SAS # 9

1. B
Answer: Effective and economical mycobactericidal disinfectants are needed to kill both
Mycobacterium tuberculosis and non-M. tuberculosis mycobacteria.

2. B
Answer: Disinfection describes the elimination of most or all pathogens (except bacterial
spores) from nonliving objects. In healthcare settings, objects usually are disinfected by liquid
chemicals or wet pasteurization. The heating process developed by Pasteur to kill microbes in
wine—pasteurization—is a method of disinfecting liquids. Pasteurization is used today to
eliminate pathogens from milk and most other beverages. It should be remembered that
pasteurization is not a sterilization procedure, because not all microbes are destroyed.

3. B
Answer: Lyophilization is a process that combines dehydration (drying) and freezing.
Lyophilized
materials are frozen in a vacuum; the container is then sealed to maintain the inactive state.

4. D
Answer: Thermophiles can be found in hot springs, compost pits, and silage as well as in and
near hydrothermal vents at the bottom of the ocean, Microorganisms that prefer salty
environments are called halophiles, piezophiles, thrive deep in the ocean and in oil wells,
where the atmospheric pressure is very high
5. C
Answer: No change in pressure occurs within the cell in an isotonic solution. Internal pressure
is increased in a hypotonic solution, resulting in swelling of the cell. Internal pressure is
decreased in a hypertonic solution, resulting in shrinking of the cell.

6. C
Answer: Clostridium species and Bacillus spp. are spore-forming bacteria that cause hospital
infections. The spores from these bacteria are transmitted from patient to patient via
healthcare workers' hands. Although alcohol-based hand rubbing is an important hand hygiene
practice, it is ineffective against bacterial spores. Thus, sporicidal agents are required to kill
bacterial endospores.

7. A
Answer: An autoclave is like a large metal pressure cooker that uses steam under pressure to
completely destroy all microbial life

8. D
Answer: Medical asepsis, or clean technique, involves procedures and practices that reduce
the number and transmission of pathogens. Medical asepsis includes all the precautionary
measures necessary to prevent direct transfer of pathogens from person to person and
indirect transfer of pathogens through
the air or on instruments, bedding, equipment, and other inanimate objects (fomites).

9. B
Answer: A selective medium has added inhibitors that discourage the growth of certain
organisms without inhibiting growth of the organism being sought. For example, MacConkey
agar inhibits growth of Gram-positive bacteria and thus is selective for Gram-negative bacteria.

10.A
Answer: An enriched medium is a broth or solid medium containing a rich supply of special
nutrients that promotes the growth of fastidious organisms. It is usually prepared by adding
extra nutrients to a medium called nutrient agar. Blood agar (nutrient agar plus 5% sheep red
blood cells) and chocolate agar (nutrient agar plus powdered hemoglobin) are examples of
solid enriched media that are used routinely in the clinical bacteriology laboratory.
SAS # 10

1. C
Answer: Patient's weight is least likely to be taken into consideration when deciding which
antibiotic to prescribe for a patient?

2. D
Answer: Aminoglycosides are bactericidal broad-spectrum drugs that inhibit bacterial protein
synthesis. Aminoglycosides are effective against a wide variety of aerobic Gram-negative
bacteria, but are ineffective against anaerobes. They are used to treat infections with
members of the family Enterobacteriaceae

3. B
Answer: The five most common mechanisms of action of antimicrobial agents are as follows:
• Inhibition of cell wall synthesis • Damage to cell membranes • Inhibition of nucleic acid
synthesis (either DNA or RNA synthesis) • Inhibition of protein synthesis • Inhibition of enzyme
activity

4. D
Answer: When two or more drugs to which in vitro susceptibility has been demonstrated are
given together, each helps prevent the emergence of tubercle bacilli resistant to the others.
The standard of care for initiating treatment of TB disease is four-drug therapy.

5. B
Answer: OPTION B, Arsphenamine, also known as Salvarsan or compound 606, is a drug that
was introduced at the beginning of the 1910s as the first effective treatment for syphilis and
African trypanosomiasis. This organoarsenic compound was the first modern antimicrobial
agent. OPTION A, C AND D; When the use of two antimicrobial agents to treat an infectious
disease produces a degree of pathogen killing that is far greater than that achieved by either
drug alone, the phenomenon is known as synergism. When the use of two drugs produces an
extent of pathogen killing that is less than that achieved by either drug alone, the
phenomenon is known as antagonism.

6. C
Answer: Penicillinases and cephalosporinases are examples of -lactamases; they destroy the -
lactam ring in penicillins and cephalosporins, respectively.

7. C
Answer: These days, it is quite common to hear about drug resistant bacteria, or “superbugs,”
as they have been labeled by the press. Although “superbug” can refer to an organism that is
resistant to only one antimicrobial agent, the term usually refers to multiply drug-resistant
organisms (i.e., organisms that are resistant to more than one antimicrobial agent).

8. B
Answer: Some strains of S. aureus, called vancomycin-intermediate S. aureus
(VISA), have developed resistance to the usual dosages of vancomycin, necessitating the use
of higher doses to treat infections caused by these organisms

9. A
Answer: Methicillin-resistant S. aureus (MRSA) and methicillin resistant Staphylococcus
epidermidis (MRSE). These strains are resistant to all antistaphylococcal drugs except
vancomycin and one or two more recently developed drugs (e.g., Synercid and Zyvox).

10. D
Answer: Vancomycin-resistant Enterococcus spp. (VRE). These strains are resistant to most
antienterococcal drugs, including vancomycin. Enterococcus spp. are common causes of
healthcare-associated infections, especially urinary tract infections.
SAS # 11

1. C
Answer:

2. D
Answer:

3. B
Answer:

4. D
Answer:

5. B
Answer:

6. C
Answer:
7. C
Answer:

8. B
Answer:

9. A
Answer:

10. D
Answer:
SAS # 12

1. C
Answer: Epidemic diseases are diseases that occur in a greater than usual number of cases in
a particular region, and usually occur within a relatively short period of time.

2. D
Answer: A pandemic disease is a disease that is occurring in epidemic proportions in many
Countries simultaneously— sometimes worldwide.

3. B
Answer: Endemic diseases are diseases that are always present within the population of a
particular geographic area. The number of cases of the disease may fluctuate over time, but
the disease never dies out completely. Endemic infectious diseases of the United States
include bacterial diseases such as tuberculosis (TB), staphylococcal and streptococcal
infections, sexually transmitted diseases (STDs) like gonorrhea and syphilis, and viral diseases
such as the common cold, influenza, chickenpox, and
mumps.

4. D
Answer: The term modes of transmission refer to how an infectious agent, also called a
pathogen, can be transferred from one person, object, or animal, to another.

5. B
Answer: There must be a portal of exit (i.e., a way for the pathogen to escape from the
reservoir). When Andy blows his nose, cold viruses get onto his hands. Transmission occurs
when the agent leaves its reservoir or host through a portal of exit

6. D
Answer: The incidence of a disease is similar to the morbidity rate for that disease, which is
usually expressed as the number of new cases of a particular disease that occurred during a
specified time period per a specifically defined population (usually per 1,000, 10,000, or
100,000 population), for example, the number of new cases of a particular disease in 2009 per
100,000 U.S. population.

7. B
Answer: The period prevalence of a particular disease is the number of cases of the disease
existing in a given population during a specific time period (e.g., the total number of cases of
gonorrhea that existed in the U.S. population during 2009).

8. C
Answer: Mortality refers to death. The mortality rate (also known as the death rate) is the
ratio of the number of people who died of a particular disease during a specified time period
per a specified population.

9. A
Answer: Epidemiology is the study of factors that determine the frequency, distribution, and
determinants of diseases in human populations, and ways to prevent, control, or eradicate
diseases in populations.

10. C
Answer: A contagious disease is defined as a communicable disease that is easily transmitted
from one person to another. Example: Assume that you are in the front row of a movie
theater. One person seated in the back row has gonorrhea and another has influenza, both of
which are communicable diseases. The person with influenza is coughing and sneezing
throughout the movie, creating an aerosol of influenza viruses
SAS # 13

1. C
Answer: Smallpox is a serious, contagious, and sometimes fatal viral disease. Patients
experience fever, malaise, headache, prostration, severe backache, a characteristic skin rash,
and occasional abdominal pain and vomiting. Smallpox can become severe, with bleeding into
the skin and mucous membranes, followed by death.

2. A
Answer: Anthrax is caused by B. anthracis, a spore-forming, Gram-positive bacillus. People can
develop anthrax in several ways, resulting in three forms of the disease: cutaneous anthrax,
inhalation anthrax, and gastrointestinal anthrax. Anthrax infections involve marked
hemorrhaging and serous effusions (fluid that has escaped from blood or lymphatic vessels) in
various organs and body cavities and are frequently fatal.

3. D
Answer: Plague is caused by Y. pestis, a Gram-negative coccobacillus. Plague is predominantly
a zoonosis and is usually transmitted to humans by flea bite.

4. B
Answer: Botulinal toxin is odorless and tasteless, and only a tiny quantity of the toxin
need be ingested to cause a potentially fatal case of botulism. Botulism is a potentially fatal
microbial intoxication, caused by botulinal toxin, a neurotoxin produced by C. botulinum. C.
botulinum is a spore-forming anaerobic Gram-positive bacillus. Botulinal toxin may cause nerve
damage, visual difficulty, respiratory failure, flaccid paralysis of voluntary muscles, brain
damage, coma, and death within a week if untreated.

5. A
Answer: Category A agents are those that:
• Pose the greatest possible threat for a bad effect on public health
• May spread across a large area or need public awareness
• Need a great deal of planning to protect the public’s health

6. C
Answer: Agents currently not believed to present a high bioterrorism risk to public health, but
could emerge as future threats.

7. D
Answer: OPTION D- Achieving a status where no further cases of that disease occur
anywhere and where continued control measures are unnecessary OPTION C- Ongoing
operations or programs aimed at reducing the incidence or prevalence of that disease
OPTION B- The reduction of case transmission to a predetermined very low level (e.g., to a
level below one case per million population)

8. C
Answer: unnecessary OPTION C- Ongoing operations or programs aimed at reducing the
incidence or prevalence of that disease. OPTION D- Achieving a status where no further
cases of that disease occur anywhere and where continued control measures are unnecessary.
OPTION B- The reduction of case transmission to a predetermined very low level (e.g., to a
level below one case per million population.

9. A
Answer: In the sewage disposal plant, large debris is first filtered out (called screening),
skimmers remove floating grease and oil, and floating debris is shredded or ground. Then,
solid material settles out in a primary sedimentation tank. Flocculating substances can be
added to cause other solids to settle out. The material that accumulates at the bottom of the
tank is called primary sludge.
10. C
Answer: Tertiary sewage treatment involves the addition of chemicals, filtration (using fine
sand or charcoal), chlorination, and sometimes distillation. In other cities, effluent water is
used to irrigate lawns; however, it is expensive to install a separate water system for this
purpose. In some communities, the sludge is heated to kill bacteria, then dried and used as
fertilizer.
SAS # 14

1. A
Answer: According to the Centers for Disease Control and Prevention (CDC), community-
acquired infections are those that are present or incubating at the time of hospital admission.
All other infections are considered HAIs, including those that erupt within 14 days of hospital
discharge.

2. D*/
Answer: -*/Fomites are inanimate objects capable of transmitting pathogens. Fomites found
within healthcare settings include patients’ gowns, bedding, towels, eating and drinking
utensils, and hospital equipment, such as bedpans, stethoscopes, latex gloves, electronic
thermometers, and electrocardiographic electrodes, which become contaminated by pathogens
from the respiratory tract, intestinal tract, or the skin of patients. Even telephones, doorknobs,
and computer keyboards can serve as fomites.

3. B
Answer: Gram-positive cocci: Staphylococcus aureus (including methicillin-resistant
strains of Staphylococcus aureus [MRSA]) Coagulase-negative staphylococci Enterococcus spp.
(including vancomycin-resistant enterococci)

4. B
Answer: Gram-negative bacilli: Escherichia coli, Pseudomonas aeruginosa
Enterobacter spp. Klebsiella spp

5. B
Answer: Certain patients are especially vulnerable to infection, particularly to invasive
environmental fungal infections. Examples of such patients are patients with severe burns,
those who have leukemia, patients who have received a transplant (such as a hematopoietic
stem cell transplant), immunosuppressed persons, those receiving radiation treatments,
leukopenic patients (those having abnormally low white blood cell counts), and premature
infants. These patients can be protected by placing them in a Protective Environment
(sometimes referred to as protective isolation or positive pressure isolation).

6. B
Answer: OPTION B is not included in the standard precautions for infection control.

7. A
Answer: Option A is not appropriate with patient suspected to have TB. TB patient must be in
Airborne precautions are used in addition to standard precautions to prevent disease
transmission from individuals known or suspected to have diseases spread by fine particles,
including TB.

8. D
Answer: Medical asepsis, or clean technique, involves procedures and practices that
reduce the number and transmission of pathogens. Medical asepsis includes all the
precautionary measures necessary to prevent direct transfer of pathogens from person to
person and indirect transfer of pathogens through the air or on instruments, bedding,
equipment, and other inanimate objects (fomites).

9. A
Answer: AIIRs are under negative pressure, and air that is evacuated from these rooms
passes through HEPA filters.
10. D
Answer: Contact transmission is the most important and frequent mode of transmission of
HAIs. Contact Precautions are used for patients known or suspected to be infected or
colonized with epidemiologically important pathogens that can be transmitted by direct or
indirect contact. Examples include multidrug-resistant bacteria, C. difficile-associated diseases,
respiratory syncytial virus (RSV) infection in children, scabies, impetigo, chickenpox or
shingles, and viral hemorrhagic fevers.