TEST BANK for Medical Microbiology 8th Edition by Murray, Ken S. Rosenthal, Pfaller

TEST BANK for Medical Microbiology 8th Edition by Ken 8th S. Rosenthal, PfallerTest Bank Medical Murray, Microbiology Edition Murray The publisher did not release test bank questions for the following chapters Murray: Medical Microbiology, 8th Edition 1,2,3,4,37,55,57,58,59,61,65,66,67,68,70,72,76,77,78 Chapter 5: Molecular Diagnosis

Test Bank MULTIPLE CHOICE 1. Target nucleic acid amplification (PCR) methods are based on which of the following? a. The ability of two nucleic acid strands that have complementary base sequences to specifically bond with each other and form a double-stranded molecule b. Detecting phenotypic traits not detectable by conventional strategies c. The principles of complementary nucleic-acid hybridization and those of nucleicacid replication that are applied repeatedly through numerous cycles d. Determining the exact nucleotide sequence of a gene or gene fragment obtained from an organism ANS: C 2. A reduction in production of HIV due to therapy can be evaluated by which of the following methods? a. ELISA assay for antibody of pNaU tieRnS tI seN ruGmTB.COM b. Western blot for antibody of patient serum c. PCR analysis of patient serum d. Real-time PCR of patient serum e. Immunofluorescence of peripheral blood T cells ANS: D 3. A 27-year-old man has focal neurologic symptoms, and MRI indicates inflammation in the temporal lobe. Which test would be most effective to confirm the diagnosis? a. ELISA assay for antibocy of patient serum b. Western blot for antibody of patient serum c. PCR analysis of patient serum d. Real-time PCR of patient serum e. Immunofluorescence of peripheral blood T cells ANS: C

Murray: Medical Microbiology, 8th Edition Chapter 6: Serologic Diagnosis

Test Bank MULTIPLE CHOICE 1. A 22-year-old spelunker has flulike illness with chest pain. Radiographs of the lungs indicate patchy infiltrates. Which of the following serologic findings would confirm a diagnosis of histoplasmosis? a. Ouchterlony demonstration of partial identity with Blastomyces b. A twofold increase in complement fixation titer c. Inhibition of hemagglutination d. Real-time PCR e. Southern blot analysis of serum ANS: A 2. A 33-year-old man is suspected of being infected with H3N2 influenza. Comparison of serum taken during disease is compared to serum taken 2 months after recovery. Which of the following sets of antibody titers would confirm infection with the H3N2 strain?

Acute Titer Convalescent N TU iteRrSINGTB.COM a.

8 16 b.

8 64 c.

4 8 d.

16 8 e.

64 16 ANS: B 3. Serology is used to follow the course of which of the following diseases? a. Influenza b. Herpes simplex virus c. Epstein Barr virus d. Yellow fever virus e. Measles ANS: C 4. Serum levels of which antibody is indicative of recent infection? a. IgA b. IgD c. IgE d. IgG

Test Bank e. IgM ANS: A

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Murray: Medical Microbiology, 8th Edition Chapter 7: Elements of Host Protective Responses

Test Bank MULTIPLE CHOICE 1. How can a B cell be distinguished from a T cell? a. B cells have a large nucleus-to-cytoplasm ratio. b. B cells have surface immunoglobulin. c. T cells mature in the bone marrow. d. Extensive gene recombinations occur in B cells. e. B cells have a sheep red-blood-cell receptor.

ANS: B 2. Which cell type would not be present in a boy born without a thymus? a. NK cell b. B cell c. T cell d. Macrophages e. Neutrophils ANS: C 3. Which cell type produces acute-phase cytokines? a. B cell b. T cell c. NK cell d. Macrophages e. Neutrophils ANS: D 4. A ruptured spleen was removed from a 37-year-old car accident victim. What would be the consequence? a. Can’t mature T cells b. Lack of IgG-producing B cells c. Lack of IgA-producing B cells d. Can’t activate macrophages e. Increased susceptibility to encapsulated bacteria ANS: E

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5. Soon after HIV infection, the gut becomes smooth due to the loss of MALT. Loss of the MALT will compromise the production of which type of antibody? a. IgA b. IgD c. IgE d. IgG e. IgM ANS: A 6. A blood count from a 6-year-old boy with fever is reported to have undergone “a left shift with an increase in bands.” This refers to an increase in: a. activated T cells in response to viral infection. b. activated eosinophils due to parasitic infection. c. immature neutrophils released from bone marrow. d. activated dendritic cells due to sepsis. e. plasma cells due to chronic infection.

ANS: C

Murray: Medical Microbiology, 8th Edition Chapter 9: Antigen-Specific Immune Responses

Test Bank MULTIPLE CHOICE 1. A 5-year-old boy has frequent upper respiratory infections. Which of the following deficiencies would be consistent with this boy’s problem? a. CD4 T cells b. Complement C8 c. IgA d. IgG e. Lysozyme ANS: C 2. A defect in the C3 component of complement would affect which of the pathways? a. Alternate b. Lectin c. Classical d. Lectin and classical e. Alternate, lectin, and classical ANS: E 3. Which of the following antibody isotypes would still be found in serum of a 2-yearold boy born without a thymus? a. IgA b. IgD c. IgE d. IgG e. IgM ANS: E 4. Which of the following steps in antibody gene development occurs outside the bone marrow? a. Juxtaposition of V4 to D2 b. Juxtaposition of V4D2 to J1 c. Juxtaposition of V4D2J1 to Cμ d. Juxtaposition of V4D2J1Cmu to Cα e. Juxtaposition of V4D2J1 to Cα ANS: E

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5. Which of the antibody isotypes remains primarily in serum? a. IgA b. IgD c. IgE d. IgG e. IgM ANS: E 6. Which of the antibody isotypes is in lowest concentration in serum? a. IgA b. IgD c. IgE d. IgG e. IgM ANS: B 7. Which of the antibody isotypes is almost always cell associated? a. IgA b. IgD c. IgE d. IgG e. IgM ANS: C 8. Which of the following describes a potential property of the variable region after cleavage of IgG with papain? a. Opsonization of bacteria b. Activation of complement c. Agglutination of antigen d. Neutralization of toxin e. Crossing the placenta ANS: D 9. Which of the following distinguishes an NK cell from a T cell? a. NK cells kill target cells with perforin. b. Activated NK cells produce interferon gamma. c. IL-2 promotes the growth of NK cells. d. NK cells kill MHC I–deficient cells. e. NK cells have Fc receptors on their cell surfaces.

ANS: D

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10. Which distinguishes MHC I from MHC II? a. MHC I acquires antigenic peptide in the cytoplasm. b. MHC I binds an 8-amino-acid peptide. c. MHC I presents peptides to the T-cell receptor. d. MHC II presents antigenic peptides to CD8 T cells. e. MHC II cross-presents antigen to CD4 T cells.

ANS: B 11. A 26-year-old male homosexual has mononucleosis symptoms but claims to have had heterophile positive mononucleosis when he was 16. He admits that he had unprotected sex within the last month. What would be the reason that flow cytometric analysis of his blood shows elevated CD3-positive cells? a. There is an increase in T cells responding to early infection with HIV or CMV. b. A recurrence of EBV-positive mononucleosis causes an increase in B cells. c. An increase in NK cells has stimulated T-cell production. d. EBV recurrence has killed off B cells, making it appear as if there are more T cells.

ANS: A 12. A new vaccine against HIV strings together multiple copies of epitopes capable of activating CD8 T cells and attaches them to a larger peptide structure called protein X. What needs to happen to produce N efUfeRcS tivIeNiG mT mB un.iC zaOtiM on? a. Protein X binds to CD8 molecules on T cells and activates these cells to produce cytokines. b. Protein X is endocytosed by macrophages, degraded, and peptides are attached to MHC II molecules to be presented to T cells. c. Protein X is endocytosed by dendritic cells, degraded, and peptides are transferred to the endoplasmic reticulum, where they bind to MHC I molecules. d. Protein X binds to MHC I molecules on the surface of follicular dendritic cells in the lymph node and are presented to T cells.

A. Protein X is degraded by macrophages, the peptides are released, and then bind CD8 molecules on macrophages to be presented to the T-cell receptor.

ANS: C 13. What must occur for a vaccine like the one described in question 4 to activate both CD4 and CD8 T cells? a. Protein X must contain different peptides from HIV that can bind to CD4 and CD8 molecules. b. Peptides from protein X bind to MHC I and MHC II molecules on the surface of T cells and activate cytokine production. c. Peptides of the protein bind to MHC II in the endosome, and others bind to MHC I in the endoplasmic reticulum. d. Protein X is taken up by macrophages, degraded in the endosome, and peptides are

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released to bind to the T-cell receptors on CD4 and CD8 T cells. e. Protein X is extended and binds to MHC I and MHC II molecules on the dendritic cell surface, and linear epitopes are presented to both CD4 and CD8 T cells.

ANS: C 14. Which of the following changes occurs during the transition of an immature (iDC) to a mature dendritic cell (DC)? a. The iDC proliferates, promoting the recombination of genes to produce MHC molecules that effectively present antigenic peptide to T cells. b. Phagocytosis is upregulated, and the cells enlarge and upregulate MHC I molecules to interact better with the lymph node. c. Pinocytosis takes over for phagocytosis, protein degradation speeds up, and the iDC moves to the lymph node. d. iDC stop taking up proteins, upregulate MHC II molecules, and move to the lymph node. e. The iDC release cytokines, become larger, and express integrins which anchor the cell to the skin.

ANS: D 15. To activate macrophages in the vicinity of a splinter, which of the following must occur that does not have to occur when dendritic cells activate T cells in the lymph node? a. Release of interferon gamma b. Binding of MHC II to TCR anNdUCRDS4INGTB.COM c. Binding of CD28 to B7 d. Binding of CD40 to CD40L e. Binding of adhesion molecules ANS: D

Murray: Medical Microbiology, 8th Edition Chapter 10: Immune Responses to Infectious Agents

Test Bank MULTIPLE CHOICE 1. What is the first antibody produced when an invading microorganism is initially encountered? a. IgA b. IgD c. IgE d. IgG e. IgM ANS: E 2. A 5-day-old baby is brought back to the hospital with signs of sepsis, is not thriving, and has vesicular lesions on his scalp at the site of monitor attachment. Why is a baby susceptible to a more serious outcome with this infection than an older child or adult? a. Immunosuppression from the mother b. Infection of a site closest to thN eU brRaiSnINGTB.COM c. Lack of IgA production d. Low levels of interferon-γ production e. More rapidly growing cells ANS: D 3. Endotoxin initiates septic responses by binding to: a. NF-κB b. Complement receptor 3d c. Toll-like receptor 4 d. C-reactive protein e. ICAM 1 ANS: C 4. Endotoxin induces production of which cytokines by macrophages? a. IL-1, TNF-α, IL-6 b. IL-2, IL-4, IL-6 c. IL-4, IL-5, IL-10 d. IL-2, IFN-γ, TNF-β e. TGF-β, IL-10, IL-17

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ANS: A 5. Which of the following cytokines is required to initiate a protective helper T cell immune response to measles virus? a. IL-1 b. IL-4 c. IL-8 d. IL-10 e. IL-12 ANS: E 6. Treatment with which cytokine makes the macrophage more efficient at killing bacteria? a. Interferon alpha b. Interferon gamma c. TGF-β d. GM-CSF e. IL-2 ANS: B 7. M. tuberculosis becomes reactivated in an AIDS patient because: a. CD8 T cells cannot kill the bN acUteRriS a.INGTB.COM b. Neutrophils do not become activated. c. Macrophages do not get an activation signal. d. B cells stop making protective antibody. e. CD4 T cells stop making TGF-β.

ANS: C 8. Identify which deficiency would most compromise a protective immune response to E. coli sepsis. a. IgG b. IgE c. CD8 T cells d. Mast cells ANS: A 9. Identify which deficiency would most compromise a protective immune response to herpes simplex virus. a. b. c. d.

IgG IgE CD8 T cells Neutrophils

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ANS: C 10. Identify which deficiency would most compromise a protective immune response to poliovirus. a. IgG b. IgE c. CD8 T cells d. Neutrophils ANS: A 11. Identify which deficiency would most compromise a protective immune response to S. aureus skin infection. a. IgA b. IgE c. CD8 T cells d. Neutrophils ANS: D 12. Identify which deficiency would most compromise a protective immune response to helminths. a. IgG b. IgE c. CD8 T cells d. Neutrophils ANS: B 13. A person with chronic granulomatous disease and related defects in the NADPH Oxidase enzyme complex would be MOST susceptible to serious outcomes from: a. S. aureus b. Herpes simplex virus c. Parainfluenza d. Neisseria meningitides e. All of the above ANS: A 14. A person with complement C7 deficiency would be MOST susceptible to serious outcomes from: a. S. aureus b. Herpes simplex virus c. Parainfluenza d. Neisseria meningitides

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All of the above

ANS: D 15. A person with hyper-IgM syndrome would be susceptible to serious outcomes from: a. S. aureus b. Herpes simplex virus c. Parainfluenza d. Neisseria meningitides e. All of the above ANS: E 16. A person with IgA deficiency would be MOST susceptible to serious outcomes from: a. S. aureus b. Herpes simplex virus c. Parainfluenza d. Strongyloides stercoralis e. All of the above ANS: C 17. A person with asplenia would be MOST susceptible to serious outcomes from: a. S. aureus b. Herpes simplex virus c. Parainfluenza d. Neisseria meningitides e. All of the above ANS: D 18. Match the hypersensitivity reaction with the response to poison ivy. a. Type I b. Type II c. Type III d. Type IV ANS: D 19. Match the hypersensitivity reaction with the anaphylactic response to penicillin. a. Type I b. Type II c. Type III d. Type IV ANS: A

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20. Match the hypersensitivity reaction with the immune complex–induced complement activation in the kidney during hepatitis B infection. a. Type I b. Type II c. Type III d. Type IV ANS: C

Murray: Medical Microbiology, 8th Edition Chapter 11: Antimicrobial Vaccines

Test Bank MULTIPLE CHOICE 1. Which of the following responses would be elicited by vaccination with Jeryl Lynn mumps vaccine but not with the hepatitis B vaccine? a. CD4 T-cell activation b. Interferon  c. Interleukin 4 d. IgG e. IgM ANS: B 2. The Gates Foundation is interested in funding the development of a new vaccine for measles. Which of the following advantages should the improved vaccine have over the current vaccine? a. Activates long-term immunity b. Administered at less than 1 yeN arUoRf S agIeNGTB.COM c. Activates both humoral and cell mediated immunity d. Live attenuated vaccine e. Will reduce the occurrence of subacute sclerosing panencephalitis ANS: B 3. Why is the inactivated polio vaccine (IPV) recommended in the United States instead of the oral live attenuated vaccine (OPV) for routine immunizations? a. IPV initiates lifelong immune response. b. IPV promotes Herd immunity. c. Smaller amounts of the IPV are required. d. IPV cannot cause disease. e. IPV is easier to administer to children.

ANS: D

4. A four-year-old child is bitten by a raccoon kitten. Unfortunately the animal has escaped. Which of the following actions should be taken? a. Wash the wound carefully, and treat the child with a 2-week course of vancomycin. b. Wash the wound carefully, infuse the area with rabies gamma globulin, and initiate live vaccine immunization.

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c. Wash the wound carefully, infuse the area with rabies gamma globulin, and initiate inactivated vaccine immunization.

ANS: C 5. What action will the rabies gamma globulin have? a. Initiate B-cell production of antibody. b. Activate T cells. c. Facilitate virus clearance by macrophages. d. Potentiate infection of macrophages. e. Block virus spread by T cells.

ANS: C 6. Match the following questions with the appropriate description for the currently used vaccines. (Choose all that apply.) a. Live attenuated microbe b. Inactivated microbe c. Subunit (protein) d. polysaccharide e. conjugated polysaccharide f. A & B g. D & E 1. Haemophilus influenzae B 2. Streptococcus pneumoniae 3. Mumps 4. Varicella zoster 5. Influenza 6. Diphtheria 7. Tetanus 8. Bordetella pertussis 9. Hepatitis B 10. Hepatitis A 11. Rotavirus ANS: 1. E 2. G 3. A 4. A 5. F 6. C 7. C 8. C 9. C

Test Bank 10. C 11. A

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Murray: Medical Microbiology, 8th Edition Chapter 12: Bacterial Classification, Structure, and Replication

Test Bank MULTIPLE CHOICE 1. Teichoic acids, mycolic acids, peptidoglycan, and disaccharide-pentapeptide subunits are all building blocks of which bacterial structure? a. Outer cell membrane b. Flagella c. Inner cell membrane d. Cell wall ANS: D 2. What is the major difference between the cell walls of gram-positive and gramnegative bacteria? a. The peptidoglycan layer in gram-positive bacteria is substantially thicker. b. The cell wall of gram-positive bacteria contains mycolic acids. c. Gram-positive bacteria contain a cytoplasmic membrane. d. Gram-positive bacteria may haNvUeRaSpI olN ysGaT ccB h. arC idO eM capsule as a covering. e. Gram-negative bacterial membranes contain ergosterol ANS: A 3. Which of the following distinguishes a bacterium from a eukaryote? a. Translation of the mRNA by the ribosome b. Phospholipid bilayer structure of the membranes c. ATP production from membrane potential at plasma membrane d. Semiconservative replication of chromosome e. Sensitivity to folate analogue antimetabolites ANS: C 4. Which reason explains why gram-positive bacteria are stain positive? a. Bacteria reduce the stain to produce the characteristic color. b. Cell wall traps the stain. c. Acetone treatment precipitates intracellular stain. d. Heat fixing uncovers stainable proteins. e. Outer membrane absorbs the stain.

ANS: B

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5. Which of the following does not occur in eukaryotes? a. Start of protein synthesis with AUG codon b. Coupling of ATP production to membrane potential c. Coupling of transcription and translation d. Movement by flagella e. Transformation of cells with foreign DNA ANS: C 6. Which of the following is not synthesized by prokaryotes? a. C55 isoprenoid phosphate b. Cardiolipin c. Cholesterol d. F1 ATPase e. Phosphatidylcholine ANS: C 7. Which of the following is present in gram-positive bacteria but not in gram-negative bacteria? a. D-Ala D-Ala carboxypeptidase b. F1 ATPase c. Flagellin d. Lipoteichoic acid e. Lysozyme ANS: D 8. Why are gram-negative bacteria insensitive to lysozyme? a. Lysozyme does not traverse porins. b. The O antigen is an inhibitor of the enzyme. c. The D-Ala D-Ala transpeptidase is insensitive to lysozyme. d. The target structure regenerates quickly. e. They lack a peptidoglycan.

ANS: A 9. After growth of E. coli obtained from a urinary tract infection in the laboratory, the bacteria became attenuated for urinary tract infections. Mutation in a gene for which of the following would cause the attenuation? a. Flagellin b. Lipopolysaccharide c. Lipoteichoic acid d. M protein e. Pilin ANS: E

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10. Between which structures does lysozyme cleave? a. Terminal D-Ala D-Ala residues b. Glycine connecting bridge and the lysine in the third peptide position c. Lipid A and the core polysaccharide d. N-acetylglucosamine and the N-acetylmuramic acid e. Terminal D-Ala D-Ala and the lysine in the third position ANS: D 11. What alteration in the structure of lipopolysaccharide results from bacitracin inhibition of bactoprenol? a. b. c. d. e.

Inhibition of lipid A synthesis Lack of O antigen Localization of LPS at adhesion sites Longer core polysaccharide Shorter core polysaccharide

ANS: B 12. Growing E. coli bacteria transferred from rich medium to a buffer containing no nutrients will: a. Lyse b. Activate fMet-initiated protein synthesis c. Trigger initiation of sporulation d. Continue DNA replication e. Convert from aerobic to anaerobic metabolism ANS: D

Murray: Medical Microbiology, 8th Edition Chapter 13: Bacterial Metabolism and Genetics

Test Bank MULTIPLE CHOICE 1. Ambient air, which contains 21% oxygen (O2) and a small amount (0.03%) of carbon dioxide (CO2), is the environmental condition that best suits which type of organism? a. Aerobes b. Anaerobes c. Capnophiles d. Microaerophiles ANS: A 2. From 5% to 10% hydrogen (H2), 5% to 10% CO2, 80% to 90% nitrogen (N2), and 0% O2 is the environmental condition that best suits which type of organism? a. Aerobes b. Anaerobes c. Capnophiles d. Microaerophiles ANS: B 3. Which of the following is not generated during anaerobic metabolism of glucose? a. Acetyl CoA b. Citrate c. Glucose-6-phosphate d. Glyceraldehyde-3-phosphate e. Pyruvate ANS: B 4. How many more ATP molecules are produced by aerobic respiration than by glycolysis? a. 2 b. 4 c. 10 d. 36 e. 100 ANS: D

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5. Which of the following intermediates is generated upon metabolism of lactose by fermentation, aerobic respiration, and anaerobic respiration? a. Succinate b. Pyruvate c. Lactic acid d. Malate e. Citrate ANS: B 6. What is the term for pieces of DNA that move from one genetic element to another and contain genes for movement, as well as genes for other features? a. Transposons b. Insertion sequences c. Plasmids d. Chromatoids ANS: A 7. What is the term for “miniature” chromosomes composed of several genes in doublestranded, closed, circular structures? a. Transposons b. Insertion sequences c. Plasmids d. Chromatoids ANS: C 8. A DNA sequence that encodes for a specific product (RNA or protein) is defined as which of the following? a. Gene b. Genome c. Nucleotide d. Deoxyribonucleic acid ANS: A 9. What are the enzymes that add nucleotide bases to each growing daughter strand in the replication process called? a. b. c. d.

Replication enzymes DNA polymerases Insertion sequence enzymes Transcriptases

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ANS: B 10. Genetic change in bacteria is accomplished by which of the following? a. Mutation b. Genetic recombination c. Gene exchange between bacteria d. All of the above ANS: D 11. Analysis of the DNA from methicillin- and vancomycin-resistant, gram-positive, coagulase-positive cocci isolated from a furuncle on a diabetic patient’s toe indicated the presence of DNA sequences from enterococci. Which of the following processes generated these new bacteria? a. Lysogeny b. Restriction enzyme cleavage c. Transduction d. Transformation e. Transversion ANS: D 12. Development of new strains oN f bUaR ctSerIiaNfG roTmBt.hC eO DM NA of killed bacteria can occur by which genetic mechanism? a. Complementation b. Conjugation c. Transformation d. Transduction e. Transposition ANS: C 13. Which of the following would promote the metabolism of galactose by E. coli? a. Binding of CAP to the operon b. Binding of cAMP to CAP c. Binding of galactose to CAP d. Binding of glucose to the repressor e. Binding of galactose to the promoter ANS: B 14. Why would a frameshift mutation in the gene for topoisomerase 1 be lethal for E. coli but not C. albicans? a. C. albicans is lysogenic. b. C. albicans is diploid.

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c. For C. albicans, topoisomerase 1 is encoded on a plasmid. d. Frameshift mutations are corrected by heterologous recombination in C. albicans. e. Topoisomerase 1 is not important for E. coli.

ANS: B 15. An E. coli with a mutation in topoisomerase 1 can grow at 28° C but not at 37° C. Which of the following changes in the protein would explain this temperature sensitive mutation? a. Frame shift mutation b. Nonsense mutation c. Missense mutation d. Null mutation e. Silent mutation ANS: C 16. Unlike for eukaryotes, excessive tryptophan can down-regulate production of the enzymes for tryptophan production in bacteria by: a. Binding to a repressor for protein synthesis b. Binding to a promoter for protein synthesis c. Activation of cAMP production d. Attenuation of transcription of operon mRNA ANS: D

Murray: Medical Microbiology, 8th Edition Chapter 14: Mechanisms of Bacterial Pathogenesis

Test Bank MULTIPLE CHOICE 1. What is persistence of Staphyococcus epidermidis on the surface of the human body called? a. Infection b. Colonization c. Nosocomial infection d. A reservoir ANS: B 2. A 57-year-old man with an indwelling catheter presents with fever. Gram-positive, catalase-positive, coagulase-negative cocci are isolated from the blood. Which of the following is virulence factors is causing the patient's disease? a. Endotoxin b. Exotoxin c. Superantigen d. Induction of autoimmune responses e. Colonization ANS: E 3. Which of the following describes the function of the diphtheria toxin? a. The A subunit acts as a superantigen. b. The A subunit activates adenylate cyclase. c. The A subunit inhibits protein synthesis. d. The B subunit blocks function of G proteins. e. The B subunit inhibits the release of neurotransmitters.

ANS: C 4. Growth of S. pneumoniae in the laboratory resulted in the development of a rough mutant strain that was attenuated for meningitis. A change in which of the following is most likely to result in this outcome? a. Capsule b. Lipoteichoic acid c. M protein d. Optochin e. Streptolysin O

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ANS: A 5. Cerebrospinal fluid from a 5-year-old boy with meningitis contains a gram-negative coccobacillus that is oxidase negative and requires X and V factors for growth. Tests indicated that the bacteria were sensitive to a third-generation cephalosporin.

Paradoxically, antimicrobial treatment caused an increase in fever and disease signs, but the boy recovered. Which of the following is the best explanation for this? a. Bacterial fragments activated acute-phase responses. b. Bacteria acquired resistance and spread through the host. c. Cephalosporins are pyrogens. d. Dead bacteria clogged the CSF. e. Third-generation cephalosporins are unable to penetrate into the bacteria.

ANS: A 6. Match the virulence factors with the appropriate consequences.

Capsule a. Activation of adenylate cyclase b. Activation of cytokine production c. Attachment d. Invasion e. Phagocytic escape ANS: E 7. Match the virulence factors with the appropriate consequences.

Cholera toxin a. Activation of adenylate cyclase b. Activation of cytokine production c. Attachment d. Invasion e. Phagocytic escape ANS: A 8. Match the virulence factors with the appropriate consequences.

Enterotoxigenic E. coli (ETEC) a. Activation of adenylate cyclase b. Activation of cytokine production c. Attachment d. Invasion e. Phagocytic escape ANS: A

9. Match the virulence factors with the appropriate consequences.

Fimbriae a. Activation of adenylate cyclase b. Activation of cytokine production c. Attachment d. Invasion e. Phagocytic escape ANS: C 10. Match the virulence factors with the appropriate consequences.

Lipase a. Activation of adenylate cyclase b. Activation of cytokine production c. Attachment d. Invasion e. Phagocytic escape ANS: D 11. Match the virulence factors with the appropriate consequences.

Lipopolysaccharide a. Activation of adenylate cyclase b. Activation of cytokine producN tioUnRSINGTB.COM c. Attachment d. Invasion e. Phagocytic escape ANS: B 12. Match the virulence factors with the appropriate consequences.

Lipoteichoic acid a. Activation of adenylate cyclase b. Activation of cytokine production c. Attachment d. Invasion e. Phagocytic escape ANS: B and C 13. Match the virulence factors with the appropriate consequences.

M protein a. Activation of adenylate cyclase b. Activation of cytokine production c. Attachment d. Invasion

e. Phagocytic escape ANS: C 14. Match the virulence factors with the appropriate consequences.

Shiga toxin a. Activation of adenylate cyclase b. Activation of cytokine production c. Attachment d. Invasion e. Phagocytic escape ANS: D 15. Match the virulence factors with the appropriate consequences.

Toxic shock syndrome toxin a. Activation of adenylate cyclase b. Activation of cytokine production c. Attachment d. Invasion e. Phagocytic escape ANS: B

Murray: Medical Microbiology, 8th Edition Chapter 15: Role of Bacteria in Disease

Test Bank MULTIPLE CHOICE 1. Which of the following is correctly associated with its means of transmission? a. Bacillus cereus: eggs b. Brucella: smoked meats c. Salmonella: shellfish d. Listeria monocytogenes: ice cream e. Vibrio cholerae: unpasteurized dairy products ANS: D

Murray: Medical Microbiology, 8th Edition Chapter 16: Laboratory Diagnosis of Bacterial Diseases

Test Bank MULTIPLE CHOICE 1. Organisms that have relatively complex nutritional needs, requiring extra media components to be used for growth, are called: a. Fastidious b. Capnophiles c. Neutrophils d. Halophiles ANS: A 2. What is the role of the agar ingredient in culture medium? a. It provides a nutritional base for bacterial metabolism. b. It solidifies the medium and provides a stable culture surface. c. It sterilizes the medium and prevents contamination. d. All of the above ANS: B 3. The MIC result recorded in antimicrobial testing can be defined as: a. The maximum concentration of an antimicrobial agent that should be used for optimal therapy b. The minimum concentration of an antimicrobial agent that should be used for optimal therapy c. The lowest antimicrobial-agent concentration that completely inhibits visible bacterial growth d. The highest antimicrobial-agent concentration that completely inhibits visible bacterial growth ANS: C 4. The decision to perform susceptibility testing depends on which factor? a. The clinical significance of a bacterial isolate b. The predictability of a bacterial isolate’s susceptibility to the antimicrobial agents most commonly used against them c. Availability of reliable standardized methods for testing the isolate d. All of the above ANS: D

Murray: Medical Microbiology, 8th Edition Chapter 17: Antibacterial Agents

Test Bank MULTIPLE CHOICE 1. What is the term for antimicrobial agents that inhibit bacterial growth but generally do not kill the organism? a. Bactericidal b. Antagonism c. Bacteriostatic d. All of the above ANS: C 2. Antimicrobial agents that usually kill target organisms are said to be: a. Bactericidal b. Antagonistic c. Bacteriostatic d. All of the above ANS: A 3. Bacterial resistance to β-lactams may be mediated by which of the following? a. Enzymatic destruction of the antibiotics b. Altered antibiotic targets c. Decreased intracellular uptake of the drug d. All of the above ANS: D 4. Match the antimicrobial with its target.

Ampicillin a. Membrane b. Peptidoglycan synthesis c. Ribosome d. RNA synthesis e. Topoisomerase ANS: B 5. Match the antimicrobial with its target.

Bacitracin

Test Bank a. b. c. d. e.

Membrane Peptidoglycan synthesis Ribosome RNA synthesis Topoisomerase

ANS: B 6. Match the antimicrobial with its target.

Chloramphenicol a. Membrane b. Peptidoglycan synthesis c. Ribosome d. RNA synthesis e. Topoisomerase ANS: C 7. Match the antimicrobial with its target.

Ciprofloxacin a. Membrane b. Peptidoglycan synthesis c. Ribosome d. RNA synthesis e. Topoisomerase ANS: E 8. Match the antimicrobial with its target.

Erythromycin a. Membrane b. Peptidoglycan synthesis c. Ribosome d. RNA synthesis e. Topoisomerase ANS: C

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Test Bank 9. Match the antimicrobial with its target.

Polymyxin a. Membrane b. Peptidoglycan synthesis c. Ribosome d. RNA synthesis e. Topoisomerase ANS: A 10. Match the antimicrobial with its target.

Rifampin a. Membrane b. Peptidoglycan synthesis c. Ribosome d. RNA synthesis e. Topoisomerase ANS: D 11. Match the antimicrobial with its target.

Streptomycin a. Membrane b. Peptidoglycan synthesis c. Ribosome d. RNA synthesis e. Topoisomerase ANS: C 12. Match the antimicrobial with its target.

Tetracycline a. Membrane b. Peptidoglycan synthesis c. Ribosome d. RNA synthesis e. Topoisomerase ANS: C 13. Match the antimicrobial with its target.

Vancomycin a. Membrane b. Peptidoglycan synthesis c. Ribosome d. RNA synthesis

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Test Bank e. Topoisomerase ANS: B

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Murray: Medical Microbiology, 8th Edition Chapter 18: Staphylococcus and Related Gram-Positive Cocci

Test Bank MULTIPLE CHOICE 1. Which species of Staphylococcus is one of the most important human pathogens? a. Staphylococcus aureus b. Staphylococcus epidermidis c. Staphylococcus lugdunensis d. Staphylococcus saprophyticus ANS: A 2. Which group of bacteria is described as catalase-positive, gram-positive cocci that grow facultatively anaerobic and form grapelike clusters? a. Neisseria b. Stomatococcus c. Staphylococcus d. Micrococcus ANS: C 3. The first identification test performed on clinical isolates of gram-positive, catalasepositive cocci would be which of the following? a. Penicillin test b. Bile solubility test c. Oxidase test d. Coagulase test ANS: D 4. In clinical isolates, the most likely identification of coagulase-positive, catalasepositive, gram-positive cocci that are penicillin resistant would be which of the following? a. Staphylococcus aureus b. Staphylococcus intermedius c. Stomatococcus luteus d. Micrococcus aureus ANS: A

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5. Which resident human flora staphylococcus is more likely to cause infections in compromised hosts such as cancer patients? a. Staphylococcus saprophyticus b. Staphylococcus aureus c. Staphylococcus epidermidis d. Staphylococcus lugdunensis ANS: C 6. Which type of staphylococcus is more likely to cause uncomplicated urinary tract infections in nonhospitalized hosts, especially sexually active young women? a. Staphylococcus saprophyticus b. Staphylococcus aureus c. Staphylococcus epidermidis d. Staphylococcus lugdunensis ANS: A 7. A baby has blister-like lesions over most of her body, and the skin is readily removed with no scarring. After making the diagnosis, which of the following is true of the infection? a. Latent infection established in the trigeminal ganglia b. Preventable by maternally acquired antibody c. Requires cell-mediated immunNeUrR esS poInNseGtToBli. mCitOpM rogression of disease d. Sequelae of sore throat e. Transmitted from the desquamated skin ANS: B 8. A 63-year-old man develops fever within 2 days of surgery for a hip replacement.

Treatment with ampicillin does not eliminate the infection. Gram-positive, coagulasepositive cocci were isolated from the blood. Which of the following is the most probable reason for antibiotic failure? a. Antibiotic-resistant target enzyme b. Chromosomal mutation in ribosome prevents drug action c. Inactivation by coagulase d. Insufficient dosing schedule e. Mutation in porins prevents drug entry ANS: A

9. A 35-year-old man complains of rhinitis. A nasal swab of his nares yields Staphylococcus epidermidis. Which of the following actions should be taken? a. Perform nasal wash with saline. b. No treatment is necessary.

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c. Test for methicillin resistance. d. Treat contacts with rifampin. e. Treat patient with vancomycin.

ANS: B 10. A group of patients was seen on an emergency basis complaining of abdominal cramps and watery diarrhea within 5 hours of attending a picnic in which ham, potato salad, and custard-filled pastries were on the menu. Which of the following is the likely cause of this disease? a. Attachment and disruption of intestinal lining due to parasitic infection b. Bacterial colonization and toxin production c. Bacterial adherence and invasion d. Preformed bacterial toxin e. Replication of virus that prevents reabsorption of water ANS: D 11. A 65-year-old man develops fever 4 days after a hip replacement. Fever does not dissipate with β-lactam antibiotic treatment. A gram-positive coccus is isolated from the blood. Which of the following antibacterial agents would be the drug of choice in this situation? a. Ampicillin b. Ciprofloxacin c. Erythromycin d. Rifampin e. Vancomycin ANS: E 12. Most of the members of a youth group visited the emergency room with complaints of abdominal cramps and watery diarrhea 4 hours after a picnic. Which of the following bacterial traits facilitate the occurrence of this outbreak? a. Ability to ferment lactose b. Ability to grow in high salt c. Anaerobic growth d. Lysis of red blood cells in agar e. Production of a double zone on egg yolk agarANS: B 13. A 67-year-old patient with an indwelling catheter develops fever, and gram-positive cocci are isolated from his blood and from a biofilm on the catheter. Which of the following traits identify these bacteria? a. β-Hemolysis b. Catalase

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c. Spore formation d. Growth in bile e. Resistance to methicillin ANS: B 14. A 1-month-old boy developed erythema around his mouth, which then covered his body within 2 days. The skin became covered with blisters, and the top layer of epidermis was sloughed off. Which of the following is consistent with the mechanism of this disease? a. Coagulase b. Lecithinase c. Lipase d. Phage e. Toxin ANS: E 15. A group of picnickers develops abdominal cramps and diarrhea within 4 hours of eating. Which of the following foods is most likely the source of the gastroenteritis? a. Chicken b. Hamburger c. Homemade salami d. Ice cream e. Lettuce ANS: C

Murray: Medical Microbiology, 8th Edition Chapter 19: Streptococcus and Enterococcus

Test Bank MULTIPLE CHOICE 1. Which genus is best described as catalase-negative, gram-positive cocci that are facultative anaerobes and form chains? a. Streptococcus b. Stomatococcus c. Staphylococcus d. Micrococcus e. Enterococcus ANS: A 2. Which genus of bacteria contains agents of important diseases such as rheumatic fever, glomerulonephritis, and exudative pharyngitis? a. Staphylococcus b. Streptococcus c. Enterococcus d. Micrococcus ANS: B 3. Streptococcus pneumoniae can be described as which of the following? a. Susceptible to bile and optochin b. β-Hemolytic c. A major cause of bacterial meningitis d. Often carrying an antiphagocytic capsule e. All of the above ANS: E 4. Development of acute rheumatic fever and subsequent valvular heart disease are problems that may be encountered by patients infected with which of the following? a. Enterococcus faecalis b. Streptococcus pneumoniae c. Streptococcus pyogenes d. Streptococcus agalactiae e. Streptococcus mutans ANS: C

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5. Development of glomerulonephritis is a problem that may be encountered by patients infected with which of the following? a. Enterococcus faecalis b. Streptococcus pneumoniae c. Streptococcus pyogenes d. Streptococcus agalactiae e. Streptococcus mutans ANS: C 6. Erythrogenic toxin, hyaluronidase, and hemolysins S and O are extracellular products of which of the following? a. Enterococcus faecalis b. Streptococcus pneumoniae c. Streptococcus pyogenes d. Streptococcus agalactiae e. Streptococcus mutans ANS: C 7. Which bacterial species can be described as able to hydrolyze hippurate, β-hemolytic, a major cause of neonatal meningitis and sepsis, and a producer of CAMP factor? a. Enterococcus faecalis b. Streptococcus pneumoniae c. Streptococcus pyogenes d. Streptococcus agalactiae e. Streptococcus mutans ANS: D 8. Which bacterial species is the major etiologic agent of bacterial endocarditis in the United States? a. Enterococcus faecalis b. Streptococcus pneumoniae c. Streptococcus pyogenes d. Streptococcus agalactiae e. Streptococcus mutans ANS: E 9. Which of the following is NOT vancomycin-resistant? a. Pediococcus b. Leuconostoc c. Streptococcus d. Lactobacillus

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ANS: C 10. What is the drug of choice for most streptococcal infections? a. Vancomycin b. Streptomycin c. Cephalosporin d. Trimethoprim-sulfamethoxazole ANS: C 11. A baby was born to a woman who had ruptured membranes and was in labor for 30 hours. The physician ordered an infectious disease workup, and the microbiology laboratory reported that the CNS culture was growing catalase-negative, gram-positive cocci.

Which of the following is the most likely etiologic agent? a. Streptococcus pneumoniae b. Listeria monocytogenes c. Staphylococcus aureus d. Enterococcus faecalis e. Streptococcus agalactiae ANS: E

CaOteMry eyes, and a cough. As her 12. An 18-month-old girl developN edUaRrSuI nnNyGnT osBe. ,w symptoms of rhinitis abated, the girl became irritable and developed a slight fever (38° C). She also complained of a sore throat and an earache. Her pediatrician observed a bulging tympanic membrane and prescribed a 7-day course of antibiotics. What is the most likely etiologic agent for the ear infection? a. b. c. d. e.

Staphylococcus aureus Corynebacterium diphtheriae Streptococcus pneumoniae Mycoplasma pneumoniae Bordetella pertussis

ANS: C 13. An 18-month-old girl developed a runny nose, watery eyes, and a cough. As her symptoms of rhinitis abated, the girl became irritable and developed a slight fever (38° C). She also complained of a sore throat and an earache. Her pediatrician observed a bulging tympanic membrane and prescribed a 7-day course of antibiotics. Which of the following is a key virulence factor the etiologic agent of this infection possesses? a. Streptolysin O b. M protein c. Pertussis toxin d. Capsule e. Lipopolysaccharide

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ANS: D 14. A 7-year-old child has a sore throat and fever. Culture yields gram-positive cocci that grow in chains and produce β-hemolysis. Which of the following reasons mandates treatment of the child? a. Lessening of symptoms b. Potential for autoimmune pathology c. Prevention of transmission d. Progression to pneumonia e. Shortening of the disease course ANS: B 15. Which of the following tests will distinguish Streptococcus pyogenes from other streptococci? a. Bacitracin sensitivity b. Growth in salt c. Growth in bile d. Hemolysis e. Optochin sensitivity ANS: A 16. A 70-year-old man was admitted for cellulitis on his thigh, which rapidly spread and was destroying surrounding tissue. Gram-positive, β-hemolytic cocci were isolated from the infection. The same bacteria were isolated from the man’s wife, who was not complaining of disease, from which of the following specimens? a. b. c. d. e.

Blood CSF Throat swab Stool Urine

ANS: C 17. A 70-year-old man was admitted for cellulitis on his thigh, which rapidly spread and was destroying surrounding tissue. Gram-positive, β-hemolytic cocci were isolated from the infection. Which of the following virulence factors is characteristic of these organisms? a. b. c. d. e.

A-B toxin capable of activating adenylate cyclase β-Lactamase production Coagulase Lecithinase Streptolysin

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ANS: E 18. The action of which protein promotes Streptococcus pyogenes escape from phagocytosis? a. DNAase b. F protein c. Lipoteichoic acid d. M protein e. Streptokinase ANS: D 19. A 3-year-old child with a sore throat is covered with a diffuse erythematous rash. The tongue has a yellowish-white coating, which upon shedding leaves a red, raw surface (strawberry tongue). A rapid ASO test of a pharyngeal sample was positive. Which of the following is an appropriate description? a. b. c. d. e.

Gram-positive coccus is isolated from the rash.

Bacteria are infected with a toxin-encoding bacteriophage.

Lipopolysaccharide promotes adherence to the infected tissue.

Production of coagulase exacerbates the sore throat.

Production of urease promotes spread of the microbe.

ANS: B 20. A 5-day-old baby develops pneumonia, and gram-positive, β-hemolytic cocci are isolated from his blood. The infection progresses to cause meningitis. The mother had a urinary tract infection at this time. The bacteria are insensitive to bacitracin but enhance β-hemolysis by S. aureus. The baby’s infection is most likely due to which of the following bacteria? a. Streptococcus agalactiae b. Streptococcus bovis c. Streptococcus mutans d. Streptococcus pneumoniae e. Streptococcus pyogenes ANS: A 21. A 66-year-old man is feverish (41° C), has been coughing up blood-tinged sputum, and has chest pain and difficulty breathing. Chest x-ray indicates pneumonia. Grampositive diplococci producing α-hemolysis on the blood agar plate are isolated from the sputum and exhibit optochin sensitivity. Which of the following is a primary virulence factor for these bacteria? a. β-Lactamase b. Capsule c. Catalase d. Streptolysin

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e. Superantigen ANS: B 22. Protective immunization for S. pneumoniae is mediated by which of the following? a. Capsular polysaccharide b. Lipopolysaccharide c. Lipoteichoic acid d. M protein e. Toxoid ANS: A 23. A 5-year-old boy with an earache develops meningitis. Gram-positive diplococci are isolated from the cerebrospinal fluid. Which of the following is a contributing virulence factor? a. b. c. d. e.

Capsule Coagulase Hemagglutinin Lipo-oligosaccharide Streptolysin

ANS: A 24. A 37-year-old man who has a damaged heart valve initiates antibacterial prophylaxis before having his teeth cleaned to prevent further damage to the heart from which of the following bacteria? a. b. c. d. e.

Bacillus cereus Corynebacterium diphtheriae Haemophilus influenzae Staphylococcus epidermidis Streptococcus mutans

ANS: E 25. Which bacterial species can be described as able to grow in 6.5% NaCl and 40% bile, part of the normal fecal flora of animals and humans, usually nonhemolytic, and a major cause of nosocomial infections? a. Enterococcus faecalis b. Streptococcus pneumoniae c. Streptococcus pyogenes d. Streptococcus agalactiae e. Streptococcus mutans ANS: A

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26. What are the drugs of choice for most enterococcal infections? a. Vancomycin and penicillin b. Clindamycin and vancomycin c. Penicillin and aminoglycosides d. Trimethoprim and sulfamethoxazole ANS: C 27. A vancomycin-resistant S. aureus was isolated following a mixed infection with methicillin-resistant S. aureus and vancomycin-resistant Enterococcus. Which of the following procedures might explain the transfer of resistance from Enterococcus to S. aureus? a. b. c. d.

Coagulation Conjugation Episomalization Lysogeny

ANS: B (Conjugation) 28. Which of the following laboratory characteristics distinguish Enterococcus from Streptococcus? a. Catalase b. Coagulase c. Gram stain d. Optochin sensitivity e. Sensitivity to bile ANS: E

Murray: Medical Microbiology, 8th Edition Chapter 20: Bacillus

Test Bank MULTIPLE CHOICE 1. Spore-forming, gram-positive bacilli that are nonhemolytic on aerobic blood agar, nonmotile, penicillin susceptible, and produce a wide zone of lecithinase on egg yolk agar can be identified as which of the following? a. Corynebacterium diphtheriae b. Bacillus anthracis c. Bacillus cereus d. Corynebacterium jeikeium e. Clostridium perfringens ANS: B 2. A bioterrorism act in the fall of 2001 resulted in 23 infections following exposure to letters laced with anthrax spores. Most cases resulted in cutaneous manifestations; however, there were five deaths as a result of massive pulmonary edema. The virulence factor of the bacterium that causesNaUnR thS raIxNcG anTbBe.dC esOcM ribed as Protective Antigen plus which of the following? a. Adenylate cyclase b. Plasminogen activator c. Ribosyl transferase d. Protein kinase e. A superantigen ANS: A 3. A sheepherder has a large black and necrotic lesion (eschar) under his chin that has grown quickly in size. There is no pus, but the patient complains of painful and swollen glands. Gram-positive bacilli are isolated from the lesion. Which of the following features of the responsible agent makes it an ideal candidate for bioterrorism? a. Capsule b. Endotoxin c. Lethal toxin d. Spore formation e. Zoonosis ANS: D 4. Which of the following properties facilitates use of Bacillus anthracis as a bioterror agent?

Test Bank a. b. c. d. e.

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Capsule Edema toxin Lethal toxin Spores Thick peptide glycan

ANS: D 5. A 43-year-old sheepherder has a necrotic eschar (black, ulcerated sore) on the back of his hand. He has fever, swollen and painful lymph nodes, and is weak. Large, boxcarappearing gram-positive bacteria are isolated from the sore. This infection is caused by which of the following bacteria? a. Bacillus anthracis b. Clostridium difficile c. Clostridium perfringens d. Francisella tularensis e. Nocardia brasiliensis ANS: A 6. A 23-year-old student develops abdominal cramps, nausea, and vomiting approximately 4 hours after eating leftover Chinese food. Which of the following is the most likely cause for his ailment? a. Bacillus cereus b. Clostridium difficile c. Escherichia coli d. Salmonella typhi e. Staphylococcus aureus ANS: A 7. A 23-year-old student develops abdominal cramps, nausea, and vomiting approximately 4 hours after eating leftover Chinese food. Approximately 10 hours after dinner, he also develops diarrhea that lasts another 24 hours. The latter stage of this disease can be attributed to which of the following? a. A-B toxin, which stimulates adenylate cyclase b. Endotoxin c. Heat-labile toxin d. Heat-stabile toxin e. Preformed toxin ANS: C

Murray: Medical Microbiology, 8th Edition Chapter 21: Listeria and Related Gram-Positive Bacteria

Test Bank MULTIPLE CHOICE 1. Small, gram-positive, catalase-positive rods with a narrow zone of β-hemolysis isolated from blood or CSF should be used as strong presumptive evidence for: a. Listeriosis b. Diphtheria c. Pertussis d. Tetanus ANS: A 2. Immunocompromised patients and pregnant women should avoid eating soft cheeses such as Mexican-style feta, Brie, Camembert, and blue-veined cheese to prevent which of following? a. Food-borne listeriosis b. Staphylococcal food poisoning c. Clostridial gas gangrene d. Salmonella infection ANS: A 3. A 24-year-old pregnant woman presents with flulike symptoms. Several days later, she prematurely delivers a stillborn infant. An autopsy of the infant yields a diagnosis of granulomatosis infantiseptica. Which of the following scenarios describes the most likely etiology in this case? a. Spirochete sexually transmitted by contact with an infected partner b. Gram-negative rods transmitted by the consumption of chicken c. Protozoan parasite carried by cats d. Gram-positive cocci colonizing the mother’s vagina e. Gram-positive rods transmitted in unpasteurized milk ANS: E

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4. A pregnant woman develops fever and chills and then sepsis. Gram-positive coccobacilli which grow on blood agar at 10° C are isolated from the blood. Which of the following foods is most likely the source of the gastroenteritis? a. b. c. d. e.

Chicken Hamburger Turkey franks Rice Lettuce

ANS: C 5. Catalase-positive, gram-positive bacilli that are not acid-fast, do not branch, and do not form spores belong to which group of bacteria? a. Corynebacterium b. Bacillus c. Actinomyces d. Mycobacterium ANS: A 6. Primary inoculation to a Loeffler slant, overnight incubation, and subculture of any growth to cystine-tellurite blood agar may improve recovery of which bacteria? a. Corynebacterium diphtheriae b. Bacillus anthracis c. Bacillus cereus d. Corynebacterium jeikeium ANS: A 7. A 12-year-old girl is evaluated for malaise, sore throat, and exudative pharyngitis.

Examination indicates the presence of a pseudomembrane covering the tonsils, uvula, and palate and a fever of 39° C. Further history indicates that her parents prevented her from receiving the standard childhood immunizations. Which of the following describes the vaccine that is used for the standard childhood immunization to prevent the disease described by these symptoms? a. Carbohydrate conjugated to protein b. Inactivated endotoxin c. Inactivated exotoxin d. Inactivated virus e. Live, attenuated virus ANS: C

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8. A 67-year-old man has low-grade fever and pharyngitis. Examination of his throat shows a firmly adhered pseudomembrane extending from the larynx up to the palate, which compromises his breathing. How is this disease normally prevented? a. b. c. d. e.

Chlorination of the water supply Good hygiene Immunization with attenuated microbe Immunization with toxoid Prophylactic treatment with ampicillin

ANS: D 9. A 67-year-old man has a low-grade fever and pharyngitis. Examination of his throat shows a firmly adhered pseudomembrane extending from the larynx up to the palate, which compromises his breathing. Which test evaluates toxin production by this microbe? a. ASO titer b. Dick test c. PPD test d. Elek test e. VDRL test ANS: D 10. Which of the following toxins has a similar target and mode of action as the Pseudomonas exotoxin? a. Botulinum toxin b. Cholera toxin c. Diphtheria toxin d. Pertussis toxin e. Shiga toxin ANS: C 11. Partially acid-fast aerobic actinomycetes include which of the following? a. Nocardia b. Rhodococcus c. Gordonia d. Tsukamurella e. All of the above ANS: E 12. A 37-year-old man attributes the onset of mycetomas on his feet to walking barefoot through the dirt while on a picnic. Which of the following organisms is responsible for this infection?

Test Bank a. b. c. d. e.

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Actinomyces israelii Clostridium tetani Nocardia brasiliensis Pseudomonas aeruginosa Streptococcus pyogenes

ANS: C 13. A 37-year-old man attributes the onset of mycetomas on his feet to walking barefoot through the dirt while on a picnic. A bacterium is identified as the agent responsible for this infection. Which of the following is a characteristic lab finding for this organism? a. Acid-fast staining b. β-Hemolysis on blood agar c. Double-zone hemolysis on blood agar d. Hydrogen sulfide production e. Cytotoxin bioassay ANS: A

Murray: Medical Microbiology, 8th Edition Chapter 22: Mycobacterium and Related Acid-Fast Bacteria

Test Bank MULTIPLE CHOICE 1. The tuberculin skin test, or PPD test, is based on which of the following? a. Delayed hypersensitivity and cell-mediated immunity to certain antigenic components of the organism b. Injection of M. tuberculosis under the skin and subsequent mild cutaneous infection c. Antigen/antibody reactions occurring at the injection site d. All of the above ANS: A 2. What is the most commonly isolated Mycobacterium in the United States? a. M. tuberculosis b. M. bovis c. M. avium-intracellulare d. M. kansasii e. M. gordonae ANS: C 3. Of the following species of mycobacteria, which causes a chronic disease of the skin, mucous membranes, and nerve tissue and has not yet been cultivated in vitro? a. M. paratuberculosis b. M. mucogenicum c. M. phlei d. M. leprae e. M. haemophilum ANS: D 4. Which of the following is the primary reservoir of the Mycobacterium responsible for leprosy? a. Infected humans b. Infected animals c. Contaminated food d. Contaminated objects ANS: A

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5. Which statement is true about the fluorochrome method of staining Mycobacterium? a. It is more sensitive than the conventional carbolfuchsin stains. b. It enables the smear to be initially examined at lower magnifications. c. It results in a higher yield of positive smears. d. It will substantially reduce the amount of time needed for examining smears. e. All of the above ANS: D 6. A 33-year-old soldier has recent weight loss, night sweats, fever, and cough. Results of a PPD test show redness and swelling at the site of injection. Radiograph results of the chest show bilateral upper-lobe involvement and mediastinal and hilar lymphadenopathy.

Which of the following media would support the growth of this microbe? a. Blood agar b. Buffered charcoal yeast extract agar c. Chocolate agar d. Lowenstein-Jensen agar e. MacConkey agar ANS: D 7. A 33-year-old soldier has recent weight loss, night sweats, fever, and cough. Results of a PPD test show redness and swelN linUgRaSt I thN eG siT teBo.f C inO jeM ction. Radiograph results of the chest show bilateral upper-lobe involvement and mediastinal and hilar lymphadenopathy.

Which of the following describes the microbe causing this disease? a. Acid-fast staining bacillus b. Weakly acid-fast staining bacillus c. Gram-positive bacillus d. Gram-positive coccus e. Gram-negative bacillus ANS: A 8. In the United States, prevention of Mycobacterium tuberculosis depends on which approach? a. Attenuated vaccine b. Eradication of mosquito breeding grounds c. Screening immune status d. Inactivated vaccine e. Screening blood supply ANS: C 9. Which of the following is the most likely trigger for reactivation of tuberculosis? a. Estrogen therapy

Test Bank b. c. d. e.

Bone marrow transplant Poor hygiene Stress Ultraviolet B light

ANS: B

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Murray: Medical Microbiology, 8th Edition Chapter 23: Neisseria and Related Genera

Test Bank MULTIPLE CHOICE 1. Which genus is best described as oxidase-positive, gram-negative cocci that are normal flora of the respiratory and other mucosal surfaces and often form diplococci? a. Haemophilus b. Stomatococcus c. Staphylococcus d. Neisseria e. Acinetobacter ANS: D 2. Neisseria meningitidis can be described as which of the following? a. Oxidase positive b. A maltose utilizer c. A major cause of bacterial meningitis d. Often carrying an antiphagocyNtiU cR caSpI suNleGTB.COM e. All of the above ANS: E 3. Collection and handling of specimens for the detection of Neisseria gonorrhoeae should optimally include which of the following? a. Charcoal-treated nontoxic swabs b. Immediate inoculation to appropriate medium c. CO2-enriched atmosphere d. All of the above ANS: D 4. A 20-year-old woman presented to the local clinic with fever and abdominal tenderness. She was at day 2 of her menstrual cycle and reported having had unprotected sexual intercourse a few weeks earlier. Gram-negative diplococci are seen in a Gram stain of vaginal secretions, many of the bacteria inside polymorphonuclear leukocytes. Which of the following is the most important virulence factor necessary for this organism to initiate infection? a. Invasive genes b. Pili c. Capsule

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d. Endotoxin e. Hyaluronidase ANS: B 5. Which of the following produces pili that are subject to both phase and antigenic variation? a. Chlamydia trachomatis b. Neisseria gonorrhoeae c. Treponema pallidum d. Streptococcus pyogenes e. Staphylococcus aureus ANS: B 6. A 17-year-old girl was brought to the emergency room because she exhibited lethargy, fever, and mental status changes. The patient had just returned from a 1-week camping trip where she shared living quarters with other teens. Physical examination was remarkable for a temperature of 39.3° C, nuchal rigidity, and a response only to painful stimuli. An emergent lumbar puncture was performed, and CSF lab findings were 130 mg/dL protein, 20 mg/dL serum glucose, and a WBC count of 1500 cells/mm3 (95% PMNs). Which of the following statements regarding this case is most correct? a. This patient is infected with an enterovirus. b. Streptococcus agalactiae is thN eU etR ioS loIgN icGaT geBn. t. COM c. Gram stain of CSF will reveal intracellular gram-negative diplococci. d. The Hib vaccine would have prevented this infection. e. This patient was infected by ingestion of contaminated hot dogs.

ANS: C 7. A 6-year-old girl is seen on an emergency basis because she is difficult to arouse and has a headache and stiff neck. She has a fever of 40° C, and petechiae are present in axillary folds. A gram-negative diplococcus is present in the spinal fluid. Within hours after ampicillin treatment, the fever and disease signs appear to worsen. Why? a. The antibiotic has no activity toward the infectious agent. b. Treatment activates β-lactamase production. c. Treatment activates toxin production. d. Treatment promotes release of endotoxin. e. Treatment promotes superinfection with another agent.

ANS: D 8. A 2-year-old child has sudden onset of fever and then petechiae and purpural marks on his skin. He is lethargic and has difficulty turning his head. Gram-negative diplococci areisolated from the CSF. Which of the following statements describes these bacteria? a. The bacteria are transmitted by the fecal-oral route.

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The bacteria can be isolated from the petechiae.

The bacteria can grow intracellularly.

The bacteria will appear as purple colonies on MacConkey agar.

The disease is exotoxin mediated.

ANS: C 9. A 2-year-old child has sudden onset of fever and then petechiae and purpural marks on his skin. He is lethargic and has difficulty turning his head. Gram-negative diplococci are isolated from the CSF. Which of the following statements describes the disease? a. A family pet is the source of this infection. b. Bacterial growth and exotoxins cause CNS damage. c. Capsule prevents entry into the CNS. d. Release of lipo-oligosaccharides can lead to Waterhouse-Friderichsen syndrome. e. The infection is spread by the fecal-oral route.

ANS: D

10. What is the common virulence factor for each of the following causes of meningitis: Neisseria meningitidis, Haemophilus influenzae, and Cryptococcus neoformans? a. Anaerobic growth b. Capsule c. Exotoxin d. Lecithinase e. Lipo-oligosaccharide ANS: B 11. A sexually active 27-year-old man complains of a greenish-yellow discharge from his urethra and difficulty urinating. Gram-negative diplococci were seen on the Gram stain.

Confirmation by culture requires plating on which of the following media? a. Buffered charcoal yeast extract agar b. Middlebrook agar c. MacConkey agar d. Mannitol salts agar e. Thayer-Martin agar ANS: E 12. A sexually active woman develops fever, abdominal pain, and vaginal discharge.

Gram-negative diplococci were isolated from the woman. Which of the following virulence factors is a contributing factor to this disease? a. Enterotoxin b. Lecithinase c. Lipoteichoic acid

Test Bank d. M protein e. Pili ANS: E

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Murray: Medical Microbiology, 8th Edition Chapter 24: Haemophilus and Related Bacteria

Test Bank MULTIPLE CHOICE 1. Which bacterial family is best described as catalase-positive, oxidase-negative, gramnegative bacilli that are facultative anaerobes and reduce nitrates to nitrites? a. Enterobacteriaceae b. Vibrionaceae c. Pseudomonadaceae d. Pasteurellaceae e. Neisseriaceae ANS: A 2. This group of gram-negative bacteria contains agents of important diseases such as gastroenteritis and enteric fevers, urinary tract infections, and bacterial pneumonia. a. Neisseriaceae b. Micrococcaceae c. Enterococcus d. Enterobacteriaceae ANS: D 3. MacConkey-Sorbitol agar is useful for detecting which organism? a. Escherichia coli b. Shigella sonnei c. Salmonella enterica d. Vibrio cholerae ANS: A 4. What is the major etiologic agent of urinary tract infections? a. Escherichia coli b. Shigella sonnei c. Salmonella enterica d. Vibrio cholerae ANS: A

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5. A 25-year-old man complains of severe abdominal cramps, profuse watery diarrhea, and fever. The stool sample contained blood, mucus, and PMNs. Gram-negative, non– lactose-fermenting bacilli were isolated from the stool. Which of the following virulence mechanisms is the primary cause of the disease? a. Adherence b. Endotoxin c. Protein synthesis inhibiting toxin d. Adenylate cyclase activation by toxin e. Phospholipase C and lecithinase toxin ANS: C 6. Which of the following gram-negative, oxidase-negative bacilli isolated from the stool of a person with diarrhea would yield a colorless colony on MacConkey agar? a. Enterobacter aerogenes b. Escherichia coli c. Klebsiella pneumoniae d. Citrobacter freundii e. Salmonella typhimurium ANS: E 7. The virulence factor associated with enterohemorrhagic E. coli diarrhea resembles a virulence factor from which of theNfU oR lloSwIinNgGbTaB ct. erC iaO ?M a. Enterobacter aerogenes b. Klebsiella pneumoniae c. Salmonella typhi d. Shigella dysenteriae e. Vibrio cholera ANS: D 8. A 5-year-old boy has bloody diarrhea for 2 days, nausea, abdominal cramps, and vomiting. He subsequently undergoes acute renal failure. Upon questioning the mother, it is learned that the diarrhea started 24 hours after the child had eaten a hamburger at a fast-food restaurant. Which of the following is the likely cause of this disease? a. Bacillus cereus b. E. coli strain O157:H7 c. Pseudomonas aeruginosa d. Shigella sonnei e. Staphylococcus aureus ANS: B

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9. Which of the following bacteria is correctly associated with its diarrhea-causing virulence factor? a. E.coli: O antigen O157:H7 b. Proteus mirabilis: fimbriae c. Pseudomonas aeruginosa: mannose lectin d. Salmonella: type III secretion system e. Shigella: adenylate cyclase activating toxin ANS: D 10. A 27-year-old man complains of dysuria and frequency. Gram-negative, lactosefermenting bacilli were isolated from the urine in high concentration. Which of the following virulence factors is most important for promoting this disease? a. Capsule b. Cholera-like toxin c. Pili d. Lipopolysaccharide e. Shiga-like toxin ANS: C 11. Gram-negative, non–lactose-fermenting, oxidase-negative bacilli were isolated from the blood and stool of a woman with a low-grade fever, nausea, vomiting, abdominal .iCngOM pain, and nonbloody diarrhea. WhNicUhRoS fI thN eG foT llB ow foods is a likely source of the disease? a. Chicken b. Hamburger c. Homemade salami d. Ice cream e. Lettuce ANS: A 12. A 47-year-old man complains of fever, headache, myalgia, malaise, and lack of appetite with gastroenteritis that has persisted for more than a week. Gram-negative, oxidase-negative, non–lactose-fermenting, hydrogen sulfide producing bacilli were isolated from the stool. Which of the following distinguishes this bacterial infection from other enterobacterial causes of gastroenteritis? a. Adherence to intestinal lining b. Colonization of gall bladder c. Invasion of M cells d. Toxin production activating adenylate cyclase e. Release of endotoxin ANS: B

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13. How is bubonic plague transmitted? a. Fecal-oral route b. On fomites c. Sexual contact d. Trauma e. Zoonotic ANS: E 14. Which of the following mechanisms is used by Yersinia pestis to evade clearance by host responses? a. Antigenic shift b. IgA protease c. Inactivation of CD4 T cells d. Inactivation of phagocytes e. Intracellular growth ANS: D 15. Gram-negative, oxidase-negative, non–lactose-fermenting motile bacteria are isolated from the urine of a woman with dysuria and frequency. Which bacterium is causing this disease? a. Escherichia coli b. Enterobacter aerogenes c. Proteus mirabilis d. Pseudomonas aeruginosa e. Salmonella typhi ANS: C

Murray: Medical Microbiology, 8th Edition Chapter 25: Enterobacteriaceae

Test Bank MULTIPLE CHOICE 1. Although most other clinically relevant gram-negative bacilli are intrinsically resistant to penicillin, it is the drug of choice for infections caused by which of the following? a. Aggregatibacter aphrophilus b. Haemophilus influenzae c. Pasteurella multocida d. Burkholderia cepacia e. Campylobacter jejuni ANS: C 2. Which of the following bacterial species is transmitted to humans during close animal contact, including bites? a. Aggregatibacter aphrophilus b. Eikenella corrodens c. Pasteurella multocida d. Burkholderia cepacia e. Haemophilus influenzae ANS: C 3. Of the following organisms, which is among the HACEK group of organisms that cause slowly progressive bacterial endocarditis? a. Capnocytophaga gingivalis b. Aeromonas hydrophila c. Enterobacter aerogenes d. Aggregatibacter actinomycetemcomitans e. Klebsiella oxytoca ANS: D 4. Chancroid is the sexually transmitted disease caused by which of the following? a. Haemophilus influenzae b. Haemophilus ducreyi c. Haemophilus aegyptius d. Haemophilus parainfluenzae ANS: B

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5. Of the following media, which provides the factors necessary for the growth of Haemophilus spp.? a. 5% sheep blood agar b. Brain Heart Infusion agar c. Chocolate agar d. Nutrient agar e. All of the above ANS: C 6. A 19-year-old prostitute presented with a painful, soft, ragged ulcer on the genitalia.

Small, gram-negative coccobacilli were isolated the lesion. What is the most likely pathogen causing this infection? a. Bacteroides fragilis b. Chlamydia trachomatis c. Haemophilus ducreyi d. Treponema pallidum e. Gardnerella vaginalis ANS: C 7. Which of the following describes the vaccine for Haemophilus influenzae? a. Multivalent polysaccharide b. Protein-conjugated polysaccharide c. Inactivated bacteria d. Live, attenuated bacteria e. Toxoid ANS: B 8. An African child has mild respiratory disease and then develops meningitis. Small gram-negative bacilli, obtained from the blood and the CSF, require heme and NAD for growth. Which of the following is the likely cause of the meningitis? a. Streptococcus agalactiae b. Escherichia coli c. Haemophilus influenzae B d. Neisseria meningitidis e. Streptococcus pneumoniae ANS: C 9. A sexually active man had a tender pimple on his genitalia, which ulcerated and was painful. Bacteria isolated from cultures of the lesion grown on chocolate agar would likely be identified as which of the following? a. Chlamydia trachomatis

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Haemophilus ducreyi Mycobacterium tuberculosis Staphylococcus aureus Treponema pallidum

ANS: B 10. A 5-year-old girl was bitten and scratched by a neighbor’s dog. Cellulitis and swollen glands resulted. Gram-negative bacteria were grown on blood agar, which formed large, buttery colonies and produced a musty odor. Which of the following bacteria is associated with dog-bite infections of this type? a. Francisella tularensis b. Pasteurella multocida c. Plesiomonas shigelloides d. Staphylococcus aureus e. Streptococcus pyogenes ANS: B

Murray: Medical Microbiology, 8th Edition Chapter 26: Vibrio and Related Bacteria

Test Bank MULTIPLE CHOICE 1. Profuse watery diarrhea (“rice-water stools”) leading to dramatic fluid loss and severe dehydration and hypotension, which frequently leads to death, are the hallmarks of which toxin activity? a. Cholera toxin (CT) b. Endotoxin c. Shiga toxin d. Exotoxin A ANS: A 2. The selective medium thiosulfate citrate bile salts sucrose (TCBS) agar is especially formulated for isolating what pathogen from stool cultures? a. Vibrio b. Salmonella c. Shigella d. Plesiomonas e. Campylobacter ANS: A 3. A 37-year-old man has voluminous watery diarrhea that has specks of mucus 2 days after winning a raw oyster eating contest. Which of the following is the cause of the diarrhea? a. Echovirus 11 b. Rotavirus c. Salmonella typhi d. Shigella sonnei e. Vibrio cholerae ANS: E 4. A 37-year-old man has voluminous watery diarrhea that has specks of mucus 2 days after winning a raw oyster eating contest. Which of the following is the cause of the diarrhea? a. Adherent bacteria b. Intracellular bacteria c. Invasive bacteria

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d. Phagocyte inactivation e. Toxin activation of adenylate cyclase ANS:

E

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Murray: Medical Microbiology, 8th Edition Chapter 27: Pseudomonas and Related Bacteria

Test Bank MULTIPLE CHOICE 1. What is the gram-negative bacillus that resembles a plump coccobacilli that tends to resist alcohol decolorization and may be mistaken for Neisseria? a. Pseudomonas b. Acinetobacter c. Stenotrophomonas d. Vibrio ANS: B 2. Which type of gram-negative bacilli is resistant to most currently available antimicrobial agents except trimethoprim/sulfamethoxazole, leaving it as the primary drug of choice for infections caused by this species? a. Pseudomonas aeruginosa b. Acinetobacter baumannii c. Stenotrophomonas maltophilia d. Vibrio cholerae ANS: C 3. Excluding Enterobacteriaceae, what is the most common gram-negative bacillus encountered in clinical specimens? a. Pseudomonas aeruginosa b. Burkholderia cepacia c. Acinetobacter baumannii d. Vibrio cholerae e. Stenotrophomonas maltophilia ANS: A 4. Production of exotoxin A, which kills host cells by inhibiting protein synthesis, and production of several proteolytic enzymes and hemolysins that destroy cells and tissue are factors that contribute to pathogenicity of which of the following? a. Pseudomonas aeruginosa b. Burkholderia cepacia c. Stenotrophomonas maltophilia d. Burkholderia pseudomallei

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ANS: A 5. The disease referred to as melioidosis is caused by which of the following? a. Pseudomonas aeruginosa b. Stenotrophomonas maltophilia c. Burkholderia mallei d. Burkholderia pseudomallei ANS: D 6. Which species of Moraxella is most commonly associated with human infections, primarily of the respiratory tract? a. Moraxella catarrhalis b. Moraxella lacunata c. Moraxella canis d. Moraxella atlantae ANS: A 7. Use of bars of soap in the hospital was indicted as a major source of nosocomial infection with a gram-negative bacillus resistant to most antibacterial agents. Which of the following is the likely agent? a. Bacillus cereus b. Escherichia coli c. Pseudomonas aeruginosa d. Salmonella enterica e. Vibrio cholerae ANS: C 8. A gram-negative, oxidase-positive, non–lactose-fermenting bacillus was isolated from the blood of a burn patient. This bacterium was difficult to treat because it was resistant to most antimicrobial agents. Which of the following bacteria was isolated from this patient? a. Bartonella henselae b. Proteus mirabilis c. Pseudomonas aeruginosa d. Staphylococcus aureus e. Streptococcus pyogenes ANS: C

Murray: Medical Microbiology, 8th Edition Chapter 28: Campylobacter and Helicobacter

Test Bank MULTIPLE CHOICE 1. The majority of human infections with Campylobacter species are caused by which of the following? a. Direct contact with carriers of the bacterium b. Contamination of food, milk, or water with animal feces c. Multiplication of the organism in food products d. Direct contact with persons infected with the bacterium ANS: B 2. Virulence determinants of Helicobacter pylori include which of the following? a. Motility b. Urease enzyme c. Adhesions d. All of the above ANS: D 3. Antimicrobial therapy for H. pylori infection consists of which treatment? a. Metronidazole b. Bismuth c. Tetracycline d. Omeprazole e. All of the above ANS: E 4. In most clinical laboratories in the United States, stools received for routine culture should be examined for the presence of which bacteria? a. Campylobacter, Salmonella, and Shigella spp. b. Salmonella and Shigella spp. c. Campylobacter and Vibrio d. Salmonella, Shigella, and Vibrio ANS: A 5. How should cultures for isolation of Campylobacter jejuni and Campylobacter coli be handled?

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a. Incubated in a capnophilic atmosphere at 42° C and examined at 24 and 48 hours b. Incubated in a microaerophilic atmosphere at 35° C and examined at 24 and 48 hours c. Incubated in regular room air at 35° C and examined at 48 and 72 hours d. Incubated in a microaerophilic atmosphere at 42° C and examined at 24 and 48 hours ANS: D 6. A man with diarrhea has more than 10 bowel movements per day with some blood in the stool. Small, curved, gram-negative, motile bacilli were seen in a wet prep and then isolated from the stool after 72 hours of growth in a microaerophilic environment on blood agar. Which of the following foods is most likely the source of the gastroenteritis? a. Chicken b. Hamburger c. Homemade salami d. Ice cream e. Lettuce ANS: A 7. How can Helicobacter pylori infection be detected? a. Breakdown of urea b. Hydrogen sulfide production c. Lactose fermentation d. Production of oxidase e. Sensitivity to bacitracin ANS: A

Murray: Medical Microbiology, 8th Edition Chapter 29: Miscellaneous Gram-Negative Rods

Test Bank MULTIPLE CHOICE 1. Which statement is true about Bordetella parapertussis? a. Grows well on 5% sheep blood or chocolate agar b. Requires 5 days to form visible colonies c. Will grow on MacConkey agar d. Will only grow on Regan-Lowe medium ANS: D 2. Pertussis (whooping cough), an epidemic disease that is a highly contagious and causes acute infection of the upper respiratory tract, is caused by which bacterium? a. Brucella b. Bordetella c. Pasteurella d. Francisella ANS: B 3. A 5-year-old boy who immigrated to the United States from a country with a poor vaccination program developed acute bronchitis. His pediatrician diagnosed a viral infection and took no action. One week later, the boy was taken to the emergency department with neurologic impairment caused by cerebral hemorrhage. His foster parents told the attending physician that the boy had been suffering from convulsive coughing spells for the past 2 days. Nasopharyngeal cultures from the boy grew gramnegative coccobacilli on charcoal blood agar. What virulence factor mediates attachment of this pathogen to the respiratory epithelium? a. Filamentous hemagglutinin b. M protein c. Protein G d. Calmodulin e. Capsule ANS: A

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4. How is Bordetella pertussis infection prevented? a. Chlorination of water supply b. Hand washing c. Heating foods d. Pasteurization e. Vaccination ANS: E 5. A 4-year-old girl has been sick for 3 weeks. Initially she had flulike symptoms, and for the last 2 weeks, she has had up to 30 series of deep coughs such that when she tries to catch her breath, she makes make a whooping sound. The child’s parents’ religious beliefs preclude vaccination. Which of the following bacteria is the likely cause of this infection? a. Bacillus anthracis b. Bordetella pertussis c. Mycoplasma pneumoniae d. Pseudomonas aeruginosa e. Streptococcus pyogenes ANS: B 6. Tularemia, characterized by glandular, ulceroglandular, oculoglandular, UoRnSicIpNreGsT oropharyngeal, systemic, and pneuNm enBta.tiC onOsM , is caused by which bacterium? a. Brucella b. Bordetella c. Pasteurella d. Francisella ANS: D 7. A butcher with a granuloma on his hand presents with chills, sweats, and fatigue over the past 6 weeks. He reports a 20-pound weight loss and a fever that comes and goes in an undulating pattern. Which of the following infections is most likely? a. Brucella abortus b. Chlamydia psittaci c. Mycobacterium tuberculosis d. Plasmodium falciparum e. Streptococcus pyogenes ANS: A 8. A rabbit breeder has a large, ulcerative skin lesion on the back of his hand, lymphadenopathy, and fever, chills, and malaise. Tularemia is suspected. Which of the following virulence mechanisms is a distinguishing characteristic of the infecting microbe?

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A-B toxin production β-Lactamase production Intracellular growth Release of lipo-oligosaccharide Wax layer protection

ANS: C 9. Which of the following risk factors is associated with Brucella infection? a. Aerosols from air-conditioner towers b. Raw chicken c. Snails d. Undercooked hamburger e. Unpasteurized milk

ANS: E 10. Specimens for culture recovery of Legionella should be inoculated to which of the following? a. BCYE (buffered charcoal yeast extract) agar b. Regan-Lowe agar c. Lowenstein-Jensen medium d. Blood and chocolate agars ANS: A 11. An outbreak of severe pneumonia with several fatalities among the residents of a nursing home was traced to contaminated respiratory therapy equipment. Specimens were collected from the equipment and grown using special culture media. The causative agent was eventually isolated from the cytoplasm of freshwater protozoa living on the respiratory equipment. What is the most likely etiologic agent causing this outbreak? a. Streptococcus pneumoniae b. Naegleria fowleri c. Mycoplasma pneumoniae d. Legionella pneumophila e. Listeria monocytogenes ANS: D 12. A pack-a-day smoker develops fever, chills, headache, and a dry, nonproductive cough. Gram-negative coccobacilli were isolated from patient cultures on BCYE agar.

How is the organism spread? a. Aerosols from air-conditioner cooling tower b. Aerosols from other people c. Fomites such as facial tissues

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d. Hand-to-nose transmission e. Systemic spread from other body site ANS: A 13. A pack-a-day smoker develops fever, chills, headache, and a dry, nonproductive cough. The diagnosis is atypical pneumonia. Gram-negative coccobacilli were isolated from patient cultures on BCYE agar. Which of the following virulence mechanisms facilitates the transmission of this microbe? a. A-B toxin b. Capsule c. Intracellular growth d. Lecithinase e. Superantigen ANS: C 14. Of the asaccharolytic, oxidase-positive bacilli that do not grow on MacConkey agar, which one is generally associated with mixed infections resulting from human bites or clenched-fist wounds and is among the HACEK group of bacteria known to cause subacute bacterial endocarditis? a. Eikenella corrodens b. Bordetella bronchiseptica c. Pseudomonas maltophilia d. Sphingomonas paucimobilis e. Pasteurella multocida ANS: A 15. Bacteremia, endocarditis, bacillary angiomatosis, cat-scratch disease, and peliosis hepatitis all can be caused by which of the following? a. Afipia felis b. Rochalimaea quintana c. Bartonella clarridgeiae d. Bartonella henselae ANS: D 16. Trench fever, bacteremia, endocarditis, chronic lymphadenopathy, and bacillary angiomatosis all can be caused by which of the following? a. Afipia felis b. Bartonella quintana c. Bartonella clarridgeiae d. Bartonella henselae ANS: B

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17. Rat-bite, or Haverhill, fever is characterized by acute onset of chills, fever, headache, vomiting, and often severe joint pains and a rash on the palms, soles of the feet, and other extremities. Which of the following causes this disease? a. Streptobacillus moniliformis b. Brucella abortus c. Bordetella bronchiseptica d. Pasteurella multocida ANS: A 18. A 6-year-old girl developed fever and lymphadenopathy in addition to swelling and purulent drainage from the site where her cat scratched her. Which of the following microbes is likely to have caused the infection? a. Bartonella henselae b. Brucella abortus c. Francisella tularensis d. Pasteurella multocida e. Pseudomonas aeruginosa ANS: A

Murray: Medical Microbiology, 8th Edition Chapter 30: Clostridium

Test Bank MULTIPLE CHOICE 1. The normal flora of the adult large bowel consists predominantly of which of the following? a. Fusobacterium b. Bacteroides c. Enterococcus d. Enterobacter e. Staphylococcus ANS: B 2. A 45-year-old woman was admitted to the hospital after an alcohol-withdrawal seizure.

She developed a cough productive of slightly blood-tinged sputum and foul-smelling breath. What is the most likely cause of her infection? a. Streptococcus pneumoniae b. Mycoplasma pneumoniae c. Haemophilus influenzae d. Mixed anaerobic infection e. Legionella pneumophila ANS: D 3. A 42-year-old patient undergoing treatment with a broad-spectrum antibiotic for several weeks develops profuse, foul-smelling and bloody diarrhea. The patient has fever and abdominal pain. Leukocytes are present in the stool. A cytotoxin is detected by assay on tissue culture cells. Cessation of the antibiotic treatment was helpful. Which of the following is the most probable agent of this disease? a. Clostridium difficile b. Escherichia coli c. Salmonella enterica d. Shigella sonnei e. Vibrio cholerae ANS: A 4. The small toe of a 72-year-old diabetic patient is gangrenous and must be amputated. Which of the following is a major virulence factor responsible for the tissue destructionby this organism?

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Coagulase Endotoxin Erythrogenic toxin Exotoxin A Lecithinase

ANS: E 5. A 67-year-old diabetic man develops intense pain and swelling on his calf, which acquires a bronze discoloration and develops significant tissue necrosis with hemorrhagic bullae and gas production. Which of the following is the most important contributing factor to the onset of this infection? a. Coinfection with E. coli b. Decreased oxygen tension c. Increased sugar for fermentation d. Poor hygiene e. Restricted diet ANS: B 6. A 67-year-old diabetic man develops intense pain and swelling on his calf, which acquires a bronze discoloration and develops significant tissue necrosis with hemorrhagic bullae and gas production. Which other disease does this organism cause? a. Endocarditis b. Gastroenteritis c. Meningitis d. Pneumonia e. Urethritis ANS: B 7. A 7-year-old boy is drooling, has spasms of his salivary muscle, and has persistent back spasms. This disease is normally prevented with which of the following types of vaccine? a. Attenuated live vaccine b. Inactivated vaccine c. Polysaccharide conjugate d. Subunit e. Toxoid ANS: E 8. Which of the following describes the mode of action of the tetanus toxin? a. The A subunit acts as a superantigen. b. The A subunit activates adenylate cyclase. c. The A subunit inhibits protein synthesis. d. The B subunit blocks function of G proteins.

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e. The B subunit inhibits the release of neurotransmitters.

ANS: E 9. Which of the following is a risk factor for infant botulism? a. Cheese b. Chicken c. Hamburger d. Honey e. Unpasteurized milk ANS: D 10. While on antibiotic therapy for urinary infection, a woman developed abdominal pain, fever, and profuse, foul-smelling and bloody diarrhea for 3 weeks. Stool examination shows leukocytes. Colonoscopy shows pseudomembranous lesions. Which microbe is responsible for this disease? a. Bacteroides fragilis b. Clostridium difficile c. Clostridium perfringens d. Escherichia coli H7:O157 e. Shigella sonnei ANS: B 11. While on antibiotic therapy for urinary infection, a woman developed abdominal pain, fever, and profuse, foul-smelling and bloody diarrhea for 3 weeks. Stool examination shows leukocytes. Colonoscopy shows pseudomembranous lesions. Which of the following virulence mechanisms is characteristic of the microbe responsible for this disease? a. A-B toxin, which activates cAMP b. A-B toxin, which inactivates ribosomes c. Cytotoxin, which disrupts cytoskeleton d. Endotoxin e. Shiga-like toxin ANS: C

Murray: Medical Microbiology, 8th Edition Chapter 31: Non–Spore-Forming Anaerobic Bacteria

Test Bank MULTIPLE CHOICE 1. What is the predominant organism in secretions from normal, healthy vaginas? a. Lactobacillus b. Streptococcus c. Escherichia d. Staphylococcus ANS: A 2. Sulfur granules were obtained from the sinus tract of a 27-year-old man. An anaerobic, filamentous organism was observed in the sample. Which of the following microbes is likely to have caused the infection? a. Actinomyces b. Aspergillus c. Mycobacterium d. Nocardia e. Streptomyces ANS: A

Murray: Medical Microbiology, 8th Edition Chapter 32: Treponema, Borrelia, and Leptospira

Test Bank MULTIPLE CHOICE 1. Which of the following is a widely used nontreponemal serologic test? a. VDRL b. TP-PA c. FTA-ABS d. MHA-TP ANS: A 2. The most common vector-borne disease in North America and Europe transmitted by the bite of Ixodes ticks is caused by which of the following? a. Leptospira interrogans b. Borrelia burgdorferi c. Treponema carateum d. Rickettsia rickettsii ANS: B 3. A neonate developed a cough, rhinitis, fever, and an elevated leukocyte count.

Congenital syphilis was suspected. What would be the most discriminating diagnostic test for this diagnosis? a. Culture for organism b. Serology for specific IgG c. Serology for specific IgM d. Gram stain of nasopharyngeal smear e. Gram stain of urethral smear ANS: C 4. A 12-year-old Boy Scout went to summer camp for 2 weeks in late August at a site located just outside Mystic, Connecticut. When he returned home, his mother noticed a ring-shaped rash on the back of her son’s left calf. Shortly after Labor Day, the boy developed a flulike illness that resolved after 4 days of bed rest. Three weeks later the boy complained to his mother that his body hurt all over whenever he moved. This prompted a visit to the pediatrician, who ordered an infectious disease workup. What is the most likely source of the boy’s infection?

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Respiratory transmission from another camper Ingestion of contaminated water from a stream Ingestion of contaminated food Tick bite Mosquito bite

ANS: D 5. A 44-year-old sexually active man complains of flulike symptoms, including fever, sore throat, muscle aches, anorexia, swollen glands, and a generalized rash over his entire body that started a week earlier. The patient recalled that he had a painless ulcer on his penis for quite a long time, but it healed approximately 4 months earlier. Which would be the appropriate action by the physician in this case? a. Culture a scraping from the rash for bacteria and test antibiotic sensitivity. b. Culture a scraping from the rash for a virus. c. Treat with appropriate antiviral drug without culturing. d. Treat with penicillin. e. Withhold treatment, because the symptoms will spontaneously resolve.

ANS: D 6. A 10-year-old girl has fever, headache, myalgia, swollen glands, and a lesion on her calf that looks like a large (6 cm), red circle with a clear center area. She recalls that the lesion increased in size approximaNteUlyRS 2I wN eeGkT sB af. teC r aOtMrip to her uncle’s farm, where she ran through the fields with the dogs. Without prompt treatment, which of the following sequelae is likely? a. Buboes b. Immunosuppression c. Migratory polyarthritis d. Mononucleosis e. Pneumonia ANS: C 7. A 27-year-old sexually active man noticed an ulcer on his penis, but because he experienced no pain, he disregarded the problem, and it went away. Approximately 6 months later, he developed flulike symptoms, with a sore throat and a generalized mucocutaneous rash over most of his body. Which test would confirm the diagnosis at this time? a. Dick test b. Lung radiograph c. PPD test d. RPR (rapid plasma reagin) test e. Schick test ANS: D

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8. A 7-year-old child from Connecticut has a large circular rash that encircles the site of a previous tick bite. She is very tired and has severe flulike symptoms that have lasted for 3 weeks. Which of the following microbes is most likely to be responsible for this disease? a. Bartonella henselae b. Borrelia burgdorferi c. Francisella tularensis d. Rickettsia rickettsii e. Rickettsia prowazekii ANS: B 9. How can infection with Borrelia burgdorferi be prevented? a. Attenuated vaccine b. Draining swampy areas c. Good hygiene d. Prophylactic antibiotic e. Protective clothing ANS: E

Murray: Medical Microbiology, 8th Edition Chapter 33: Mycoplasma and Ureaplasma

Test Bank MULTIPLE CHOICE 1. A 35-year-old woman has been very tired, with a low-grade fever and chills. She has a nonproductive cough and runs out of breath easily. Results of a chest radiograph show patchy infiltrates. A Gram stain of sputum revealed many white blood cells but no bacteria. Empirical treatment for walking pneumonia was initiated. Results of a cold agglutinin assay were positive. Which of the following microbes is most likely the cause of this disease? a. Bordetella pertussis b. Chlamydophila pneumoniae c. Mycobacterium tuberculosis d. Mycoplasma pneumoniae e. Streptococcus pneumoniae ANS: D

Murray: Medical Microbiology, 8th Edition Chapter 34: Rickettsia, Ehrlichia, and Related Bacteria

Test Bank MULTIPLE CHOICE 1. Which of the following is characteristic of the rickettsia? a. Anaerobic growth b. Carried by mosquitoes c. Lack of peptidoglycan d. Obligate intracellular parasite e. Waxy outer layer ANS: D 2. A 37-year-old man developed a fever, chills, headache, and muscle aches 4 days after returning from a summer hiking trip in North Carolina. The prodrome symptoms were followed by a rash after 3 days. He recalls being bitten by a tick on his hike. The diagnosis was confirmed by an indirect fluorescent antibody test. This man has which of the following diseases? a. Brucellosis b. Lyme disease c. Relapsing fever d. Rocky Mountain spotted fever e. Tularemia ANS: D

Murray: Medical Microbiology, 8th Edition Chapter 35: Chlamydia and Chlamydophila

Test Bank MULTIPLE CHOICE 1. Of the following organisms, which has a unique developmental life cycle, including a replicative form, the reticulate body, and an extracellular, metabolically inert infective form, the elementary body? a. Rickettsia b. Chlamydia c. Ehrlichia d. Coxiella ANS: B 2. What is the intracellular growth, or replicative form, of Chlamydia? a. Reticulate body b. Elementary body c. Replicate body d. Initial body ANS: A 3. A sexually active man complains of local pain and swelling of his inguinal lymph nodes.

In addition, he has been having fever and headaches. Why would this STD not be treated with a β-lactam antibiotic? a. There was poor pharmacologic delivery of the antibiotic to the site of infection. b. The agent lacks the enzyme target for β-lactam antibiotics. c. The agent makes a β-lactamase. d. The agent overproduces the enzyme target for β-lactam antibiotics. e. The infection requires antiviral drug therapy.

ANS: B 4. Which of the following properties distinguishes Chlamydia from a virus? a. Encodes DNA polymerase b. Encodes RNA polymerase c. Obligate intracellular parasite d. Protein synthesis e. Size ANS: D

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5. A 27-year-old sexually active man developed swollen and painful inguinal lymph nodes (buboes). Which of the following is the most likely cause of this infection? a. Chlamydia trachomatis b. Mycobacterium tuberculosis c. Neisseria gonorrhoeae d. Treponema pallidum e. Yersinia pestis ANS: A 6. A 33-year-old man had urethritis, difficulty urinating, and a greenish-yellow discharge.

Isolation of Neisseria gonorrhoeae on Thayer-Martin medium prompted treatment with ceftriaxone, but he continued to have a watery discharge that contained white blood cells. The treatment should also have covered which of the following agents? a. Gram-negative bacillus requiring X and V growth factors b. Gram-negative bacillus, urease positive, and motile c. Gram-positive coccus, catalase positive, coagulase negative d. Obligate anaerobic spirillum e. Obligate intracellular dimorphic bacterium ANS: E

Murray: Medical Microbiology, 8th Edition Chapter 36:

Test Bank MULTIPLE CHOICE 1. Herpes simplex virus was genetically engineered as a gene delivery vehicle. Insertion of the new gene into which of the viral genes would prevent replication of the virus in all cells? a. DNA-dependent DNA polymerase b. DNA-dependent RNA polymerase c. RNA-dependent DNA polymerase d. RNA-dependent RNA polymerase e. Thymidine kinase ANS: A 2. An outbreak of gastroenteritis occurred on a cruise ship. A stool sample from one of the passengers contained a very small detergent-resistant virus. What other parameter would be true for this virus? a. Also causes pharyngitis b. Also causes paralysis c. Double-stranded RNA genome d. Enveloped e. Infectious genome ANS: E 3. A 34-year-old woman is jaundiced, has fever and nausea, lacks appetite, and has abdominal pain. She claims that the disease signs started 3 days earlier. A stool sample contained a small detergent-resistant virus. Which of the following describes a likely consequence of this infection? a. Cancer b. Chronic infection c. Complete recovery 99% of the time d. Fulminant disease and cirrhosis e. Development of serum immune complexes ANS: C 4. A 34-year-old woman has been feeling very tired for several months, and blood tests showed elevated levels of liver enzymes. A blood sample tested positive for viral antigen and RNA for a +RNA virus, but no virus could be grown from the serum or seen in this

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or other samples. Which of the following describes the most likely consequence of this infection? a. Cancer b. Chronic infection c. Complete recovery 99% of the time d. Fulminant disease and cirrhosis e. Development of serum immune complexes ANS: B 5. A 3-year-old child has a group of lesions that include vesicles, crusted vesicles, and ulcers around the corner of his mouth. A Tzanck smear shows Cowdry type A inclusion bodies. Which is the most appropriate description for this microbe? a. Genome is a circular small DNA. b. Genome replication occurs in the cytoplasm. c. Gene transcription occurs in three phases. d. Translation results in a polyprotein. e. Two different types of +RNAs are produced during virus replication.

ANS: C 6. During the course of HIV infection of a person, the target cell changes from macrophages and some CD4 T cells to include other CD4 T cells. A mutation in which viral protein would most likely accountNfU orRtS hiI sN chGaT ngBe. ? COM a. RNA-dependent DNA polymerase b. GP120 c. Integrase d. TAT e. REV ANS: B

Murray: Medical Microbiology, 8th Edition Chapter 38: Role of Viruses in Disease

Test Bank MULTIPLE CHOICE 1. Which of the following is transmitted in saliva by an animal bite, and invades the peripheral and central nervous systems? a. Rubella virus b. Alpha virus c. Rabies virus d. Poxvirus ANS: C 2. Which virus causes a benign disease with rash and fever unless it occurs in a pregnant patient, in whom it can infect the developing fetus and result in multiple congenital anomalies? a. Alpha virus b. Rabies virus c. Poxvirus d. Rubella virus ANS: D 3. The most pathogenic of the hemorrhagic fever viruses, which group of long, filamentous viruses includes Marburg and Ebola? a. Coronaviruses b. Bunyaviruses c. Caliciviruses d. Filoviruses ANS: D 4. Viruses that cause arbovirus diseases such as yellow fever, dengue, West Nile virus, and Japanese and St. Louis encephalitis belong to what group of viruses? a. Flaviviruses b. Bunyaviruses c. Caliciviruses d. Filoviruses ANS: A

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5. Varicella-zoster virus, Epstein-Barr virus, and cytomegalovirus are included in which group of ubiquitous viruses? a. Coronaviruses b. Herpesviruses c. Caliciviruses d. Filoviruses ANS: B 6. Mononucleosis symptoms in a heterophile antibody–negative patient could be due to which of the following viruses? a. Herpes simplex virus or varicella-zoster virus b. Rubella or B19 c. Adenovirus or Western equine encephalitis virus d. Cytomegalovirus or HIV e. Measles virus or coronavirus ANS: D 7. A 2-year-old child with a barking cough that can be treated with hot steam is likely to be infected with which of the following viruses? a. Parainfluenza b. Rhinovirus c. Coronavirus d. Influenza A e. Adenovirus ANS: A 8. Which of the following describes the agent causing an outbreak of conjunctivitis and sore throat among members of the swimming team of a summer camp? a. Adenovirus b. Herpes simplex virus c. Rhinovirus d. Metapneumovirus e. California encephalitis virus ANS: A 9. A 25-year-old pediatric resident has a serious case of pneumonia and then breaks out in vesicular lesions. All stages of the lesions can be seen at any given time. What could have prevented this disease in the resident? a. Immunization with a killed vaccine or good hygiene b. Infection during childhood or immunization with a live vaccine c. Immunization with a live vaccine or use of insect repellant d. Clean water or a reassortant vaccine

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e. Careful monitoring of the beef production or antiviral drug prophylaxis ANS: B 10. A baby is born with calcification of the brain and a small head. Urine contains abnormally large cells which contain an owl’s-eye staining aberration in the nucleus. What is the appropriate antiviral treatment for this baby? a. Acyclovir b. Amantadine c. Ganciclovir d. Rubella gamma globulin e. Zoster immune globulin ANS: C 11. A 37-year-old kidney transplant recipient develops lymphoma. Biopsy of an affected lymph node is likely to detect cells containing which of the following viruses? a. Adenovirus b. Cytomegalovirus c. Epstein-Barr virus d. JC virus e. Human papillomavirus 16 ANS: C

Murray: Medical Microbiology, 8th Edition Chapter 37: Laboratory Diagnosis of Viral Diseases

Test Bank MULTIPLE CHOICE 1. The pandemics of influenza that occurred in 1947 and 1977 were both caused by an H1N1 virus. Which of the following techniques would best demonstrate the similarity between these two strains? a. Cytopathologic effect b. Hemagglutinin c. Hemagglutination inhibition d. RT-PCR e. Southern blot ANS: D 2. What is the specimen of choice for detecting respiratory syncytial virus? a. Throat swab b. Nasopharyngeal aspirate c. Bronchoalveolar wash d. Lung biopsy ANS: B 3. What is the specimen of choice for detecting rotavirus? a. Throat swab b. Urine sample c. Bronchoalveolar wash d. Fecal sample ANS: D 4. Specimens from the lip or genitalia are most likely collected for the detection of which virus? a. Varicella-zoster virus b. Herpes simplex virus c. Cytomegalovirus d. Rotavirus ANS: B 5. Urine specimens are most likely collected for the detection of which virus?

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Varicella-zoster virus Herpes simplex virus Cytomegalovirus Rotavirus

ANS: C 6. Stool specimens from infants should most likely be tested for which virus? a. Varicella-zoster virus b. Herpes simplex virus c. Cytomegalovirus d. Rotavirus ANS: D 7. A dermatologist who routinely uses laser surgery for removal of warts acquires a wart on his nose. Which of the following techniques would allow him to determine whether he acquired the infection from a patient? a. Immunofluorescence b. Restriction fragment length polymorphism c. Serologic analysis for P24 protein d. Tissue culture isolation and cytopathic effect e. Western blot analysis ANS: B 8. A 30-year-old male was experiencing profound fatigue, fever, and swollen glands.

Blood work indicated lymphocytosis with atypical lymphocytes. The patient reported that a month prior to the onset of symptoms, he had been to the equivalent of an orgy and had unprotected sex. The monospot test was negative, and the anti-EBV/VCA titer was unremarkable. Which of the following tests should be performed to evaluate the patient’s HIV status? a. ELISA b. Hemagglutination inhibition c. RT-PCR d. Southern blot e. Western blot ANS: C 9. A 30-year-old male was experiencing profound fatigue, fever, and swollen glands.

Blood work indicated lymphocytosis with atypical lymphocytes. The patient reported that a month prior to the onset of symptoms, he had been to the equivalent of an orgy and had unprotected sex. The monospot test was negative, and the anti-EBV/VCA titer was unremarkable.

Which of the following criteria would be important in choosing the appropriate test for

Test Bank evaluating the patient's HIV status? a. Age of patient b. Nature of sample for test c. Sensitivity of assay d. Specificity of assay e. Time course of disease progression ANS: E

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Murray: Medical Microbiology, 8th Edition Chapter 40: Antiviral Agents and Infection Control

Test Bank MULTIPLE CHOICE 1. In January, a 63-year-old man had fever, headache, severe myalgia, and nonproductive cough, which then progressed to pneumonia. Amantadine treatment was initiated 7 days after onset but did not seem to affect the course of disease. Hemagglutination inhibition antibody titers for the H1N1 virus were taken during the acute stage of disease (1/16) and 4 weeks after the disease had resolved (1/256). Which of the following reasons would best explain the poor activity of amantadine? a. Inappropriate choice of drug b. Infection with influenza B virus c. Infection with a non-influenza virus d. Resistant strain of influenza e. Treatment too late to be effective ANS: E 2. A 5-day-old baby was brought N baUcR kS toIthNeGhToB sp.itC alOwMith signs of sepsis, is not thriving, and has vesicular lesions on his head near the site of monitor attachment. Which of the following is the most appropriate treatment? a. Acyclovir b. Amantadine c. Azidothymidine d. Ganciclovir e. Ribavirin ANS: A 3. Resistance to oseltamivir (Tamiflu) would occur upon mutation of which of the following proteins? a. DNA-dependent DNA polymerase b. RNA-dependent DNA polymerase c. Hemagglutinin d. Neuraminidase e. Thymidine kinase ANS: D 4. Resistance to indinavir would occur upon mutation of which of the following proteins? a. DNA-dependent DNA polymerase

Test Bank b. RNA-dependent DNA polymerase c. Neuraminidase d. Protease e. Thymidine kinase ANS: D 5. Which of the following combinations is representative of highly active retroviral therapy? a. Acyclovir, azidothymidine, and ribavirin b. Lamivudine, cidofovir, and nevirapine c. Efavirenz, azidothymidine, lamivudine d. Amantadine, ribavirin, pleconaril e. Trifluridine, penciclovir, delavirdine ANS: C

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Murray: Medical Microbiology, 8th Edition Chapter 41: Papillomaviruses and Polyomaviruses

Test Bank MULTIPLE CHOICE 1. A 27-year-old pregnant woman had difficulty with speaking and coordination that progressed to mental deterioration, paralysis, and then death. At autopsy, abnormal oligodendrocytes were present near areas of demyelination in multiple foci of the brain.

Which of the following describes the most probable agent of this disease? a. Encapsulated yeast b. Gram-negative diplococcal bacteria c. Gram-positive coccobacillus d. Large, enveloped, double-stranded DNA virus e. Small, double-stranded DNA virus ANS: E 2. During a cervical examination of a 35-year-old sexually active woman, a whitish area was seen by colposcopy after dabbing with 5% acetic acid. Which of the following tests TBa .PC would be appropriate to identify thNeUaRgS enIt N frG om AO PM smear? a. Cell culture isolation of HPV-18 b. Cell culture for HSV-2 c. PCR for HPV-16 d. PCR for HSV-2 e. Immunofluorescence for HPV-18 ANS: C 3. A 37-year-old patient with AIDS had complained of a combination of neurologic problems, including blurred vision, speech problems, poor coordination, and forgetfulness. The disease progressed to paralysis of his legs and then death. On autopsy, areas of demyelination and enlarged cells resembling glioblastomas were noted in the brain. Which of the following is an appropriate description of the agent causing this disease? a. Enveloped dsDNA virus b. Enveloped (+)ssRNA virus c. Infectious protein d. Naked capsid dsDNA virus e. Naked capsid +RNA virus ANS: D

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4. How do the polyomaviruses synchronize the production of their structural proteins? a. Binding of a late promoter to each gene b. Coordination with viral DNA polymerase production c. Production of a late polyprotein d. Selective inhibition of early proteins e. Use of the same transcriptional start for mRNA ANS: E

Murray: Medical Microbiology, 8th Edition Chapter 42: Adenoviruses

Test Bank MULTIPLE CHOICE 1. What is the most common route for transmission of adenovirus? a. Sexual contact b. Respiratory spread c. Fecal-oral spread d. Intravenous drug abuse e. Transplacental transmission ANS: B 2. Tissue-culture cells infected with an isolate obtained from a 5-year-old child with a sore throat and pink eye (conjunctivitis) contained basophilic nuclear inclusion bodies.

Which of the following describes the virus responsible for this disease? a. Enveloped dsDNA genome b. Enveloped +RNA genome c. Naked capsid dsDNA genome d. Naked capsid –RNA genome e. Naked capsid +RNA genome ANS: C 3. Tissue-culture cells infected with an isolate obtained from a 5-year-old child with a sore throat and pink eye (conjunctivitis) contained basophilic nuclear inclusion bodies.

Which of the following describes the virus structure responsible for initiating target cell infection? a. Capsid glycoprotein b. Cleft in penton c. Envelope glycoprotein d. Hexon capsomere e. Penton fiber ANS: E

Murray: Medical Microbiology, 8th Edition Chapter 43: Human Herpesviruses

Test Bank MULTIPLE CHOICE 1. A 60-year-old man received a kidney transplant and was placed on immunosuppressive therapy following surgery. He developed fever, pneumonia and retinitis. Despite a good tissue antigen match, the transplant failed. What virus is most likely responsible for these problems , and what is the effective antiviral drug that would be used to treat him? a. HSV and acyclovir b. CMV and ganciclovir c. Hepatitis C and ribavirin d. HIV and AZT e. VZV and acyclovir ANS: B 2. A 5-year old-boy presents with vesicular lesions around the crimson border of the lips.

A Tzanck smear taken from the base of a lesion demonstrates multinucleated giant cells.

Which of the following is a correcNt U deRsS crI ipNtiG onToBf.thCeOpM robable responsible agent? a. Enveloped virus with –RNA genome b. Enveloped virus with +RNA genome c. Enveloped virus with dsDNA genome d. Naked capsid virus with dsDNA genome e. Naked capsid virus with +RNA genome ANS: C 3. A 5-year-old boy presents with vesicular lesions around the crimson border of the lips.

A Tzanck smear taken from the base of a lesion demonstrates multinucleated giant cells.

Which of the following is true about the probable agent? a. Disinfected with soap b. Preventable by an available vaccine c. Lesion leads to permanent scarring d. Transmitted by the fecal-oral route e. Treatable with azidothymidine (AZT) ANS: A

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4. A 24-year-old man complains of sore throat and being very tired. He has fever, lymphadenopathy, hepatosplenomegaly, and when treated empirically for the sore throat with ampicillin, he develops a rash on his chest. Which of the following actions should be taken? a. Determine ASO titer. b. Determine heterophile antibody titer. c. Examine eyes for conjunctivitis. d. Switch to an appropriate antibiotic to prevent pathologic sequelae. e. Treat with an inhibitor of viral neuraminidase.

ANS: B 5. A woman has a headache, slight fever, and vesicular lesions on her vagina that look like a dewdrop on a rose petal. Cell culture of vesicular fluid results in cytopathologic effects, including margination of chromatin, Cowdry type A inclusion bodies, and rare syncytia. Which of the following properties promotes the sexual transmission of this agent? a. Antigenic variation b. Asymptomatic replication c. IgA protease d. Syncytia formation e. Mannose lectin ANS: B 6. Approximately 70 days after a bone marrow transplant, a patient developed fatigue, hepatitis, and leukopenia. Enlarged cells with a large nuclear inclusion body could be found in the urine. Which of the following is most likely to be responsible for the disease signs? a. Adenovirus b. Cytomegalovirus c. Hepatitis B virus d. Hepatitis C virus e. Mycobacterium tuberculosis ANS: B 7. A 65-year-old man developed a belt of vesicular lesions along his trunk, which were very painful. No lesions were present anywhere else. What mechanism of spread produced this disease presentation? a. Blood-borne b. Fecal-oral route c. Neuronal d. Respiratory e. Viremia

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ANS: C 8. A 23-year-old wrestler develops vesicular lesions on his shoulder. The lesions appear as a blister with an erythematous base. Which of the following findings would be most useful in confirming the diagnosis? a. Hemadsorption b. Koilocytosis c. Negri bodies d. Owl’s eye inclusion bodies e. Syncytia ANS: E 9. A 17-year-old girl has a sore throat and lymphadenopathy. She has been very tired for the last week. Empirical treatment of the sore throat with ampicillin produced a rash.

Results of a blood test showed atypical lymphocytes and the presence of heterophile antibody. Which of the following is a likely means of acquisition of this infection? a. Breathing in close quarters b. Mosquito bite c. Poor hand washing d. Shared water bottle e. Unprotected sex ANS: D 10. A 17-year-old girl has a sore throat and lymphadenopathy. She has been very tired for the last week. Empirical treatment of the sore throat with ampicillin produced a rash.

Results of a blood test showed atypical lymphocytes and the presence of heterophile antibody. What is the primary target cell for this disease? a. B cell b. Fibroblast c. Genital epithelial cell d. Respiratory epithelial cell e. T cell ANS: A 11. A 17-year-old girl has a sore throat and lymphadenopathy. She has been very tired for the last week. Empirical treatment of the sore throat with ampicillin produced a rash.

Results of a blood test showed atypical lymphocytes and the presence of heterophile antibody. Which of the following profiles indicates serologic confirmation that this infection is in remission?

Heterophile antibodies VCA-IgM VCA-IgG EA EBNA a. + + – – – b. – – + + – c. – – + – –

Test Bank d. e.

+ –

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+ +

+ +

+ +

ANS: E 12. A healthy 24-year-old man is infected with cytomegalovirus. Which of the following is the most likely outcome? a. Asymptomatic infection b. Chorioretinitis c. Colitis d. Esophagitis e. Pneumonitis ANS: A 13. A neonate was born to a mother who remained promiscuous while pregnant. The baby had a small head, intracerebral calcification, hepatosplenomegaly, and a rash. The baby’s urine contained cells with owl’s eye inclusion bodies. Which of the following viruses is the most likely cause of this infection? a. B19 b. Cytomegalovirus c. Epstein-Barr virus d. Herpes simplex virus e. Rubella ANS: B 14. An HIV-positive person with CD4 T-cell levels of 20 per mm3 develops pneumonitis and chorioretinitis. Results of a lung biopsy show an epithelial cell with an owl’s eye inclusion body. Which of the following antiviral drugs would be appropriate for treatment of the pneumonitis and chorioretinitis? a. Acyclovir b. AZT c. Ganciclovir d. Interferon-α e. Ribavirin ANS: C 15. A 3-year-old boy suddenly develops a high fever (40° C). After the fever dissipates, a rash appears. Which of the following is an appropriate description of the rash? a. B cells are present in the rash. b. Fever will recur during the rash. c. T cells are present in the rash. d. The rash corresponds to a viremia. e. Virus can be isolated from the rash.

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ANS: C 16. A 5-year-old girl develops erythema infectiosum with fever, chills, myalgia, and then a distinctive rash on her face that appears as if her cheeks had been slapped. Which of the following aspects of this infection correlate with the pathogenesis of the early phase (fever, chills, myalgia) of the disease? a. Antibody production b. Latency c. Replication in the lungs d. Replication in the skin e. Viremia ANS: E

Murray: Medical Microbiology, 8th Edition Chapter 44: Poxviruses

Test Bank MULTIPLE CHOICE 1. A 5-year-old child has a patch of wartlike skin lesions that are pearl-like raised nodules that exude a caseous plug upon squeezing. Large eosinophilic cytoplasmic inclusions are present within cells from the lesion. Which of the following describes the virus causing this infection? a. Circular dsDNA virus that replicates in the nucleus b. Linear dsDNA virus that replicates in the cytoplasm c. Linear dsDNA virus that replicates in the nucleus d. Linear (+)ssRNA virus that replicates in the cytoplasm e. Linear (+)ssRNA virus that replicates in the nucleus ANS: B 2. Why is routine immunization with vaccinia virus restricted to military personnel and few others ? a. The price of the vaccine is tooNhUigRhS . INGTB.COM b. The risk of disease outweighs the benefits. c. The vaccine reverts to wild-type virulence. d. The endemic virus shifted serotype, and the vaccine was no longer effective. e. Vaccinia virus has been successfully controlled.

ANS: B

Murray: Medical Microbiology, 8th Edition Chapter 45: Parvoviruses

Test Bank MULTIPLE CHOICE 1. A 4-year-old girl comes home from daycare feeling very tired with a fever (39 C) and a runny nose. Her father thinks she is coming down with a “cold” but is shocked the next morning when she awakes with a rash on her face and trunk. What is the most likely agent causing this girl’s symptoms? a. Epstein-Barr virus b. Parvovirus B19 c. Cytomegalovirus d. Varicella-zoster virus e. Herpes simplex virus ANS: B 2. A 5-year-old girl develops erythema infectiosum with fever, chills, myalgia, and then a distinctive rash on her face that appears as if her cheeks had been slapped. Which of the UoRuSldIsNigGnT following predisposing conditionsNw ifiB ca.nC tlO yM complicate this infection? a. Anemia b. C7 complement deficiency c. Cystic fibrosis d. Diabetes e. IgA deficiency ANS: A 3. A 5-year-old girl develops erythema infectiosum with fever, chills, myalgia, and then a distinctive rash on her face that appears as if her cheeks had been slapped. Which of the following is the initial step in replication of the genome of the virus causing this disease? a. Circularization of the DNA b. Generation of a +DNA strand c. Generation of a +RNA strand d. Generation of a –RNA strand e. Integration of the +RNA genome ANS: B

Murray: Medical Microbiology, 8th Edition Chapter 46: Picornaviruses

Test Bank MULTIPLE CHOICE 1. A 5-year-old boy came home from daycare with a fever and complaining of a sore throat. His mother took him to the clinic, where the attending physician noticed an inflammation of the pharynx and distinct vesicles on the palate; a presumptive diagnosis of herpangina was made. What is the most likely etiologic agent that caused these symptoms? a. Group A Streptococcus b. Poliovirus c. Influenza virus d. Coxsackie virus e. Herpes simplex virus ANS: D 2. A 27-year-old woman presents with an abrupt onset of sneezing, runny nose, headache, and a slight sore throat that startedNtU heRpSrI evNioGuTs B da.yC. O ShMe complains of being tired, but there is no fever. The symptoms are expected to last another 5 days. Which is the most likely mode of acquisition of the infection? a. Large number of pigeons on the windowsill of her apartment b. Handshaking at a family affair c. Immunocompromised state d. Mosquito bite e. Trip to the Sonoran Desert in Arizona ANS: B 3. Virus can be readily isolated from the rash associated with which of these diseases? a. Hand-foot-and-mouth disease b. Erythema infectiosum c. Exanthem subitum d. Measles e. Rubella ANS: A 4. Eradication of natural poliovirus disease in the Western Hemisphere has prompted a switch to the inactivated vaccine. Why? a. Does not mutate

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Elicitation of a more natural immune response Lifelong immunity Potential for Herd immunity Production of secretory immunity

ANS: A 5. How does the common cold virus differ from the rest of the members of its family? a. It causes asymptomatic disease in a large percentage of the population. b. Its genomic RNA has a protein cap. c. It requires negative-strand replicative intermediate RNA. d. It is sensitive to acid inactivation. e. It is spread by the respiratory route.

ANS: D 6. An African child had fever, headache, malaise, sore throat, and vomiting, which progressed and caused flaccid paralysis of the left leg. The child had not received standard childhood vaccines. Which of the following viruses is most likely to be responsible for this disease? a. Herpes simplex virus b. Measles c. Polio d. Rabies e. West Nile encephalitis virus ANS: C 7. An African child had fever, headache, malaise, sore throat, and vomiting, which progressed and caused flaccid paralysis of the left leg. The child had not received standard childhood vaccines. How is this virus transmitted? a. Aerosols b. Animal bite c. Contact d. Fecal-oral route e. Mosquitoes ANS: D

Murray: Medical Microbiology, 8th Edition Chapter 47: Coronaviruses and Noroviruses

Test Bank MULTIPLE CHOICE 1. A 60-year-old man died 10 days after presenting with a fever of 39 C, a severe cough, shortness of breath, and pneumonia that started 4 days after a trip to China. A positivestrand RNA virus is isolated, which in electron micrographs is enveloped but has a halo appearance around the envelope. To which of the following families does the virus belong? a. Arenavirus b. Coronavirus c. Orthomyxovirus d. Paramyxovirus e. Picornavirus ANS: B 2. A 60-year-old man died 10 days after presenting with a fever of 39 C, a severe cough, shortness of breath, and pneumonN iaUthRaS t sItaNrG teT dB 4. daCyO sM after a trip to China. A positivestrand RNA virus is isolated, which in electron micrographs is enveloped but has a halo appearance around the envelope. What property does this virus have that is unusual compared to other enveloped respiratory viruses? a. Hemagglutination of erythrocytes b. Detergent stability c. Infection of animals in addition to man d. More severe presentation in older adults e. Oncogenic transformation ANS: B 3. An outbreak of gastroenteritis occurs on a cruise ship. Which of the following is the best description of the likely virus causing the disease? a. Enveloped, positive-strand DNA genome b. Enveloped, negative-strand RNA genome c. Naked capsid, positive-strand RNA genome d. Naked capsid, negative-strand RNA genome e. Naked capsid, double-strand DNA genome ANS: C

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Murray: Medical Microbiology, 8th Edition Chapter 48: Paramyxoviruses

Test Bank MULTIPLE CHOICE 1. What is one of the most common etiologic agents of lower respiratory tract infection among previously healthy patients 2 months to 5 years old? a. Chlamydophila pneumoniae b. Mycoplasma pneumoniae c. Streptococcus pneumoniae d. Respiratory syncytial virus ANS: D 2. Several patients in the pediatric ward developed flulike symptoms. Many of the sick children suffered from respiratory distress. Which virus is the most likely etiologic agent? a. Influenza B virus b. Rubella virus c. Parainfluenza virus type 4 d. Respiratory syncytial virus e. Epstein-Barr virus ANS: D 3. A 7-year-old Pakistani child is coughing and has a runny nose, conjunctivitis, and a rash. Small vesicular lesions are present in the back of the mouth. By which of the following routes is this disease transmitted? a. Aerosol b. Contact c. Fecal-oral d. Mosquito e. Tick ANS: A 4. Which of the following vaccines would not be safe for a 1-year-old boy who has DiGeorge syndrome? a. Hepatitis A b. Hepatitis B c. Influenza d. Measles e. Polio

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ANS: D 5. A college senior develops a cough, conjunctivitis, runny nose, small vesicular lesions on his buccal mucosa, and a rash. Which of the following describes the agent causing this disease? a. Double-capsid virion structure b. Promotes fusion of infected cells c. Replicates genome through a –RNA intermediate d. Resistant to detergents e. Uses cellular RNA polymerase for genome replication ANS: B 6. What is the best reason for the near disappearance of subacute sclerosing panencephalitis? a. Animal control b. Antiviral drugs c. Childhood vaccination program d. Good hygiene e. Mutation of the virus ANS: C 7. A 1-month-old baby developed severe bronchiolitis, which severely compromised the baby’s breathing. Antiviral drug therapy was initiated with which of the following drugs? a. Acyclovir b. Amantadine c. Ganciclovir d. Ribavirin e. Zanamivir ANS: D 8. A 27-year-old man who, because of religious beliefs, has never been vaccinated develops orchitis. Which of the following describes the virus responsible for this disease? a. Enveloped DNA virus b. Enveloped +RNA virus c. Enveloped –RNA virus d. Naked-capsid DNA virus e. Naked-capsid +RNA virus ANS: C

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9. A 3-month-old baby girl had severe cough, increased respiratory rate, and cyanosis.

She was treated with aerosolized ribavirin and showed improvement. Which of the following best describes the most likely agent for this infection? a. Acid-fast bacillus b. Encapsulated, gram-positive coccus c. Filamentous fungus d. Gram-negative diplococcus e. Negative-strand RNA virus ANS: E

Murray: Medical Microbiology, 8th Edition Chapter 49: Orthomyxoviruses

Test Bank MULTIPLE CHOICE 1. A poultry farmer in China experienced fatigue, malaise, sore throat, and fever. During the past 2 weeks, his poultry farm had to kill all of its chickens because of a sudden virus outbreak that almost decimated the entire flock. A neighboring farmer raises swine. The virus infecting the chicken farmer arose by antigenic shift. Which of the following best describes this process? a. An avian virus obtained specific human genetic sequences by recombination. b. A gradual accumulation of mutations in one subtype created a new strain. c. An avian strain reassociated with a human strain in swine. d. Genetic mutations were acquired by transposon-containing viral elements. e. Mutations were acquired by long terminal repeats within the viral genome.

ANS: C 2. Which of the following factors promotes the need for a new annual influenza A vaccine? a. Ability to infect animals b. Enveloped virus structure c. Error-prone DNA polymerase d. RNA genome e. Segmented genome ANS: E 3. A sudden outbreak of the H5N2 influenza virus occurred in Hong Kong, requiring the killing of millions of chickens. Which of the following would rapidly prevent disease in the owners of these chickens? a. Immunization of the human population with an H5N2 vaccine b. Immunization of the remaining chickens with an H5N2 vaccine c. Quarantine of the island d. Treatment with an inhibitor of neuraminidase e. Treatment with an inhibitor of RNA polymerase

ANS: D

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4. The pandemics of influenza that occurred in 1947 and 1977 were both caused by an H1N1 virus. Which of the following techniques would best assist in demonstrating the similarity between these two strains? a. Cytopathologic effect b. Hemagglutination c. Hemagglutination inhibition d. RT-PCR e. Southern blot ANS: D 5. Which of the following genetic mechanisms promotes the development of a pandemic strain of influenza A? a. Complementation b. Conjugation c. Reassortment d. Recombination e. Transcapsidation ANS: C

Murray: Medical Microbiology, 8th Edition Chapter 50: Rhabdoviruses, Filoviruses, and Bornaviruses

Test Bank MULTIPLE CHOICE 1. A 6-year-old child is bitten on his face by a baby raccoon that he recently found in the woods near the body of its mother. Which of the following precautions should be taken? a. Immunization with immune IgG and attenuated vaccine b. Immunization with immune IgG and killed vaccine c. Immunization with immune IgG and vaccinia-G protein hybrid vaccine d. Treatment with broad-spectrum antibiotic and immunization with attenuated vaccine e. Treatment with broad-spectrum antibiotic and immunization with killed vaccine ANS: B 2. A 47-year-old woman from Indonesia, who is visiting relatives in the United States, is brought to the emergency room after losing her balance, falling, and hurting herself. She refuses analgesics, claiming that it hurts to swallow. She seems anxious and confused.

She is treated and released but 1 wNeU ekRlSatIeN r iG sT brBo. ugChO t bMack in a coma and then dies of cardiac arrest within another week. Autopsy shows Negri bodies in brain cells. Which of the following describes the virus that causes this disease? a. Enveloped DNA virus b. Enveloped, positive-strand RNA virus c. Enveloped, negative-strand RNA virus d. Naked-capsid, positive-strand RNA virus e. Naked-capsid DNA virus ANS: C

Murray: Medical Microbiology, 8th Edition Chapter 51: Reoviruses

Test Bank MULTIPLE CHOICE 1. Several different rotavirus vaccines have been developed and are currently in human trials. The vaccine for rotavirus uniquely resembles the vaccine for which of the following? a. Measles b. Mumps c. Polio d. Yellow fever e. Small pox ANS: E 2. A 6-month-old baby develops severe diarrhea. Immunoelectron microscopy shows large quantities of a medium-sized, encapsidated virus in the stool. Which of the following describes the virus that causes this disease? a. Double-capsid, segmented, dsN RU NR ASgI enNoG mTeB.COM b. Enveloped, segmented, RNA genome c. Naked-capsid DNA genome d. Naked-capsid +RNA genome e. Naked-capsid –RNA genome ANS: A 3. A 6-month-old baby develops severe diarrhea. Immunoelectron microscopy shows large quantities of a medium-sized, encapsidated virus in the stool. A more rapid technique was developed for routine analysis of this virus. Which of the following describes the approach for detecting virions from stool? a. Add antiviral antibody to sample, then measure residual infectivity on tissueculture cells. b. Add sample to a tube with antigen immobilized to the wall of the tube, then use enzyme-linked second antibody. c. Add sample to a tube with antivirus antibody immobilized to the wall of the tube, then use enzyme-linked second antibody. d. Fix sample to slide, then add fluorescent antibody. e. Mix sample with antiviral antibody and complement, then measure residual complement activity.

ANS: C

Murray: Medical Microbiology, 8th Edition Chapter 52: Togaviruses and Flaviviruses

Test Bank MULTIPLE CHOICE 1. Why are humans not a natural reservoir for Eastern equine encephalitis virus? a. Human erythrocytes are incompatible with this virus. b. EEEV establishes an abortive infection in man. c. The virus establishes a transient viremia in man. d. The virus kills its host before transmission can occur. e. The virus mutates during infection of man.

ANS: C 2. A baby is born to a 23-year-old woman who, because of religious beliefs, has never been vaccinated. The baby is born with a small head, cataracts, and deafness. The woman recalls having a mild rash in the second trimester of her pregnancy. Which of the following descriptions fits the virus responsible for this disease? a. Enveloped DNA genome b. Enveloped +RNA genome c. Enveloped –RNA genome d. Naked-capsid DNA genome e. Naked-capsid +RNA genome ANS: B 3. Which of the following distinguishes togavirus replication from picornavirus replication? a. Production of glycoproteins from a late gene b. Replication from a full-length, negative RNA template c. Production of polyproteins d. RNA-dependent RNA polymerase encoded by virus e. Microinjection of genome is sufficient for infection ANS: A 4. Why can yellow fever, dengue fever, and West Nile encephalitis viruses undergo both jungle and urban cycles of transmission. a. Birds are a reservoir for the virus. b. These viruses establish an extended viremia in the human host. c. These viruses establish latent infection of the host and frequent recurrence. d. Asymptomatic disease promotes unknowing dissemination.

Test Bank e. The vector for these viruses grows in swamps.

ANS: B

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Murray: Medical Microbiology, 8th Edition Chapter 53: Bunyaviridae and Arenaviridae

Test Bank MULTIPLE CHOICE 1. Several ranchers in the southwestern United States showed signs of respiratory distress syndrome. The Centers for Disease Control and Prevention was notified and traced the outbreak to an animal vector. Using PCR analysis as a diagnostic test, the causative agent was identified. What is the most likely etiologic agent and mode of transmission? a. Rabies virus by dog bite b. West Nile virus by mosquito bite c. Hantavirus by inhalation of rodent excreta d. Legionella pneumophila by inhalation of spores e. Mycobacterium tuberculosis by exposure to bird droppings ANS: C 2. A 35-year-old man returns from Africa after attending the funeral of his father and mother. He has serious flulike symptoms and then begins to bleed from his nose and cough up blood. He dies within 2 N wU eeRkS sI ofNrG etT urBn. inC gO toMthe United States. A virus with a sandy internal appearance was isolated from the father’s blood in a special containment facility. What is the usualreservoir for this disease? a. Aedes mosquito b. Anopheles mosquito c. Mouse d. Sandfly e. Tick ANS: C 3. A 7-year-old boy attending summer camp in Ohio suddenly has a headache, nausea, and fever, is very lethargic, and has a stiff neck. An examination of his CSF shows inflammatory cells. He recovers within 6 days. La Crosse virus is suspected. What is the major risk factor that promoted this child’s infection? a. Contaminated drinking water source b. Contaminated food c. Contaminated swimming site d. Fatigue e. Forest environment ANS: E

Murray: Medical Microbiology, 8th Edition Chapter 54: Retroviruses

Test Bank MULTIPLE CHOICE 1. Why do AIDS patients have an increased risk of developing progressive multifocal leukoencephalopathy (PML)? a. Cell-mediated immunity is necessary to prevent prion infections. b. Immunodeficiency predisposes patients to development of PML. c. Infection with JC virus is much more common among AIDS patients. d. JC virus preferentially replicates in CD4+ lymphocytes. e. JC virus is a sexually transmitted disease.

ANS: B 2. A 35-year-old man with HIV presents with a severe cough, blood-streaked sputum, night sweats, weight loss, and a low CD4 count. An acid-fast staining bacillus is isolated from the sputum. The decrease in T cells in this man has resulted in a reduction in the production of which of the following cytokines, resulting in the disease described by these symptoms? a. GM-CSF b. IL-4 c. IL-6 d. IFN-γ e. TGF-β ANS: D 3. A 47-year-old man with a painful, white coating on his tongue and mouth. Gram stain of the organism shows budding and filamentous structures. He also suffers from retinitis and complains of shortness of breath. Which describes the most likely CD4 count (per mm3) for this patient? a. >5000 b. >2000 c. 1000 d. 500 e. 50 ANS: E 4. A 35-year-old man develops retinitis, pneumonitis, and a thrush infection of his mouth.

Which describes the most appropriate therapy?

Test Bank a. b. c. d. e.

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IFN-γ, TNF-α, IL-2 Acyclovir and famciclovir Amantadine and oseltamivir Abacavir, zidovudine, and lamivudine Zidovudine

ANS: D 5. A 35-year-old man develops retinitis, pneumonitis, and a thrush infection of his mouth.

Analysis of his blood indicates that his CD4 T-cell level is at 50 per mm3. Which of the following is an appropriate target for antiviral drug therapy for this virus? a. DNA-dependent RNA polymerase b. Thymidine kinase c. Neuraminidase d. RNA-dependent DNA polymerase e. RNA-dependent RNA polymerase ANS: D 6. A 35-year-old man develops retinitis, pneumonitis, and a thrush infection of his mouth.

Analysis of his blood indicates that his CD4 T-cell level is at 50 per mm3. Which of the following receptors is on myeloid but not all T-cell targets and is necessary for the initial infection of the individual? a. CD4 b. CD21 C3d complement receptor c. Erythrocyte blood group P antigen d. CXCR4 e. CCR5 ANS: E 7. A 59-year-old Japanese native develops acute T-cell lymphocytic leukemia and is seropositive for HTLV-1. Which of the following mechanisms does the virus use to promote the onset of the leukemia? a. Chromosomal translocation of myc gene to the immunoglobulin gene b. Enhanced production of IL-2 and IL-2 receptor c. Production of an activated tyrosine kinase d. Production of an activated G protein e. Production of the myc protein ANS: B

Test Bank

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8. A 25-year-old sexually active woman complains of being extremely tired and has swollen glands, fever of 39° C, and a slight rash. She noted that her boyfriend developed a serious yeast infection of his mouth and has lost considerable weight recently. Serology results indicate that she has antibodies for Epstein-Barr virus membrane antigen, VCA, and EBNA but no heterophile antibodies. Which of the following tests should be performed to confirm the diagnosis? a. ELISA b. Monospot test c. PCR d. Reverse transcriptase PCR e. Virus isolation ANS: D

Murray: Medical Microbiology, 8th Edition Chapter 56: Prion Diseases

Test Bank MULTIPLE CHOICE 1. More than 100 cases of variant Creutzfeldt-Jacob disease (vCJD) have been diagnosed in Great Britain. How were these cases thought to have occurred? a. Transmission of the agent from contaminated cows to humans b. Contaminated stocks of human growth hormone c. Development of new mutations in the human PrP gene d. Contamination of the food chain with genetically modified organisms e. JC virus epidemic ANS: A 2. A 65-year-old woman complained of severe headache and at the time had a constant tremor of the left hand. Within 1 month, she experienced memory loss and confusion.

Her condition continued to deteriorate. Within 3 months, she was in a coma but underwent occasional clonic twitching and startle myoclonic jerking to loud noises. The patient died of pneumonia after 4 N mUoR ntS hsI. N AG utT opBs. y CreOsuMlts revealed no inflammation, but intracellular vacuolation was present throughout the cerebral cortex, indicative of a spongiform encephalopathy. The lack of inflammation in this disease is related to which of the following? a. Activation of T-suppressor cells b. Direct cell-cell transmission of agent c. Inhibition of complement cascade d. Killing of CD4 T cells e. Tolerance to host proteins ANS: E 3. Within a 4-month period, a 65-year-old man progressed from problems with muscle coordination and experiencing myoclonic jerks and tremors to dementia, coma, and then death. No gross abnormalities in the brain were noted at autopsy; however, vacuolation was observed throughout the cerebral cortex on microscopic examination. For which of the following characteristics is this disease noted? a. Cowdry type A inclusion bodies b. Cytolysis of microglial cells c. Inhibition of neuronal protein synthesis d. Lack of T-cell activation e. Transformation of astrocytes

Test Bank

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ANS: D 4. Within a 4-month period, a 65-year-old man progressed from problems with muscle coordination and experiencing myoclonic jerks and tremors to dementia, coma, and then death. No gross abnormalities in the brain were noted at autopsy; however, vacuolation was observed throughout the cerebral cortex on microscopic examination. Which of the following is characteristic of the agent that causes this disease? a. Transmitted by mosquitoes b. Encodes a DNA polymerase c. Induces syncytia formation d. Replicates through a +RNA intermediate e. Resistant to standard disinfection procedures ANS: E

Murray: Medical Microbiology, 8th Edition Chapter 60: Laboratory Diagnosis of Fungal Diseases

Test Bank MULTIPLE CHOICE 1. The term dematiaceous is used to describe which of the following? a. Molds that have septate hyphae b. Molds that have pauciseptate hyphae c. The presence of pigmentation within the hyphae or the spores d. The absence of pigmentation within the hyphae or the spores ANS: C 2. Features of the fungi as a group include which of the following? a. Presence of chitin in the cell wall b. Presence of ergosterol in the cell membrane c. Reproduction by means of spores, either asexually or sexually d. Heterotopic nature e. All of the above ANS: E 3. Optimal recovery of fungi from specimens in the clinical microbiology laboratory requires which of the following? a. Media with and without blood enrichment b. Incubation at 35° C c. Relative humidity in the range of 10% to 20% d. Use of decontamination and concentration methods e. All of the above ANS: E 4. Which group of molds characteristically produce large, ribbonlike hyphae that are irregular in diameter and contain only occasional septa? a. Dermatophytes b. Zygomycetes c. Dimorphic fungi d. Dematiaceous fungi ANS: B

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5. Immunocompromised patients, particularly those who have uncontrolled diabetes mellitus and those who are receiving prolonged corticosteroid, antibiotic, or cytotoxic therapy, are at greatest risk of developing infection with which of the following? a. Dermatophytes b. Zygomycetes c. Dimorphic fungi d. Dematiaceous fungi ANS: B 6. Large, spherical, thick-walled yeast cells 8 to 15 µm in diameter, often with a single bud that is connected to the parent cell by a broad base, usually indicate infection with which of the following? a. Coccidioides immitis b. Blastomyces dermatitidis c. Histoplasma capsulatum d. Paracoccidioides brasiliensis ANS: B 7. The presence of nonbudding, thick-walled spherules, 20 to 200 µm in diameter, containing either granular material or numerous small, nonbudding endospores, usually indicates infection with which of the following? a. Coccidioides immitis b. Blastomyces dermatitidis c. Histoplasma capsulatum d. Paracoccidioides brasiliensis ANS: A

Murray: Medical Microbiology, 8th Edition Chapter 62: Superficial and Cutaneous Mycoses

Test Bank MULTIPLE CHOICE 1. The patient had a ringlike rash on his scalp. The fungi causing this infection share which common feature? a. Branching macroconidia structure b. Dimorphic pathogens c. Metabolism of keratin d. Primarily an opportunistic infection e. Sensitivity to amphotericin ANS: C

Murray: Medical Microbiology, 8th Edition Chapter 63: Subcutaneous Mycoses

Test Bank MULTIPLE CHOICE 1. A gardener has a nodular infection that is progressing along the draining lymphatics from the site where a rose thorn had pricked her hand 2 weeks earlier. Which of the following agents is most likely responsible for the infection? a. Candida albicans b. Mycobacterium marinum c. Sporothrix schenckii d. Staphylococcus aureus e. Tinea capitis ANS: C 2. A gardener develops a series of nodular skin lesions on her lower arm, and the draining lymph node is swollen. Which of the following fungi is the most likely cause of this disease? a. Blastomyces dermatitidis b. Coccidioides immitis c. Pneumocystis carinii d. Sporothrix schenckii e. Trichosporon beigelii ANS: D

Murray: Medical Microbiology, 8th Edition Chapter 64: Systemic Mycoses Caused by Dimorphic Fungi

Test Bank MULTIPLE CHOICE 1. A 45-year-old man with HIV has a chronic headache, fever, and a stiff neck. Infection with Cryptococcus neoformans is suspected. Which of the following tests would be performed to confirm the diagnosis? a. Growth on Sabouraud’s dextrose agar b. Antibody test c. Antigen test d. Skin test for DTH e. Treatment with 10% potassium hydroxide ANS: C 2. Which of the following fungal infections is correctly associated with its primary risk factor? a. Candida albicans: gardening b. Coccidioides immitis: trip to ANfU ricRaSINGTB.COM c. Cryptococcus neoformans: working with sheep d. Histoplasma capsulatum: cave exploring in Ohio e. Sporothrix schenckii: immunodeficiency ANS: D

Murray: Medical Microbiology, 8th Edition Chapter 69: Pathogenesis of Parasitic Diseases

Test Bank MULTIPLE CHOICE 1. A 41-year-old patient with AIDS developed headaches, weakness, and slurred speech.

A cryptococcal antigen test of the patient’s spinal fluid was negative. A brain scan revealed multiple ring-enhancing lesions. The infectious agent causing the neurologic symptoms in this patient was most likely transmitted by which of the following? a. Dissemination from vegetation on a heart valve b. Ingestion of oocysts c. Inhalation of infective arthroconidia d. Sexual contact e. Person-to-person spread by respiratory droplet ANS: B

Murray: Medical Microbiology, 8th Edition Chapter 71: Laboratory Diagnosis of Parasitic Disease

Test Bank MULTIPLE CHOICE 1. Which statement is true about the direct wet mount as part of the O&P (Ova and Parasite) examination? a. It requires freshly passed, unpreserved stool. b. It is designed to allow detection of motile helminth ova. c. It is examined microscopically at low, high, dry, and oil-immersion magnifications. d. It is performed for specimens received in the laboratory in stool-collection preservatives. e. All of the above ANS: A 2. The eggs of which intestinal parasite are not commonly found in feces and must be detected by other diagnostic techniques? a. Giardia lamblia b. Cryptosporidium parvum c. Clonorchis sinensis d. Enterobius vermicularis e. Ascaris lumbricoides ANS: D 3. The examination of spinal fluid may reveal which parasitic agent of meningoencephalitis? a. Ascaris lumbricoides b. Strongyloides stercoralis c. Paragonimus westermani d. Naegleria fowleri ANS: D 4. What is the most common larvae found in stool specimens? a. Ascaris lumbricoides b. Strongyloides stercoralis c. Paragonimus westermani d. Naegleria fowleri

Test Bank

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ANS: B 5. An amoebic trophozoite described as 20 to 30 microns, with fine, uniform, nuclear peripheral chromatin, small central karyosome, and finely granular cytoplasm was isolated from an individual with hepatic amebiasis. Which of the following would most likely be the microbe? a. Entamoeba histolytica b. Entamoeba coli c. Cryptosporidium parvum d. Entamoeba hartmanni ANS: A 6. Which species of Schistosoma has a prominent lateral spine? a. Schistosoma japonicum b. Schistosoma haematobium c. Schistosoma mansoni d. Schistosoma mekongi ANS: C

Murray: Medical Microbiology, 8th Edition Chapter 73: Intestinal and Urogenital Protozoa

Test Bank MULTIPLE CHOICE 1. A 17-year-old summer camp counselor has been shunned by his bunkmates because of his profuse, foul-smelling diarrhea. The diarrhea is not bloody. The problem started approximately 14 days after returning from a survivalist camping trip into the woods.

Identification of which of the following structures in the stool would be diagnostic? a. Cryptosporidium sporozoite b. Giardia lamblia trophozoite c. Toxoplasma gondii oocyst d. Ascaris lumbricoides egg e. Schistosoma mansoni egg ANS: B 2. A 30-year-old woman experienced frequent and foul-smelling diarrhea with abdominal cramping and flatus approximately 2 weeks after backpacking in the Bridger National Wilderness in Colorado. Cysts wiN thUfR ouSr I nuNcGleTi B an.dCfO ouMr parabasal bodies and an occasional flagellated trophozoite with two nuclei are observed in the stool. Which of the following is most likely the cause of these symptoms? a. Cryptosporidium parvum b. Diphyllobothrium latum c. Entamoeba coli d. Giardia lamblia e. Trichuris trichiura ANS: D

Murray: Medical Microbiology, 8th Edition Chapter 74: Blood and Tissue Protozoa

Test Bank MULTIPLE CHOICE 1. A 65-year-old missionary is seen on an emergency basis in November complaining of fever and chills which recur every 48 hours. Which of the following details from the patient history would be most helpful in making the diagnosis? a. Failed to get annual influenza immunization b. Family member with runny nose and fever c. Recent meal from a street vendor d. Recent return from mission in Liberia e. Undergoing therapy for prostate cancer ANS: D

Murray: Medical Microbiology, 8th Edition Chapter 75: Nematodes

Test Bank MULTIPLE CHOICE 1. A butcher complains of fever, muscle pains, and weakness. A CBC revealed eosinophilia, and a muscle biopsy showed spiral-shaped encysted larvae. Which of the following is the most likely source of the infection? a. Bite of a tsetse fly b. Contact with cysts obtained from cat feces c. Drinking water on a camping trip d. Tasting of pork sausage ingredients e. Walking through ponds filled with snails ANS: D

The publisher did not release test bank questions for the following chapters 1,2,3,4,37,55,57,58,59,61,65,66,67,68,70,72,76,77,78