New MCQs in Microbiology 1

MCQs in Microbiology 1
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Question 1 - Single Best Answer
Annie is obviously in need of psychological counseling which you understand that both she and her mother
are getting. The MOST worrisome physical problem(s) she could be suffering from is/are Bugs Database
A) malnutrition
B) cancers of the female genitalia
C) infectious diseases, including AIDS
D) pregnancy
E) both C and D
What are three of the four major groups of pathogens that can cause infectious diseases? Bugs Database
A) E. coli, Salmonella, and AIDS
B) prokaryotes, metakaryotes, and eukaryotes
C) viruses, bacteria, and fungi
D) protozoa, worms, and bacteria
E) symbionts, commensals, and parasites
Pathogens can be either prokaryotes or eukaryotes. Which are viruses? Bugs Database
A) prokaryotes
B) eukaryotes
C) neither
Which of the following are prokaryotes? Bugs Database
A) plasmodia
B) herpes
C) people
D) Neisseria
Page 1 of 13 MCQs in Microbiology 1 -
25 / 08 / 35 http://aama-a.com/vb/showthread.php?t=7602
E) more than one of the above
Question 5 - Best 2 Answers
Why is it important to know which microbes are prokaryotes and which are eukaryotes? Bugs Database
A) most antibiotics are directed against the prokaryotes
B) eukaryotes cause much more serious disease
C) there are no vaccines for diseases caused by prokaryotes
D) viruses that are human pathogens only replicate in eukaryotic cells
E) it is not important to know
What is the major difference between prokaryotes and eukaryotes? Bugs Database
A) only eukaryotes have peptidoglycan
B) viruses only replicate in prokaryotes
C) only prokaryotes have mitochondria
D) only eukaryotes have a cell membrane
E) only eukaryotes have a nuclear membrane
Getting back to Annie, you note that she looks much older than her age, is somewhat tired and drawn, but
looks in reasonably good health. A pelvic exam reveals erythema of the vulvar area and a discharge with the
consistency of cottage cheese. She tells you it is also somewhat uncomfortable to urinate. When you ask her
about her menstrual periods, she says she has not had a period in about three months .
Which of the four major groups of pathogens could be causing Annie's presenting problem (vaginal discharge
with itching and pain when urinating)? Bugs Database
A) bacteria
B) virus
C) parasite
D) fungus
E) any or all of the above
Which of the following specific agents is the most likely to produce the very thick discharge you have seen?
Bugs Database
A) Trichomonas vaginalis
B) Gardnerella vaginalis
C) Candida albicans
D) Neisseria gonorrhoea
E) Chlamydia trachomatis
What implements would you need to diagnose her problem? Bugs Database
A) microscope
B) x-ray machine
C) CAT scanner
D) agar plates and an incubator
E) none -- you can tell just by looking
Treatment of a sample of the discharge with KOH (potassium hydroxide) reveals no unusual odor. Microscopic
exam of the KOH treated preparation reveals yeast and pseudomycelia. A wet mount does not reveal any
motile organisms. A Gram stain shows PMN's but no intracellular Gram negative diplococci .
What in the world are Gram negative diplococci? Bugs Database
A) a part of the endoplasmic reticulum
B) a kind of bacterium with a double layered cell wall
C) what mitochondria in PMN's are sometimes called
D) a rod-shaped bacterium
E) a protozoan parasite that stays in mating pairs, microbial love-bugs
The exam of Annie's discharge with the microscope confirms a diagnosis of____ Bugs Database
A) Trichomonas vaginalis
B) Gardnerella vaginalis
C) Candida albicans
D) Neisseria gonorrhoea
E) Chlamydia trachomatis
What are some things that can increase the likelihood of a disease-producing Candida infection? Bugs
Database
A) AIDS
B) antibiotic treatment
C) sex with a partner who is infected
D) two of the above
E) all of the above
Her Candida is an endogenous infection. But pathogens can be passed from person to person (horizontal
transmission) in a variety of ways. Besides the most popular way (sexual) what are some other routes of
horizontal transmission? Bugs Database
A) transplacental transmission
B) respiratory
C) ingestion
D) through a break in the skin
What are some other tests that you would order for Annie? Bugs Database
A) VDRL
B) HIV
C) fluorescent antibody assay for chlamydia
D) A and C above
E) all of the above
You think that an HIV test is very important because vaginal candidiasis is one of the signs of AIDS unique to
women. What is another? Bugs Database
A) increased outbreaks of Herpes lesions
B) invasive cervical cancer
C) tuberculosis
D) cryptosporidiosis
E) gonorrhea
Would you recommend a pregnancy test? Bugs Database
A) definitely
B) only if her mother says its o.k .
C) only if Annie wants one
Annie took the pregnancy test. It was positive. She refused the HIV test .
How does one screen for the presence of HIV? Bugs Database
A) count CD4 cells
B) look for antibody to the virus with the Elisa test
C) look for the lesions of Kaposi's sarcoma
D) look for antibody with a Western blot
E) all of the above
Does the fact that Annie is pregnant change your concern that she have an HIV test? Bugs Database
A) yes
B) no
If the HIV test is positive, could you discuss the possibility of an abortion? Bugs Database
A) yes
B) no
If the HIV test is positive and she wanted to have the baby, how would you treat her? Bugs Database
A) acyclovir
B) AZT
C) thymidine kinase
D) methotrexate
E) rifampicin
What is the causative agent of AIDS? Bugs Database
A) a double-stranded DNA virus
B) a virus that contains two strands of RNA
C) a virus with circular RNA
D) a helical virus
E) it is not caused by a microbe, its just a response to a life style
What does the fact that the donor had a fever MOST LIKELY indicate
He had an infection .
He had a viral infection .
He was going to die
He had a pulmonary embolism
All of the above
What region of the body is responsible for temperature regulation
kidney
liver
hypothalamus
blood brain barrier
What are three of the four major groups of pathogens that usually cause infectious diseases? Bugs Database
symbionts, commensals, parasites
measles, mumps, and Herpes
prokaryotes, metakaryotes, and eukaryotes
viruses, bacteria, and fungi
protozoa, worms, and bacteria
Staphylococcus, influenza, and AIDS, and malaria
In spite of all these leading questions about infections and fever, it was determined that Mr. X's fever did not
indicate an underlying cause for his death and donor eligibility screening and testing did not reveal any
contraindications to transplantation. The patient's family agreed to organ donation. Lungs, kidneys, and liver
were therefore recovered. The liver and kidneys were transplanted into three recipients on May 4 at a
transplant center in Texas. The liver recipient was a man with end-stage liver disease. He did well immediately
after transplantation and was discharged home on postoperative day 5. Twenty-one days after transplant, the
patient was readmitted with tremors, lethargy, and anorexia. The patient's neurologic status deteriorated
rapidly during the next 24 hours and he became febrile; he required intubation and critical care support. A
lumbar puncture indicated a mild lymphocytic pleocytosis (25 white blood cells/mm3) and a mildly elevated
protein .
In general, what can one tell about an infection from a change in numbers of white cells
Whether there is one or not
Whether the cause is viral or bacterial
Both of the above are true
This man's spinal fluid profile indicates a possible viral infection. (Had he had a bacterial meningitis there
would have been PMN's in his spinal fluid.) His neurologic status continued to deteriorate. Six days after
admission, an MRI indicated diffuse encephalitis. The patient subsequently died .
Was the man's death a likely failure of his liver transplant
Yes
No
Was his death likely due to infection of the wound
Yes
No
Could he have become infected with a virus directly from the transplanted organ
Yes
No
We know so far that all three patients that received organs from Mr. X died of a probable virus infection (see
response to correct answer of previous question). Now we would like to know the exact cause .
Why is it important to diagnose a disease
Prognosis
Treatment
Epidemiology
all of the above
Now, before talking about exact causes we need to think a little bit about how viruses are classified .
What are two major STRUCTURAL groups of viruses
viruses with no protein coat, just plain nucleic acid, and viruses with coats
viruses with lipid coats and viruses with protein coats
protein viruses and nucleic acid viruses
naked viruses and enveloped viruses
What are the two major GENETIC distinctions of viruses
cellular or acellular
DNA or RNA
mRNA or tRNA
ribosomes or no ribosomes
How many groups of viruses, BASED ON THEIR REPLICATION SCHEMES, are there

What kind of cells can viruses replicate in
eukaryotic cells
bacterial cells
fungal cells
all of the above
What kinds of viruses could infect the brain? (Note: SEE the Bugs database, in the Pathogens file, under brain
. (
measles, polio, coxsackie virus
rabies, vaccinia, influenza
polio, rabies, EEEV (Eastern Equine Encephalitis Virus (
Streptocuccus pneumonia, Hemophilus influenzae, Neisseria meningitidis
How can a viral infection be diagnosed
Culture
Serology ....detection of the host's antibodies
Detection of viral antigens
Detection of viral nucleic acids
All of the above
How would you diagnose polio
acid fast stain
blood smear
serology
Dane particle
Negri bodies
How would you diagnose rabies
serology
Dane particle
Negri bodies or mouse inoculation
evidence of a bite wound
In all the three patients that had received organs from Mr. X, histopathologic examination of central nervous
system tissues revealed an encephalitis with viral inclusions suggestive of Negri bodies; the diagnosis of
rabies in all three recipients was confirmed by immunohistochemical testing and by the detection of rabies
virus antigen in fixed brain tissue by direct fluorescent antibody tests (Fig 1). Electron microscopy of CNS
tissue of one of the renal transplant recipients also identified characteristic rhabdovirus inclusions and viral
particles. (Fig 2 ( .
There are, in general, four routes by which viruses (or any microorganisms) can be transmitted. These are
respiratory, oral, sexual, percutaneous (needles, wounds, bites ( .
How is rabies usually transmitted
insect bite
respiratory droplets
sexually
bite of a carnivorous animal
ingestion of the virus through contaminated food
What kind of virus is rabies? (Note: The highly astute will have gotten a hint above; for the others, go to the
Bugs database and click on Rabies virus (
Rhabdoviridae
ssRNA ) - (
helical
enveloped
all of the above
Are enveloped viruses more or less stable in the environment
More
Less
What directly determines where, in the body, a virus will replicate? This is called a tropism. Rabies, for
instance, has a tropism for brain tissue .
the viral RNA
the viral DNA
the matrix protein
attachment proteins on the viral surface and cell surface receptors .
If it had been realized that the three transplant patients had been exposed to rabies BEFORE THEY HAD ANY
SYMPTOMS, what could have been done to prevent the disease, if anything
nothing
acyclovir and other antiviral drugs
anti-rabies antibodies
rabies immunization
more than one of the above
Were the hospital personnel or family members of the three patients at risk
High risk
Very low risk
No risk
Has "nosocomial" transmission of rabies been previously reported
Yes
No
What are the most common causes of sore throat/pharyngitis? Bugs Database
A) respiratory viruses
B) sexually transmitted bacteria
C) mycoplasma
D) Gram positive bacteria
E) normal oral flora
What are the three most common bacterial causes of sore throat? Bugs Database
A) Streptococcus, Staphylococcus, and Bordetella
B) Streptococcus, Staphylococcus, and Corynebacteria
C) Streptococcus, Corynebacteria, and Neisseria
D) Bordetella, Corynebacteria, Clostridia
E) Neisseria, Corynebacteria, Clostridia
How would you test for a bacterial cause for her sore throat? Bugs Database
A) serology
B) throat swab and culture on McConkey's or EMB agar
C) monospot test
D) throat swab and culture on blood agar
E) none of the above
Palpation of her lymph nodes showed that her cervical nodes were enlarged as were her axillary nodes.
Splenomegaly was also present .
What does the lymphadenopathy and splenomegaly in a young adult with sore throat suggest? Bugs Database
A) Streptococcus pyogenes infection
B) diphtheria
C) infectious mononucleosis
D) rhinovirus infection
E) influenza virus infection
What is/are the viral causes of infectious mononucleosis? Bugs Database
A) Epstein-Barr virus
B) Cytomegalovirus
C) B19 virus
D) A and B
What family of viruses do CMV and EBV belong to? Bugs Database
A) Initialviridae
B) Hepadnaviridae
C) Herpesviridae
D) Orthomyxoviridae
E) Paramyxoviridae
Which of the following also belongs to the Herpes family? Bugs Database
A) measles virus
B) rubella virus
C) varicella (chicken pox (
D) variola
E) Neisseria
What is one common pathogenic mechanism that all Herpes viruses have? Bugs Database
A) anti-interferon RNA
B) endotoxin
C) antigenic variation
D) latency
E) capsule
What is a non-viral cause of a mononucleosis type syndrome? Bugs Database
A) B19
B) rickettsia
C) Streptococcus
D) toxoplasma
E) varicella
Getting back to your patient, what tests would you order first to best help her? Bugs Database
A) CBC and throat culture
B) CBC and liver enzymes
C) Liver enzymes and throat culture
D) viral serology
E) chest x-ray and liver enzymes
Why would you order a throat culture if you thought she had mononucleosis? Bugs Database
A) Viral mononucleosis is exacerbated by Streptococcus pyogenes
B) Rheumatic fever is more common after a Strep throat in people with mononucleosis
C) Mononucleosis is diagnosed with a throat culture
D) Strep throat can co-exist with mononucleosis
E) Toxoplasmosis can be ruled out with a throat culture
Why is it so important to diagnose a Streptococcal sore throat? Bugs Database
A) because it can be cured with antibiotics
B) because a non-suppurative sequela can be prevented with antibiotics
C) because it can be an antecedent to viral pneumonia
D) Strep throat is a reportable communicable disease
Her CBC showed a hematocrit of 45% and a WBC count of 12,000 (per sq mm) with 30% neutrophils, 29%
lymphocytes, 21% atypical lymphocytes, and 20% monocytes. There were no beta-hemolytic colonies on the
blood agar plate from her throat swab. Liver enzyme levels were also measured and were found to be
elevated.Normal Lab Values
Which of the findings is the "hallmark" of infectious mononucleosis? Bugs Database
A) the low hematocrit
B) the throat culture
C) the high white count
D) the atypical lymphcytes
How would you confirm a diagnosis of acute EBV mononucleosis? Bugs Database
A) anti-EBV IgG ) + (
B) heterophile antibody ) - (
C) heterophile antibody ) + (
D) culture the virus
E) culture immortal B lymphocytes
Her heterophile antibodies were positive .
What do you think the most likely diagnosis is at this point? Bugs Database
A) Streptococcal pharyngitis caused by non-hemolytic streptococci
B) EBV mononucleosis
C) viral hepatitis
D) toxoplasmosis
E) CMV mononucleosis
What therapy would you institute for this patient? Bugs Database
A) aspirin and rest
B) penicillin
C) interferon
D) acyclovir
E) amantadine
How did she get mono? Bugs Database
A) raw oysters
B) sexual transmission
C) bug bite
D) saliva
E) respiratory route
What other diseases does EBV cause? Bugs Database
A) Burkitt's lymphoma
B) nasopharyngeal carcinoma
C) oral hairy leukoplakia (OHL (
D) all of the above
Which would you consider to be the most likely type of diarrhea in this child? Bugs Database
A) infectious
B) non-infectious
What are the three major kinds of infectious agents that might be the cause? Bugs Database
A) ETEC, EPEC, EHEC
B) viruses, parasites, bacteria
C) E. coli, rotaviruses, Campylobacter
D) rotaviruses, Norwalk viruses, enteroviruses
What are the two major kinds of diarrhea that it is important to differentiate? Bugs Database
A) secretory and watery
B) inflammatory and secretory
C) viral and bacterial
D) bacterial and parasite
E) dysentery and inflammatory
Initial tests showed that his urine had a high specific gravity and that there were no fecal leukocytes .
The high urine specific gravity is consistent with the child's dehydration. What is the significance of the fact
that no fecal leukocytes were found? Bugs Database
A) he does not have an infection
B) he has a viral diarrhea
C) he has diarrhea caused by a parasite
D) he has a noninflammatory or secretory diarrhea
What are some causes of noninflammatory or watery diarrhea? Bugs Database
A) E. coli and rotaviruses
B) Shigella and Campylobacter
C) Vibrio cholera and Epstein-Barr virus
D) Epstein-Barr virus and Norwalk virus
Besides rotaviruses, what are some other viral causes of watery diarrhea? Bugs Database
A) Herpes and CMV
B) Rubella and rubeola
C) Norwalk and adeno
D) E. coli and Vibrio
What is the first thing you should initiate for this child? Bugs Database
A) oral rehydration
B) intravenous rehydration
C) fever reduction
D) antibiotics
E) A or B, depending on the circumstances
The child was started on intravenous fluids. Microscopic examination of a fecal smear revealed no indication
of parasites. Routine stool cultures were done and were all negative. This latter result indicates? Bugs
Database
A) he had no bacteria in his GI tract
B) his diarrhea was not caused by an infectious agent
C) his diarrhea was not caused by a parasite
D) his diarrhea was viral or caused by a parasite
How would you diagnose a case of viral diarrhea? Bugs Database
A) virus isolation
B) IgG antibodies in the serum
C) DNA probe of a fecal smear
D) detection of viral antigen in the stool
The child was shown to have rotavirus diarrhea. What is a risk factor for this disease? Bugs Database
A) malnutrition
B) under 5 y.o .
C) daycare centers
D) all of the above
What is the mechanism by which rotaviruses cause diarrhea? Bugs Database
A) they produce a toxin that stimulates adenyl cyclase
B) they cause a low osmolarity in the lumen of the intestine and this causes water secretion
C) they inhibit water adsorption by the columnar epithelial cells
D) they coat the brush border cells with virus so that no water can be adsorbed
The child recovered uneventfully and could return to his daycare center the next week. His mother found,
when she took him back, that many of the other children had a similar illness .
What is the best way to prevent this disease? Bugs Database
A) don't eat raw oysters
B) wash hands
C) don't drink unpasteurized milk
D) cook hamburger meat well
The yellow skin is called jaundice or icterus and results from an abnormal accumulation of which of the
following compounds in the blood? Bugs Database
A) hemoglobin
B) albumin
C) urea
D) bilirubin
E) glucuronic acid
Bilirubin is normally removed from the bloodstream in the liver, conjugated with glucuronic acid and excreted
via the bile. In considering possible causes of jaundice, one must consider things that would increase the
production of bilirubin, or decrease its uptake and secretion. If its secretion is decreased there will be
conjugated bilirubin in the blood. If its production is increased there will be unconjugated bilirubin in the
blood. Things that might increase its production include? Bugs Database
A) blockage of bile flow through the small bile ducts in the liver
B) hepatocellular damage
C) carcinoma of the pancreas
D) none of the above
What are some of the things that could damage the liver and cause jaundice? Bugs Database
A) drugs
B) alcohol
C) viruses
D) bacteria
E) all of the above
Urine that is extremely concentrated often has a dark appearance. What is another thing that could make the
urine dark? Bugs Database
A) protein
B) unconjugated bilirubin
C) conjugated bilirubin
D) breakdown products of urea
E) all of the above
Would you expect dark urine to accompany the jaundice if it were caused by viral damage to the liver? Bugs
Database
A) yes
B) no
You find that Mr. Livermore has a slight fever. You question him about the pain and find that it is right upper
quadrant pain. You also note that his liver is enlarged and tender. You order lab tests .
Some initial lab results were as follows :
AST (SGOT): 470 IU/L (normal: 10-40 (
ALT (SGPT): 520 IU/L (normal: 5-35 (
Bilirubin total/direct: 3.4/2.8 mg/dl (normal: 0.2-1.2/0-0.3 (
Stool ova and parasites: negative
monospot; negative
Normal Lab Values
What do the elevated AST and ALT indicate? Bugs Database
A) red blood cell lysis
B) viral infection
C) liver damage
D) sexually transmitted disease
Below are some lists of possible differential diagnoses. Pick the one that most closely agrees with your
differential at this point. (Note: the diseases are listed in the order of the most likely to the least likely.) Bugs
Database
A) liver tumor, alcoholic hepatitis, viral hepatitis, brucellosis
B) viral hepatitis, infectious mononucleosis, liver tumor, Lyme disease
C) viral hepatitis, CMV mononucleosis, leptospirosis, liver tumor
D) amoebic liver abscess, CMV mononucleosis, viral hepatitis
Leptospirosis is a bacterial disease, one of only a very few that can affect the liver. How is it transmitted?
Bugs Database
A) from animals to man via urine-contaminated water
B) from animals to man via an insect vector
C) from animals to man via ingestion of undercooked meat
D) it is a sexually transmitted disease
How many Hepatitis viruses are there? Bugs Database
A) 1
B) 2
C) 5
D) 10
Which Hepatitis virus is in the same family as polio virus? Bugs Database
A) A
B) B
C) C
D) D
E) E
Which of the hepatitis viruses can be spread by contaminated food or water? Bugs Database
A) A only
B) A and E
C) B only
D) B, C, and D
E) none of them can be spread by food or water
A and E can also be spread another way. What is it? Bugs Database
A) respiratory
B) sexually
C) insects
D) kitty litter
What is the major route of transmission of Hepatitis viruses B, C, and D? Bugs Database
A) respiratory
B) fecal-oral
C) animal bite
D) blood
E) sexual
Does the patient's history help at all in diagnosing the cause of hepatitis? Bugs Database
A) Yes
B) No
You decide to take a better history and find that Mr. Livermore is married with two children. He has
experienced fatigue, loss of appetite and mild diarrhea over a 7-10 day period. Answers to specific questions
indicate that he has had no contact with other people who are jaundiced, has not traveled or been camping,
and has consumed no drugs. He drinks alcohol socially on the weekends only. He became irritated about his
sexual preferences and reiterated that he is a married man. He has not been to any "raw" (sushi or oyster)
bars lately. He also has never had a transfusion .
Does the history help in your diagnosis? Bugs Database
A) definitely yes
B) definitely no
C) it makes some things less likely
Can you tell which Hepatitis virus is causing disease by the clinical signs? Bugs Database
A) Yes
B) No
You order some more specific tests and find the following :
HBsAg -- positive
Anti-HAV IgG -- positive
Anti-HAV IgM -- negative
Anti-HBs IgG -- negative
Anti-HBc IgM -- positive
) HBsAg is HBV surface antigen; anti-HBs is antibody to the surface antigen and anti-HBc is antibody to the
HBV core antigen. Anti-HAV is antibody to the whole HAV virus.) Normal Lab Values
These results show? Bugs Database
A) he has HAV now and has had HBV in the past
B) he has a current infection with HAV and a reactivated HBV infection
C) he has a primary infection with HBV now and has had HAV in the past
D) he has a reactivated HBV infection now and has had HAV in the past
E) he is chronically infected with both HAV and HBV
It was determined that Mr. Livermore has active Hepatitis B and has had Hepatitis A in the past. He does not
have infectious mononucleosis now (see initial lab results), another disease that can present with symptoms
of hepatitis. After an explanation that his disease was highly contagious to all sexual partners, Mr. Livermore
admitted that he was bisexual. He had multiple male sex partners once every two or three months when he
went on business to San Francisco, as well as an ongoing relationship with his wife .
It was determined that Mr. Livermore's wife was not sick but HBV has a very long incubation period. How can
we tell if Mrs. Livermore is currently infected? Bugs Database
A) HbsAg
B) anti-HBc IgM
C) anti-HBs IgG
D) anti-HBc IgG
Mrs. Livermore was negative for HBsAg, anti HBc and anti HBs. How might she be protected from getting the
infection? Bugs Database
A) condoms
B) vaccine
C) hyperimmune serum globulin
D) not having sex with her husband
E) all of the above
What other diseases is Mr. Livermore at risk for? Bugs Database
A) syphilis
B) AIDS
C) liver cancer
D) chronic Hepatitis B
E) all of the above
Generally, hepatitis is a self-limiting disease, although some people with Hepatitis B do become chronic
carriers. They are not sick, but are a major source for the spread of the virus. Mr. Livermore's jaundice
gradually disappeared over the next two months. He regained his appetite and began to feel better. His liver
enzyme levels returned to normal. He was cultured for gonorrhea and a serum test for syphilis and HIV were
done -- all were negative. Four of Mr. Livermore's sexual partners were immunized, as was his wife. Mr.
livermore and his wife went to counseling as she was very unhappy with his life style, but they were divorced
within a year .
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