JRKCa-at MSU GSC-COM [GENERAL PATHOLOGY Q2]

Infectious Diseases II
A 28-year-old woman from rural Guyana with a history of rheumatoid arthritis develops painful swelling of her Strongyloidiasis (correct
hands and feet. She is treated with corticosteroid therapy. A month later, she develops profuse, watery diarrhea answer)
along with fever and cough. On examination, she has a temperature of 37.3° C. Laboratory studies show WBC
count, 12,900/mm3; and the WBC differential count shows 57% segmented neutrophils, 5% bands, 16% Schistosomiasis (answer in
lymphocytes, 8% monocytes, and 14% eosinophils. Microscopic examination of a stool specimen shows ova and the quiz; 2 schistosomiasis in
small rhabditoid larvae. Similar larvae are present in a sputum specimen. Which of the following infectious the choices)
diseases is most likely to produce these findings?
A 41-year-old man has had worsening fever, cough, and dyspnea for 2 weeks. On examination, he has rales and HIV infection (correct
diminished breath sounds on auscultation of his chest. A chest radiograph shows scattered infiltrates in both lungs. answer)
A tuberculin skin test shows 6 mm of induration. A sputum sample is negative, but bronchoalveolar lavage is
positive, for acid-fast bacilli. His WBC count is 4600/mm3 with differential count of 80% neutrophils, 10% Diabetes mellitus (answer in
lymphocytes, and 10% monocytes. Which of the following is the most likely risk factor for his pulmonary disease? the quiz)
A study of sexually transmitted infections identifies an organism most commonly found in tropical and subtropical Haemophilus ducreyi
regions. This organism is associated with painful ulcerating genital papules in HIV-infected persons. Microscopic (correct answer)
examination of lesional exudate with silver stain shows coccobacilli. Which of the following organisms is most likely
to produce these findings? Chlamydia trachomatis
(answer in the quiz)
A 17-year-old boy has had generalized muscle pain with fever for 1 week. Over the past 2 days, he has developed Trichinosis
increasing muscular weakness and diarrhea. On physical examination, his temperature is 38° C. All of his muscles
are tender to palpation, but he has a normal range of motion, and no significant decrease in muscle strength.
Laboratory findings include hemoglobin, 14.6 g/dL; hematocrit, 44.3%; MCV, 90 μm3; platelet count,
275,000/mm3; and WBC count, 16,700/mm3 with differential of 68% segmented neutrophils, 6% bands, 10%
lymphocytes, 4% monocytes, and 12% eosinophils. What is the most likely diagnosis?
A 75-year-old woman has a postoperative wound infection responding poorly to antibiotic therapy. Over the next 3 Superantigen
days she develops confusion, nausea, vomiting, diarrhea, chills, and myalgias. On examination, she is febrile; the
wound site is erythematous with necrotic, purulent exudate. Laboratory studies show neutrophilia with left shift.
Gram stain of the wound exudate shows gram-positive cocci in clusters. Which of the following substances is most
likely being elaborated by the infectious organisms?
Within the same day, an emergency department is visited by 20 individuals, all of whom work in the same building. Francisella tularensis
Over the past day, they all experienced the sudden onset of high fever, headache, backache, and malaise. On
examination, they are febrile. They do not have lymphadenopathy or hepatosplenomegaly. Over the next 2 days,
they develop a maculopapular rash on the face, forearms, and mucous membranes of the oropharynx. Despite
supportive care, a third of these patients die. Which of the following organisms is the most likely causative agent?
A longitudinal study of men and women who have developed aortic root dilation and aortic insufficiency in Fluorescent treponemal
adulthood is performed. They have a history of unprotected sexual intercourse with multiple partners. Which of antibody-absorption (FTA)
the following laboratory tests is most likely to yield a positive result in these persons?
An 8-year-old girl has developed a mild febrile illness with a sore throat over the past 2 days. On physical Poliovirus
examination, her temperature is 38.4° C, and she has a mild pharyngitis. The girl’s symptoms subside in 1 week
without therapy. Over the next 2 months, she has increasing right-sided facial drooping with inability to close the
right eye. Which of the following infectious organisms is most likely to produce these findings?
In an experiment, phagocytosis of bacteria by neutrophils is studied. Bacteria are introduced into plasma Carbohydrate capsule
containing neutrophils. It is observed that phagocytosis of Streptococcus pneumoniae, Haemophilus influenzae, formation
and Neisseria meningitidis is reduced, compared with Enterobacteriaceae. Which of the following immune evasion
mechanisms in these three bacterial species best explains this finding?
A 91-year-old woman is hospitalized with sepsis. On examination she has fever and hypotension. Laboratory Endotoxin
studies show positive blood cultures. She has disseminated intravascular coagulopathy and pulmonary diffuse
alveolar damage with respiratory distress. Analysis of the microbiology laboratory findings shows that the
organisms cultured are gram-negative bacilli. Which of the following substances elaborated by these organisms is
most likely to cause this complex of clinical findings?
A 43-year-old man cuts the skin over his shin while repairing a fence on his farm. The wound heals without any Cleavage of synaptobrevin
complications. Four days later, he develops muscle spasms of the face and extremities. These spasms worsen to in synaptic vesicles of
the point of severe contractions. Which of the following actions of the microbial toxins is most likely responsible neurons
for the clinical features in this case?
A radical group commissions scientists to develop a Category A bioterrorism agent. They want an agent that will Clostridium botulinum
paralyze victims within hours and be disguised within innocuous-appearing cans of split pea soup. Which of the
following organisms best meets the requirements stated?
A 14-year-old boy presents with fever, sore throat, and cervical lymphadenopathy. He then develops Cytotoxic CD8 cells
hepatomegaly and splenomegaly lasting for 2 months. His peripheral blood smear shows leukocytosis with
“atypical” lymphocytes. Which of the following cell types is most likely to eliminate the virally infected cells?
A 45-year-old man experiences malaise and fatigue, which slowly become more noticeable over a 2-month period. Leishmaniasis
He returned from a vacation along the Costa del Sol near Barcelona 10 months ago. He now has occasional
diarrhea and a low-grade fever. His abdominal discomfort worsens over the next month. On physical examination,
his vital signs include temperature of 38.3° C. He has pronounced splenomegaly, an increased liver span, and
 JRKCa-at MSU GSC-COM [GENERAL PATHOLOGY Q2]

generalized lymphadenopathy. Laboratory studies show hemoglobin, 11.8 g/dL; hematocrit, 34.9%; platelet count,
89,000/mm3; and WBC count, 3350/mm3 with 29% segmented neutrophils, 5% bands, 48% lymphocytes, and 18%
monocytes. His total serum protein is 7.6 g/dL, albumin is 3.2 g/dL, AST is 67 U/L, ALT is 51 U/L, alkaline
phosphatase is 190 U/L, and total bilirubin is 1.3 mg/dL. A stool sample is negative for occult blood. Which of the
following is the most likely diagnosis?
An infant born at term to a 33-year-old woman is severely hydropic. On physical examination, there is a diffuse Syphilis
rash with sloughing skin on the palms and soles. Within 2 days, the infant dies of respiratory distress. At autopsy,
there is marked hepatosplenomegaly. Microscopic examination of the femur and vertebrae shows periosteitis and
osteochondritis. The lungs have nodular masses with central necrosis surrounded by mononuclear leukocytes,
palisading macrophages, and fibroblasts. A serologic test result for which of the following agents is most likely to
be positive in the infant’s mother?
A 66-year-old man incurs extensive thermal burns to his skin and undergoes skin grafting procedures in the surgical Pseudomonas aureginosa
intensive care unit. Two weeks later, he has increasing respiratory distress. Laboratory studies show hemoglobin,
13.1 g/dL; hematocrit, 39.2%; platelet count, 222,200/mm3; and WBC count, 4520/mm3 with 15% segmented
neutrophils, 3% bands, 67% lymphocytes, and 15% monocytes. A chest radiograph shows extensive bilateral
infiltrates with patchy areas of consolidation. Bronchoscopy is performed, and microscopic examination of a
transbronchial biopsy specimen shows pulmonary vasculitis and surrounding areas of necrosis with sparse
inflammatory exudate. Which of the following infectious agents is most likely to produce these findings?
In an epidemiologic study of individuals who died in a worldwide pandemic after World War I, many individuals Recombination with RNA
were shown to have contracted a virulent form of influenza pneumonia. At the beginning of the 21st century, a segments from animal
similar epidemic is still possible from such a strain of influenza for which no vaccine may be readily available. viruses
Molecular analysis of samples of tissues showed changes in the virus responsible for these virulent forms of
influenza. Which of the following changes most likely occurs in this virus to increase its virulence?
A 23-year-old man from Irian Jaya, Indonesia, has a lesion on his penis that has enlarged over the past 4 months. Granuloma inguinale
On physical examination there is a painless 2-cm papular lesion of the dorsum of his penis that evolves into a beefy
red expansile ulceration that bleeds easily. No inguinal lymphadenopathy is present. A biopsy of the lesion is taken
and examined microscopically, showing pseudoepitheliomatous hyperplasia and mixed inflammatory infiltrate.
Giemsa stain shows coccobacilli within vacuoles in macrophages. Social history reveals multiple sexual partners.
Which of the following is the most likely diagnosis?
An epidemiologic study is conducted with children ages 1 to 5 years who are infected with HIV-1. Most of these Transfer across placenta
children have CD4+ lymphocyte counts above 500/mm3 and undetectable plasma HIV-1 RNA levels. On physical
examination they have no abnormal findings. What is the most likely mode of transmission by which these children
get infected?
A 9-year-old child who is living in a mud hut in Paraguay has a sore persisting on her face for 4 days. Physical Dilated cardiomyopathy
examination shows an indurated area of erythema and swelling just lateral to the left eye, accompanied by
posterior cervical lymphadenopathy. She has unilateral painless edema of the palpebrae and periocular tissues.
Two days later, she has malaise, fever, anorexia, and edema of the face and lower extremities. On physical
examination 1 week later, there is hepatosplenomegaly and generalized lymphadenopathy. Which of the following
pathologic findings is most likely to develop in this patient?
A 5-year-old child is exposed to Mycobacterium tuberculosis. A month later the child’s tuberculin skin test is Hilar lymphadenopathy
positive. The child then develops fever, inspiratory stridor, and nonproductive cough. Which of the following
findings is most likely to be present on the chest radiograph of this child?
A 50-year-old woman residing in Port-au-Prince has observed a small vesicle on her right labium majus for the past Chlamydia trachomatis
4 days. She is sexually active. On physical examination, the 0.5-cm vesicle is filled with purulent exudate. Tender cervicitis
inguinal lymph nodes are palpable. She was diagnosed with non-Hodgkin lymphoma 10 years ago. A biopsy of one
of the lymph nodes is performed and microscopically shows multiple abscesses in which central necrosis is
surrounded by palisading histiocytes. These clinical and pathologic findings are most likely caused by which of the
following conditions?
In October 1347, a Genoese trading ship returning from the Black Sea docked at Messina, Sicily. The ship’s crew Fleas
had been decimated by an illness marked by a short course of days from onset of inguinal lymph node
enlargement with overlying skin ulceration to prostration and death. A small, ulcerated pustule ringed by a rosy
rash was seen on the lower extremities of some of the crew. Within days, more than half of the population of the
port city had died. Which of the following insect vectors was most likely responsible for the rapid spread of this
disease?
A 6-year-old girl who lives in the Yucatán peninsula has developed a high fever over the past 3 days. On physical Mosquito
examination, she has a temperature of 39.6° C and marked tenderness in all muscles. Laboratory studies show
WBC count of 2950/mm3 with 12% segmented neutrophils, 4% bands, 66% lymphocytes, and 18% monocytes.
Over 1 week, she becomes more lethargic, with a decreased level of consciousness, and petechiae and purpura
develop over the skin. Further laboratory studies show thrombocytopenia with markedly prolonged prothrombin
time and partial thromboplastin time. CT scan of the brain shows a hemorrhage in the right parietal lobe. Which of
the following is most likely the vector of the agent causing infection in this patient?
A 4-year-old child develops a runny nose and cough. After the cough persists for 2 weeks, she exhibits paroxysms Ciliary movement
of coughing so severe she becomes cyanotic. On physical examination, her temperature is 37.4° C. Her mouth and
pharynx reveal no erythema or swelling. On auscultation of the chest, her lungs show crackles bilaterally. She has
spasmodic coughing, with a series of coughs on a single breath, bringing up mucus plugs, followed by labored
inspiration. The pathogenesis of her disease most likely results from disabling of which of the following?
 JRKCa-at MSU GSC-COM [GENERAL PATHOLOGY Q2]

A 6-month-old infant has abrupt onset of vomiting followed by profuse, watery diarrhea. On physical examination, Decreased absorption of
the infant has a temperature of 38.3° C. Development is normal for age, and the only abnormal finding is poor skin sodium and water
turgor. Laboratory studies show serum Na+ of 153 mmol/L, K+ of 4.4 mmol/L, Cl– of 113 mmol/L, CO2 of 28
mmol/L, and glucose of 70 mg/dL. Examination of a stool specimen shows mucus but no RBCs or WBCs. Which of
the following mechanisms best accounts for this diarrhea?
A 20-year-old woman has had increasing delirium for 2 days and is admitted to the hospital. On physical Exotoxin-induced cell injury
examination, she has acute pharyngitis with an overlying dirty-white, tough mucosal membrane. Paresthesias with
decreased vibratory sensation are present in the extremities. On auscultation, there is an irregular cardiac rhythm.
A chest radiograph shows cardiomegaly. A Gram stain of the pharyngeal membrane shows numerous small, gram-
positive rods within a fibrinopurulent exudate. Which of the following is the most likely mechanism for
development of cardiac disease in this patient?
A study of nosocomial infections involving urinary catheters is performed. The study shows that the longer an Biofilm formation
indwelling urinary catheter remains, the higher the rate of symptomatic urinary tract infections (UTIs). Most of
these infections are bacterial. Which of the following properties of these bacteria increase the risk for nosocomial
UTIs?
A 24-year-old soldier stationed in the Middle East has noted the appearance of a 0.5-cm papule on his left forearm. Leishmania major
It becomes a 1-cm nodule with a central depression, and then ulcerates over the next month. On physical
examination, the 2-cm ulcerated lesion has an indurated border, and there are three smaller satellite lesions.
There is no hepatosplenomegaly, but he has left axillary lymphadenopathy. Laboratory studies show hemoglobin,
14.1 g/dL; hematocrit, 42.5%; platelet count, 233,200/mm3; and WBC count, 6270/mm3. Which of the following
infectious organisms is most likely to produce these findings?
A 6-year-old girl has a blotchy, reddish-brown rash on her face, trunk, and proximal extremities that developed Rubeola
over the course of 3 days. On physical examination, she has 0.2-cm to 0.5-cm ulcerated lesions on the oral cavity
mucosa and generalized tender lymphadenopathy. A cough with minimal sputum production becomes
progressively worse over the next 3 days. Which of the following viruses is most likely to produce these findings?
A 45-year-old Bangladeshi woman with atrophic gastritis has sudden onset of severe, profuse, watery diarrhea. Cholera
Over the next 3 days, she becomes severely dehydrated. On physical examination, she is afebrile, but has poor skin
turgor. Laboratory studies of the diarrheal fluid show microscopic flecks of mucus, but no blood and few WBCs. A
blood culture is negative. The woman is hospitalized and receives intravenous fluid therapy for 1 week. Which of
the following is the most likely diagnosis?
A 52-year-old man has a fever and cough productive of thick, gelatinous sputum that worsens over 4 days. On Abscess formation
physical examination, his temperature is 38.2° C. On auscultation of the chest, diffuse crackles are heard at the
right lung base. Laboratory studies show WBC count, 13,240/mm3 with 71% segmented neutrophils, 8% bands,
15% lymphocytes, and 6% monocytes. A sputum gram stain shows gram-negative bacilli with mucoid capsules. His
condition improves after a course of gentamicin therapy. Which of the following complications of this infection is
he most likely to develop?
A 29-year-old man has had hematuria for the past month. On physical examination, he is afebrile. There is diffuse Eggs of Schistosoma
lower abdominal tenderness, but no palpable masses. An abdominal radiograph shows a small bladder outlined by haematobium
a rim of calcification. Cystoscopy is performed, and the entire bladder mucosa is erythematous and granular.
Biopsy samples are taken. Which of the following histologic findings is most likely to be seen in these samples?
A 44-year-old woman notices an erythematous papule on her left lower leg that develops into a ring-like rash and Lyme disease
then subsides over 3 weeks. Over the next 5 months, she has migratory joint and muscle pain, substernal chest
pain, and an irregular heart rhythm. These problems subside, but 2 years after the initial rash appeared, she
develops a chronic arthritis involving the hips, knees, and shoulders. Which of the following is the most likely
diagnosis?
A 50-year-old man with a neurodegenerative disease has had a fever and cough productive of yellow sputum for Actinomyces israelii
the past 3 days. On physical examination, there is dullness to percussion at the left lung base. A chest radiograph
shows areas of consolidation in the left lower lobe. Despite antibiotic therapy, the course of the disease is
complicated by abscess formation, and he dies. At autopsy, there is a bronchopleural fistula surrounded by a
pronounced fibroblastic reaction. Small, yellow, 1-cm to 2-mm “sulfur granules” are grossly visible within the area
of abscess formation. Which of the following organisms is most likely to produce these findings?
A 15-year-old boy has developed a small eschar on his left forearm around the site of a tick bite he received 6 days Rickettsia rickettsii
ago. A hemorrhagic rash involving the trunk, extremities, palms, and soles then develops over the next 3 days.
Over the past day, small, 0.2-cm to 0.4-cm foci of skin necrosis have developed on his fingers and toes. His
temperature is 39° C. He is treated with doxycycline and improves over the next 2 weeks. Which of the following
organisms is most likely to produce these findings?
A 20-year-old man who has multiple sexual partners and does not use barrier precautions has had a nontender Perivascular inflammation
ulcer on his penis for the past week. On physical examination, the 0.6-cm lesion has a firm, erythematous base and with plasma cells
sharply demarcated borders. The lesion is scraped, and microscopic darkfield examination is positive for motile
spirochetes. Which of the following inflammatory processes is most likely to accompany this infection?
A 26-year-old man is an injection drug user and has developed fever over the past day. On examination, he has a Pathogenicity island transfer
heart murmur. A blood culture is positive for Staphylococcus aureus and antibiotic sensitivity testing shows
resistance to methicillin due to presence of the mecA gene in these organisms. Through which of the following
adaptations are these bacteria most likely to acquire their methicillin resistance?
When Pharaoh did not heed Moses and let the Hebrews go, a series of plagues fell on Egypt. In the fifth plague, Bacillus anthracis
large domesticated mammals, including cattle, horses, and sheep, died. This was followed by a plague in which the
 JRKCa-at MSU GSC-COM [GENERAL PATHOLOGY Q2]

Egyptians developed cutaneous boils that probably appeared as 1-cm to 5-cm areas of erythema with central
necrosis forming an eschar. Some Egyptians also may have developed a mild, nonproductive cough associated with
fatigue, myalgia, and lowgrade fever over 72 hours, followed by a rapid onset of severe
dyspnea with diaphoresis and cyanosis. Vital signs might have included temperature of 39.5° C, pulse of 105/min,
respirations of 25/min, and blood pressure of 85/45 mm Hg. On auscultation of the chest, crackles would be heard
at the lung bases. A chest radiograph would show a widened mediastinum and small pleural effusions. “Legacy”
laboratory findings would include a CBC with WBC count of 13,130/mm3, hemoglobin of 13.7 g/dL, hematocrit of
41.2%, MCV of 91 μm3, and platelet count of 244,000/mm3. Despite antibiotic therapy with anachronistic
ciprofloxacin and doxycycline, many of those affected would die. Which of the following organisms is most likely to
produce these findings?
A 24-year-old man who is sexually active with multiple partners has had pain during urination for the past 4 days. Chlamydia trachomatis
On physical examination, there are no lesions on the penis. He is afebrile. Urinalysis shows no blood, ketones,
protein, or glucose. Microscopic examination of the urine shows few WBCs and no casts or crystals. What
infectious agent is most likely to produce these findings?
A 25-year-old woman has had pelvic pain, fever, and vaginal discharge for 3 weeks. On physical examination, she Neisseria gonorrhoeae
has lower abdominal adnexal tenderness and a painful, swollen left knee. Laboratory studies show WBC count of
11,875/mm3 with 68% segmented neutrophils, 8% bands, 18% lymphocytes, and 6% monocytes. She receives
ceftriaxone therapy, but is not adherent with this therapy. She undergoes a work-up for infertility 5 years later.
Which of the following infectious agents is most likely to produce these findings?
A 25-year-old soldier incurs multiple skin wounds that get infected and produce extensive tissue damage within a Gangrenous necrosis
day. Culture of necrotic tissue from deep inside one of the wounds reveals anaerobic spore-forming gram-positive
rods. Which of the following microscopic pathologic reactions are the toxins produced by these organisms most
likely to cause?
Persons living in southern Africa where black flies are common and who have developed blindness are studied to Microfilariae
identify a potential infectious cause. These persons are found to have a chronic dermatitis that preceded their
blindness. Skin lesions are pruritic, scaling, and hypopigmented. Ocular lesions include punctate keratitis and focal
corneal opacities, sclerosing keratitis, iridocyclitis with glaucoma, and retinitis. Which of the following morphologic
forms of the infectious agent is most likely to be found in skin biopsies of these persons?
A 5-year-old boy has had diarrhea for a week, averaging six low volume stools per day, which appear mucoid and Epithelial disruption with
sometimes blood-tinged. On physical examination, his temperature is 37.4° C. He has mild lower abdominal overlying neutrophilic
tenderness, but no masses. A stool culture is positive for Shigella sonnei. Which of the following microscopic exudate
findings would most likely be seen in this child’s colon?
In a study of individuals living in a subtropical region in which an irrigation project has been completed, it is noted Hepatic fibrosis
that rice farmers have experienced an increased rate of an infectious illness since the project began. Investigators
determine that the infection is acquired through cercariae that penetrate the skin. The cercariae are released from
snails living in the irrigation canals. Infected individuals develop progressive ascites. Which of the following
pathologic findings is most likely to be present in these infected individuals as a consequence of the infection?
A 42-year-old HIV-positive man has had a fever and cough for the past month. On physical examination, his Nocardia asteroids
temperature is 37.5° C. On auscultation of the chest, decreased breath sounds are heard over the right posterior
lung. A chest radiograph shows a large area of consolidation with a central air-fluid level involving the right middle
lobe. A transbronchial biopsy specimen contains gram-positive filamentous organisms that are weakly acid-fast. His
course is complicated further by empyema and acute onset of a headache. A head CT scan shows a 4-cm discrete
lesion of the right hemisphere with ring enhancement. Which of the following infectious agents is most likely
causing his disease?
A 6-year-old boy developed a rash over his chest that began as 0.5-cm reddish macules. Within 2 days, the macules Shingles
became vesicles. Three days later, the vesicles ruptured and crusted over. Over the next 2 weeks, crops of the
lesions spread to the face and extremities. Which of the following clinical manifestations of this infection is most
likely to appear decades later?
A 22-year-old man has had more than 6 episodes of urethritis in the past 4 years since becoming sexually active. Pili
Each time, gram-negative cocci are identified in the neutrophilic exudate. Which of the following components in
these organisms undergo change that prevents development of lasting protective immunity?
A 33-year-old primigravida at 18 weeks’ gestation develops nausea with vomiting for 3 days and then a severe Ingestion of contaminated
headache and neck stiffness. On physical examination, her temperature is 38.2° C. She has no papilledema. A food
lumbar puncture is performed, and a Gram stain of the CSF obtained shows many short, gram-positive rods, and
with a wet mount, the organisms demonstrate tumbling motility. In culture, this organism grows at 25° C. She most
likely acquired this illness through which of the following mechanisms?
 JRKCa-at MSU GSC-COM [GENERAL PATHOLOGY Q2]

A 31-year-old HIV-positive man has had increasing respiratory Cytomegalovirus

difficulty for the past 2 days. On physical examination, crackles are
auscultated over all lung fields. A chest radiograph shows bilateral
interstitial infiltrates. Laboratory studies show 26,800 copies of
HIV-1 RNA/mL. A transbronchial biopsy is performed; the
microscopic appearance of the specimen is shown in the figure.
Which of the following is the most likely causative organism of his
pulmonary disease?

An 11-year-old boy from Liberia has had episodic fevers for 2 Liver
weeks. He developed a severe headache a week ago and has
become progressively more somnolent. On funduscopic
examination, he has papilledema. The representative microscopic
appearance of a cerebral vein is shown. Which of the following
organs is most likely to serve as the reservoir for proliferation of
the infectious agent producing this disease?

A 46-year-old woman has had a high fever and swelling, warmth, Streptococcus pyogenes
and tenderness of the right leg for the past 3 days. On physical
examination, she has a temperature of 39.4° C and the facial
appearance shown in the figure. She receives macrolide antibiotic
therapy with which she recovers. Infection with which of the
following organisms has most likely produced these findings?

A 10-year-old girl with leukemia undergoes hematopoietic stem Aspergillus fumigatus

cell transplantation. She has poor engraftment, and 1 month later
she develops fever and dyspnea. On physical examination, her
temperature is 39° C. On auscultation of the chest, wheezes and
crackles are heard in both lungs. A chest CT scan shows nodular
lesions accompanied by cavitation, hemorrhage, and infarction.
Laboratory studies show hemoglobin,
8.8 g/dL; hematocrit, 26.5%; platelet count, 91,540/mm3; and WBC
count, 1910/mm3 with 10% segmented neutrophils, 2% band
neutrophils, 74% lymphocytes, and 14% monocytes. A
bronchoalveolar lavage is performed; the fluid was stained with
Gomori methenamine silver stain and analyzed microscopically, as
shown in the figure. Which of the following infectious agents is
most likely to produce these findings?
A 22-year-old woman has had recurrent vesicular lesions on her Multinucleated (syncytial)
labia majora and perineum for 5 years. On physical examination, cells containing pink-to-
she is afebrile. Clusters of clear, 0.2-cm to 0.5- cm vesicles are purple intranuclear
present on the labia, with some surrounding erythema. The figure inclusions
shows the representative microscopic appearance at low
magnification of one of the lesions. Which of the following cellular
changes is most likely to be seen under higher magnification of this
lesion?

A 60-year-old man has had persistent bloody diarrhea, abdominal Entamoeba histolytica
cramps, and fever for the past week. On physical examination, his
temperature is 38.1° C. He has mild diffuse abdominal pain. A stool
sample is positive for occult blood. Colonoscopy shows marked
mucosal erythema with focal ulceration from the rectum to the
ascending colon. The ulcers do not penetrate the muscularis
propria. A biopsy is performed, and the microscopic appearance of
the specimen is shown in the figure. Which of the following
infectious organisms is most likely to produce these findings?
 JRKCa-at MSU GSC-COM [GENERAL PATHOLOGY Q2]

A 32-year-old man has maculopapular and nodular skin lesions, Hansen disease
mainly involving his face, elbows, wrists, and knees. The nodular
lesions have slowly enlarged over the past 10 years and are now
beginning to cause deformity. The lesions are not painful, but he
has hypoesthesia to anesthesia in these areas. The figure shows a
microscopic acid-fast stain of a biopsy specimen of a nodular skin
lesion. Which of the following is the most likely diagnosis?

A 19-year-old woman goes on a camping trip to a wooded area in Babesia microti

New England (USA) with lots of insects, but has forgotten to bring
insect repellant. A month later, she has increasing malaise, low-
grade fever, headaches, and myalgias. On physical examination,
she has hepatosplenomegaly. Laboratory studies show
hemoglobin, 10.4 g/dL; WBC count, 5820/mm3; and platelet count,
205,000/mm3. Her peripheral blood smear is shown in the figure.
Which of the following infectious agents is most likely to produce
these findings?
A 40-year-old man has had progressive enlargement of the right leg Wuchereria bancrofti
for the past 6 years, leading to the appearance shown in the figure.
On physical examination, he is afebrile. He has inguinal
lymphadenopathy and scrotal edema. Infection with which of the
following organisms is most likely to be present in this man?

A 22-year-old man with extensive travel history is bitten by an West Africa

insect and has developed a rubbery, red, 1-cm chancre on his right
forearm over the past week. Three months later, he develops
splenomegaly and lymphadenopathy. Two months later, he
exhibits progressive wasting with cachexia and decreased
mentation. His peripheral blood smear has the appearance shown
in the figure. Where is his disease most likely to have been
acquired?

A 24-year-old woman has noted worsening pain on the right side of Mucor circinelloides
her face for the past 24 hours. On examination, there is marked
tenderness and swelling inferior to the zygomatic arch and lateral
to the nasolabial fold on the right. Laboratory studies show WBC
count, 9900/mm3; serum creatinine, 2 mg/dL; sodium, 151
mmol/L; potassium, 5.4 mmol/L; chloride, 119 mmol/L;
bicarbonate, 8 mmol/L; and glucose, 483 mg/dL. A head CT scan
shows soft tissue swelling and bony destruction around the right
maxillary sinus. A biopsy is performed; the figure shows the
findings on microscopic examination. Which of the following
organisms is the most likely causative agent for this patient’s
infection?
A 31-year-old man has had cough with a low-grade fever and a 4-kg Elaboration of nitric oxide
weight loss over the course of 3 months. On physical examination, by macrophages
his temperature is 37.5° C. Laboratory studies show anemia of
chronic disease. A bone marrow biopsy is performed, and the
microscopic appearance is shown in the figure. An acid-fast stain of
this tissue is positive. The causative infectious agent is most likely
being destroyed by which of the following mechanisms

A 27-year-old man is involved in a rollover accident in which he is Toxin-mediated lecithin

ejected from the vehicle. He sustains a compound fracture of the degradation
right humerus and undergoes open reduction with internal fixation
of the humeral fracture. Three days later, he has marked swelling
of the right arm and palpable crepitus. A Gram stain of necrotic
exudate from the wound site has the appearance shown in the
figure. Through which of the following mechanisms is this organism
most likely causing extensive tissue necrosis?
 JRKCa-at MSU GSC-COM [GENERAL PATHOLOGY Q2]

Syphilis is divided into stages

Primary Chancre
Secondary Palmar rash, lymphadenopathy
Tertiary Neurosyphilis

Human Protozoal Diseases

Location and Species
Luminal or epithelia Entamoeba histolytica
Intracellular Toxoplasma gondii
Central nervous system Naegleria fowleri Acanthamoeba spp
Bloodstream Plasmodium spp.

Life Cycle of Plasmodium falciparum

 JRKCa-at MSU GSC-COM [GENERAL PATHOLOGY Q2]

Parasitic Infections

Cysticercus cyst in the skin

African trypanosomiasis
Brain biopsy showing a cyst of T. gondi

Erythrocytes with Babesia

Trichinella spiralis larvae Typhus nodule in the brain

Mucicarmine stain of gram-positive Clostridium

cryptococci perfringens
pseudohyphae and budding
yeast of Candida spp

septate hyphae with acute-angle

Pneumonia caused by branching, consistent with
tuberculosis. tubercle at low
Pneumocystis jirovecii Aspergillus
magnification
 JRKCa-at MSU GSC-COM [GENERAL PATHOLOGY Q2]

tuberculosis. tubercle at high spirochetes in histologic sections Lepromatous leprosy. Acid-fast

magnification of placental syphilis bacilli

dense chronic lymphocytic and

histiocytic infiltration into large
nerve bundles, Leprosy

fibrosis of the liver due to chronic filariasis Severe candidiasis of the distal
Schistosoma japonicum esophagus

Secondary pulmonary Miliary tuberculosis of the

tuberculosis Primary pulmonary tuberculosis, spleen
Ghon complex