the most important known consequence of this ability?
(A) The number of plasmids increases significantly, which greatly enhances antibiotic resistance.
(B) The amount of endotoxin increases significantly, which greatly enhances the ability to cause septic shock.
(C) The surface antigens of the bacteria vary significantly, which greatly enhances the ability to avoid opsonization
by antibody.
(D) The ability of the bacterium to be lysogenized is significantly increased, which greatly enhances the ability to
produce increased amounts of exotoxins.
(E) The ability of the bacterium to survive intracellularly is greatly increased.

18. Which statement is the most accurate regarding transposons?

(A) They encode enzymes that degrade the ends of the bacterial chromosome.
(B) They are short sequences of DNA that often encode enzymes that mediate antibiotic resistance.
(C) They are short sequences of RNA that silence specific regulatory genes.
(D) They are a family of transfer RNAs that enhance mutations at “hot spots” in the bacterial genome.

19. Corynebacterium diphtheriae causes the disease diphtheria by producing diphtheria toxin. The gene encoding
the toxin is integrated into bacterial genome during lysogenic conversion. The toxin gene was acquired by which
process?
(A) Conjugation
(B) Transduction
(C) Transformation
(D) Translocation
(E) Transposition

20. The colon is the site of the largest number of normal flora bacteria. Which one of the following bacteria is found
in the greatest number in the colon?
(A) Bacteroides fragilis
(B) Clostridium perfringens
(C) Enterococcus faecalis
(D) Escherichia coli
(E) Lactobacillus species

21. A 76–year–old woman with a prosthetic (artificial) hip comes to you complaining of fever and pain in that joint.
You are concerned about an infection by S. epidermidis. Using your knowledge of normal flora, what is the most
likely source of this organism?
(A) Dental plaque
(B) Mouth
(C) Skin
(D) Stomach
(E) Vagina

22. Your patient is a 30-year-old woman with a previous history of rheumatic fever who has had fever for the past 2
weeks. On examination, you find a new heart murmur. You suspect endocarditis and do a blood culture, which
grows a viridans group streptococcus later identified as S. sanguinis. Using your knowledge of normal flora, what is
the most likely source of this organism?
(A) Duodenum
(B) Skin
(C) Throat
(D) Urethra
(E) Vagina

23. An outbreak of postsurgical wound infections caused by S. aureus has occurred in the hospital. The infection
control team was asked to determine whether the organism could be carried by one of the operating room personnel.
Using your knowledge of normal flora, which one of the following body sites is the most likely location for this
organism?
(A) Colon
(B) Gingival crevice
(C) Mouth
(D) Nose
(E) Throat

24. Handwashing is an important means of interrupting the chain of transmission from one person to another.
Infection by which one of the following bacteria is most likely to be interrupted by handwashing?
(A) Borrelia burgdorferi
(B) Legionella pneumophila
(C) Staphylococcus aureus
(D) Streptococcus agalactiae (group B streptococcus)
(E) Treponema pallidum

25. Vertical transmission is the transmission of organisms from mother to fetus or newborn child. Infection by which
one of the following bacteria is most likely to be transmitted vertically?
(A) Chlamydia trachomatis
(B) Clostridium tetani
(C) Haemophilus influenzae
(D) Shigella dysenteriae
(E) Streptococcus pneumoniae

26. The cells involved with pyogenic inflammation are mainly neutrophils, whereas the cells involved with
granulomatous inflammation are mainly macrophages and helper T cells. Infection by which one of the following
bacteria is most likely to elicit granulomatous inflammation?
(A) Escherichia coli
(B) Mycobacterium tuberculosis
(C) Neisseria gonorrhoeae
(D) Streptococcus pyogenes
(E) Staphylococcus aureus

27. Which one of the following sets of properties of exotoxins and endotoxins is correctly matched?
(A) Exotoxins—polypeptides; endotoxins—lipopolysaccharide
(B) Exotoxins—weakly antigenic; endotoxins—highly antigenic
(C) Exotoxins—produced only by gram-negative bacteria; endotoxins—produced only by gram-positive bacteria
(D) Exotoxins—weakly toxic per microgram; endotoxins—highly toxic per microgram
(E) Exotoxins—toxoid vaccines are ineffective; endotoxins—toxoid vaccines are effective
28. Which one of the following sets consists of bacteria both of which produce exotoxins that increase cyclic AMP
within human cells?
(A) Vibrio cholerae and Corynebacterium diphtheriae
(B) Clostridium perfringens and Streptococcus pyogenes
(C) Escherichia coli and Bordetella pertussis
(D) Corynebacterium diphtheriae and Staphylococcus aureus
(E) Bacillus anthracis and Staphylococcus epidermidis

29. Which one of the following sets of bacteria produces exotoxins that act by ADPribosylation?
(A) Corynebacterium diphtheriae and Escherichia coli
(B) Clostridium perfringens and Staphylococcus aureus
(C) Clostridium tetani and Bacillus anthracis
(D) Enterococcus faecalis and Mycobacterium tuberculosis
(E) Escherichia coli and Streptococcus pyogenes

30. Which of the following bacteria produce an exotoxin that inhibits the release of acetylcholine at the
neuromuscular junction?
(A) Bacillus anthracis
(B) Bordetella pertussis
(C) Clostridium botulinum
(D) Corynebacterium diphtheriae
(E) Escherichia coli

31. A 25-year-old man with abdominal pain was diagnosed with acute appendicitis. He then had a sudden rise in
temperature to 39°C and a sudden fall in blood pressure. Which one of the following is the most likely cause of the
fever and hypotension?
(A) An exotoxin that ADP-ribosylates elongation factor-2
(B) An exotoxin that stimulates production of large amounts of cyclic AMP
(C) An endotoxin that causes release of tumor necrosis factor
(D) An endotoxin that binds to class I MHC protein
(E) An exoenzyme that cleaves hyaluronic acid

32. Several biotech companies have sponsored clinical trials of a drug consisting of monoclonal antibody to lipid A.
Sepsis caused by which one of the following sets of bacteria is most likely to be improved following administration
of this antibody?
(A) Bordetella pertussis and Clostridium perfringens
(B) Escherichia coli and Neisseria meningitidis
(C) Pseudomonas aeruginosa and Bacillus anthracis
(D) Staphylococcus epidermidis and Staphylococcus aureus
(E) Streptococcus pneumoniae and Staphylococcus aureus

33. Regarding endotoxin, which one of the following is the MOST accurate?
(A) Endotoxin is a polypeptide, the toxic portion of which consists of two Dalanines.
(B) Endotoxin is produced by both gram-positive cocci as well as gram-negative cocci.
(C) Endotoxin acts by binding to class II MHC proteins and the variable portion of the beta chain of the T-cell
receptor.
(D) Endotoxin causes fever and hypotension by inducing the release of interleukins such as interleukin-1 and tumor
necrosis factor.
(E) The antigenicity of endotoxin resides in its fatty acid side chains.

34. Which one of the following host defense processes is the MOST important in preventing the action of
exotoxins?
(A) Binding of cytokines to exotoxin-specific receptors inhibits the attachment of exotoxins
(B) Degradation of exotoxins by the membrane attack complex of complement
(C) Lysis of exotoxins by perforins produced by cytotoxic T cells
(D) Neutralization of exotoxins by antibody prevents binding to target cell membrane
(E) Phagocytosis of exotoxins by neutrophils and subsequent destruction by hypochlorite

35. An inflammatory response in the skin is characterized by erythema (redness). Which one of the following is the
most important cause of this erythema?
(A) C3b component of complement
(B) Gamma interferon
(C) Histamine
(D) Hypochlorite
(E) Superoxide

36. A 1-year-old child with repeated infections was diagnosed with chronic granulomatous disease (CGD). A defect
in which one of the following is the cause of CGD?
(A) Gamma interferon receptor
(B) LFA-integrins
(C) Mannose-binding protein
(D) NADPH oxidase
(E) Nitric oxide

37. Opsonization is the process by which:

(A) bacteria are made more easily phagocytized.
(B) chemokines attract neutrophils to the site of infection.
(C) neutrophils migrate from the blood through the endothelium to reach the site of infection.
(D) the acute-phase response is induced.
(E) the alternate pathway of complement is activated.

38. If the venipuncture site is inadequately disinfected, blood cultures are most often contaminated with which one
of the following bacteria?
(A) Escherichia coli
(B) Haemophilus influenzae
(C) Pseudomonas aeruginosa
(D) Staphylococcus epidermidis
(E) Streptococcus pneumoniae

39. The main purpose of performing a throat culture is to detect the presence of which one of the following bacteria?
(A) Neisseria meningitidis
(B) Staphylococcus aureus
(C) Staphylococcus epidermidis
(D) Streptococcus pneumoniae
(E) Streptococcus pyogenes

40. A sputum culture will be rejected (i.e., it will not be stained or cultured) by the clinical laboratory if:
(A) it is streaked with blood.
(B) it contains IgA antibody.
(C) it contains many more epithelial cells than neutrophils.
(D) it contains pus.
(E) it contains sulfur granules.

41. The identification of Salmonella and Shigella in stool cultures using Eosin–Methylene Blue (EMB) media is
dependent on which one of the following properties?
(A) Salmonella and Shigella produce a blue colony in the presence of methylene blue.
(B) Salmonella and Shigella produce a colorless colony because they do not ferment lactose.
(C) Salmonella and Shigella produce a green colony because they utilize the bile in the media.
(D) Salmonella and Shigella produce a red colony in the presence of eosin.
(E) Salmonella and Shigella produce a yellow colony because they ferment glucose.
42. Cefazolin is often given prior to surgery to prevent postsurgical wound infections. Which one of the following
best describes the mode of action of cefazolin?
(A) It acts as an electron sink depriving the bacteria of reducing power.
(B) It binds to the 30S ribosome and inhibits bacterial protein synthesis.
(C) It inhibits transcription of bacterial mRNA.
(D) It inhibits transpeptidases needed to synthesize peptidoglycan.
(E) It inhibits folic acid synthesis needed to act as a methyl donor.

43. Which one of the following drugs inhibits bacterial nucleic acid synthesis by blocking the production of
tetrahydrofolic acid?
(A) Ceftriaxone
(B) Erythromycin
(C) Metronidazole
(D) Rifampin
(E) Trimethoprim

44. Regarding both penicillins and aminoglycosides, which one of the following is the most accurate?
(A) Both act at the level of the cell wall.
(B) Both are bactericidal drugs.
(C) Both require an intact β-lactam ring for their activity.
(D) Both should not be given to children under the age of 8 years because damage to cartilage can occur.
(E) They should not be given together because they are antagonistic.

45. Listed below are drug combinations that are used to treat certain infections. Which one of the following is a
combination in which both drugs act to inhibit the same metabolic pathway?
(A) Amphotericin and flucytosine
(B) Isoniazid and rifampin
(C) Penicillin G and gentamicin
(D) Sulfonamide and trimethoprim

46. Regarding penicillins and cephalosporins, which one of the following is the most accurate?
(A) Cleavage of the β-lactam ring will inactivate penicillins but not cephalosporins.
(B) Penicillins act by inhibiting transpeptidases but cephalosporins do not.
(C) Penicillins and cephalosporins are both bactericidal drugs.
(D) Penicillins and cephalosporins are active against gram-positive cocci but not against gram-negative rods.
(E) Renal tubule damage is an important adverse effect caused by both penicillins and cephalosporins.

47. Regarding antimicrobial drugs that act by inhibiting nucleic acid synthesis in bacteria, which one of the
following is the most accurate?
(A) Ciprofloxacin inhibits RNA polymerase by acting as a nucleic acid analogue.
(B) Rifampin inhibits the synthesis of messenger RNA.
(C) Sulfonamides inhibit DNA synthesis by chain termination of the elongating strand.
(D) Trimethoprim inhibits DNA polymerase by preventing the unwinding of double-stranded DNA.

48. Regarding aminoglycosides and tetracyclines, which one of the following is the most accurate?
(A) Both classes of drugs are bactericidal.
(B) Both classes of drugs inhibit protein synthesis by binding to the 30S ribosomal subunit.
(C) Both classes of drugs inhibit peptidyl transferase, the enzyme that synthesizes the peptide bond.
(D) Both classes of drugs must be acetylated within human cells to form the active antibacterial compound.
(E) Both classes of drugs cause brown staining of teeth when administered to young children.

49. The selective toxicity of antifungal drugs, such as amphotericin B and itraconazole, is based on the presence in
fungi of which one of the following?
(A) 30S ribosomal subunit
(B) Dihydrofolate reductase
(C) DNA gyrase
(D) Ergosterol
(E) Mycolic acid

50. The next three questions ask about the adverse effects of antibiotics, which are an important consideration when
deciding which antibiotic to prescribe. Which antibiotic causes significant neurotoxicity and must be taken in
conjunction with pyridoxine (vitamin B6) to prevent these neurologic complications?
(A) Amoxicillin
(B) Ceftriaxone
(C) Isoniazid
(D) Rifampin
(E) Vancomycin

51. Of the following antibiotics, which one causes the most phototoxicity (rash when exposed to sunlight)?
(A) Amphotericin B
(B) Ciprofloxacin
(C) Gentamicin
(D) Metronidazole
(E) Sulfamethoxazole

52. Which of the following antibiotics causes “red man” syndrome?

(A) Azithromycin
(B) Doxycycline
(C) Gentamicin
(D) Sulfamethoxazole
(E) Vancomycin

53. The spread of antibiotic resistance from one bacterium to another is a well-recognized and clinically important
phenomenon. Which one of the following mechanisms is most likely to be involved with the spread of resistance?
(A) Acetylation
(B) Conjugation
(C) Programmed rearrangement
(D) Protoplast mobility
(E) Translation

54. Regarding the specific mechanisms by which bacteria become resistant to antimicrobial drugs, which one of the
following is the most accurate?
(A) Some bacteria contain an enzyme that cleaves the ring of aminoglycosides.
(B) Some bacteria contain clavulanic acid, which binds to penicillin G and inactivates it.
(C) Some bacteria contain a mutated gene encoding an altered transpeptidase, which makes it resistant to
doxycycline.
(D) Some bacteria contain a mutated gene that encodes an altered RNA polymerase, which makes it resistant to
rifampin.
(E) Some bacteria contain an altered ribosomal protein, which makes it resistant to isoniazid.

55. The susceptibility of bacteria to an antibiotic is often determined by using the minimal inhibitory concentration
(MIC) assay. Regarding the MIC assay, which one of the following is the most accurate?
(A) MIC is the lowest concentration of the bacteria isolated from the patient that inhibits the activity of a standard
dose of antibiotic.
(B) MIC is the lowest concentration of antibiotic that inhibits the growth of the bacteria isolated from the patient.
(C) MIC is the lowest concentration of antibiotic that kills the bacteria isolated from the patient.
(D) MIC is the lowest concentration of antibiotic in the patient’s serum that inhibits the activity of a standard dose of
antibiotic.

56. The minimal inhibitory concentration (MIC) of the patient’s organism to penicillin is 1 μg/mL and the MIC to
gentamicin is 8 μg/mL. However, the MIC to a combination of penicillin and gentamicin is 0.01 μg/mL. Which one
of the following terms is the most accurate to describe this effect?
(A) Activation
(B) Antagonism
(C) Reassortment
(D) Recombination
(E) Synergism

57. Regarding the mechanisms of resistance to specific drugs, which one of the following is most accurate?
(A) Certain strains of Enterococcus faecalis produce D-lactate rather than Dalanine, which causes them to be
resistant to vancomycin.
(B) Certain strains of Escherichia coli produce ergosterol, which causes them to be resistant to gentamicin.
(C) Certain strains of Neisseria gonorrhoeae produce a mutant peptidyl transferase, which causes them to be
resistant to tetracycline.
(D) Certain strains of Streptococcus pyogenes produce a β-lactamase, which causes them to be resistant to
erythromycin.

58. Which one of the following is the immunogen in the vaccine against Streptococcus pneumoniae?
(A) Capsular polysaccharide
(B) Endotoxin
(C) Formaldehyde-killed organisms
(D) Pilus protein
(E) Toxoid

59. Disease caused by which one of the following bacteria is prevented by a toxoid vaccine?
(A) Bacteroides fragilis
(B) Corynebacterium diphtheriae
(C) Neisseria meningitidis
(D) Salmonella typhi
(E) Vibrio cholerae

60. Disease caused by which one of the following bacteria is prevented by a vaccine in which the immunogen is
covalently bound to a carrier protein (conjugate vaccine)?
(A) Bacillus anthracis
(B) Clostridium tetani
(C) Haemophilus influenzae
(D) Mycobacterium tuberculosis
(E) Streptococcus pyogenes

61. Passive immunity is used to prevent or to treat disease caused by which one of the following sets of bacteria?
(A) Clostridium tetani and Clostridium botulinum
(B) Escherichia coli and Staphylococcus aureus
(C) Neisseria meningitidis and Bacillus anthracis
(D) Streptococcus pneumoniae and Haemophilus influenzae
(E) Streptococcus pyogenes and Salmonella typhi

62. Regarding sterilization and disinfection, which one of the following is the most accurate statement?
(A) Seventy percent alcohol is a better antiseptic than iodine, so 70% alcohol should be used to disinfect the skin
prior to drawing a blood culture rather than iodine.
(B) Disinfectants kill both bacterial cells and bacterial spores.
(C) During sterilization by autoclaving, the temperature must be raised above boiling in order to kill bacterial
spores.
(D) Transmission of milk-borne diseases can be prevented by pasteurization, which kills both bacterial cells and
spores.
(E) Ultraviolet light used in the operating room to disinfect the room kills bacteria primarily by causing oxidation of
lipids in the cell membrane.
63. Which one of the following chemicals is used to sterilize heat-sensitive materials, such as surgical instruments,
in the hospital?
(A) Benzalkonium chloride
(B) Cresol (Lysol)
(C) Ethylene oxide
(D) Thimerosal
(E) Tincture of iodine

64. Each of the following statements concerning the surface structures of bacteria is correct EXCEPT:
(A) Pili mediate the interaction of bacteria with mucosal epithelium.
(B) Polysaccharide capsules retard phagocytosis.
(C) Both gram-negative rods and cocci have lipopolysaccharide (“endotoxin”) in their cell wall.
(D) Bacterial flagella are nonantigenic in humans because they closely resemble human flagella in chemical
composition.

65. Each of the following statements concerning peptidoglycan is correct EXCEPT:

(A) It has a backbone composed of alternating units of muramic acid and acetylglucosamine.
(B) Cross-links between the tetrapeptides involve D-alanine.
(C) It is thinner in gram-positive than in gram-negative cells.
(D) It can be degraded by lysozyme.

66. Each of the following statements concerning bacterial spores is correct

EXCEPT:
(A) Their survival ability is based on their enhanced metabolic activity.
(B) They are formed by gram-positive rods.
(C) They can be killed by being heated to 121°C for 15 minutes.
(D) They are formed primarily when nutrients are limited.

67. Which one of the statements is the MOST accurate comparison of human, bacterial, and fungal cells?
(A) Human cells undergo mitosis, whereas neither bacteria nor fungi do.
(B) Human and fungal cells have a similar cell wall, in contrast to bacteria, whose cell wall contains peptidoglycan.
(C) Human and bacterial cells have plasmids, whereas fungal cells do not.
(D) Human and fungal cells have similar ribosomes, whereas bacterial ribosomes are significantly different.

68. Which statement is MOST accurate regarding the drug depicted in the diagram?
(A) It inhibits DNA synthesis.
(B) It is bacteriostatic.
(C) It binds to 30S ribosomes.
(D) It prevents formation of folic acid.

69. Each of the following statements regarding the selective action of antibiotics on bacteria is correct EXCEPT:
(A) Chloramphenicol affects the large subunit of the bacterial ribosome, which is different from the large subunit of
the human ribosome.
(B) Isoniazid affects the DNA polymerase of bacteria but not that of human cells.
(C) Sulfonamides affect folic acid synthesis in bacteria, a pathway that does not occur in human cells.
(D) Penicillins affect bacteria rather than human cells because bacteria have a cell wall, whereas human cells do not.

70. Each of the following statements concerning endotoxins is correct EXCEPT:

(A) They are less toxic (i.e., less active on a weight basis) than exotoxins.
(B) They are more stable on heating than exotoxins.
(C) They bind to specific cell receptors, whereas exotoxins do not.
(D) They are part of the bacterial cell wall, whereas exotoxins are not.

71. The MAIN host defense against bacterial exotoxins is:

(A) Activated macrophages secreting proteases
(B) IgG and IgM antibodies
(C) Helper T cells
(D) Modulation of host cell receptors in response to the toxin

72. Which one of the following processes involves a sex pilus?

(A) Transduction of a chromosomal gene
(B) Transposition of a mobile genetic element
(C) Integration of a temperate bacteriophage
(D) Conjugation resulting in transfer of an R (resistance) factor

73. Each of the following statements concerning the normal flora is correct EXCEPT:
(A) The most common organism found on the skin is Staphylococcus epidermidis.
(B) Escherichia coli is a prominent member of the normal flora of the throat.
(C) The major site where Bacteroides fragilis is found is the colon.
(D) One of the most common sites where Staphylococcus aureus is found is the nose.

74. Each of the following statements concerning the mechanism of action of antimicrobial drugs is correct EXCEPT:
(A) Vancomycin acts by inhibiting peptidoglycan synthesis.
(B) Quinolones, such as ciprofloxacin, act by inhibiting the DNA gyrase of bacteria.
(C) Erythromycin is a bactericidal drug that disrupts cell membranes by a detergent-like action.
(D) Aminoglycosides such as streptomycin are bactericidal drugs that inhibit protein synthesis.

75. Each of the following statements concerning the resistance of bacteria to antimicrobial drugs is correct
EXCEPT:
(A) Resistance to chloramphenicol is known to be due to an enzyme that acetylates the drug.
(B) Resistance to penicillin is known to be due to reduced affinity of transpeptidases.
(C) Resistance to penicillin is known to be due to cleavage by β-lactamase.
(D) Resistance to tetracycline is known to be due to an enzyme that hydrolyzes the ester linkage.

76. Of the following choices, the MOST important function of antibody in host defenses against bacteria is:
(A) Activation of lysozyme that degrades the cell wall
(B) Acceleration of proteolysis of exotoxins
(C) Facilitation of phagocytosis
(D) Inhibition of bacterial protein synthesis

77. Which of the following events is MOST likely to be due to bacterial conjugation?
(A) A strain of Corynebacterium diphtheriae produces a toxin encoded by a prophage.
(B) A strain of Pseudomonas aeruginosa produces β-lactamase encoded by a plasmid similar to a plasmid of another
gram-negative organism.
(C) An encapsulated strain of Streptococcus pneumoniae acquires the gene for capsule formation from an extract of
DNA from another encapsulated strain.
(D) A gene encoding resistance to gentamicin in the Escherichia coli chromosome appears in the genome of a
bacteriophage that has infected E. coli.

78. Which one of the following BEST describes the mode of action of endotoxin?
(A) Degrades lecithin in cell membranes
(B) Inactivates elongation factor-2
(C) Blocks release of acetylcholine
(D) Causes the release of tumor necrosis factor

79. The identification of bacteria by serologic tests is based on the presence of specific antigens. Which one of the
following bacterial components is LEAST likely to contain useful antigens?
(A) Capsule
(B) Flagella
(C) Exotoxins
(D) Ribosomes
80. Each of the following statements concerning bacterial spores is correct EXCEPT:
(A) Spores are formed under adverse environmental conditions such as the absence of a carbon source.
(B) Spores are resistant to boiling.
(C) Spores are metabolically inactive and contain dipicolinic acid, a calcium chelator.
(D) Spores are formed primarily by organisms of the genus Neisseria.

81. Each of the following statements concerning the mechanism of action of antibacterial drugs is correct EXCEPT:
(A) Cephalosporins are bactericidal drugs that inhibit the transpeptidase reaction and prevent cell wall synthesis.
(B) Tetracyclines are bacteriostatic drugs that inhibit protein synthesis by blocking tRNA binding.
(C) Aminoglycosides are bacteriostatic drugs that inhibit protein synthesis by activating ribonuclease, which
degrades mRNA.
(D) Erythromycin is a bacteriostatic drug that inhibits protein synthesis by blocking translocation of the polypeptide.

82. Each of the following is a typical property of obligate anaerobes EXCEPT:

(A) They generate energy by using the cytochrome system.
(B) They grow best in the absence of air.
(C) They lack superoxide dismutase.
(D) They lack catalase.

83. Each of the following statements concerning the Gram stain is correct EXCEPT:
(A) Escherichia coli stains pink because it has a thin peptidoglycan layer.
(B) Streptococcus pyogenes stains blue because it has a thick peptidoglycan layer.
(C) Mycobacterium tuberculosis stains blue because it has a thick lipid layer.
(D) Mycoplasma pneumoniae is not visible in the Gram stain because it does not have a cell wall.

84. Each of the following statements concerning the killing of bacteria is correct EXCEPT:
(A) Lysozyme in tears can hydrolyze bacterial cell walls.
(B) Silver nitrate can inactivate bacterial enzymes.
(C) Detergents can disrupt bacterial cell membranes.
(D) Ultraviolet light can degrade bacterial capsules.

85. In the Gram stain, the decolorization of gram-negative bacteria by alcohol is MOST closely related to:
(A) Proteins encoded by F plasmids
(B) Lipids in the cell wall
(C) 70S ribosomes
(D) Branched polysaccharides in the capsule

86. Chemical modification of benzylpenicillin (penicillin G) has resulted in several beneficial changes in the clinical
use of this drug. Which one of the following is NOT one of those beneficial changes?
(A) Lowered frequency of anaphylaxis
(B) Increased activity against gram-negative rods
(C) Increased resistance to stomach acid
(D) Reduced cleavage by penicillinase

87. Each of the following statements concerning resistance to antibiotics is correct EXCEPT:
(A) Resistance to aminoglycosides can be due to phosphorylating enzymes encoded by R plasmids.
(B) Resistance to sulfonamides can be due to enzymes that hydrolyze the fivemembered ring structure.
(C) Resistance to penicillins can be due to alterations in binding proteins in the cell membrane.
(D) Resistance to cephalosporins can be due to cleavage of the β-lactam ring.

88. The effects of endotoxin include each of the following EXCEPT:

(A) Opsonization
(B) Fever
(C) Activation of the coagulation cascade
(D) Hypotension
89. Bacterial surface structures that show antigenic diversity include each of the following EXCEPT:
(A) Pili
(B) Capsules
(C) Flagella
(D) Peptidoglycan

90. The effects of antibody on bacteria include each of the following EXCEPT:
(A) Lysis of gram-negative bacteria in conjunction with complement
(B) Augmentation of phagocytosis
(C) Increase in the frequency of lysogeny
(D) Inhibition of adherence of bacteria to mucosal surfaces

91. Each of the following statements concerning exotoxins is correct EXCEPT:

(A) When treated chemically, some exotoxins lose their toxicity and can be used as immunogens in vaccines.
(B) Some exotoxins are capable of causing disease in purified form, free of any bacteria.
(C) Some exotoxins act in the gastrointestinal tract to cause diarrhea.
(D) Some exotoxins contain lipopolysaccharides as the toxic component.

92. Each of the following statements concerning bacterial and human cells is correct EXCEPT:
(A) Bacteria are prokaryotic (i.e., they have one molecule of DNA, are haploid, and have no nuclear membrane),
whereas human cells are eukaryotic (i.e., they have multiple chromosomes, are diploid, and have a nuclear
membrane).
(B) Bacteria derive their energy by oxidative phosphorylation within mitochondria in a manner similar to human
cells.
(C) Bacterial and human ribosomes are of different sizes and chemical compositions.
(D) Bacterial cells possess peptidoglycan, whereas human cells do not.

93. Each of the following statements concerning penicillin is correct EXCEPT:

(A) An intact β-lactam ring of penicillin is required for its activity.
(B) The structure of penicillin resembles that of a dipeptide of alanine, which is a component of peptidoglycan.
(C) Penicillin is a bacteriostatic drug because autolytic enzymes are not activated.
(D) Penicillin inhibits transpeptidases, which are required for cross-linking peptidoglycan.

94. Each of the following statements concerning the mechanisms of resistance to antimicrobial drugs is correct
EXCEPT:
(A) R factors are plasmids that carry the genes for enzymes that modify one or more drugs.
(B) Resistance to some drugs is due to a chromosomal mutation that alters the receptor for the drug.
(C) Resistance to some drugs is due to transposon genes that code for enzymes that inactivate the drugs.
(D) Resistance genes are rarely transferred by conjugation.

95. Each of the following statements concerning endotoxins is correct EXCEPT:

(A) The toxicity of endotoxins is due to the lipid portion of the molecule.
(B) Endotoxins are found in most gram-positive bacteria.
(C) Endotoxins are located outside of the cell wall peptidoglycan.
(D) The antigenicity of somatic (O) antigen is due to repeating oligosaccharides.

96. Each of the following statements concerning exotoxins is correct EXCEPT:

(A) Exotoxins are polypeptides.
(B) Exotoxins are more easily inactivated by heat than are endotoxins.
(C) Exotoxins are less toxic than the same amount of endotoxins.
(D) Exotoxins can be converted to toxoids.

97. Each of the following statements concerning the killing of bacteria is correct EXCEPT:
(A) A 70% solution of ethanol kills more effectively than absolute (100%) ethanol.
(B) An autoclave uses steam under pressure to reach the killing temperature of 121°C.
(C) The pasteurization of milk kills pathogens but allows many organisms and spores to survive.
(D) Iodine kills by causing the formation of thymine dimers in bacterial DNA.

98. Each of the following statements concerning the drug depicted in the diagram is correct EXCEPT:
(A) The drug is bacteriostatic.
(B) The drug inhibits cell wall synthesis.
(C) The drug is made by a fungus.
(D) The portion of the molecule required for activity is labeled B.

99. Each of the following statements concerning the normal flora is correct EXCEPT:
(A) The normal flora of the colon consists predominantly of anaerobic bacteria.
(B) The presence of the normal flora prevents certain pathogens from colonizing the upper respiratory tract.
(C) Fungi (e.g., yeasts) are not members of the normal flora.
(D) Organisms of the normal flora are permanent residents of the body surfaces.

100. Each of the following statements concerning the structure and chemical composition of bacteria is correct
EXCEPT:
(A) Some gram-positive cocci contain teichoic acid external to the peptidoglycan.
(B) Some gram-positive rods produce spores that are resistant to boiling.
(C) Some gram-negative rods contain lipid A in their outer cell membrane.
(D) Some mycoplasmas contain pentaglycine in their peptidoglycan.

101. Each of the following statements concerning the normal flora is correct EXCEPT:
(A) Streptococcus mutans is found in the mouth and contributes to the formation of dental caries.
(B) The predominant organisms in the alveoli are viridans streptococci.
(C) Bacteroides fragilis is found in greater numbers than Escherichia coli in the colon.
(D) Candida albicans is part of the normal flora of both men and women.

102. Each of the following statements concerning cholera toxin is correct EXCEPT:
(A) Cholera toxin inhibits elongation factor-2 in the mucosal epithelium.
(B) Binding of cholera toxin to the mucosal epithelium occurs via interaction of the B subunit of the toxin with a
ganglioside in the cell membrane.
(C) Cholera toxin acts by adding ADP-ribose to a G protein.
(D) Cholera toxin activates the enzyme adenylate cyclase in the enterocyte.

DIRECTIONS (Questions 103–114): Select the ONE lettered option that is MOST closely associated with the
numbered items. Each lettered option may be selected once, more than once, or not at all.

Questions 103–106
(A) Penicillins
(B) Aminoglycosides
(C) Chloramphenicol
(D) Rifampin
(E) Sulfonamides
103. Inhibit(s) bacterial RNA polymerase
104. Inhibit(s) cross-linking of peptidoglycan
105. Inhibit(s) protein synthesis by binding to the 30S ribosomal subunit
106. Inhibit(s) folic acid synthesis

Questions 107–109
(A) Transduction
(B) Conjugation
(C) DNA transformation
(D) Transposition
107. During an outbreak of gastrointestinal disease caused by an Escherichia coli strain sensitive to ampicillin,
tetracycline, and chloramphenicol, a stool sample from one patient yields E. coli with the same serotype resistant to
the three antibiotics.
108. A mutant cell line lacking a functional thymidine kinase gene was exposed to a preparation of DNA from
normal cells; under appropriate growth conditions, a colony of cells was isolated that makes thymidine kinase.
109. A retrovirus without an oncogene does not induce leukemia in mice; after repeated passages through mice,
viruses recovered from a tumor were highly oncogenic and contained a new gene.

Questions 110–114
(A) Diphtheria toxin
(B) Tetanus toxin
(C) Botulinum toxin
(D) Toxic shock syndrome toxin
(E) Cholera toxin
110. Causes paralysis by blocking release of acetylcholine
111. Inhibits protein synthesis by blocking elongation factor-2
112. Stimulates T cells to produce cytokines
113. Stimulates the production of cyclic AMP by adding ADP-ribose to a G protein
114. Inhibits the release of inhibitory neurotransmitters causing muscle spasms
immunolgy
1. Which one of the following is an attribute of the innate, rather than
the adaptive (acquired), arm of our host defenses?
(A) Is highly specific in its response to bacteria
(B) Responds to viruses and fungi, but not bacteria
(C) Exhibits memory following exposure to bacteria
(D) Is part of our host defense against bacteria but not against
fungi
(E) Is as effective the first time it is exposed to bacteria as it is
subsequent times
2. Regarding antibody-mediated immunity and cell-mediated immunity,
which one of the following is the most accurate?
(A) Antibody-mediated immunity helps prevent graft rejection.
(B) Antibody-mediated immunity protects against anaphylactic
shock.
(C) Antibody-mediated immunity protects against autoimmune
diseases.
(D) Cell-mediated immunity neutralizes extracellular viruses.
(E) Cell-mediated immunity protects against fungal infections.
3. Which one of the following is most likely to induce an IgM antibody
response without the participation of helper T cells?
(A) Diphtheria toxoid
(B) Pneumococcal capsular polysaccharide
(C) Pneumococcal polysaccharide conjugated to diphtheria toxoid
(D) Tetanus toxoid
(E) Toxic shock syndrome toxin
4. Regarding haptens, which one of the following is the most accurate?
(A) A hapten is the antigen-binding site in the hypervariable region
of IgG.
(B) A hapten cannot induce antibody by itself but when covalently
bound to a carrier protein can do so.
(C) A hapten can bind to the antigen receptor of CD4-positive T
cells without being processed by macrophages.
(D) A hapten is defined by its ability to bind to the smaller of the
two polypeptides that comprise the class I MHC proteins.
5. Certain components of our immune system are characterized by
two attributes: one, being able to respond specifically to microbes
and, two, to exhibit memory of having responded to a particular
microbe previously. Which one of the following has BOTH specificity
and memory?
(A) B cells
(B) Basophils
(C) Dendritic cells
(D) Macrophages
(E) Neutrophils
6. Your patient says that she must travel on business 3 days from now
to a country where hepatitis A is endemic. She just read in the newspaper
that there are two types of protection against this disease: one
is a vaccine that contains killed hepatitis A virus and the other is
serum globulin preparation that contains antibodies to the virus.
She asks which you would recommend and for what reason?
(A) The vaccine containing killed hepatitis A virus is best because
it induces the most antibody.
(B) The vaccine containing killed hepatitis A virus is best because
it provides the most long-lived immunity.
(C) The serum globulin preparation containing antibodies against
the virus is best because it provides immunity in the shortest
time.
(D) The serum globulin preparation containing antibodies against
the virus is best because it provides the most long-lived
immunity.

1. (E)
2. (E)
3. (B)
4. (B)
5. (A)
6. (C)

2. Which one of the following sets of cells can present antigen to

helper T cells?
(A) B cells and dendritic cells
(B) B cells and cytotoxic T cells
(C) Macrophages and eosinophils
(D) Neutrophils and cytotoxic T cells
(E) Neutrophils and plasma cells
3. The activation of a CD8-positive T lymphocyte requires presentation
of antigen in association with:
(A) Class I MHC protein and synthesis of interleukin-2 by CD4 T
lymphocytes
(B) Class I MHC protein and synthesis of gamma-interferon by
macrophages
(C) Class II MHC protein and synthesis of interleukin-1 by macrophages
(D) Class II MHC protein and synthesis of interleukin-4 by CD4 T
lymphocytes
4. Regarding Th-1, Th-2, and Th-17 cells, which one of the following
is the most accurate?
(A) Th-17 cells produce interleukin-17, which stimulates the
production of Th-2 cells.
(B) The production of Th-1 cells is enhanced by interleukin-4,
whereas the production of Th-2 cells is enhanced by
interleukin-2.
(C) Th-2 cells synthesize gamma interferon that is important in
controlling infections caused by Staphylococcus aureus and
other pyogenic bacteria.
(D) Th-1 cells are involved with delayed hypersensitivity reactions,
such as those that control infections caused by Mycobacterium
tuberculosis.
5. Regarding events that occur in the thymus during the maturation of
T cells, which one of the following is the most accurate?
(A) T cells bearing antigen receptors that recognize self antigens
are deleted, a process known as negative selection.
(B) Superantigens are “super” because they play a selective role in
both the positive and the negative selection that occurs in the
thymus.
(C) T cells bearing antigen receptors that recognize antigen in
association with foreign MHC proteins survive, a process
known as positive selection.
(D) Most mature T cells have both CD4 and CD8 proteins in their
surface that ensures their ability to react with antigen presented
by either MHC class I and MHC class II proteins.
6. Regarding interleukins, which one of the following is the most
accurate?
(A) IL-2 is made by B cells and increases class switching from IgM
to IgG.
(B) IL-4 is made by cytotoxic T cells and mediates the killing of
virus-infected cells.
(C) IL-12 is made by eosinophils and enhances the production of
cells that mediate immediate hypersensitivity.
(D) Gamma interferon is made by Th-1 cells and activates macrophages
to phagocytose more effectively.
7. Regarding chemokines, which one of the following is the most
accurate?
(A) Chemokines penetrate the membranes of target cells during
attack by cytotoxic T cells.
(B) Chemokines bind to the T-cell receptor outside of the antigenbinding
site and activate many T cells.
(C) Chemokines attract neutrophils to the site of bacterial infection,
thereby playing a role in the inflammatory response.
(D) Chemokines induce gene switching in B cells, which increases
the amount of IgE synthesized, thereby predisposing to
allergies.
8. Your patient is a 20-year-old woman who experienced the sudden
onset of fever, vomiting, myalgias, and diarrhea. This was followed
by hypotension and a sunburn-like rash over most of her body. You
make a presumptive diagnosis of toxic shock syndrome. Which one
of the following is the most accurate description of the pathogenesis
of this disease?
(A) It is caused by the release of large amounts of histamine from
basophils.
(B) It is caused by an insufficient amount of inhibitor of the C1
component of complement.
(C) It is caused by a superantigen that induces an overproduction
of cytokines from helper T cells.
(D) It is caused by a delayed hypersensitivity response to procainamide,
which she was taking for her atrial fibrillation.
(E) It is caused by a mutation in the gene for ZAP-70, one of the
signal transduction proteins in T lymphocytes.
ANSWERS
1. (B)
2. (A)
3. (A)
4. (D)
5. (A)
6. (D)
7. (C)
8. (C)

1. It’s time to play “Who am I?”. I am the first class of antibody to

appear, so my presence indicates an active infection rather than an
infection that occurred in the past. I can fix complement, which is
an important feature of our early defenses against bacterial infections.
I am found in plasma as a pentamer.
(A) IgA
(B) IgD
(C) IgE
(D) IgG
(E) IgM
2. Regarding IgG, which one of the following is the most accurate?
(A) Each IgG molecule has one antigen binding site.
(B) It is the most important antigen receptor on the surface of
neutrophils.
(C) During the primary response, it is made in larger amounts
than is IgM.
(D) The ability of IgG to fix complement resides on the constant
region of the light chain.
(E) It is the only one of the five immunoglobulins that is transferred
from mother to fetus in utero.
3. If a person had a mutation in the gene encoding J (joining) chains,
which of the following classes of antibodies could NOT be produced?
(A) IgA and IgM
(B) IgA and IgG
(C) IgG and IgE
(D) IgD and IgE
(E) IgM and IgE

4. Regarding the function of the different classes of antibodies, which

one of the following statements is the most accurate?
(A) IgE blocks the binding of viruses to the gut mucosa.
(B) IgA acts as an antigen receptor on the surface of B cells.
(C) IgD is our most important defense against worm parasites,
such as hookworms.
(D) IgG can activate the alternative pathway of complement,
resulting in the production of C3a that degrades the bacterial
cell wall.
(E) There are receptors for the heavy chain of IgG on the surface
of neutrophils that mediate a host defense process called
opsonization.
5. Regarding the genes that encode antibodies, which one of the following
is most accurate?
(A) Hypervariable regions are encoded by the genes of both the
light and heavy chains.
(B) The genes for the light and heavy chains are linked on the
same chromosome adjacent to the HLA locus.
(C) During the production of IgG, the light and the heavy chains
acquire the same antigen binding sites by translocation of the
same variable genes.
(D) The gene for the constant region of the gamma heavy chain is
first in the sequence of heavy chain genes, and that is why IgG
is made in greatest amounts.
ANSWERS
1. (E)
2. (E)
3. (A)
4. (E)
5. (A)

1. Regarding the primary and secondary (anamnestic) immune

responses, which one of the following is most accurate?
(A) The IgM made in the primary response is made primarily by
memory B cells.
(B) The lag phase is shorter in the primary response than in the
secondary response.
(C) In the primary response, memory B cells are produced, but
memory T cells are not.
(D) The amount of IgG made in the secondary response is greater
than the amount made in the primary response.

2. Which one of the following is a function of humoral (antibodymediated)

immunity?
(A) Neutralize bacterial toxins
(B) Activate the alternative pathway of complement
(C) Inhibit the growth of Mycobacterium tuberculosis
(D) Inhibit the growth of virus-infected cells by enhancing the
production of perforins
ANSWERS
1. (D)
2. (A)

1. Regarding tissue transplantation, which one of the following is the

most accurate?
(A) An allograft is a graft that transfers tissue or an organ from one
member of a species to a member of another species.
(B) The mother or father of the patient are typically the best
donors of a graft because they are two haplotype matches.
(C) The ABO blood groups of the donor and recipient do not have
to be matched because they do not play a role in allograft
rejection.
(D) Even when a donor and a recipient are matched at both the
class I and class II MHC loci, rejection can occur and the
recipient should be given immunosuppressive drugs.
(E) If the same donor is the source of tissue for two grafts to a
recipient and the second graft is performed 1 month after the
first graft is rejected, then the second graft will not be rejected.
2. Regarding the MHC proteins and the genes that encode them,
which one of the following is the most accurate?
(A) The genes encoding MHC-2 proteins are highly polymorphic,
whereas the genes encoding MHC-1 proteins are not.
(B) The genes encoding MHC-1 proteins are located on a different
chromosome from the genes encoding MHC-2 proteins.
(C) The genes are codominant, and each person expresses MHC-1
and MHC-2 genes inherited from both mother and father.
(D) MHC-2 proteins are found on the surface of all cells, whereas
MHC-1 proteins are found only on the surface of phagocytes.
3. Regarding the graft-versus-host reaction, which one of the following
is the most accurate?
(A) It occurs primarily when a kidney is transplanted.
(B) It is caused primarily by mature T cells in the graft.
(C) It occurs primarily when ABO blood groups are matched.
(D) It occurs primarily when the donor is immunocompromised.
(E) It occurs primarily when the haplotypes of the donor and
recipient are matched.
ANSWERS
1. (D)
2. (C)
3. (B)
1. Regarding the complement pathway, which one of the following is
the most accurate?
(A) C3 convertase protects normal cells from lysis by complement.
(B) C3a is a decay accelerating factor and causes the rapid decay
and death of bacteria.
(C) In general, gram-positive bacteria are more likely to be killed
by complement than gram-negatives.
(D) The membrane attack complex is formed as a result of activation
of the classic pathway but not by activation of the alternative
pathway.
(E) The first time a person is exposed to a microorganism, the
alternative pathway of complement is more likely to be activated
than the classic pathway.
2. Of the following complement components, which one is the most
important opsonin?
(A) C1
(B) C3a
(C) C3b
(D) C5a
(E) C5b
3. Of the following complement components, which one is the most
potent in attracting neutrophils to the site of infection (i.e., acting as
a chemokine)?
(A) C1
(B) C2
(C) C3b
(D) C5a
(E) Mannose-binding lectin
4. Of the following, which one is the most important function of the
complex formed by complement components C5b,6,7,8,9
(A) To enhance antibody production
(B) To inhibit immune complex formation
(C) To opsonize viruses
(D) To perforate bacterial cell membranes
(E) To release histamine from mast cells
5. A deficiency of which one of the following complement components
predisposes to bacteremia caused by members of the genus
Neisseria?
(A) C1
(B) C3b
(C) C5a
(D) C5b
(E) C5b,6,7,8,9
6. Your patient is a 20-year-old woman who complains of swellings on
her arms and legs and a feeling of fullness in her throat that makes
it difficult to breath. The swellings are not red, hot or tender. You
suspect she may have angioedema caused by a complement abnormality.
Of the following, which one is the most likely explanation?
(A) She has too little C1 inhibitor
(B) She has too little C3b
(C) She has too little factor B
(D) She has too much C5a
(E) She has too much C9
ANSWERS
1. (E)
2. (C)
3. (D)
4. (D)
5. (E)
6. (A

1. Your patient has episodes of eye tearing, “blood-shot” eyes, and

runny nose, which you think may be due to an allergy to some plant
pollen. You refer the patient to an allergist, who performs skin tests
with various allergens. A wheal-and-flare reaction is seen on the
patient’s back at the site where several pollens were injected. What
is the most likely sequence of events that produced the wheal-andflare
reaction?
(A) Allergen binds to IgE on the surface of B cells and IL-4 is
released.
(B) Allergen binds to IgE on the surface of mast cells and histamine
is released

(C) Allergen binds to IgE in the plasma, which activates complement

to produce C3b.
(D) Allergen binds to IgE in the plasma, and the allergen-IgE complex
binds to the surface of macrophages and IL-1 is released.
2. One important test to determine whether your patient has been
exposed to Mycobacterium tuberculosis, the organism that causes
tuberculosis, is to do a PPD skin test. In this test, purified protein
derivative (PPD) extracted from the organism is injected intradermally.
Of the following, which one is most likely to occur at the site
of a positive PPD?
(A) Cytotoxic T cells kill target cells at the site.
(B) Macrophages and CD-4 positive T cells infiltrate the site.
(C) Histamine and leukotrienes are liberated from mast cells at
the site.
(D) Immune complexes consisting of PPD and IgG are deposited at
the site.
3. Your patient is a 77-year-old man with enterococcal endocarditis
who was treated with penicillin G and gentamicin. Five days later,
fever and a diffuse maculopapular rash developed. There is no urticaria,
hypotension, or respiratory compromise. Urinalysis revealed
proteinuria and granular casts. You suspect he may have serum sickness.
Which one of the following immunopathogenic mechanisms is
most likely to be the cause?
(A) One of the drugs formed immune complexes with IgG.
(B) One of the drugs activated CD4-positive T cells and macrophages.
(C) One of the drugs activated the alternative pathway of complement.
(D) One of the drugs cross-linked IgE on the mast cells and caused
the release of histamine.
4. Of the following diseases, which one is most likely to be caused by a
delayed hypersensitivity reaction?
(A) Autoimmune hemolytic anemia
(B) Contact dermatitis, such as poison oak
(C) Hemolytic disease of the newborn
(D) Post-streptococcal glomerulonephritis
(E) Systemic lupus erythematosus
5. Atopic individuals (i.e., those with a hereditary predisposition to
immediate hypersensitivity reactions) produce an increased amount
of IgE. Of the following, which one is the most likely explanation for
the increased production of IgE?
(A) Large amounts of IL-1 are produced by dendritic cells.
(B) Large amounts of IL-2 are produced by macrophages.
(C) Large amounts of IL-4 are produced by Th-2 cells.
(D) Large amounts of gamma interferon are produced by Th-1
cells.
(E) Large amounts of C3a are produced by the alternative pathway
of complement.
6. Of the following four types of hypersensitivity reactions, which one
causes the hemolysis that occurs in hemolytic disease of the newborn
(erythroblastosis fetalis)?
(A) Type I—immediate hypersensitivity
(B) Type II—cytotoxic hypersensitivity
(C) Type III—immune complex hypersensitivity
(D) Type IV—delayed hypersensitivity

ANSWERS
1. (B)
2. (B)
3. (A)
4. (B)
5. (C)
6. (B)

1. Regarding immunological tolerance, which one of the following is

the most accurate?
(A) Clonal deletion occurs with T cells but not with B cells.
(B) Tolerance to certain self antigens occurs by negative selection
of immature T cells in the thymus.
(C) The presence of B7 on the surface of the antigen-presenting cell
is one of the essential steps required to establish tolerance.
(D) Tolerance is easier to establish in adults than in newborns
because more self-reactive T cells have undergone apoptosis in
adults than in newborns.
(E) Once tolerance is established to an antigen, it is permanent (i.e.,
that individual cannot react against that antigen even though
the antigen is no longer present).
2. Antibodies against normal components of the body typically occur
in autoimmune diseases. In which one of the following sets of two
diseases does antibodies against DNA occur in one disease and
antibodies against IgG occur in the other disease?
(A) Myasthenia gravis and systemic lupus erythematosus
(B) Pernicious anemia and rheumatic fever
(C) Rheumatic fever and myasthenia gravis
(D) Rheumatoid arthritis and pernicious anemia
(E) Systemic lupus erythematosus and rheumatoid arthritis

3. Regarding the pathogenesis of autoimmune diseases, which one of

the following is the most accurate?
(A) In Reiter’s syndrome, neuropathy occurs following viral respiratory
tract infections.
(B) In myasthenia gravis, antibodies are formed against acetylcholine
at the neuromuscular junction.
(C) In Goodpasture’s syndrome, antibodies are formed against the
synovial membrane in the large weight-bearing joints.
(D) In autoimmune hemolytic anemia, the red cells are destroyed
by tumor necrosis factor produced by activated macrophages.
(E) In Graves’ disease, antibodies bind to the receptor for thyroidstimulating
hormone, which stimulates the thyroid to produce
excess thyroxine.
4. Your patient is a 25-year-old woman with a fever, a malar facial rash,
alopecia, and ulcerations on two fingertips. Urinalysis shows proteinuria.
You suspect she has systemic lupus erythematosus. Which one
of the following is the most likely explanation for her proteinuria?
(A) Cytotoxic T cells attack the glomerular basement membrane.
(B) An IgE-mediated response releases histamine and leukotrienes
that damage the tubules.
(C) A delayed hypersensitivity response consisting of macrophages
and CD4-positive T cells damages the glomeruli.
(D) Immune complexes are trapped by glomeruli and activate
complement, then C5a attracts neutrophils that damage the
glomeruli.
ANSWERS
1. (B)
2. (E)
3. (E)
4. (D

tumor immunity)

1. Regarding tumor immunity, which one of the following is the most

accurate?
(A) Both cytotoxic T cells and cytotoxic antibodies attack human
cancer cells.
(B) An elevated level of alpha fetoprotein is a marker for carcinoma
of the lung.
(C) A declining level of CEA is an indication that the patient’s
colon cancer has recurred.
(D) Cancer cells induced by chemicals have new antigens on the
surface but cancer cells induced by viruses do not.
(E) Natural killer (NK) cells do not participate in the cell-mediated
response to cancer cells because they do not have an antigenspecific
receptor on their surface.

immunodeficiency

1. Your patient is a 2-year old boy who has had several episodes of
pustules and lymphadenitis caused by Staphylococcus aureus. His
immunoglobulins and complement levels are normal. A nitroblue
tetrazolium test reveals defective cells. Which one of the following
cells is the most likely to be defective?
(A) CD4-positive T lymphocytes
(B) CD8-positive T lymphocytes
(C) Eosinophils
(D) Natural killer cells
(E) Neutrophils
2. Your patient is a 25-year-old woman who has had several serious
episodes of bacterial pneumonia in the last 5 months. She has not
had frequent or unusual infections prior to the onset of these pneumonias.
Which one of the following is the most likely immunodeficiency
that predisposes her to these infections?
(A) She is likely to have a defect in her cytotoxic T cells.
(B) She is likely to have a reduced level of immunoglobulins.
(C) She is likely to have a mutation in the gene that encodes the
C3a portion of complement.
(D) She is likely to have a mutation in one of the genes that encode
the class I MHC proteins.
3. Regarding Bruton’s agammaglobulinemia, which one of the following
is most accurate?
(A) There is very little IgG produced, but IgM and IgA levels are
normal.
(B) Viral infections are more common than pyogenic bacterial
infections.
(C) The number of B cells is normal, but they cannot differentiate
into plasma cells.
(D) There is a mutation in the gene for tyrosine kinase, an important
enzyme in the signal transduction pathway in B cells.

4. Which one of the following is the most accurate description of the

defect in chronic granulomatous disease?
(A) There is an inability to produce an oxidative burst.
(B) There is a failure to produce sufficient interleukin-2.
(C) There is a deficiency of a late-acting complement component.
(D) There is a mutant protein kinase in a signal transduction
pathway.
(E) There is a mutation in the gene that encodes an MHC class 2
protein.
5. Which one of the following immunodeficiencies is most likely to
predispose to both pyogenic bacterial infections and viral infections
in a young child?
(A) Bruton’s agammaglobulinemia
(B) Chronic granulomatous disease
(C) DiGeorge’s syndrome
(D) Job’s syndrome
(E) Severe combined immunodeficiency disease
6. Regarding immunodeficiency diseases, which one of the following
is most accurate?
(A) Patients who have a deficiency of IgA have a high incidence of
pyogenic infections of the sinuses and lungs.
(B) Common variable hypogammaglobulinemia typically occurs
in boys under the age of 6 months and results from an virtual
absence of B cells.
(C) In Wiskott-Aldrich syndrome, the combination of antibody
deficiency and complement deficiency leads to disseminated
viral and fungal infections.
(D) Patients with DiGeorge’s syndrome (congenital thymic aplasia)
have a reduced number of both T cells and B cells and have
severe infections caused by pyogenic bacteria.
(E) Patients who cannot produce one or more of the late-acting
complement components, such as C 6, 7, 8, or 9, have episodes
of angioedema, including laryngeal edema that can be fatal.
ANSWERS
1. (E)
2. (B)
3. (D)
4. (A)
5. (E)
1. Which one of the following is the immunogen in the vaccine against
Streptococcus pneumoniae ?
(A) Capsular polysaccharide
(B) Endotoxin
(C) Formaldehyde killed organisms
(D) Pilus protein
(E) Toxoid
2. Disease caused by which one of the following bacteria is prevented
by a toxoid vaccine?
(A) Bacteroides fragilis
(B) Corynebacterium diphtheriae
(C) Neisseria meningitidis
(D) Salmonella typhi
(E) Vibrio cholerae
3. Disease caused by which one of the following bacteria is prevented
by a vaccine in which the immunogen is covalently bound to a carrier
protein (conjugate vaccine)?
(A) Bacillus anthracis
(B) Clostridium tetani
(C) Haemophilus influenzae
(D) Mycobacterium tuberculosis
( E) Streptococcus pyogenes

4. Passive immunity is used to prevent or to treat disease caused by

which one of the following sets of bacteria?
(A) Clostridium tetani and Clostridium botulinum
(B) Escherichia coli and Staphylococcus aureus
(C) Neisseria meningitidis and Bacillus anthracis
(D) Streptococcus pneumoniae and Haemophilus influenzae
(E) Streptococcus pyogenes and Salmonella typhi
ANSWERS
1. (A)
2. (B)
3. (C)
4. (A)