IMMUNOLOGY:
1)
T-cell activation involves:
A
B
C
D
2)
Natural Killer cell are
A
B
C
D
3)
The hapten be recognized by helper T-cells
The hapten be recognized by suppressor T-cells
The protein be recognized by B-cells
The protein be recognized by helper T-cells
Two dissimilar inbred strains of mice, A and B, are crossed to yield
an F1 hybrid strain. If a large dose of spleen cells from an adult A
mouse is injected into an adult AB mouse, which of the following is
MOST likely to occur? The spleen cells will
A
B
C
D
5)
Able to kill virus-infected cells without prior sensitization
B-cells
Cytotoxic T-cells
Increased by immunization
In the immune response to a hapten-protein conjugate, in order to
get anti-hapten antibodies it is essential that
A
B
C
D
4)
Autocrine and paracrine cytokines
Conformational changes in the CD3 peptide chains.
Docking of tyrosine kinases to extracellular domains of the
CD3 peptide chains
Irreversible increases in intracellular Ca2+
be destroyed
induce a graft-versus-host reaction in the recipient
survive and induce tolerance to strain A grafts in the
recipient
survive without any effects on the recipient
Antigen-presenting cells that activate helper T-cells must express
which one of the following on their surface?
1
A
B
C
D
E
6)
Class I MHC
Class II MHC
CD4
IgM
Thy-1
The role of macrophages during an antibody response is to
A
Express Fc receptors
B
Lyse virally infected cells
C
Process and present antigen
D
Suppress cytotoxic T-cells
MICROBIOLOGY: VIROLOGY
1) The virion of the following viruses contains a polymerase EXCEPT:
A
B
C
D
Hepatitis B virus
Human Immunodeficiency virus
Influenza virus
Togavirus
2) All of the following statements about negative-stranded RNA viruses are
true, EXCEPT:
A
B
C
D
All of them have helical capsids
They are all enveloped viruses
They are genetically related and likely have a common ancestor
They replicate exclusively in the cytoplasm
3) Rhinovriuses are causative agents of the common cold. No vaccine is
available against these infections, because:
A
B
It has been difficult to attenuate the virus in the laboratory for
vaccine preparations
It mutates rapidly
2
C
D
Human rhinoviruses combine with animal strains so that new
antigenic types continually emerge
There are too many serotypes, which makes vaccination impractical
4) Respiratory syncytial virus is an important respiratory pathogen. All of
the following statements are true, EXCEPT:
A
B
C
D
Because it is a DNA virus there is no effective antiviral agent
available to treat this infection
It is the most common cause of lower respiratory infections in
infants and causes approximately 90000 hospitalization per year
It occurs in yearly outbreaks
Unlike with some of the common childhood viral infections, lifelong immunity does not occur and re-infections may occur
throughout life.
5) The following statements about interferons are true, EXCEPT:
A
B
C
D
Interferons can bind to and inactivate viruses directly
Interferons can modulate immunity
Interferons posses anti-tumor activity
Interferons suppress both viral and cellular mRNA translation
6) Acyclovir is used against HSV and VZV infections because:
A
B
C
It can effectively eliminate latency established by HSV and VZV
It is efficiently converted to the active monophosphate form by the
cellular
thymidine kinase in HSV and VZV infected cells
It reduces the duration of virus shedding and the frequency of
recurrences
7) All of the following statements about polyomaviruses are true, EXCEPT:
A
B
C
D
They are able to establish a latent infection in humans
They have circular double stranded DNA
They have an envelope
The T-antigen is an important structural protein
3
8) All of the following statements about papillomaviruses are true, EXCEPT:
A
B
C
D
They infect epithelial cells
They have been associated with cervical dysplasia
The virion contains a single stranded DNA molecule
More than 80 serotypes have been identified
9) Because retroviruses have genomes composed of RNA (hence the name
RNA tumor viruses), they would not be affected by drugs that inhibit
DNA synthesis:
A
B
True
False
True (A) or False (B)?
10)
11)
12)
13)
14)
15)
16)
17)
Adenovirus virion contains a single stranded DNA molecule
Adenovirus replicates in the nucleus of the host cell
Different strains of adenoviruses replicate either in the respiratory
tract or the gut, never in both
Adenovirus interferes with the interferon response
B19 uses its own polymerase for replication
B19 can be transmitted through the placenta
B19 infects mature and progenitor erythroid cells
A major reason for the high incidence of herpes simplex
virus infections in the U.S. population is that the virus:
A
B
C
D
E
18)
Has a very short incubation period, which facilitates rapid spread.
Mutates frequently and escapes immune surveillance.
Prevents the production of antibodies in the infected host
Remains highly infective for many days on objects or surfaces
touched by infected individuals.
Sheds from infected individuals even when they are asymptomatic
Erythema infectiosum (Fifth disease), a self-limiting disease of children, is
caused by:
A
Human Herpesvirus 3
4
B
C
D
E
F
19)
Human Herpesvirus 6
Measles virus
Parvovirus
Rubellavirus
Variolavirus
Which of the following statements is NOT true about
adults, who have herpes simplex infections: They
A
B
C
D
E
Carry the virus in a latent state
Develop circulating antibodies to the virus
Develop permanent immunity that prevents recurrent infections
May shed virus for long periods
Usually acquire the infection in childhood
FOR QUESTION 20 AND 21:
20) A two-week-old infant was admitted for a two-day history of fever and irritability.
He was born to a 20-year-old mother with no prior pregnancies but a gestation
complicated by a painful vaginal infection in the sixth month, treated with an
unknown oral medicine. On physical examination, the infant was found to have
small red vesicular and pustular lesions on the scalp, was irritable and running a
fever of 102.5°F. The mother had been immunized as a child against measles,
mumps and rubella, but her antibody titer to these viruses were unknown. She
had chicken pox as a child.
Based on this information, the most likely cause of the infant’s illness is which of the
following:
A
B
C
D
Congenital Cytomegalovrus infection
Congenital Herpes Simplex infection
Congenital Rubellavirus infection
Congenital Varicellavirus infection
21)
Which of the following courses of management should be followed?
A
Culture fluid from the scalp lesions, blood and CSF for viruses. Await the
result before starting treatment
Culture fluid from the scalp lesions and the CSF for Herpes simplex and
begin acyclovir treatment immediately
B
5
C
D
Culture fluid from the scalp lesions and the CSF for Herpes simplex and
begin ribavirin treatment immediately
Measure serum antibody titers to Herpes simplex, Varicella-zostervirus
and Cytomegalovirus in both the mother and the infant to establish the
diagnosis. Await the result before starting treatment.
FOR QUESTIONS 22 AND 23:
22) An 18-year-old Caucasian male presented with a one-week history of low-grade
fever, fatigue, abdominal pain and vomiting. A day prior to presentation he
became jaundiced. There was no history of exposure to hepatitis, but he was
sexually active and reported IV drug use within the prior 6 months. His
bilirubin and liver enzymes were elevated, suggesting inflammation of the
liver. Hepatitis B surface antigen (HbsAg) test was positive and tests for the
other forms of viral hepatitis were negative.
What instruction regarding infectivity of this patient is correct?
A
B
C
D
A Hepatitis B e-antigen (HbeAg) test should be done and if negative he
should be considered non-infectious.
He is most likely a chronically infected by Hepatitis B virus and should be
considered non-infectious as soon as the bilirubin and liver enzyme values
have normalized
His illness is most likely due to Hepatitis B virus and he should be
considered infectious (through blood and sexual contact) until HBsAg
becomes negative and Hepatitis B surface antibody (anti-Hbs) becomes
positive
To avoid fecal-oral transmission to other individuals he should not be
allowed to prepare food for others
23) Which of the following statements regarding the above patient are TRUE?
A
Antibody to hepatitis B core antigen (antiHBc antibody) will become
positive several months after recovery from hepatitis B
B
The most likely outcome of his infection is cancer of the liver
C
The surest way of preventing his infection would have for him to have
been vaccinated against Hepatitis B as a child
D
Since he acquired Hepatitis B as an adult he has a 90% risk of becoming
chronically infected
24) Which of the following viruses are often associated with congenital infections of
newborns, which damage the developing fetus during pregnancy ?
6
25)
i
ii
iii
iv
v
vi
vii
Cytomegalovirus
Human immunodeficiency virus
Measlesvirus
Mumpsvirus
Rubellavirus
Parvovirus
Varicella zostervirus
A
B
C
D
i, ii, iv, v, vi, vii
i, ii, v, vi, vii
i, ii, v, vi,
i, v, vi
Which of the following viral infections is commonly transmitted by small droplet
aerosol and is the most contagious of them all?
A
B
C
D
E
26)
CMV
B19
Hepatitis B virus
Rubella
Variola
Which of the following properties made smallpox eradicable?
A
B
C
D
Monkeys are a reservoir
no carrier state
no inapparent infection
only one antigenic viral strain exists
MICROBIOLOGY: DIAGNOSTIC MICROBIOLOGY
1) Which of he following steps may be involved when attempting to identify a
pathogen in a specimen?
A
Differentiation
organisms
between
7
endogenous
and
pathogenic
B
C
D
Selection against endogenous organisms
Both
Neither
2) If you were to develop an Enzyme-Linked-Immunosorbent-Assay (ELISA) to
detect the presence of growth hormone, would you absorb antigen or antibody to
the ELISA plate (solid phase)?
A
B
Antibody
Antigen
3) Why is a change in antibody titer considered significant only when it is
fourfold or larger?
A
B
C
D
the intrinsic error of the ELISA is two
the intrinsic error of the ELISA is four
twofold differences occur frequently due to the high intrinsic
background of serum
within any given individual the daily fluctuations of
antibody titers are twofold
MICROBIOLOGY: GENERAL MICROBIOLOGY:
1)
The most efficient skin disinfection for a surgical patients is application of:
A
B
C
D
2)
alcohol
detergent and soaps
germicidal lamp exposure
iodophor compounds
Which one of the following statements is NOT true?
A In Europe and the US death due to infection is increasing
B Infectious diseases are spread by five basic methods: food, fomite
spread, respiratory transmission, sexual transmission, vector borne,
zoonotic and vertical.
C Knowledge of the pathogen and pharmacology is usually sufficient
8
to initiate effective treatment
D Most people worldwide die of an infectious disease
3)
Which one of the following statements is NOT true?
A A special group of toxins, usually related to the bacterial cell wall
are called endotoxins
B HIV and malaria evade the host’s immune system by frequently
changing their surface antigens
C The human host’s first line of defense against infections are
antibodies and cytotoxic killer cells
D To cause disease an infectious apthogen must be presented to the
host in a way and in an environment that will allow it to grow
E Virulence factors are mechanisms employed by a pathogen to
establish itself and produce disease
4)
Which one of the following statements is NOT true?
A Eighty percent of diagnoses are made from just the history and the
physical exam
B It is very common for people, who have an infection, not to show
any identifiable symptoms and yet become immune
C Most people die of infectious diseases, which are not preventable
D The incubation period is the time it takes for the pathogen to
establish itself to the point where the first symptoms appear
E The same infectious disease agent can cause a variety of different
clinical syndromes
MICROBIOLOGY: BACTERIOLOGY: GRAM (+) COCCI:
1) A 2250 gram male infant was born to a 23-year-old woman. Pregnancy
was uneventful. At 52 hours of age, the infant developed a generalized
convulsion. Cultures of blood and CSF yielded b-hemolytic organisms.
Which one of the following characteristics is consistent with this
organism?
A
B
Positive CAMP test
Positive Catalase
9
C
D
Pyrrolidonyl arylamidase (PYRase) positive
Susceptible to optochin
2) A 6-year-old boy presented with a 1-week history of fever, sore throat and
headache. One day before hospital admission, he awakened with pain and
swelling in the right ankle. In addition to a warm, swollen right ankle, he
was noted to have a new grade II/IV systolic heart murmur thought to be
consistent with mitral regurgitaion. He was admitted to the hospital with
a presumptive diagnosis of acute rheumatic fever. Which one of the
following is consistent with this organism?
A
B
C
D
CAMP test positive
Produces alpha hemolysis on sheep blood agar plates
Pyrrolidonyl arylamide (PYRase) positive
Resistant to bacitracin
3) A 7-year-old girl was admitted with a 3-day history of increasing pain and
swelling of her left leg. The patient recalled some trauma to her left leg.
The patient was febrile (temperature of 39.2oC), left leg was red, swollen,
warm and very tender. Bone scan and CT revealed subperiosteal abscess.
Cultures of blood and abscess grew gram positive organisms. Which one
of the following characteristics is consistent with this organisms?
A
B
C
D
Able to grow in bile and in 6.5% salt
Almost all strains produce coagulase
Catalase negative cocci in clusters
Resistance to nacomycimn is common
MICROBIOLOGY: BACTERIOLOGY: GRAM (-)BACILLI:
1) Enteroinvasive E.coli has the following properties EXCEPT:
A
B
C
D
E
Causes bloody, mucous diarrhea
Chromosomal sequences related Shigella
Destroys the intestinal mucosa
Does not require antibiotic treatment
Produces Shiga toxin
10
2) Salmonella thyphi causes disease by
A
B
C
D
Forming a thick capsule
Releasing endotoxin
Resisting phagocytosis
Producing an exotoxin
3) Salmonella typhi and Salmonella enteritis share the following properties
EXCEPT:
A
B
C
D
Spread systemically
Invade the epithelial cells of the intestine
Are food borne pathogens
Possess endotoxin
4) Legionella pneumophila is characterized by the following statements:
A
B
C
Air conditioning units are often the source of the pathogen
It is diagnosed in HE stained sputum specimen
Requires X and V factor to grow in culture
MICROBIOLOGY:BACTERIOLOGY:GRAM (+) BACILLI:
FOR QUESTION 1 AND 2:
A 2 year-old child was brought to the ER with an upper respiratory infection.
The patient was febrile to 38.9oC and had an exudate in the posterior pharynx
that was described as a yellowish membrane, which bled when scraped and
removed. The patient’s medical history revealed that he had not received any
immunizations.
1)
The patient was admitted. Special cultures were requested for the
suspected pathogen. What was the suspected pathogen?
A Bordetella pertussis
B Corynebacterium diphteriae
C Haemophilus influenzae
11
D Streptococcus pyogenes
E Epstein Barr Virus
2)
How does this organism cause disease?
A
B
C
D
E
3)
Causes disseminated intravascular coagulation
Causes Toxic Shock syndrome
Spreads to the CNS, where it causes meningitis
Produces toxins that interfere with protein translation
Produces toxins that increase cellular cAMP level
The patient is a neonate born at 32 weeks of gestation. The baby was
intubated at birth because of poor respiratory effort. Blood and CSF
specimens taken from the infant grew small, aerobic, gram positive
rods. On the basis of the patient’s age and the description of the
organism, what organism is likely?
A
B
C
D
Bacillus cereus
Clostridium perfringens
Gardnerella spp
Listeria monocytogenes
For question #4,5 and 6:
A 64-year-old man presented to the clinic with an abscess in his mouth.
He stated that the abscess had been getting larger for a period of three
months. He was homeless and had not sought medical care until this
presentation. A sinus track had formed from the abscess to the outside
of the face. An aspirate of the abscess was sent to the laboratory for
gram stain and culture. The culture was positive for Actimomyces spp.
4)
What was the Gram stain report of this organism?
A
B
C
D
5)
Gram positive, box car cells
Gram positive, branching, thin rods
Gram positive cocci in clusters
Gram negative, intracellular diplococci
What is the source of this organism?
12
A
B
C
D
6)
Contaminated food
Gastrointestinal flora
Oral flora
Soil
How can this organism be differentiated from Nocardia spp?
A
B
C
D
Actinomyces spp forms target hemolysis on a blood agar plate
Nocardia spp has a capsule
Nocardia spp is acid fast
Nocardia spp produces branching rods
For question #7 and 8:
A 13-week-old baby girl was brought to the Peds ER. The baby was weak,
lethargic, fed poorly and constipated. Baby was hospitalized. After
admission, it was noted that the baby was gradually becoming paralysed.
A diagnosis was made when the mother reported that she had sweetened
the baby’s formula with organically grown honey.
7)
What is the most likely diagnosis?
A
B
C
D
8)
Group B streptococcal disease
Infant botulism
Infant poliomyelitis
Listeriosis
How can the diagnosis be confirmed?
A
B
C
D
Culture of baby’s formula
Culture of baby’s stool
Culture of baby’s stool and detection of toxin in baby’s stool
Detection of toxin in baby’s blood
For question #9, 10 and 11:
The patient was a 35-ear-old woman. She worked in a fast food
restaurant. She was brought to the emergency room, weak and
somnolent. She had trouble swallowing. She told the physicians that
13
previously she had been in good health. Her condition worsened and
she developed descending quadraparesis, requiring intubation.
Cultures of her stool and gastric content were negative. A blood
specimen was sent to the laboratory and gave a positive result. She
remained hospitalized for six weeks and then returned to her previous
good health.
9)
What was wrong with this patient?
A
B
C
D
10)
Classical botulism
Classical tetanus
Systemic Clostridium perfringens infection
Enterohemorrhagic E.coli
What test was ordered to confirm the diagnosis?
A Antibody titer
B Blood culture
C Toxin detection
11)
What is the appropriate for this patient?
A Antibiotics
B Hyperbaric pressure treatment
C Maintenance of respiratory function
For question #11 and 12:
A 21-year-old male presents with three days of abdominal pain and
tenderness in midgastric and lower abdomen. He was febrile (39.2oC),
tachycardic and tachypneic. He was admitted and blood cultures were
sent to the laboratory. On an exploratory laparotomy, he was found to
have a gangrenous and perforated appendix.
12)
The blood cultures were positive for a Gram neg rod. What is the most
likely organism?
A Bacteriodes fragilis
B Bacillus subtilis
C Bacillus cereus
14
D Clostridium perfringens
13)
What is the possible source for this organism?
A
B
C
D
Contaminated food
Gastrointestinal flora
Genital flora
Oral flora
MICROBIOLOGY:BACTERIOLOGY:ACID-FAST
BACILLI
1) Which one of the following statements is NOT true?
A
B
C
D
E
An individual gets infected with TB by inhaling tubercle bacilli
present in small droplets
From 1985 through 1992, the number of new TB cases in the United
States increased by 80%
Mycobacterium tuberculosis complex includes M. tuberculosis, M.
bovis and M. ulcerans
TB is the leading cause of death due to infectious disease in adults
around the world
The resurgence in TB cases between 1985 and 1992 can be
attributed to the HIV epidemic, immigration from countries where
TB is common, the spread of TB in correctional facilities and
homeless shelters and inadequate funding for TB control
2) Which one of the following statements is NOT true?
A
B
C
D
AIDS reduces the patient’s immune response to TB so they have
less severe disease
Because they are relatively resistant to disinfection, the
Mycobacterium fortuitum complex have caused infections related to
artificial heart valves, hip prostheses and dialysis fluids.
Isolation from blood or other normally sterile body tissues is
sufficient to make a diagnosis of disseminated non-tuberculosis
mycobacterial disease
Mycobacterium avium complex (MAC) is most associated with
disseminated disease in patients with AIDS
15
E
F
Patients, whose sputum is smear positive for tuberculosis transmit
the disease and should be treated
The non-tuberculous mycobacteria are difficult to treat because
they are drug resistant
3) Which one of the following statements is NOT true?
A
B
C
D
About 75% of leprosy patients with an early solitary lesion heal
spontaneously
Mycobacterium leprae causes a chronic disease of the superficial
segments of peripheral nerves
Mycobacterium leprae is an obligate intracellular parasite, which
multiplies very slowly in mononuclear phagocytes
The diagnosis of leprosy is confirmed by growth of Mycobacterium
leprae on culture medium for a period of six weeks
MICROBIOLOGY: PARASITOLOGY
1) What morphological form of the malaria parasite will you most likely see
in a blood smear during a fever episode?
1)
2)
3)
4)
5)
6)
7)
A
B
C
D
Ringform
Young trophozoite
Mature trophozoite
Young schizont
Mature schizont
Mereozoite
None
1 and 5
1, 5 and 6
2, 3 and 4
7
For question #2 and #3:
A young woman from Syria presented with skin lesions on her arm and face.
The lesions were raised papules that were firm but not painful. On the same
day, a young man from Africa presented with hepatosplenomegaly (enlarged
16
liver and spleen), abdominal pain, fever and pallor. In both cases the cause of
their symptoms was discovered to be a parasitic infection with Leishmania,
but b two different species of this parasite.
2) The symptoms of the patient from Africa are consistent with:
A
B
C
D
Disseminated helminth infection
Disseminated protozoan infection
Localized helminth infection
Localized protozoan infection
3) The differences in the symptoms of the two patients was determined in
part by a difference in the species of the parasite; this difference is most
likely related to the following:
A
B
C
D
Host temperature optimum
Invertebrate host
Parasite temperature requirement
Vertebrate host
4) A patient arrived in a rural health clinic in Columbia, South America, with
a distended and painful abdomen and reported that he had not had a
bowl movement in more than six weeks. The patient reported that his
home was infested with vinchuca, also known as the “kissing bug”.
This patient is most likely infected by
A
B
C
D
Leishmania braziliensis
Leishmania donovani
Trypanosoma cruzi
Trypanosoma gambiense
5) A 40-year-old woman presented with a chronic history of vague
abdominal discomfort, hunger pains and indigestion. She was found to
have moderate eosinophilia and was slightly anemic. She reported that
she and her husband frequently dined in gourmet restaurants and greatly
enjoyed steak tartare (highly seasoned raw beef). An ova and parasite
examination of the patient’s stool was positive for proglottids and eggs of
Taenia sagginata, the beef tape worm. Taenia sagginata undergoes sexual
reproduction in the human gastrointestinal tract, therefore, humans are
considered to be the
17
A
B
C
D
Definitive host
Intermediate host
Paratenic host
Sexual host
MICROBIOLOGY: UPPER RESPIRATORY INFECTIONS
1) Which of these conditions occurs because a bacteriophage containing the
genetic information governing toxin production infects the causative
organism?
A
B
C
D
Diphteric membranous pharyngitis and scarlet fever
Gonococcal pharyngitis and staphylococcal pharyngitis
Infectious mononucleosis and mumps
Sore throat without a rash due to Streptococcus pyogenes and
epiglottis due to Haemophilus influenzae
MICROBIOLOGY: LOWER RESPIRATORY TRACT
INFECTIONS
1) In an adult patient with pneumonia, a Gram stain of sputum, which
shows >25 polymornuclear leukocytes (PMNs) per Low Power Field (LPF)
and <10 epithelial cells per LPF associated with >8-10 lancet-shaped
Gram-positive cocci, suggests which of the following organisms:
A
B
C
D
Haemophilus influenzae
Klebsiella pneumoniae
Mycoplasma pneumoniae
Streptococcus pneumoniae
2) In patients with HIV/AIDS the most important pathogen causing
pneumonia is which of the following:
A
B
C
Coccidiodes immitis
Mycoplasma pneumoniae
Pneumocystis carinii
18
D
Staphylococcus aureus
3) A 65-year-old male presents with a 3 day history of cough productive of
green sputum with right sided chest pain on deep inspiration. He also
reports high fever, rigors and a 5 pound weight loss in the past month. On
physical exam he is noted to have a temperature of 38.5°C, RR 26, BP
120/80, HR=100 regular, poor dentition, injected pharynx, 0.5cm nontender lymph nodes in anterior cervical area and decreased breath sounds
at the right base, dullness to percussion at right base and course bronchi
and rales at the right lower lobe. Sputum examination reveals ,10
epithelial cells, >25 WBC/LPF with numerous gram negative bacilli. Lab
revealed a WBC of 13,400 with 60 segs, 14% bands, 30% lymphs and a
serum Cr of 1.8. CXR shows a right lower lobe infiltrate with blunted
costrophrenic angle. Based on the clinical presentation and the Gram stain
the most likely diagnosis is:
A
B
C
D
E
F
Klebsiella pneumoniae
Mycobacterium tuberculosis
Mycoplasma pneumoniae
Pneumocystis carinii
Staphylococcus aureus
Streptococcus pneumoniae
4) A 65-year-old female presents with a 3 day history of cough productive of
green sputum with right sided chest pain on deep inspiration. She also
reports high fevers, rigors and a 3 pound weight loss in the past month.
Also of note, she had “the flu” with URI symptoms, sore throat, severe
myalgias, fever and cough (mildly productive) that also “attacked” other
friends and family. On physical exam she is noted to have a temperature
of 38.5°C, RR 26, BP 120/80, HR=100 regular, poor dentition, injected
pharynx, 0.5cm non-tender lymph nodes in anterior cervical area and
decreased breath sounds at the right base, dullness to percussion at right
base and course bronchi and rales at the right lower lobe. Sputum
examination reveals <10 epithelial cells, >25WBC/LPF with numerous
gram positive cocci in clusters. Lab revealed a WBC of 13,400 with 60%
segs, 14% bands and 30% lymphs and serum Cr of 1.8. CXR shows a right
lower lobe infiltrate with blunted costophrenic angle. Based on the clinical
presentation and Gram stain the most likely diagnosis is:
A
B
Klebsiella pneumoniae
Mycobacterium tuberculosis
19
C
D
E
F
Mycoplasma pneumoniae
Pneumocystis carinii
Staphylococcus aureus
Streptococcus pneumoniae
MICROBIOLOGY: CNS INFECTIONS
1) A 55-year-old renal transplant recipient on chronic steroid therapy is
hospitalized with fever and headaches of 5 days duration. On
examination, the patient is confused and has nuchal rigidity. A lumbar
puncture disclosed 120 WBC (80% Lymphocytes), CSF glucose of 40 and
CSF protein of 95. A smear of CSF revealed many WBC but no organisms.
The most likely cause is:
A
B
C
D
Herpes simplex meningitis
Listeria meningitis
Neisserial meningitis
Pneumococcal meningitis
MICROBIOLOGY: SYSTEMIC INFECTIONS
1) What are the current most common etiologic agents in the US causing
sepsis in children beyond the neonatal period?
A
B
C
D
E
Haemophilus influenzae and Neisseria meningitides
Listeria monocytogenes and Herpes simplex
Neisseria meningitidis and Streptococcus pneumoniae
Staphylococcus aureus and Streptococcus agalactiae
Streptococcus agalactiae and E.coli
2) Injecting drugs users are at an increased risk of bloodstream infection due
to which of the following organisms?
A
B
C
D
Brucella melitensis
Rhodotorula rubra
Saccharomyces cerevisiae
Staphylococcus epidermidis
20
3) A 38-year-old male with a diagnosis of AIDS and Cytomegalovirus
retinitis, with an indwelling IV catheter for receipt of CMV treatment is
admitted to the hospital with fevers to 103 °F and shaking chills. Physical
exam is normal and there is no evidence of infection at the catheter
insertion site. 24 hours following admission, the laboratory reports that
blood cultures are positive for gram positive cocci in clusters. What
organisms are likely?
A
B
C
D
Enterococcus faecalis
Staphylococccus aureus
Staphylococcus epidermidis
Staphylococcus epidermidis and Staphylococcus aureus
MICROBIOLOGY: GI INFECTIONS
1) Half of the attendees at a student reunion became ill two hours after a
luncheon buffet. The menu included quiche, baked chicken, deviled eggs,
potatoe salad, gelatin salad and egg custard among other fine picnic fare.
Those ill, experienced projectile vomiting, nausea and abdominal pain.
Several of the affected individuals also had diarrhea. If you cultured all of
the above menu items, high level of contamination with which organism
is most likely?
A
B
C
D
E
Enterococcus faecalis
Salmonella typhi
Staphylococcus aureus
Staphylococcus epidermidis
Yersinia enterocolitia
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