TEST BANK for Microbiology Basic and Clinical Principles 2nd Edition Lourdes P. Norman-McKay by ACADEMIAMILL

Microbiology: Basic & Clinical Principles, 2e (Norman-McKay) Chapter 1 Introduction to Microbiology 1.1 Multiple Choice Questions 1) Which of the following is not a microorganism? A) bacteria B) archaea C) fungi D) mosquito E) helminth Answer: D Chapter/Section: 1.1 Learning Outcome: 1.1 Bloom's Taxonomy: 1-2: Remembering/Understanding 2) When do opportunistic pathogens tend to cause disease? A) when the host is weakened B) when the host has recently traveled to a remote area C) when the host is young D) when the host is pregnant E) when the host didn't wash with soap Answer: A Chapter/Section: 1.1 Learning Outcome: 1.2 Bloom's Taxonomy: 1-2: Remembering/Understanding 3) Which of the following could be used as evidence for spontaneous generation? A) Uncovered meat will give rise to maggots. B) The meat in gauze-covered jars will not give rise to maggots. C) The broth in Pasteur's S-necked flasks did not spoil. D) Tilting Pasteur's S-necked flasks did spoil the broth. E) Flies lay eggs that develop into maggots. Answer: A Chapter/Section: 1.1 Learning Outcome: 1.3 Bloom's Taxonomy: 1-2: Remembering/Understanding

4) ________ showed that biogenesis is responsible for the propagation of life. A) Louis Pasteur B) Robert Hooke C) Antonie van Leeuwenhoek D) Joseph Lister E) Carl Linnaeus Answer: A Chapter/Section: 1.1 Learning Outcome: 1.3 Bloom's Taxonomy: 1-2: Remembering/Understanding 5) Robert Koch helped establish the germ theory of disease by discovering that anthrax was caused by a bacterial microorganism. After he isolated and purified the same bacteria from several diseased animals, what would be the next step in order to show that this bacteria caused anthrax? A) perform physiological testing B) introduce the bacteria into a new mouse to see if it established the same infection C) visualize the bacteria with an electron microscope D) culture the bacteria on Petri dishes E) find out if antibiotics treat the diseased animals Answer: B Chapter/Section: 1.1 Learning Outcome: 1.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 6) How many principles are there in Koch's postulates of disease? A) 1 B) 2 C) 3 D) 4 E) 5 Answer: D Chapter/Section: 1.1 Learning Outcome: 1.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 7) Aseptic technique can be used for all of the following except A) preventing healthcare-acquired infections. B) safely studying microbes in the laboratory. C) keeping samples pure for studying. D) replacing gloves instead of hand washing when time is short. E) limiting the spread of diseases. Answer: D Chapter/Section: 1.1 Learning Outcome: 1.5 Bloom's Taxonomy: 1-2: Remembering/Understanding 2 Copyright © 2023 Pearson Education, Inc.

8) Which of the following individuals does not correctly match with their contribution to microbiology? A) Ignaz Semmelweis: First developed aseptic techniques to decrease mortality rates from childbed fever B) Joseph Lister: Developed the first anesthetic solution for use in surgeries C) Florence Nightingale: Established the use of aseptic techniques in nursing practices D) Robert Koch: Developed criteria for determining the causative agent of an infectious disease E) Louis Pasteur: Showed that biogenesis is responsible for the propagation of life Answer: B Chapter/Section: 1.1 Learning Outcome: 1.6 Global LO: G2 Bloom's Taxonomy: 3-4: Applying/Analyzing 9) The scientific method starts with a(n) A) hypothesis. B) prediction. C) observation. D) question. E) proposal. Answer: D Chapter/Section: 1.1 Learning Outcome: 1.7 Global LO: G1 Bloom's Taxonomy: 1-2: Remembering/Understanding 10) Inference-observation confusion occurs when someone A) jumps to a conclusion. B) cannot understand your accent. C) remembers events wrong. D) lies about what happened. E) incorrectly assesses a patient. Answer: A Chapter/Section: 1.1 Learning Outcome: 1.7 Global LO: G1 | G2 Bloom's Taxonomy: 3-4: Applying/Analyzing

11) ________ predict what happens, while ________ explain how and why something occurs. A) Theories; laws B) Hypotheses; conclusions C) Laws; theories D) Observations; hypotheses E) Observations; conclusions Answer: C Chapter/Section: 1.1 Learning Outcome: 1.7 Global LO: G1 Bloom's Taxonomy: 1-2: Remembering/Understanding 12) Which of the following is the correct way to type a scientific name? A) escherichia coli B) Escherichia Coli C) escherichia coli D) Escherichia coli E) Escherichia coli Answer: D Chapter/Section: 1.2 Learning Outcome: 1.10 Bloom's Taxonomy: 1-2: Remembering/Understanding 13) What is the order of the taxonomic hierarchy from least specific to most specific? A) species, genus, order, family, class, phylum, kingdom, domain B) domain, kingdom, phylum, class, order, family, genus, species C) class, order, phylum, kingdom, domain, genus, family, species D) domain, phylum, order, kingdom, class, family, genus, species E) domain, order, class, kingdom, phylum, species, family, genus Answer: B Chapter/Section: 1.2 Learning Outcome: 1.8 Bloom's Taxonomy: 1-2: Remembering/Understanding 14) All of the following are reasons to classify a new strain of bacteria except A) mutations. B) gene transfers. C) take up genetic material from their environment. D) 50% different genetic material. E) genetic variant. Answer: D Chapter/Section: 1.2 Learning Outcome: 1.9 Bloom's Taxonomy: 1-2: Remembering/Understanding

15) Why can't prokaryotic species be defined as a group of similar organisms that could sexually reproduce together? A) Bacteria reproduce asexually. B) Bacteria are all too different to be considered similar. C) The mating rituals of bacteria have not been studied enough. D) They can be. E) We can't see them in enough detail to tell how similar they really are yet. Answer: A Chapter/Section: 1.2 Learning Outcome: 1.8 | 1.10 ASM LO: 1.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 16) Normal microbiota are responsible for all of the following except A) training our immune system. B) producing vitamins for us. C) helping us digest foods. D) inducing spontaneous mutations in our genome. E) impacting our moods and brain functions. Answer: D Chapter/Section: 1.2 Learning Outcome: 1.12 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 17) Which of the following does not contribute to shifts in our normal microbiota? A) hormonal changes B) diet C) age D) proper hand-washing technique E) our general environment Answer: D Chapter/Section: 1.2 Learning Outcome: 1.12 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding

18) Microbes and humans have evolved a variety of ________ relationships, including ________ where microbes help the host. A) commensal; mutualism B) symbiotic; parasitism C) symbiotic; commensalism D) dynamic; commensalism E) symbiotic; mutualism Answer: E Chapter/Section: 1.2 Learning Outcome: 1.11 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 19) Carriers of the sickle-cell gene A) are more likely to die from a malaria infection. B) are more susceptible to contracting malaria. C) have a survival advantage in areas where malaria is common. D) are often found in high concentrations in U.S. cities. E) experience painful changes in nerve cell shape. Answer: C Chapter/Section: 1.2 Learning Outcome: 1.13 Bloom's Taxonomy: 1-2: Remembering/Understanding 20) Which of the following is true about bioremediation? A) Bioremediation never harms the environment. B) Bioremediation will use genetically-modified organisms to break down the chemicals found in the spill zone. C) The Environmental Protection Agency documents a handful of chemical spills per year in the United States alone. D) Antibiotics are used to seed the spill zone to prevent growth of unwanted microbial species. E) Nitrogen, sulfur, phosphate, and sometimes iron supplements are added to the spill zone to encourage microbial growth. Answer: E Chapter/Section: 1.2 Learning Outcome: 1.15 ASM LO: 6.3 Bloom's Taxonomy: 1-2: Remembering/Understanding

21) All of the following are or can be produced by microbes except A) food like chocolate. B) drugs like penicillin. C) consumer products like biodegradable plastics. D) electronics like computer memory. E) biofuels like diesel. Answer: D Chapter/Section: 1.2 Learning Outcome: 1.15 ASM LO: 6.3 Bloom's Taxonomy: 1-2: Remembering/Understanding 22) All of the following may involve biofilms except A) kidney stones. B) inner ear infections. C) atherosclerosis. D) endocarditis. E) Influenza. Answer: E Chapter/Section: 1.2 Learning Outcome: 1.14 Global LO: G2 ASM LO: 5.2 Bloom's Taxonomy: 3-4: Applying/Analyzing 23) When ________ bacteria attach to a surface and begin to replicate, creating multiple layers, sticky communities called ________ may form. A) planktonic; biofilms B) pathogenic; quorums C) plaque; microbiota D) infectious; flora E) matrix; cavities Answer: A Chapter/Section: 1.2 Learning Outcome: 1.14 ASM LO: 5.2 Bloom's Taxonomy: 1-2: Remembering/Understanding

24) Which of the following statements is true? A) Media for bacterial growth only comes in a few varieties. B) Picking which type of media format to use depends only on the space available. C) Picking which type of media to use depends on how much money the researcher is willing to spend. D) Agar is used as a solidifying agent for bacterial culture media. E) Scientists were not able to grow bacteria in the lab until the creation of the Petri dish. Answer: D Chapter/Section: 1.3 Learning Outcome: 1.16 Bloom's Taxonomy: 1-2: Remembering/Understanding 25) When practicing aseptic culturing techniques, it is important to keep all of the following in mind except A) as long as nothing unintended touches the media, there will be no contamination. B) the media used to grow the specimen is sterile. C) all of the instruments and lab ware that directly touch the specimen is sterile. D) surrounding surfaces are decontaminated before and after handling cultures. E) gloves and other protecting clothing may be required depending on the specimen being used. Answer: A Chapter/Section: 1.3 Learning Outcome: 1.17 Bloom's Taxonomy: 1-2: Remembering/Understanding 26) A biological safety cabinet minimizes the chances of contaminating cultures by all of the following except A) limiting access to inside the cabinet. B) maintaining a specific flow of filtered air. C) readily being decontaminated using UV light. D) regular surface cleaning with an antimicrobial solution. E) consistent flame sterilization on the inside surfaces. Answer: E Chapter/Section: 1.3 Learning Outcome: 1.17 Bloom's Taxonomy: 1-2: Remembering/Understanding 27) The goal of the streak plate technique is to A) compare all of the colonies on a plate with a mixed culture. B) visualize all of the colonies on a plate from a pure culture. C) isolate a pure culture for study from a single colony. D) spread out a thick layer of bacteria and isolate the bacteria that outcompete the rest. E) compare how the shape, color, and margin differ in colonies from a pure culture. Answer: C Chapter/Section: 1.3 Learning Outcome: 1.18 Bloom's Taxonomy: 1-2: Remembering/Understanding 8 Copyright © 2023 Pearson Education, Inc.

28) Which of the following can be determined using simple stains? A) the presence of a waxy cell wall B) the number and position of flagella C) the presence of capsules D) the presence of endospores E) size, shape, and cellular arrangement Answer: E Chapter/Section: 1.3 Learning Outcome: 1.19 ASM LO: 2.3 Bloom's Taxonomy: 1-2: Remembering/Understanding 29) All of the following can make interpreting the Gram stain difficult except A) the culture is between 24 and 48 hours old. B) testing bacteria that have a waxy cell wall. C) testing bacteria that are forming endospores. D) the culture is more than 48 hours old and contains damaged cells. E) testing bacteria with especially resistant cell walls. Answer: A Chapter/Section: 1.3 Learning Outcome: 1.20 Bloom's Taxonomy: 1-2: Remembering/Understanding 30) The acid-fast stain is an important diagnostic tool for detecting the causative agent(s) of A) gonorrhea. B) tuberculosis and leprosy. C) plague. D) malaria. E) Lyme disease and necrotizing fasciitis. Answer: B Chapter/Section: 1.3 Learning Outcome: 1.21 Bloom's Taxonomy: 1-2: Remembering/Understanding 31) Which of the following statements is true about the decolorizing step for the acid-fast stain? A) The decolorizing step is the differentiating step. B) Over-decolorizing can lead to false-positive results. C) Acetone-alcohol solution is the decolorizing agent. D) Because acid-fast bacteria have a waxy cell wall that resists decolorization by the acetonealcohol rinse, they appear a deep blue at the end of the procedure. E) Non-acid-fast bacteria appear bright pink-red at the end of the procedure. Answer: A Chapter/Section: 1.3 Learning Outcome: 1.21 Global LO: G2 Bloom's Taxonomy: 1-2: Remembering/Understanding 9 Copyright © 2023 Pearson Education, Inc.

32) Which of the following statements about bright field microscopy is true? A) Bright field microscopy is great for seeing living samples. B) Dark field, phase contract, and differential interference contract microscopy are better for observing dead samples. C) Bright field microscopy is the simplest and most common form of microscopy. D) Bright field microscopy is able to see specimens without natural coloration. E) Bright field microscopy has the sample appear as a brighter contrasting image on a dark background. Answer: C Chapter/Section: 1.3 Learning Outcome: 1.22 ASM LO: 2.1 Bloom's Taxonomy: 1-2: Remembering/Understanding 33) Which of the following statements is false? A) Resolution is the ability to distinguish two distinct points as separate. B) Immersion oil is used to get a better resolution at high-power magnifications. C) Ultimately, the resolving power of bright field microscopes is limited by the wavelength of visible light. D) Immersion oil has a lower refractive index than the glass slide to help increase sample clarity. E) Immersion oil channels as much light as possible up through the objective lens instead of being bent. Answer: D Chapter/Section: 1.3 Learning Outcome: 1.23 ASM LO: 2.1 Bloom's Taxonomy: 1-2: Remembering/Understanding 34) Which of the following statements is false? A) Scanning electron microscopy provides information about surface structures. B) Transmission electron microscopy provides information about internal structures. C) Immunofluorescence is when fluorochromes bind to a specific target and fluoresce after exposure to UV light. D) Fluorescence microscopy is when fluorochromes stain a sample so it will fluoresce when exposed to UV light. E) Fluorochromes can be natural or synthetic. Answer: C Chapter/Section: 1.3 Learning Outcome: 1.24 ASM LO: 2.1 Bloom's Taxonomy: 1-2: Remembering/Understanding

35) Why do electron microscopes have a better resolution than light microscopes? A) An electron beam has a wavelength of about 800 nm, and resolution improves with larger wavelengths. B) An electron beam has a wavelength of about 1 nm, and resolution improves with smaller wavelengths. C) The lenses used to focus the electron beam are more adjustable than the ones in a light microscope. D) The lenses, knobs, and strength of the electron beam can all be highly controlled, which also explains why electron microscopes are so expensive. E) The additional steps necessary to prepare the sample for viewing provide the improved resolution. Answer: B Chapter/Section: 1.3 Learning Outcome: 1.24 ASM LO: 2.1 Bloom's Taxonomy: 1-2: Remembering/Understanding 36) Louis Pasteur's S-necked flask experiment strengthened the theory of A) spontaneous generation. B) biogenesis. C) abiogenesis. D) evolution. E) specific gravity. Answer: B Chapter/Section: 1.1 Learning Outcome: 1.3 Bloom's Taxonomy: 1-2: Remembering/Understanding 37) For which of the following situations could Koch's Postulates be used? A) Determining that an outbreak of measles in a school could be traced to someone who had recently traveled to an area where measles was endemic. B) Studying the relationship between diet and exercise on rates of heart disease in an elderly population. C) Determining whether a vaccine could prevent the spread of influenza in a population. D) Determining the specific genus and species of the bacterial organism that causes cholera. E) Determining how a breakdown in proper aseptic technique caused an outbreak of C. difficile in a local hospital. Answer: D Chapter/Section: 1.1 Learning Outcome: 1.4 Global LO: G2 Bloom's Taxonomy: 3-4: Applying/Analyzing

38) Which of the following type of microbe is always unicellular? A) fungi B) helminths C) protists D) bacteria E) viruses Answer: D Chapter/Section: 1.2 Learning Outcome: 1.8 Bloom's Taxonomy: 1-2: Remembering/Understanding 39) All of the following correctly describe a bacterial colony except A) All of the cells in a colony presumably arose from a single parent cell and are clones of one another. B) The best way to produce a colony is the streak plate method. C) A variation in size between different colonies on a streak plate indicates that the culture is contaminated. D) A pure culture can be obtained from a mixed culture by isolating bacterial colonies. E) Different species of bacteria will produce distinctive colonies that can aid in identification. Answer: C Chapter/Section: 1.3 Learning Outcome: 1.18 ASM LO: 8.2 Bloom's Taxonomy: 3-4: Applying/Analyzing 40) A student was in a hurry to finish lab and forgot to apply the final counterstain (safranin) during a Gram stain procedure. Which statement below best describes the expected result when the stain is viewed under the microscope? A) There would be no effect on Gram-positive cells, but Gram-negative cells would not be visible. B) There would be no effect on Gram-negative cells, but Gram-positive cells would not be visible. C) Any Gram-negative cells in the stain would appear to be Gram-positive. D) Any Gram-positive cells in the stain would appear to be Gram-negative. E) All cells in the stain would be bright pink. Answer: A Chapter/Section: 1.3 Learning Outcome: 1.20 Global LO: G2 ASM LO: 2.1 Bloom's Taxonomy: 3-4: Applying/Analyzing

41) A researcher needs to view the details of the entry of a virus into a host cell. Which of the following microscopic techniques would be most appropriate? A) Bright field light microscopy B) Dark field microscopy C) Transmission electron microscopy D) Scanning electron microscopy E) Fluorescence microscopy Answer: C Chapter/Section: 1.3 Learning Outcome: 1.24 Bloom's Taxonomy: 3-4: Applying/Analyzing 1.2 True/False Questions 1) Robert Hooke refined earlier versions of the microscope and became the first to see bacteria. Answer: FALSE Chapter/Section: 1.1 Learning Outcome: 1.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 2) Florence Nightingale investigated processes for aseptic surgery and her work in the 1860s proved that sterilizing instruments, and sanitizing wounds with carbolic acid encouraged healing and prevented pus formation. Answer: FALSE Chapter/Section: 1.1 Learning Outcome: 1.6 Bloom's Taxonomy: 1-2: Remembering/Understanding 3) Only a small minority of microbes are human pathogens. Answer: TRUE Chapter/Section: 1.2 Learning Outcome: 1.11 Bloom's Taxonomy: 1-2: Remembering/Understanding 4) Proper hand-washing technique can disrupt normal microbiota. Answer: FALSE Chapter/Section: 1.2 Learning Outcome: 1.12 Bloom's Taxonomy: 1-2: Remembering/Understanding 5) Biofilms allow microbes to coordinate responses within an environment, making the community much more durable than single free-floating bacteria. Answer: TRUE Chapter/Section: 1.2 Learning Outcome: 1.14 ASM LO: 5.2 Bloom's Taxonomy: 1-2: Remembering/Understanding 13 Copyright © 2023 Pearson Education, Inc.

6) Fixation adheres the sample to the slide, so that it is not as easily washed away during the staining process, but does not kill most of the cells in the specimen. Answer: FALSE Chapter/Section: 1.3 Learning Outcome: 1.19 Bloom's Taxonomy: 1-2: Remembering/Understanding 7) Simple staining techniques use only one dye. Answer: TRUE Chapter/Section: 1.3 Learning Outcome: 1.19 Bloom's Taxonomy: 1-2: Remembering/Understanding 8) Knowing the Gram property of a specimen has important clinical implications, including potential pathogenic features of the organism, and what antibiotics might be most effective in combating it. Answer: TRUE Chapter/Section: 1.3 Learning Outcome: 1.20 ASM LO: 2.2 Bloom's Taxonomy: 1-2: Remembering/Understanding 9) Fungi are always unicellular. Answer: FALSE Chapter/Section: 1.1 Learning Outcome: 1.1 Bloom's Taxonomy: 1-2: Remembering/Understanding 1.3 Essay Questions 1) Explain the differences between a hypothesis, law, and theory. Answer: A hypothesis is based on prior experience or observation, and is proposed as a potential answer to a specific question. A law is a precise statement, or mathematical formula, that predicts a specific occurrence. Laws only hold true under carefully defined and limited circumstances. By contrast, a theory is a hypothesis that has been proven through many studies with consistent, supporting conclusions. Laws predict what happens, while theories explain how and why something occurs. Unlike a hypothesis, which focuses on a specific problem, theories are comprehensive bodies of work that are useful for making generalized predictions about natural phenomena. Theories unite many different hypotheses and laws. Chapter/Section: 1.1 Learning Outcome: 1.7 Global LO: G8 Bloom's Taxonomy: 1-2: Remembering/Understanding

2) Explain how disruptions in normal microbiota can lead to infections. Answer: When an antibiotic is used, it may kill many types of benign resident bacteria along with the pathogen being targeted. With normal microbiota reduced, opportunistic pathogens are able to establish infections. A common example of this is when a woman takes antibiotics to treat a urinary tract infection (UTI), only to develop a vaginal yeast infection soon after the antibiotic therapy concludes. The yeast Candida albicans is an opportunistic pathogen that is usually present in the vagina. Its growth is kept in check by the normal microbiota of the vagina. Thus, when the vaginal normal microbiota is disrupted, the yeast has an opportunity to thrive and cause symptoms. Similarly, diarrhea is a common side effect of antibiotic therapies, likely due to how our gut microbiome is affected. Chapter/Section: 1.2 Learning Outcome: 1.12 Global LO: G8 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 3) Explain the differences between basic and acidic dyes and how they are used. Answer: Basic dyes are mildly basic on the pH scale. Being basic means they are positively charged, resulting in the stain being attracted to the negatively charged cell surface of microbes and easily entering cells. Frequently used basic dyes include methylene blue, crystal violet, safranin, and malachite green. Occasionally acidic dyes, such as nigrosin or India ink, are also used. Acidic dyes are negatively charged, so they do not easily enter cells. They stain the background of a specimen in a technique called negative staining. An advantage of negative staining is that it doesn't require heating or chemical fixation, and the dye is not absorbed by the sample. This means the sample has a more true-to-life appearance, with fewer distortions of delicate cellular features. Chapter/Section: 1.3 Learning Outcome: 1.19 Global LO: G8 Bloom's Taxonomy: 1-2: Remembering/Understanding

4) Discuss Louis Pasteur's S-necked flask experiment. Specifically, how did he disprove spontaneous generation? What were his positive and negative experimental controls? Answer: Louis Pasteur used S-necked flasks with liquid broth that had been sterilized. He then set up three different experimental groups. For the first group (negative control), he just left the S-necked flasks with the broth for an extended period of time. No microbes ever grew in the flask. For the second group (positive control), he broke the opening at the top and dust was able to settle into the broth. Microbes grew in this flask very quickly. For the third experimental group, he first let the flasks sit for an extended period of time and observed that no microbes grew. However, he then tipped the flask just enough that the broth came in contact with dust that had settled in the S-neck over time. Just this brief contact was enough for microbes to start growing in the flask. This proved that microbes from the air, and not just the broth itself, were required in order for cells to start growing, even if the broth had the perfect conditions for growth. This effectively disproved spontaneous generation, and proved biogenesis, the theory that only existing living organisms can give rise to new living cells. Chapter/Section: 1.1 Learning Outcome: 1.3 Global LO: G8 Bloom's Taxonomy: 3-4: Applying/Analyzing

Microbiology: Basic & Clinical Principles, 2e (Norman-McKay) Chapter 2 Biochemistry Basics 2.1 Multiple Choice Questions 1) An atom is best described as A) the smallest unit of an element. B) having a nucleus containing protons and electrons. C) defined by its atomic mass. D) always containing an equal number of protons and neutrons. E) defined by its number of electrons. Answer: A Chapter/Section: 2.1 Learning Outcome: 2.1 Bloom's Taxonomy: 1-2: Remembering/Understanding 2) Which particle is described incorrectly? A) Electron: Found in shells orbiting the nucleus B) Electron: Negatively charged and negligible mass C) Neutron: Found in the nucleus and 1 atomic mass unit D) Proton: Found in shells orbiting the nucleus E) Proton: Positively charged and 1 atomic mass unit Answer: D Chapter/Section: 2.1 Learning Outcome: 2.1 Bloom's Taxonomy: 1-2: Remembering/Understanding

3) What information can you determine about the element nitrogen from the periodic table entry shown?

A) The atomic number for nitrogen is 7. B) The atomic number for nitrogen is 14.007. C) There are 14 neutrons in the nucleus of a nitrogen atom. D) The atomic number for nitrogen is 7 and there are 14 neutrons in the nucleus of a nitrogen atom. E) The atomic number for nitrogen is 14.007 and there are 14 neutrons in the nucleus of a nitrogen atom. Answer: A Chapter/Section: 2.1 Learning Outcome: 2.2 Bloom's Taxonomy: 1-2: Remembering/Understanding 4) An anion is formed when A) an atom gains one or more positively charged protons. B) an atom loses one or more positively charged protons. C) an atom gains one or more negatively charged electrons. D) an atom loses one or more negatively charged electrons. E) an atom has an equal number of positively charged protons and negatively charged electrons. Answer: C Chapter/Section: 2.1 Learning Outcome: 2.3 Bloom's Taxonomy: 1-2: Remembering/Understanding

5) Isotopes are atoms of the same element that differ in A) the number of electrons orbiting the nucleus. B) the number of neutrons found in the nucleus. C) the number of protons found in the nucleus. D) the number of protons and neutrons found in the nucleus. E) the number of protons and electrons found in the atom. Answer: B Chapter/Section: 2.1 Learning Outcome: 2.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 6) A feature of many of the isotopes that are used in the field of medicine is that the isotopes are radioactive. What does this mean? A) The nucleus of the isotope is unstable and decays over time. B) Anionic forms of the atoms are used. C) The atoms with the greatest atomic mass are used. D) The same number of atoms are arranged into different molecular structures. E) Cationic forms of the atom are used. Answer: A Chapter/Section: 2.1 Learning Outcome: 2.4 Bloom's Taxonomy: 1-2: Remembering/Understanding

7) The pictured molecules all contain six carbon atoms, twelve hydrogen atoms, and six oxygen atoms (C6H12O6). However, these atoms are arranged differently in each molecule. What are these molecules called?

A) anions B) functional groups C) isomers D) isotopes E) R groups Answer: C Chapter/Section: 2.1 Learning Outcome: 2.5 Bloom's Taxonomy: 1-2: Remembering/Understanding 8) Which of the following is an organic compound? A) carbon dioxide (CO2) only B) ethanol (C2H6O) only C) methane (CH4 D) both ethanol (C2H6O) and methane (CH4) E) carbon dioxide (CO2), ethanol (C2H6O), and methane (CH4) Answer: D Chapter/Section: 2.1 Learning Outcome: 2.7 Bloom's Taxonomy: 1-2: Remembering/Understanding

9) Which functional group is incorrectly matched with its structure? A) alcohol: R-OH B) amino: R-NH2 C) carboxyl: R-COOH D) ether: R-CH3 E) phosphate: R-PO42− Answer: D Chapter/Section: 2.1 Learning Outcome: 2.7 Bloom's Taxonomy: 1-2: Remembering/Understanding 10) Which of the following is incorrectly matched? A) Acid: Release hydrogen ions (H+) in an aqueous solution B) Base: Release hydroxide ions (OH−) in an aqueous solution C) pH: Measure of the acidity or basicity of a solution D) Salt: Formed by the combination of hydrogen ions (H+) and hydroxide ions (OH−) E) Water: Is the solvent in aqueous solutions Answer: D Chapter/Section: 2.1 Learning Outcome: 2.8 Bloom's Taxonomy: 1-2: Remembering/Understanding 11) Pure water is defined by A) a neutral pH of 7. B) an equal number of H+ and OH− ions. C) its ability to serve as a pH buffer in solutions. D) a neutral pH of 7 and an equal number of H+ and OH− ions. E) a neutral pH of 7, an equal number of H+ and OH− ions, and its ability to serve as a pH buffer in solutions. Answer: D Chapter/Section: 2.1 Learning Outcome: 2.9 Bloom's Taxonomy: 1-2: Remembering/Understanding 12) Compared to a solution with a pH value of 4, a solution with a pH value of 2 has ________ H+ ions. A) one hundred times fewer B) half as many C) the same number of D) twice as many E) one hundred times as many Answer: E Chapter/Section: 2.1 Learning Outcome: 2.9 Global LO: G2 Bloom's Taxonomy: 3-4: Applying/Analyzing 5 Copyright © 2023 Pearson Education, Inc.

13) A compound which stabilizes pH by absorbing or releasing H+ ions is called a(n) A) acid. B) base. C) buffer. D) salt. E) solute. Answer: C Chapter/Section: 2.1 Learning Outcome: 2.10 Bloom's Taxonomy: 1-2: Remembering/Understanding 14) Which statement is not true about valence electrons? A) Valence electrons are found in the innermost shell. B) Valence electrons participate in chemical reactions. C) Interactions between valence electrons in reacting atoms determine what kind of chemical bond is formed. D) If the valence shell is full, an atom tends to be nonreactive. E) Valence electrons tend to be situated in an atom's outermost shells. Answer: A Chapter/Section: 2.2 Learning Outcome: 2.11 Bloom's Taxonomy: 1-2: Remembering/Understanding 15) Which of the following statements is not true regarding ionic bonds? A) Ionic bonds are electrostatic forces of attraction between oppositely charged ions. B) Ionic bonds form when electrons are transferred from one atom to another. C) Ionic bonds only exist as ions in aqueous solution. D) Ionic bonds are electrostatic forces of attraction between oppositely charged ions and form when electrons are transferred from one atom to another. E) Ionic bonds are stronger bonds than hydrogen bonds. Answer: C Chapter/Section: 2.2 Learning Outcome: 2.12 Bloom's Taxonomy: 1-2: Remembering/Understanding

16) Which of the following shows an ionic bond? A)

17) Which of the following statements does not correctly describe electrolytes? A) Electrolytes include acids, bases, and salts. B) Electrolytes are ionic compounds dissolved in solution. C) Electrolytes are involved in regulating the nervous system and heartbeat. D) Electrolytes are ionic compounds that can cause damage if consumed during heavy exercise. E) Electrolytes are involved in regulating blood volume and water balance in the body. Answer: D Chapter/Section: 2.2 Learning Outcome: 2.13 Bloom's Taxonomy: 1-2: Remembering/Understanding 18) In a polar covalent bond, A) electrons are transferred from one atom to another. B) electrons are shared equally between two atoms. C) electrons are shared unequally between two atoms. D) electrons are shared unequally between more than two atoms. E) an acid and a base neutralize each other to form a salt. Answer: C Chapter/Section: 2.2 Learning Outcome: 2.14 Bloom's Taxonomy: 1-2: Remembering/Understanding

19) In the figure shown, which atom(s) will have a partial negative charge?

A) hydrogen only B) nitrogen only C) oxygen only D) hydrogen and oxygen E) nitrogen and oxygen Answer: E Chapter/Section: 2.2 Learning Outcome: 2.15 Bloom's Taxonomy: 1-2: Remembering/Understanding

20) In the figure shown, what does the dotted line represent?

A) sharing of electrons between the ammonia and water molecules B) an electrostatic interaction between the partially positive hydrogen and the partially negative nitrogen C) transfer of the electron from the hydrogen atom to the nitrogen atom D) an interaction between a hydrophilic and a hydrophobic molecule E) a Van der Waals interaction Answer: B Chapter/Section: 2.2 Learning Outcome: 2.15 Bloom's Taxonomy: 1-2: Remembering/Understanding

21) Hydrogen bonds A) are responsible for the unique properties of water. B) are involved in stabilizing the structure of proteins and nucleic acids. C) form whenever hydrogen is involved in any covalent or ionic bond. D) are responsible for the unique properties of water and are involved in stabilizing the structure of proteins and nucleic acids. E) are stronger bonds than covalent bonds. Answer: D Chapter/Section: 2.2 Learning Outcome: 2.15 Bloom's Taxonomy: 1-2: Remembering/Understanding 22) Van der Waals interactions A) are another name for hydrogen bonds. B) are responsible for the repulsion between hydrophilic and hydrophobic compounds. C) occur when temporary dipoles within molecules form that are not the result of hydrogen bonds. D) are stronger than either hydrogen bonds or ionic bonds. E) exhibit a force of repulsion that serves to destabilize molecules. Answer: C Chapter/Section: 2.2 Learning Outcome: 2.16 Bloom's Taxonomy: 1-2: Remembering/Understanding 23) Which term is incorrectly matched to its description? A) Amphipathic: Has properties that are neither hydrophilic nor hydrophobic B) Hydrophilic: Substances which readily dissolve in water C) Hydrophobic: Substances which are not readily dissolved in water D) Hydrophilic: Substances which readily dissolve in water AND hydrophobic: substances which are not readily dissolved in water are both incorrectly matched. E) Amphipathic: Has properties that are neither hydrophilic nor hydrophobic; AND hydrophilic: substances which readily dissolve in water are both incorrectly matched. Answer: A Chapter/Section: 2.2 Learning Outcome: 2.17 Bloom's Taxonomy: 1-2: Remembering/Understanding 24) A micelle is formed of A) hydrophilic molecules only. B) hydrophobic molecules only. C) amphipathic molecules where the hydrophobic portion faces toward the center. D) amphipathic molecules where the hydrophilic portion faces toward the center. E) both hydrophilic and hydrophobic molecules. Answer: C Chapter/Section: 2.2 Learning Outcome: 2.17 Bloom's Taxonomy: 1-2: Remembering/Understanding 11 Copyright © 2023 Pearson Education, Inc.

25) Plasma membranes, the key boundary layer of cells, are composed of amphipathic molecules called phospholipids. Why would neither purely hydrophilic nor purely hydrophobic molecules be a suitable molecule for plasma membranes? A) Hydrophilic molecules would dissolve in the aqueous environment in which cells live, disrupting the structural integrity of the cell. B) Hydrophobic molecules would dissolve in the aqueous environment in which cells live, disrupting the structural integrity of the cell, while hydrophilic molecules could not interact. C) Both hydrophilic and hydrophobic molecules would dissolve in the aqueous environment in which cells live, disrupting the structural integrity of the cell. D) Hydrophobic molecules would be unable to interact with the aqueous environment in which cells live. E) Hydrophilic molecules would dissolve in the aqueous environment in which cells live, disrupting the structural integrity of the cell, and hydrophobic molecules would be unable to interact with the aqueous environment in which cells live. Answer: E Chapter/Section: 2.2 Learning Outcome: 2.17 Global LO: G2 Bloom's Taxonomy: 3-4: Applying/Analyzing 26) Consider the reaction AB → A + B. What is/are the product(s) of this reaction? A) A B) B C) AB D) A and B E) A, B, and AB Answer: D Chapter/Section: 2.3 Learning Outcome: 2.18 Bloom's Taxonomy: 1-2: Remembering/Understanding 27) Which reaction has X and Y as reactants? A) X + Y → XY B) XY → X + Y C) XY + AB → XB + AY D) XY + W → WY + X E) X + YZ → Y + XZ Answer: A Chapter/Section: 2.3 Learning Outcome: 2.18 Bloom's Taxonomy: 1-2: Remembering/Understanding

28) Which statement does not describe a catalyst? A) A catalyst may be an inorganic substance. B) A catalyst may be an organic substance. C) A catalyst will decrease the rate of a reaction. D) A catalyst will increase the rate of a reaction. E) A catalyst is not used up in the reaction. Answer: C Chapter/Section: 2.3 Learning Outcome: 2.19 Bloom's Taxonomy: 1-2: Remembering/Understanding 29) Which reaction is incorrectly matched with its name? A) Decomposition: AB → A + B B) Double exchange: AB + CD → AD + CB C) Hydrolysis: A + B → AB + H2O D) Single exchange: AB + C → AC + B E) Synthesis: A + B → AB Answer: C Chapter/Section: 2.3 Learning Outcome: 2.20 Bloom's Taxonomy: 1-2: Remembering/Understanding 30) In a dehydration synthesis reaction, macromolecules are built when ________ is removed to form a covalent bond. A) an amino acid B) carbon dioxide C) an electron D) oxygen E) water Answer: E Chapter/Section: 2.3 Learning Outcome: 2.21 Bloom's Taxonomy: 1-2: Remembering/Understanding

31) What type of reaction does the figure show?

A) decomposition B) dehydration synthesis C) hydrolysis D) decomposition and hydrolysis E) dehydration synthesis and hydrolysis Answer: D Chapter/Section: 2.3 Learning Outcome: 2.21 Bloom's Taxonomy: 1-2: Remembering/Understanding

32) Activation energy A) is the minimum amount of energy needed to get a reaction started. B) is due to the necessity of collisions between reactants which have enough energy and with the reactants properly oriented. C) can be lowered by catalysts such as enzymes in biochemical reactions. D) is the minimum amount of energy needed to get a reaction started AND is due to the necessity of collisions between reactants which have enough energy and with the reactants properly oriented. E) is the minimum amount of energy needed to get a reaction started AND is due to the necessity of collisions between reactants which have enough energy and with the reactants properly oriented AND can be lowered by catalysts such as enzymes in biochemical reactions. Answer: E Chapter/Section: 2.3 Learning Outcome: 2.22 Bloom's Taxonomy: 1-2: Remembering/Understanding

33) The figure shown is an exergonic reaction because

A) activation energy was required. B) it is a decomposition reaction. C) the products have a lower final energy than the reactants. D) activation energy was required and it is a decomposition reaction. E) it is a decomposition reaction and the products have a lower final energy than the reactants. Answer: C Chapter/Section: 2.3 Learning Outcome: 2.23 Global LO: G2 Bloom's Taxonomy: 3-4: Applying/Analyzing 34) Which of the following does not describe equilibrium? A) A forward and reverse reaction occur at the same rate. B) A reaction has stopped. C) The total amount of products and reactants is no longer changing. D) when there is an equal amount of products and reactants E) when there is an equal amount of products and reactants and a reaction has stopped Answer: E Chapter/Section: 2.3 Learning Outcome: 2.24 Bloom's Taxonomy: 1-2: Remembering/Understanding 16 Copyright © 2023 Pearson Education, Inc.

35) Which of the following is not one of the four main groups of biomolecules? A) carbohydrates B) electrolytes C) lipids D) nucleic acids E) proteins Answer: B Chapter/Section: 2.4 Learning Outcome: 2.25 Bloom's Taxonomy: 1-2: Remembering/Understanding 36) Which of the biomolecules is incorrectly matched with its building block? A) Carbohydrate: Polysaccharide B) Lipid: Fatty acid C) Lipid: Glycerol D) Nucleic acid: Nucleotide E) Protein: Amino acid Answer: A Chapter/Section: 2.4 Learning Outcome: 2.25 Bloom's Taxonomy: 1-2: Remembering/Understanding 37) The type of bond which links the amino group of one amino acid to the carboxyl group of another amino acid is called a(n) A) amino bond. B) glycosidic bond. C) glycerol bond. D) peptide bond. E) phosphodiester bond. Answer: D Chapter/Section: 2.4 Learning Outcome: 2.26 Bloom's Taxonomy: 1-2: Remembering/Understanding 38) Which statement is true about carbohydrates? A) They consist of simple sugars which contain carbon, hydrogen, and oxygen in a 2: 1: 2 ratio. B) They may be saturated or unsaturated. C) They are a component of the cell wall of different types of organisms. D) They have primary, secondary, tertiary, and quaternary structure. E) They are usually hydrophobic. Answer: C Chapter/Section: 2.4 Learning Outcome: 2.27 Bloom's Taxonomy: 1-2: Remembering/Understanding

39) Which type of lipid is incorrectly matched to its description? A) Glycolipid: A lipid linked to a carbohydrate B) Mono-, di-, or triglyceride: One, two, or three fatty acids linked to a glycerol molecule C) Phospholipid: An amphipathic lipid found in the plasma membrane of cells D) Steroid: Made of four fused hydrocarbon rings E) Wax: Refers to any lipid which is solid at room temperature Answer: E Chapter/Section: 2.4 Learning Outcome: 2.27 Bloom's Taxonomy: 1-2: Remembering/Understanding 40) Deoxyribonucleotides and ribonucleotides differ in all of the following except A) the sugar is different in the two types of nucleotides. B) the nitrogenous base thymine is only found in deoxyribonucleotides while the nitrogenous base uracil is only found in ribonucleotides. C) phosphodiester bonds can only form between deoxyribonucleotides, not ribonucleotides. D) ribonucleotides can serve as energy molecules such as ATP while deoxyribonucleotides do not. E) deoxyribonucleotides are found in DNA while ribonucleotides are found in RNA. Answer: C Chapter/Section: 2.4 Learning Outcome: 2.29 Bloom's Taxonomy: 1-2: Remembering/Understanding 41) Plasma membranes must be in a fluid (liquid) state in order to function properly. Fluidity is temperature-dependent. Bacteria can regulate the specific lipid composition of their plasma membranes. Which of the following statements is true? A) The proportion of saturated lipids in the plasma membrane will increase with cooler growth temperatures. B) The proportion of unsaturated lipids in the plasma membrane will increase with cooler growth temperatures. C) The proportion of unsaturated lipids in the plasma membrane will increase with warmer growth temperatures. D) The proportion of saturated lipids in the plasma membrane will increase with both cooler and warmer growth temperatures. E) The proportion of saturated lipids in the plasma membrane will increase with cooler growth temperatures while the proportion of unsaturated lipids will increase with warmer growth temperatures. Answer: B Chapter/Section: 2.4 Learning Outcome: 2.28 Global LO: G2 Bloom's Taxonomy: 3-4: Applying/Analyzing

42) The primary structure of a protein A) is the linear sequence of amino acids which are held together by peptide bonds. B) is unique to that protein and lays the foundation for all higher-order structure of that protein. C) is dictated by the genetic sequence. D) is the linear sequence of amino acids which are held together by peptide bonds AND is dictated by the genetic sequence. E) is the linear sequence of amino acids which are held together by peptide bonds AND is dictated by the genetic sequence AND is unique to that protein AND lays the foundation for all higher order structure of that protein. Answer: E Chapter/Section: 2.4 Learning Outcome: 2.30 Bloom's Taxonomy: 1-2: Remembering/Understanding 43) Which level of protein structure can involve hydrogen bonds? A) primary only B) secondary only C) tertiary only D) both primary and secondary E) both secondary and tertiary Answer: E Chapter/Section: 2.4 Learning Outcome: 2.30 Bloom's Taxonomy: 1-2: Remembering/Understanding 44) In the human genetic disease sickle cell anemia, a single change in the genetic sequence of the hemoglobin-beta gene results in the amino acid valine being substituted for the amino acid glutamic acid in the beta chain of the hemoglobin protein. Which level(s) of the protein structure will be affected? A) primary structure only B) secondary structure only C) tertiary structure only D) quaternary structure only E) primary, secondary, tertiary, and quaternary structures Answer: E Chapter/Section: 2.4 Learning Outcome: 2.30 Global LO: G2 Bloom's Taxonomy: 3-4: Applying/Analyzing

45) Chaperone proteins A) ensure that amino acids are placed in the correct order when forming a protein. B) ensure that a protein is folded correctly. C) escort proteins to the location in a cell where they are needed. D) ensure that DNA molecules form double-stranded helices. E) cleave a phosphate from ATP to release energy. Answer: B Chapter/Section: 2.4 Learning Outcome: 2.31 Bloom's Taxonomy: 1-2: Remembering/Understanding 46) How would the following chemical designation be best described? Na2+ A) It represents an isotope. B) It represents an anion. C) It represents a cation. D) It represents an atom that has gained 2 protons. E) It represents an atom that has gained 2 electrons. Answer: C Chapter/Section: 2.1 Learning Outcome: 2.3 Bloom's Taxonomy: 1-2: Remembering/Understanding 47) In a non-polar covalent bond, A) electrons are transferred from one atom to another. B) electrons are shared equally between two atoms. C) electrons are shared unequally between two atoms. D) electrons are shared unequally between more than two atoms. E) an acid and a base neutralize each other to form a salt. Answer: B Chapter/Section: 2.2 Learning Outcome: 2.14 Bloom's Taxonomy: 1-2: Remembering/Understanding

48) How would the following "fully abbreviated" chemical line drawing be best represented as a chemical formula?

A) C1H6O6 B) C2H12O6 C) C6H12O6 D) C6H6O6 E) C2(H2O)4 Answer: C Chapter/Section: 2.2 Learning Outcome: 2.6 Bloom's Taxonomy: 3-4: Applying/Analyzing 2.2 True/False Questions 1) A cation forms when an atom loses one or more negatively charged electrons. Answer: TRUE Chapter/Section: 2.1 Learning Outcome: 2.3 Bloom's Taxonomy: 1-2: Remembering/Understanding 2) are both molecules and compounds. Answer: TRUE Chapter/Section: 2.1 Learning Outcome: 2.5 Bloom's Taxonomy: 1-2: Remembering/Understanding 3) A molecule of glucose contains six carbon atoms, twelve hydrogen atoms, and six oxygen atoms. The proper way to write the molecular formula for glucose is 6C12H6O. Answer: FALSE Chapter/Section: 2.1 Learning Outcome: 2.6 Bloom's Taxonomy: 1-2: Remembering/Understanding

4) Acids increase the H+ concentration in a solution and so lower pH. Answer: TRUE Chapter/Section: 2.1 Learning Outcome: 2.8 Bloom's Taxonomy: 1-2: Remembering/Understanding 5) Blood pH is stabilized by carbonic acid (H2CO3) which releases H+ ions to lower pH and bicarbonate (HCO3-) which absorbs H+ ions to raise pH. Answer: TRUE Chapter/Section: 2.1 Learning Outcome: 2.10 Bloom's Taxonomy: 1-2: Remembering/Understanding 6) During vigorous exercise, both carbon dioxide and lactic acid enter the blood in increased amounts. Both compounds have the effect of lowering the blood pH. In order to maintain blood pH within the normal range of 7.35-7.45, we would expect the carbonic acid (H2CO3) portion of the blood buffer system to pick up the extra H+ ions. Answer: FALSE Chapter/Section: 2.1 Learning Outcome: 2.10 Global LO: G2 Bloom's Taxonomy: 3-4: Applying/Analyzing 7) In a polar covalent bond involving hydrogen and oxygen, the hydrogen takes on a partial negative charge while the oxygen takes on a partial positive charge. Answer: FALSE Chapter/Section: 2.2 Learning Outcome: 2.14 Bloom's Taxonomy: 1-2: Remembering/Understanding 8) Endergonic reactions make products with a lower final energy than the reactants and use more energy than is released. Answer: FALSE Chapter/Section: 2.3 Learning Outcome: 2.23 Bloom's Taxonomy: 1-2: Remembering/Understanding 9) A reversible reaction is one in which the forward and reversible reactions are both possible such as: AB → A + B and A + B → AB. Answer: TRUE Chapter/Section: 2.3 Learning Outcome: 2.24 Bloom's Taxonomy: 1-2: Remembering/Understanding

10) A phosphodiester bond links a fatty acid to a glycerol molecule to form a fat or an oil. Answer: FALSE Chapter/Section: 2.4 Learning Outcome: 2.26 Bloom's Taxonomy: 1-2: Remembering/Understanding 11) In the molecule CH4, non-polar covalent bonds are formed between one carbon and four hydrogen atoms. The carbon will have a partial negative charge due to the hydrogen bonds. Answer: FALSE Chapter/Section: 2.2 Learning Outcome: 2.15 2.3 Essay Questions 1) Describe the relationship between acids, bases, salts, and water, and explain how the pH scale is used to measure acidity and basicity. Answer: Acids are substances that increase the concentration of hydrogen ions (H+) when dissolved in water. Bases are substances that increase the concentration of hydroxide ions (OH−) when dissolved in water. When an acid and a base are mixed, the result is a salt and water. For example: hydrogen chloride + sodium hydroxide → sodium chloride and water or HCl + NaOH → NaCl + H2O. The pH scale measures the amount of H+ ions in an aqueous solution. Neutral pH is defined as 7.0 where the amount of H+ ions and OH− ions are equal; this is the pH of pure water. Acids lower pH values; values below 7 are considered acidic and lower numbers are more acidic than higher numbers. Bases raise pH value; values above 7 are considered basic and higher numbers are more basic than lower numbers. The pH scale is a logarithmic scale, so each whole number step pH represents a tenfold change in acidity or basicity. Chapter/Section: 2.1 Learning Outcome: 2.8 | 2.9 Bloom's Taxonomy: 1-2: Remembering/Understanding

2) Compare and contrast ionic bonds, covalent bonds, polar covalent bonds, and hydrogen bonds. Explain how valence electrons are involved in the formation of each. Answer: Chemical bonds form between two atoms to form molecules. Chemical bonds form by the action of the valence electrons, those found in the outer shell of each atom. Atoms combine in a way to achieve full valence shells which is the most stable configuration for atoms. Ionic bonds are electrostatic forces of attraction between a cation and an anion. These bonds form when one or more valence electrons are transferred from one atom to another. The receiving atom becomes the negatively charged anion while the donating atom becomes the positively charged cation. Covalent bonds are electrostatic forces of attraction between atoms that share one or more pairs of valence electrons. The two atoms may share the paired electrons equally or symmetrically in which case the covalent bond is referred to as non-polar. Conversely, the shared valence electron pair may spend more time orbiting one of the atoms in the pair than the other. This causes the first atom to acquire a partial negative charge while the other acquires a partial positive charge. In this case, the covalent bond is said to be polar. Hydrogen bonds are not really bonds but are non-covalent electrostatic interactions between atoms in two different molecules or within the same, large molecules. Hydrogen bonds form because of the partial negative or positive charges that occur on polar molecules. In particular, when hydrogen is bonded to either oxygen or nitrogen, the hydrogen becomes partially positively charged, while the oxygen or nitrogen is becomes partially negatively charged. The attraction of the oppositely charged atoms forms the hydrogen bond. Chapter/Section: 2.2 Learning Outcome: 2.15 Bloom's Taxonomy: 1-2: Remembering/Understanding 3) Vitamin deficiencies (not getting enough of a certain vitamin) pose obvious health problems, but an excess of certain vitamins in the system can also be harmful. Explain why you would be far less likely to experience an excess of water-soluble vitamins compared to fat-soluble vitamins in the context of the characteristics of polar and non-polar substances. Answer: Water-soluble vitamins are polar molecules which dissolve in water (hydrophilic). They are easily excreted from the body in the urine, and therefore are unlikely to build up to toxic levels. Fat-soluble vitamins are non-polar. They do not dissolve in water (hydrophobic) and so are not easily excreted in urine. Instead they are stored in fat, where it is possible for them to build up to unsafe levels if an excess amount is ingested over a period of time. Due to the hydrophobic nature of fat-soluble vitamins, they can also more readily cross the lipid membrane and enter cells where they may have a toxic effect at high levels. Chapter/Section: 2.2 Learning Outcome: 2.17 Global LO: G2 Bloom's Taxonomy: 3-4: Applying/Analyzing

4) List the four types of biomolecules. For each type, name the monomer building block, the type of chemical bond which joins the building block, and give two functions, naming a specific example where appropriate. Answer: The four types of biomolecules are carbohydrates, lipids, nucleic acids, and proteins. (1) Carbohydrates include monomer building blocks called monosaccharides, or simple sugars which usually have 3, 5, or 6 carbons along with hydrogen and oxygen in a 1: 2: 1 ratio. A monosaccharide may join with another monosaccharide through a glycosidic bond to form a disaccharide; multiple monosaccharides chained together through glycosidic bonds are called polysaccharides. Carbohydrates are the chief energy sources in biological systems, serve as structural biomolecules, and mediate cellular adhesion, communication, and environmental sensing. Glucose is a favorite energy source for cells while cellulose, peptidoglycan, and chitin are all constituents of cell walls. (2) Lipids are a group of mostly hydrophobic molecules including fats, oils, waxes, and steroids. Lipids such as fats and oils are composed of fatty acid chains attached to a glycerol molecule through an ester bond. The fatty acids may be saturated (no double bonds, i.e., the maximum possible amount of hydrogen is bonded to each carbon atom) or unsaturated (one or more double bonds, i.e., less than the maximum number of hydrogen atoms bonded to each carbon atom). Fats and oils serve as energy sources for cells, as cell structure components, and mediate cell signaling. Waxes are fatty acids bonded to a longchain alcohol; they serve a variety of protective functions. Steroids are composed of four fused hydrocarbon rings; they are involved in cell signaling pathways. (3) Nucleic acids come in two varieties: DNA and RNA. Both are composed of polymers of nucleotide monomers. Nucleotides are held together in chains through a phosphodiester bond. Each nucleotide is composed of a pentose sugar (deoxyribose or ribose), one to three phosphate groups, and one of five nitrogenous bases. DNA serves as the genetic blueprint for all cells and some viruses; RNA can serve as the genetic blueprint for viruses and directs the production of proteins in all cells and viruses. (4) Proteins are polymers of amino acids joined in a chain by peptide bonds. The sequence of amino acids used in a given protein is unique to that protein and determines the structural and functional characteristics of that protein. Proteins typically fold into specific threedimensional structures which are determined by the amino acids found in the protein. Proteins may serve as structural scaffolds in cells, as enzymes facilitating chemical reactions, cellular transporters, and are involved in cell recognition and communication. Chapter/Section: 2.4 Learning Outcome: 2.27 Bloom's Taxonomy: 1-2: Remembering/Understanding

5) List and describe the four levels of protein structure. Explain how the levels of structure are dependent on each other and describe what types of molecular interactions are involved. Answer: The four levels of protein structure include primary, secondary, tertiary, and quaternary structure. (1) Primary structure is the linear sequence of amino acids in the protein, which are linked together by a type of covalent bond known as a peptide bond. A protein's primary structure is unique to that type of protein, and the overall structure and function of the protein results from the properties of each amino acid in the protein. All higher levels of protein structure are dependent on specific interactions between particular amino acids, so the primary structure of a protein determines its secondary, tertiary, and (if applicable) its quaternary structure. (2) Secondary structure consists of regular, consistent coils or folds in the protein chain which are held together by hydrogen bonds between amino acids. Types of secondary structure include alpha-helices and beta-pleated sheets. (3) Tertiary structure is the folding of the protein chain upon itself to form a characteristic three-dimensional structure. These structures are formed by both covalent and non-covalent interactions between specific amino acids. Not all proteins display quaternary structure. (4) Quaternary structure occurs when two or more separate polypeptide chains combine to form a functional protein. Both non-covalent and covalent interactions are involved in quaternary structure. Chapter/Section: 2.4 Learning Outcome: 2.30 Bloom's Taxonomy: 1-2: Remembering/Understanding

Microbiology: Basic & Clinical Principles, 2e (Norman-McKay) Chapter 3 Introduction to Prokaryotic Cells 3.1 Multiple Choice Questions 1) Which of the following statements is false? A) Archaea and Bacteria are prokaryotic domains. B) Both Archaea and Bacteria are unicellular. C) Eukaryotic cells evolved from prokaryotic cells. D) Prokaryotes are unicellular and lack a membrane-bound nucleus. E) Eukaryotes have a much simpler genetic makeup than prokaryotic cells. Answer: E Chapter/Section: 3.1 Learning Outcome: 3.1 ASM LO: 1.1 Bloom's Taxonomy: 1-2: Remembering/Understanding 2) Why aren't Archaea discussed as much as bacteria? A) Archaea are only found in a few limited environments. B) Archaea infections are easy to treat. C) Archaea haven't been linked to human diseases. D) Archaea are not part of the human microbiome. E) Archaea only live in extreme environments. Answer: C Chapter/Section: 3.1 Learning Outcome: 3.1 Bloom's Taxonomy: 1-2: Remembering/Understanding 3) Why are most prokaryotic cells small? A) Nutrient diffusion is most efficient for smaller cells. B) Intracellular inclusions demand that cell size be small. C) Storage bodies within a cell enable cells to be small so they need fewer nutrients. D) A low surface area-to-volume ratio helps smaller cells divide easier. E) A high surface area-to-volume ratio helps smaller cells divide easier. Answer: A Chapter/Section: 3.1 Learning Outcome: 3.2 Bloom's Taxonomy: 1-2: Remembering/Understanding

4) Which of the following cell shapes look like a comma? A) bacilli B) spirochetes C) stella D) vibrio E) coccobacilli Answer: D Chapter/Section: 3.1 Learning Outcome: 3.3 Bloom's Taxonomy: 1-2: Remembering/Understanding 5) Cell shape is determined by which of the following? A) the way cells move through their media B) cell wall and cytoskeleton components C) the way cells divide D) whether or not the species is pathogenic E) whether or not the species uses a flagellum Answer: B Chapter/Section: 3.1 Learning Outcome: 3.3 Bloom's Taxonomy: 1-2: Remembering/Understanding 6) Which of the following arrangements is sometimes referred to as having a beads-on-a-string appearance? A) diplococci B) streptococci C) staphylococci D) palisade E) streptobacilli Answer: B Chapter/Section: 3.1 Learning Outcome: 3.3 Bloom's Taxonomy: 1-2: Remembering/Understanding 7) Bacterial cells that have the ability to take on different cell shapes are known as A) chemotactic. B) pyloric. C) pleomorphic. D) pallidic. E) biphasic. Answer: C Chapter/Section: 3.1 Learning Outcome: 3.4 Bloom's Taxonomy: 1-2: Remembering/Understanding

8) Which of the following is incorrect when E. coli cause a UTI? A) Within the first few hours of invading host tissues, E. coli cells triple in size. B) When inside host cells, E. coli exist as nonmotile rods. C) As the infection progresses, E. coli pass through a stage where they appear as cocci. D) When infection has been established, the E. coli return to being motile rods that swim away from biofilms to perpetuate infections. E) It is believed that E. coli avoid the host immune response by assuming a filamentous form. Answer: A Chapter/Section: 3.1 Learning Outcome: 3.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 9) Most prokaryotic cells reproduce A) sexually. B) by mitosis. C) by meiosis. D) by binary fission. E) extremely quickly. Answer: D Chapter/Section: 3.1 Learning Outcome: 3.5 ASM LO: 1.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 10) Membrane proteins perform all of the following functions except A) transporters. B) anchors. C) receptors. D) enzymes. E) blocking cell division. Answer: E Chapter/Section: 3.2 Learning Outcome: 3.6 Bloom's Taxonomy: 1-2: Remembering/Understanding 11) How can cells increase the fluidity of their plasma membrane? A) move to colder temperatures B) a lower proportion of unsaturated fats in the fatty acid portion of phospholipids C) fewer phospholipids in the plasma membrane D) a higher proportion of unsaturated fats in the fatty acid portion of phospholipids E) remove double bonds in the hydrocarbon backbone Answer: D Chapter/Section: 3.2 Learning Outcome: 3.6 Bloom's Taxonomy: 1-2: Remembering/Understanding

12) In order to maintain a fluid plasma membrane in cold conditions, bacteria commonly have A) more short unsaturated fatty acids in their phospholipids. B) more long saturated fatty acids in their phospholipids. C) more cholesterol in their phospholipids. D) less concentrated phospholipids. E) more concentrated phospholipids. Answer: A Chapter/Section: 3.2 Learning Outcome: 3.7 Bloom's Taxonomy: 1-2: Remembering/Understanding 13) How does the plasma membrane of bacteria and archaea differ? A) Bacteria have phospholipids built from branched fatty acids. B) Archaea have phospholipids built from linear fatty acids. C) Bacteria build only lipid monolayers. D) Archaea have phospholipids built from branched fatty acids. E) Archaea build only lipid monolayers. Answer: D Chapter/Section: 3.2 Learning Outcome: 3.7 Global LO: G2 Bloom's Taxonomy: 3-4: Applying/Analyzing 14) How does the cell wall of bacteria and archaea differ? A) Bacteria use peptidoglycan. B) Archaea use peptidoglycan. C) Bacteria use pseudopeptidoglycan. D) Archaea have little diversity in the makeup of their cell walls. E) Bacteria have a lot of diversity in the makeup of their cell walls. Answer: A Chapter/Section: 3.2 Learning Outcome: 3.7 Global LO: G2 Bloom's Taxonomy: 3-4: Applying/Analyzing 15) Why are Gram-negative bacteria more resistant than Gram-positive bacteria to damage by certain chemical agents like lysozyme? A) Gram-negative bacteria lack a cell wall. B) Gram-negative bacteria have porins. C) Gram-negative bacteria contain peptidoglycan in their cell wall. D) Gram-negative bacteria have an outer membrane as part of their cell wall. E) Gram-negative bacteria have a thicker layer of peptidoglycan in their cell wall. Answer: D Chapter/Section: 3.2 Learning Outcome: 3.8 ASM LO: 2.2 Bloom's Taxonomy: 1-2: Remembering/Understanding 4 Copyright © 2023 Pearson Education, Inc.

16) In which of the following environments do Gram-positive not have a survival advantage over Gram-negative bacteria? A) exposure to penicillin-based drugs B) dry environment C) mechanical crushing D) needing to adhere to a host E) abrasive environment Answer: A Chapter/Section: 3.2 Learning Outcome: 3.8 Bloom's Taxonomy: 1-2: Remembering/Understanding 17) Why is the acid-fast stain clinically useful? A) It confirms the results of the Gram stain. B) It confirms that a single dose of antibiotics is enough to kill the bacteria. C) It identifies the causative agent of strep throat and Scarlet fever. D) It identifies the causative agent of certain fungal infections. E) It identifies the causative agent of leprosy and tuberculosis. Answer: E Chapter/Section: 3.2 Learning Outcome: 3.9 Bloom's Taxonomy: 1-2: Remembering/Understanding 18) Why is it so difficult to kill acid-fast bacteria? A) The acid in the bacteria denatures most antibiotics before they can work. B) The bacteria are able to quickly break down several types of antibiotics before the concentration can reach dangerous levels. C) Mycolic acid in the cell wall makes it very difficult for antimicrobial drugs to enter cells. D) The bacteria are very motile and can travel to areas with a lower concentration of hazardous chemicals. E) They form endospores that are highly resistant to antibiotics. Answer: C Chapter/Section: 3.2 Learning Outcome: 3.9 ASM LO: 3.4 Bloom's Taxonomy: 1-2: Remembering/Understanding

19) How are L-forms different than Mycoplasma bacteria? A) L-forms have never had a cell wall. B) L-forms live inside plant cells. C) L-forms live inside animal cells. D) L-forms are resistant to certain environmental stresses such as boiling and autoclaving. E) L-forms are susceptible to antibiotics that target the cell wall. Answer: D Chapter/Section: 3.2 Learning Outcome: 3.10 Global LO: G2 Bloom's Taxonomy: 3-4: Applying/Analyzing 20) Which type of cellular transport uses transport proteins and moves substances from an area of high concentration to an area of low concentration? A) simple diffusion B) facilitated diffusion C) primary active transport D) secondary active transport E) phosphotransferase system Answer: B Chapter/Section: 3.2 Learning Outcome: 3.11 Bloom's Taxonomy: 1-2: Remembering/Understanding 21) What term most correctly describes when energy released by the flow of an ion from high to low concentration fuels the transport of an unrelated substance from low to high concentration but in the same direction? A) primary active transport B) tertiary active transport C) symport D) antiport E) phosphotransferase system Answer: C Chapter/Section: 3.2 Learning Outcome: 3.11 Bloom's Taxonomy: 1-2: Remembering/Understanding 22) What happens when you place a bacterial cell into a hypertonic solution? A) The cell will undergo plasmolysis. B) The cell will lyse. C) There will be no effect on the cell. D) The cell will burst. E) The cell will swell. Answer: A Chapter/Section: 3.2 Learning Outcome: 3.12 Bloom's Taxonomy: 1-2: Remembering/Understanding 6 Copyright © 2023 Pearson Education, Inc.

23) Short, bristle-like structures that extrude from the cell surface are called A) fimbriae. B) pili. C) flagella. D) cilia. E) mating bridges. Answer: A Chapter/Section: 3.2 Learning Outcome: 3.13 ASM LO: 2.3 Bloom's Taxonomy: 1-2: Remembering/Understanding 24) Which of the following structures allow bacteria to transfer genetic information through conjugation? A) fimbriae B) pili C) glycocalyx D) slime layer E) capsule Answer: B Chapter/Section: 3.2 Learning Outcome: 3.13 ASM LO: 2.3 | 4.5 Bloom's Taxonomy: 1-2: Remembering/Understanding 25) Which of the following structures do not help the bacteria adhere to surfaces? A) flagella B) fimbriae C) pili D) slime layer E) capsule Answer: A Chapter/Section: 3.2 Learning Outcome: 3.13 ASM LO: 2.3 Bloom's Taxonomy: 1-2: Remembering/Understanding

26) Bacteria that have flagella distributed all over the cell surface are described as (having) A) monotrichous. B) lophotrichous. C) amphitrichous. D) peritrichous. E) periplasmic flagella. Answer: D Chapter/Section: 3.2 Learning Outcome: 3.14 ASM LO: 2.3 Bloom's Taxonomy: 1-2: Remembering/Understanding 27) Periplasmic flagella are unlike most flagella because they A) move their flagella in a counter-clockwise direction. B) move their flagella in a clockwise direction. C) are located in the space between the plasma membrane and the peptidoglycan. D) have fibers that stick into the cytoplasm for a better hold. E) are located in the space between the peptidoglycan and the outer membrane. Answer: E Chapter/Section: 3.2 Learning Outcome: 3.14 ASM LO: 2.3 Bloom's Taxonomy: 1-2: Remembering/Understanding 28) The genetic material of bacteria can be found in the A) nucleus. B) nucleolus. C) nucleoid. D) nucleosome. E) cytoskeleton. Answer: C Chapter/Section: 3.3 Learning Outcome: 3.15 Bloom's Taxonomy: 1-2: Remembering/Understanding 29) Which of the following is false about the bacterial cytoskeleton? A) The bacterial cytoskeleton is composed of long protein filaments. B) The bacterial cytoskeleton acts as scaffolding to organize cell division. C) The bacterial cytoskeleton directs the construction of the rigid cell wall. D) The bacterial cytoskeleton provides an overall general organization to the cytoplasm for a variety of biochemical processes. E) The bacterial cytoskeleton contains actin and tubulin proteins. Answer: E Chapter/Section: 3.3 Learning Outcome: 3.16 Bloom's Taxonomy: 1-2: Remembering/Understanding 8 Copyright © 2023 Pearson Education, Inc.

30) 70S is the sedimentation rate of the ribosomes found in which of the following? A) eukaryotic cells B) prokaryotic cells C) chloroplasts and mitochondria D) eukaryotic cells, chloroplasts, and mitochondria E) prokaryotic cells, chloroplasts, and mitochondria Answer: E Chapter/Section: 3.3 Learning Outcome: 3.17 ASM LO: 2.2 Bloom's Taxonomy: 1-2: Remembering/Understanding 31) Which of the following is true about ribosomes? A) Antibiotics often take advantage of functional differences between prokaryotic and eukaryotic ribosomes. B) Ribosomes are organelles made of RNA and carbohydrates. C) Prokaryotic ribosomes have a lower overall mass and diameter than eukaryotic ribosomes. D) Ribosomes build amino acids by linking together nucleic acids. E) Prokaryotic ribosomes are also easily differentiated from eukaryotic ribosomes based on chemical composition. Answer: C Chapter/Section: 3.3 Learning Outcome: 3.17 ASM LO: 2.2 Bloom's Taxonomy: 1-2: Remembering/Understanding 32) Which of the following is an example of an inclusion body? A) ribosomes B) magnetosomes C) lysosomes D) endosomes E) peroxisomes Answer: B Chapter/Section: 3.3 Learning Outcome: 3.18 Bloom's Taxonomy: 1-2: Remembering/Understanding

33) What is the function of a carboxysome? A) fix carbon B) store energy C) store carbon D) protect against oxygen radicals E) acts as a magnetic compass to guide bacteria Answer: A Chapter/Section: 3.3 Learning Outcome: 3.18 ASM LO: 6.1 Bloom's Taxonomy: 1-2: Remembering/Understanding 34) Which of the following is true about endospores? A) Endospores are metabolically active structures. B) Endospores are highly resistant to environmental stress such as heat, drying, freezing, and radiation. C) Endospores are only viable for a short time. D) Endospores are considered reproductive structures. E) Endospores are susceptible to various chemicals. Answer: B Chapter/Section: 3.3 Learning Outcome: 3.19 Bloom's Taxonomy: 1-2: Remembering/Understanding 35) Which of the following does not enable bacterial endospores to be heat resistant? A) spore coat B) exosporium C) low water content D) high amount of dipicolinic acid E) peptidoglycan Answer: E Chapter/Section: 3.3 Learning Outcome: 3.19 Bloom's Taxonomy: 1-2: Remembering/Understanding 36) A typical bacterial cell is 2 micrometers (2µm) in diameter. How many millimeters (mm) in diameter? A) 200 mm B) 20 mm C) 0.02 mm D) 0.002 mm E) 0.2 mm Answer: D Chapter/Section: 3.1 Learning Outcome: 3.2 Global LO: G4 Bloom's Taxonomy: 3-4: Applying/Analyzing 10 Copyright © 2023 Pearson Education, Inc.

37) A clinical microbiologist is studying a suspected E. coli UTI in a patient. After obtaining a sample from the patient and immediately performing a Gram stain, the bacterial cells were determined to be Gram-negative with a filamentous shape. However, after culturing the sample for 24 hours, the cells were observed to be Gram-negative bacillus-shaped cells. What is the most likely explanation for these results? A) The bacterial species mutated from a filamentous to a bacillus-shaped bacterial species. B) The sample was contaminated during culturing. C) The organism is pleomorphic and displays different characteristics when grown in a lab than during an infection. D) The Gram staining procedure was defective. E) The patient has a viral rather than a bacterial infection. Answer: C Chapter/Section: 3.1 Learning Outcome: 3.4 Bloom's Taxonomy: 3-4: Applying/Analyzing 38) Penicillin (an antibiotic that prevents peptidoglycan from forming during cell division) is added to a bacterial culture, and after several hours the bacteria are placed in a hypotonic environment. What is the likely outcome? A) The cells will lyse due to a weakened cell wall. B) The cells will undergo plasmolysis. C) Water will be drawn into the cells, but the cell wall will prevent them from lysing. D) The cells will continue to grow normally, because the hypotonic solution will prevent penicillin from working. E) The cells will divide more quickly since peptidoglycan will not form during binary fission. Answer: A Chapter/Section: 3.2 Learning Outcome: 3.12 Bloom's Taxonomy: 3-4: Applying/Analyzing 3.2 True/False Questions 1) Spirochetes move in a corkscrew-rotary motion due to a specialized periplasmic flagellum. Answer: TRUE Chapter/Section: 3.1 Learning Outcome: 3.3 Bloom's Taxonomy: 1-2: Remembering/Understanding 2) Binary fission is more complicated than mitosis. Answer: FALSE Chapter/Section: 3.1 Learning Outcome: 3.5 Bloom's Taxonomy: 1-2: Remembering/Understanding

3) Gram-positive bacteria stain purple when the Gram stain is complete. Answer: TRUE Chapter/Section: 3.2 Learning Outcome: 3.8 Bloom's Taxonomy: 1-2: Remembering/Understanding 4) Prokaryotic cells that move in response to oxygen levels are said to display chemotaxis. Answer: FALSE Chapter/Section: 3.2 Learning Outcome: 3.13 Bloom's Taxonomy: 1-2: Remembering/Understanding 5) Bacteria that have flagella at both poles of the cell are described as amphitrichous. Answer: TRUE Chapter/Section: 3.2 Learning Outcome: 3.13 Bloom's Taxonomy: 1-2: Remembering/Understanding 6) A capsule is one type of glycocalyx that is fairly unorganized and loosely associated with the cell wall. Answer: FALSE Chapter/Section: 3.2 Learning Outcome: 3.13 Bloom's Taxonomy: 1-2: Remembering/Understanding 7) Bacteria that have periplasmic flagella always have a spirochete shape. Answer: TRUE Chapter/Section: 3.2 Learning Outcome: 3.14 Bloom's Taxonomy: 1-2: Remembering/Understanding 8) Bacterial DNA can be found in the nucleus of the cell. Answer: FALSE Chapter/Section: 3.3 Learning Outcome: 3.15 Bloom's Taxonomy: 1-2: Remembering/Understanding 9) A capsule is a well-organized glycocalyx that causes increased phagocytosis by host immune cells during an infection. Answer: FALSE Chapter/Section: 3.2 Learning Outcome: 3.13 Bloom's Taxonomy: 1-2: Remembering/Understanding

3.3 Essay Questions 1) Explain the steps of binary fission. Answer: Binary fission occurs in five main steps. First, the cell that is preparing to divide copies its DNA-containing chromosome, so that each daughter cell will receive a complete chromosome. Because the chromosome is tethered to the cell membrane, as the cell grows, the copied chromosomes separate and are drawn to opposite ends of the cell. Eventually the cell reaches a critical size and a septum (partition) begins to form near the midpoint. The septum, which is essentially the newly forming cell wall, eventually walls off the resulting two daughter cells from one another. The daughter cells may completely separate or they can remain associated to form a variety of cellular arrangements. Chapter/Section: 3.1 Learning Outcome: 3.5 Global LO: G2 ASM LO: 7.3a Bloom's Taxonomy: 3-4: Applying/Analyzing 2) If you were to design a pathogenic bacteria, justify why your bacteria would be Gram-positive or Gram-negative. Answer: My bacteria would be Gram-negative because the outer membrane could guard against damage by certain agents, including lysozyme, a variety of drugs, and some detergents and disinfectants. Because Gram-negative cells have a thin layer of peptidoglycan and the added protection of the outer membrane, they tend to be less sensitive to compounds like penicillin than Gram-positive bacteria are. Or the student could answer: My bacteria would be Gram-positive because those bacteria have cell walls that retain moisture longer due to their thick peptidoglycan layer, making these cells better at surviving in dry environments. The thick peptidoglycan layer protects Gram-positive cells from mechanical stresses such as abrasion and crushing. Gram-positive bacteria also have teichoic acids, which stabilize the cell wall, help maintain shape, transport cations into the cell, and aid regulation of cell division. Teichoic acids also aid certain Gram-positive bacteria in causing disease by promoting adhesion to host tissues and protecting them from various antimicrobial compounds. Chapter/Section: 3.2 Learning Outcome: 3.8 Global LO: G2 ASM LO: 7.3a Bloom's Taxonomy: 3-4: Applying/Analyzing

3) What about Pseudomonas aeruginosa makes it especially problematic in burn victims and cystic fibrosis patients? Answer: Pseudomonas aeruginosa is notorious for its efflux pumps, which have rendered the species resistant to whole families of antibiotics It also uses pili to move along surfaces. Pseudomonas species are also highly resistant to many disinfectants and antiseptics that are commonly used in hospitals. Chapter/Section: 3.2 Learning Outcome: 3.13 Global LO: G2 ASM LO: 4.1 | 7.3a Bloom's Taxonomy: 3-4: Applying/Analyzing 4) Without using chemical agents, name two examples of how the bacterial cell wall can be damaged that would result in Gram-positive bacteria showing a Gram-negative result. Answer: Gram-positive bacteria can show a Gram-negative result when the culture is too old or when bacteria produce endospores. Both of these result in damage to the cell wall as the bacteria get old and die or release the endospore. The cell wall, specifically the peptidoglycan, becomes thinner and more porous. As a result, during the Gram stain procedure, the crystal violet will be removed during the decolorization step, which will lead to the cells having a false Gram-negative result at the end of the staining procedure. Chapter/Section: 3.2 | 3.3 Learning Outcome: 3.8 | 3.19 Global LO: G2 ASM LO: 7.3a Bloom's Taxonomy: 3-4: Applying/Analyzing

Microbiology: Basic & Clinical Principles, 2e (Norman-McKay) Chapter 4 Introduction to Eukaryotic Cells 4.1 Multiple Choice Questions 1) Evidence in support of the endosymbiotic theory includes A) the presence of 70S ribosomes in mitochondria and chloroplasts. B) a single membrane enclosing the mitochondria and chloroplasts. C) linear DNA in mitochondria and chloroplasts. D) the presence of 70S ribosomes in mitochondria and chloroplasts and a single membrane enclosing the mitochondria and chloroplasts. E) the presence of 70S ribosomes in mitochondria and chloroplasts and linear DNA in mitochondria and chloroplasts. Answer: A Chapter/Section: 4.1 Learning Outcome: 4.1 ASM LO: 1.1 Bloom's Taxonomy: 1-2: Remembering/Understanding 2) Which of the following statements defines eukaryotic cells? A) They have a singular circular chromosome in the nucleus. B) They contain membrane-bound organelles such as a nucleus. C) They may divide using binary fission, mitosis, or meiosis. D) They may contain 80S or 70S ribosomes in their cytoplasm. E) They may contain a cell wall made of peptidoglycan. Answer: B Chapter/Section: 4.1 Learning Outcome: 4.2 ASM LO: 2.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 3) You have discovered a compound that inhibits the placement of sterols in the plasma membrane. What can you deduce about the efficacy of this drug? A) This drug may be broadly effective against prokaryotic cells. B) This drug may be broadly effective against eukaryotic cells. C) This drug may be broadly effective against both prokaryotic and eukaryotic cells. D) This drug may be broadly effective against eukaryotic cells but may be toxic in human patients. E) This drug may be broadly effective against both prokaryotic and eukaryotic cells but may be toxic in human patients. Answer: D Chapter/Section: 4.1 Learning Outcome: 4.2 Global LO: G2 ASM LO: 2.2 Bloom's Taxonomy: 3-4: Applying/Analyzing 1 Copyright © 2023 Pearson Education, Inc.

4) A similarity between mitosis and meiosis is A) two sequential cell divisions. B) production of genetically unique daughter cells. C) copying DNA before the cell divides. D) sexual reproduction. E) production of daughter cells with the same number of chromosomes as the parent. Answer: C Chapter/Section: 4.1 Learning Outcome: 4.3 ASM LO: 2.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 5) Which of the following processes is incorrectly matched to its description? A) Endocytosis: Imports materials into a cell B) Exocytosis: Exports materials out of a cell C) Phagocytosis: Imports undissolved substances but not whole cells or viruses D) Pinocytosis: Imports dissolved substances using small vesicles E) Receptor-mediated endocytosis: Uses specific binding between structures on the plasma membrane and ligands. Answer: C Chapter/Section: 4.1 Learning Outcome: 4.4 ASM LO: 2.4 Bloom's Taxonomy: 1-2: Remembering/Understanding

6) Which process is pictured?

A) endocytosis B) exocytosis C) phagocytosis D) pinocytosis E) receptor-mediated endocytosis Answer: B Chapter/Section: 4.1 Learning Outcome: 4.4 ASM LO: 2.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 7) Which group is not a kingdom-level classification of eukaryotic organisms? A) animals B) fungi C) plants D) protista E) protozoa Answer: E Chapter/Section: 4.2 Learning Outcome: 4.5 Bloom's Taxonomy: 1-2: Remembering/Understanding

8) You have isolated a new organism which has eukaryotic cells, is multicellular, grows as hyphae, does not perform photosynthesis, and has a cell wall. This organism most likely belongs to which kingdom? A) archaea B) bacteria C) fungi D) protista E) either fungi or protista Answer: C Chapter/Section: 4.2 Learning Outcome: 4.5 Global LO: G2 ASM LO: 2.4 Bloom's Taxonomy: 3-4: Applying/Analyzing 9) You have isolated a new eukaryotic organism which is unicellular and performs photosynthesis. The organism is most likely classified as a(n) A) animal. B) bacterium. C) fungus. D) fungi-like protista. E) plant-like protista. Answer: E Chapter/Section: 4.2 Learning Outcome: 4.5 Global LO: G2 ASM LO: 2.4 Bloom's Taxonomy: 3-4: Applying/Analyzing 10) Most helminthic parasites spend at least some part of their life cycle in the A) cardiovascular system. B) gastrointestinal tract. C) genitourinary tract. D) respiratory tract. E) skin. Answer: B Chapter/Section: 4.2 Learning Outcome: 4.6 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding

11) Which statement does not describe helminthic parasites? A) All are hermaphroditic. B) All reproduce sexually. C) All tend to have complex life cycles that can involve different host species. D) They are generally classified into one of two groups: roundworms or flatworms. E) An important mode of transmission is ingestion of the eggs or organism from fecescontaminated food and water. Answer: A Chapter/Section: 4.2 Learning Outcome: 4.6 Bloom's Taxonomy: 1-2: Remembering/Understanding 12) Hyphae are A) a collection of tubular structures that result from fungal growth. B) reproductive structures in fungi. C) a unicellular yeast-like form found in some fungi. D) collections of fungal growth on the skin. E) the main growth form of pathogenic fungi when they are infecting humans. Answer: A Chapter/Section: 4.2 Learning Outcome: 4.7 ASM LO: 2.4 Bloom's Taxonomy: 1-2: Remembering/Understanding

13) Which of the following are asexual fungal spores?

A) ascospores, basidiospores, and zygospores B) conidiospores and sporangiospores C) ascospores, basidiospores, and conidiospores D) any type of fungal spore can be asexual or sexual depending on how it formed E) No types of fungal spores are asexual. Answer: B Chapter/Section: 4.2 Learning Outcome: 4.8 ASM LO: 2.4 Bloom's Taxonomy: 1-2: Remembering/Understanding

14) Fungal infections are called A) basidium. B) coencytic. C) dimorphic. D) mycoses. E) sporgangia. Answer: D Chapter/Section: 4.2 Learning Outcome: 4.9 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 15) Which persons may be at increased risk for mycoses? A) those with weakened immune systems B) those who have had their normal microbiome disrupted by antibiotic therapy C) those who have not received the recommended vaccine schedule D) either those with weakened immune systems or those who have had their normal microbiome disrupted by antibiotic therapy E) either those with weakened immune systems or those who have not received the recommended vaccine schedule Answer: D Chapter/Section: 4.2 Learning Outcome: 4.9 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 16) Which of the following does not describe most protozoans? A) unicellular B) lacks a cell wall C) usually heterotrophic D) performs photosynthesis E) may reproduce sexually or asexually Answer: D Chapter/Section: 4.2 Learning Outcome: 4.11 ASM LO: 2.4 Bloom's Taxonomy: 1-2: Remembering/Understanding

17) Amoeboid protozoans A) move via cilia. B) are always free-living. C) may exist in the environment encased in a tough protective layer called a cyst. D) move via cilia and are always free-living. E) move via cilia, are always free-living and may exist in the environment encased in a tough protective layer called a cyst. Answer: C Chapter/Section: 4.2 Learning Outcome: 4.11 ASM LO: 2.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 18) A patient presents with symptoms of severe gastrointestinal distress. Bacterial and viral pathogens are ruled out. A protozoan which moves via hair-like appendages is observed upon microscopic examination of the patient's stool. The most likely cause of the infection is A) Balantidium coli, a ciliated protozoan. B) Giardia lamblia, a flagellated protozoan. C) Entamoeba histolytica, an amoeboid protozoan. D) Plasmodium, an apicomplexan. E) ergot toxin, a fungal mycotoxin. Answer: A Chapter/Section: 4.2 Learning Outcome: 4.11 Global LO: G2 ASM LO: 5.4 Bloom's Taxonomy: 3-4: Applying/Analyzing 19) A researcher discovers a chemical compound which prevents the incorporation of ergosterol in the plasma membrane. We can predict that this compound would be toxic to which kinds of organisms? A) animals B) bacteria C) fungi D) plants E) viruses Answer: C Chapter/Section: 4.3 Learning Outcome: 4.12 Global LO: G2 ASM LO: 2.2 Bloom's Taxonomy: 3-4: Applying/Analyzing

20) Which pairing of organism and the chemical component(s) of its cell wall is matched incorrectly? A) Archaea: Xylan or silica B) Bacteria: Peptidoglycan C) Fungi: Chitin D) Plants: Cellulose E) Protista: Cellulose, silica, or other components Answer: A Chapter/Section: 4.3 Learning Outcome: 4.13 ASM LO: 2.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 21) The role of the glycocalyx in eukaryotic cells may include A) protection against mechanical and osmotic stress. B) tissue development. C) transport processes. D) tissue development and transport processes. E) protection against mechanical and osmotic stress, tissue development, and transport processes. Answer: B Chapter/Section: 4.3 Learning Outcome: 4.14 ASM LO: 2.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 22) Which does not describe eukaryotic flagella? A) 9+2 arrangement of microtubules B) anchored by a basal body connected to a centriole C) flagellin protein D) plasma membrane-enclosed E) whip-like motion Answer: C Chapter/Section: 4.3 Learning Outcome: 4.15 ASM LO: 2.4 Bloom's Taxonomy: 1-2: Remembering/Understanding

23) Which picture shows the flagella? A)

Answer: A Chapter/Section: 4.3 Learning Outcome: 4.15 ASM LO: 2.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 24) A chemical compound which specifically disrupts the 9+2 microtubule arrangement would be a potential drug candidate as a(n) A) antibiotic targeting motile bacteria. B) antimicrobial targeting amoeboid protozoans. C) contraceptive drug disabling motility of human sperm. D) drug targeting fungal pathogens. E) herbicide (weed-killer). Answer: C Chapter/Section: 4.3 Learning Outcome: 4.15 Global LO: G2 ASM LO: 2.4 Bloom's Taxonomy: 3-4: Applying/Analyzing 25) Where is the "mucocilliary escalator" located in the human body? A) female reproductive system B) large intestine C) lining blood vessels D) oral cavity E) respiratory tract Answer: E Chapter/Section: 4.3 Learning Outcome: 4.16 Bloom's Taxonomy: 1-2: Remembering/Understanding

26) Prokaryotic and eukaryotic ribosomes share which of the following features? A) composed of protein and rRNA B) contain a large and a small subunit C) function is making DNA D) composed of a large and a small subunit AND composed of protein and rRNA E) composed of protein and rRNA AND function is making DNA Answer: D Chapter/Section: 4.4 Learning Outcome: 4.17 ASM LO: 2.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 27) Which statement is not true about eukaryotic ribosomes? A) Bound ribosomes are always bound while free ribosomes are always free. B) Bound ribosomes are attached to the endoplasmic reticulum (ER). C) Bound ribosomes produce proteins that are destined for secretion from the cell. D) Both bound and free ribosomes consist of a 40S and a 60S subunit. E) Ribosomes found in mitochondria are 70S rather than the 80S type found in the cytoplasm. Answer: A Chapter/Section: 4.4 Learning Outcome: 4.17 ASM LO: 2.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 28) Which is not a function which the cytoskeleton performs? A) movement of the cell B) movement of chromosomes during cell division C) passive transport of substances through the plasma membrane D) protection from external forces E) transport of vesicles and organelles Answer: C Chapter/Section: 4.4 Learning Outcome: 4.18 ASM LO: 2.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 29) Which fiber of the cytoskeleton is matched correctly with its function or structure? A) Microfilaments: Interact with the motor protein myosin B) Microfilaments: Polymerize to form the spindle during mitosis C) Intermediate filament: Polymerize and depolymerize to facilitate cell movement D) Microtubule: Composed of the protein actin E) Microtubule: Contribute tensile strength to the cytoskeleton Answer: A Chapter/Section: 4.4 Learning Outcome: 4.18 ASM LO: 2.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 12 Copyright © 2023 Pearson Education, Inc.

30) A chemical compound is discovered which prevents the actin protein from interacting with the myosin protein. What can you deduce about this compound? A) It might be an effective compound against bacterial pathogens. B) It might be an effective compound against amoeboid protozoans. C) It might have toxic effects against all eukaryotic cells. D) It might be an effective compound against bacterial pathogens and amoeboid protozoans. E) It might be an effective compound against amoeboid protozoans but might also be too toxic to human cells to be used. Answer: E Chapter/Section: 4.4 Learning Outcome: 4.18 Global LO: G2 ASM LO: 2.2 Bloom's Taxonomy: 3-4: Applying/Analyzing 31) The primary function of the nucleus is A) digestion and processing of nutrients. B) housing the cell's DNA. C) production of the cell's energy molecule, ATP. D) serving as the site of most of the cell's chemical reactions. E) serving as the site of ribosome synthesis of protein. Answer: B Chapter/Section: 4.4 Learning Outcome: 4.19 ASM LO: 2.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 32) The chromatin is A) a collection of DNA and protein. B) the entry and exit point for material into and out of the nucleus. C) a liquid filling the nucleus. D) an organelle which is continuous with the nuclear envelope. E) the site where ribosomal subunits begin their development. Answer: A Chapter/Section: 4.4 Learning Outcome: 4.19 ASM LO: 2.4 Bloom's Taxonomy: 1-2: Remembering/Understanding

33) Which structure pictured is the site of synthesis of proteins destined for secretion?

A) cisternae B) rough endoplasmic reticulum C) smooth endoplasmic reticulum D) rough and smooth endoplasmic reticulum E) rough and smooth endoplasmic reticulum, and cisternae Answer: B Chapter/Section: 4.4 Learning Outcome: 4.20 ASM LO: 2.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 34) The rough ER and the smooth ER are distinguished from each other by A) the presence or absence of DNA. B) the presence or absence of membrane-bound ribosomes. C) synthesis of lipids by the rough ER and synthesis of proteins by the smooth ER. D) the presence or absence of both DNA and membrane-bound ribosomes. E) the presence or absence of membrane-bound ribosomes AND the synthesis of lipids by the rough ER AND the synthesis of proteins by the smooth ER. Answer: B Chapter/Section: 4.4 Learning Outcome: 4.20 ASM LO: 2.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 14 Copyright © 2023 Pearson Education, Inc.

35) Vesicles that bud off the ER are typically shuttled to the ________ where their contents can be modified, sorted, and distributed. A) Golgi apparatus B) lysosome C) mitochondria D) nucleus E) plasma membrane Answer: A Chapter/Section: 4.4 Learning Outcome: 4.21 ASM LO: 2.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 36) Which type of vesicle/vacuole is incorrectly matched with its description? A) Lysosome: Contains hydrolytic enzymes that break down substances engulfed by the cell B) Peroxisome: Protects the cell from hydrogen peroxide and other toxic oxygen intermediates C) Secretory vesicle: Replenishes the lipid bilayer and deliver proteins for incorporation into the membrane D) Transport vesicle: Moves substances to diverse cellular destinations within the cell E) Vacuole: Contains water and substances such as nutrients, toxins, or waste products Answer: C Chapter/Section: 4.4 Learning Outcome: 4.22 ASM LO: 2.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 37) Mitochondria share all the following features with bacteria except A) linear DNA. B) 70S ribosomes. C) 80S ribosomes. D) linear DNA and 80S ribosomes. E) 70S and 80S ribosomes. Answer: D Chapter/Section: 4.4 Learning Outcome: 4.23 ASM LO: 2.4 Bloom's Taxonomy: 1-2: Remembering/Understanding

38) Mitochondria do not participate in which function? A) motility B) production of amino acids and vitamins C) production of ATP D) programmed cell death E) regulation of cell division Answer: A Chapter/Section: 4.4 Learning Outcome: 4.23 ASM LO: 2.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 39) Which portion of the mitochondria is folded to create a large surface area?

A) inner membrane B) outer membrane C) inner and outer membranes D) intercristal space E) matrix Answer: A Chapter/Section: 4.4 Learning Outcome: 4.23 ASM LO: 2.4 Bloom's Taxonomy: 1-2: Remembering/Understanding

40) Tinea, or ringworm infections, are caused by A) bacteria. B) viruses. C) helminths. D) fungi. E) protozoa. Answer: D Chapter/Section: 4.2 Learning Outcome: 4.9 Bloom's Taxonomy: 1-2: Remembering/Understanding 41) The causative agent of malaria (Plasmodium spp.) is a spore-forming protozoan (apicomplexa). Which of the following statements is true? A) Plasmodium is a free-living ciliated protozoan. B) Plasmodium uses flagella for motility. C) Plasmodium uses pseudopods for motility. D) Plasmodium is an obligate intracellular parasite. E) Plasmodium is transmitted to humans via contaminated drinking water. Answer: D Learning Outcome: 4.11 Bloom's Taxonomy: 1-2: Remembering/Understanding 42) A compound is discovered that causes misfolding of the tubulin protein. Which of the following statements is correct? A) The compound should not be toxic to human cells because human cells do not have flagella. B) The compound would not have an effect on bacterial cells because bacterial cells do not have flagella. C) The compound would likely inhibit the motility of flagellated protozoa. D) The compound would likely disrupt the function of bacterial cell flagella. E) The compound would likely be a candidate for a chemotherapeutic drug. Answer: C Chapter/Section: 4.3 Learning Outcome: 4.15 Bloom's Taxonomy: 3-4: Applying/Analyzing

4.2 True/False Questions 1) According to the endosymbiotic theory we can reason that the merging event that led to the mitochondria occurred before the merging event that led to the chloroplast because all eukaryotic cells which have chloroplasts also have mitochondria, but all eukaryotic cells do not necessarily have chloroplasts. Answer: TRUE Chapter/Section: 4.1 Learning Outcome: 4.1 Global LO: G2 ASM LO: 1.1 Bloom's Taxonomy: 3-4: Applying/Analyzing 2) Binary fission, mitosis, and meiosis all produce genetically identical daughter cells. Answer: FALSE Chapter/Section: 4.1 Learning Outcome: 4.3 ASM LO: 2.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 3) The kingdom Protista contains species which have plant-like features, others which contain animal-like features, and still others that contain fungal-like features. This is because scientists do not have a set of standard features by which to group them. Answer: TRUE Chapter/Section: 4.2 Learning Outcome: 4.10 ASM LO: 2.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 4) The four groups of protozoans are grouped by their mode of reproduction. Answer: FALSE Chapter/Section: 4.2 Learning Outcome: 4.11 Bloom's Taxonomy: 1-2: Remembering/Understanding 5) Bacterial plasma membranes differ from eukaryotic plasma membranes in that bacterial membranes always contain cholesterol while eukaryotic membranes rarely do. Answer: FALSE Chapter/Section: 4.3 Learning Outcome: 4.12 ASM LO: 2.4 Bloom's Taxonomy: 1-2: Remembering/Understanding

6) Animal cells are unique among all other eukaryotic kingdoms in that they universally lack a cell wall. Answer: TRUE Chapter/Section: 4.3 Learning Outcome: 4.13 Bloom's Taxonomy: 1-2: Remembering/Understanding 7) Unlike antibiotics which target the 70S bacterial ribosomes, there are no known chemical substances which can bind to 80S eukaryotic ribosomes. Answer: FALSE Chapter/Section: 4.4 Learning Outcome: 4.17 Global LO: G2 ASM LO: 2.2 Bloom's Taxonomy: 3-4: Applying/Analyzing 8) Cells which are active and have high energy demand will have more mitochondria than cell that are less active and have lower energy demand. Answer: TRUE Chapter/Section: 4.4 Learning Outcome: 4.23 Bloom's Taxonomy: 1-2: Remembering/Understanding 9) Dimorphic pathogenic fungi exhibit a yeast-like growth in the environment and a hyphae growth form during an active infection in a human host. Answer: FALSE Chapter/Section: 4.2 Learning Outcome: 4.7 Bloom's Taxonomy: 1-2: Remembering/Understanding 10) Photosynthetic cells have chloroplasts that allow them to harvest energy from sunlight, so they generally lack mitochondria. Answer: FALSE Chapter/Section: 4.3 Learning Outcome: 4.23 Bloom's Taxonomy: 1-2: Remembering/Understanding

4.3 Essay Questions 1) Describe the sequence of events in the evolution of eukaryotic cells as described by the endosymbiotic hypothesis. List four pieces of evidence which support this theory. Answer: The endosymbiotic theory describes the evolution of eukaryotic cells as a series of sequential, cell-merging events between a eukaryotic ancestor and certain prokaryotes. First, a non-photosynthetic prokaryote merged with the ancestral cell. Over time, the prokaryote lost the ability to live independently and evolved into the mitochondria. Later, descendants of these cells merged again with a photosynthetic prokaryote which became the chloroplast. Evidence for the endosymbiotic theory include the following: mitochondria and chloroplasts each contain circular DNA and 70S ribosomes similar to those found in bacteria, they are bound by a doublemembrane within the eukaryotic cell, they are similar in size and appearance to bacteria, and replicate by a process similar to binary fission. A number of mitochondrial genes resemble genes found in certain bacteria (namely rickettsial species) while genes in the chloroplast resemble genes found in cyanobacteria/photosynthetic bacteria. Chapter/Section: 4.1 Learning Outcome: 4.1 ASM LO: 1.1 Bloom's Taxonomy: 1-2: Remembering/Understanding 2) Protozoan infections are common in (though definitely not limited to) developing countries where limited medical and laboratory facilities may hinder diagnosis. Each of the four groups of protozoans may be identified by certain characteristics visible under the microscope. Name the groups and explain those characteristics which lead to identification. Answer: Protozoans are grouped into four categories by their means of motility of their mature stage which can be observed in a microscope. 1) Amoeboid protozoans move by means of cytoplasmic extensions called pseudopods. 2) Flagellated protozoans move by one or more "whip-like" flagella. 3) Ciliated protozoans move by hair-like appendages called cilia which cover the entire surface of the cell. 4) Spore-forming protozoans do not have flagella, cilia, or pseudopods in their mature form; they move by gliding. Chapter/Section: 4.2 Learning Outcome: 2.11 Global LO: G2 ASM LO: 2.1 Bloom's Taxonomy: 3-4: Applying/Analyzing

3) Antimicrobial therapies against fungal or protozoan pathogens are challenging to develop because these microbes have eukaryotic cells just as humans do. However, differences do exist between animal cells and the cells of these microbes which provide the opportunity to develop therapies which target these unique structures or molecules. Describe three cellular components of fungal and/or protozoan cells which are not found in animal cells which could be potential targets for drug therapy. Answer: All eukaryotic cells contain sterols in their plasma membranes; however, the specific type of sterol differs. Animal cells contain cholesterol while fungal and protozoan cells contain a variety of different sterols with ergosterol being a common example. Animal cells universally lack a cell wall while fungi have cell walls made of chitin while protists cell walls may contain cellulose, calcium carbonate, xylan, silica, and a variety of other protein- and carbohydrate-based substances. Flagella or cilia are found in flagellated protozoans or ciliate protozoans, respectively. Animal cells do not generally contain these structures with two important exceptions. Many animal sperm are flagellated, and the epithelial cells of the upper airway in vertebrate animals contain cilia. The glycocalyx in different organisms may be made of different types of carbohydrates, glycoproteins, and glycolipids. The glycocalyx of pathogenic fungi and protozoans is known to impact infectivity and immune responses. Chapter/Section: 4.3 Learning Outcome: 4.12 | 4.13 | 4.14 | 4.15 | 4.16 ASM LO: 2.2 Bloom's Taxonomy: 1-2: Remembering/Understanding 4) Eukaryotic organelles may be targeted by environmental toxins or microbial pathogens. Describe two examples of disease in humans which result from damage or malfunction to an organelle or other intracellular structure. Answer: The bacteria Shigella and E. coli produce a toxin which binds to the 60S ribosomal subunit of eukaryotes. The plant toxin ricin also targets this ribosomal subunit. The bacteria Salmonella enterica and Listeria monocytogenes both alter fibers in the host cell cytoskeleton as a means of entering cells. Certain anticancer drugs target the cytoskeleton in tumor cells. Several pathogens including the protozoan Toxoplasma gondii induce a stress response in the endoplasmic reticulum which can lead to tissue damage or cancer. Damage to mitochondria due to exposure to toxic oxygen products is associated with aging and other chronic diseases such as Parkinson's, cancer, atherosclerotic heart disease, and type II diabetes. Chapter/Section: 4.4 Learning Outcome: 4.17 | 4.18 | 4.20 | 4.22 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding

5) Compare and contrast prokaryotic and eukaryotic flagella. Describe at least three key differences. Answer: Prokaryotic flagella are composed of flagellin protein, while eukaryotic flagella are composed of tubulin filaments which are actually extensions of the cytoskeleton microtubules (in a 9+2 arrangement) connected to the centriole. Prokaryotic flagella are attached externally to the cell wall via a basal body (rings and hook/rod), while eukaryotic flagella are not in a separate compartment, but are extensions of the cell itself that are encased in the cytoplasmic membrane and contain cytoplasm. Eukaryotic flagella move in a back-and-forth "whip-like" movement while prokaryotic flagella move like a rotary propeller. Finally, eukaryotic flagella tend to be thicker and longer than prokaryotic flagella. Chapter/Section: 4.3 Learning Outcome: 4.15 Global LO: G2 Bloom's Taxonomy: 3-4: Applying/Analyzing

Microbiology: Basic & Clinical Principles, 2e (Norman-McKay) Chapter 5 Genetics 5.1 Multiple Choice Questions 1) Which of the following terms refers to the genetic makeup of an organism? A) phenotype B) genotype C) heritable D) primosome E) RNA Answer: B Chapter/Section: 5.1 Learning Outcome: 5.1 Bloom's Taxonomy: 1-2: Remembering/Understanding 2) Where can the DNA of prokaryotic cells be found? A) nucleoid B) nucleus C) nucleolus D) around histones E) in numerous linear chromosomes Answer: A Chapter/Section: 5.1 Learning Outcome: 5.2 Bloom's Taxonomy: 1-2: Remembering/Understanding 3) Which of the following nitrogen bases is found only in RNA and NOT in DNA? A) thymine B) cytosine C) guanine D) adenine E) uracil Answer: E Chapter/Section: 5.1 Learning Outcome: 5.3 | 5.5 Bloom's Taxonomy: 1-2: Remembering/Understanding

4) Which direction are phosphodiester bonds of DNA and RNA usually built in? A) 5' → 3' B) 3' → 5' C) 1' → 5' D) 5' → 1' E) Any direction is fine and will not affect the function of the DNA or RNA strand. Answer: A Chapter/Section: 5.1 Learning Outcome: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 5) RNA differs from DNA in all of the following ways except A) RNA is usually single stranded. B) RNA has a hydroxyl group on the 2' carbon of the ribose. C) RNA has directionality. D) there are several different types of RNA including mRNA, tRNA, and rRNA. E) in RNA, uracil (U) replaces thymine (T). Answer: C Chapter/Section: 5.1 Learning Outcome: 5.5 Bloom's Taxonomy: 3-4: Applying/Analyzing 6) The primary flow of genetic information in cells is from A) DNA → protein → RNA. B) DNA → RNA → protein. C) RNA→ DNA → protein. D) protein → DNA→ RNA. E) protein → RNA → DNA. Answer: B Chapter/Section: 5.1 Learning Outcome: 5.6 Bloom's Taxonomy: 1-2: Remembering/Understanding 7) DNA replication is A) slow. B) error prone. C) exactly the same for prokaryotes and eukaryotes. D) the process a cell uses to make protein. E) going to result in relatively few mutations. Answer: E Chapter/Section: 5.2 Learning Outcome: 5.7 Bloom's Taxonomy: 1-2: Remembering/Understanding

8) Which of the following statements about the primosome is false? A) The primosome is responsible for starting DNA replication. B) The primosome includes RNA polymerase to build the protein. C) The primosome includes helicase to unwind the DNA. D) The primosome includes primase to lay down RNA primers that will jump-start replication. E) The primosome is recruited to the origin of replication. Answer: B Chapter/Section: 5.2 Learning Outcome: 5.8 Bloom's Taxonomy: 1-2: Remembering/Understanding 9) All of the following are true of helicase except A) unwinds the DNA. B) creates the replication fork. C) causes a bubble of single-stranded DNA to form. D) allows for DNA polymerase III to bind to the DNA. E) relieves coiling tension that develops as the helix is unwound. Answer: E Chapter/Section: 5.2 Learning Outcome: 5.9 Bloom's Taxonomy: 1-2: Remembering/Understanding 10) As replication proceeds in a prokaryotic cell, how many replication forks exist on one chromosome? A) 1 B) 2 C) 3 D) 4 E) 5 Answer: B Chapter/Section: 5.2 Learning Outcome: 5.10 Bloom's Taxonomy: 1-2: Remembering/Understanding 11) Which of the following statements about DNA replication on the lagging strand is false? A) It is a discontinuous process. B) It is where one would find Okazaki fragments. C) It builds in the opposite direction of the helix unwinding. D) It requires the synthesis of many RNA primers. E) It uses only one molecule of DNA polymerase I. Answer: E Chapter/Section: 5.2 Learning Outcome: 5.11 Bloom's Taxonomy: 1-2: Remembering/Understanding

12) Eukaryotic replication differs from prokaryotic replication, because prokaryotic replication A) has more DNA to copy. B) takes longer to copy. C) has multiple replication initiation sites. D) involves only one circular chromosome. E) involves more protein factors. Answer: D Chapter/Section: 5.2 Learning Outcome: 5.12 ASM LO: 4.2 Bloom's Taxonomy: 3-4: Applying/Analyzing 13) Which of the following statements about protein synthesis is false? A) Protein synthesis is central to life. B) Protein synthesis has two main stages: replication and transcription. C) Protein synthesis can be disrupted by many antibiotics. D) Protein synthesis is where genetic information is read and used to create gene products. E) Protein synthesis is responsible for most physical and functional cell features. Answer: B Chapter/Section: 5.3 Learning Outcome: 5.13 Bloom's Taxonomy: 1-2: Remembering/Understanding 14) Which of the following statements about transcription in prokaryotes is false? A) It uses DNA as the template to make RNA. B) It uses RNA polymerase as the main enzyme. C) It is tightly regulated by the cell. D) It occurs in the nucleus. E) It uses a lot of cellular energy. Answer: D Chapter/Section: 5.3 Learning Outcome: 5.14 ASM LO: 4.2 Bloom's Taxonomy: 1-2: Remembering/Understanding 15) ________ RNA carries a genetic message in triplet code (codons) and is translated to build a protein. A) Messenger B) Transfer C) Ribosomal D) Alternative E) Junk Answer: A Chapter/Section: 5.3 Learning Outcome: 5.15 Bloom's Taxonomy: 1-2: Remembering/Understanding 4 Copyright © 2023 Pearson Education, Inc.

16) The genetic code A) has 60 codons. B) encodes for 18 amino acids. C) contains sense codons and nonsense codons. D) uses a quartet code to encode the codons. E) relies on codons made up of DNA. Answer: C Chapter/Section: 5.3 Learning Outcome: 5.16 Bloom's Taxonomy: 1-2: Remembering/Understanding 17) Which of the following statements about reverse transcription is false? A) Reverse transcription is performed by certain viruses and human cells. B) Reverse transcription uses special enzymes called reverse transcriptase. C) Reverse transcription uses RNA as a template. D) Reverse transcription builds copy DNA (cDNA). E) Reverse transcription requires a particular initiation sequence. Answer: E Chapter/Section: 5.3 Learning Outcome: 5.17 Bloom's Taxonomy: 1-2: Remembering/Understanding 18) Introns A) are only found in eukaryotes. B) are removed from mRNA in the cytoplasm. C) are considered to simply be junk DNA. D) are removed by a complex called the spliceosome. E) are sometimes left in the mRNA sequence for alternative splicing. Answer: D Chapter/Section: 5.3 Learning Outcome: 5.18 Bloom's Taxonomy: 1-2: Remembering/Understanding 19) Which of the following statements is false? A) There are hundreds of amino acids found in nature. B) There are 22 amino acids that are genetically encoded by codons. C) Four amino acids are considered nonstandard. D) In some species, one stop codon has been swapped out for one of the nonstandard amino acids. E) Nonstandard amino acids are found in prokaryotes and eukaryotes. Answer: C Chapter/Section: 5.3 Learning Outcome: 5.19 Bloom's Taxonomy: 1-2: Remembering/Understanding

20) Which of the following statements about post-translational modifications is false? A) Post-translational modifications can include the addition of extra amino acids. B) Additional organic factors could be added. C) Additional inorganic factors could be added. D) Post-translational modifications are often required for a protein to function. E) Post-translational modifications provide a way for cells to regulate gene product functionality. Answer: A Chapter/Section: 5.3 Learning Outcome: 5.20 Bloom's Taxonomy: 1-2: Remembering/Understanding 21) Which of the following statements about constitutive genes is false? A) Constitutive genes account for less than 20 percent of a cell's genes. B) Constitutive genes are expressed at any given time. C) Constitutive genes are referred to as housekeeping genes. D) Constitutive genes produce their proteins when a cell encounters a specific environmental change. E) Constitutive genes function differently than facultative genes. Answer: D Chapter/Section: 5.4 Learning Outcome: 5.21 Bloom's Taxonomy: 1-2: Remembering/Understanding 22) Which of the following statements about pre-transcriptional regulation is false? A) It helps cells control when transcription occurs. B) It helps cells control how often transcription occurs. C) It is the only way cells can manage to control protein synthesis. D) It is managed by transcription factors. E) It allows organisms to rapidly respond to frequent and dramatic changes in the environment. Answer: C Chapter/Section: 5.4 Learning Outcome: 5.22 Bloom's Taxonomy: 1-2: Remembering/Understanding 23) Which of the following statements about an inducible operon is false? A) It is off by default. B) Certain conditions activate transcription. C) When present, an inducer will inactivate the repressor. D) When the operon is off, the repressor is bound to the operator. E) When the operon is off, RNA polymerase is blocked by the operator. Answer: E Chapter/Section: 5.4 Learning Outcome: 5.23 ASM LO: 4.3 Bloom's Taxonomy: 1-2: Remembering/Understanding

24) Which of the following statements is true about epigenetic regulation? A) Epigenetic regulation is a way to control protein synthesis. B) Epigenetic regulation changes the sequence of DNA nucleotides. C) DNA methylation is one example of epigenetic regulation that is only found in prokaryotes. D) Epigenetic regulation is unable to affect a cell's phenotype. E) Epigenetic regulation is completely understood. Answer: A Chapter/Section: 5.4 Learning Outcome: 5.24 ASM LO: 4.1 | 4.3 Bloom's Taxonomy: 1-2: Remembering/Understanding 25) Which of the following statements is false about quorum sensing? A) Bacteria can communicate using chemical messengers called autoinducers. B) Quorum sensing allows bacteria to alter their protein synthesis in response to changes in population density. C) Quorum sensing allows unicellular organisms to coordinate their processes. D) Coordinated protein synthesis through quorum sensing is the foundation for forming biofilms. E) Bacteria that experience quorum sensing have a decreased chance of survival. Answer: E Chapter/Section: 5.4 Learning Outcome: 5.25 ASM LO: 3.2 | 4.1 | 4.3 Bloom's Taxonomy: 1-2: Remembering/Understanding 26) All of the following are examples of post-transcriptional regulation except A) cells can regulate translation by affecting how readily ribosomes associate with mRNA to read it. B) cells can regulate translation by methylating certain DNA nucleotides. C) cells can regulate how mRNA is spliced and exported out of the nucleus before translation occurs. D) in eukaryotic cells, small noncoding RNAs that work in post-transcriptional regulation include microRNAs and short interfering RNAs. E) in prokaryotic cells, small noncoding RNAs that work in post-transcriptional regulation include small RNAs. Answer: B Chapter/Section: 5.4 Learning Outcome: 5.26 ASM LO: 4.3 Bloom's Taxonomy: 1-2: Remembering/Understanding

27) Which of the following statements about mutations is false? A) A mutation is a change in the genetic material of a cell or virus. B) Mutations are essential to evolution within species. C) A mutation in a single-celled organism is more likely to be passed to daughter cells than a multicellular organism. D) Multicellular organisms evolve faster than unicellular organisms. E) Mutations are essential to variation within species. Answer: D Chapter/Section: 5.5 Learning Outcome: 5.27 ASM LO: 4.1 Bloom's Taxonomy: 1-2: Remembering/Understanding 28) Which of the following terms is correctly matched with its description? A) Substitution mutations: Occur when an incorrect amino acid is added. B) Insertion mutations: Occur when a cell adds one or more nucleotides to its genome sequence. C) Deletion mutations: Occur when one or more amino acids are removed from a protein sequence. D) Point mutations: Occur when an incorrect carbohydrate is added. E) Substitution mutations: Occur when an incorrect fatty acid is added. Answer: B Chapter/Section: 5.5 Learning Outcome: 5.28 Bloom's Taxonomy: 1-2: Remembering/Understanding 29) A ________ mutation does not change the amino acid sequence of a protein. A) deletion B) missense C) nonsense D) silent E) frameshift Answer: D Chapter/Section: 5.5 Learning Outcome: 5.29 Bloom's Taxonomy: 1-2: Remembering/Understanding 30) Frameshift mutations can do all of the following except A) insert or delete a DNA base. B) cause the DNA to revert back to the original sequence. C) change the protein's amino acid sequence. D) render the protein useless to the cell. E) insert or eliminate an amino acid. Answer: B Chapter/Section: 5.5 Learning Outcome: 5.30 Bloom's Taxonomy: 1-2: Remembering/Understanding 8 Copyright © 2023 Pearson Education, Inc.

31) Naturally occurring mutations are often referred to as ________ mutations. A) deleterious B) insertion C) spontaneous D) neutral E) unnoticed Answer: C Chapter/Section: 5.5 Learning Outcome: 5.31 Bloom's Taxonomy: 1-2: Remembering/Understanding 32) ________ mutagens are agents that can introduce genetic change through recombination. A) Biological B) Chemical C) Physical D) Frameshift E) Organic Answer: A Chapter/Section: 5.5 Learning Outcome: 5.32 Bloom's Taxonomy: 1-2: Remembering/Understanding 33) In the Ames test, what happens when his- bacteria are exposed to a chemical and experience a higher level of growth than the control? A) The reversion rate is lower than seen for spontaneous mutations. B) The tested chemical is regarded as a non-mutagen. C) The his- bacteria utilized DNA repair tools to fix the mutation. D) A reversion mutation allowed the his- bacteria to regain their ability to make histidine (revert to his+). E) The his- bacteria now utilized histidine from the media. Answer: D Chapter/Section: 5.5 Learning Outcome: 5.33 Bloom's Taxonomy: 3-4: Applying/Analyzing 34) Which of the following statements about thymine dimers is false? A) They are repaired by excision repair. B) They can be produced by exposure to UV light. C) If resulting mutations accumulate, it can result in cancers. D) Patients with xeroderma pigmentosum have faulty DNA repair mechanisms. E) They are repaired by one enzyme that can clip out, lay down new nucleotides, and seal the gap. Answer: E Chapter/Section: 5.5 Learning Outcome: 5.34 Bloom's Taxonomy: 1-2: Remembering/Understanding 9 Copyright © 2023 Pearson Education, Inc.

35) Which of the following statements about plasmids is false? A) Plasmids are nonchromosomal DNA segments found in bacteria and a number of eukaryotic cells. B) Plasmids are commonly shared among cells by horizontal gene transfer mechanisms. C) Plasmids are easily manipulated in the laboratory. D) Molecular biologists often use plasmids to generate cell lines that make useful products for medical applications. E) If present, plasmids are always essential to cell survival. Answer: E Chapter/Section: 5.6 Learning Outcome: 5.35 ASM LO: 4.5 Bloom's Taxonomy: 1-2: Remembering/Understanding 36) Key mechanisms of horizontal gene transfer include all of the following except A) conjugation. B) transformation. C) transduction. D) reproduction. E) transposons. Answer: D Chapter/Section: 5.6 Learning Outcome: 5.36 Bloom's Taxonomy: 1-2: Remembering/Understanding 37) Which of the following statements about conjugation is false? A) Conjugation is sexual reproduction for bacteria. B) In conjugation a bacterium carries a fertility plasmid. C) In conjugation a bacterium forms a small hollow tube called a pilus. D) In conjugation a bacterium attaches to a neighboring bacterial cell that lacks a fertility plasmid. E) Conjugation can be a problem because fertility plasmids often carry genes that endow cells with drug resistance or the ability to produce toxins. Answer: A Chapter/Section: 5.6 Learning Outcome: 5.37 Bloom's Taxonomy: 1-2: Remembering/Understanding

38) ________ is when the fertility plasmid merges with the bacterial cell's chromosome and ceases to be an independent plasmid in the cytoplasm. A) Recombination B) Transformation C) Transduction D) Conjugation E) Transfection Answer: A Chapter/Section: 5.6 Learning Outcome: 5.38 Bloom's Taxonomy: 1-2: Remembering/Understanding 39) How does transformation differ from conjugation? A) Transformation involves a pilus. B) Transformation requires only fresh DNA be used. C) Transformation takes up DNA from the environment. D) Transformation requires DNA to be on a plasmid. E) Transformation can only exchange DNA between bacteria of the same species. Answer: C Chapter/Section: 5.6 Learning Outcome: 5.39 Bloom's Taxonomy: 3-4: Applying/Analyzing 40) Which of the following statements is true about specialized transduction? A) Specialized transduction occurs in all bacteriophage except the temperate phages. B) Specialized transduction always directs the production of new phage particles immediately upon infecting the host bacterium. C) Bacteriophage undergoing specialized transduction integrate their DNA into a random region of the host cell's genome. D) A bacteriophage may at some point become reactivated, excise itself and surrounding bacterial genes from the genome, and begin to build new phage particles. E) Specialized transduction requires that bacteriophage infect at least two different cells to be carried out. Answer: D Chapter/Section: 5.6 Learning Outcome: 5.40 Bloom's Taxonomy: 1-2: Remembering/Understanding

41) Which of the following is true about retrotransposons? A) Retrotransposons do not require an RNA intermediate. B) Retrotransposons rely on an RNA intermediate to insert into a new part of the genome. C) Retrotransposons can use a "cut-and-paste" strategy. D) Retrotransposons can use a "copy-and-paste" strategy. E) Retrotransposons never remain in their original location. Answer: B Chapter/Section: 5.6 Learning Outcome: 5.41 Bloom's Taxonomy: 1-2: Remembering/Understanding 42) A microbiologist is analyzing a sample collected from the ocean floor. Two new organisms are discovered. During DNA analysis, it is determined that Organism 1 has 3 chromosomes, while Organism 2 has 12 chromosomes. Which of the following conclusions can be made from this research? A) Organism 1 is more complex. B) Organism 2 is more complex. C) Organism 1 is most likely a unicellular organism, while Organism 2 is a multicellular organism. D) Organism 1 is most likely a multicellular organism, while Organism 2 is a unicellular organism. E) No conclusion can be made regarding overall complexity of the newly isolated organisms based on number of chromosomes. Answer: E Chapter/Section: 5.1 Learning Outcome: 5.2 Global LO: G2 Bloom's Taxonomy: 3-4: Applying/Analyzing 43) In general, the more complex an organism is, the more ________ it has. A) chromosomes B) genes C) cytoplasm D) mutations E) histones Answer: B Chapter/Section: 5.1 Learning Outcome: 5.2 Bloom's Taxonomy: 1-2: Remembering/Understanding

44) Which of the following does not describe a specific DNA sequence? A) operon B) promoter C) operator D) repressor E) regulatory gene Answer: D Chapter/Section: 5.4 Learning Outcome: 5.23 Bloom's Taxonomy: 1-2: Remembering/Understanding 45) Consider the following sequences: the first is an original DNA sequence and the second is an altered sequence. What type of mutation does the second sequence represent? 5'-AAT GCC GAT-3' 5'-AAT CCC GAT-3' A) Frameshift mutation B) Reversion mutation C) Substitution mutation D) Deletion mutation E) Insertion mutation Answer: C Chapter/Section: 5.5 Learning Outcome: 5.30 Global LO: G2 ASM LO: 4.5 Bloom's Taxonomy: 3-4: Applying/Analyzing

46) In Griffith's experiments, mice that were exposed to both killed encapsulated bacteria and live nonencapsulated bacteria died even though killed encapsulated bacteria alone or live nonencapsulated bacteria alone did not result in illness. What is the best way to explain this result? A) A bacteriophage used specialized transduction to shuttle the capsule-making genes into the nonencapsulated bacteria. B) The live nonencapsulated bacteria picked up the capsule-making genes from the environment in the process of transformation. C) The live nonencapsulated bacteria underwent a reversion mutation to restore the function of capsule-making genes. D) The killed encapsulated bacteria released toxins that killed the mice. E) Transposons allowed the capsule-making genes to "jump" from an inactive part to an active part of the genome. Answer: B Chapter/Section: 5.6 Learning Outcome: 5.39 Global LO: G2 ASM LO: 4.1 Bloom's Taxonomy: 3-4: Applying/Analyzing 5.2 True/False Questions 1) An organism's genotype influences its phenotype. Answer: TRUE Chapter/Section: 5.1 Learning Outcome: 5.1 Bloom's Taxonomy: 1-2: Remembering/Understanding 2) Gyrase breaks the hydrogen bonds between DNA strands and unwinds the DNA strands while topoisomerases relieve the coiling tension that develops as the helix unwinds. Answer: FALSE Chapter/Section: 5.2 Learning Outcome: 5.10 Bloom's Taxonomy: 1-2: Remembering/Understanding 3) DNA replication is a semiconservative process. Answer: TRUE Chapter/Section: 5.2 Learning Outcome: 5.11 Bloom's Taxonomy: 1-2: Remembering/Understanding 4) A sequence of cDNA would contain introns but no exons. Answer: FALSE Chapter/Section: 5.3 Learning Outcome: 5.17 Bloom's Taxonomy: 3-4: Applying/Analyzing 14 Copyright © 2023 Pearson Education, Inc.

5) Introns shouldn't be perceived as junk or a nuisance, rather, they provide an opportunity for genetic diversity. Answer: TRUE Chapter/Section: 5.3 Learning Outcome: 5.17 Bloom's Taxonomy: 1-2: Remembering/Understanding 6) A repressible operon produces a repressor that is inactive from the start. Answer: TRUE Chapter/Section: 5.4 Learning Outcome: 5.23 Bloom's Taxonomy: 1-2: Remembering/Understanding 7) A reversion mutation is when a base-substitution mutation is changed back to the original DNA sequence. Answer: TRUE Chapter/Section: 5.5 Learning Outcome: 5.29 Bloom's Taxonomy: 1-2: Remembering/Understanding 8) Many mutagens cause a rate of mutation that promotes the development of cancers; such mutagens are called carcinogens. Answer: TRUE Chapter/Section: 5.5 Learning Outcome: 5.32 Bloom's Taxonomy: 1-2: Remembering/Understanding 9) DNA transposons rely on the enzyme reverse transcriptase to insert a copy of cDNA into a new location in the genome. Answer: FALSE Chapter/Section: 5.6 Learning Outcome: 5.41 Bloom's Taxonomy: 1-2: Remembering/Understanding 10) Transformation requires cells to be in direct contact with each other in order for DNA exchange to occur. Answer: FALSE Chapter/Section: 5.6 Learning Outcome: 5.39 Bloom's Taxonomy: 1-2: Remembering/Understanding

5.3 Essay Questions 1) Using the central dogma of molecular biology, explain how an organism's genotype influences its phenotype. Answer: An organism's genetic makeup or, genotype (DNA in all living cells, but DNA or RNA in viruses), is used to product their mRNA through transcription. The mRNA is used to produce their proteins through translation. It is these proteins that are responsible for shaping the phenotype (the "genetic expression") of the organism. This flow of information is referred to as the central dogma of molecular biology and closely links the genotype of an organism to its phenotype. Chapter/Section: 5.1 Learning Outcome: 5.1 | 5.6 Global LO: G7 | G8 ASM LO: 4.2 Bloom's Taxonomy: 3-4: Applying/Analyzing 2) What are the differences between DNA replication on the leading and lagging strands and why do they exist? Answer: The leading strand only requires primase to lay down one RNA primer while many RNA primers are needed on the lagging strand. DNA polymerase III is basically the only polymerase that is used on the leading strand to build DNA off of the one RNA primer, but the lagging strand also requires DNA polymerase I to replace the many RNA primers used. Ligase is also needed extensively on the lagging strand to glue the Okazaki fragments together after DNA polymerase I has done its job. Since the leading strand is one continuous read, Okazaki fragments are not found on this strand. Chapter/Section: 5.2 Learning Outcome: 5.11 Global LO: G2 | G8 Bloom's Taxonomy: 3-4: Applying/Analyzing 3) Explain how a bacterium living in a biofilm behaves very similarly to a primitive multicellular organism. Answer: Bacteria living in a community or biofilm produce chemicals called autoinducers. Bacteria are able to use these signals to better sense what is occurring in their community and this is referred to as quorum sensing. Quorum sensing allows bacteria to alter their protein synthesis in response to changes in the density of the population. In this way, quorum sensing allows unicellular organisms to coordinate their processes and behave more collectively, almost like a primitive multicellular organism. Chapter/Section: 5.4 Learning Outcome: 5.25 Global LO: G8 ASM LO: 4.1 | 5.2 Bloom's Taxonomy: 3-4: Applying/Analyzing

4) Both prokaryotes and eukaryotes have several types of pre- and post-transcriptional regulation. What advantage does pre-transcriptional regulation have over post-transcriptional regulation and vice versa? Name three examples of each type of regulation. Answer: Pre-transcriptional regulation is very useful to the cell because it can save the cell a lot of energy and additional resources (for example RNA nucleotides) by stopping transcription before it even starts. Although post-transcriptional regulation will have already used some of the cell's energy and resources, its major advantage is that the cell will be able to respond faster to environmental changes. Examples of pre-transcriptional regulation include: operons, quorum sensing, epigenetic control (such as DNA methylation), and recruitment of transcription factors. Examples of post-transcriptional regulation include: recruiting ribosomes to mRNA, controlling mRNA stability, small noncoding RNAs, and riboswitches. In addition, eukaryotes can also control RNA processing (for example: processing of introns and exons) and nuclear export. Chapter/Section: 5.4 Learning Outcome: 5.22 | 5.26 Global LO: G8 ASM LO: 4.3 Bloom's Taxonomy: 3-4: Applying/Analyzing 5) Describe the four scenarios of Griffith's experiment in the 1920s and summarize the main conclusion. Answer: In scenario 1, Griffith infected a mouse with a living encapsulated bacteria and the mouse died. In scenario 2, Griffith infected a mouse with a living nonencapsulated bacteria and the mouse lived. In scenario 3, Griffith infected a mouse with a heat-killed encapsulated bacteria and the mouse lived. In scenario 4, Griffith infected a mouse with a living nonencapsulated bacteria and a heat-killed encapsulated bacteria and the mouse died. Live encapsulated bacteria were found in the mouse's blood. To conclude, the nonencapsulated bacteria were able to take up DNA from the killed encapsulated bacteria via transformation. This changed the nonpathogenic bacteria into the virulent variety. Griffith's experiments demonstrated that environmental DNA could transform bacteria and help pathogens evolve. Chapter/Section: 5.6 Learning Outcome: 5.39 Global LO: G8 ASM LO: 4.5 | 5.3 Bloom's Taxonomy: 1-2: Remembering/Understanding

Microbiology: Basic & Clinical Principles, 2e (Norman-McKay) Chapter 6 Viruses and Prions 6.1 Multiple Choice Questions 1) Viruses are considered to be non-living pathogens for which reason? A) their extremely small size B) their ability to synthesize only some of their own components C) they are acellular D) their unique type of cells E) their unique type of cells and their lack of metabolic processes Answer: C Chapter/Section: 6.1 Learning Outcome: 6.1 Bloom's Taxonomy: 1-2: Remembering/Understanding 2) Compared to both prokaryotic and eukaryotic cells, viruses A) are generally smaller. B) have similar metabolic processes. C) lack genetic material. D) lack proteins. E) are not filterable. Answer: A Chapter/Section: 6.1 Learning Outcome: 6.2 Bloom's Taxonomy: 1-2: Remembering/Understanding 3) A previously undescribed infection has been detected among inhabitants in an isolated village in a remote tropical rainforest. When serum from an infected individual is passed through a filter, the infection can be transmitted to laboratory animals. Nothing is observed when the serum is examined with a light microscope at the highest magnification. Biochemical tests show the presence of RNA and protein but no carbohydrates or lipids. This data is consistent with what type of infectious agent? A) eukaryote B) prokaryote C) virus D) either a virus or a prokaryote E) either a virus, a prokaryote, or a eukaryote Answer: C Chapter/Section: 6.1 Learning Outcome: 6.2 Global LO: G2 Bloom's Taxonomy: 3-4: Applying/Analyzing

4) Which statement is not true about the virus capsid? A) Both bacteriophage and animal viruses have capsids. B) The capsid determines the shape of the virus. C) The capsid is made of one or more types of protein subunits. D) The capsid functions as a package for the viral genetic material. E) Because the capsid is not essential to the virus, it is not a useful target for antiviral drugs. Answer: E Chapter/Section: 6.1 Learning Outcome: 6.3 Bloom's Taxonomy: 1-2: Remembering/Understanding 5) When a virus has an envelope, A) it likely escapes its host cell by budding. B) it likely escapes its host cell by lysis. C) it may escape its host cell either by budding or by lysis. D) it is always an RNA-containing virus. E) it is always a bacteriophage. Answer: A Chapter/Section: 6.1 Learning Outcome: 6.3 Bloom's Taxonomy: 1-2: Remembering/Understanding 6) Which of the following statements is not correct regarding viral spikes? A) Viral spikes allow the virus to attach and enter host cells. B) Viral spikes may be a target for the host immune system. C) Viral spikes show specificity in binding to particular structures on the host cell. D) Viral spikes may mutate to evade the immune response, leading to new viral strains. E) Viral spikes always extend from the envelope, so non-enveloped viruses will not include spikes. Answer: E Chapter/Section: 6.1 Learning Outcome: 6.3 Bloom's Taxonomy: 1-2: Remembering/Understanding

7) Which picture shows an icosahedral enveloped virus with spikes? A)

Answer: C Chapter/Section: 6.1 Learning Outcome: 6.3 Bloom's Taxonomy: 1-2: Remembering/Understanding 8) Which genomic arrangement has not been found in viruses? A) double-stranded circular DNA B) single-stranded circular DNA C) double-stranded segmented RNA D) single-stranded linear RNA E) double-stranded circular RNA Answer: E Chapter/Section: 6.1 Learning Outcome: 6.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 9) All viruses must use their genome to produce ________, which is then used by the host cell to produce ________. A) DNA; mRNA B) DNA; proteins C) mRNA; proteins D) proteins; DNA E) proteins; mRNA Answer: C Chapter/Section: 6.1 Learning Outcome: 6.5 Bloom's Taxonomy: 1-2: Remembering/Understanding

10) Retroviruses use the enzyme reverse transcriptase to A) direct the production of double-stranded DNA from a single-stranded RNA genome. B) synthesize sense-stranded mRNA from an antisense RNA genome. C) synthesize double-stranded RNA. D) transcribe mRNA from a DNA genome. E) convert a segmented DNA genome into a circular RNA genome. Answer: A Chapter/Section: 6.1 Learning Outcome: 6.5 Bloom's Taxonomy: 1-2: Remembering/Understanding 11) A newly-discovered double-stranded RNA virus which infects animal cells is found to contain a unique enzyme which synthesizes double-stranded RNA using an RNA template. Which of the following statements is likely to be true? A) The enzyme probably came from the host animal cell. B) The virus must bring this enzyme into the host cell as synthesizing RNA from an RNA template does not happen in animal cells. C) This enzyme would not be a good antiviral drug target as the host cell likely has a similar enzyme which could be affected by such a drug. D) This enzyme is coded for by a gene in the host cell. E) The enzyme probably came from the host animal cell and is coded for by a gene in the host cell. Answer: B Chapter/Section: 6.1 Learning Outcome: 6.5 Global LO: G2 Bloom's Taxonomy: 3-4: Applying/Analyzing 12) Which of the following are contributors to viral genome evolution? A) quick replication time B) the large number of virions released within a host C) superior proofreading by RNA polymerases compared to DNA polymerases D) quick replication time and the large number of virions released within a host E) quick replication time and superior proofreading by RNA polymerases compared to DNA polymerases Answer: D Chapter/Section: 6.1 Learning Outcome: 6.6 Bloom's Taxonomy: 1-2: Remembering/Understanding

13) Which description of antigenic drift and antigenic shift in the influenza virus is incorrectly matched? A) Antigenic drift: Spontaneous mutation leads to a minor change in HA or NA spikes. B) Antigenic drift: A host vaccinated against an influenza strain before antigenic drift may lack effective immunity and be susceptible to infection. C) Antigenic drift: Often involves reassortment of viral strains in an animal host followed by a "species jump" to humans. D) Antigenic shift: May result in a pandemic outbreak due to widespread lack of immunity. E) Antigenic shift: Often leads to viral strains with new features such as increased infectivity or expanded host range. Answer: C Chapter/Section: 6.1 Learning Outcome: 6.7 Bloom's Taxonomy: 1-2: Remembering/Understanding 14) Which property is not currently used to classify viruses? A) type of nucleic acid present B) capsid symmetry C) presence or absence of an envelope D) genome architecture E) host range of the virus Answer: E Chapter/Section: 6.2 Learning Outcome: 6.8 Bloom's Taxonomy: 1-2: Remembering/Understanding 15) Which viral family and representative disease contains single-stranded+ RNA and reverse transcriptase? A) Filoviridae (Ebola) B) Orthomyxoviridae (influenza) C) Paramyxoviridae (measles) D) Retroviridae (AIDS) E) Rhabdoviridae (rabies) Answer: D Chapter/Section: 6.2 Learning Outcome: 6.9 Bloom's Taxonomy: 1-2: Remembering/Understanding

16) All the following are DNA viruses except A) Adenoviridae. B) Hepadnaviridae. C) Herpesviridae. D) Papillomaviridae. E) Picornaviridae. Answer: E Chapter/Section: 6.2 Learning Outcome: 6.9 Bloom's Taxonomy: 1-2: Remembering/Understanding 17) Viruses which infect many different tissue types are said to have a(n) A) broad host range. B) broad tropism. C) indeterminate host range. D) narrow host range. E) narrow tropism. Answer: B Chapter/Section: 6.2 Learning Outcome: 6.10 Bloom's Taxonomy: 1-2: Remembering/Understanding 18) Which suffix denotes the "family" level of classification for viruses? A) - virales B) - viridae C) - virion D) - virus E) Viruses are not classified to the "family" level. Answer: B Chapter/Section: 6.2 Learning Outcome: 6.11 Bloom's Taxonomy: 1-2: Remembering/Understanding 19) The key event that occurs during lysogenic replication of bacteriophage that does not occur during lytic replication is A) assembly of new phage by packing viral genomes into capsids. B) attachment of the phage to specific proteins in the bacterial cell. C) integration of the phage DNA into the host cell DNA. D) penetration of the phage DNA into the host cell. E) release of mature viral particles by lysis of the bacterial cell. Answer: C Chapter/Section: 6.3 Learning Outcome: 6.12 ASM LO: 2.5 Bloom's Taxonomy: 1-2: Remembering/Understanding

20) During lytic replication of bacteriophage, which process uses factors from the host cell, rather than (those or factors) coded by the viral genome? A) DNAases to break up the host cell genome B) enzymes which transcribe and translate viral genes C) lysozyme to rupture the host cell D) proteins to build new phage particles E) proteins to copy the viral genome Answer: B Chapter/Section: 6.3 Learning Outcome: 6.12 ASM LO: 4.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 21) Phage conversion occurs when A) prophage confer new pathogenic properties on bacterial cells. B) prophage excise themselves and resume lytic replication when the host cell is stressed. C) bacteriophage are used clinically to treat bacterial infections. D) a host cell is infected by a bacteriophage. E) bacteriophage are released from the host cell. Answer: A Chapter/Section: 6.3 Learning Outcome: 6.13 ASM LO: 2.5 Bloom's Taxonomy: 1-2: Remembering/Understanding 22) Which stage of animal virus replication may be blocked by a drug that binds with the viral spike? A) attachment B) penetration C) uncoating D) replication E) assembly Answer: A Chapter/Section: 6.3 Learning Outcome: 6.14 ASM LO: 2.5 Bloom's Taxonomy: 1-2: Remembering/Understanding

23) HIV, the virus which causes AIDS, interacts with two receptors on the host cell membrane: CD4 and CCR5. A small percentage of individuals have a genetic mutation which causes their cells to lack CCR5. These individuals will never develop AIDS nor are they able to pass HIV on to others. Which part of viral replication is being blocked by the lack of a receptor? A) HIV cannot attach to the host cell without the proper membrane receptor. B) Endocytosis is being prevented. C) The host cell enzymes are unable to replicate the HIV genome. D) The virus components cannot be assembled into new virions. E) Newly assembled virions cannot be released from the host cell. Answer: A Chapter/Section: 6.3 Learning Outcome: 6.14 Global LO: G2 ASM LO: 4.4 Bloom's Taxonomy: 3-4: Applying/Analyzing

24) Which stage of viral replication is shown?

A) attachment B) penetration via membrane fusion C) penetration via endocytosis D) release by budding E) release by lysis Answer: D Chapter/Section: 6.3 Learning Outcome: 6.14 ASM LO: 2.5 Bloom's Taxonomy: 1-2: Remembering/Understanding

25) Which stage of animal virus replication will not be different between naked viruses and enveloped viruses? A) penetration B) uncoating C) replication D) assembly E) release Answer: C Chapter/Section: 6.3 Learning Outcome: 6.15 ASM LO: 2.5 Bloom's Taxonomy: 1-2: Remembering/Understanding 26) Which statement is not true about chronic persistent viral infections? A) The immune system fails to clear the infection. B) A period of quiet infection where the host is asymptomatic is followed by a period of active viral replication. C) May involve periods of flare-up where the virus is actively replicating alternating with periods of dormancy. D) Small numbers of virions may be produced and released from host cells during the quiet periods. E) May involve integration of the virus into the host cell DNA to form a provirus. Answer: C Chapter/Section: 6.3 Learning Outcome: 6.16 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding

27) Which type of viral infection is demonstrated by the graph?

A) acute persistent B) chronic persistent C) latent persistent D) lysogenic E) acute non-persistent Answer: C Chapter/Section: 6.3 Learning Outcome: 6.16 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 28) Oncogenic viruses A) are never RNA viruses. B) increase host cell responsiveness to death signals. C) stimulate uncontrolled host cell division. D) are never maintained episomally. E) always integrate into the host cell DNA. Answer: C Chapter/Section: 6.3 Learning Outcome: 6.17 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding

29) Which is not a cancer linked to a specific virus? A) adult T-cell leukemia B) cervical cancer C) Kaposi sarcoma D) liver cancer E) skin cancer Answer: E Chapter/Section: 6.3 Learning Outcome: 6.17 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 30) Animal viruses can be grown in all of the following except A) tissue culture. B) embryonated eggs. C) live animal hosts. D) HeLa cells. E) E. coli cells. Answer: E Chapter/Section: 6.4 Learning Outcome: 6.18 ASM LO: 4.4 Bloom's Taxonomy: 1-2: Remembering/Understanding

31) When mixed with their host bacterium and plated on solid agar, lytic phage will form clear areas in the bacterial growth. What are these clear areas called?

A) assays B) halos C) plaques D) titers E) zones of inhibition Answer: C Chapter/Section: 6.4 Learning Outcome: 6.18 Bloom's Taxonomy: 1-2: Remembering/Understanding 32) One ml of a liquid suspension of bacteriophage is mixed with its host bacteria and plated. After incubation, the plate is completely clear. What is the probable explanation? A) The phage concentration was so high that all the host bacterial cells were killed. B) The bacteria mutated and could no longer be infected by this phage. C) The bacteriophage doesn't grow on the type of agar used. D) The bacteriophage culture was dead. E) The phage concentration was too low to infect many bacterial cells. Answer: A Chapter/Section: 6.4 Learning Outcome: 6.19 Global LO: G2 Bloom's Taxonomy: 3-4: Applying/Analyzing

33) What does the plaque assay determine? A) number of bacteriophage in a sample B) type of bacteriophage in a sample C) if the phage is a lysogenic phage D) if the virus can grow in a live animal host E) if a given drug will be useful in treating a given viral infection Answer: A Chapter/Section: 6.4 Learning Outcome: 6.19 Bloom's Taxonomy: 1-2: Remembering/Understanding 34) Which of the following tests works by detecting viral nucleic acid? A) agglutination with beads coated with antibodies to the virus B) agglutination with beads coated with viral antigens C) ELISA D) PCR E) aglutination with beads coated with either antibodies or antigens Answer: D Chapter/Section: 6.4 Learning Outcome: 6.20 Bloom's Taxonomy: 1-2: Remembering/Understanding 35) An individual uses an in-home test kit one week after engaging in high-risk behavior for HIV infection. The test kit uses a saliva sample that is mailed to a lab where an agglutination test to detected HIV antibodies is run. The results come back negative for HIV. What should the patient consider regarding these test results? A) One week may not be enough time for HIV antibodies to be detected. B) Agglutination tests will not detect viruses if the infection is latent. C) Agglutination tests are not appropriate for testing samples of body fluids. D) An ELISA test is needed to detect the presence of HIV nucleic acid. E) Agglutination tests will not detect viruses if the infection is latent, nor are they appropriate for testing samples of body fluids. Answer: A Chapter/Section: 6.4 Learning Outcome: 6.20 Global LO: G2 Bloom's Taxonomy: 3-4: Applying/Analyzing

36) Challenges in developing effective antiviral drugs with minimal side effects to the patient include A) viruses have many more chemically distinct targets than living pathogens. B) drugs can be easily delivered to reach viruses within host cells. C) the immune system is rarely successful in ending viral infections so there is no natural model to work from. D) viruses use the cell's own machinery and metabolism for replication. E) only the attachment stage of the viral life cycle is a suitable target for antiviral drug action. Answer: D Chapter/Section: 6.4 Learning Outcome: 6.21 Bloom's Taxonomy: 1-2: Remembering/Understanding 37) Which of the following antiviral drug categories is incorrectly matched with its description? A) Antisense antivirals: Short sequences of nucleotides that are complementary to viral RNA B) Interferons: Used for postexposure prophylaxis C) Nucleoside analogs: Mimic normal nucleotides interfering with nucleic acid replication D) Nucleotide reverse transcriptase inhibitors: Target retroviruses E) Proteases: Target protein-cutting enzymes which make mature virions Answer: B Chapter/Section: 6.4 Learning Outcome: 6.21 Bloom's Taxonomy: 1-2: Remembering/Understanding 38) Prions are A) infectious nucleic acids. B) living, acellular entities. C) misfolded proteins which can cause normal versions to also misfold. D) diagnosed with a simple blood test. E) associated with many tissue types. Answer: C Chapter/Section: 6.5 Learning Outcome: 6.22 Bloom's Taxonomy: 1-2: Remembering/Understanding 39) Which of the following prion diseases may be acquired by eating beef contaminated with a cattle prion? A) Gerstmann-Straussler-Schienker syndrome B) variant CJD C) sporadic CJD D) inherited CJD E) iatrogenic CJD Answer: B Chapter/Section: 6.5 Learning Outcome: 6.23 Bloom's Taxonomy: 1-2: Remembering/Understanding 16 Copyright © 2023 Pearson Education, Inc.

40) How would the structure of the SARS-CoV2 virion (causative agent of COVID-19) be best described? A) naked icosahedral B) enveloped icosahedral C) naked helical D) enveloped helical E) enveloped complex Answer: D Chapter/Section: 6.2 Learning Outcome: 6.9 Bloom's Taxonomy: 1-2: Remembering/Understanding 41) Which viral family and representative disease contains single-stranded, positive-sense, nonsegmented RNA? A) Filoviridae (Ebola) B) Coronaviridae (COVID-19) C) Paramyxoviridae (measles) D) Orthomyxoviridae (influenza) E) Rhabdoviridae (rabies) Answer: B Chapter/Section: 6.2 Learning Outcome: 6.9 Bloom's Taxonomy: 1-2: Remembering/Understanding 42) Determining the receptor (the protein on the surface of human cells that binds to the Spike protein) of the SARS-CoV2 virus in human cells was an active area of research after the emergence of COVID-19. Angiotension Converting Enzyme-2 (ACE-2) was determined to be the human receptor protein. ACE-2 is found on human epithelial cells lining the nasal passages, lungs, heart, blood vessels, and gastrointestinal tract. How would these experimental data be best described? A) The virus has broad tropism, with a narrow host range. B) The virus has narrow tropism, with a narrow host range. C) The virus has broad tropism, with a broad host range. D) The virus has narrow tropism, with a broad host range. E) The virus has broad tropism, but host range was not addressed in these experiments. Answer: E Chapter/Section: 6.2 Learning Outcome: 6.10 Global LO: G2 Bloom's Taxonomy: 3-4: Applying/Analyzing

43) A patient presented at the doctor's office with a fever, sore throat, and lesions on the feet and hands. The doctor prescribed an anti-viral prescription medication and a topical cortisone ointment. The symptoms resolved within about a week, but two months later, the patient returned to the doctor with the same signs and symptoms. What type of viral infection is indicated by the signs and symptoms the patient presented? A) acute nonpersistent infection B) chronic persistent infection C) latent persistent infection D) oncogenic infection E) latent nonpersistent infection Answer: C Chapter/Section: 6.3 Learning Outcome: 6.16 Global LO: G2 Bloom's Taxonomy: 3-4: Applying/Analyzing 44) Convalescent antibodies are derived from the serum of individuals who have recovered from COVID-19. They are infused into the blood of those with a serious case of the illness, improving patient outcomes. How does this treatment work? A) The convalescent antibodies bind to the SARS-CoV2 virus and block attachment and entry of the virus into non-infected cells. B) The convalescent antibodies enter any cells infected with the virus and block viral uncoating. C) The convalescent antibodies have a placebo effect, because naturally-produced antibodies to SARS-CoV2 are not effective. D) The convalescent antibodies target the reverse transcriptase enzyme, blocking viral genome replication. E) The convalescent antibodies block viral release from infected host cells. Answer: A Chapter/Section: 6.4 Learning Outcome: 6.21 Global LO: G2 | G8 Bloom's Taxonomy: 3-4: Applying/Analyzing 6.2 True/False Questions 1) Both viruses and prokaryotes reproduce by binary fission. Answer: FALSE Chapter/Section: 6.1 Learning Outcome: 6.2 Bloom's Taxonomy: 1-2: Remembering/Understanding 2) The shape of a virus may be determined by either its capsid or its envelope. Answer: FALSE Chapter/Section: 6.1 Learning Outcome: 6.3 Bloom's Taxonomy: 1-2: Remembering/Understanding 18 Copyright © 2023 Pearson Education, Inc.

3) The number of species that a specific virus infects is called its host range while the types of tissues that the virus infects is called tropism. Answer: TRUE Chapter/Section: 6.2 Learning Outcome: 6.10 Bloom's Taxonomy: 1-2: Remembering/Understanding 4) Like bacteriophage, when an animal cell virus enters a host cell, only the genome enters while the capsid remains outside the cell. Answer: FALSE Chapter/Section: 6.3 Learning Outcome: 6.14 ASM LO: 4.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 5) Naked viruses usually exit the animal host cell by budding while enveloped viruses exit by lysis. Answer: FALSE Chapter/Section: 6.3 Learning Outcome: 6.15 ASM LO: 4.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 6) All persistent viral infections occur when the virus integrates into the host cell DNA to form a provirus. Answer: FALSE Chapter/Section: 6.3 Learning Outcome: 6.16 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 7) Both agglutination and ELISA procedures may be used to detect the presence of either viral antigen or the patient's antibodies to a virus. Answer: TRUE Chapter/Section: 6.4 Learning Outcome: 6.20 Bloom's Taxonomy: 1-2: Remembering/Understanding 8) Antiviral drugs exist that target all stages of viral replication except the production of viral nucleic acids. Answer: FALSE Chapter/Section: 6.4 Learning Outcome: 6.21 Bloom's Taxonomy: 1-2: Remembering/Understanding

9) In both lytic and lysogenic bacteriophage replication, the first two steps (Attachment and Penetration) are the same. Answer: TRUE Chapter/Section: 6.3 Learning Outcome: 6.12 ASM LO: 2.5 Bloom's Taxonomy: 1-2: Remembering/Understanding 10) Due to advances in science, tissue culture cells are no longer required for growth of animal viruses. Answer: FALSE Chapter/Section: 6.4 Learning Outcome: 6.18 ASM LO: 4.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 6.3 Essay Questions 1) Use the concepts of antigenic drift and antigenic shift to describe why influenza causes both "routine" seasonal outbreaks as well as periodically causes more serious global outbreaks, or pandemics. Answer: Influenza has two spikes, HA and NA, which allow the virus to attach to and escape cells. During infection, the immune system generates antibodies which will neutralize that influenza pathogen during a current or subsequent infection. Because influenza is an RNA virus, it undergoes frequent mutations which result in minor changes in the spikes. These spikes may be different enough to evade quick detection by the previously-generated antibodies. This is antigenic drift, and is why a new influenza vaccine must be formulated each year and why a portion of the population is unprotected, leading to seasonal outbreaks. Antigenic shift occurs when the virus undergoes a major genetic reassortment that dramatically changes the spikes. These "new" viruses may have increased infectivity or expanded host range, and are also unlikely to be recognized by current vaccines. Most of the population will have no residual immunity to this new strain, so the virus spreads rapidly and causes serious illness. Chapter/Section: 6.1 Learning Outcome: 6.7 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding

2) Describe the lytic and lysogenic bacteriophage replication cycles. Answer: Both lytic and lysogenic bacteriophage begin a replication cycle when contact is made with a suitable host bacterium. During attachment, components of the phage capsid bind to a specific molecule on the host bacterium. The bacteriophage genetic material is then injected into the bacterium, leaving the capsid on the outside. At this point, a lytic phage infection will result in the use of host cell factors to transcribe and translate viral genes. DNAases produced by the virus will break up the bacterial genome, and the viral genome is replicated. Once many copies of the viral genetic material and capsid proteins are produced, new phages are assembled by inserting the genome into the capsid. To release the bacteriophage, an enzyme called lysozyme breaks down the host cell wall. During a lysogenic infection, the phage DNA is not immediately replicated, transcribed, and translated, but instead, inserts itself into the bacterial genome. The phage DNA remains as a prophage and is copied whenever the host cell replicates its genome. The prophage is passed down the bacterium's daughter cells through binary fission. If the bacterial cell is ever under stress, the prophage may excise itself and begin a replication cycle identical to the remaining steps of the lytic cycle. Chapter/Section: 6.3 Learning Outcome: 6.12 ASM LO: 2.5 Bloom's Taxonomy: 1-2: Remembering/Understanding

3) Select three points in the viral replication process and describe how an antiviral drug may be used to target that point. Provide the name of one drug or drug family that targets the steps you chose.

Answer: Attachment may be blocked by antibodies or other molecules which prevent the virus from interacting with the host cell receptor. Enfuviritide*, Docosanol*, Palivizumab, HRIG. Penetration may be blocked by interfering with membrane fusion or endocytosis. Interferonalpha. Uncoating may be blocked to prevent access to the virus nucleic acid for replication. Amantadine, Rimantadine, Vapendavir. Replication may be blocked to prevent the viral nucleic acids from being replication or transcribed, or by blocking reverse transcription in retroviruses. Nucleoside reverse transcriptase inhibitors (AZT), nucleoside/nucleotide analogs (Ribavirin), antisense antivirals (Vitravene). Assembly can be blocked to prevent mature virions from being put together. Protease inhibitors, interferons. Release can be blocked to prevent viral budding from the host cell membrane. Oseltamivir (Tamiflu), Zanamivir (Relenza). Chapter/Section: 6.4 Learning Outcome: 6.21 ASM LO: 4.4 Bloom's Taxonomy: 1-2: Remembering/Understanding

4) Why are several neurodegenerative disorders such as Alzheimer's disease, Parkinson's disease and amyotrophic lateral sclerosis (ALS) described as being "prion-like"? Discuss these diseases in light of recent medical research. Answer: Prion diseases are caused by "infectious" misfolded proteins. These prions are proteins that have a normal important function in the cell, but they become dangerous when misfolded. They are dangerous not only because they are no longer functional, but because they can also "transmit" this dysfunction on to other similar proteins. Thus, there is a cascade effect leading to more and more misfolded proteins. Alzheimer's, Parkinson's, and ALS have long been known as neurological diseases that were caused by a build-up of misfolded proteins, but there wasn't evidence for a cascade or infectious "prion-like" effect. However, recent studies have isolated misfolded proteins from patients with these diseases and exposed healthy mice to the proteins. The mice then developed neurological signs similar to Alzheimer's, Parkinson's, and/or ALS. Thus, there is evidence that the misfolded proteins in these diseases can transmit in a "prion-like" way to other healthy tissues, even non-human tissue. These diseases are not considered to be prion diseases, but to have a similar mechanism in terms of the progression and pathology of the disease. Chapter/Section: 6.5 Learning Outcome: 6.23 Global LO: G8 ASM LO: 7.3a Bloom's Taxonomy: 3-4: Applying/Analyzing

Microbiology: Basic & Clinical Principles, 2e (Norman-McKay) Chapter 7 Fundamentals of Microbial Growth and Decontamination 7.1 Multiple Choice Questions 1) Which of the following terms refers to bacteria reproducing asexually, creating two daughter cells by dividing the cell in half? A) budding B) binary fission C) sporulation D) conidia E) hypha Answer: B Chapter/Section: 7.1 Learning Outcome: 7.2 Bloom's Taxonomy: 1-2: Remembering/Understanding 2) Mycobacterium tuberculosis are grown for 80 hours. During that time, they go through four generations of growth. What is the generation time? A) 10 hours B) 20 hours C) 40 hours D) 20 minutes E) 60 minutes Answer: B Chapter/Section: 7.1 Learning Outcome: 7.3 Global LO: G2 ASM LO: 7.2a Bloom's Taxonomy: 3-4: Applying/Analyzing 3) In which growth phase do bacteria grow exponentially? A) habituation phase B) lag phase C) log phase D) stationary phase E) acculturation phase Answer: C Chapter/Section: 7.1 Learning Outcome: 7.4 Bloom's Taxonomy: 1-2: Remembering/Understanding

4) In which growth phase do bacteria adjust to their environment and grow little, if any? A) habituation phase B) lag phase C) log phase D) stationary phase E) acculturation phase Answer: B Chapter/Section: 7.1 Learning Outcome: 7.4 Global LO: G3 Bloom's Taxonomy: 1-2: Remembering/Understanding 5) In which growth phase do bacteria produce antibiotics and endospores? A) death phase B) lag phase C) log phase D) stationary phase E) acculturation phase Answer: D Chapter/Section: 7.1 Learning Outcome: 7.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 6) Which of the following is not an environmental factor that would affect the growth of E. coli? A) temperature B) availability of nutrients C) concentration of other bacteria D) antibiotics produced from other bacterial species E) generation time of E. coli Answer: E Chapter/Section: 7.1 Learning Outcome: 7.1 Bloom's Taxonomy: 1-2: Remembering/Understanding 7) Which term represents the temperature at which bacteria grow the fastest? A) minimum temperature B) maximum temperature C) optimal temperature D) thermal growth point E) human body temperature Answer: C Chapter/Section: 7.2 Learning Outcome: 7.5 Bloom's Taxonomy: 1-2: Remembering/Understanding

8) Which of the following types of organisms is associated with foodborne illness? A) psychrophiles B) psychrotrophs C) mesophiles D) thermophiles E) extreme thermophiles Answer: B Chapter/Section: 7.2 Learning Outcome: 7.6 Bloom's Taxonomy: 1-2: Remembering/Understanding 9) Which temperature group are most pathogens associated with? A) psychrophiles B) psychrotrophs C) mesophiles D) thermophiles E) extreme thermophiles Answer: C Chapter/Section: 7.2 Learning Outcome: 7.6 Bloom's Taxonomy: 1-2: Remembering/Understanding 10) Extreme thermophiles that live near thermal vents must have all of the following adaptations except A) proteins that resist thermal denaturing. B) specialized chaperone proteins. C) plasma membrane lipids that are highly branched and saturated. D) plasma membrane lipids that are highly unsaturated. E) they must also be barophiles. Answer: D Chapter/Section: 7.2 Learning Outcome: 7.6 Bloom's Taxonomy: 1-2: Remembering/Understanding 11) Which of the following pH classifications would be able to grow in a pickle jar with vinegar? A) acidophiles B) neutralophiles C) alkaliphiles D) barophiles E) psychrophiles Answer: A Chapter/Section: 7.2 Learning Outcome: 7.7 Bloom's Taxonomy: 1-2: Remembering/Understanding

12) Which of the following pH classifications make up most of the pathogens we know today? A) acidophiles B) neutralophiles C) alkaliphiles D) barophiles E) psychrophiles Answer: B Chapter/Section: 7.2 Learning Outcome: 7.7 Bloom's Taxonomy: 1-2: Remembering/Understanding 13) Which of the following methods do alkaliphiles use to survive in their environments? A) enrich their plasma membrane with acidic compounds to attract H+ ions to their cell surface B) enrich their plasma membrane with basic compounds to attract OH- ions to their cell surface C) use proton pumps to export excess protons from the cytoplasm D) build special monolayer plasma membranes E) use plasma membrane lipids that are highly branched and saturated Answer: A Chapter/Section: 7.2 Learning Outcome: 7.7 Bloom's Taxonomy: 1-2: Remembering/Understanding 14) Which of the following terms refers to microbes that thrive in high-salt environments? A) neutralophiles B) barophiles C) halophiles D) psychrophiles E) acidophiles Answer: C Chapter/Section: 7.2 Learning Outcome: 7.8 Bloom's Taxonomy: 1-2: Remembering/Understanding 15) How do halophiles combat osmotic stress? A) They keep a high concentration of organic materials and ions in their cytoplasm. B) They enrich their plasma membrane with basic compounds to attract OH- ions to their cell surface. C) They use proton pumps to export excess protons from the cytoplasm. D) They build special monolayer plasma membranes. E) They use plasma membrane lipids that are highly branched and saturated. Answer: A Chapter/Section: 7.2 Learning Outcome: 7.8 Bloom's Taxonomy: 1-2: Remembering/Understanding

16) Staphylococcus aureus tolerates higher solute concentrations but doesn't grow especially well in them. Therefore, it is called a A) halo-psychrophile. B) halo-alkaliphile. C) obligate halophile. D) halo-thermophile. E) facultative halophile. Answer: E Chapter/Section: 7.2 Learning Outcome: 7.8 Bloom's Taxonomy: 1-2: Remembering/Understanding 17) Which group of microbes prefers using oxygen but can survive without it? A) obligate aerobe B) obligate anaerobe C) microaerophile D) aerotolerant anaerobe E) facultative anaerobe Answer: E Chapter/Section: 7.2 Learning Outcome: 7.9 Bloom's Taxonomy: 1-2: Remembering/Understanding 18) Microbes that primarily infect the lungs are likely to be classified as which of the following? A) obligate aerobe or facultative anaerobe B) obligate anaerobe or facultative anaerobe C) microaerophile D) aerotolerant anaerobe E) obligate anaerobe Answer: A Chapter/Section: 7.2 Learning Outcome: 7.9 ASM LO: 3.3 Bloom's Taxonomy: 1-2: Remembering/Understanding 19) Nutrients that a cell needs to build new cells and make up a bulk of a cell's dry weight are called A) micronutrients. B) trace nutrients. C) essential nutrients. D) tiny nutrients. E) small nutrients. Answer: C Chapter/Section: 7.2 Learning Outcome: 7.10 Bloom's Taxonomy: 1-2: Remembering/Understanding 5 Copyright © 2023 Pearson Education, Inc.

20) The necessary substances that a cell can't make on its own are called A) nitrogenous bases. B) growth factors. C) proteins. D) fastidious. E) carbohydrates. Answer: B Chapter/Section: 7.2 Learning Outcome: 7.10 Bloom's Taxonomy: 1-2: Remembering/Understanding 21) Which type of organism gets energy from breaking down nutrients and uses CO2 as a carbon source? A) photoautotroph B) photoheterotroph C) chemoautotroph D) chemoheterotroph E) lithotroph Answer: C Chapter/Section: 7.2 Learning Outcome: 7.10 Global LO: G2 Bloom's Taxonomy: 3-4: Applying/Analyzing 22) When would a microbiologist want to use broth media? A) when growing large batches of microbes B) when isolating colonies C) when observing specific culture characteristics D) when performing the streak plate isolation technique E) when testing for motility Answer: A Chapter/Section: 7.3 Learning Outcome: 7.11 Bloom's Taxonomy: 1-2: Remembering/Understanding 23) Which type of organism would a microbiologist grow on defined media? A) fastidious organisms B) a broad collection of heterotrophs C) pathogens from clinical samples D) organisms with complex growth requirements E) certain autotrophs Answer: E Chapter/Section: 7.3 Learning Outcome: 7.12 Bloom's Taxonomy: 1-2: Remembering/Understanding

24) Which type of media has ingredients that foster the growth of certain bacteria while suppressing the growth of others? A) differential B) selective C) complex D) defined E) synthetic Answer: B Chapter/Section: 7.3 Learning Outcome: 7.12 Bloom's Taxonomy: 1-2: Remembering/Understanding 25) When would a microbiologist use thioglycolate? A) when storing plates anaerobically B) when making defined media C) when making complex media D) when storing selective plates E) when storing differential plates Answer: A Chapter/Section: 7.3 Learning Outcome: 7.13 Bloom's Taxonomy: 1-2: Remembering/Understanding 26) Which of the following could result in the wrong patient diagnosis and improper treatment? A) proper hand washing before and after specimen collection B) wearing gloves C) quickly sealing samples in containers D) carefully sampling only the site in question without touching other body structures or surface sites E) using a cotton-tipped swab to collect a suspected pathogen Answer: E Chapter/Section: 7.3 Learning Outcome: 7.14 Bloom's Taxonomy: 1-2: Remembering/Understanding 27) What is the purpose of the streak plate technique? A) to determine the concentration of a microbial sample B) to identify the best temperature for growing a particular microbe C) to identify the correct concentration of nutrients needed for optimal bacterial growth D) to obtain a pure culture from a mixed or unknown source E) to ascertain the age of a particular culture Answer: D Chapter/Section: 7.3 Learning Outcome: 7.15 Bloom's Taxonomy: 1-2: Remembering/Understanding

28) Which of the following cell-counting methods is capable of differentiating between living and dead cells? A) microscopic count B) Coulter counter C) flow cytometer D) turbidity measurement E) dry weight Answer: C Chapter/Section: 7.3 Learning Outcome: 7.16 Bloom's Taxonomy: 1-2: Remembering/Understanding 29) Which of the following is an indirect cell-counting method? A) microscopic count B) Coulter counter C) flow cytometer D) turbidity measurement E) viable plate count Answer: D Chapter/Section: 7.3 Learning Outcome: 7.16 Bloom's Taxonomy: 1-2: Remembering/Understanding 30) A chemical used to control microbial growth on inanimate objects is called a(n) A) disinfectant. B) antiseptic. C) microbiocidal. D) microbiostatic. E) antibacterial agent. Answer: A Chapter/Section: 7.4 Learning Outcome: 7.17 ASM LO: 3.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 31) The minimum temperature needed to kill all microbes in a sample within ten minutes is called the A) thermal death time. B) thermal death point. C) decimal reduction time. D) essential reduction point. E) critical death time. Answer: B Chapter/Section: 7.4 Learning Outcome: 7.18 ASM LO: 3.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 8 Copyright © 2023 Pearson Education, Inc.

32) Which of the following methods would surgical staff use to disinfect surfaces in operating rooms? A) ionizing radiation B) non-ionizing radiation C) autoclaving D) gamma ray radiation E) x-ray radiation Answer: B Chapter/Section: 7.4 Learning Outcome: 7.19 ASM LO: 3.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 33) Which of the following factors does not affect the efficiency of a germicide? A) how the object is used B) the number of microbes to be killed C) what infectious agents are most likely present D) the presence of excessive inorganic substances like minerals and salts in hard water E) the presence of excessive organic substances like blood, soil, or fecal matter Answer: A Chapter/Section: 7.4 Learning Outcome: 7.20 | 7.22 ASM LO: 3.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 34) Low-level disinfectants are sufficient to remove microbes from which of the following equipment tiers? A) non-vital B) semicritical C) noncritical D) vital E) nonessential Answer: C Chapter/Section: 7.4 Learning Outcome: 7.21 ASM LO: 3.4 Bloom's Taxonomy: 1-2: Remembering/Understanding

35) Which of the following microbes is not correctly matched to an acceptable control method? A) Mycobacteria: Hydrogen peroxide B) Endospore: Autoclaving C) Enveloped virus: Glutaraldehyde-based detergents D) Protozoan: Boiling water E) Prions: Chlorine treatment Answer: E Chapter/Section: 7.4 Learning Outcome: 7.23 Global LO: G2 ASM LO: 2.2 | 3.4 Bloom's Taxonomy: 3-4: Applying/Analyzing 36) When bacteria use budding for reproduction, A) the daughter cells are not genetically identical. B) the daughter cells are not equal in size. C) the daughter cells are produced by sexual reproduction. D) conidia form long hyphae extensions. E) the bud forms as a way to survive unfavorable growth conditions. Answer: B Chapter/Section: 7.1 Learning Outcome: 7.2 Bloom's Taxonomy: 1-2: Remembering/Understanding 37) How would humans (and many microbes that inhabit the human body) be best described in terms of nutritional requirements? A) photoautotroph B) photoheterotroph C) chemoautotroph D) chemoheterotroph E) Humans are not microorganisms, so these categories do not apply. Answer: D Chapter/Section: 7.2 Learning Outcome: 7.10 Bloom's Taxonomy: 3-4: Applying/Analyzing

38) A patient sample from an infected wound was cultured on medium containing high salt so that only halophilic organisms could grow. In addition, the medium contains mannitol (a sugar alcohol) and phenol red dye that indicates whether or not fermentation of mannitol has taken place by changing to a yellow color as the pH drops. This type of media would best be described as A) selective medium. B) differential medium. C) enrichment medium. D) selective AND differential medium. E) selective AND enrichment medium. Answer: D Chapter/Section: 7.3 Learning Outcome: 7.12 Global LO: G2 ASM LO: 3.3 Bloom's Taxonomy: 3-4: Applying/Analyzing 39) A water treatment plant is testing for E. coli and other coliforms using Eosin-Methylene blue (EMB) media that will produce metallic green colonies in the presence of coliform bacteria. After performing serial dilutions and spread-plating 1 ml of each of the dilutions on the EMB, the 1:1000 dilution plate produced 130 total colonies, with 85 metallic green colonies. How many coliforms (in CFU/ml) were in the original water sample? A) 130 CFU/ml B) 130,000 CFU/ml C) 85 CFU/ml D) 8,500 CFU/ml E) 85, 000 CFU/ml Answer: E Chapter/Section: 7.3 Learning Outcome: 7.16 Global LO: G2 | G4 ASM LO: 7.2 | 8.4 Bloom's Taxonomy: 3-4: Applying/Analyzing 7.2 True/False Questions 1) Bacterial spore formation is a type of sexual reproduction. Answer: FALSE Chapter/Section: 7.1 Learning Outcome: 7.2 Bloom's Taxonomy: 1-2: Remembering/Understanding

2) In the death phase of a closed pure batch system a small number of the cells survive by adapting to the new waste-filled environment and by feeding off dead cells. Answer: TRUE Chapter/Section: 7.1 Learning Outcome: 7.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 3) Many microbes have evolved ways to detoxify reactive oxygen species so that they can safely use oxygen in their metabolism. Answer: TRUE Chapter/Section: 7.2 Learning Outcome: 7.9 Bloom's Taxonomy: 1-2: Remembering/Understanding 4) Chemoheterotrophs (or Photoheterotrophs) use an inorganic carbon source. Answer: FALSE Chapter/Section: 7.2 Learning Outcome: 7.10 Bloom's Taxonomy: 1-2: Remembering/Understanding 5) The Simmons citrate test and triple sugar iron (TSI) media are common examples of slants. Answer: TRUE Chapter/Section: 7.3 Learning Outcome: 7.11 Bloom's Taxonomy: 1-2: Remembering/Understanding 6) The pour plate method is capable of detecting an exact cell number in the plated sample. Answer: FALSE Chapter/Section: 7.3 Learning Outcome: 7.16 Bloom's Taxonomy: 1-2: Remembering/Understanding 7) Disinfectants are applied to living tissue such as skin. Answer: FALSE Chapter/Section: 7.4 Learning Outcome: 7.17 ASM LO: 3.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 8) Phenols are commonly used in hospitals to sterilize critical equipment. Answer: FALSE Chapter/Section: 7.4 Learning Outcome: 7.21 ASM LO: 3.4 | 7.3a Bloom's Taxonomy: 1-2: Remembering/Understanding

9) A pure culture of bacteria grown in the lab does not offer a fully realistic representation of how microbes normally live and grow in nature. Answer: TRUE Chapter/Section: 7.1 Learning Outcome: 7.1 Bloom's Taxonomy: 1-2: Remembering/Understanding 7.3 Essay Questions 1) Name three differences between how microbes grow in a closed pure batch system as compared to in nature. Answer: Microbes are unlikely to experience a phase of rapid exponential growth in nature because the growth conditions for nutrients, pH level, and temperature will not be optimized. When growing in nature, it is uncommon to have a pure culture and as a result of that bacteria will compete for nutrients and release different antibiotics in order to horde vital resources. Furthermore, when growing in nature, bacteria are likely to be growing as a biofilm which can significantly change the metabolism of the bacteria as well as several other features. Chapter/Section: 7.1 Learning Outcome: 7.1 Global LO: G2 | G8 ASM LO: 5.2 | 7.3a Bloom's Taxonomy: 3-4: Applying/Analyzing 2) Name one benefit and one challenge to using genetic methods to identify microbes. Answer: Genetic methods are good at identifying microbes because they can be quick and are highly sensitive. However, they rely on the use of previously designed probes, which means that you already have to have an idea about what you are looking for. A negative result only tells you, you don't have that kind of microbe, it doesn't tell you which kind you do have or even if you have anything at all. Chapter/Section: 7.3 Learning Outcome: 7.16 Global LO: G2 | G8 ASM LO: 7.3a Bloom's Taxonomy: 3-4: Applying/Analyzing

3) What are two benefits to a germicide that quickly evaporates compared to a germicide that leaves a residue behind? Answer: A germicide that quickly evaporates is capable of working to kill microbes and then leaves no trace behind. This reduces the chances that microbes would be able to evolve an immunity to the germicide because of their limited contact with the chemical. A second benefit would be that there is no rinse step required before the next patient comes into contact with the equipment. It is also less likely to be corrosive or to damage delicate medical or scientific equipment. Chapter/Section: 7.4 Learning Outcome: 7.20 | 7.22 Global LO: G2 | G8 ASM LO: 1.3 | 7.3a Bloom's Taxonomy: 3-4: Applying/Analyzing 4) Hand sanitizer dispensers can now be found located in many supermarkets, schools, and health-care settings. Alcohol-based sanitizers are used frequently to replace hand washing. Discuss the pros and cons of using alcohol-based sanitizers. Are they a good replacement for hand washing? Based on what you know about the mechanism of action of alcohol, would these sanitizers be equally effective on enveloped viruses vs. non-enveloped viruses? Answer: Hand sanitizers are better than nothing when it comes to proper hand hygiene. However, they are not a complete replacement for hand washing, as they may not remove or kill many microbes on the hands. Over time due to evaporation, if the percentage of alcohol drops lower than 65%, the sanitizer will be ineffective at killing pathogens. The mechanism of action for alcohol is to denature proteins and break down lipid membranes. Because non-enveloped viruses do not have an outer membrane, they will be much less susceptible to alcohol-based sanitizers, while enveloped viruses will be more easily killed. Another issue is that alcohol evaporates quickly, so pathogens may not be in contact with the alcohol long enough for it to have an effect. Also, if someone uses alcohol-based sanitizers frequently, it can dry out the skin, leading to the opposite of the intended effect. As the skin dries out and cracks, this allows for more access to environmental pathogens. Chapter/Section: 7.4 Learning Outcome: 7.20 | 7.22 Global LO: G7 | G8 ASM LO: 3.4 | 7.3a

Microbiology: Basic & Clinical Principles, 2e (Norman-McKay) Chapter 8 Microbial Metabolism 8.1 Multiple Choice Questions 1) The term ________ includes both the chemical reactions that organisms use to break down substances to release energy, as well as the reactions that use released energy to build new substances. A) anabolism B) biosynthesis C) catabolism D) metabolism E) oxidation-reduction Answer: D Chapter/Section: 8.1 Learning Outcome: 8.1 Bloom's Taxonomy: 1-2: Remembering/Understanding 2) Anabolic reactions A) are endergonic. B) involve dehydration synthesis. C) involve breaking down larger molecules into smaller molecules. D) are endergonic and involve dehydration synthesis. E) are endergonic and involve breaking down larger molecules into smaller molecules. Answer: D Chapter/Section: 8.1 Learning Outcome: 8.2 Bloom's Taxonomy: 1-2: Remembering/Understanding 3) Catabolic reactions A) are endergonic. B) are hydrolytic. C) involve breaking down larger molecules into smaller molecules. D) are endergonic and are hydrolytic. E) are hydrolytic and involve breaking down larger molecules into smaller molecules. Answer: E Chapter/Section: 8.1 Learning Outcome: 8.2 Bloom's Taxonomy: 1-2: Remembering/Understanding

4) Which of the following statements best describes how catabolic and anabolic reactions depend upon each other? A) Anabolic reactions split bigger molecules into smaller components, which are in turn used by catabolic reactions to build more complex molecules. B) Catabolic reactions split bigger molecules into smaller components which are then used by anabolic reactions to build more complex molecules. C) Catabolic reactions release energy which is used by anabolic reactions. D) Anabolic reactions split bigger molecules into smaller components, which are in turn used by catabolic reactions to build more complex molecules AND catabolic reactions release energy which is used by anabolic reactions. E) Catabolic reactions split bigger molecules into smaller components which are then used by anabolic reactions to build more complex molecules AND catabolic reactions release energy which is used by anabolic reactions. Answer: E Chapter/Section: 8.1 Learning Outcome: 8.3 Bloom's Taxonomy: 1-2: Remembering/Understanding 5) In the typical ATP-ADP cycle, which part of the ATP molecule is removed when energy is released and added back when energy is stored? A) adenine B) ribose C) the terminal phosphate group D) the terminal two phosphate groups E) all three phosphate groups Answer: C Chapter/Section: 8.1 Learning Outcome: 8.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 6) What is the relationship between the ATP-ADP cycle and catabolic and anabolic reactions? A) Energy released from catabolic reactions is used to recharge ADP back to ATP. Then the energy needed for anabolic reactions is released by breaking ATP down to ADP. B) Energy released from anabolic reactions is used to recharge ADP back to ATP. Then the energy needed for catabolic reactions is released by breaking ATP down to ADP. C) Energy released from catabolic reactions is used to break ATP down to ADP. Then the energy needed for anabolic reactions is released by to recharging ADP back to ATP. D) Catabolic reactions require energy, which is provided by anabolic reactions. ADP is recharged to ATP by energy from anabolic reactions. E) There is no relationship between the ATP-ADP cycle and catabolic and anabolic reactions. Answer: A Chapter/Section: 8.1 Learning Outcome: 8.4 Bloom's Taxonomy: 1-2: Remembering/Understanding

7) Enzymes are necessary for cells because A) enzymes allow chemical reactions to take place that would otherwise be impossible. B) enzymes slow down chemical reactions that would otherwise occur too quickly to facilitate life. C) enzymes allow chemical reactions to occur under physiological conditions. D) enzymes allow chemical reactions to occur quickly enough to facilitate life. E) enzymes allow chemical reactions to occur under physiological conditions AND quickly enough to facilitate life. Answer: E Chapter/Section: 8.2 Learning Outcome: 8.5 Bloom's Taxonomy: 1-2: Remembering/Understanding 8) Which structural and functional feature(s) listed are key to an enzyme's activity? A) consumed each time a reaction takes place B) consists of a three-dimensional protein structure that interacts with a substrate in a fixed "lock-and-key" model C) contains an active site where the enzyme can interact with a specific substrate D) consumed each time a reaction takes place AND consists of a three-dimensional protein structure that interacts with a substrate in a fixed "lock-and-key" model E) consumed each time a reaction takes place AND contains an active site where the enzyme can interact with a specific substrate Answer: C Chapter/Section: 8.2 Learning Outcome: 8.5 Bloom's Taxonomy: 1-2: Remembering/Understanding

9) Which facts about enzymes are not visualized in this figure?

A) Enzymes are not consumed or permanently changed in a reaction. B) A substrate binds to an enzyme at the active site as described by the "induced-fit" model. C) Specific products are generated. D) A cofactor is often required for enzyme activity. E) The substrate is converted to products after going through the transition state. Answer: D Chapter/Section: 8.2 Learning Outcome: 8.5 Bloom's Taxonomy: 3-4: Applying/Analyzing

10) Enzymes can lower the activation energy of a chemical reaction by A) properly positioning reactants. B) stabilizing the transition state. C) raising the temperature so that reactants collide more forcefully. D) properly positioning reactants AND stabilizing the transition state. E) properly positioning reactants AND raising the temperature so that reactants collide more forcefully. Answer: D Chapter/Section: 8.2 Learning Outcome: 8.6 Bloom's Taxonomy: 1-2: Remembering/Understanding 11) Which coenzyme is incorrectly matched with its function? A) NAD+ /NADP+: Electron transfers B) FAD / FMN: Electron transfers C) Coenzyme A: Metabolism of pyruvic acid and lipids D) Cobalamin: Transfer of CO2 groups E) THF / DHF: Make purines and pyrimidines Answer: D Chapter/Section: 8.2 Learning Outcome: 8.7 Bloom's Taxonomy: 1-2: Remembering/Understanding 12) Which of the following statements does NOT correctly describe ribozymes? A) They are made of RNA. B) They work on RNA substrates. C) They may have medical applications such as antiviral therapies. D) They are made of RNA and work on protein substrates. E) They may be naturally occurring or man-made. Answer: D Chapter/Section: 8.2 Learning Outcome: 8.8 Bloom's Taxonomy: 1-2: Remembering/Understanding 13) Which of the following factors may influence an enzyme's activity by altering its threedimensional structure? A) competitive inhibitor only B) pH only C) temperature only D) pH and temperature only E) pH, temperature, and competitive inhibitor Answer: D Chapter/Section: 8.2 Learning Outcome: 8.9 ASM LO: 3.3 Bloom's Taxonomy: 1-2: Remembering/Understanding 5 Copyright © 2023 Pearson Education, Inc.

14) The graph shows enzyme activity as a function of temperature for a mesophilic microbe. How would you predict that the graph would change if the organism was a psychrophile (an organism that thrives at low temperatures)?

A) The graph would be similar, but would be shifted toward the left. B) The graph would be similar, but would be shifted toward the right. C) The graph would be wider (extended further both left and right) but the peak would be lower. D) The graph would not peak then drop off, but would continue rising indefinitely. E) The graph would be a horizontal straight line. Answer: A Chapter/Section: 8.2 Learning Outcome: 8.9 ASM LO: 3.3 Bloom's Taxonomy: 3-4: Applying/Analyzing

15) The figure shows which process?

A) allosteric activation B) allosteric inhibition C) competitive inhibition D) non-competitive inhibition E) either allosteric inhibition, competitive inhibition, or non-competitive inhibition Answer: C Chapter/Section: 8.2 Learning Outcome: 8.9 Bloom's Taxonomy: 1-2: Remembering/Understanding

16) Oxidation of nutrients by cells results in A) a release of energy, which can be used to recharge ADP to ATP. B) a release of energy, which is released by converting ATP to ADP. C) a requirement for energy which can be used to recharge ADP to ATP. D) a requirement for energy which can be obtained by converting ATP to ADP. E) either a release or a requirement for energy depending on what type of nutrient is available. Answer: A Chapter/Section: 8.3 Learning Outcome: 8.10 Bloom's Taxonomy: 1-2: Remembering/Understanding 17) When electrons are removed from nutrients via an oxidation reaction, the coupled reduction reaction may be A) FAD → FADH2. B) NAD+ → NADH. C) NADH → NAD+. D) either FAD → FADH2 or NAD+ → NADH. E) either NAD+ → NADH or NADH → NAD+. Answer: D Chapter/Section: 8.3 Learning Outcome: 8.10 Bloom's Taxonomy: 1-2: Remembering/Understanding 18) Which phosphorylation mechanism for recharging ADP to ATP is incorrectly matched with its description? A) Oxidative Phosphorylation: Passes electrons stripped from nutrients through an electron transport chain B) Photophosphorylation: Passes electrons energized by solar energy through an electron transport chain C) Substrate-level phosphorylation: A phosphate is transferred to ADP from a high-energy substrate after passing through an electron transport chain. D) The descriptions for oxidative phosphorylation and photophosphorylation are both incorrectly matched. E) The descriptions for oxidative phosphorylation, photophosphorylation, and substrate-level phosphorylation are all incorrectly matched. Answer: C Chapter/Section: 8.3 Learning Outcome: 8.11 Bloom's Taxonomy: 1-2: Remembering/Understanding

19) Which of the following does not describe cellular respiration? A) may include multiple pathways including glycolysis, an intermediate step, the Krebs cycle and fermentation B) collection of reactions that extract energy from nutrients using redox reactions C) involves a transfer of energy into the bonds of ATP D) may occur in both prokaryotic and eukaryotic cells E) occurs in part in the mitochondria of eukaryotic cells Answer: A Chapter/Section: 8.4 Learning Outcome: 8.12 Bloom's Taxonomy: 1-2: Remembering/Understanding

20) Refer to the numbered steps in the figure when answering the question. Which step shows an energy investment in the form of ATP?

A) steps 1 and 3 B) steps 1 and 10 C) steps 3 and 7 D) steps 7 and 10 E) steps 1, 3, 7, and 10 Answer: A Chapter/Section: 8.4 Learning Outcome: 8.13 Bloom's Taxonomy: 1-2: Remembering/Understanding 10 Copyright © 2023 Pearson Education, Inc.

21) Refer to the numbered steps in the figure when answering the question. Which step is a redox reaction?

22) What are the products made during glycolysis? A) 4 ATP (net gain of 2) B) 2 NADH C) 2 pyruvic acid D) 4 ATP (net gain of 2) and 2 NADH E) 4 ATP (net gain of 2) and 2 NADH and 2 pyruvic acid Answer: E Chapter/Section: 8.4 Learning Outcome: 8.13 Bloom's Taxonomy: 1-2: Remembering/Understanding 23) Which molecule is the main product of the intermediate step that enters the Krebs cycle? A) acetyl CoA B) ATP C) carbon dioxide D) NAD+ E) pyruvic acid Answer: A Chapter/Section: 8.4 Learning Outcome: 8.14 Bloom's Taxonomy: 1-2: Remembering/Understanding

24) Refer to the numbered steps in the figure when answering the question. Two carbons in the form of acetyl-CoA enter the Krebs cycle by joining with oxaloacetic acid, a 4-carbon molecule. During which step does carbon leave the Krebs cycle in the form of CO2?

A) step 1 B) step 3 C) step 4 D) step 1 and step 3 and step 4 E) step 3 and step 4 Answer: E Chapter/Section: 8.4 Learning Outcome: 8.14 Bloom's Taxonomy: 1-2: Remembering/Understanding 13 Copyright © 2023 Pearson Education, Inc.

25) Sequence the following events as they occur at the electron transport chain. I. Protons accumulate on one side of the membrane to form a proton motive force. II. The coenzymes NADH and FADH2 drop off electrons to the carriers in the respiratory chain. III. Protons flow back through the membrane via ATP synthase, which captures the energy of the flowing protons and uses it to recharge ADP to ATP. IV. Electrons moving through the chain release energy to pump protons across the membrane where the carrier proteins are found. A) I → II → III → IV B) II → IV → I → III C) III → II → IV → I D) I → III → IV → II E) II → I → IV → III Answer: B Chapter/Section: 8.4 Learning Outcome: 8.15 Bloom's Taxonomy: 1-2: Remembering/Understanding 26) Which of the following statements correctly describes what happens during chemiosmosis? A) Protons are added directly to ADP to recharge it to ATP. B) The purpose is to generate water from oxygen. C) The energy of protons flowing through the ATP synthase enzyme powers the recharge of ADP to ATP. D) Protons flow through the ATP synthase enzyme from the side of the membrane where they are lower in concentration to the side where they are higher in concentration. E) Only electrons from the reduced carrier NADH are delivered to the electron transport chain; the reduced carrier FADH2 takes its electrons elsewhere. Answer: C Chapter/Section: 8.4 Learning Outcome: 8.15 Bloom's Taxonomy: 1-2: Remembering/Understanding 27) Cyanide is a poison which prevents the last carrier in the electron transport chain (cytochrome C oxidase) from transferring electrons to the final electron acceptor. Which of the following would not be a consequence of exposure to this poison? A) Movement of electrons through the electron transport chain would stop. B) Protons would no longer be pumped across the membrane. C) Glycolysis, the intermediate reaction, and the Krebs cycle would stop as the cell would run out of the necessary oxidized coenzymes NAD+ and FAD. D) Carbon dioxide would continue to be generated. E) ADP would no longer be recharged to form ATP. Answer: D Chapter/Section: 8.4 Learning Outcome: 8.15 Bloom's Taxonomy: 3-4: Applying/Analyzing

28) Consider this summarized chemical reaction for aerobic cellular respiration: C6H12O6 + 6 O2 + 38 ADP + 38 PO32- → 6 CO2 + 6 H2O + 38 ATP What would not be different in a summarized chemical reaction for anaerobic cellular respiration? A) The numbers of ADP and PO32-used would be different. B) The oxygen would be replaced by a different inorganic compound. C) The water would be replaced by a different reduced product. D) Glucose (C6H12O6) would be replaced by a different starting nutrient. E) The number of ATP produced would be different. Answer: D Chapter/Section: 8.4 Learning Outcome: 8.16 ASM LO: 3.1 Bloom's Taxonomy: 3-4: Applying/Analyzing 29) Which is the key difference between aerobic and anaerobic respiratory chains? A) Aerobic respiratory chains always use oxygen as the final electron acceptor while anaerobic respiratory chains may use a variety of inorganic substances other than oxygen as the final electron acceptor. B) Aerobic respiratory chains accept electrons from both NADH and FADH2 while anaerobic chains only accept electrons from FADH2. C) Aerobic respiratory chains that accept electrons depend on membrane-associated electron carrier molecules that carry out redox reactions while anaerobic chains use cytoplasm-associated molecules that carry out redox reactions. D) Aerobic respiratory chains are organized so that electrons are passing from a higher to lower energy state while anaerobic chains are organized so that electrons are passing from a lower to a higher energy state. E) Aerobic respiratory chains are found in prokaryotic cells only while anaerobic chains are found in eukaryotic cells only. Answer: A Chapter/Section: 8.4 Learning Outcome: 8.17 ASM LO: 3.1 Bloom's Taxonomy: 1-2: Remembering/Understanding

30) Which statement is not true about the pentose phosphate pathway? A) It converts 5-carbon sugars into 3- and 6-carbon sugars for use in glycolysis. B) It diverts glucose-6-phosphate from glycolysis to synthesize 5-carbon sugars needed for nucleotides. C) It generates the coenzyme NADPH needed for anabolic pathways. D) It allows cellular respiration to occur without the need for oxygen. E) It can be used in part by photosynthetic cells to build glucose from carbon dioxide. Answer: D Chapter/Section: 8.5 Learning Outcome: 8.18 ASM LO: 3.1 Bloom's Taxonomy: 1-2: Remembering/Understanding 31) The main goal of fermentation is to sustain ATP production by glycolysis. This is accomplished by A) diverting glycolysis intermediates into the pentose phosphate pathway. B) producing acids which lower cellular pH to promote more efficient ATP recharge. C) producing acids and alcohols which the microorganism can use as an alternative nutrient source when glucose is not available. D) enabling the cell to use its respiratory chain without oxygen being available. E) passing the electrons on NADH to pyruvic acid, regenerating NAD+ so glycolysis can continue. Answer: E Chapter/Section: 8.5 Learning Outcome: 8.19 ASM LO: 3.1 Bloom's Taxonomy: 1-2: Remembering/Understanding 32) Which of the following pathways are operational in a cell growing via fermentation? A) glycolysis only B) intermediate step only C) Krebs cycle only D) glycolysis and intermediate step only E) glycolysis, intermediate step, and the Krebs cycle Answer: A Chapter/Section: 8.5 Learning Outcome: 8.19 ASM LO: 3.1 Bloom's Taxonomy: 1-2: Remembering/Understanding

33) Of the following fermentation pathways, which can be carried out by human muscle cells? A) alcoholic B) butanediol C) lactic acid: heterolactic D) lactic acid: homolactic E) mixed acid Answer: D Chapter/Section: 8.5 Learning Outcome: 8.20 ASM LO: 3.1 Bloom's Taxonomy: 1-2: Remembering/Understanding 34) In order to harvest energy from polysaccharides, lipids or proteins, cells must use ________ to break down these large macromolecules extracellularly before bringing them into the cell. A) beta-oxidation B) deamination C) Entner-Doudoroff pathway D) exoenzymes E) glycogenesis Answer: D Chapter/Section: 8.5 Learning Outcome: 8.21 Bloom's Taxonomy: 1-2: Remembering/Understanding 35) Gluconeogenesis A) is building glucose from non-sugar starting materials. B) can be accomplished by funneling intermediates from glycolysis, the Krebs cycle, and lipid or protein catabolism. C) is an example of biosynthesis. D) is building glucose from non-sugar starting materials AND can be accomplished by funneling intermediates from glycolysis, the Krebs cycle, and lipid or protein catabolism. E) is building glucose from non-sugar starting materials AND can be accomplished by funneling intermediates from glycolysis, the Krebs cycle, and lipid or protein catabolism AND is an example of biosynthesis. Answer: E Chapter/Section: 8.6 Learning Outcome: 8.22 Bloom's Taxonomy: 1-2: Remembering/Understanding

36) The intermediate(s) needed to synthesize lipids from sugar catabolism is (are) A) acetyl CoA. B) citric acid. C) dihydroxyacetone phosphate (DHAP). D) acetyl CoA and dihydroxyacetone phosphate (DHAP). E) citric acid and dihydroxyacetone phosphate (DHAP). Answer: D Chapter/Section: 8.6 Learning Outcome: 8.22 Bloom's Taxonomy: 1-2: Remembering/Understanding 37) Many strains of E. coli are able to grow on minimal media which consists only of a single sugar, usually glucose, and inorganic salts to provide nitrogen, sulfur, phosphorous and trace nutrients. What does this tell you about E. coli's biosynthetic capabilities? A) All amino acids are "essential" to E. coli. B) E. coli can funnel intermediates from glycolysis, the intermediate step, and the Krebs cycle to synthesize amino acids, fatty acids, glycerol, and nucleotides. C) E. coli will be unable to perform amination. D) E. coli will use salvage pathways to make nucleotides. E) E. coli will be unable to build the peptidoglycan it needs for its cell wall. Answer: B Chapter/Section: 8.6 Learning Outcome: 8.22 ASM LO: 3.1 Bloom's Taxonomy: 3-4: Applying/Analyzing 38) One of the ways that cells balance anabolism and catabolism is to A) use the same enzyme to run a reaction in both the catabolic and anabolic direction. B) use feedback inhibition to shut down a pathway that is not needed. C) use separate coenzymes such as NAD+ vs. NADP+ for catabolic vs. anabolic pathways. D) use the same enzyme to run a reaction in both the catabolic and anabolic direction AND use feedback inhibition to shut down a pathway that is not needed. E) use feedback inhibition to shut down a pathway that is not needed AND use separate coenzymes such as NAD+ vs. NADP+ for catabolic vs. anabolic pathways. Answer: E Chapter/Section: 8.6 Learning Outcome: 8.23 Bloom's Taxonomy: 1-2: Remembering/Understanding

39) A pathway that functions simultaneously in both anabolism and catabolism is termed A) allosteric. B) amphibolic. C) biosynthetic. D) cyclic. E) redox. Answer: B Chapter/Section: 8.7 Learning Outcome: 8.24 Bloom's Taxonomy: 1-2: Remembering/Understanding 40) Which is not one of the categories used to classify an organism based on its nutrition? A) ability to fix carbon B) initial source of electrons for reduction reactions C) source of energy for making ATP D) ability to run either catabolic or anabolic pathways E) ability to fix carbon AND source of energy for making ATP Answer: D Chapter/Section: 8.8 Learning Outcome: 8.25 ASM LO: 3.1 Bloom's Taxonomy: 1-2: Remembering/Understanding 41) Bacteria that live in deep ocean volcanic vents form the base of an ecosystem that exists without light. They obtain electrons from hydrogen sulfide compounds dissolved in the vent water, and synthesize sugars from carbon, hydrogen, and oxygen. The bacteria would be classified as A) chemoautotrophs. B) chemoheterotrophs. C) photochemoautotrophs. D) photoautotrophs. E) photoheterotrophs. Answer: A Chapter/Section: 8.8 Learning Outcome: 8.25 ASM LO: 3.1 Bloom's Taxonomy: 3-4: Applying/Analyzing

42) Biochemical tests are useful to microbiology because A) they can be used to identify microbes. B) they can be used to detect metabolic end-products, intermediates, or particular enzymes. C) they can be used to identify potential pathogens in clinical samples. D) they can be used to identify microbes AND to identify potential pathogens in clinical samples. E) they can be used to identify microbes AND to identify potential pathogens in clinical samples AND to detect metabolic end-products, intermediates, or particular enzymes. Answer: E Chapter/Section: 8.9 Learning Outcome: 8.26 ASM LO: 3.1 Bloom's Taxonomy: 1-2: Remembering/Understanding 43) Which category of biochemical tests is incorrectly matched with its description? A) Amino acid catabolism tests: Detect specific enzymes involved in catabolism of amino acids B) Exoenzyme tests: Detect enzymes involved in extra-cellular breakdown of macromolecules C) Fermentation tests: Detects various fermentation end-products or specific pathways D) Oxidase and catalase tests: Identifies the presence of enzymes related to anaerobic respiratory chains E) Rapid identification techniques: Provide a semi-automated process of running multiple types of tests with a single inoculation Answer: D Chapter/Section: 8.9 Learning Outcome: 8.27 ASM LO: 3.1 Bloom's Taxonomy: 1-2: Remembering/Understanding 44) Besides biochemical tests, which techniques are also useful for identifying a bacterial specimen? A) microscopy B) molecular genetics techniques C) observation of general culture characteristics D) microscopy and observation of general culture characteristics E) microscopy and molecular genetics techniques and observation of general culture characteristics Answer: E Chapter/Section: 8.9 Learning Outcome: 8.28 ASM LO: 3.1 Bloom's Taxonomy: 1-2: Remembering/Understanding

45) What is the advantage of a rapid identification tool such as the API system? A) allows a high volume of samples to be processed quickly and reliably B) can be inoculated with a mixed or unpurified culture C) can often be read using an automated reader D) allows a high volume of samples to be processed quickly and reliably AND can often be read using an automated reader E) allows a high volume of samples to be processed quickly and reliably AND can be inoculated with a mixed or unpurified culture Answer: D Chapter/Section: 8.9 Learning Outcome: 8.29 Bloom's Taxonomy: 1-2: Remembering/Understanding 46) Why is the "lock-and-key" model no longer widely used to describe substrate binding to an enzyme? A) Because substrate binding to an active site is not as highly specific as a lock and key. B) Because the interaction between the active site and substrate is more dynamic and flexible, and not as rigid as a lock and key. C) Because specific substrate binding to the active site is not required for a reaction to occur. D) Because activation energy is not well described by the "lock-and-key" model. E) Because the "lock-and-key" model does not describe the transition state of the substrate adequately. Answer: B Chapter/Section: 8.2 Learning Outcome: 8.6 Bloom's Taxonomy: 1-2: Remembering/Understanding

47) The graph shows enzyme activity as a function of temperature for a mesophilic microbe. How would you predict that the graph would change if the organism was a thermophile (an organism that thrives at high temperatures)?

A) The graph would be similar, but would be shifted toward the left. B) The graph would be similar, but would be shifted toward the right. C) The graph would be wider (extended further both left and right) but the peak would be lower. D) The graph would not peak then drop off, but would continue rising indefinitely. E) The graph would be a horizontal straight line. Answer: B Chapter/Section: 8.2 Learning Outcome: 8.9 Global LO: G3 ASM LO: 3.3 Bloom's Taxonomy: 3-4: Applying/Analyzing

48) A researcher is studying the effect of a new drug on HMG-CoA reductase, a liver enzyme that is involved in the cholesterol production pathway. Enzyme activity assays show that the new drug causes a 30% decrease in production of cholesterol. If 5 times the original amount of HMGCoA (the substrate) is added to the reaction, a 30% decrease in activity is still observed. How would the new drug be best described? A) competitive inhibitor B) non-competitive inhibitor C) feedback activator D) feedback inhibitor E) allosteric activator Answer: B Chapter/Section: 8.2 Learning Outcome: 8.9 Global LO: G2 Bloom's Taxonomy: 3-4: Applying/Analyzing 49) Which of the products of the Krebs cycle provide the main energy benefit in terms of ATP production in the electron transport chain? A) NADH and FADH2 B) Acetyl-CoA C) CO2 D) citric acid E) ADP and GDP Answer: A Chapter/Section: 8.4 Learning Outcome: 8.14 Bloom's Taxonomy: 1-2: Remembering/Understanding 50) An unknown organism is being tested for the ability to ferment various sugars. The pH indicator phenol red is added to a fermentation broth containing sucrose. Phenol red indicator is pink at a pH above 8, red at pH 7, and yellow at a pH below 7. After incubation, if the organism can ferment sucrose, what color will the fermentation broth be? A) Red, because fermentation of sucrose will result in a neutral pH. B) Red, because fermentation of sucrose will produce acidic products. C) Yellow, because fermentation of sucrose will result in the production of basic products. D) Yellow, because fermentation of sucrose will result in the production of acidic products. E) Pink, because fermentation of sucrose will result in the production of basic products. Answer: D Chapter/Section: 8.9 Learning Outcome: 8.27 Bloom's Taxonomy: 3-4: Applying/Analyzing

8.2 True/False Questions 1) Catabolic reactions are hydrolytic and exergonic while anabolic reactions are biosynthetic and endergonic. Answer: TRUE Chapter/Section: 8.1 Learning Outcome: 8.2 Bloom's Taxonomy: 1-2: Remembering/Understanding 2) Ribozymes are enzymes which are made of protein but only work on RNA molecules as substrates. Answer: FALSE Chapter/Section: 8.2 Learning Outcome: 8.8 Bloom's Taxonomy: 1-2: Remembering/Understanding 3) Cells harvest energy from nutrients by stripping electrons from them. In other words, the nutrients are oxidized. Answer: TRUE Chapter/Section: 8.3 Learning Outcome: 8.10 Bloom's Taxonomy: 1-2: Remembering/Understanding 4) By the end of the Krebs cycle, every carbon originally in glucose is converted into carbon dioxide. Answer: TRUE Chapter/Section: 8.4 Learning Outcome: 8.14 Bloom's Taxonomy: 1-2: Remembering/Understanding 5) The main energy benefit of the Krebs cycle is the mass production of both ATP and the reduced factors NADH and FADH2. Answer: FALSE Chapter/Section: 8.4 Learning Outcome: 8.14 Bloom's Taxonomy: 1-2: Remembering/Understanding 6) In chemiosmosis, protons funnel through ATP synthase from an area where they are more concentrated to an area where they are less concentrated. Answer: TRUE Chapter/Section: 8.4 Learning Outcome: 8.15 Bloom's Taxonomy: 1-2: Remembering/Understanding

7) The Entner-Doudoroff pathway is a less efficient alternative to glycolysis which likely evolved early in the history of life to catabolize glucose. Answer: TRUE Chapter/Section: 8.5 Learning Outcome: 8.18 ASM LO: 3.1 Bloom's Taxonomy: 1-2: Remembering/Understanding 8) A bacterial culture which is growing under conditions that only allow for fermentation will grow at the same rate as a culture of the same species growing under conditions which allow for aerobic cellular respiration, all other conditions being identical. Answer: FALSE Chapter/Section: 8.5 Learning Outcome: 8.19 ASM LO: 3.1 Bloom's Taxonomy: 3-4: Applying/Analyzing 9) Generally, purines and pyrimidines are not synthesized de novo but rather obtained through salvage pathways to recycle them from food because de novo synthesis has a high energy cost. Answer: TRUE Chapter/Section: 8.6 Learning Outcome: 8.22 Bloom's Taxonomy: 1-2: Remembering/Understanding 10) Usually, a single biochemical test is all that is needed to identify an unknown microbial sample. Answer: FALSE Chapter/Section: 8.9 Learning Outcome: 8.26 Bloom's Taxonomy: 1-2: Remembering/Understanding 11) A molecule that is oxidized has less energy than one that is reduced. Answer: TRUE Chapter/Section: 8.3 Learning Outcome: 8.10 Bloom's Taxonomy: 1-2: Remembering/Understanding

8.3 Essay Questions 1) Describe or diagram the relationship between catabolic pathways, anabolic pathways and the ATP-ADP cycle. Include in your answer an explanation of the role each of these plays in the metabolism of a cell. Answer: All the chemical reactions that take place in a cell, including those reactions which release energy and those reactions which require energy, are collectively termed metabolism. Most metabolic reactions in a cell are organized into sets of reactions called biochemical pathways. Catabolic pathways break down substances and release energy. Anabolic pathways build new molecules from existing molecules, using energy in the process. The energy released from catabolic pathways is temporarily stored in a molecule called ATP. ATP has three phosphate groups. The terminal phosphate can be removed from the ATP to form ADP and release energy. This released energy can be used for anabolic reactions. ADP must continually be recharged, so a constant input of energy into the cell is required. The cycling of ADP to ATP, driven by energy from catabolic reactions and then back to ADP as the energy is released to fuel anabolic reactions, is a continual process in every cell. Chapter/Section: 8.1 Learning Outcome: 8.3 Global LO: G8 Bloom's Taxonomy: 1-2: Remembering/Understanding

2) Describe two factors which may increase enzyme activity and two factors which may decrease enzyme activity. Explain how each factor works to increase or decrease enzyme activity, and identify whether that factor is used internally by the cell (i.e. for regulation of a chemical reaction) or acts externally (i.e. is a component of the environment or a human-influenced component). Answer: The following factors may influence enzyme activity. 1) Cofactors/coenzymes are nonprotein chemicals associated with certain enzymes and are necessary for enzyme function. They are cellular components and function internally. 2) Temperature is an environmental factor working externally to the cell. Increasing temperature up to the optimum will increase enzyme activity, but temperatures hotter than optimum will lead to a rapid decline in enzyme function as the enzyme denatures, or loses its shape. 3) An environmental pH value more acidic or more basic than the optimum pH of the enzyme will lead to a decline in enzyme activity due to changes to the enzyme's shape. 4) Enzyme activity will increase with increasing enzyme concentration relative to the substrate concentration. As substrate concentration increases, a saturation point will be reached where all enzymes are occupied by a substrate. Cells can regulate the amount of enzyme up or down to accommodate its need for a given product. 5) Cells can reversibly activate or deactivate enzymes based on need by adding or removing phosphate groups to the enzyme. 6) Competitive inhibitors are molecules that directly compete with the substrate to bind at the enzyme active site, thereby decreasing enzyme activities. Noncompetitive inhibitors interact with an enzyme at some location other than the active site, but decrease enzyme activity. Many pharmaceuticals, poisons, and toxins act as either competitive or noncompetitive inhibitors. 7) Allosteric regulators bind with enzymes at a specific location called the allosteric site and may either activate or inhibit enzyme activity. This is often used by cells as an internal means of regulation. Chapter/Section: 8.2 Learning Outcome: 8.9 Global LO: G8 Bloom's Taxonomy: 1-2: Remembering/Understanding

3) Compare and contrast aerobic cellular respiration, anaerobic cellular respiration, and fermentation in terms of purpose, pathways used, the final electron acceptor, amount of ATP produced, method of phosphorylation to produce ATP, the use of an electron transport chain, the role of oxygen, and the end-products (other than ATP) which are produced. Answer: Aerobic cellular respiration, anaerobic cellular respiration, and fermentation are all metabolic processes which organisms use to extract energy from nutrients and generate ATP. Aerobic cellular respiration and anaerobic cellular respiration use glycolysis, an intermediate step, the Krebs cycle, and an electron transport chain (respiratory chain). During both aerobic and anaerobic cellular respiration, substrate-level and oxidative phosphorylation are used to generate ATP. In aerobic cellular respiration, oxygen is the final electron acceptor, a maximum of 38 ATP per glucose molecule can be generated, and carbon dioxide and water are the endproducts. In anaerobic respiration, the final electron acceptor is an inorganic molecule other than oxygen, and a reduced end-product is made by adding electrons and protons to the final acceptor. Carbon dioxide is also an end-product. The amount of ATP produced varies from more than 2 to less than 38 depending upon the specific respiratory chain used. During fermentation, oxygen is not required and fermentation occurs when the organism does not have a respiratory chain or when an appropriate final electron acceptor is not available. Only the glycolysis pathway is operational, and the final electron acceptor is an organic molecule, such as pyruvic acid or a derivative. Typical end-products of fermentation may include organic acids, alcohols, and gases such as carbon dioxide and hydrogen. Two ATP molecules are generated during the glycolysis pathway and fermentation does not add to that total. Chapter/Section: 8.5 Learning Outcome: 8.16 | 8.19 Global LO: G8 ASM LO: 3.1 | 7.3a Bloom's Taxonomy: 1-2: Remembering/Understanding

4) Radioactive isotopes of various elements can be used to label molecules for use in studies of metabolic pathways. For example, 14C is a radioactive isotope of carbon and naturally occurs at much lower rates than non-radioactive 12C (i.e. most molecules contain 12C carbon atoms). A cell can be fed a nutrient molecule labeled with the radioactive isotope and scientists can detect where the radioactive isotope ends up. For each of the following scenarios, trace the radioactive isotope to where it ultimately would end up after moving through the cellular respiration, fermentation, or biosynthetic pathways. Only consider these metabolic pathways; do not consider any other cellular processes. A. E. coli is fed 14C-labeled glucose and grown under aerobic conditions. B. E. coli is fed 14C-labeled glucose and grown under anaerobic conditions (fermentation). C. E. coli is fed 14C-labeled fatty acids and grown under aerobic conditions. D. E. coli is fed 14C-labeled acetyl CoA and grown under conditions that promote biosynthetic pathways. Answer: In scenario A, the 14C glucose would enter the glycolysis pathway where it would be split into 2 molecules of pyruvic acid. These would then move through the intermediate step and the Krebs cycle. During these pathways, carbon molecules are released as carbon dioxide; eventually all the carbons in glucose are released as CO2 so the radioactive isotope would ultimately be found in CO2. In scenario 2, the 14C-labeled glucose will enter glycolysis to become 2 molecules of pyruvic acid. The lack of oxygen will cause E. coli to use fermentation. Pyruvic acid will be reduced by electrons from NADH. Depending on which fermentation pathway is used, the 14C-label will eventually be found in the waste products of fermentation: various organic acids, alcohols, or CO2. In Scenario 3, fatty acids are broken down by betaoxidation to form acetyl CoA which will enter the Krebs cycle. Carbons from acetyl-CoA will be released as CO2, so the radioactive carbon isotope will be found in CO2. In scenario 4, acetylCoA can be diverted from entering the Krebs cycle and instead be used to make fatty acids. In this case, the radioactive carbon isotope will be found in fatty acids and lipids. AcetylCoA can also enter the Krebs cycle then various intermediates can be diverted to make amino acids, so some radioactive carbon may end up in amino acids and proteins. Chapter/Section: 8.6 Learning Outcome: 8.23 Global LO: G2 | G8 Bloom's Taxonomy: 3-4: Applying/Analyzing

5) Describe how organisms can be classified in terms of their nutritional pattern. Specifically categorize organisms in terms of how they obtain organic carbon, the source of electrons for their redox reactions, and the source of energy to make ATP. Finally, use correct terminology to combine these categories to organize the types of organisms by their metabolic strategies. Answer: Organisms can either "fix" inorganic carbon dioxide into organic forms by adding hydrogen (autotrophs) or must have an external source of organic carbon (heterotrophs). Energy can be obtained from light (phototrophs) or from the chemical bonds of nutrients (chemotrophs). Photoautotroph: uses light energy / fixes carbon Photoheterotroph: uses light energy/cannot fix carbon Chemoheterotroph: obtains energy from nutrient breakdown / cannot fix carbon Chemoautotroph: obtains energy from nutrient breakdown / fixes carbon Chapter/Section: 8.8 Learning Outcome: 8.25 ASM LO: 3.1 | 7.3a Bloom's Taxonomy: 1-2: Remembering/Understanding

Microbiology: Basic & Clinical Principles, 2e (Norman-McKay) Chapter 9 Principles of Infectious Disease and Epidemiology 9.1 Multiple Choice Questions 1) What is the definition of a true pathogen? A) does not require a weakened host to cause disease B) needs to passed from one person to the next C) must be a bacterial or viral pathogen D) causes disease within one week of infecting the patient E) must cause diarrhea, vomiting, and fever in the patient Answer: A Chapter/Section: 9.1 Learning Outcome: 9.2 Bloom's Taxonomy: 1-2: Remembering/Understanding 2) Endemic infections A) are routinely detected in a population or region. B) are isolated infections in a particular population. C) are infections that have only been recorded within the past 1,000 years and not before. D) are infections that are expected to be cured and wiped out by the year 2050. E) are infections that are life threatening if not treated in a timely manner. Answer: A Chapter/Section: 9.1 Learning Outcome: 9.2 Bloom's Taxonomy: 1-2: Remembering/Understanding 3) What is a pandemic? A) a widespread disease outbreak in a particular region during a specific time frame B) a widespread disease outbreak that spreads to numerous countries during a specific time frame C) isolated infections in a particular population D) an infection routinely detected in a population or region E) an infection where the host does not have signs or symptoms Answer: B Chapter/Section: 9.1 Learning Outcome: 9.3 Bloom's Taxonomy: 1-2: Remembering/Understanding

4) How is a reemerging pathogen different from an emerging pathogen? A) A reemerging pathogen is an infectious bacterial infection that manifests once every few months but goes away without treatment and only blisters the skin in another few months. B) A reemerging pathogen is an infectious helminth that was detected in one location of the body but receded and emerged from a second location. C) A reemerging pathogen is an infectious agent that was under control due to prevention or treatment strategies but is now resurfacing. D) A reemerging pathogen is an infectious agent that was identified previously in one location but is now emerging in a new separate location. E) A reemerging pathogen is an infectious agent that went away when the patient was taking antibiotics but quickly returned when the patient stopped taking the antibiotics. Answer: C Chapter/Section: 9.1 Learning Outcome: 9.4 ASM LO: 1.3 Bloom's Taxonomy: 1-2: Remembering/Understanding 5) Why are Koch's postulates important to microbiology? A) They demonstrate the preferred route of infection for a particular disease. B) They provide a way to select the most effective concentration of antibiotic to use for a patient. C) They enable us to characterize the species of the infectious disease whether it is a bacteria, virus, or fungi. D) They allow us to identify the causative pathogens of many infectious diseases. E) They explain how a particular disease produces specified signs in a patient. Answer: D Chapter/Section: 9.1 Learning Outcome: 9.5 Bloom's Taxonomy: 1-2: Remembering/Understanding 6) Which of the following pathogenic agents is multicellular? A) prions B) viruses C) bacteria D) protozoans E) helminths Answer: E Chapter/Section: 9.1 Learning Outcome: 9.1 Bloom's Taxonomy: 1-2: Remembering/Understanding

7) Which of the following is an endogenous source of infection? A) contaminated food B) contaminated medical equipment C) zoonotic disease D) bacteria from the skin entering a surgical incision E) contact with another person Answer: D Chapter/Section: 9.2 Learning Outcome: 9.6 Bloom's Taxonomy: 1-2: Remembering/Understanding 8) Which of the following is an indirect infectious disease transmission mode? A) person to person B) animal C) vehicle D) environment E) vertical Answer: C Chapter/Section: 9.2 Learning Outcome: 9.7 Bloom's Taxonomy: 1-2: Remembering/Understanding 9) Which of the following infectious disease transmission modes is not correctly paired with an example? A) Swimming: Swimmer's ear B) Windborne: Cholera C) Breast milk: HIV D) Touching: Cat-scratch fever E) Flea bite: Plague Answer: B Chapter/Section: 9.2 Learning Outcome: 9.7 Bloom's Taxonomy: 1-2: Remembering/Understanding 10) It is called a ________ vector when the vector has a role in the pathogen's life cycle. A) biological B) mechanical C) fomite D) vehicle E) zoonotic Answer: A Chapter/Section: 9.2 Learning Outcome: 9.8 Bloom's Taxonomy: 1-2: Remembering/Understanding

11) What is the order of the five stages of infectious disease? A) acute phase, incubation period, prodromal phase, convalescent phase, period of decline B) incubation period, prodromal phase, acute phase, period of decline, convalescent phase C) acute phase, prodromal phase, incubation period, convalescent phase, period of decline D) prodromal phase, acute phase, incubation period, period of decline, convalescent phase E) incubation period, acute phase, prodromal phase, convalescent phase, period of decline Answer: B Chapter/Section: 9.2 Learning Outcome: 9.9 Bloom's Taxonomy: 1-2: Remembering/Understanding 12) If you had to choose to be either a chronic carrier or an asymptomatic carrier, which would you choose and why? A) chronic carrier because I would be infected but never show signs or symptoms B) chronic carrier because I would only spread the infection when having symptoms C) asymptomatic carrier because I wouldn't experience any symptoms D) asymptomatic carrier because I wouldn't spread the infection E) asymptomatic carrier because after the initial symptomatic infection I would only experience symptoms from time to time Answer: C Chapter/Section: 9.2 Learning Outcome: 9.10 Bloom's Taxonomy: 1-2: Remembering/Understanding 13) Of the following goals listed, which two statements best encompass the general goals of epidemiology? I. isolate the infectious pathogen for study and vaccine creation II. describe the nature, cause, and extent of new or existing diseases in populations III. identify patient zero and how the initial infection occurred IV. intervene to protect and improve health in populations V. distribute vaccines so that future outbreaks do not occur A) I and II B) III and V C) I and III D) II and IV E) III and IV Answer: D Chapter/Section: 9.3 Learning Outcome: 9.11 Bloom's Taxonomy: 1-2: Remembering/Understanding

14) When is knowing the host and environmental factors that lead to a disease more important to saving lives than knowing the etiological causative agent? A) when the disease is spread through sexual contact B) when the source of infection is a particular geographical location C) when the host range is very large D) when specific health factors within a person's control are particularly risky E) when there is no cure for the disease Answer: E Chapter/Section: 9.3 Learning Outcome: 9.12 Bloom's Taxonomy: 1-2: Remembering/Understanding 15) What are the three factors of the epidemiological triangle? A) time from exposure to symptoms, access to transportation, quality of hospitals B) survivability, length of acute phase, cultural factors C) pathogen type, host health, and geographic overlap D) vaccine use, disinfectant use, and hand-washing policy E) environmental factors, etiological agent, and host factors Answer: E Chapter/Section: 9.3 Learning Outcome: 9.12 Bloom's Taxonomy: 1-2: Remembering/Understanding 16) Which of the following is not a goal of the public health system? A) investigates B) diagnoses C) prevents D) designs treatments, cures, or vaccines E) works to reduce health problems in the community Answer: D Chapter/Section: 9.3 Learning Outcome: 9.14 Bloom's Taxonomy: 1-2: Remembering/Understanding 17) When is quarantine an effective tool to limit disease? A) when there is not enough funding for public education campaigns B) when the population it too dense or poor for vector control to work C) when the disease has a short incubation time D) when the disease has a long incubation time E) when the population is too spread out for vector control to be cost effective Answer: C Chapter/Section: 9.3 Learning Outcome: 9.13 Bloom's Taxonomy: 1-2: Remembering/Understanding

18) Why are numerical measures of epidemiological data useful? A) They allow the CDC to profile those most likely to need quarantine. B) They provide insight as to where public health campaigns or prevention efforts may be needed most. C) They help to track down patient zero. D) They allow physicians to estimate when a patient can return to work. E) They specify how much protection you need if coming into contact with someone that has the disease. Answer: B Chapter/Section: 9.4 Learning Outcome: 9.15 Bloom's Taxonomy: 1-2: Remembering/Understanding 19) Which of the following would not be important when evaluating measures of frequency? A) factors that may be linked to cases of the disease B) prevalence rate C) incidence rate D) how long the infection lasts E) how the population is defined Answer: A Chapter/Section: 9.4 Learning Outcome: 9.17 Bloom's Taxonomy: 1-2: Remembering/Understanding 20) Which of the following would not be important when evaluating measures of association? A) ethnicity B) duration of the disease C) age D) geographical area E) number of sexual partners Answer: B Chapter/Section: 9.4 Learning Outcome: 9.17 Bloom's Taxonomy: 1-2: Remembering/Understanding 21) If a population contains 800 individuals and documents 400 cases of measles within the population, what is the prevalence rate? A) 30% B) 40% C) 50% D) 60% E) 80% Answer: C Chapter/Section: 9.4 Learning Outcome: 9.18 Global LO: G2 | G3 Bloom's Taxonomy: 3-4: Applying/Analyzing 6 Copyright © 2023 Pearson Education, Inc.

22) What is the definition of morbidity? A) deaths due to sexually transmitted infections during a specific time period B) the number of deaths during a specific time period C) death D) existence of disease E) the number of infections during a specific time period Answer: D Chapter/Section: 9.4 Learning Outcome: 9.19 Bloom's Taxonomy: 1-2: Remembering/Understanding 23) Which of the following is an example of a rate? A) In the United States, in people age 65 and older, there are 0.77 male/female. B) 1 in 4 people currently has a sexually transmitted disease. C) 80 percent of women with gonorrhea do not have symptoms. D) 6 out of 10 deaths due to stroke are in women. E) About 4,932 people become infected with HIV each day. Answer: E Chapter/Section: 9.4 Learning Outcome: 9.16 Global LO: G2 Bloom's Taxonomy: 3-4: Applying/Analyzing 24) Which of the following is an example of analytical epidemiology? A) correlation studies B) cross-sectional studies C) case reports D) observational studies E) descriptive studies Answer: D Chapter/Section: 9.4 Learning Outcome: 9.21 Bloom's Taxonomy: 1-2: Remembering/Understanding

25) Which of the following statements is not correct with respect to healthcare-acquired infections? A) Due to the installation of hand sanitizing dispensers in hospitals, healthcare-acquired infections decreased significantly in the past several years. B) Healthcare-acquired infections may also occur outside of a healthcare facility during administration of professional home health care. C) Hospitals have been inadvertent sources of infection for thousands of years. D) Healthcare-acquired infections add an extra $10 billion dollars per year to U.S. healthcare costs. E) About 75,000 people die from healthcare-acquired infections every year. Answer: A Chapter/Section: 9.5 Learning Outcome: 9.22 Global LO: G5 Bloom's Taxonomy: 1-2: Remembering/Understanding 26) Which of the following does not help to limit the spread of healthcare-acquired infections? A) proper hand washing even if gloves will be worn B) transporting patients as often as possible to keep the healthy patients away from the sick patients C) consistent use of personal protective wear (gloves, masks, and gowns) D) environmental sanitization and equipment sterilization E) dedicating equipment for a single patient's use whenever possible (a blood pressure cuff) Answer: B Chapter/Section: 9.5 Learning Outcome: 9.23 Bloom's Taxonomy: 1-2: Remembering/Understanding 27) Which of the following key HAI's is not associated with its correct cause? A) Clostridioides difficile: Causes acute illness that is followed by a high risk of chronic infection that causes severe liver damage and increases the risk of liver cancer B) E. coli: Urinary tract infections and bacteremia C) Methicillin-resistant Staphylococcus aureus (MRSA): Causes dangerous infections of surgical wounds, bedsores, and central lines; primarily transmitted by touch D) Pseudomonas aeruginosa: Causes infections in burn patients, catheterized patients, and people on ventilators E) Vancomycin-resistant enterococci (VRE): Causes wound, bloodstream, and urinary tract infections Answer: A Chapter/Section: 9.5 Learning Outcome: 9.24 Global LO: G2 Bloom's Taxonomy: 3-4: Applying/Analyzing

28) Which of the following is not a reason why healthcare settings are hot zones for antibioticresistant pathogens? A) There is extensive antibiotic use. B) Air is recirculated from patient isolation rooms to the rest of the hospital. C) There is an abundance of susceptible hosts. D) Caregivers may be overly fatigued and not wash their hands properly. E) Healthcare staff caring for a high number of patients may wrongly assume that glove use can replace hand hygiene. Answer: B Chapter/Section: 9.5 Learning Outcome: 9.25 Bloom's Taxonomy: 1-2: Remembering/Understanding 29) When a healthcare provider diagnoses a reportable disease, with whom do they document the case? A) CDC national database B) FDA national database C) local or state public health authority D) World Health Organization E) White House Epidemiology Center Answer: C Chapter/Section: 9.6 Learning Outcome: 9.26 Bloom's Taxonomy: 1-2: Remembering/Understanding 30) What are emerging diseases? A) diseases that improved during antibiotic therapy but returned when the patient stopped taking the antibiotics B) diseases that were present hundreds of years ago but due to increased contact with fossils are now becoming active again C) infections that were central to one location but are now beginning to spread for unknown reasons D) new or newly identified infections in a population E) were previously under control, but are now showing increased incidence Answer: D Chapter/Section: 9.6 Learning Outcome: 9.27 ASM LO: 1.3 Bloom's Taxonomy: 1-2: Remembering/Understanding

31) Which of the following is not a reason(s) that we see an increased rate of disease emergence worldwide? A) climate change B) changes in sociocultural practices (such as injectable illicit drugs, widespread global travel, and increased food processing and handling) C) deforestation and urbanization D) population crowding E) decreased water quality Answer: E Chapter/Section: 9.6 Learning Outcome: 9.27 ASM LO: 1.3 Bloom's Taxonomy: 1-2: Remembering/Understanding 32) Which of the following factors would make eradication of a disease harder? A) easily identifiable B) treatable or preventable C) only humans transmit and catch D) longer incubation period E) does not cause latent infections Answer: D Chapter/Section: 9.6 Learning Outcome: 9.28 Bloom's Taxonomy: 1-2: Remembering/Understanding 33) What is the epidemiological definition of eradication of an infectious disease? A) There are no longer any cases of the microbe anywhere in the world for three consecutive years. B) The patient no longer shows any symptoms. C) The patient has a zero blood count for the infectious microbe. D) There are no longer any cases of the microbe in the country. E) Ten or more developed countries have gone ten years without reporting one case. Answer: A Chapter/Section: 9.6 Learning Outcome: 9.28 Bloom's Taxonomy: 1-2: Remembering/Understanding

34) Which of the following is not a way that ethical issues emerge in epidemiology? A) new threats or diseases B) more aware of old threats or diseases C) new technologies or studies that provide more information or better insight D) new laws are passed E) more visible infections noticeable in the community Answer: E Chapter/Section: 9.6 Learning Outcome: 9.29 ASM LO: 7.4a Bloom's Taxonomy: 1-2: Remembering/Understanding 35) What is herd immunity? A) the protection offered to you by the size of your country, as it limits potential outside contact with an infected individual B) small communities protect their children from being exposed to outside pathogens by limiting the contact their children have with outside visitors or workers C) the protection offered when an entire population is socially-distanced and restricted from traveling due to a pandemic. D) the only protection available to those who are unable to receive immunizations due to medical reasons E) at least 25 percent of the population needs to be immune before those too poor to receive the vaccination can be protected Answer: D Chapter/Section: 9.6 Learning Outcome: 9.28 Bloom's Taxonomy: 1-2: Remembering/Understanding 36) Why are Koch's postulates not appropriate to use for diseases caused by obligate intracellular pathogens such as viruses? A) because obligate intracellular pathogens replicate too quickly for Koch's postulates to be useful B) because obligate intracellular pathogens mutate too quickly for Koch's postulates to be useful C) because obligate intracellular pathogens replicate too quickly AND mutate too quickly for Koch's postulates to be useful D) because obligate intracellular pathogens require growth inside a host cell and cannot be independently cultured E) because obligate intracellular pathogens will become attenuated during culturing outside of a host cell Answer: D Chapter/Section: 9.1 Learning Outcome: 9.5 ASM LO: 4.4 Bloom's Taxonomy: 1-2: Remembering/Understanding

37) In the 1950s, it was observed that polio spread more widely during the summer months, when children were out of school and ice-cream trucks were commonly seen in neighborhoods. The media reported that an increase in polio in school-aged children could be directly correlated with an increase in the consumption of ice cream during the summer, causing ice cream sales to plummet. What conclusion can be drawn from these observations? A) The ice cream was likely contaminated with polio virus, and children contracted polio from eating the ice cream. B) The ice cream truck worker likely spread polio to the children by coughing on the ice cream. C) No evidence for causation between consumption of ice cream and an increase in polio should be assumed from these data—more research is needed. D) The polio virus is more active in the heat of the summer months. E) The children's immune systems were compromised by eating unhealthy treats like ice cream. Answer: C Chapter/Section: 9.4 Learning Outcome: 9.20 Global LO: G2 | G5 ASM LO: 7.3b | 7.4 Bloom's Taxonomy: 3-4: Applying/Analyzing 38) In the year 2000, measles was declared eradicated from the U.S. (no transmission of the virus observed for 12 consecutive months). However, in the year 2019, according to the CDC, there were 1282 cases reported in the U.S. How would the measles virus be best described? A) a reemerging pathogen B) an emerging pathogen C) a zoonotic pathogen D) a mutating pathogen E) an endemic pathogen Answer: A Chapter/Section: 9.6 Learning Outcome: 9.27 ASM LO: 7.4 Bloom's Taxonomy: 3-4: Applying/Analyzing 9.2 True/False Questions 1) Chronic diseases have a rapid onset and progression. Answer: FALSE Chapter/Section: 9.1 Learning Outcome: 9.2 Bloom's Taxonomy: 1-2: Remembering/Understanding 2) Zoonotic diseases are spread from animals to humans. Answer: TRUE Chapter/Section: 9.1 Learning Outcome: 9.2 Bloom's Taxonomy: 1-2: Remembering/Understanding 12 Copyright © 2023 Pearson Education, Inc.

3) The source of an infectious agent is the animate or inanimate habitat where the pathogen is naturally found. Answer: FALSE Chapter/Section: 9.2 Learning Outcome: 9.6 Bloom's Taxonomy: 1-2: Remembering/Understanding 4) The acute phase of an infectious disease, when the pathogen levels are the highest, is the most contagious stage of any pathogen. Answer: FALSE Chapter/Section: 9.2 Learning Outcome: 9.9 Bloom's Taxonomy: 1-2: Remembering/Understanding 5) The epidemiological triangle is equally useful for describing noninfectious diseases as it is infectious diseases. Answer: TRUE Chapter/Section: 9.3 Learning Outcome: 9.12 Bloom's Taxonomy: 1-2: Remembering/Understanding 6) It is legal for the CDC to quarantine any person entering or already in the United States who may have an infectious disease that is deemed quarantinable. Answer: TRUE Chapter/Section: 9.3 Learning Outcome: 9.13 Bloom's Taxonomy: 1-2: Remembering/Understanding 7) It can be challenging to accurately determine incidence rate for diseases with high percentages of asymptomatic cases or when a pathogen mutates to become more infective and/or virulent. Answer: TRUE Chapter/Section: 9.4 Learning Outcome: 9.18 Bloom's Taxonomy: 1-2: Remembering/Understanding 8) When two things happen at the same time, that correlation indicates one factor is causing the other. Answer: FALSE Chapter/Section: 9.4 Learning Outcome: 9.20 Bloom's Taxonomy: 1-2: Remembering/Understanding

9) Hospital microbiologists should routinely test isolated pathogens for their susceptibility to commonly prescribed drugs in order to share these susceptibility rates with the healthcare team to help them make informed decisions about antibiotic therapies. Answer: TRUE Chapter/Section: 9.5 Learning Outcome: 9.25 Bloom's Taxonomy: 1-2: Remembering/Understanding 10) Asymptomatic cases of SARS-CoV2 (COVID-19) are unable to transmit the virus to others. Answer: FALSE Chapter/Section: 9.2 Learning Outcome: 9.10 Bloom's Taxonomy: 1-2: Remembering/Understanding 9.3 Essay Questions 1) Name the five limitations of Koch's postulates. Answer: They do not apply to noninfectious diseases, since those illnesses are not directly caused by pathogens. Other infectious agents called obligate intracellular pathogens, which include viruses and certain bacteria and protozoans, only replicate inside a host cell and are therefore impossible to grow as independent pure cultures. In still other cases, growing a microbe as a pure culture may cause it to attenuate, or lose its ability to cause disease. Furthermore, there are many human-specific infectious agents. Lastly, Koch's postulates do not easily deal with characterization of asymptomatic or latent disease. Chapter/Section: 9.1 Learning Outcome: 9.5 Global LO: G2 | G8 ASM LO: 7.3a Bloom's Taxonomy: 3-4: Applying/Analyzing 2) Explain how and why healthcare epidemiology programs are essential to quality care. Answer: Healthcare epidemiology programs reduce transmission of infectious diseases through surveillance, prevention, and control programs. Since about 70 percent of HAIs are preventable; healthcare epidemiology programs have a significant opportunity to save lives. Estimates also show that every dollar invested in preventing nosocomial infections will lead to $3 of net direct cost savings. Furthermore, healthcare staff are there to increase the quality of life for their patients. Chapter/Section: 9.5 Learning Outcome: 9.22 Global LO: G2 | G8 ASM LO: 7.3a Bloom's Taxonomy: 3-4: Applying/Analyzing

3) What is the difference between reportable diseases and notifiable diseases? Answer: The diseases on a state or local tracking list are called reportable diseases. Usually the list of reportable diseases includes the diseases that the CDC has an interest in monitoring, as well as diseases that the local authorities want to monitor. The diseases that the CDC recommends monitoring are called notifiable diseases. Chapter/Section: 9.6 Learning Outcome: 9.26 Global LO: G2 | G8 ASM LO: 7.3a Bloom's Taxonomy: 3-4: Applying/Analyzing 4) Discuss (and/or diagram) the components of the epidemiological triangle. Give examples of each component. Describe at least one specific example of how the epidemiological triangle could be broken in order to prevent disease transmission. Answer: The three components of the epidemiological triangle are: etiological agent, environmental factors, and host factors. The etiological agent (the "what") is the causative pathogen of the disease, whether it be bacterial, fungal, protozoan, or viral. Environmental factors (the "where") include geographical location and availability of vectors such as insects, and other sources (such as water/food) in the given location that may carry the disease. The third component includes host factors (the "who") of the specific person exposed to the given etiological agent. Some examples of host factors include: general health, sex, age, and lifestyle. These three components must intersect in order for disease to occur. Thus, changing just one of these three factors is usually enough to prevent disease transmission. Usually, complete eradication of the etiological agent is not practical; however, changing environmental conditions (such as improving food/water hygiene) or host factors (such as lifestyle changes) are more feasible. One example of this would be something as simple as frequent hand washing. This would be a host factor/lifestyle change that could significantly decrease the amount of disease transmission regardless of the etiological agent or environmental factors for the given disease. Another example would be environmental changes such as removal of standing water so that a mosquito vector of a given disease could no longer replicate. This would also break the epidemiological triangle and stop disease transmission. Chapter/Section: 9.3 Learning Outcome: 9.12 Global LO: G2 | G8 ASM LO: 5.4 | 7.3a Bloom's Taxonomy: 3-4: Applying/Analyzing

Microbiology: Basic & Clinical Principles, 2e (Norman-McKay) Chapter 10 Host-Microbe Interactions and Pathogenesis 10.1 Multiple Choice Questions 1) Host-microbe interactions A) involve a dynamic give-and-take between the microbe and the host. B) are always harmful. C) are generally commensal. D) never result in the normal species of the microbiota causing disease. E) do not involve host factors. Answer: A Chapter/Section: 10.1 Learning Outcome: 10.1 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 2) Examples of healthy host-microbe interactions with our normal microbiota include all except A) immune system maturation. B) vitamin manufacture. C) competition with pathogens. D) microbiota disruption. E) moderation of immune attack against microbiota species while in their normal tissues. Answer: D Chapter/Section: 10.1 Learning Outcome: 10.1 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 3) Which factors may result in a normal microbiota species causing disease? A) dysbiosis due to antibiotic therapy B) immune system attack on the host's own tissues C) invasion of other tissues by the microbiota species D) dysbiosis due to antibiotic therapy OR immune system attack on the host's own tissue E) dysbiosis due to antibiotic therapy OR invasion of other tissues by the microbiota species Answer: E Chapter/Section: 10.1 Learning Outcome: 10.2 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding

4) Which statement shows an example of a commensal species in one host becoming a pathogenic species in another host? A) E. coli lives harmlessly in the appendix but will be attacked by the immune system if it invades the abdominal cavity. B) C. difficile flourishes in the large intestine after antibiotic therapy. C) Up to 30 percent of pregnant women harbor Group B streptococci in the vagina to no ill effect, but when transmitted to their newborns, a proportion of babies develop serious infection. D) Shigella flexneri preferably infects the tissues of humans and other primates. E) New infectious diseases are due to an expansion in host tropism. Answer: C Chapter/Section: 10.1 Learning Outcome: 10.3 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 5) The preference of a pathogen for a specific host is A) dysbiosis. B) opportunism. C) pathogenicity. D) tropism. E) virulence. Answer: D Chapter/Section: 10.1 Learning Outcome: 10.4 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 6) Which factor is responsible for many emerging pathogens in humans? A) expanded host or tissue range of the pathogen B) increased use of antibiotics in the past half-century C) improved sanitation and hygiene practices D) availability of vaccines E) longer life spans resulting in a larger elderly population Answer: A Chapter/Section: 10.1 Learning Outcome: 10.4 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding

7) The degree or extent of disease that a pathogen causes is A) attenuation. B) a host factor. C) pathogenicity. D) toxicity. E) virulence. Answer: E Chapter/Section: 10.2 Learning Outcome: 10.5 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 8) Which is not a category of virulence factors? A) adhesion B) attenuation C) immune system evasion D) nutrient acquisition E) toxins Answer: B Chapter/Section: 10.2 Learning Outcome: 10.6 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 9) Properties that contribute to virulence A) are determined solely by the microbe. B) are determined solely by the host. C) are fixed and unchanging. D) are determined by both the microbe and the host, and are fixed and unchanging. E) are determined by both the microbe and the host, and may evolve over time. Answer: E Chapter/Section: 10.2 Learning Outcome: 10.6 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 10) What is an example of a virulence factor that is related to nutrient acquisition? A) capsule B) fimbriae C) flagella D) iron-binding protein E) LPS in Gram-negative cell wall Answer: D Chapter/Section: 10.2 Learning Outcome: 10.6 ASM LO: 2.3 | 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 3 Copyright © 2023 Pearson Education, Inc.

11) Which is not an example of virulence as an evolving property? A) Historically, smallpox appeared to shift from a highly virulent pathogen that killed its victims quickly to one that did not kill immediately but more easily spread from person to person. B) The 1918 influenza pandemic primarily killed young adults rather than elderly persons which is more typical of influenza both before and after that time. C) Cold viruses that generate more coughs and sneezes while allowing the host to remain mobile will have an evolutionary advantage over those that cause their host to be bedridden. D) As hosts evolve more effective defenses against a given pathogen, the pathogen in turn will evolve virulence factors to combat those defenses. E) Each of these is an example of virulence as an evolving property. Answer: E Chapter/Section: 10.2 Learning Outcome: 10.8 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 12) An attenuated pathogen A) has lost virulence factors needed to cause disease in an immune competent host. B) has recently acquired virulence factors allowing it to jump species. C) is part of the normal human microbiome. D) has become antibiotic-resistant. E) produces toxins. Answer: A Chapter/Section: 10.2 Learning Outcome: 10.9 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 13) ID50 describes A) the number of cells or virions which will kill 50 individuals. B) the number of cells or virions which will kill 50 percent of exposed hosts. C) the number of cells or virions needed to establish an infection in 50 percent of exposed hosts. D) the amount of toxin lethal to a 50-pound human or other animal. E) the percentage of individuals which will develop an infection after exposure to 50 cells or virions. Answer: C Chapter/Section: 10.2 Learning Outcome: 10.10 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding

14) Which type of toxin is pictured?

A) endotoxin B) type I exotoxin C) type II exotoxin D) type III exotoxin E) either type I, type II, or type III exotoxins Answer: A Chapter/Section: 10.2 Learning Outcome: 10.11 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 15) Which type of bacterial toxin is matched incorrectly with its description? A) Type I exotoxin: Binds to the targeted host cell at a membrane receptor but does not enter the cell B) Type II exotoxin: Disrupts and damages the host cell membrane leading to cell lysis C) Type III exotoxin: Binds to a membrane receptor then enters the cell D) Endotoxin: Enters the bloodstream during infection with Gram-negative bacteria E) Toxemia: A toxin produced during a viral infection Answer: E Chapter/Section: 10.2 Learning Outcome: 10.11 | 10.12 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 16) Exotoxins are A) secreted. B) only made by Gram-positive bacteria. C) the targets of some childhood vaccines. D) secreted and only made by Gram-positive bacteria. E) secreted and the targets of some childhood vaccines. Answer: E Chapter/Section: 10.2 Learning Outcome: 10.11 | 10.12 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 5 Copyright © 2023 Pearson Education, Inc.

17) Toxemia is a condition A) where a toxin is acting on tissues locally. B) where a toxin has entered the bloodstream resulting in systemic effects. C) that may describe both localized and systemic effects. D) where a vaccine is used to protect against a toxin. E) where a toxin acts as a superantigen. Answer: B Chapter/Section: 10.2 Learning Outcome: 10.11 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 18) Septic shock is typically associated with A) Gram-negative infections. B) either Gram-negative or Gram-positive infections. C) exotoxins. D) exotoxins or endotoxin. E) superantigens. Answer: A Chapter/Section: 10.2 Learning Outcome: 10.11 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 19) Which portal of entry is mismatched to its description? A) Parenteral: Pathogen is passed from mother to child through the placenta B) Otic: Pathogen enters via the ear C) Gastrointestinal: Often involves fecal-to-oral transmission D) Urogenital: Often associated with sexually transmitted pathogens E) Ocular: Via the conjunctiva Answer: A Chapter/Section: 10.3 Learning Outcome: 10.14 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding

20) Which portal of exit will a bloodborne pathogen likely use? A) ocular B) GI mucosa C) parenteral D) respiratory mucosa E) skin Answer: C Chapter/Section: 10.3 Learning Outcome: 10.14 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 21) Adhesins A) include molecules that are typically found deep inside the pathogenic cell. B) are limited to only a few known types. C) allow pathogens to stick to host tissues only in a nonspecific manner. D) include molecules that bind to host factors such as fibronectin, sialic acid, and heparin / heparin sulfate. E) make poor targets for vaccine development. Answer: D Chapter/Section: 10.3 Learning Outcome: 10.15 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 22) Which type of invasin allows a pathogen to break down a blood clot that the body has generated to trap their spread? A) coagulase B) collagenase C) flagella D) kinase E) neuraminidase Answer: D Chapter/Section: 10.3 Learning Outcome: 10.15 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding

23) Pathogens can obtain iron from the body using A) lipases. B) proteases. C) siderophores. D) transferrin. E) siderophores or transferrin. Answer: C Chapter/Section: 10.3 Learning Outcome: 10.16 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 24) Which method of hiding from the host immune system is incorrectly matched with its description? A) Latency: A pathogen exists quietly inside the host cell B) Living intracellularly: A pathogen resides on the surface of a host cell where it is hidden by host cell surface molecules C) Antigen variation: The pathogen frequently switches its antigens D) Antigen mimicry: The pathogen's antigens are similar in structure to host molecules E) Antigen masking: The pathogen covers itself in host factors to avoid detection of its own antigens Answer: B Chapter/Section: 10.3 Learning Outcome: 10.17 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 25) Which of the following is not a way that pathogens can avoid destruction by the phagocytes of the host immune system? A) adapt to living inside the phagocyte B) make a capsule which is toxic to the phagocyte C) release toxins which kill the phagocyte D) block fusion of the phagosome with the lysosome inside the phagocyte E) neutralize the hydrolytic enzymes produced by the phagocyte Answer: B Chapter/Section: 10.3 Learning Outcome: 10.17 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding

26) A potential antimicrobial drug is tested and found to strip away the capsules made by certain pathogenic bacteria. How would this drug affect the bacteria's ability to cause disease? A) The phagocytes would be better able to ingest the bacteria. B) The bacteria would not be able to kill phagocytes. C) The bacteria would only be able to colonize surface tissues and not penetrate more deeply. D) The bacteria would be unable to acquire needed nutrients from the body. E) The bacteria would be unable to survive inside the phagocyte. Answer: A Chapter/Section: 10.3 Learning Outcome: 10.17 Global LO: G2 ASM LO: 5.4 Bloom's Taxonomy: 3-4: Applying/Analyzing 27) How are symptoms of an infection associated with the mode of transmission of the pathogen? A) There is no relationship between symptoms and mode of transmission. B) Bodily fluids produced during an illness are often rich in infectious organisms. C) Bodily fluids are rarely a source of disease transmission during an infection. D) Lack of symptoms indicates that the infection is not transmissible to others. E) The worse the patient feels, the more likely the disease is transmissible to others. Answer: B Chapter/Section: 10.3 Learning Outcome: 10.18 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 28) Which of the following can be a potential disease reservoir for a pathogen that infects humans? A) only humans B) only humans or nonhuman animals C) only humans or inanimate objects that an infected human directly handles D) environmental niches such as soil or water E) Humans, nonhuman animals, inanimate objects, or environmental niches can all serve as reservoirs for a pathogen that infects humans. Answer: E Chapter/Section: 10.3 Learning Outcome: 10.19 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding

29) Criteria for assigning pathogens to a biosafety level include all the following except A) ability to culture the pathogen using standard laboratory media and equipment. B) availability of disease prevention and/or treatment. C) extent of disease and mortality rates. D) level of infectivity. E) mode of transmission. Answer: A Chapter/Section: 10.4 Learning Outcome: 10.20 Bloom's Taxonomy: 1-2: Remembering/Understanding 30) Which biosafety level is incorrectly matched with its description? A) BSL-1: Nonpathogens or those that rarely cause disease in healthy people B) BSL-2: Known pathogens but the infection is treatable or preventable C) BSL-2+: Known animal pathogens which do not infect humans D) BSL-3: Serious, lethal pathogens though some diseases may be treatable E) BSL-4: Dangerous, lethal pathogens with no cures and limited treatments Answer: C Chapter/Section: 10.4 Learning Outcome: 10.21 Bloom's Taxonomy: 1-2: Remembering/Understanding 31) Which of the following microbes are classified as BSL-2? A) Bacillus subtilis B) E. coli K-12 C) Staphylococcus aureus D) Staphylococcus epidermidis E) Both Staphylococcus aureus and Staphylococcus epidermidis Answer: C Chapter/Section: 10.4 Learning Outcome: 10.21 Bloom's Taxonomy: 1-2: Remembering/Understanding 32) Which statement is true about standard precautions? A) They are used only when the patient is known to be infected with a BSL-2 or higher pathogen. B) They are used in student labs that only handle BSL-1 pathogens. C) They are in force only for bloodborne pathogens. D) They require full face shields, gloves, and barrier gowns for all patient contact situations. E) They apply to all healthcare providers working with all patients. Answer: E Chapter/Section: 10.4 Learning Outcome: 10.22 Bloom's Taxonomy: 1-2: Remembering/Understanding

33) Which mode of transmission is not addressed by transmission precautions? A) direct contact B) airborne C) droplet D) vector E) airborne and droplet Answer: D Chapter/Section: 10.4 Learning Outcome: 10.23 Bloom's Taxonomy: 1-2: Remembering/Understanding 34) Droplet and airborne precautions both A) require the use of a procedural mask. B) involve transmission through fine aerosols which require close contact for transmission. C) involve diseases of the respiratory system and/or diseases transmitted through a respiratory route. D) require isolation in a specially ventilated room (AIIR). E) require use of an N95 respirator. Answer: C Chapter/Section: 10.4 Learning Outcome: 10.23 Bloom's Taxonomy: 1-2: Remembering/Understanding 35) The role of healthcare workers in the management of disease outbreaks A) is only important in BSL-3 or higher facilities. B) can be approached casually. C) should be addressed through periodic training and re-training. D) is limited to properly using personal protective equipment. E) is not critical in U.S. healthcare facilities. Answer: C Chapter/Section: 10.4 Learning Outcome: 10.24 Bloom's Taxonomy: 1-2: Remembering/Understanding

36) A new strain of influenza is observed to be spreading rapidly in a local population. Based on contact tracing, it is determined that a patient who attended a party spread the virus to at least 5 friends. Later that week, 30 total people who tested positive were determined to have had direct contact with the 5 friends of the first patient. Estimate the R-naught (R0 ) for this new strain of influenza. A) less than 1 B) 6 C) 10 D) 30 E) over 150 Answer: B Chapter/Section: 10.2 Learning Outcome: 10.7 Global LO: G2 | G4 ASM LO: 5.4 | 7.2 Bloom's Taxonomy: 3-4: Applying/Analyzing 37) At the beginning of the SARS-CoV2 pandemic, safeguards were put in place (such as social distancing, working from home, distance learning, etc.) to slow the transmission of the virus. In comparing R-naught (R0) to the "effective reproduction number" (Re) of SARS-CoV2, which of the following statements is correct regarding the goals of the measures put in place? A) The R0 should have been lower than the Re due to preventative measures. B) The R0 should have been equal to the Re since preventative measures will not change these values. C) The R0 should have been higher than the Re due to preventative measures. D) The R0 should have been lower than the Re since a vaccine had not yet been developed. E) The R0 should have been higher than the Re due to rapid mutation of the virus. Answer: C Chapter/Section: 10.2 Learning Outcome: 10.7 Global LO: G2 | G5 ASM LO: 5.3 | 7.4 Bloom's Taxonomy: 3-4: Applying/Analyzing

38) A research study was performed on the SARS-CoV2 virus to estimate the ID50 of the virus. The data indicated that the ID50 was approximately 300 virions. By comparison, the ID50 of norovirus is approximately 50 virions. Which of the following statements is correct? A) Norovirus is more infectious than SARS-CoV2. B) SARS-CoV2 is more infectious than norovirus. C) SARS-CoV2 is more virulent than norovirus. D) Norovirus is more virulent than SARS-CoV2 E) SARS-CoV2 is both more infectious and more virulent than norovirus. Answer: A Chapter/Section: 10.2 Learning Outcome: 10.10 Global LO: G2 ASM LO: 5.4 | 7.1 Bloom's Taxonomy: 3-4: Applying/Analyzing 39) Which of the following is not one of the tasks all microbes must complete in order to successfully infect a host? A) utilize a specific portal of entry to enter the host B) adhere to host cells C) acquire nutrients D) mutate to allow for increased cytopathic effects in host cells E) evade the host immune system cells such as phagocytes Answer: D Chapter/Section: 10.3 Learning Outcome: 10.13 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 10.2 True/False Questions 1) More than half of new infectious diseases in humans emerged due to expanded host tropism by the infectious organism. Answer: TRUE Chapter/Section: 10.1 Learning Outcome: 10.4 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 2) A microbe is either pathogenic or it is not. A microbe is either virulent or it is not. Both pathogenicity and virulence are all-or-nothing terms. Answer: FALSE Chapter/Section: 10.2 Learning Outcome: 10.5 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding

3) A microbe with a low ID50 does not necessarily cause severe disease. Answer: TRUE Chapter/Section: 10.2 Learning Outcome: 10.10 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 4) A pathogen which uses a specific portal of entry will only be able to establish an infection in the system associated with that portal. Answer: FALSE Chapter/Section: 10.3 Learning Outcome: 10.14 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 5) A pathogen will always use the same portal for both entry and exit. Answer: FALSE Chapter/Section: 10.3 Learning Outcome: 10.14 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 6) While a reservoir can be a source of infection, not all sources of infection are reservoirs. Answer: TRUE Chapter/Section: 10.3 Learning Outcome: 10.19 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 7) Members of the genus Vibrio, which includes the species that causes cholera, are found in marine environments. However, most cases of cholera occur when people drink water that has been contaminated with feces from other humans with cholera. If an effective vaccine against cholera were developed so that humans would become immune to the disease, both the reservoir and the source of the cholera bacteria would be eliminated. Answer: FALSE Chapter/Section: 10.3 Learning Outcome: 10.19 Global LO: G2 ASM LO: 5.4 Bloom's Taxonomy: 3-4: Applying/Analyzing

8) An emerging infectious disease has been identified that is lethal in more than 90% of cases. While the etiologic agent has not yet been determined, epidemiological evidence suggests that this pathogen is transmitted only through direct contact with the blood of ill or recently deceased patients. Patient blood and tissue samples would best be handled at BSL-2 until more information can be learned about the pathogen. Answer: FALSE Chapter/Section: 10.4 Learning Outcome: 10.21 Global LO: G2 Bloom's Taxonomy: 3-4: Applying/Analyzing 9) Both HIV and SARS-CoV2 emerged in the human population as a result of an expansion in tropism by the causative agents of these infections. Answer: TRUE Chapter/Section: 10.1 Learning Outcome: 10.4 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 10) The gastrointestinal tract is the most common portal of entry for human pathogens. Answer: FALSE Chapter/Section: 10.4 Learning Outcome: 10.14 Bloom's Taxonomy: 1-2: Remembering/Understanding 10.3 Essay Questions 1) Contrast pathogenicity and virulence, and describe why virulence can be considered an evolving property. Answer: Pathogenicity is the ability of a pathogen to cause disease; virulence describes the degree or extent of disease that a pathogen causes. Whereas pathogenicity is an all-or-nothing term, virulence varies, may depend on both pathogen and host features, and may evolve over time. To endure over time, a pathogen's ability to break down defenses and live within a host must be balanced with the ability to transmit to others. A highly virulent pathogen which is transmitted person-to-person and causes high-mortality outbreaks that rapidly kill or debilitate hosts usually remains geographically isolated and causes short-lived outbreaks. Over time, this pathogen may evolve into one which does not kill victims right away, thus increasing the time available for transmission. Chapter/Section: 10.2 Learning Outcome: 10.5 | 10.8 Global LO: G2 | G8 ASM LO: 5.4 Bloom's Taxonomy: 3-4: Applying/Analyzing

2) If you had the ability to genetically engineer a pathogenic bacterium, what features would you include? Choose a portal of entry and a portal of exit for your pathogen. Then choose three virulence factors from at least two of the following areas: toxins, adhesins, invasins, acquisition of nutrients, and avoidance of the immune system, and describe how each factor will help your bacterium survive in the host. Your virulence factors should make sense for the portals of entry and exit that you chose. Answer: Answers to this question will be highly variable dependent upon student choice. The portals of entry and exit should be logically connected (for example, if the student chooses a gastrointestinal portal of entry such as the mouth, they should also choose a gastrointestinal portal of exit). When a selected virulence factor has a specific tissue or cellular target, this should also align to the portal of entry. Chapter/Section: 10.2 | 10.3 Learning Outcome: 10.11 | 10.12 | 10.14 | 10.15 | 10.16 | 10.17 Global LO: G2 | G8 ASM LO: 5.4 Bloom's Taxonomy: 3-4: Applying/Analyzing 3) You are a consultant with an architectural firm designing a BSL-3 hospital facility for patient care and diagnostic laboratory services. The facility will specialize in airborne pathogens such as Mycobacterium tuberculosis. Describe the characteristics of pathogens handled in a BSL-3 facility and describe at least five features that must go into the facility design. Answer: A BSL-3 facility handles pathogens which cause serious, sometimes lethal, human disease. Some pathogens in this category may be treatable. These pathogens may be contagious and transmitted through airborne routes which means that the pathogen may remain infectious in the environment for some time. Besides all measures for BSL-1 and BSL-2 facilities, the BSL-3 facility should have: controlled access with self-closing double doors, airflow management such as airborne infection isolation rooms (AIIR) to keep airborne pathogens from other parts of the building, biological safety cabinets for pathogen handling and manipulation, decontamination facilities for waste and personal protective equipment that will be laundered, availability of gloves, protective lab coverings, and respirators for personnel which will remain in the BSL-3 facility, adequate warning signage detailing infection risks, and available vaccination and/or monitoring of personnel for infection. Chapter/Section: 10.4 Learning Outcome: 10.21 Global LO: G8 Bloom's Taxonomy: 1-2: Remembering/Understanding

4) Biofilms are of special concern, with 60-80 percent of human infections resulting from microbes in a biofilm. Discuss some important features of biofilms, including common locations where biofilms are found in healthcare associated settings. How does quorum sensing play a role in the expression of virulence factors? Use a specific example of when quorum sensing can lead to increased virulence in a pathogen. Answer: A biofilm is a community of bacteria, as opposed to bacteria living in "planktonic" or free-floating form. Biofilms are found in a variety of healthcare settings, in particular on implanted medical devices such as catheters, respiratory/central line tubing, or prosthetic joints. Quorum sensing refers to the signals/chemicals that bacteria release to communicate with other organisms in a biofilm. These signals can cause bacteria in a biofilm to turn on gene expression of specific virulence factors. One example (Note: Other examples might be used by the student) would be toxins that Staphylococcus aureus releases to attack and lyse white blood cells during a Staph infection. The genes that produce these toxins are activated via quorum sensing when the Staph bacteria are in a biofilm community. Chapter/Section: 10.3 Learning Outcome: 10.17 Global LO: G8 ASM LO: 5.2 | 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding

Microbiology: Basic & Clinical Principles, 2e (Norman-McKay) Chapter 11 Innate Immunity 11.1 Multiple Choice Questions 1) Which of the following does not describe adaptive immunity? A) generalized responses that don't vary based on the pathogen being fought B) only in vertebrate animals C) matures over time D) recognizes pathogens it previously fought, allowing for quicker and more aggressive defense mobilization upon later exposures to the same agent E) evolved more recently Answer: A Chapter/Section: 11.1 Learning Outcome: 11.1 Bloom's Taxonomy: 1-2: Remembering/Understanding 2) Which of the following features are shared between both innate and adaptive immunity? A) recognize diverse pathogens and eliminate identified invaders B) respond immediately and remember antigens C) discriminate between self and foreign antigens D) respond immediately, remember antigens, and exist in all eukaryotic organisms E) recognize diverse pathogens, eliminate identified invaders, and discriminate between self and foreign antigens Answer: E Chapter/Section: 11.1 Learning Outcome: 11.1 Bloom's Taxonomy: 1-2: Remembering/Understanding 3) Which of the following is not a benefit of our normal microbiota? A) competes for nutrients with pathogens B) competes for space with pathogens C) makes substances that may directly damage pathogens D) neutralizes harmful wastes that pathogens produce E) generates an environment that limits pathogen survival Answer: D Chapter/Section: 11.1 Learning Outcome: 11.2 Bloom's Taxonomy: 1-2: Remembering/Understanding

4) The general goal of first-line defenses is to A) tag intruders with a signaling molecule to identify them as foreign. B) prevent pathogen entry. C) destroy pathogens. D) weaken pathogens. E) isolate pathogens. Answer: B Chapter/Section: 11.2 Learning Outcome: 11.3 Bloom's Taxonomy: 1-2: Remembering/Understanding 5) Which of the following is an example of a mechanical barrier? A) skin B) lysozyme C) the mucociliary escalator D) antimicrobial peptides E) stomach acid Answer: C Chapter/Section: 11.2 Learning Outcome: 11.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 6) Which of the following is not an example of a chemical barrier? A) peristalsis B) the low pH of urine C) stomach acid D) antimicrobial peptides in mucus E) lysozyme in tears Answer: A Chapter/Section: 11.2 Learning Outcome: 11.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 7) Which of the following is not a reason the skin is a useful barrier? A) The outermost layer is made up of tightly compacted dead epithelial cells. B) The skin is enriched with specialized proteins such as keratin. C) The skin is enriched with lipids to serve as a water-resistant layer. D) The skin produces mucus to trap microbes. E) The skin is enriched with antimicrobial peptides. Answer: D Chapter/Section: 11.2 Learning Outcome: 11.5 Bloom's Taxonomy: 1-2: Remembering/Understanding

8) Which of the following is false about the enzyme lysozyme? A) acts as a chemical barrier B) can be found in mucus, saliva, tears, and breast milk C) breaks down bacterial cell walls D) destroys viruses and fungi E) kills bacterial cells Answer: D Chapter/Section: 11.2 Learning Outcome: 11.6 Bloom's Taxonomy: 1-2: Remembering/Understanding 9) Which of the following is true about antimicrobial peptides? A) specifically target viral capsids for degradation B) about 50 different AMPs exist. C) microbes often develop resistance to AMPs. D) only destroy bacteria E) produced by leukocytes Answer: E Chapter/Section: 11.2 Learning Outcome: 11.7 Bloom's Taxonomy: 1-2: Remembering/Understanding 10) Antimicrobial peptides can do all of the following except A) regulate body temperature. B) target intracellular components. C) insert themselves into target cell membranes. D) disrupt plasma membrane and/or cell wall. E) stimulate leukocytes. Answer: A Chapter/Section: 11.2 Learning Outcome: 11.7 Bloom's Taxonomy: 1-2: Remembering/Understanding 11) What are the two categories of second-line defenses? A) platelets and red blood cells B) assorted molecular factors and leukocytes C) mucus and lysozyme D) antibodies and platelets E) red blood cells and antibodies Answer: B Chapter/Section: 11.3 Learning Outcome: 11.8 Bloom's Taxonomy: 1-2: Remembering/Understanding

12) In the correct order, what are the names of the fluid leaving the capillaries, going into the space between cells and then into the lymphatic capillaries? A) lymph, interstitial fluid, and plasma B) interstitial fluid, lymph, and plasma C) plasma, interstitial fluid, and lymph D) plasma, lymph, and interstitial fluid E) lymph, plasma, and interstitial fluid Answer: C Chapter/Section: 11.3 Learning Outcome: 11.9 Bloom's Taxonomy: 1-2: Remembering/Understanding 13) What is edema? A) tissue swelling B) when a capillary bursts and is releasing fluid under the skin C) irregular heart palpitations D) the hardening of infected lymph nodes E) the spreading of a pathogen from the circulatory system to the lymphatic system Answer: A Chapter/Section: 11.3 Learning Outcome: 11.9 Bloom's Taxonomy: 1-2: Remembering/Understanding 14) Which of the following are primary lymphoid tissues? A) lymph nodes and spleen B) spleen and mucosa-associated lymphoid tissue C) bone marrow and mucosa-associated lymphatic lymphoid tissue D) thymus and bone marrow E) thymus and lymph nodes Answer: D Chapter/Section: 11.3 Learning Outcome: 11.10 Bloom's Taxonomy: 1-2: Remembering/Understanding

15) From the image below, identify which of the following numbers are indicating primary lymphoid tissues?

A) 1 and 2 B) 3 and 4 C) 5 and 7 D) 6 and 8 E) 1 and 8 Answer: B Chapter/Section: 11.3 Learning Outcome: 11.10 Bloom's Taxonomy: 1-2: Remembering/Understanding

16) Secondary lymphoid tissues A) are where leukocytes mature. B) are where formed elements in blood are produced. C) are neutrophils and eosinophils. D) are monocytes and dendritic cells. E) filter lymph and sample surrounding body sites for antigens. Answer: E Chapter/Section: 11.3 Learning Outcome: 11.10 Bloom's Taxonomy: 1-2: Remembering/Understanding 17) What role do erythrocytes play in our blood? A) deliver oxygen B) clump together and help stem blood loss C) damage blood vessels when released by bacteria D) form mesh like clots to trap pathogens E) give rise to white blood cells that phagocytize pathogens Answer: A Chapter/Section: 11.3 Learning Outcome: 11.11 Bloom's Taxonomy: 1-2: Remembering/Understanding 18) Which of the following is an agranulocyte? A) neutrophil cell B) eosinophil cell C) basophil cell D) dendritic cell E) mast cell Answer: D Chapter/Section: 11.3 Learning Outcome: 11.11 Bloom's Taxonomy: 1-2: Remembering/Understanding 19) What is the general classification used to categorize leukocytes? A) It depends on the age of the cell, as all agranulocytes start off as a granulocyte and later change their function and structure over the life of the cell. B) whether or not the cells contain a nucleus C) whether or not leukocytes have granules in their cytoplasm that are visible when stained and then viewed by light microscopy D) whether they function as part of the innate or adaptive immune system E) whether the cells originate from primary or secondary lymphoid tissues Answer: C Chapter/Section: 11.3 Learning Outcome: 11.11 Bloom's Taxonomy: 1-2: Remembering/Understanding

20) Which cell type is the most numerous white blood cell in circulation, is the first leukocyte recruited from the bloodstream to injured tissues, and releases potent antimicrobial peptides? A) neutrophils B) eosinophils C) basophils D) dendritic cells E) monocytes Answer: A Chapter/Section: 11.4 Learning Outcome: 11.13 Bloom's Taxonomy: 1-2: Remembering/Understanding 21) Which cell type has a nucleus that appears to have two lobes connected by a thin band, has granules that contain diverse enzymes and antimicrobial toxins, and has mediators that are expelled in response to certain allergens and parasites? A) neutrophils B) eosinophils C) basophils D) mast cells E) monocytes Answer: B Chapter/Section: 11.4 Learning Outcome: 11.13 Bloom's Taxonomy: 1-2: Remembering/Understanding

22) Which of the following images represents a mast cell that produces granules that act as the initial chemical alarm that recruits neutrophils and other leukocytes to the scene and simultaneously promotes early phases of inflammation? A)

Answer: D Chapter/Section: 11.4 Learning Outcome: 11.13 Bloom's Taxonomy: 1-2: Remembering/Understanding 23) Which cell type works to prevent our immune system from attacking self and from overreacting to nonthreatening substances, is abundant in tissues next to body openings, and phagocytizes a broad range of antigens? A) monocytes B) macrophages C) dendritic cells D) lymphocytes E) natural killer cells Answer: C Chapter/Section: 11.4 Learning Outcome: 11.14 Bloom's Taxonomy: 1-2: Remembering/Understanding

24) Which cell type is the largest agranular white blood cell, mature as they leave the circulatory system, and increase cell levels due to chronic infections and inflammation, autoimmune disorders, and certain cancers? A) lymphocytes B) mast cells C) dendritic cells D) monocytes E) natural killer cells Answer: D Chapter/Section: 11.4 Learning Outcome: 11.14 Bloom's Taxonomy: 1-2: Remembering/Understanding 25) Which cell type is a lymphocyte that is abundant in the liver, and has important roles in innate immune protection against viruses, bacteria, parasites, and even tumor cells? A) dendritic cells B) T cells C) B cells D) natural killer cells E) macrophages Answer: D Chapter/Section: 11.4 Learning Outcome: 11.15 Bloom's Taxonomy: 1-2: Remembering/Understanding 26) Which of the following is not a function of a molecular second-line defense? A) recruiting leukocytes to the site of infection B) producing antibodies specific to the bacterial infection C) triggering fever D) stimulating inflammation E) slowing the growth of the pathogen Answer: B Chapter/Section: 11.5 Learning Outcome: 11.16 Bloom's Taxonomy: 1-2: Remembering/Understanding

27) Why are leukocytes so central to second-line molecular defenses? A) Leukocytes remove second-line molecular defenses to inhibit damage to healthy tissues in the surrounding area. B) Leukocytes have nothing to do with second-line molecular defenses. C) Leukocytes are useful in clinical medicine as diagnostic and therapeutic agents. D) Leukocytes trigger apoptosis in cancer cells. E) Leukocytes produce second-line molecular defenses, as well as respond to the production of second-line molecular defenses by other leukocytes. Answer: E Chapter/Section: 11.5 Learning Outcome: 11.17 Bloom's Taxonomy: 1-2: Remembering/Understanding 28) Which of the following pairs is not an example of a cytokine and its function? A) Chemokines: Recruit white blood cells to areas of injury or infection B) Interleukins: Regulate inflammation, fever, T cell development, and innate and adaptive immune responses C) Interferons: Produced by virus-infected cells to signal neighboring cells to mount antiviral defenses D) Tumor necrosis factors: Induce inflammation and kills tumor cells E) Eicosanoids: Promote the replication and gathering of leukocytes Answer: E Chapter/Section: 11.5 Learning Outcome: 11.18 Bloom's Taxonomy: 1-2: Remembering/Understanding 29) What are cytokines? A) organic chemicals which stimulate fever via an increase in metabolism B) carbohydrates which reduce inflammation in the body C) signaling proteins that help cells communicate with each other, initiating and coordinating immune actions D) alert hormones that trigger the body to prepare for injury by shrinking capillaries and increasing platelet production E) enzymes that promote the replication and gathering of leukocytes Answer: C Chapter/Section: 11.5 Learning Outcome: 11.18 Bloom's Taxonomy: 1-2: Remembering/Understanding

30) Which of the following is an example of a bacterial cell utilizing a siderophore to collect iron? A) Bacteria collect host iron-binding proteins and break them down to extract iron. B) Bacteria produce organic molecules that steal iron from host iron-binding proteins. C) Hemolytic bacteria collect hemoglobin from host red blood cells and break them down to extract iron. D) Bacteria use manganese instead of iron. E) Bacteria produce proteins that degrade host cells and cause the release of iron. Answer: B Chapter/Section: 11.5 Learning Outcome: 11.19 Bloom's Taxonomy: 1-2: Remembering/Understanding 31) Neisseria gonorrhoeae circumvents our iron-sequestering defenses by A) capturing our iron-binding proteins and pulling the iron out of them for their own use. B) making siderophores that pull iron from our iron-binding proteins. C) breaking down red blood cells to get to the iron-rich hemoglobin inside. D) using manganese in their metal-requiring enzymes instead of iron. E) releasing lytic enzymes and then scavenging the debris for iron. Answer: A Chapter/Section: 11.5 Learning Outcome: 11.19 Global LO: G2 Bloom's Taxonomy: 3-4: Applying/Analyzing 32) Where is the iron-binding protein transferrin found? A) red blood cells B) milk and tears C) blood plasma and extracellular fluids D) neutrophil granules E) saliva and mucus Answer: C Chapter/Section: 11.5 Learning Outcome: 11.19 Bloom's Taxonomy: 1-2: Remembering/Understanding 33) Which of the following describes the classical pathway of complement activation? A) Complement proteins activate when antibodies bind to a pathogen. B) Complement proteins activate by directly interacting with the pathogen. C) Complement proteins activate when mannose-binding lectin binds to the pathogen. D) Complement proteins activate when triggered by macrophages or neutrophils. E) Complement proteins activate by coming into contact with certain blood-clotting proteins. Answer: A Chapter/Section: 11.5 Learning Outcome: 11.20 Bloom's Taxonomy: 1-2: Remembering/Understanding 12 Copyright © 2023 Pearson Education, Inc.

34) Which of the following is an outcome of complement activation? A) opsonization B) cytolysis C) opsonization and cytolysis D) cytolysis and inflammation E) opsonization, cytolysis, and inflammation Answer: E Chapter/Section: 11.5 Learning Outcome: 11.20 Bloom's Taxonomy: 1-2: Remembering/Understanding 35) Which of the following is not a way that bacteria can evade complement activation? A) produce proteins that mimic our naturally occurring regulators of complement activation B) build a capsule to hide surface antigens that would trigger complement activation C) release enzymes that break down complement proteins D) release enzymes that break down antibodies that trigger complement activation E) release enzymes that break down lectins responsible for triggering complement activation Answer: E Chapter/Section: 11.5 Learning Outcome: 11.20 Bloom's Taxonomy: 1-2: Remembering/Understanding 36) Which of the following is not a main goal of inflammation? A) recruit immune defenses to the injured tissue B) limit the spread of infectious agents C) deliver oxygen and nutrients essential for tissue recovery D) produce localized heat and swelling in an effort to denature key bacterial proteins E) transport chemical factors essential for tissue recovery Answer: D Chapter/Section: 11.6 Learning Outcome: 11.21 Bloom's Taxonomy: 1-2: Remembering/Understanding 37) Which of the following are the three phases of inflammation? A) cytokine production, vasodilation, and phagocytosis B) vascular changes, leukocyte recruitment, and resolution C) chemoattractant production, exudate release, and healing D) margination, histamine release, and apoptosis E) vasoactive release, diapedesis, and angiogenesis Answer: B Chapter/Section: 11.6 Learning Outcome: 11.21 Bloom's Taxonomy: 1-2: Remembering/Understanding

38) Which of the following is not a cardinal sign of inflammation? A) redness B) pain C) fever D) swelling E) loss of function Answer: C Chapter/Section: 11.6 Learning Outcome: 11.22 Bloom's Taxonomy: 1-2: Remembering/Understanding 39) Which of the following key chemical mediators in inflammation is not matched to its function? A) Kinins: Induce vascular changes, stimulate pain receptors, and assist in blood-clotting cascades B) Thromboxanes: Reduce pain receptor stimulation and reduces fever C) TNF-α: Enhances inflammation D) Prostaglandins: Induce vascular changes and stimulate pain receptors E) Histamine: Induces vascular changes Answer: B Chapter/Section: 11.6 Learning Outcome: 11.23 Bloom's Taxonomy: 1-2: Remembering/Understanding 40) Chronic inflammation A) is not useful or protective and promotes atherosclerosis, cancers, and neurodegenerative disorders. B) can lead to muscle aches and fatigue as the body struggles to heal itself. C) can take years to go away but will go away eventually. D) is only of concern if the chronic inflammation is occurring in or next to the brain. E) works to protect host tissues until all pathogens have been eradicated. Answer: A Chapter/Section: 11.6 Learning Outcome: 11.24 Bloom's Taxonomy: 1-2: Remembering/Understanding 41) What triggers the release of cytokines, which signal the hypothalamus of the brain to raise the body's baseline temperature from 37°C to a higher temperature? A) interleukin 1 B) pyrogens C) tumor necrosis factor D) interferon alpha E) prostaglandins Answer: B Chapter/Section: 11.6 Learning Outcome: 11.25 Bloom's Taxonomy: 1-2: Remembering/Understanding 14 Copyright © 2023 Pearson Education, Inc.

42) Which of the following is not a potentially useful effect of a fever? A) enhances antiviral effects of interferons B) increases phagocyte efficiency C) enhances cytokine production D) limits growth of certain pathogens E) promotes tissue repair Answer: C Chapter/Section: 11.6 Learning Outcome: 11.25 Bloom's Taxonomy: 1-2: Remembering/Understanding 43) Which term describes an elevated body temperature that fluctuates, but doesn't reach normal in the course of the fluctuations? A) Pel-Ebstein fever B) intermittent fever C) remittent fever D) relapsing fever E) sustained fever Answer: C Chapter/Section: 11.6 Learning Outcome: 11.26 Bloom's Taxonomy: 1-2: Remembering/Understanding 44) Which term describes a fever lasting 3-10 days followed by a nonfever state of similar length? A) Pel-Ebstein fever B) intermittent fever C) remittent fever D) relapsing fever E) sustained fever Answer: A Chapter/Section: 11.6 Learning Outcome: 11.26 Bloom's Taxonomy: 1-2: Remembering/Understanding

45) Which of the following would you expect to see if your patient had been bitten by a tick infected with the Borrelia bacteria species? A) Pel-Ebstein fever B) relapsing fever C) tertian fever D) quartan fever E) intermittent fever Answer: B Chapter/Section: 11.6 Learning Outcome: 11.26 Global LO: G2 Bloom's Taxonomy: 3-4: Applying/Analyzing 46) Which of the following is not an example of normal microbiota interacting with the host organism in a beneficial relationship? A) Streptococcus mitis is a nonpathogenic strain of bacteria that grows in the throat. It competes with the growth of Streptococcus pyogenes, the causative agent of Strep throat. B) Lactobacillus bacteria lower the pH of the vagina, preventing the growth of Candida albicans, a strain of yeast. C) Helicobacter pylori is a bacterial species that neutralizes stomach acid and absorbs vitamins and other nutrients. D) E. coli is found in the small intestine of most mammals, fermenting sugars and producing acid and Vitamin K. E) Various halophilic species of bacteria grow on the skin, competing with Staphylococcus aureus, an organism that causes Staph infections. Answer: C Chapter/Section: 11.1 Learning Outcome: 11.2 ASM LO: 5.4 Bloom's Taxonomy: 3-4: Applying/Analyzing 47) A patient visited her primary care physician due to a high fever, headache, and sore throat. The physician probed the lymph nodes under her chin, finding them to be tender and swollen. Based on your understanding of the lymphatic system, what is the most likely molecular explanation? A) Bacteria growing in the lymph nodes have caused them to swell. B) Leukocytes in the lymph nodes are rapidly proliferating to respond to a bacterial or viral infection. C) Irritation and heat from the fever is causing edema and swelling in the lymph nodes. D) The patient may have tumors in her lymph nodes. E) The patient has produced antibodies that are attacking her lymph nodes leading to an autoimmune response. Answer: B Chapter/Section: 11.3 Learning Outcome: 11.9 | 11.10 Bloom's Taxonomy: 3-4: Applying/Analyzing 16 Copyright © 2023 Pearson Education, Inc.

48) Which of the following terms describes the process of tagging an invader with complement proteins so that it is more readily cleared by phagocytic cells? A) Membrane-attack complex B) Cytolysis C) Complement cascade D) Opsonization E) Cytokine storm Answer: D Chapter/Section: 11.5 Learning Outcome: 11.20 Bloom's Taxonomy: 1-2: Remembering/Understanding 49) Which of the terms related to inflammation is not properly matched with its description? A) Vasodilation: Vessels decrease in diameter, resulting in decreased vessel permeability and higher blood pressure B) Exudate: Fluid released as a result of increased vessel permeability C) Margination: Leukocytes slow down and eventually adhere to the blood vessel wall D) Diapedesis: Leukocytes change shape and squeeze out of the blood vessel into the surrounding tissue E) Angiogenesis: New blood vessels are built during the resolution phase of inflammation Answer: A Chapter/Section: 11.6 Learning Outcome: 11.22 | 11.23 Bloom's Taxonomy: 1-2: Remembering/Understanding 11.2 True/False Questions 1) Skin is one of the most important physical barriers. Answer: TRUE Chapter/Section: 11.2 Learning Outcome: 11.5 Bloom's Taxonomy: 1-2: Remembering/Understanding 2) Antimicrobial peptides are able to stimulate leukocytes and destroy bacteria by disrupting their plasma membranes. Answer: TRUE Chapter/Section: 11.2 Learning Outcome: 11.7 Bloom's Taxonomy: 1-2: Remembering/Understanding 3) The spleen is a primary lymphoid tissue. Answer: FALSE Chapter/Section: 11.3 Learning Outcome: 11.10 Bloom's Taxonomy: 1-2: Remembering/Understanding

4) Eosinophil granules contain diverse enzymes and antimicrobial toxins that are released into surrounding tissues in response to certain allergens and parasites. Answer: TRUE Chapter/Section: 11.4 Learning Outcome: 11.13 Bloom's Taxonomy: 1-2: Remembering/Understanding 5) Dendritic cells prevent the immune system from attacking self and from over-reacting to nonthreatening substances. Answer: TRUE Chapter/Section: 11.4 Learning Outcome: 11.14 Bloom's Taxonomy: 1-2: Remembering/Understanding 6) Molecular second-line defenses include cytokines, iron-binding proteins, and complement proteins. Answer: TRUE Chapter/Section: 11.5 Learning Outcome: 11.16 Bloom's Taxonomy: 1-2: Remembering/Understanding 7) Ferritin is a specific example of a siderophore produced by Borrelia burgdorferi. Answer: FALSE Chapter/Section: 11.5 Learning Outcome: 11.19 Bloom's Taxonomy: 1-2: Remembering/Understanding 8) Complement activation has three different outcomes but which outcome occurs depends on which complement pathway is activated. Answer: FALSE Chapter/Section: 11.5 Learning Outcome: 11.20 Bloom's Taxonomy: 1-2: Remembering/Understanding 9) Kinins block histamine's actions and therefore serve as anti-inflammatory drugs. Answer: FALSE Chapter/Section: 11.6 Learning Outcome: 11.23 Bloom's Taxonomy: 1-2: Remembering/Understanding 10) Pyretic drugs such as aspirin, ibuprofen, and acetaminophen are all commonly used to reduce fever by increasing the production of prostaglandins in the hypothalamus. Answer: FALSE Chapter/Section: 11.6 Learning Outcome: 11.26 Bloom's Taxonomy: 1-2: Remembering/Understanding 18 Copyright © 2023 Pearson Education, Inc.

11) Plasma, interstitial fluid, and lymph are all the same basic substance with different names depending on its current location in the lymphatic system. Answer: TRUE Chapter/Section: 11.3 Learning Outcome: 11.9 Bloom's Taxonomy: 1-2: Remembering/Understanding 11.3 Essay Questions 1) Explain the hygiene hypothesis and describe one example that supports it. Answer: The hygiene hypothesis proposes that decreasing the diversity and levels of microbes in our normal microbiota may negatively affect immune responses. (1) Studies performed on germfree animals that were born and raised in microbe-free environments reveal that these animals have an underdeveloped immune system and struggle to combat pathogens. (2) People with chronic inflammatory disorders like irritable bowel disease (IBD) have clear shifts in the normal gut microbiota. In mouse models for IBD, Clostridia bacteria populations are especially decreased. (3) Pathogens face robust competition from the normal microbiota of the intestinal tract and may fail to find a niche to survive in unless the microbiota population is decreased. Clostridium difficile is a case in point of this. (4) Vaginal pH is kept low by lactic acid-producing bacteria called lactobacilli. A reduction in lactobacilli levels, as can occur following antibiotic therapies, leads to an increase in vaginal pH, which in turn allows the opportunistic pathogen Candida albicans (a yeast) to grow and cause a vaginal yeast infection. Chapter/Section: 11.1 Learning Outcome: 11.20 Global LO: G2 | G8 ASM LO: 7.3a Bloom's Taxonomy: 3-4: Applying/Analyzing 2) Explain the mechanical, chemical and physical barriers of the skin. Answer: Mechanical barriers rinse, flush, or trap pathogens to limit their spread into the body. Tightly compacted dead epithelial cells are constantly being sluffed off and as they do so, they carry away any bacteria that might be on them. Epithelial cells are enriched with specialized proteins (such as keratin) and lipids to serve as a water-resistant layer. The skin's relatively dry, low nutrient, salty, and slightly acidic environment inhibits the growth of many microbes. Certain fatty acids in sweat serve as additional chemical barriers. Certain skin cells also make antimicrobial peptides. Chapter/Section: 11.2 Learning Outcome: 11.5 Global LO: G2 | G8 ASM LO: 7.3a Bloom's Taxonomy: 3-4: Applying/Analyzing

3) Explain the collection and flow of lymph. Answer: Interstitial fluid flows into lymphatic capillaries, where it is then called lymph. Lymph flows toward lymph nodes, is filtered and screened for invading agents, and finally rejoins the venous blood supply. Upon rejoining the blood it is no longer called lymph, but is now plasma. Chapter/Section: 11.3 Learning Outcome: 11.9 Global LO: G2 | G8 ASM LO: 7.3a Bloom's Taxonomy: 3-4: Applying/Analyzing 4) Name two similarities between macrophages and dendritic cells. Answer: Macrophages and dendritic cells use phagocytosis to clear invaders. They also activate the adaptive branch of immunity. Chapter/Section: 11.4 Learning Outcome: 11.14 Global LO: G2 | G8 Bloom's Taxonomy: 3-4: Applying/Analyzing 5) Name three reasons why inflammation can be protective and useful? Answer: 1. Recruit immune defenses to the injured tissue. 2. Limit the spread of infectious agents. 3. Deliver oxygen, nutrients, and chemical factors essential for tissue recovery. Chapter/Section: 11.5 Learning Outcome: 11.21 Global LO: G2 | G8 ASM LO: 7.3a Bloom's Taxonomy: 3-4: Applying/Analyzing

Microbiology: Basic & Clinical Principles, 2e (Norman-McKay) Chapter 12 Adaptive Immunity 12.1 Multiple Choice Questions 1) How does adaptive immunity differ from innate immunity? A) Adaptive immunity generates immunological memory. B) Adaptive immunity's effects are immediate upon exposure to a pathogen. C) Adaptive immunity is specific to each pathogen. D) Adaptive immunity generates immunological memory and is specific to each pathogen. E) Adaptive immunity generates immunological memory and its effects are immediate upon exposure to a pathogen. Answer: D Chapter/Section: 12.1 Learning Outcome: 12.1 Bloom's Taxonomy: 1-2: Remembering/Understanding 2) The branches of adaptive immunity are A) the cellular response and the humoral response. B) the antigen response and the memory response. C) the cellular response and the memory response. D) the humoral response and the memory response. E) the cellular response, the humoral response, and the memory response. Answer: A Chapter/Section: 12.1 Learning Outcome: 12.1 Bloom's Taxonomy: 1-2: Remembering/Understanding 3) All of the following apply to T cells except A) originate in the bone marrow. B) mature in the thymus. C) reside in the lymphoid tissue. D) coordinate the humoral response by making antibodies. E) have the capacity to recognize virtually any type of antigen. Answer: D Chapter/Section: 12.1 Learning Outcome: 12.2 Bloom's Taxonomy: 1-2: Remembering/Understanding

4) All the following apply to B cells except A) coordinate the humoral response by making antibodies. B) mature in the bone marrow. C) play a critical role in both the cellular and humoral responses. D) reside in the lymphoid tissue. E) originate in the bone marrow. Answer: C Chapter/Section: 12.1 Learning Outcome: 12.2 Bloom's Taxonomy: 1-2: Remembering/Understanding 5) Which T cell class is incorrectly matched with its description? A) TC: attack other T cells during self-tolerance screening B) TH1: stimulate TC cells C) TH2: stimulate B cells to make antibodies D) Treg: ensures that immune responses subside once a threat subsides E) TH: identified by the CD4 proteins on the cell surface Answer: A Chapter/Section: 12.1 Learning Outcome: 12.3 Bloom's Taxonomy: 1-2: Remembering/Understanding 6) The human immunodeficiency virus (HIV) selectively infects any cell which carries the CD4 surface glycoprotein. Which immune function will be impaired? A) stimulation of B cells and antibody production B) stimulation of macrophage activity C) stimulation of Tc cells and destruction of virally infected cells D) stimulation of B and Tc cells but not of macrophage E) stimulation of macrophage, B and TC cells Answer: E Chapter/Section: 12.1 Learning Outcome: 12.3 Global LO: G2 Bloom's Taxonomy: 3-4: Applying/Analyzing 7) A substance that may trigger an immune response, if presented in the right context is termed a(n) A) antibody. B) antigen. C) cytokine. D) effector. E) hapten. Answer: B Chapter/Section: 12.1 Learning Outcome: 12.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 2 Copyright © 2023 Pearson Education, Inc.

8) While not a hard-and-fast rule, molecules may be ranked from more immunogenic to less immunogenic. Which shows the correct ranking form more immunogenic to less immunogenic? A) haptens > lipids > polysaccharides > proteins B) polysaccharides > lipids > proteins > haptens C) proteins > polysaccharides > lipids > haptens D) haptens > proteins > lipids > polysaccharides E) Only haptens are less immunogenic; lipids, polysaccharides, and proteins have about equal immunogenicity. Answer: C Chapter/Section: 12.1 Learning Outcome: 12.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 9) Which statement does not apply to haptens? A) Haptens are generally too small to be immunogenic on their own. B) Haptens must bind to a more complex molecule to stimulate an immune response. C) Haptens are also known as incomplete antigens. D) Antibiotics such as penicillin are often haptens. E) Haptens are any nonpathogenic substance, rather than a microorganism, which can stimulate an immune response. Answer: E Chapter/Section: 12.1 Learning Outcome: 12.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 10) What is the role of B cell receptors (BCRs) and T cell receptors (TCRs) in the immune response? A) to recognize specific epitopes of an antigen B) to communicate with lymphocytes and other white blood cells C) to release the cytokines needs for immune cell stimulation D) to release chemicals which destroy pathogens E) to combine with haptens so they can stimulate an immune response Answer: A Chapter/Section: 12.1 Learning Outcome: 12.5 Bloom's Taxonomy: 1-2: Remembering/Understanding

11) How is the immune system able to recognize a limitless number of different antigens and epitopes? A) Each lymphocyte is coated with many different receptors, each of which recognizes a different epitope. B) While each lymphocyte carries receptors that recognize only one type of epitope, the immune system produces a wide variety of lymphocytes each of which carries unique receptors. C) If a lymphocyte encounters an antigen it does not recognize, it immediately switches receptors until it finds one that is a match. D) Each lymphocyte is coated with many different receptors, each of which recognizes a different epitope AND the immune system produces a wide variety of lymphocytes. E) A genetic ‟memory" of the pathogens your parents encountered (and their parents and so on) is passed on to each generation, increasing the number of possible responses over time. Answer: B Chapter/Section: 12.1 Learning Outcome: 12.5 Global LO: G2 Bloom's Taxonomy: 3-4: Applying/Analyzing 12) Which statement provides the best explanation of the need for self-tolerance screening of lymphocytes? A) The process which generates the vast array of diverse antigen receptors is a random process that could produce receptors which will bind to the body's own tissues. B) The process which generates the vast array of diverse antigen receptors is a highly controlled process, so the generation of receptors which can bind to the body's own tissues is a rare occurrence due to a genetic mutation. C) Self-tolerance involves "self" lymphocytes which bind to and form a protective layer over all body tissues. D) It is necessary to have some lymphocytes with receptors that are self-tolerant to respond to intracellular infections by viruses. E) Lymphocytes which would attack the body's own tissues are never generated. Answer: A Chapter/Section: 12.1 Learning Outcome: 12.6 Bloom's Taxonomy: 1-2: Remembering/Understanding 13) A newly generated T cell can recognize MHCs and is not self-reactive. What is its fate? A) It is signaled for destruction via apoptosis. B) It will migrate to the lymphoid tissues to await activation by its antigen. C) It will migrate to the bone marrow for screening for the ability to make antibodies against self-antigens. D) It will undergo genetic shuffling to change its receptor to increase self-tolerance. E) It will become part of an autoimmune attack in the body's tissues at some time in the future. Answer: B Chapter/Section: 12.1 Learning Outcome: 12.6 Global LO: G2 Bloom's Taxonomy: 3-4: Applying/Analyzing 4 Copyright © 2023 Pearson Education, Inc.

14) The cellular branch of adaptive immunity A) is organized by T helper cells and carried out by T cytotoxic cells. B) is organized by T cytotoxic cells and carried out by T helper cells. C) is based on antibody production. D) is based on the activity of both T and B cells. E) does not involve a memory function. Answer: A Chapter/Section: 12.2 Learning Outcome: 12.7 Bloom's Taxonomy: 1-2: Remembering/Understanding 15) What is the role of MHC I in the immune response? A) MHC I is found only on antigen-presenting cells. B) MHC I is found on all body cells except red blood cells. C) MHC I presents a sample of cellular proteins, including those of any intracellular pathogens, to T cells. D) MHC I is found only on antigen-presenting cells AND presents a sample of cellular proteins, including those of any intracellular pathogens, to T cells. E) MHC I is found on all body cells except red blood cells AND presents a sample of cellular proteins, including those of any intracellular pathogens, to T cells. Answer: E Chapter/Section: 12.2 Learning Outcome: 12.8 Bloom's Taxonomy: 1-2: Remembering/Understanding 16) Which statement is not true about MHC II? A) MHC II primarily displays extracellular antigens which have been phagocytized. B) MHC II is present only on antigen-presenting cells. C) MHC II interacts with the CD4 receptor on T helper cells. D) MHC II interacts with both the CD4 and CD8 receptors on T helper and T cytotoxic cells. E) When displaying an antigen, MHC II serves a key role in activation of the appropriate T cells. Answer: D Chapter/Section: 12.2 Learning Outcome: 12.8 Bloom's Taxonomy: 1-2: Remembering/Understanding

17) When "matching" a donated organ or tissue to a recipient, it is necessary that the ________ of the donor and the recipient be as similar as possible. A) antibodies B) APCs C) blood type D) MHCs E) T helper cells Answer: D Chapter/Section: 12.2 Learning Outcome: 12.8 Bloom's Taxonomy: 1-2: Remembering/Understanding 18) The two-signal activation process for T cells includes A) interaction of the T-cell receptor with the MHC-antigen complex on the APC AND the presence of a superantigen. B) the presence of antibodies AND binding between co-stimulatory proteins on the T cell and APC surfaces. C) interaction of the T cell receptor with the MHC-antigen complex on the APC AND binding between co-stimulatory proteins on the T cell and APC surfaces. D) the presence of a superantigen and the presence of appropriate antibodies. E) the presence of a superantigen AND binding between co-stimulatory proteins on the T cell and APC surfaces. Answer: C Chapter/Section: 12.2 Learning Outcome: 12.9 Bloom's Taxonomy: 1-2: Remembering/Understanding 19) Which of the following is not required for T cell activation? A) antibody B) bound antigen C) co-stimulatory proteins D) involvement of CD4 or CD8 E) MHC I or II Answer: A Chapter/Section: 12.2 Learning Outcome: 12.9 Bloom's Taxonomy: 1-2: Remembering/Understanding

20) Which statement is not true about T cell subclass differentiation? A) Each subclass will include both effector and memory cells. B) Particular combinations of cytokines will favor the development of some T cell subclasses over others. C) Regardless of which T helper cell subclass develops during an immune response, the humoral response is not impacted. D) The release of cytokines that cause T cell subclass differentiation is influenced by the nature and amount present of the antigen. E) The specific T helper cell subclass that develops may impact the progression and outcome of an infectious disease. Answer: C Chapter/Section: 12.2 Learning Outcome: 12.9 Bloom's Taxonomy: 1-2: Remembering/Understanding 21) Consider a genetic mutation which causes T helper cells to be unable to respond to stimulation by the cytokines which lead to TH2 differentiation. This mutation would cause a patient to be deficient in which activity? A) action of cytotoxic T cells B) action of macrophages C) production of antibodies D) production of memory cells E) decrease of the immune response once the pathogen is eliminated Answer: C Chapter/Section: 12.2 Learning Outcome: 12.9 Global LO: G2 Bloom's Taxonomy: 3-4: Applying/Analyzing 22) The difference between T cell activation by normal antigens and T cell activation by superantigens is that superantigens A) are not processed and presented by APCs. B) cause nonspecific activation of many T cells at once, including those that would not normally recognize the antigen. C) suppress cytokine release. D) cause nonspecific activation of many T cells at once, including those that would not normally recognize the antigen AND suppress cytokine release. E) are not processed and presented by APCs AND cause nonspecific activation of many T cells at once, including those that would not normally recognize the antigen. Answer: E Chapter/Section: 12.2 Learning Outcome: 12.10 Bloom's Taxonomy: 1-2: Remembering/Understanding

23) Which lymphocyte type is shown attacking the infected cell in the figure?

A) cytotoxic T cell B) helper T cell C) memory T cell D) B cell E) antigen-presenting cell Answer: A Chapter/Section: 12.2 Learning Outcome: 12.11 Bloom's Taxonomy: 1-2: Remembering/Understanding 24) Cytotoxic T cells eliminate pathogens by A) releasing chemicals which cause infected or cancerous cells to undergo apoptosis. B) releasing chemicals which are toxic to cellular pathogens. C) ingesting and digesting cellular pathogens. D) ingesting and digesting infected or cancerous cells. E) coordinating the activities of other immune cells. Answer: A Chapter/Section: 12.2 Learning Outcome: 12.11 Bloom's Taxonomy: 1-2: Remembering/Understanding

25) What is the role of memory cells? A) circulate in the body at elevated levels to maintain an active attack against any possible pathogen B) remain in the lymphoid tissue to rapidly proliferate and differentiate upon subsequent exposure to the same pathogen C) suppress the cellular response once the infection has passed D) provide immune protection specifically for the central nervous system E) prevent an immune response against members of the normal microbiota Answer: B Chapter/Section: 12.2 Learning Outcome: 12.11 Bloom's Taxonomy: 1-2: Remembering/Understanding 26) T-independent antigens A) are usually polysaccharides. B) are usually proteins. C) are able to bind multiple B cell receptors on a given B cell. D) are usually polysaccharides and able to bind multiple B cell receptors on a given B cell. E) may be polysaccharides or proteins, and generally bind a single B cell receptor on a given B cell. Answer: D Chapter/Section: 12.3 Learning Outcome: 12.12 Bloom's Taxonomy: 1-2: Remembering/Understanding 27) Which is not a step in the process of B cell activation by a T-dependent antigen? A) binding of the antigen to the B cell receptor B) binding of the antigen to a T helper cell receptor C) processing and displaying the antigen with MHC II on the B cell D) interaction between co-stimulatory proteins on the B and T cells E) release of cytokines by the T helper cell provide the second activation signal for the B cell Answer: B Chapter/Section: 12.3 Learning Outcome: 12.12 Bloom's Taxonomy: 1-2: Remembering/Understanding

28) Which stage of the humoral response is pictured?

A) B cell activation by a T-independent antigen B) B cell activation by a T-dependent antigen C) B cell proliferation D) B cell differentiation E) isotype switching Answer: A Chapter/Section: 12.3 Learning Outcome: 12.12 Bloom's Taxonomy: 1-2: Remembering/Understanding

29) Which number on the diagram is labeling the portion of the antibody that makes it specific for the antigen it binds to?

A) 1 B) 2 C) 3 D) 4 E) 5 Answer: D Chapter/Section: 12.3 Learning Outcome: 12.13 Bloom's Taxonomy: 1-2: Remembering/Understanding

30) Each antibody molecule consists of A) a "light" protein chain. B) a ‟heavy" protein chain. C) various combinations of light and heavy protein chains. D) one light and one heavy protein chain. E) two light and two heavy protein chains. Answer: E Chapter/Section: 12.3 Learning Outcome: 12.13 Bloom's Taxonomy: 1-2: Remembering/Understanding 31) Antibodies do all the following except A) activate the complement cascade. B) activate killing by T cytotoxic cells. C) neutralize antigens to prevent binding to host cells. D) increase phagocytosis by agglutination of antigens. E) increase phagocytosis by opsonization. Answer: B Chapter/Section: 12.3 Learning Outcome: 12.13 Bloom's Taxonomy: 1-2: Remembering/Understanding 32) Isotype switching occurs when A) a B cell switches which epitope it recognizes. B) activated B cells differentiate into either plasma or memory cells. C) a B cell changes which antibody class it is producing. D) an antibody changes epitope it can recognize. E) an antibody changes which class it is. Answer: C Chapter/Section: 12.3 Learning Outcome: 12.14 Bloom's Taxonomy: 1-2: Remembering/Understanding 33) Advantages of isotype switching include A) ability to respond to multiple epitopes of the same antigen with the same B cell. B) expanded antibody response as different isotypes predominate in different areas of the body. C) rapid response when a pathogen engages in antigen variation. D) ability to respond to multiple epitopes of the same antigen with the same B cell and rapid response when a pathogen engages in antigen variation. E) ability to respond to multiple epitopes of the same antigen with the same B cell, expanded antibody response as different isotypes predominate in different areas of the body, and rapid response when a pathogen engages in antigen variation. Answer: B Chapter/Section: 12.3 Learning Outcome: 12.14 ASM LO: 2.2 Bloom's Taxonomy: 1-2: Remembering/Understanding 12 Copyright © 2023 Pearson Education, Inc.

34) The most abundant antibody class in the body, found in all body fluids, is A) IgA. B) IgD. C) IgE. D) IgG. E) IgM. Answer: D Chapter/Section: 12.3 Learning Outcome: 12.15 Bloom's Taxonomy: 1-2: Remembering/Understanding 35) The antibody class which is involved in fighting parasites is A) IgA. B) IgD. C) IgE. D) IgG. E) IgM. Answer: C Chapter/Section: 12.3 Learning Outcome: 12.15 Bloom's Taxonomy: 1-2: Remembering/Understanding 36) The antibody found in breastmilk and coating mucous membranes is A) IgA. B) IgD. C) IgE. D) IgG. E) IgM. Answer: A Chapter/Section: 12.3 Learning Outcome: 12.15 Bloom's Taxonomy: 1-2: Remembering/Understanding 37) Generally, the first antibody class made upon a primary antigen exposure is A) IgA. B) IgD. C) IgE. D) IgG. E) IgM. Answer: E Chapter/Section: 12.3 Learning Outcome: 12.15 Bloom's Taxonomy: 1-2: Remembering/Understanding

38) IgE antibody, which is associated with allergic responses, A) is usually found circulating in the bloodstream. B) is passed from mother to child through breastfeeding and may prevent the development of allergies in the child. C) encourages mast cells and basophils to release chemicals such as histamine and leukotrienes. D) is resistant to destruction by stomach acid. E) can be found bound to B cells. Answer: C Chapter/Section: 12.3 Learning Outcome: 12.15 Bloom's Taxonomy: 1-2: Remembering/Understanding 39) A patient antibody titer which shows an increasing level of IgM but very little IgG would likely indicate that A) the patient is in the early stages of developing an immune response. B) the patient was vaccinated against this pathogen rather than having the infection. C) the patient has nearly recovered from the infection. D) the patient is having an allergic reaction. E) the patient is currently a nursing mother. Answer: A Chapter/Section: 12.4 Learning Outcome: 12.16 Global LO: G2 Bloom's Taxonomy: 3-4: Applying/Analyzing 40) In contrast to a primary immune response, immunological memory A) provides a rapid reactivation of both cellular and humoral responses. B) generates higher antibody titers. C) generates antibodies with enhanced affinity for its antigen. D) provides a rapid reactivation of humoral responses only by generating higher antibody titers and antibodies with increased affinity for its antigen. E) provides a rapid reactivation of both cellular and humoral responses including generating higher antibody titers and antibodies with increased affinity for its antigen. Answer: E Chapter/Section: 12.4 Learning Outcome: 12.16 Bloom's Taxonomy: 1-2: Remembering/Understanding

41) The amount of antibody present in the blood is termed the antibody ________. A) affinity B) effector C) isotype D) specificity E) titer Answer: E Chapter/Section: 12.4 Learning Outcome: 12.17 Bloom's Taxonomy: 1-2: Remembering/Understanding 42) The graph shows

A) primary antigen exposure. B) secondary antigen exposure. C) immunological memory. D) natural passive immunity. E) likely immune response upon exposure to a pathogen for which the patient has been vaccinated. Answer: A Chapter/Section: 12.4 Learning Outcome: 12.17 Bloom's Taxonomy: 1-2: Remembering/Understanding

43) Which means of acquiring immunity is likely to produce the longest lasting protection? A) active B) artificial C) natural D) passive E) active, artificial, natural, and passive all provide equally long-lasting protection. Answer: A Chapter/Section: 12.4 Learning Outcome: 12.18 Bloom's Taxonomy: 1-2: Remembering/Understanding 44) Postexposure prophylaxis, a form of artificial passive immunity, is often given when a person is bitten by an animal that is suspected of having rabies, or if the rabies status of the animal cannot be confirmed. What specifically, is being given to the patient in this type of treatment? A) antigens from the rabies virus B) antibodies harvested from a host who has developed an immune response to the rabies virus C) memory cells from a host who has developed an immune response to the rabies virus D) effector B and T cells from a host who has developed an immune response to the rabies virus E) antigen-presenting cells which increase the rate at which the rabies antigens can be presented to T cells for activation Answer: B Chapter/Section: 12.4 Learning Outcome: 12.18 Global LO: G2 Bloom's Taxonomy: 3-4: Applying/Analyzing 45) Pregnant women are usually advised to be vaccinated against influenza to protect themselves and the baby after birth. The mother will acquire ________ immunity from the vaccine while the baby will acquire ________ immunity. A) artificial active; artificial active B) artificial active; artificial passive C) artificial active; natural passive D) artificial passive; artificial passive E) natural active; natural passive Answer: C Chapter/Section: 12.4 Learning Outcome: 12.18 Bloom's Taxonomy: 1-2: Remembering/Understanding

46) A newly generated B cell in the bone marrow is being screened for self-tolerance. It has the potential to make antibodies that will cross-react with self-antigens. What is its fate? A) It is signaled for destruction via apoptosis. B) It will migrate to the lymphoid tissues to await activation by its antigen. C) It will migrate to the thymus for further maturation and screening. D) It will undergo genetic shuffling to change its receptor to increase self-tolerance. E) It will become part of an autoimmune attack in the body's tissues at some time in the future. Answer: A Chapter/Section: 12.1 Learning Outcome: 12.6 Global LO: G2 Bloom's Taxonomy: 3-4: Applying/Analyzing 47) A researcher has identified a genetic mutation that causes T helper (TH) cells to be unable to respond to the cytokines that lead to differentiation into regulatory T (Treg) cells. This would cause a patient to be deficient in which activity? A) action of cytotoxic T cells B) action of macrophages C) production of antibodies D) tapering off of the immune response once the pathogen is eliminated E) production of memory cells Answer: D Chapter/Section: 12.2 Learning Outcome: 12.9 Global LO: G2 Bloom's Taxonomy: 3-4: Applying/Analyzing 48) Consider the structural features of an antibody molecule. How many antigen binging sites does the pentameric form of IgM have? A) 1 B) 2 C) 4 D) 5 E) 10 Answer: E Chapter/Section: 12.3 Learning Outcome: 12.13 | 12.15 Bloom's Taxonomy: 3-4: Applying/Analyzing

49) Which antibody class would be expected to be elevated in a patient experiencing a severe allergic reaction? A) IgA. B) IgD. C) IgE. D) IgG. E) IgM. Answer: C Chapter/Section: 12.3 Learning Outcome: 12.15 Bloom's Taxonomy: 1-2: Remembering/Understanding 50) Convalescent plasma was obtained from the serum of individuals who recovered from COVID-19. This plasma was infused into the blood of those with a serious case of the illness. What type of immunity is being acquired by those receiving the infusion? A) naturally acquired active immunity B) naturally acquired passive immunity C) artificially acquired active immunity D) artificially acquired passive immunity E) both natural and artificially acquired passive immunity Answer: D Chapter/Section: 12.4 Learning Outcome: 12.18 Global LO: G2 Bloom's Taxonomy: 3-4: Applying/Analyzing 12.2 True/False Questions 1) Both the cellular and humoral branches of adaptive immunity have the goal of eliminating an identified antigen, but only the humoral branch develops a memory of the antigen so that future responses are faster. Answer: FALSE Chapter/Section: 12.1 Learning Outcome: 12.1 Bloom's Taxonomy: 1-2: Remembering/Understanding 2) An antigen may consist of multiple epitopes, each of which is recognized by different lymphocytes. Answer: TRUE Chapter/Section: 12.1 Learning Outcome: 12.4 ASM LO: 2.2 Bloom's Taxonomy: 1-2: Remembering/Understanding

3) Allorecognition occurs when B and T cells are screened for self-tolerance. Answer: FALSE Chapter/Section: 12.2 Learning Outcome: 12.8 Bloom's Taxonomy: 1-2: Remembering/Understanding 4) Graft-versus-host disease occurs when transplanted bone marrow gives rise to B and T cells that attack the recipient's tissues. Answer: TRUE Chapter/Section: 12.2 Learning Outcome: 12.8 Bloom's Taxonomy: 1-2: Remembering/Understanding 5) T cell subclass differentiation allows T cell clones to recognize different epitopes of the same antigen. Answer: FALSE Chapter/Section: 12.2 Learning Outcome: 12.9 Bloom's Taxonomy: 1-2: Remembering/Understanding 6) Both the light and the heavy chains of an antibody are involved with epitope recognition and binding. Answer: TRUE Chapter/Section: 12.3 Learning Outcome: 12.13 Bloom's Taxonomy: 1-2: Remembering/Understanding 7) The humoral immune response can enhance phagocytosis by either direct interaction of antibodies with their antigen, or though antibody activation of the complement cascade. Answer: TRUE Chapter/Section: 12.3 Learning Outcome: 12.13 Bloom's Taxonomy: 1-2: Remembering/Understanding 8) Isotype switching of antibodies is beneficial because some pathogens are able to alter their antigens. Answer: FALSE Chapter/Section: 12.3 Learning Outcome: 12.14 ASM LO: 2.2 Bloom's Taxonomy: 1-2: Remembering/Understanding

9) A patient with a high antibody titer to a pathogen for which there is no vaccination indicates that this person is currently infected with the pathogen or was exposed in the past. Answer: TRUE Chapter/Section: 12.4 Learning Outcome: 12.17 Bloom's Taxonomy: 1-2: Remembering/Understanding 10) Artificially acquired immunity is characterized by short-lived immune protection because the patient is not making their own memory cells or antibodies. Answer: FALSE Chapter/Section: 12.4 Learning Outcome: 12.18 Bloom's Taxonomy: 1-2: Remembering/Understanding 11) T-independent antigens will stimulate production of memory B cells with more robust longterm protection than will T-dependent antigens. Answer: FALSE Chapter/Section: 12.3 Learning Outcome: 12.12 Bloom's Taxonomy: 1-2: Remembering/Understanding 12.3 Essay Questions 1) List and describe the four stages that occur during both the cellular and humoral response. Answer: Stage 1 is antigen presentation. Antigen-presenting cells process and present antigens to T cells. B cells can directly interact with antigens without presentation by another cell. Stage 2 is lymphocyte activation. Successful antigen presentation causes the release of signaling molecules called cytokines which act on both T and B lymphocytes. Stage 3 involves lymphocyte proliferation and differentiation. Activated lymphocytes undergo many rounds of cell division to generate a collection of cloned cells. These cells may differentiate into effector cells or memory cells. Stage 4 is antigen elimination and memory. Effector cells will carry out activities to eliminate the antigen, while memory cells endure in lymphatic tissue long after the antigen has been eliminated. Memory cells provide a rapid recognition of the antigen if it is encountered in the future. Chapter/Section: 12.1 Learning Outcome: 12.1 Bloom's Taxonomy: 1-2: Remembering/Understanding

2) Adaptive immune responses are specific to a particular antigen. Provide and explain 5 examples which illustrate this concept. Answer: 1) Lymphocytes will recognize antigen using surface proteins called T cell receptors (TCRs) or B cell receptors (BCRs). Each lymphocyte is covered with many copies of these receptors, but each receptor on a given lymphocyte only recognizes one specific epitope of one specific antigen. 2) The body makes a diverse variety of TCRs and BCRs through a gene shuffling process as lymphocytes mature, so the body's capacity to respond to different antigens is nearly limitless. It is possible that during lymphocyte maturation, a cell with a receptor that responds to a molecule on normal body cells will be generated. To avoid an immune attack on normal cells, maturing lymphocytes are screened for self-tolerance. Those that attack normal cells are eliminated in this process. 3) Body cells are identified as ‟self" through a group of surface proteins called major histocompatibility complex (MHC) proteins. All body cells (except red blood cells) wear MHC 1 proteins, while immune cells which present antigen also wear MHC 2 proteins. When a cell is infected, altered such as by cancer, or has ingested an antigen for presentation, the foreign antigens will be displayed by the MHC proteins for recognition by T and/or B lymphocytes with receptors that recognize that antigen. To insure successful organ transplants, donor and recipient tissue must be matched so that their MHC proteins are as similar as possible. 4) During T cell activation, presentation of antigen by an antigen-presenting cell preferentially activates T cells whose receptors bind to that antigen. After activation, proliferation, and differentiation, all T cell clones will respond to the antigen that stimulated the original response. T cytotoxic cells will locate and eliminate cells displaying the specific antigen in question. 5) During a humoral response, a B cell with the correct receptor will bind to an antigen. After proliferation and differentiation of the B cell clones, the plasma B cells will secrete large quantities of antibody molecules that are able to specifically bind to the antigen which stimulated the B cell line. Chapter/Section: 12.1 | 12.2 | 12.3 Learning Outcome: 12.5 | 12.6 | 12.8 | 12.11 | 12.13 Global LO: G2 Bloom's Taxonomy: 3-4: Applying/Analyzing 3) Describe how antibodies are used to eliminate antigens. Answer: Antibodies bind to the antigen that triggered the activation of the B cell line that produced them. Antibodies activate the complement cascade, which leads to cytolysis, inflammation, and opsonization. Antibodies can neutralize antigens by binding to them. By binding to the antigen, the antibodies prevent toxins, viruses, or bacteria from binding to their targeted host cell receptors. Finally, antibodies can directly increase the process of phagocytosis. Antibody-binding causes precipitation of small, soluble antigen which make them more detectable to phagocytes. When binding to larger antigens, antibodies cause agglutination of groups of cells which can then be more efficiently ingested by phagocytes. Antibodies also serve as tags, or opsonins, to mark antigens for phagocytosis. Chapter/Section: 12.3 Learning Outcome: 12.13 Bloom's Taxonomy: 1-2: Remembering/Understanding

4) Describe the basic structure of an antibody and detail the function of each of the 5 antibody classes. Answer: Each antibody molecule is made up of four protein chains: two identical "light" chains and two identical "heavy" chains. The four chains are held together by covalent disulfide bonds. The antibody shape can be approximately thought of as a "Y." At the tip of each branch at the top of the "Y" is the site where the antibody binds to its antigen. The five antibody classes in order of abundance are IgG, IgM, IgA, IgE, and IgD. IgG is found in blood and all body fluids. It has strong neutralization, complement activation, and opsonization activity, and is the only antibody to cross the placenta to protect the fetus. IgA may occur as a monomer or dimer, and is abundant in mucous secretions and coating the mucous membranes. IgA has strong neutralizing capability, and is secreted in breastmilk; it is also resistant to stomach acid. IgM is the first antibody made during a primary immune response. It occurs as a monomer or pentamer. It has strong complement activation and agglutination/precipitation activity. IgE is relatively rare. Its key role is fighting parasite infections by encouraging mast cells and basophils to release histamine and other inflammatory mediators. This also explains its role in allergic responses. IgD is the least abundant antibody. It is primarily found bound to B cells and it specific function is poorly understood. Chapter/Section: 12.3 Learning Outcome: 12.13 | 12.15 Bloom's Taxonomy: 1-2: Remembering/Understanding 5) Describe the two ways humoral immunity may be acquired, and describe the active and passive forms of each. Answer: Both active and passive forms of humoral immunity may be acquired through either natural or artificial means. Active immunity involves the patient generating their own immune response, specifically the production of memory cells and high antibody titers. Passive immunity involves the transfer of antibodies made by another host to an individual. Because the individual did not generate the response themselves, the immunity only lasts as long as the antibodies remain in circulation, usually only a few days to weeks. Natural active immunity occurs when a patient contracts an infection and generates an effective immune response to that infection. Artificial active immunity is generated through vaccination. Natural passive immunity is the transfer of antibodies from a mother to her unborn child as the mother's IgG antibodies cross the placenta, or to the baby after birth through breastfeeding. This protects the baby until its own immune systems is fully functional. Artificial passive immunity involves the medical transfer of antibodies generated by the exposure of another host (person or animal) to an antigen. Examples of this include antivenom treatment for snakebites, antitoxin treatment, or an effort to treat the victim of an otherwise incurable disease using antibodies from a survivor. Chapter/Section: 12.4 Learning Outcome: 12.18 Bloom's Taxonomy: 1-2: Remembering/Understanding

Microbiology: Basic & Clinical Principles, 2e (Norman-McKay) Chapter 13 Immune System Disorders 13.1 Multiple Choice Questions 1) Which of the following can cause primary immunodeficiencies? A) aging B) congenital genetic disorders C) infectious agents D) medical interventions E) diabetes and other metabolic disorders Answer: B Chapter/Section: 13.1 Learning Outcome: 13.1 Bloom's Taxonomy: 1-2: Remembering/Understanding 2) Which of the following is not a hallmark sign of infections in patients with primary immunodeficiencies? A) severe B) persistent C) recurring D) caused by uncommon agents E) acute Answer: E Chapter/Section: 13.1 Learning Outcome: 13.1 Bloom's Taxonomy: 1-2: Remembering/Understanding 3) What two types of patients help demonstrate that cancer can be considered a failure of the immune system? A) rheumatoid arthritis patients and multiple sclerosis patients B) transplant patients and HIV/AIDS patients C) hepatitis C infected patients and human papilloma viruses infected patients D) nervous system complication patients and pulmonary system complication patients E) migraine patients and digestive issue patients Answer: B Chapter/Section: 13.1 Learning Outcome: 13.2 Bloom's Taxonomy: 1-2: Remembering/Understanding

4) Which of the following is not a proposed explanation for the development of autoimmunity? A) Genetics B) If a pathogen has antigens that resemble host factors, it could trigger the production of antibodies that cross-react with host tissues. C) Overuse of antibiotics and other medications can cause activation of B cells and production of auto-antibodies. D) Certain pathogens may release superantigens that inappropriately activate certain T cells against self-factors. E) Cytopathic effects generated by a pathogen could encourage host antigen-presenting cells to process and present self-antigens to T cells. Answer: C Chapter/Section: 13.1 Learning Outcome: 13.3 Bloom's Taxonomy: 1-2: Remembering/Understanding 5) Autoimmune disorders are A) acute infections that target the immune system. B) short-term mistakes made by the immune system that are quickly recognized and self-limited. C) genetic conditions present from birth that continually degrade over time. D) chronic conditions that develop from the immune system attacking healthy self-tissues that should normally be left alone. E) caused by the immune system not being stimulated enough in adolescence and as a result is over-reactive and can cross-react with host tissues. Answer: D Chapter/Section: 13.1 Learning Outcome: 13.3 Bloom's Taxonomy: 1-2: Remembering/Understanding 6) Autoimmune disorders are diagnosed using A) a collection of tests and careful assessment of signs and symptoms. B) family history. C) metabolic factors. D) blood tests. E) detection of autoantibodies. Answer: A Chapter/Section: 13.1 Learning Outcome: 13.4 Bloom's Taxonomy: 1-2: Remembering/Understanding

7) The erythrocyte sedimentation rate is used to monitor A) pregnancy. B) inflammation. C) infectious status. D) anemia. E) declining health in aging patients. Answer: B Chapter/Section: 13.1 Learning Outcome: 13.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 8) ________ reactions are inappropriate responses against a threat that lead to immune-based pathologies such as allergy and autoimmunity. A) Aversion B) Autopathic C) Hypersensitivity D) Sensitivity E) Endopathic Answer: C Chapter/Section: 13.2 Learning Outcome: 13.5 Bloom's Taxonomy: 1-2: Remembering/Understanding 9) Immune complex reactions belong to which class of hypersensitivity reactions? A) type I B) type II C) type III D) type IV E) type V Answer: C Chapter/Section: 13.2 Learning Outcome: 13.7 Bloom's Taxonomy: 1-2: Remembering/Understanding 10) Which of the following classes of hypersensitivity reactions is/are not associated with autoimmunity? A) allergies B) cytotoxic C) immune complex D) delayed hypersensitivity E) cytotoxic AND immune complex Answer: A Chapter/Section: 13.2 Learning Outcome: 13.8 Bloom's Taxonomy: 1-2: Remembering/Understanding

11) A patient that experiences a tuberculin skin test reaction is experiencing which class of hypersensitivity reactions? A) type I B) type II C) type III D) type IV E) type V Answer: D Chapter/Section: 13.2 Learning Outcome: 13.8 Bloom's Taxonomy: 1-2: Remembering/Understanding 12) Which of the following is not a type I hypersensitivity reaction? A) atopic eczema B) allergy-based asthma C) Goodpasture syndrome D) food allergies E) seasonal allergies Answer: C Chapter/Section: 13.3 Learning Outcome: 13.9 Bloom's Taxonomy: 1-2: Remembering/Understanding 13) Which of the following factors impacts the signs, symptoms, and severity of an allergic response? A) family history B) route of exposure C) IgE production levels D) route of exposure and IgE production levels E) family history, route of exposure, and IgE production levels Answer: E Chapter/Section: 13.3 Learning Outcome: 13.10 Bloom's Taxonomy: 1-2: Remembering/Understanding

14) Which of the following describes how the hygiene hypothesis is related to type I hypersensitivity reactions? A) Between 1997 and 2011, the incidence of food allergies in the United States increased by 50 percent. B) Up to 30 percent of people in undeveloped countries suffer from allergic rhinitis. C) Food allergies have increased 3-fold in chronically poor families as compared to wealthy families in the United States. D) Wealthy individuals are 10 times more likely to experience anaphylactic shock as compared to someone raised in an orphanage during adolescences. E) Children living on a farm are 25 percent more likely to experience seasonal allergies than children living in a large city. Answer: A Chapter/Section: 13.3 Learning Outcome: 13.6 Bloom's Taxonomy: 3-4: Applying/Analyzing 15) Localized anaphylaxis tends to feature isolated symptoms such as A) fainting, chest pain, or vomiting. B) confusion, hives, or hoarseness. C) decreased blood pressure, shortness of breath, or abdominal pain. D) anxiety, nausea, or swelling. E) watery eyes, a runny nose, or a confined rash. Answer: E Chapter/Section: 13.3 Learning Outcome: 13.11 Bloom's Taxonomy: 1-2: Remembering/Understanding 16) What is the difference between an intolerance and an allergy? A) Intolerances have mild symptoms, while allergic reactions can be life threatening. B) Intolerances produce symptoms that last several days, while patients having an allergic reaction recover in less than 24 hours. C) Intolerances tend to have a delayed onset of symptoms, while allergic reactions occur rapidly. D) Intolerances involve the immune system, while allergic reactions do not. E) Intolerances can change over a patient's lifetime, but allergic reactions do not change throughout a patient's life. Answer: C Chapter/Section: 13.3 Learning Outcome: 13.12 Bloom's Taxonomy: 1-2: Remembering/Understanding

17) Healthcare providers determine the specific allergen that is generating symptoms by using a blood test to look at ________ levels. A) IgG B) IgE C) IgD D) IgA E) IgM Answer: B Chapter/Section: 13.3 Learning Outcome: 13.12 Bloom's Taxonomy: 1-2: Remembering/Understanding 18) Which of the following allergies and treatments is mismatched? A) Atopic asthma: inhaled drugs that open up the bronchi B) Atopic dermatitis: usually treated topically with ointments that may contain steroid antiinflammatory drugs C) Anaphylaxis: epinephrine may be administered and emergency medical care must be sought D) Insect bite/sting allergy: continued preemptive treatment with an injected antibody preparation that ties up the patient's IgE antibodies E) Food allergy: managed on a contact basis using antihistamines like Benadryl Answer: D Chapter/Section: 13.3 Learning Outcome: 13.13 Bloom's Taxonomy: 1-2: Remembering/Understanding 19) In desensitization immunotherapy, an antigen is used to stimulate ________, which can then stimulate ________ and cause the production of ________. A) T regulatory cell; T helper 1 cell; and IgG antibodies B) T regulatory cell; T helper 2 cell, and IgE antibodies C) mast cell, T helper 2 cell, and IgE antibodies D) T regulatory cell, mast cell, and IgD antibodies E) T helper 1 cell, T helper 2 cell, and IgG antibodies Answer: A Chapter/Section: 13.3 Learning Outcome: 13.14 Bloom's Taxonomy: 1-2: Remembering/Understanding

20) Desensitization immunotherapies are least effective to treat allergies from which of the following? A) bee stings B) fire ant stings C) dust mites D) milk E) pollen Answer: D Chapter/Section: 13.3 Learning Outcome: 13.14 Bloom's Taxonomy: 1-2: Remembering/Understanding 21) Graves' disease is an example of which of the following type II hypersensitivity cytotoxic reactions? A) IgM binds to nonsoluble antigens on the surface of a cell causing complement cascade activation to lyse cells. B) IgG binds to nonsoluble antigens on the surface of a cell causing complement proteins to opsonize the target, thereby tagging it for phagocytosis. C) Antibodies directly recruit leukocytes to lyse tagged extracellular cells. D) Antibodies interact with a cell-surface receptor on self-cells causing the inactivation of the receptor. E) Antibodies interact with a cell-surface receptor on self-cells causing the overactivation of the receptor. Answer: E Chapter/Section: 13.4 Learning Outcome: 13.15 Bloom's Taxonomy: 1-2: Remembering/Understanding 22) Which of the following examples of type II hypersensitivities are matched incorrectly with their mediated mechanism? A) Hemolytic disease of the newborn: Cytolytic B) Goodpasture syndrome: Noncytolytic C) Rheumatic heart disease: Cytolytic D) Myasthenia gravis: Noncytolytic E) Graves' disease: Noncytolytic Answer: B Chapter/Section: 13.4 Learning Outcome: 13.16 Bloom's Taxonomy: 1-2: Remembering/Understanding

23) A patient with the antigens A and RH+ would not be able to receive blood from which of the following? A) A+ B) AC) B+ D) O+ E) OAnswer: C Chapter/Section: 13.4 Learning Outcome: 13.17 Bloom's Taxonomy: 1-2: Remembering/Understanding 24) In which of the following cases is RhoGAM not given to the RH− mother in order to prevent hemolytic disease of the newborn? A) after amniocentesis or chorionic villus sampling B) following an episode of vaginal bleeding during pregnancy C) around the 8th week of pregnancy D) within 72 hours of delivery E) subsequent to miscarriage or abortion Answer: C Chapter/Section: 13.4 Learning Outcome: 13.18 Bloom's Taxonomy: 1-2: Remembering/Understanding 25) In what situation is hemolytic disease of the newborn a life and death situation? A) when an RH− mom is pregnant for the first time with an RH+ fetus B) when an RH− mom is pregnant for the second time with an RH+ fetus C) when an RH+ woman and an RH- male have intercourse D) when an RH− woman and an RH+ male have intercourse E) when an RH+ mom is pregnant for the second time with an RH− fetus Answer: B Chapter/Section: 13.4 Learning Outcome: 13.18 Bloom's Taxonomy: 1-2: Remembering/Understanding

26) Which of the following statements about type III hypersensitivities is false? A) They develop when IgD or IgE antibodies bind to insoluble targets. B) Relatively large antigen-antibody aggregates form. C) Insoluble complexes are deposited in tissues. D) Massive inflammation is triggered by the antibody aggregates activating complement cascades. E) Antibodies involved in type III reactions can be made as part of an autoimmune response or formed as a normal response to foreign antigens. Answer: A Chapter/Section: 13.5 Learning Outcome: 13.19 Bloom's Taxonomy: 1-2: Remembering/Understanding 27) Which of the following diseases makes antibodies against centromeres and topoisomerases? A) systemic lupus erythematosus B) rheumatoid arthritis C) scleroderma D) Sjögren's syndrome E) poststreptococcal glomerulonephritis Answer: C Chapter/Section: 13.5 Learning Outcome: 13.20 Bloom's Taxonomy: 1-2: Remembering/Understanding 28) Although antivenom can save lives, it can also cause what type of reaction in certain patients? A) type I hypersensitivity B) type II hypersensitivity C) autoimmune type III hypersensitivity D) nonautoimmune type III hypersensitivity E) type IV hypersensitivity Answer: D Chapter/Section: 13.5 Learning Outcome: 13.21 Bloom's Taxonomy: 1-2: Remembering/Understanding 29) Which of the following would not cause serum sickness? A) anti-inflammatory drugs B) antivenom C) antitoxin D) penicillin E) sulfa drugs Answer: A, D, E Chapter/Section: 13.5 Learning Outcome: 13.21 Bloom's Taxonomy: 1-2: Remembering/Understanding 9 Copyright © 2023 Pearson Education, Inc.

30) Which of the following are used to treat serum sickness? A) anti-inflammatory drugs B) antihistamines C) sulfa drugs D) anti-inflammatory drugs and antihistamines E) anti-inflammatory drugs, antihistamines, and sulfa drugs Answer: D Chapter/Section: 13.5 Learning Outcome: 13.21 Bloom's Taxonomy: 1-2: Remembering/Understanding 31) Which of the following hypersensitivities are T cell-mediated responses against self-antigens or otherwise harmless antigens? A) type I hypersensitivities and type II hypersensitivities B) type I hypersensitivities C) type II hypersensitivities D) type III hypersensitivities E) type IV hypersensitivities Answer: E Chapter/Section: 13.6 Learning Outcome: 13.22 Bloom's Taxonomy: 1-2: Remembering/Understanding 32) Why are type IV hypersensitivities called delayed hypersensitivity reactions? A) Type IV reactions manifest slowly over 12-72 hours after the stimulating antigen is encountered. B) Type IV reactions affect nerve cells and cause nerve impulses to slow resulting in visibly slower movements from the patient. C) Although type IV reactions can cause skin lesions, watery eyes, and a runny nose, treatment for those symptoms needs to be delayed due to the rapid drop in blood pressure which soon follows and needs to be dealt with first. D) Type IV reactions only occur in underdeveloped countries and medical attention often needs to be delayed until the patient can be brought to a hospital. E) Drugs to counteract type IV reactions are large and slow to be absorbed by the affected cells causing the patient to tolerate a lengthy symptomatic phase before recovery is complete. Answer: A Chapter/Section: 13.6 Learning Outcome: 13.22 Bloom's Taxonomy: 1-2: Remembering/Understanding

33) Which of the following is not an autoimmune type IV hypersensitivity? A) Guillain-Barré syndrome B) Hashimoto thyroiditis C) multiple sclerosis D) graft-versus-host disease E) celiac disease Answer: D Chapter/Section: 13.6 Learning Outcome: 13.23 Bloom's Taxonomy: 1-2: Remembering/Understanding 34) Allografts are A) transplants from self, like a self-skin graft from one part of the body to another location. B) transplanted tissue from an identical twin. C) similar to the host, but not genetically identical. D) transplants that are made in an immune-privileged site in the body. E) interspecies transplants. Answer: C Chapter/Section: 13.6 Learning Outcome: 13.24 Bloom's Taxonomy: 1-2: Remembering/Understanding 35) What is graft-versus-host disease? A) Immune system cells in transplanted bone marrow attack the body of its new host. B) Immune system cells of the host attack the newly transplanted bone marrow and reject it. C) It occurs when tissue from a xenograft is rejected. D) It occurs when tissue from an allograft is rejected. E) It occurs when tissue from an isograft is rejected. Answer: A Chapter/Section: 13.6 Learning Outcome: 13.25 Bloom's Taxonomy: 1-2: Remembering/Understanding 36) Which of the following best describes what happens during a postsensitization exposure to an allergen during a Type I allergic reaction? A) B cells are activated, becoming plasma cells that release IgG into the serum. B) The allergen binds to IgE on the surface of mast cells and/or basophil surfaces, triggering degranulation. C) IgE binds to the surface of mast cells and/or basophils. D) IgE specific to the allergen is produced by activated B cells. E) Basophils and mast cells are activated, leading to proliferation and differentiation. Answer: B Chapter/Section: 13.3 Learning Outcome: 13.10 Bloom's Taxonomy: 1-2: Remembering/Understanding

37) Which of the following is not a symptom of systemic anaphylaxis? A) hives B) shortness of breath C) rapid heart rate D) increased blood pressure E) chest pain Answer: D Chapter/Section: 13.3 Learning Outcome: 13.11 Bloom's Taxonomy: 1-2: Remembering/Understanding 38) A patient with AB− blood was given a blood transfusion after an accident. Within hours the patient started to show signs of a hemolytic transfusion reaction, including fever, chills, and tachycardia. Based on your understanding of blood types, which of the following blood types did the patient most likely receive to cause this reaction? A) AB+ B) AB− C) B− D) O− E) A− Answer: A Chapter/Section: 13.4 Learning Outcome: 13.17 Global LO: G2 Bloom's Taxonomy: 3-4: Applying/Analyzing 13.2 True/False Questions 1) Currently, there are no cures or preventions for autoimmune disorders. Answer: TRUE Chapter/Section: 13.1 Learning Outcome: 13.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 2) An allergen is any antigen that triggers IgE production and leads to a scenario where the immune system fights off a perceived threat that would otherwise be harmless. Answer: TRUE Chapter/Section: 13.3 Learning Outcome: 13.10 Bloom's Taxonomy: 1-2: Remembering/Understanding 3) An allergy is a scenario where the immune system fights off a perceived threat that would otherwise eventually cause the breakdown of skin or other localized tissue. Answer: FALSE Chapter/Section: 13.3 Learning Outcome: 13.10 Bloom's Taxonomy: 1-2: Remembering/Understanding 12 Copyright © 2023 Pearson Education, Inc.

4) Any allergen can cause an anaphylactic response, but usually this dangerous scenario is caused by injected or ingested allergens such as foods, drugs, and insect venoms. Answer: TRUE Chapter/Section: 13.3 Learning Outcome: 13.11 Bloom's Taxonomy: 1-2: Remembering/Understanding 5) If the patient has an allergy to the tested allergen, then the skin develops a lesion consisting of a flattened reddened area called the wheal and a raised, inflamed area called the flare. Answer: FALSE Chapter/Section: 13.3 Learning Outcome: 13.12 Bloom's Taxonomy: 1-2: Remembering/Understanding 6) The blood type AB+ is referred to as the universal donor. Answer: FALSE Chapter/Section: 13.4 Learning Outcome: 13.17 Bloom's Taxonomy: 1-2: Remembering/Understanding 7) The antibodies involved in type III reactions can be made as part of an autoimmune response or formed as a normal response to foreign antigens. Answer: TRUE Chapter/Section: 13.5 Learning Outcome: 13.19 Bloom's Taxonomy: 1-2: Remembering/Understanding 8) A contributing factor to increasing latex sensitivities among healthcare workers is that wearing gloves on a regular basis often causes dry, cracked skin that may promote entry of the latex into the skin to trigger sensitization. Answer: TRUE Chapter/Section: 13.6 Learning Outcome: 13.22 Bloom's Taxonomy: 1-2: Remembering/Understanding 9) Immune-privileged sites include the eye, brain, uterus, and testicles. Answer: TRUE Chapter/Section: 13.6 Learning Outcome: 13.24 Bloom's Taxonomy: 1-2: Remembering/Understanding 10) A positive PPD test indicates that the patient has an active tuberculosis infection. Answer: FALSE Chapter/Section: 13.6 Learning Outcome: 13.23 Bloom's Taxonomy: 1-2: Remembering/Understanding 13 Copyright © 2023 Pearson Education, Inc.

13.3 Essay Questions 1) Why is it challenging for clinicians to narrow down the autoimmune disorder at play and how is it diagnosed in the end? Answer: It can be challenging for clinicians to narrow down the autoimmune disorder at play due to the large number of options, variability of symptoms, and the fact that signs and symptoms can take a long time to fully develop and may change over time. Diagnosis often involves detecting self-reactive immune system cells and/or autoantibodies, which are antibodies that bind to self-tissues. Depending on the suspected disorder, the clinician may also order other hematological tests (blood tests) that look for specific inflammation and metabolic factors. An autoimmune disorder is rarely definitively diagnosed using a single test; instead, a collection of tests and careful assessment of signs and symptoms are required. Some autoimmune disorders have scoring criteria to help clinicians make a diagnosis. As a generic example, if the patient met five out of a dozen criteria for a particular disorder, then he or she might have an 85 percent likelihood of being affected by it, based on historical data. Typically, the more criteria a patient meets in such a scoring system, the greater the chance that the diagnosis is accurate. Chapter/Section: 13.1 Learning Outcome: 13.4 Global LO: G8 ASM LO: 7.3a Bloom's Taxonomy: 3-4: Applying/Analyzing 2) Why would someone allergic to pecans want to avoid other tree nuts as well? Answer: Allergens may share antigenic features. This means that a sensitizing exposure to one allergen may generate cross-reactivity to other related allergens. For example, a person may only ever have been exposed to pecans, but the generated IgE antibodies may cross-react with antigens in walnuts, almonds, and cashews rendering the patient allergic to all of those foods even if they have never been directly exposed to them. For this reason, a person who reacted against one tree nut would be advised to avoid all tree nuts as a precaution. Chapter/Section: 13.3 Learning Outcome: 13.11 Global LO: G8 ASM LO: 7.3a Bloom's Taxonomy: 3-4: Applying/Analyzing 3) Explain the difference between Celiac disease and an actual gluten allergy. Answer: Celiac disease is sometimes called gluten allergy, but actually isn't an allergy, since IgE does not mediate it. Exposure to gluten—a protein found in wheat, rye, and barley—causes T cells to attack the lining of the small intestine within 2-3 days of consuming it. Extreme inflammation and tissue damage result, interfering with the ability to absorb essential vitamins and minerals from food. Chapter/Section: 13.6 Learning Outcome: 13.22 Global LO: G8 ASM LO: 7.3a Bloom's Taxonomy: 3-4: Applying/Analyzing 14 Copyright © 2023 Pearson Education, Inc.

Microbiology: Basic & Clinical Principles, 2e (Norman-McKay) Chapter 14 Biomedical Applications: Vaccines, Diagnostics, Therapeutics, and Molecular Methods 14.1 Multiple Choice Questions 1) In the practice of variolation, how were patients exposed to the smallpox pathogen? A) They were placed in a room with a person who currently had smallpox. B) They were exposed to a bovine version of the disease, which is mild in humans. C) They were exposed to dried scabs from smallpox lesions. D) Babies were nursed by women who already had smallpox. E) They were exposed to bedding or clothes of a person with smallpox. Answer: C Chapter/Section: 14.1 Learning Outcome: 14.1 Bloom's Taxonomy: 1-2: Remembering/Understanding 2) The technique of vaccination as developed by Jenner was an improvement over variolation because A) the cowpox virus used by Jenner was not fatal to humans but provided protection against smallpox. B) cowpox vaccination was not just preventative but could also cure an active case of smallpox. C) cowpox was common in Europe at the time while smallpox was not. D) the smallpox virus mutates frequently but the cowpox virus does not. E) Jenner's technique required a lower rate of herd immunity to prevent the spread of smallpox. Answer: A Chapter/Section: 14.1 Learning Outcome: 14.1 Bloom's Taxonomy: 1-2: Remembering/Understanding 3) A major factor in the re-emergence of vaccine-preventable diseases in the early 21st century was A) a flawed research study incorrectly linking vaccination to breast cancer published in the late 1990s. B) a flawed research study incorrectly linking vaccination to autism published in the late 1990s. C) fears of biological weapons after the September 11, 2001 terrorist attacks turned public sentiment against vaccines. D) microbes can develop resistance to vaccines just as they do to antibiotics. E) concerns about animal rights have led people to avoid pharmaceuticals and other products that might have been tested on animals. Answer: B Chapter/Section: 14.1 Learning Outcome: 14.2 Bloom's Taxonomy: 1-2: Remembering/Understanding

4) The aspect of the immune response that vaccines are based on is A) stimulation of phagocytosis. B) protection of the normal microbiota. C) inflammation and fever. D) stimulation of cellular, as opposed to humoral, immunity. E) production of memory cells and high antibody titers from pathogen exposure. Answer: E Chapter/Section: 14.2 Learning Outcome: 14.3 Bloom's Taxonomy: 1-2: Remembering/Understanding 5) Herd immunity describes A) the process of immunizing animals so that people do not acquire zoonotic diseases. B) the temporary immunity an infant receives from its mother during gestation and from breastfeeding. C) the protection conferred to non-immunized people when a sizable portion of the rest of the population is immunized. D) the social phenomenon of vaccine refusal reinforced by internet memes and social media. E) the process of spacing out vaccinations in infants to just one per doctor's visit. Answer: C Chapter/Section: 14.2 Learning Outcome: 14.4 Bloom's Taxonomy: 1-2: Remembering/Understanding

6) In the figure, gray figures represent nonimmune individuals; black figures represent immune individuals. Which population will be least likely to experience disease outbreak?

A) Population 1 B) Population 2 C) Population 3 D) None of the populations would experience disease outbreak. E) All of the populations are equally likely to experience disease outbreak. Answer: C Chapter/Section: 14.2 Learning Outcome: 14.4 Global LO: G2 Bloom's Taxonomy: 3-4: Applying/Analyzing

7) Live attenuated vaccines A) are the closest to the actual infectious agent encountered in nature. B) stimulate potent immune responses to multiple antigens on the pathogen. C) require the use of an adjuvant. D) are the closest to the actual infectious agent encountered in nature AND stimulate potent immune responses to multiple antigens on the pathogen. E) are closest to the actual infectious agent encountered in nature AND require the use of an adjuvant. Answer: D Chapter/Section: 14.2 Learning Outcome: 14.5 Bloom's Taxonomy: 1-2: Remembering/Understanding 8) Conjugate vaccines which link the target antigen to a more immunogenic antigen are usually A) vaccines against bacterial polysaccharide antigens. B) vaccines against bacterial exotoxins. C) vaccines against Gram-negative endotoxin. D) vaccines against viral envelopes. E) vaccines against viral nucleic acid. Answer: A Chapter/Section: 14.2 Learning Outcome: 14.5 ASM LO: 2.2 Bloom's Taxonomy: 1-2: Remembering/Understanding 9) A drawback of inactivated vaccines is that A) they require complex genetic engineering techniques to produce. B) they may mutate to a more virulent form. C) they are likely to cause disease in immunocompromised hosts. D) they are quickly cleared from the body, limiting antigen exposure. E) they may cause secondary transmission from the immunized person to another host. Answer: D Chapter/Section: 14.2 Learning Outcome: 14.5 Bloom's Taxonomy: 1-2: Remembering/Understanding 10) A vaccine additive which enhances the body's natural immune response is called a(n) A) adjuvant. B) attenuant. C) booster. D) recombinant. E) toxoid. Answer: A Chapter/Section: 14.2 Learning Outcome: 14.6 Bloom's Taxonomy: 1-2: Remembering/Understanding 4 Copyright © 2023 Pearson Education, Inc.

11) Adjuvants appear to work by A) stimulating isotype-switching in B cells. B) stimulating cytokine release. C) encouraging the uptake and processing of antigens by dendritic cells. D) stimulating isotype-switching in B cells and cytokine release. E) stimulating cytokine release AND encouraging the uptake and processing of antigens by dendritic cells. Answer: E Chapter/Section: 14.2 Learning Outcome: 14.6 Bloom's Taxonomy: 1-2: Remembering/Understanding 12) A DNA vaccine involves placing genes into a plasmid and introducing the plasmid into human cells. Human cells then transcribe and translate the genes to produce antigen, stimulating an immune response in the recipient. What is the source of the genes being introduced? A) a pathogen B) human B or T cells C) a harmless virus D) a member of the patient's microbiome E) a laboratory animal (such as a mouse) Answer: A Chapter/Section: 14.2 Learning Outcome: 14.7 Global LO: G2 ASM LO: 4.5 Bloom's Taxonomy: 3-4: Applying/Analyzing 13) In a recombinant vector vaccine, genetic material from a pathogen is placed into a ________ and introduced to human cells. A) harmless virus or bacteria B) pathogenic virus or bacteria C) human B or T cell D) human dendritic cell E) plasmid vector Answer: A Chapter/Section: 14.3 Learning Outcome: 14.7 ASM LO: 4.5 Bloom's Taxonomy: 1-2: Remembering/Understanding

14) Advantages that immunological diagnostics have over biochemical testing include all except A) identification of both cellular and viral pathogens. B) identification of organisms that cannot be cultured in the lab. C) faster completion times. D) identification of past exposure to a pathogen, not just a current infection. E) detection of an organism that has not been previously identified. Answer: E Chapter/Section: 14.3 Learning Outcome: 14.8 Bloom's Taxonomy: 1-2: Remembering/Understanding 15) Agglutination tests make use of the fact that A) antibodies bound to antigen will precipitate in a gel matrix. B) T cells will release interferon gamma during certain infections. C) the presence of antibodies in a patient's serum will prevent viral infection of cells in culture. D) antibodies have two antigen-binding sites and will cause clumping when bound to antigen. E) a reporter enzyme can be bound to an antibody to provide a visual change with a positive test. Answer: D Chapter/Section: 14.3 Learning Outcome: 14.9 Bloom's Taxonomy: 1-2: Remembering/Understanding

16) According to the agglutination tests pictured below, what is the blood type of the sample being tested?

A) A B) B C) AB D) O E) Either A or B Answer: B Chapter/Section: 14.3 Learning Outcome: 14.9 Global LO: G2 Bloom's Taxonomy: 3-4: Applying/Analyzing 17) Plaque reduction neutralization tests (PRNT) are based on the fact that A) antibodies bound to antigen will precipitate in a gel matrix. B) T cells will release interferon gamma during certain infections. C) the presence of antibodies in a patient's serum will prevent viral infection of cells in culture. D) antibodies have two antigen-binding sites and will cause clumping when bound to antigen. E) a reporter enzyme can be bound to an antibody to provide a visual change with a positive test. Answer: C Chapter/Section: 14.3 Learning Outcome: 14.10 Bloom's Taxonomy: 1-2: Remembering/Understanding

18) The plaque reduction neutralization test (PRNT) is preferred over other methods mainly because A) PRNT can differentiate between closely related viruses which have similar antigens. B) it is faster than most other methods. C) working with the live pathogens required for PRNT is risky. D) PRNT can detect low levels of antibody. E) PRNT does not require working directly with a patient blood sample. Answer: A Chapter/Section: 14.3 Learning Outcome: 14.10 Bloom's Taxonomy: 1-2: Remembering/Understanding 19) In a direct ELISA, the reporter enzyme A) is bound to the detection antibody. B) reacts directly with the antigen the assay is seeking. C) chemically modifies an added substrate to generate a colorimetric or chemiluminescent change. D) is bound to the detection antibody AND chemically modifies an added substrate to generate a colorimetric or chemiluminescent change. E) reacts directly with the antigen the assay is seeking AND chemically modifies an added substrate to generate a colorimetric or chemiluminescent change. Answer: D Chapter/Section: 14.3 Learning Outcome: 14.11 Bloom's Taxonomy: 1-2: Remembering/Understanding 20) Compared to a direct ELISA, a sandwich ELISA A) is less sensitive. B) only requires the use of one antibody. C) can be designed to be read without a plate reader, making it suitable for home use. D) does not depend on a reporter enzyme. E) does not require unbound antibody to be washed away. Answer: C Chapter/Section: 14.3 Learning Outcome: 14.11 Bloom's Taxonomy: 1-2: Remembering/Understanding

21) An indirect ELISA is pictured. In which step is the detector antibody added to the assay?

A) step 1 B) step 2 C) step 3 D) step 4 E) steps 3 and 4 Answer: C Chapter/Section: 14.3 Learning Outcome: 14.11 Bloom's Taxonomy: 1-2: Remembering/Understanding 22) While performing an ELISA, a lab technician fails to rinse away unbound detection antibody from the wells before adding the substrate for the reporter enzyme. What is the likely outcome of this error? A) The test results will not be affected. B) All wells, including controls, will indicate a positive result. C) All wells, including controls, will indicate a negative result. D) The control wells will indicate a negative result, but the wells with the test sample will indicate a positive result. E) The outcome cannot be determined from this information. Answer: B Chapter/Section: 14.3 Learning Outcome: 14.11 Global LO: G2 Bloom's Taxonomy: 3-4: Applying/Analyzing

23) How does immunofluorescence microscopy detect rabies in brain tissue of an infected animal? A) Fluorescent-tagged antibodies bind to rabies antigen in the tissue and are visible in a specialized microscope. B) Fluorescent-tagged antibodies bind to the antibodies generated to fight the infection. C) Fluorescent-tagged antibodies bind to cytotoxic T cells that are attempting to kill infected cells in the tissue. D) Fluorescent-tagged antibodies provide light needed to see the virus particles in the microscope. E) Rabies virus naturally fluoresces under ultraviolet light. Answer: A Chapter/Section: 14.4 Learning Outcome: 14.12 ASM LO: 2.1 Bloom's Taxonomy: 1-2: Remembering/Understanding 24) The interferon gamma release assay for tuberculosis infection works because A) the TB bacterium releases interferon-gamma. B) the T cells of an infected person release more interferon gamma than that of a noninfected person. C) one can perform an indirect ELISA to detect antibodies to interferon gamma in a patient with TB. D) individuals who have had the TB vaccine can be identified by the amount of interferon gamma in their blood. E) the presence of interferon gamma indicates a person is susceptible to TB infection. Answer: B Chapter/Section: 14.4 Learning Outcome: 14.13 Bloom's Taxonomy: 1-2: Remembering/Understanding 25) Advantages of the interferon gamma release assay (IGRA) over the traditional TB skin test include all of the following except A) IGRA can be used on persons who have been vaccinated against TB. B) IGRA requires only one patient visit as opposed to two with the skin test. C) IGRA only detects active TB infections. D) IGRA can provide results within a day. E) IGRAs are sensitive enough to detect early cases of TB. Answer: C Chapter/Section: 14.4 Learning Outcome: 14.13 Bloom's Taxonomy: 1-2: Remembering/Understanding

26) Which aspect of the polymerase chain reaction (PCR) is mismatched with its description? A) dNTPs: Building blocks of DNA B) DNA primers: Sequences specifically chosen to be complementary to the DNA which flanks a target gene or region of interest C) Template DNA: The DNA to be copied; must be present at a high concentration for the procedure to work D) Taq polymerase: A DNA-replication enzyme which functions at high temperatures E) Variable temperatures: The highest temperature required for double-stranded DNA separation, the lowest temperature to allow primers to anneal, and a midrange temperature for DNA replication Answer: C Chapter/Section: 14.4 Learning Outcome: 14.14 ASM LO: 6.3 Bloom's Taxonomy: 1-2: Remembering/Understanding 27) Reverse transcription PCR (RT-PCR) is used specifically to A) detect a mutated gene during screening for genetic disorders. B) detect the presence of RNA viruses. C) measure how many copies of a specific gene are in a sample. D) perform PCR at cooler temperatures. E) replace a mutated gene with a corrected gene. Answer: B Chapter/Section: 14.4 Learning Outcome: 14.14 ASM LO: 6.3 Bloom's Taxonomy: 1-2: Remembering/Understanding

28) The correct order of steps to follow when using recombinant DNA technology to produce a protein for pharmacological use is A) isolate the desired gene, insert the gene into an expression vector, transform host cells with the expression vector, grow the transformed cells into suitable quantities, purify the expressed protein. B) isolate the desired gene, purify the expressed protein, grow the transformed cells into suitable quantities, insert the gene into an expression vector, transform host cells with the expression vector. C) purify the expressed protein, insert the gene into an expression vector, transform host cells with the expression vector, grow the transformed cells into suitable quantities, isolate the desired gene. D) grow the transformed cells into suitable quantities, transform host cells with the expression vector, insert the gene into an expression vector, isolate the desired gene, purify the expressed protein. E) transform host cells with the expression vector, grow the transformed cells into suitable quantities, isolate the desired gene, insert the gene into an expression vector, purify the expressed protein. Answer: A Chapter/Section: 14.4 Learning Outcome: 14.15 ASM LO: 4.5 | 6.3 Bloom's Taxonomy: 1-2: Remembering/Understanding 29) Recombinant DNA technologies are most often used for A) creating billions of copies of a target gene in a few hours. B) measuring expression levels of a gene in a particular cell. C) producing large amounts of a particular protein quickly and easily. D) genetic screening of newborns for inherited diseases. E) detecting the presence of a virus in a clinical sample. Answer: C Chapter/Section: 14.4 Learning Outcome: 14.15 ASM LO: 4.5 | 6.3 Bloom's Taxonomy: 1-2: Remembering/Understanding 30) Which enzyme is used to generate compatible sticky ends in order to join a desired gene to a plasmid vector in recombinant DNA techniques? A) CRISPR-Cas9 B) DNA ligase C) restriction enzymes D) reverse transcriptase E) Taq polymerase Answer: C Chapter/Section: 14.4 Learning Outcome: 14.16 ASM LO: 4.5 | 6.3 Bloom's Taxonomy: 1-2: Remembering/Understanding 12 Copyright © 2023 Pearson Education, Inc.

31) The CRISPR-Cas9 system uses all except which of the following? A) a guide RNA which locates the gene to be edited B) an enzyme to cut both strands of DNA at the target site C) replacement DNA to be inserted at the cut site D) prokaryotic or eukaryotic cells to be edited E) reverse transcriptase enzyme Answer: E Chapter/Section: 14.4 Learning Outcome: 14.17 ASM LO: 4.5 | 6.3 Bloom's Taxonomy: 1-2: Remembering/Understanding 32) In order to successfully and safely deliver a gene to a human cell, a virus vector must be A) infectious but not pathogenic. B) pathogenic but not infectious. C) both infectious and pathogenic. D) a retrovirus. E) packaged with RNA rather than DNA. Answer: A Chapter/Section: 14.4 Learning Outcome: 14.18 ASM LO: 4.5 | 6.3 Bloom's Taxonomy: 1-2: Remembering/Understanding 33) Genome mapping A) documents the position of every nucleotide. B) may reveal the presence of "pathogenicity islands" as well as information about genes for basic cellular functions. C) provides a blueprint for the proteins and regulatory RNAs produced by a cell. D) documents the position of every nucleotide and provides a blueprint for the proteins and regulatory RNAs produced by a cell. E) documents the position of every nucleotide, provides a blueprint for the proteins and regulatory RNAs produced by a cell, and may reveal the presence of "pathogenicity islands" as well as information about genes for basic cellular functions. Answer: E Chapter/Section: 14.4 Learning Outcome: 14.19 ASM LO: 4.1 Bloom's Taxonomy: 1-2: Remembering/Understanding

34) DNA microarrays reveal A) which genes are found in a given cell. B) which genes are being expressed in a given cell. C) if any genes are mutated in a given cell. D) if a particular gene was acquired via horizontal gene transfer. E) if reverse transcriptase is present in a given cell. Answer: B Chapter/Section: 14.4 Learning Outcome: 14.20 Bloom's Taxonomy: 1-2: Remembering/Understanding 35) Which of the following is a genetics-based test that helps physicians determine whether a given cancer will recur, or what types of chemotherapy or radiation therapy treatments would be most successful? A) CRISPR-Cas9 B) DNA microarray C) genome mapping D) real-time PCR E) recombinant DNA techniques Answer: B Chapter/Section: 14.4 Learning Outcome: 14.20 Bloom's Taxonomy: 1-2: Remembering/Understanding 36) Which of the following is not a drawback of live attenuated vaccines? A) They generally must be refrigerated until they are administered, limiting their use in developing countries. B) They may mutate back to a pathogenic form. C) They are quickly cleared from the body, limiting antigen exposure. D) They may cause disease in immunocompromised hosts. E) They may cause secondary transmission from an immunized person to another host. Answer: C Chapter/Section: 14.2 Learning Outcome: 14.5 Bloom's Taxonomy: 1-2: Remembering/Understanding

37) During production of an mRNA vaccine, lipid nanoparticles are used to encase mRNA. These lipid nanoparticles are readily uptaken into host cells after vaccine injection. Host cells then translate the viral mRNA to produce viral antigens, invoking an immune response. What is the original source of the mRNA in the vaccine? A) a harmless virus or bacteria B) human B or T cells C) a member of the patient's microbiome D) a pathogenic virus or bacteria E) a laboratory animal (such as a mouse) Answer: D Chapter/Section: 14.2 Learning Outcome: 14.7 Global LO: G2 ASM LO: 4.4 Bloom's Taxonomy: 3-4: Applying/Analyzing 38) During an agglutination reaction to determine blood type, the patient's blood agglutinated when anti-A, anti-B, or anti-D antibodies were added. What is the correct blood type designation? A) AB− B) AB+ C) O− D) O+ E) The blood type could be A, B, or O. More testing is needed. Answer: B Chapter/Section: 14.3 Learning Outcome: 14.9 Global LO: G2 ASM LO: 7.1 Bloom's Taxonomy: 3-4: Applying/Analyzing 39) The rapid "at home" COVID-19 tests work in the following way. A swab from the patient's nasal passages is applied to the strip. Liquid is added that will diffuse any protein toward a line that includes an antibody-linked enzyme that will bind to SARS-CoV2 protein. Over a few minutes, this line will turn pink if antigen from the virus is present. Based on this description, which best describes the type of diagnostic test being performed? A) plaque-reduction neutralization test (PRNT) B) interferon gamma release assay (IGRA) C) enzyme-linked immunosorbent assay (ELISA) D) reverse transcriptase polymerase chain reaction (RT-PCR) E) agglutination reaction Answer: C Chapter/Section: 14.3 Learning Outcome: 14.9 | 14. 10 | 14.11 Global LO: G2 ASM LO: 7.1 Bloom's Taxonomy: 3-4: Applying/Analyzing 15 Copyright © 2023 Pearson Education, Inc.

14.2 True/False Questions 1) Vaccines are only necessary for infants and children. Answer: FALSE Chapter/Section: 14.2 Learning Outcome: 14.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 2) The more closely a vaccination agent resembles the actual infectious agent, the more likely a strong adaptive immune response will be elicited. Answer: TRUE Chapter/Section: 14.2 Learning Outcome: 14.5 Bloom's Taxonomy: 1-2: Remembering/Understanding 3) The risk of a vaccine for an immunocompromised individual is higher for inactivated vaccines than for live attenuated vaccines. Answer: FALSE Chapter/Section: 14.2 Learning Outcome: 14.5 Bloom's Taxonomy: 1-2: Remembering/Understanding 4) Immunological diagnostic tests are based on the fact that a given antibody will bind only with a specific antigen. Answer: TRUE Chapter/Section: 14.3 Learning Outcome: 14.8 Bloom's Taxonomy: 1-2: Remembering/Understanding 5) A plaque reduction neutralization assay is performed with a patient serum. The presence of abundant plaques on the plate indicates that the patient is currently infected with the virus in question. Answer: FALSE Chapter/Section: 14.3 Learning Outcome: 14.10 Bloom's Taxonomy: 1-2: Remembering/Understanding 6) A direct ELISA is most useful for detection of antigens while an indirect ELISA is used to determine if a patient has a particular type of antibody in their blood. Answer: TRUE Chapter/Section: 14.3 Learning Outcome: 14.11 Bloom's Taxonomy: 1-2: Remembering/Understanding

7) Polymerase chain reaction (PCR) techniques can detect the presence as few as a single viral particle in a sample. Answer: TRUE Chapter/Section: 14.4 Learning Outcome: 14.14 ASM LO: 6.3 Bloom's Taxonomy: 1-2: Remembering/Understanding 8) The CRISPR-Cas9 gene editing system so far can only be used to alter prokaryotic cells. Answer: FALSE Chapter/Section: 14.4 Learning Outcome: 14.17 ASM LO: 4.5 | 6.3 Bloom's Taxonomy: 1-2: Remembering/Understanding 9) mRNA vaccines do not require adjuvants because they rely on the host cell to produce the viral antigens. Answer: TRUE Chapter/Section: 14.2 Learning Outcome: 14.7 Bloom's Taxonomy: 1-2: Remembering/Understanding 10) One advantage of the interferon gamma release assay (IGRA) as compared to tuberculin skin tests is that it can distinguish between active and latent tuberculosis infections. Answer: FALSE Chapter/Section: 14.3 Learning Outcome: 14.13 Bloom's Taxonomy: 1-2: Remembering/Understanding

14.3 Essay Questions 1) Describe the different vaccine types, and the advantages and disadvantages of each. Answer: Currently available vaccines are categorized on whether the vaccine agent is active (live) or inactive. Live vaccines contain a microbe that is infectious but not pathogenic, a condition known as attenuated. Live attenuated vaccines stimulate potent immunological responses, long-lived memory, and activation of B and T cells against multiple antigens. Live vaccine agents may rarely mutate to a more virulent form, posing risks to immunocompromised persons especially. These vaccines may have the potential to transmit other agents from the tissue cultures in which they are grown, and may also transmit from the vaccinated individuals to unwitting contacts. Live attenuated vaccines must be refrigerated up until the time of use. Inactivated vaccines may contain whole inactivated pathogens, parts of pathogens, or inactivated toxins. These vaccines pose no risk of infectivity to immunocompromised individuals, but they are cleared quickly from the body, so multiple doses are needed for full immunity to develop and be maintained. Whole-agent inactivated vaccines contain the entire pathogen which has been treated with heat, chemicals, or radiation. Subunit vaccines contain select purified antigens from the pathogen, and may be harvest from the pathogen itself or manufactured using recombinant DNA technologies. Toxoid vaccines contain inactivated toxins so that the protection is to the bacterial toxin and not the bacteria itself. Conjugate vaccines contain polysaccharide antigens such as bacteria capsules. Because polysaccharides are poorly immunogenic on their own, these molecules are conjugated to more immunogenic protein molecules. A third category of vaccines based on DNA technologies include DNA vaccines and recombinant vector vaccines. These vaccines introduce pathogen DNA into selected host cells. The genes are transcribed and translated in the patient's own cells, and when secreted or displayed on the cell surface, stimulate an immune response. These vaccines are currently in the experimental stage. Chapter/Section: 14.2 Learning Outcome: 14.4 | 14.7 Bloom's Taxonomy: 1-2: Remembering/Understanding

2) Describe the principles of ELISA and contrast the three types. Answer: Enzyme-linked immunosorbent assays (ELISAs) are widely used diagnostic tests. ELISA relies on the specific interaction between an antibody and the antigen it binds to. All variations of ELISA use a reporter enzyme linked to a detection antibody. The detection antibody binds to its specific antigen or to another antibody. After unbound antibody is removed by washing, the chemical substrate for the reporter enzyme is added. Typically, the enzymesubstrate pair is chosen to generate a colorimetric or chemiluminescent reaction which can be visually observed or detected with a device called a plate reader. ELISAs can be run in bulk in 96-well plates or can be designed in a variety of single-use devices such as a home pregnancy test or the "rapid-Strep" used in clinics and doctors' offices. There are three ELISA "formats" but ELISAs can be designed for virtually any antigen, and hundreds of different ELISAs are commercially available. Direct ELISA allows for identification of an antigen in a sample in three basic steps: binding antigens to a well surface, addition of the detector antibody with bound enzyme, followed by the enzyme substrate. Direct ELISA is not recommended for crude samples. Indirect ELISA is often used to detect the presence of a specific antibody in a patient sample. With the indirect ELISA, the antigen is already bound to the plate. The test sample containing unknown antibodies is added, followed by a secondary detection antibody which is designed to bind to the antibody being measured. Finally, the enzyme substrate is added. A sandwich ELISA allows detection of an antigen in a sample but is more sensitive than the direct ELISA. The wells come with a capture antibody already loaded. The patient sample is added, and if the antigen is present, it will bind to the capture antibody. The enzyme-linked detection antibody is added, sandwiching the antigen between the two antibodies. Finally, the enzyme substrate is added. All forms of ELISA depend specifically on the binding of the specific antigen to its antibody. If the antigen being sought is not in the sample, antibody cannot bind and will be washed away prior to the addition of the enzyme substrate. Chapter/Section: 14.3 Learning Outcome: 14.11 Bloom's Taxonomy: 1-2: Remembering/Understanding

3) Describe how the polymerase chain reaction (PCR) works and discuss its applications. Answer: The polymerase chain reaction (PCR) technique can detect a specific sequence of DNA in virtually any sample, even if the desired DNA is present in only minute quantities. PCR works by rapidly cycling a sample containing DNA through a series of three temperatures. The first temperature, 95°C, separates any double-stranded DNA in the sample. A lower temperature between 50-65°C allows added DNA molecules called primers to bind to complementary regions on the DNA in the sample. The primers are specifically chosen to flank the segment of interest on the sample DNA. Once the primers bind, temperature is again shifted to 65-75°C This allows the sample DNA to be replicated between the two primer segments. Replication is accomplished by an added DNA polymerase enzyme (Taq polymerase) which is isolated from a thermophile bacterium. Using a heat-tolerant enzyme allows it to maintain its activity during the high temperatures required for strand separation. Deoxynucleotide triphosphates (dNTPs) are provided to serve as the raw material for DNA synthesis. The cycle then repeats, and both the original DNA and the newly synthesized DNA strands can serve as templates for the next round of replication. As a result, the number of DNA copies doubles with every cycle, and after a typical run of 30 cycles, one DNA molecule is multiplied to 10 billion copies. The amplified DNA sample is often visualized using gel electrophoresis. A variation called real-time PCR bypasses the need for gel electrophoresis by adding florescence imaging to visualize the DNA as it is being produced (and also allows for quantification). Reverse transcription PCR allows detection of RNA in a sample by using to reverse transcriptase enzyme to convert the RNA into DNA. Chapter/Section: 14.4 Learning Outcome: 14.14 ASM LO: 6.3 Bloom's Taxonomy: 1-2: Remembering/Understanding 4) Compare and contrast mRNA and recombinant vector vaccines. When would each be used? Use specific examples for each type of vaccine. Answer: In both of these vaccine types, genetic material encoding an antigenic protein from the pathogen is inserted into host cells. The host cell will then use the genetic information to produce the viral antigen in its own cells, invoking an immune response. 1. For mRNA vaccines: mRNA encoding a viral antigen is encased in lipid nanoparticles for protection until vaccine injection. After vaccination, these lipid nanoparticles non-specifically enter host cells by fusion with plasma membranes. Once inside the host cell, the host will use its ribosomes to translate the viral mRNA into antigenic proteins that will be displayed on the cell surface, stimulating an immune response. The first vaccines approved by the FDA for COVID19 were both mRNA vaccines (Pfizer and Moderna). In both cases, the mRNA in the vaccine encoded the SARS-CoV2 virus Spike protein.

2. For recombinant vector vaccines: Specific genes (usually in the form of DNA) containing information to encode an antigen from a pathogenic organism are encased inside a harmless virus or bacteria (the "vector"). The vector then "infects" target host cells, but since it is missing key pathogenic elements, it is unable to replicate inside the host cell. The gene for the antigen from the pathogen is transcribed and translated by the host cell, and similarly to mRNA vaccines, these antigens are displayed on the cell surface, causing an immune response. Examples of recombinant vector vaccines include a vaccine for Ebola, and one for SARS-CoV2 (Johnson and Johnson/Janssen). Chapter/Section: 14.2 Learning Outcome: 14.7 Global LO: G2 | G7 ASM LO: 4.4 Bloom's Taxonomy: 3-4: Applying/Analyzing

Microbiology: Basic & Clinical Principles, 2e (Norman-McKay) Chapter 15 Antimicrobial Drugs 15.1 Multiple Choice Questions 1) Why did Alexander Fleming suspect he could get penicillin from a species of mold? A) Soldiers eating moldy bread were not suffering from wound infections. B) Wounds with superficial mold on the bandages were not becoming septic. C) Bacteria on culture plates were unable to grow near mold contamination. D) Patients infected with a fungus such as athlete's foot were less likely to have bacterial infections. E) Soldiers drinking fermented alcohol were less likely to have bacterial infections. Answer: C Chapter/Section: 15.1 Learning Outcome: 15.1 Bloom's Taxonomy: 1-2: Remembering/Understanding 2) Why might broad-spectrum antimicrobials be initially used when treating a patient? A) The physician has never encountered that pathogen before. B) They are cheaper to use. C) It's best to start with broad-spectrum antimicrobials until patient records are available that show if the patient has any antimicrobial allergies. D) An initial round of broad-spectrum antimicrobials increases the efficiency of narrowspectrum antimicrobials. E) They may initially be used to treat the patient since it can take several days to make a definitive bacterial identification. Answer: E Chapter/Section: 15.1 Learning Outcome: 15.2 Bloom's Taxonomy: 1-2: Remembering/Understanding 3) Bactericidal drugs tend to target bacterial A) cell walls, cell membranes, and nucleic acids. B) cell walls and cell membranes. C) nucleic acids. D) cell walls and enzyme activation. E) protein synthesis and nucleic acids. Answer: A Chapter/Section: 15.1 Learning Outcome: 15.3 ASM LO: 2.2 Bloom's Taxonomy: 1-2: Remembering/Understanding

4) What is the major challenge with developing new synthetic antimicrobials? A) deciding what bacteria to test it on B) figuring out if the drug is bacteriostatic or bactericidal C) the need to screen thousands of potential candidates D) finding the right dose E) choosing which bacterial structure to target Answer: C Chapter/Section: 15.1 Learning Outcome: 15.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 5) An antibiotic is A) a drug which is wholly manufactured by chemical processes. B) medicine that removes pathogenic organisms from the body. C) a chemical that kills or removes bacteria, viruses, protozoa, helminths, or fungi. D) a preparation used to sterilize a person or object. E) a naturally occurring compound that kills microbes or inhibits their growth. Answer: E Chapter/Section: 15.1 Learning Outcome: 15.5 Bloom's Taxonomy: 1-2: Remembering/Understanding 6) A therapeutic index is a ratio between A) patients that benefited from drug versus patients that experienced side effects. B) maximum safe dose versus minimum effective dose. C) toxicity versus half-life. D) potential patients not ruled out due-to-drug interactions or contraindications versus patients who experienced side effects. E) patient survivability versus patient allergies. Answer: B Chapter/Section: 15.1 Learning Outcome: 15.6 Bloom's Taxonomy: 1-2: Remembering/Understanding 7) Which of the following would pertain to a bad antibiotic? A) narrow therapeutic index B) low toxicity C) long half-life D) no contraindications E) no drug interactions Answer: A Chapter/Section: 15.1 Learning Outcome: 15.6 | 15.8 Bloom's Taxonomy: 1-2: Remembering/Understanding

8) Which organs are particularly susceptible to damage by certain antimicrobial drugs? A) heart and lungs B) pancreas and gallbladder C) kidneys and liver D) stomach and intestines E) brain and spleen Answer: C Chapter/Section: 15.1 Learning Outcome: 15.7 Bloom's Taxonomy: 1-2: Remembering/Understanding 9) Which of the following is an example of a hepatotoxic drug? A) gentamicin B) streptomycin C) vancomycin D) amoxicillin-clavulanate E) aspirin Answer: D Chapter/Section: 15.1 Learning Outcome: 15.7 Bloom's Taxonomy: 1-2: Remembering/Understanding 10) Which of the following is not a beta-lactam drug? A) penicillin B) cephalosporin C) carbapenem D) monobactam E) quinolone Answer: E Chapter/Section: 15.2 Learning Outcome: 15.9 Bloom's Taxonomy: 1-2: Remembering/Understanding 11) How do glycopeptide drugs differ from beta-lactam drugs? A) Glycopeptide drugs do not have a beta-lactam ring, so they are not susceptible to betalactamases. B) Glycopeptide drugs specifically target Gram-negative bacteria. C) Glycopeptide drugs are broad-spectrum drugs, unlike beta-lactamases which are narrowspectrum drugs. D) Glycopeptide drugs are often found to be ineffective due to antibiotic-resistance. E) Glycopeptide drugs are easily absorbed across the intestines and therefore commonly used as oral preparations against systemic infections. Answer: A Chapter/Section: 15.2 Learning Outcome: 15.10 Bloom's Taxonomy: 1-2: Remembering/Understanding

12) Which of the following is false about quinolones? A) They are synthetic antimicrobials that target cell-wall synthesis. B) The more modern and most commonly prescribed group of quinolones contains a fluorine atom. C) They are excellent in situations where there isn't time to identify the responsible pathogen. D) In rare instances, these drugs have been associated with more serious side effects such as nerve damage, tendonitis, and possible tendon rupture. E) They have a broad spectrum of action, can be taken orally, and have a relatively long half-life. Answer: A Chapter/Section: 15.2 Learning Outcome: 15.11 Bloom's Taxonomy: 1-2: Remembering/Understanding 13) Which of the following is false about rifamycins? A) They inhibit transcription by binding to RNA polymerase. B) The drugs are useful to combat mycobacterial species that can be especially tough to treat due to the challenges of getting drugs across their waxy mycolic acid-enriched cell wall. C) Because the chemical structure is such a good fit with RNA polymerase, it is unlikely to cause interactions with any other medications currently known. D) They were originally isolated from bacteria. E) They are broad-spectrum antimicrobials that are effective against most Gram-positive bacteria and some Gram-negative bacteria too. Answer: C Chapter/Section: 15.2 Learning Outcome: 15.11 Bloom's Taxonomy: 1-2: Remembering/Understanding 14) Why don't sulfa drugs target mammalian cells? A) Mammals make their own folic acid but use a completely different substrate to start the process and therefore sulfa drugs are unable to disrupt the process. B) Mammals do not make their own folic acid and therefore do not have the enzyme that these drugs target. C) Mammalian cells do not use folic acid and therefore do not have the enzyme that these drugs target. D) Mammalian cells produce inhibitors to the sulfa drugs. E) Sulfa drugs do target mammalian cells but the therapeutic index is so high that a very low dosage is effective and there is minimal damage to the cells. Answer: B Chapter/Section: 15.2 Learning Outcome: 15.12 Bloom's Taxonomy: 1-2: Remembering/Understanding

15) Which of the following antimicrobials does not match its potential shortcomings? A) Macrolides: This narrow-spectrum drug must be administered parenterally. B) Lincosoamides: One common lincosoamide is associated with pseudomembranous colitis caused by Clostridium difficile. C) Phenicols: Has a narrow therapeutic index and is associated with bone marrow toxicity that results in aplastic anemia. D) Tetracyclines: Induce photosensitivity, causes detrimental effects on bones and teeth in children younger than 8 years old, and are associated with an increased risk of Clostridium difficile infection E) Aminoglycosides: Are known to cause irreversible hearing loss when administered other than topically. Answer: A Chapter/Section: 15.2 Learning Outcome: 15.13 Bloom's Taxonomy: 1-2: Remembering/Understanding 16) Which of the following antimicrobials does not match its target? A) Macrolides: 50S subunit of the ribosome B) Lincosamides: 50S subunit of the ribosome C) Phenicols: 50S subunit of the ribosome D) Tetracyclines: 50S subunit of the ribosome E) Aminoglycosides: 30S subunit of the ribosome Answer: D Chapter/Section: 15.2 Learning Outcome: 15.13 ASM LO: 2.2 Bloom's Taxonomy: 1-2: Remembering/Understanding 17) How do polypeptide drugs work? A) They work by inhibiting transpeptidase enzymes that are central to building the peptide crosslinks in peptidoglycan. B) They target the DNA replication enzymes DNA gyrase and topoisomerases. C) They interact with lipopolysaccharide and destabilize the outer membrane of the Gramnegative cell wall leading to cytoplasmic leakage and cell lysis. D) They target the 50S subunit of prokaryotic ribosomes to block protein synthesis. E) They act as competitive inhibitors of folic acid production. Answer: C Chapter/Section: 15.3 Learning Outcome: 15.14 Bloom's Taxonomy: 1-2: Remembering/Understanding

18) Why is it difficult to develop drugs that specifically target viruses and eukaryotic pathogens? A) Viruses and eukaryotes evolve too rapidly for drugs to be effective. B) The drugs often inflict collateral damage on our own cells. C) There are often duplicate metabolic pathways that pick up the slack from any disturbance caused by these drugs. D) The ethical concerns with testing these drugs are too great. E) Security enzymes break down these foreign drugs before they can exert their effects. Answer: B Chapter/Section: 15.3 Learning Outcome: 15.15 Bloom's Taxonomy: 1-2: Remembering/Understanding 19) Which of the following does not make a good target for antiviral drugs? A) viral integration B) viral attachment C) viral replication and assembly D) viral release E) viral penetration Answer: A Chapter/Section: 15.3 Learning Outcome: 15.16 Bloom's Taxonomy: 1-2: Remembering/Understanding 20) Which of the following drugs are not matched correctly with their uses? A) Azoles: Athlete's foot, ringworm, and yeast infections B) Allylamines: Systemic fungal infections such as coccidiomycosis caused by Coccidioides immitis C) Polyenes: Cutaneous candidiasis caused by Candida albicans or treating life-threatening systemic fungal infections D) Echinocandin drugs: Systemic fungal infections in immune-compromised patients E) Flucytosine: Administered in combination with amphotericin B for severe fungal infections such as Cryptococcus meningitis and systemic Candidiasis infections Answer: B Chapter/Section: 15.3 Learning Outcome: 15.17 Bloom's Taxonomy: 1-2: Remembering/Understanding

21) Which of the following drugs are not matched correctly with their mode of action? A) Azoles: Inhibits ribosome function by entering ribosome as a tRNA, covalently binding to mRNA, and forcing the destruction of the complex B) Allylamines: Inhibits enzymes that build ergosterol which leads to improperly built plasma membranes and fungal cell lysis C) Polyenes: Directly interacts with ergosterols which causes targeted plasma membranes to become leaky and leads to cell lysis D) Echinocandin drugs: Inhibits fungal cell wall synthesis by targeting an enzyme that makes a component of the fungal cell wall E) Flucytosine: Blocks fungal DNA replication and transcription when it is converted to a nucleic acid analog that blocks DNA and RNA synthesis Answer: A Chapter/Section: 15.3 Learning Outcome: 15.17 Bloom's Taxonomy: 1-2: Remembering/Understanding 22) Artemisinin-based combination therapies are used to treat A) life-threatening, multidrug-resistant infections, especially those caused by Pseudomonas aeruginosa, Acinetobacter baumannii, or Klebsiella pneumoniae. B) severe fungal infections such as Cryptococcus meningitis and systemic Candidiasis infections. C) chronic Toxoplasma gondii infections. D) mild to moderate C. difficile infections that don't have complications. E) cases of malaria caused by resistant strains of Plasmodium. Answer: E Chapter/Section: 15.3 Learning Outcome: 15.18 Bloom's Taxonomy: 1-2: Remembering/Understanding 23) What does nitrazoxanide do in order to target Giardia and Cryptosporidium as well as certain parasitic worms? A) targets nucleic acids B) blocks anaerobic energy metabolism C) the mechanisms of action are unclear D) paralyzes the protozoans or parasitic worms E) interferes with glucose uptake by targeting microtubules Answer: B Chapter/Section: 15.3 Learning Outcome: 15.18 Bloom's Taxonomy: 1-2: Remembering/Understanding

24) What is the mechanism of action for the antihelminthic drug praziquantel? A) targets nucleic acids B) blocks anaerobic energy metabolism in protozoa C) the mechanisms of action are unclear D) paralyzes the parasites E) interferes with glucose uptake by targeting microtubules Answer: D Chapter/Section: 15.3 Learning Outcome: 15.19 Bloom's Taxonomy: 1-2: Remembering/Understanding 25) Why is it entirely possible for a pathogen to appear susceptible in susceptibility testing and resistant in a real-life context? A) An active infection is more likely to mutate due to the larger population. B) A real-life infection allows for the possibility of genetic crossover with different bacteria, whereas tests in the lab are focused on studying a single strain of bacteria. C) The ability of the pathogen to live as part of a biofilm and benefit from the protection of other bacteria does not exist in susceptibility tests. D) A person's liver may break down the drug before it even begins to benefit the patient. E) Bacterial levels and active drug concentrations vary from one tissue to another in an active infection. Answer: E Chapter/Section: 15.4 Learning Outcome: 15.20 Bloom's Taxonomy: 1-2: Remembering/Understanding 26) The collected data of a Kirby-Bauer test is often presented in A) a graph. B) a pie chart. C) an antibiogram. D) a minimal inhibitory concentration report. E) a bacteriostatic or bactericidal report. Answer: C Chapter/Section: 15.4 Learning Outcome: 15.21 Bloom's Taxonomy: 1-2: Remembering/Understanding 27) An E-test can reveal A) if a drug is bacteriostatic or bactericidal. B) the minimal inhibitory concentration of a drug. C) the mechanism of action for a particular drug. D) the minimum bactericidal concentration. E) the minimum bacteriostatic concentration. Answer: B Chapter/Section: 15.4 Learning Outcome: 15.22 | 15.23 Bloom's Taxonomy: 1-2: Remembering/Understanding

28) Which of the following drugs demonstrates the most effective minimal inhibitory concentration?

A) 2 B) 4 C) 5 D) 6 E) 9 Answer: E Chapter/Section: 15.4 Learning Outcome: 15.23 Global LO: G2 | G3 Bloom's Taxonomy: 3-4: Applying/Analyzing 29) In order to identify the minimum bactericidal concentration in broth dilution tests, what must be determined first? A) minimal inhibitory concentration B) minimal bacteriostatic concentration C) drug concentration and bacterial concentration D) how many bacteria grow on a plate from each of the broth dilution tests E) how successfully the bacteria grow in broth cultures Answer: A Chapter/Section: 15.4 Learning Outcome: 15.24 Bloom's Taxonomy: 1-2: Remembering/Understanding

30) If a superbug is resistant to an antibiotic due to horizontal gene transfer, the microbe is said to have A) evolutionary resistance. B) mutational resistance. C) natural resistance. D) intrinsic resistance. E) acquired resistance. Answer: E Chapter/Section: 15.5 Learning Outcome: 15.25 ASM LO: 1.2 | 1.3 Bloom's Taxonomy: 1-2: Remembering/Understanding 31) Pseudomonas aeruginosa is one of the most notoriously resistant pathogens. Which of the following mechanisms does this bacterial species use to evade antimicrobials? A) target alterations B) drug inactivation C) efflux pumps D) reduced permeability E) This bacterial species uses all of the possible ways to evade antimicrobials, which is why it is so good at it. Answer: C Chapter/Section: 15.5 Learning Outcome: 15.26 Bloom's Taxonomy: 1-2: Remembering/Understanding 32) In terms of personal health, why should vegetarians still care about the misuse of antibiotics in livestock? A) Livestock live happier lives without constantly eating antibiotics. B) Manure-contaminated water and manure-based fertilizers introduce resistant bacteria into the food chain. C) Manure-contaminated runoff is destroying aquatic life when this runoff gets into local waterways. D) Recreational water activities become a source of infection when manure-contaminated runoff finds its way into these areas. E) Food is often cross contaminated but it's better to have an easily treatable GI infection compared to an antibiotic resistant GI infection. Answer: B Chapter/Section: 15.5 Learning Outcome: 15.27 Global LO: G2 | G5 Bloom's Taxonomy: 3-4: Applying/Analyzing

33) Which of the following reasons to not take unnecessary antibiotics is false? A) Antibiotics cost money and are time consuming to take. B) Antibiotics can cause severe side effects like red man syndrome. C) Antibiotics are not safe to take during pregnancy. D) Taking unnecessary antibiotics can put you at risk for developing an antibiotic resistant bacterial infection that could be life threatening. E) Antibiotics can cause mild side effects such as diarrhea, nausea, sunburn, headache, vomiting, and a rash. Answer: C Chapter/Section: 15.5 Learning Outcome: 15.28 Global LO: G5 Bloom's Taxonomy: 1-2: Remembering/Understanding 34) Although all of the following microbes are of serious concern, which one is ranked as urgent on the CDC's list of top drug-resistant pathogens? A) Mycobacterium tuberculosis B) Clostridioides difficile (C. diff) C) Campylobacter D) E. coli strain K-12 E) Pseudomonas aeruginosa Answer: B Chapter/Section: 15.5 Learning Outcome: 15.29 Bloom's Taxonomy: 1-2: Remembering/Understanding 35) Which of the following is not an approach to combat drug-resistant bacteria? A) identify new antimicrobials B) find multidrug approaches C) pair a redesigned antimicrobial with inhibitors that block bacterial-resistance mechanisms D) use lytic bacteriophages to specifically target pathogens E) flood a patient's system with healthy bacteria to quickly remove access to nutrients and starve the pathogen Answer: E Chapter/Section: 15.5 Learning Outcome: 15.30 ASM LO: 1.3 Bloom's Taxonomy: 1-2: Remembering/Understanding

36) Drug A and Drug B are being developed and tested as potential antimicrobials. Drug A has a therapeutic index of 10, with a half-life of 1 hour, whereas Drug B has a therapeutic index of 90, with a half-life of 4 hours. Which drug should be chosen to continue on to the next stage of development? A) Drug A due to having a short half-life will not remain in the patient's system for very long, limiting potential side effects. B) Drug A due to having both a short half-life and a low therapeutic index. C) Drug B due to having a longer half-life will remain in the patient's system for longer, requiring less frequent dosing. D) Drug B due to having both a longer half-life and a higher therapeutic index. E) Neither Drug A or B would be suitable for further development as drugs should always have a therapeutic index of at least 100 to continue on to clinical trials. Answer: D Chapter/Section: 15.1 Learning Outcome: 15.6 Global LO: G2 ASM LO: 7.2 Bloom's Taxonomy: 3-4: Applying/Analyzing 37) What is/are the main challenges in using drugs from the penicillin family? A) These drugs tend to have a narrow therapeutic index. B) There drugs tend to cause patient allergies and numerous resistant bacterial strains have also arisen. C) These drugs tend to have serious side effects including hepatotoxicity and nephrotoxicity. D) These drugs have a long half-life, so close monitoring of the patient is required. E) These drugs generally are bacteriostatic rather than bactericidal, limiting their clinical effectiveness. Answer: B Chapter/Section: 15.2 Learning Outcome: 15.9 ASM LO: 2.2 Bloom's Taxonomy: 1-2: Remembering/Understanding

38) Which of the following drugs demonstrates the least effective minimal inhibitory concentration?

A) 2 B) 4 C) 5 D) 6 E) 9 Answer: C Chapter/Section: 15.4 Learning Outcome: 15.23 Global LO: G2 | G3 Bloom's Taxonomy: 3-4: Applying/Analyzing 39) Which of the following is the location where antimicrobial resistant strains of dangerous human pathogens most often arise? A) day care centers and elementary schools B) gyms and fitness centers C) underdeveloped and economically disadvantaged countries D) hospitals and other healthcare facilities E) farms and other agricultural areas Answer: D Chapter/Section: 15.5 Learning Outcome: 15.27 ASM LO: 1.3 Bloom's Taxonomy: 1-2: Remembering/Understanding

15.2 True/False Questions 1) A patient with bacterial meningitis will be given a bacteriostatic antibiotic, as well as an antiinflammatory steroid. Answer: FALSE Chapter/Section: 15.1 Learning Outcome: 15.3 Bloom's Taxonomy: 1-2: Remembering/Understanding 2) Nephrotoxic antimicrobial drugs can induce liver damage and are leading agents of druginduced liver injury. Answer: FALSE Chapter/Section: 15.1 Learning Outcome: 15.7 Bloom's Taxonomy: 1-2: Remembering/Understanding 3) When combating methicillin- and oxacillin-resistant Staphylococcus aureus strains, it is effective to administer alternative beta-lactam drugs. Answer: FALSE Chapter/Section: 15.2 Learning Outcome: 15.9 Bloom's Taxonomy: 1-2: Remembering/Understanding 4) Combination therapy uses two or more drugs in combination to decrease the likelihood that a pathogen will survive the therapy due to drug resistance. Answer: TRUE Chapter/Section: 15.2 Learning Outcome: 15.11 ASM LO: 1.3 Bloom's Taxonomy: 1-2: Remembering/Understanding 5) If two drugs that target different steps of the same biochemical pathway are used together, these two drugs tend to exhibit synergism. Answer: TRUE Chapter/Section: 15.2 Learning Outcome: 15.12 Bloom's Taxonomy: 1-2: Remembering/Understanding 6) Trimethoprim-sulfamethoxazole is an antifolate drug combination that works by blocking folate production in certain bacteria as well as in certain protozoans. Answer: TRUE Chapter/Section: 15.3 Learning Outcome: 15.18 Bloom's Taxonomy: 1-2: Remembering/Understanding

7) Although protozoan parasites develop drug resistance, it's difficult and time consuming to test them for their drug response, which means the prescribed therapy tends to use a trial-and error approach. Answer: TRUE Chapter/Section: 15.4 Learning Outcome: 15.20 ASM LO: 1.3 Bloom's Taxonomy: 1-2: Remembering/Understanding 8) Clostridioides difficile naturally forms endospores that inherently resist most antibiotics due to their dormant nature and their tough spore coat that blocks drug entry. Answer: TRUE Chapter/Section: 15.5 Learning Outcome: 15.25 Bloom's Taxonomy: 1-2: Remembering/Understanding 9) An E-test can be used to determine the minimal bactericidal concentration (MBC) of an antimicrobial drug. Answer: FALSE Chapter/Section: 15.4 Learning Outcome: 15.22 | 15.23 Bloom's Taxonomy: 1-2: Remembering/Understanding 10) The significant increase in antibiotic resistance is largely due to antibiotic overuse and misuse. Answer: TRUE Chapter/Section: 15.5 Learning Outcome: 15.27 Bloom's Taxonomy: 1-2: Remembering/Understanding 15.3 Essay Questions 1) Why is there not a clinical distinction between bacteriostatic and bactericidal antibiotics? Answer: An antimicrobial drug that is bactericidal for one pathogen may be bacteriostatic for another. Furthermore, a drug's bactericidal or bacteriostatic properties can change based on the drug dose, length of the drug regimen, pathogen load, and route of administration. Chapter/Section: 15.1 Learning Outcome: 15.3 Global LO: G2 | G8 ASM LO: 7.3a Bloom's Taxonomy: 3-4: Applying/Analyzing

2) In what ways are humans affected by agricultural practices that promote bacterial resistance? Answer: Although the U.S. Food and Drug Administration (FDA) has banned adding antimicrobials used in human medicine to animal feed for growth promotion purposes, the FDA still allows antimicrobials that are not approved for human use to be used as livestock growth enhancers. While this may seem like a way to prevent resistance to clinically useful antimicrobials, it is not necessarily a safe bet. Drugs used for animals have been documented to induce cross-resistance to human antibiotics. Resistant strains can then be introduced into humans through meat, the environment, animal handling, or through vegetable crops that are fertilized with manure or watered with reclaimed water that may be manure contaminated. Chapter/Section: 15.5 Learning Outcome: 15.27 Global LO: G2 | G5 | G8 ASM LO: 1.3 | 7.3a Bloom's Taxonomy: 3-4: Applying/Analyzing 3) Explain what ECE stands for and how it can help you to say no to a patient requesting a prescription for antibiotics for a viral infection. Answer: Empathy: Make it clear to your patient that you care about her, that you want to do the best thing for her short- and longer-term medical well-being, and that you know she is suffering and longing for relief. Take a moment to recall the last time you felt miserable and desperate to feel better. Share that feeling with her. Competence: Help your patient feel confident in your competence. Give her a peek into the systematic thought process that led to the diagnosis. Try to infuse some information about how viral and bacterial infections can be differentiated and share what features make it clear that she has a viral infection. Education: Close the "no" conversation with some education about antibiotics. Explain that antibiotics don't cure viral infections; they may cause adverse side effects such as diarrhea and nausea that may be just as unpleasant as a cold, and that if used unnecessarily they could be ineffective when they are really needed. Let your patient know that if her condition worsens or she develops new symptoms, you are there to help and will adjust the care plan as needed to best protect her health. Chapter/Section: 15.5 Learning Outcome: 15.28 Global LO: G2 | G5 | G8 ASM LO: 7.3a Bloom's Taxonomy: 3-4: Applying/Analyzing

Microbiology: Basic & Clinical Principles, 2e (Norman-McKay) Chapter 16 Respiratory System Infections 16.1 Multiple Choice Questions 1) The upper respiratory tract is lined with a mucous membrane that secretes mucus. What is the purpose of mucus? A) warms and humidifies the air we breathe B) cools and dries the air we breathe C) traps microbes and debris from the air we breathe D) warms and humidifies, and traps microbes and debris from the air we breathe E) cools and dries, and traps microbes from the air we breathe Answer: D Chapter/Section: 16.1 Learning Outcome: 16.1 | 16.2 Bloom's Taxonomy: 1-2: Remembering/Understanding 2) Which component of the lower respiratory tract is incorrectly matched with a function or description? A) Alveoli: Site of gas exchange B) Bronchioles: Have ciliated mucous membranes C) Bronchi: Direct air to the lungs D) Larynx: Contains the mucociliary escalator E) Lungs: Contain the alveolar sacs Answer: D Chapter/Section: 16.1 Learning Outcome: 16.1 Bloom's Taxonomy: 1-2: Remembering/Understanding 3) Infection in the respiratory tract is limited by all except A) alveolar macrophages. B) ciliated mucous membranes. C) coughing to bring microbes away from the lungs. D) the epiglottis sealing the airway during swallowing. E) resident microbiota. Answer: D Chapter/Section: 16.1 Learning Outcome: 16.2 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding

4) Which statement is not true about the resident microbiota of the respiratory tract? A) Normal microbiota are only found in the upper respiratory tract. B) Resident microbiota secrete antimicrobial peptides and compete with pathogens. C) The resident microbiota of a healthy person include a wide diversity of species. D) Smoking affects the numbers and types of species in the microbiota. E) The lungs have recently been found to contain a resident microbiome that resembles that found in the mouth. Answer: A Chapter/Section: 16.1 Learning Outcome: 16.4 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 5) Pneumonia is A) wheezing or loud breathing associated with airway obstruction. B) inflammation of the entire lower respiratory tract except the lungs. C) inflammation of the alveoli which interferes with gas exchange. D) shortness of breath. E) rapid swelling of the airway that can block breathing. Answer: C Chapter/Section: 16.1 Learning Outcome: 16.3 Bloom's Taxonomy: 1-2: Remembering/Understanding 6) A life-threatening bacterial infection that results in complete blockage of the airway due to swelling of a flap of tissue that normally protects the lungs during swallowing is A) croup. B) dyspnea. C) epiglottitis. D) hay fever. E) stridor. Answer: C Chapter/Section: 16.1 Learning Outcome: 16.3 Bloom's Taxonomy: 1-2: Remembering/Understanding

7) A two-year-old child presents to a pediatric practice with a barking cough and loud wheezing. The parent is alarmed and insists on antibiotics. What is the likely diagnosis, and are antibiotics appropriate? A) allergies / no, allergies are caused by irritants and are not infections B) croup / no, most cases are viral C) epiglottitis / yes, this is a life-threatening bacterial infection D) pneumonia / yes, this can be a life-threatening condition and is often bacterial E) sinusitis / no, most cases are due to viral infections or irritants Answer: B Chapter/Section: 16.1 Learning Outcome: 16.4 Bloom's Taxonomy: 3-4: Applying/Analyzing 8) Development of a successful vaccine to prevent acute respiratory infections (such as the common cold) is unlikely because A) there are many distinct virus strains and serovars that cause the common cold. B) humans do not generate a strong immune response to common cold viruses. C) there is a relatively low social and economic cost associated with the common cold. D) antibiotics easily cure the common cold. E) colds are easily misdiagnosed as something else. Answer: A Chapter/Section: 16.2 Learning Outcome: 16.5 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 9) Influenza differs from the common cold in that A) the virus is not subject to mutation. B) it can cause seasonal outbreaks. C) you can get only get influenza once. D) it is not treatable with antivirals. E) it has a higher mortality rate. Answer: E Chapter/Section: 16.2 Learning Outcome: 16.5 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding

10) The demographic(s) most at risk from respiratory syncytial virus is/are A) the elderly. B) young infants. C) both the elderly and young infants. D) smokers. E) pet owners. Answer: C Chapter/Section: 16.2 Learning Outcome: 16.6 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 11) Although each of the following viral groups causes acute respiratory illnesses, ________ can also be associated with conjunctivitis, gastroenteritis, or cystitis. A) adenovirus B) rhinovirus C) influenza virus D) respiratory syncytial virus E) human parainfluenza virus Answer: A Chapter/Section: 16.2 Learning Outcome: 16.6 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 12) Influenza A strains are characterized by A) the type of animal in which the strain originated. B) the country in which the strain originated. C) whether the virus contains DNA or RNA. D) the type of HA and NA spikes found on the viral surface. E) whether or not humans are infected. Answer: D Chapter/Section: 16.2 Learning Outcome: 16.7 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding

13) An unusual feature of the 1918 Spanish influenza pandemic is that A) most fatalities were among young adults, rather than infants or the elderly. B) it originated in Europe, rather than Asia as most influenza strains do. C) victims had unusually poor immune responses to the virus. D) most fatalities were among young adults, and victims had unusually poor immune responses to the virus. E) it originated in Europe, most fatalities were among young adults, and victims had unusually poor immune responses. Answer: A Chapter/Section: 16.2 Learning Outcome: 16.7 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 14) COVID-19 is caused by the A) SARS-CoV2 virus. B) MERS-CoV virus. C) influenza virus. D) paramyxovirus. E) SARS-CoV1 virus. Answer: A Chapter/Section: 16.2 Learning Outcome: 16.8 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 15) The spread of the SARS-CoV1 virus during the initial 2003 outbreak was successfully contained due to A) school closures. B) limiting global air travel. C) quarantine of exposed individuals. D) rapid development of a vaccine. E) limiting global air travel and quarantine of exposed individuals. Answer: E Chapter/Section: 16.2 Learning Outcome: 16.8 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding

16) A 21-year-old male was admitted to the hospital in severe respiratory distress. Despite care, he died of rapid pulmonary edema within 12 hours of admission. Family members reported that he had recently started work at a nearby state park. He was on a detail to clean out and renovate a group of rodent-infested rental cabins. Based on this information, what is the likely diagnosis? A) hanta pulmonary syndrome B) human parainfluenza virus infection C) influenza H1N1 D) respiratory syncytial virus E) SARS Answer: A Chapter/Section: 16.2 Learning Outcome: 16.10 ASM LO: 1.3 | 5.4 Bloom's Taxonomy: 3-4: Applying/Analyzing 17) A key factor in the high prevalence of otitis media in children is A) the orientation of the eustachian tube in children prevents efficient fluid drainage. B) the maturing of the innate and adaptive immune responses in children. C) the lack of a mature microbiome in the auditory canal. D) children do not complete their routine vaccine schedule until adolescence. E) children are more likely to suffer from colds and influenza than adults. Answer: A Chapter/Section: 16.3 Learning Outcome: 16.11 Bloom's Taxonomy: 1-2: Remembering/Understanding 18) This disease is caused by strains of Streptococcus pyogenes, which produce an erythrogenic toxin due to the presence of a lysogenized bacteriophage. A) rheumatic fever B) scarlet fever C) streptococcal pharyngitis D) bacterial pneumonia E) necrotizing fasciitis Answer: B Chapter/Section: 16.3 Learning Outcome: 16.12 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding

19) A child with no known congenital problems is diagnosed with inflammation of the heart valves. The medical history of the child is unremarkable except for a sore throat and fever six weeks prior, which the parents attributed to a common cold. The heart valve inflammation is most likely due to A) atypical pneumonia. B) autoimmune complications of Streptococcus pyogenes. C) Bordetella pertussis. D) Corynebacterium diphtheriae. E) tuberculosis. Answer: B Chapter/Section: 16.3 Learning Outcome: 16.12 ASM LO: 5.4 Bloom's Taxonomy: 3-4: Applying/Analyzing 20) The development of a pseudomembrane on the tonsils and throat is characteristic of A) diphtheria. B) pertussis. C) pneumococcal pneumonia. D) streptococcal pharyngitis. E) tuberculosis. Answer: A Chapter/Section: 16.3 Learning Outcome: 16.13 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 21) Pertussis is characterized by A) a high fever with a bright red rash across the body. B) a pneumonia-like infection acquired from air conditioning or water systems. C) a positive tuberculin skin test. D) high prevalence among those who handle birds. E) severe coughing attacks where the patient struggles to catch their breath. Answer: E Chapter/Section: 16.3 Learning Outcome: 16.14 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding

22) Recent reemergence of pertussis is due primarily to A) increased antibiotic resistance. B) reactivation of latent infections in older individuals. C) ease of global travel. D) waning immunity in adolescents and adults from the short-lived DTaP vaccine. E) increased human contact with animal reservoirs. Answer: D Chapter/Section: 16.3 Learning Outcome: 16.14 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 23) Latent tuberculosis A) accounts for only a small minority of cases. B) is easily spread through respiratory droplets. C) will eventually progress to active TB in most individuals. D) will result in a negative tuberculin skin test. E) results when M. tuberculosis bacteria are phagocytized and effectively walled off within granulomas in the lungs. Answer: E Chapter/Section: 16.3 Learning Outcome: 16.15 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 24) The infectious agent that causes tuberculosis is A) an acid-fast bacterial species of the genus Mycobacterium. B) one of several Gram-negative bacterial species. C) HIV. D) unpasteurized milk. E) avian influenza virus. Answer: A Chapter/Section: 16.3 Learning Outcome: 16.15 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding

25) A diagnostic sign of typical pneumonia is consolidation which A) appears as a white opaque region on a chest X-ray. B) is fluid rather than air in the alveoli. C) is a granuloma walling off infected phagocytes in the lungs. D) is fluid rather than air in the alveoli and appears as a white opaque region on a chest X-ray. E) is a granuloma walling off infected phagocytes in the lungs and appears as a clear region on a chest X-ray. Answer: D Chapter/Section: 16.3 Learning Outcome: 16.16 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 26) An elderly patient with no recent hospitalizations presents with shortness of breath, chest pain, a deep productive cough, and evidence of consolidation. Acid-fast and Gram stains are performed on a sputum sample. No acid-fast bacteria are detected but Gram-negative, nonencapsulated bacteria are observed. A likely diagnosis is A) influenza. B) Legionnaires' disease. C) Mycobacterium avium. D) nontypable Hemophilus influenzae B. E) Streptococcus pneumoniae. Answer: D Chapter/Section: 16.3 Learning Outcome: 16.16 ASM LO: 5.4 Bloom's Taxonomy: 3-4: Applying/Analyzing 27) The most common cause of atypical pneumonia, Mycoplasma pneumoniae, has all the following characteristics except A) no cell wall. B) a parasitic lifestyle inside host cells. C) contains more genes than most other bacteria. D) one of the smallest self-replicating organisms known. E) difficult to see with a standard light microscope. Answer: C Chapter/Section: 16.3 Learning Outcome: 16.17 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding

28) A wildlife biologist might be more likely than the average person to contract which types of atypical pneumonia? A) Legionnaires' disease and Q fever B) Q fever, psittacosis, and tularemia C) Legionnaires' disease and psittacosis D) tularemia, chlamydophila pneumonia, and psittacosis E) walking pneumonia, chlamydophila pneumonia, and Legionnaires' disease Answer: B Chapter/Section: 16.3 Learning Outcome: 16.17 ASM LO: 5.4 Bloom's Taxonomy: 3-4: Applying/Analyzing 29) Which of the following is not a factor in increased incidence of fungal infections? A) increasing antibiotic resistance B) climate change C) deforestation D) increasing number of people living with immunosuppression E) urban development Answer: A Chapter/Section: 16.4 Learning Outcome: 16.18 ASM LO: 1.3 Bloom's Taxonomy: 1-2: Remembering/Understanding 30) Endemic mycoses are A) due to changes in the patient's normal microbiota. B) restricted to a specific geographic location. C) caused by species that inhabit multiple ecological niches. D) easily transmitted person-to-person. E) unable to establish infections in healthy people. Answer: B Chapter/Section: 16.4 Learning Outcome: 16.19 ASM LO: 1.3 Bloom's Taxonomy: 1-2: Remembering/Understanding 31) A fungal species which can grow in varied climates and under diverse conditions is termed A) endemic. B) microbiotic. C) mycosis. D) normal. E) ubiquitous. Answer: E Chapter/Section: 16.4 Learning Outcome: 16.19 Bloom's Taxonomy: 1-2: Remembering/Understanding 10 Copyright © 2023 Pearson Education, Inc.

32) An endemic fungal infection that is found in the semi-arid to dry soils in the southwestern United States and Mexico is A) aspergillosis. B) blastomycosis. C) coccidioidomycosis. D) histoplasmosis. E) murcomycosis. Answer: C Chapter/Section: 16.4 Learning Outcome: 16.20 Bloom's Taxonomy: 1-2: Remembering/Understanding 33) Histoplasmosis should be suspected in cases of fungal respiratory infections found in A) cattle or dairy farm workers. B) construction workers. C) dog owners. D) HIV-AIDS patients. E) the Mississippi and Ohio River Valley regions. Answer: E Chapter/Section: 16.4 Learning Outcome: 16.20 Bloom's Taxonomy: 1-2: Remembering/Understanding 34) In an immunocompromised patient with pulmonary or rhinocerebral invasive fungal disease, suspect A) aspergillosis. B) mucormycosis. C) pneumocystis pneumonia. D) either aspergillosis or mucormycosis. E) either aspergillosis, mucormycosis, or pneumocystis pneumonia. Answer: D Chapter/Section: 16.4 Learning Outcome: 16.21 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding

35) Which statement does not apply to pneumocystis pneumonia and its causative organism, Pneumocystis jirovecii? A) The fungus does not make spores. B) Serological evidence suggests that most people are exposed to the organism in early childhood. C) The organism has some characteristics found in protozoans rather than fungi. D) Like all other pathogenic fungi, the reservoir is soil. E) HIV-AIDS patient are at high risk for this infection. Answer: D Chapter/Section: 16.4 Learning Outcome: 16.21 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 36) While all viruses experience antigenic drift, Influenza A has the special ability for antigenic shift because A) it has a positive-sense RNA genome. B) the genome consists of multiple segments that recombine when a host is co-infected with multiple strains of the virus. C) the virus is endemic. D) there are at least 18 different HA subtypes that have been identified. E) new vaccines must be developed every year. Answer: B Chapter/Section: 16.2 Learning Outcome: 16.7 ASM LO: 1.2 | 5.4 Bloom's Taxonomy: 3-4: Applying/Analyzing 37) Which of the following is not a common sign or symptom of COVID-19? A) anosmia B) fever and chills C) shortness of breath D) seizures E) headache Answer: D Chapter/Section: 16.2 Learning Outcome: 16.8 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding

38) Which of the following statements is not true regarding SARS-CoV2? A) Since it is an RNA virus, mutations will arise more frequently than in a DNA virus. B) While there are several new variants of SARS-CoV2, no new strains have yet been identified. C) Any active infection presents an opportunity for the virus to mutate and produce a new variant. D) New SARS-CoV2 variants are categorized as variants of interest, concern, or high consequence depending on the risk they present to the public. E) The virus will very likely become endemic, with a seasonal pattern similar to that seen for influenza viruses. Answer: B Chapter/Section: 16.2 Learning Outcome: 16.8 | 16.9 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 39) A nurse who works in a rehabilitation facility presents with a chronic cough, fatigue, and weight loss. Acid-fast and Gram stains are performed on a sputum sample. Small red bacilli are observed under the microscope when the acid-fast stain is performed. The likely causative agent of this infection is A) Mycobacterium tuberculosis. B) Influenza A. C) SARS-CoV2. D) Hemophilus influenzae B. E) Streptococcus pneumoniae. Answer: A Chapter/Section: 16.3 Learning Outcome: 16.15 ASM LO: 5.4 Bloom's Taxonomy: 3-4: Applying/Analyzing 16.2 True/False Questions 1) A healthy respiratory microbiome is dominated by species from the phyla Bacteroides, Firmicutes, and Proteobacteria. Answer: TRUE Chapter/Section: 16.1 Learning Outcome: 16.3 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 2) Sinusitis is routinely treated with antibiotics, which is appropriate because most cases are due to bacterial infections. Answer: FALSE Chapter/Section: 16.1 Learning Outcome: 16.4 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 13 Copyright © 2023 Pearson Education, Inc.

3) In most individuals, symptoms of the common cold and of influenza are virtually impossible to tell apart in severity. Answer: FALSE Chapter/Section: 16.2 Learning Outcome: 16.5 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 4) To date, only zoonotic strains of hantavirus have been detected. Answer: FALSE Chapter/Section: 16.2 Learning Outcome: 16.10 ASM LO: 1.3 Bloom's Taxonomy: 1-2: Remembering/Understanding 5) The diphtheria vaccine is a toxoid vaccine made using inactived diptheria toxin; therefore, the prevalence of asymptomatic carriers of Corynebacterium diphtheriae may be high even as prevalence of the disease itself is low. Answer: TRUE Chapter/Section: 16.3 Learning Outcome: 16.13 ASM LO: 5.4 Bloom's Taxonomy: 3-4: Applying/Analyzing 6) A positive tuberculin skin test definitively indicates the presence of an active tuberculosis infection. Answer: FALSE Chapter/Section: 16.3 Learning Outcome: 16.15 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 7) Mycoses are becoming more common due to changes in the patient population, such as immunosuppression, as well as environmental and ecological changes. Answer: TRUE Chapter/Section: 16.4 Learning Outcome: 16.18 ASM LO: 1.3 Bloom's Taxonomy: 1-2: Remembering/Understanding

8) Endemic fungal infections are most likely to occur in immunocompromised patients while ubiquitous fungal infections are routinely found in otherwise healthy individuals. Answer: FALSE Chapter/Section: 16.4 Learning Outcome: 16.20 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 9) The SARS-CoV2 virus uses its spike proteins to gain entry into host cells by binding to angiotensin-converting enzyme (ACE-2) on the host cell surface. Answer: TRUE Chapter/Section: 16.2 Learning Outcome: 16.8 Bloom's Taxonomy: 1-2: Remembering/Understanding 10) SARS-CoV2 (the causative agent of COVID-19) was the first coronavirus to be discovered. Answer: FALSE Chapter/Section: 16.2 Learning Outcome: 16.9 Bloom's Taxonomy: 1-2: Remembering/Understanding 16.3 Essay Questions 1) Describe the anatomical and physiological features of the respiratory system that limit the establishment of pathogenic organisms. Answer: When air enters the upper respiratory tract, it passes through the paranasal sinus cavities. These cavities are lined with mucous membranes which secrete mucus to trap microbes and debris. The mucus is swept toward the nose and mouth for expulsion by cilia, hair-like projections lining the airway. In the pharynx, the epiglottis is a cartilage structure that seals the entry to the lower respiratory tract while swallowing, preventing the entry of food, beverages, and associated microorganisms to the lungs. The lower respiratory tract airways, which include the trachea, bronchi, and bronchioles, are lined with ciliate mucous membranes, which trap microbes and debris and sweep them upward away from the lungs. This is called the mucociliary escalator. Respiratory infection symptoms such as a runny nose, cough, and sneezing help to expel pathogens but also provide a means for the pathogen to move to the next host. The respiratory tract has an abundant microbiome, even in the lungs. Microbiome members may prevent the establishment of pathogens by competing with pathogens for space and producing antimicrobial peptides. Chapter/Section: 16.1 Learning Outcome: 16.1 | 16.2 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding

2) Describe the progression of infection in latent vs. active tuberculosis along with diagnostic criteria and treatment options. Answer: Tuberculosis (TB) is a highly communicable bacterial disease spread by respiratory droplets. Despite a high global incidence and easy transmission, the vast majority of TB cases remain latent. In latent TB, inhaled bacteria are engulfed by phagocytes in the lungs. Some bacterial cells can survive inside the macrophage; however, these infected macrophages are detected by the immune system and walled off within a fibrous granuloma. Approximately 90% of such cases will remain latent for the rest of the patient's lifetime. The remaining cases will progress to active TB at some point in the future. Active TB develops when the center of the granuloma liquifies and breaks down, allowing bacteria to spread to other parts of the lung or other organs, and be transmitted to others. The most common screening test for TB is the tuberculin skin test; however, it can only show past exposure through infection or vaccination and cannot distinguish between active and latent TB. Interferon gamma assays and Xpert MTB/RIF likewise cannot differentiate between active and latent TB. Culturing and microscopy of the acid-fast bacterium can detect active TB but not latent. A chest X-ray can be used on a patient who tests positive through a screening method and may detect lung damage due to active TB. Latent TB is treated with rifampin and/or isoniazid for 4-9 months. Active TB requires treatment with multiple antibiotics from 6 months to two years depending on the antibioticresistance profile of the strain involved. Chapter/Section: 16.3 Learning Outcome: 16.15 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding

3) Contrast endemic and ubiquitous fungal infections, and describe two examples of each type. Answer: Fungi termed endemic require specific climate and soil conditions for their growth and are restricted to specific geographic areas. These infections may impact any person who inhales fungal spores. Ubiquitous fungi are widely distributed ecologically and geographically, and may even be members of the normal human microbiome. Ubiquitous fungal infections are also acquired when fungal spores are inhaled, but are generally a danger only to immunocompromised patients. Specific endemic fungal infections include blastomycosis, coccidioidomycosis, and histoplasmosis. Blastomycosis (Blastomyces dematitidis) is found in the Ohio and Mississippi River Valleys, the Great Lakes and the St. Lawrence seaway regions. The fungus thrives in soils with decomposing plant matter and becomes airborne by digging, wood clearing, or construction. Treatment is available, but the infection has a 40% mortality rate in immunocompromised patients. Coccidioidomycosis (Coccidioides immitis and C. posadasii) is also called Valley fever and is found in the semi-arid and dry areas of the southwestern United States, northern Mexico, and Central and South America. In the lungs, the fungi form multinucleated structures called spherules which contain fungal endospores. When the spherules rupture, the endospores are released and cause lung damage. Histoplasmosis (Histoplasma capsulatum) thrives in soil enriched with bird or bat droppings. The fungus is global but concentrated in the Ohio and Mississippi River Valleys. Workers who are exposed to droppings are at greatest risk for infection, and immunocompromised patients are mostly likely to develop the disseminated, systemic form of the disease. Three common ubiquitous fungal infections include aspergillosis, mucormycosis, and pneumocystis pneumonia (PCP). Most people are exposed to aspergillus spores (Aspergillus fumigatus) on a routine basis; organ transplant patients and chemotherapy or corticosteroid recipients are most at risk to develop invasive disease, of which pulmonary and rhinocerebral are the most common forms. Mucormycosis is caused by a fungus (Rhizopus arrhizus) that is found in soil enriched with rotting wood material. Invasive forms also include pulmonary and rhinocerebral disease. PCP (Pneumocystis jirovecii) is found in AIDS patients and others who are severely immunosuppressed. This fungus is not found in soil but probably is spread by asymptomatic human carriers. Preventative and treatment medications are available; untreated cases have a 100% fatality rate while treatment lowers mortality to 40%. Chapter/Section: 16.4 Learning Outcome: 16.18 | 16.19 | 16.20 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding

Microbiology: Basic & Clinical Principles, 2e (Norman-McKay) Chapter 17 Skin and Eye Infections 17.1 Multiple Choice Questions 1) The presence of ________, a waterproofing protein, in epidermis prevents many microorganisms from gaining access to the body. A) antibiotics B) keratin C) lysozyme D) melanin E) sebum Answer: B Chapter/Section: 17.1 Learning Outcome: 17.1 ASM LO: 3.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 2) Why is perspiration an effective defense against microorganisms? A) basic pH B) low salt content C) presence of lysozyme D) basic pH and low salt content E) basic pH, low salt content, and presence of lysozyme Answer: C Chapter/Section: 17.1 Learning Outcome: 17.1 ASM LO: 3.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 3) Which factor may influence the specific types of microbes found on the skin? A) hormones B) moisture levels C) soap and cosmetics usage D) moisture levels and soap and cosmetics usage E) hormones, moisture levels, and soap and cosmetics usage Answer: E Chapter/Section: 17.1 Learning Outcome: 17.2 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding

4) Which primary skin lesion is incorrectly matched with its description? A) Cyst: Closed fluid-filled sac deep in skin B) Macule: Flat, discolored area of the skin C) Papule: Sore of irregular size and shape that results as epidermal and dermal skin layers are destroyed D) Pustule: Raised lesion with pus below the surface E) Vesicle: Elevated lesion with clear fluid Answer: C Chapter/Section: 17.1 Learning Outcome: 17.3 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 5) These two secondary lesions arise when bleeding or burst capillaries occur in the skin. A) bullae and vesicles B) crust and scale C) cysts and ulcers D) papular and maculopapular rashes E) petechiae and purpura Answer: E Chapter/Section: 17.1 Learning Outcome: 17.3 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 6) Which factor, beginning in 1995, is responsible for the decline in chicken pox from a routine childhood disease to a rare infection? A) routine vaccination B) development of effective anti-viral medications C) natural evolution of the virus to a less virulent form D) ecological changes affecting the natural reservoir of the virus E) changes in global migration patterns Answer: A Chapter/Section: 17.2 Learning Outcome: 17.4 ASM LO: 3.4 Bloom's Taxonomy: 1-2: Remembering/Understanding

7) Which virus results in shingles when it is reactivated with peripheral nerves? A) HSV-1 B) rubeola C) rubella D) varicella-zoster E) variola major Answer: D Chapter/Section: 17.2 Learning Outcome: 17.4 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 8) Which statement describes an important similarity between chickenpox and smallpox? A) Both have a similar mortality rate of about 30%. B) Both are caused by viruses which lie dormant in nerve cells and be reactivated later in life. C) Both involve the formation of a vesicular rash. D) Both are treatable with antiviral therapy. E) Vaccinations against both are recommended for all children. Answer: C Chapter/Section: 17.2 Learning Outcome: 17.5 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 9) Which is not a specific cause of reactivation of HSV-1? A) hormonal changes B) stress C) ultraviolet radiation D) having a cold or fever E) menstruation Answer: D Chapter/Section: 17.2 Learning Outcome: 17.6 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 10) A maculopapular rash is characteristic of A) measles. B) chickenpox. C) warts. D) measles and chickenpox. E) chickenpox and warts. Answer: A Chapter/Section: 17.2 Learning Outcome: 17.8 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 3 Copyright © 2023 Pearson Education, Inc.

11) A parent calls the pediatrician's office about uncomfortable sores on the inside of her child's mouth. You suspect hand, foot, and mouth disease (HFMD), but need to rule out measles. Which information could help you to rule out measles? A) vaccination history B) other symptoms of illness such as fever and sore throat C) presence of a rash on the face, trunk, and extremities D) vaccination history and other symptoms of illness such as fever and sore throat E) vaccination history, other symptoms of illness such as fever and sore throat, and presence of a rash on the face, trunk, and extremities Answer: A Chapter/Section: 17.2 Learning Outcome: 17.8 Global LO: G2 ASM LO: 5.4 Bloom's Taxonomy: 3-4: Applying/Analyzing 12) You are a nurse serving as a medical volunteer in a refugee camp. Due to extreme poverty, political instability, and displacement, most individuals at the camp have not received any preventative medical care, including vaccinations. While providing care to a young woman in about the fourth month of pregnancy, she mentions that several children, including her toddler, suffered from a mild illness last month. Her toddler had a low fever, a runny nose, and a rash that started on his face then moved downward. The illness resolved quickly in all the children. What illness might the children have had and why should you be concerned? A) Hand, foot, and mouth disease; the virus may re-activate at a later time. B) Measles; the children may be more susceptible to other infections. C) Measles; the child may develop shingles at a later time. D) Rubella; it is a mild, self-limiting disease so there are no further concerns. E) Rubella; the unborn child of the exposed mother may be stillborn or suffer from birth defects. Answer: E Chapter/Section: 17.2 Learning Outcome: 17.8 Global LO: G2 ASM LO: 5.4 Bloom's Taxonomy: 3-4: Applying/Analyzing 13) A distinctive red rash on the cheeks with an otherwise mild illness is most likely A) chickenpox. B) fifth disease. C) measles. D) roseola. E) rubella. Answer: B Chapter/Section: 17.2 Learning Outcome: 17.8 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 4 Copyright © 2023 Pearson Education, Inc.

14) Which statement is not true about viral warts? A) Papillomaviruses are the cause of many warts. B) Plantar warts are found on the feet. C) Warts result from abnormal cell growth and so are highly likely to become cancerous. D) Warts can spread from one part of the body to another via autoinoculation. E) Warts can be removed but may return later. Answer: C Chapter/Section: 17.2 Learning Outcome: 17.9 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 15) Which factor is not a reason Propionibacterium acnes (P. acnes) is often associated with acne? A) the ability of P. acnes to metabolize sebum B) biofilm formation by P. acnes in pores and glands C) increased oxygen levels in clogged pores favoring bacterial growth D) increased sebum production during adolescence E) the inflammatory responses to P. acnes which causes pustules and cysts Answer: C Chapter/Section: 17.3 Learning Outcome: 17.10 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 16) What role do capsules and protein A play as virulence factors of Staphylococcus aureus? A) break down blood clots B) form blood clots C) lyse red blood cells D) protect the bacterium from neutrophils E) protect the bacterium from phagocytosis Answer: E Chapter/Section: 17.3 Learning Outcome: 17.11 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding

17) Which staphylococcal infection is not correctly matched with its description? A) Cellulitis: Deep infection of the lower dermal and subcutaneous fat B) Erysipelas: A milder form of impetigo with only localized inflammation and mild pain C) Impetigo: Presence of pus-filled vesicles on the face, lips, or extremities, usually in children D) Folliculitis: Swollen, red, pus-filled hair follicles E) Scalded skin syndrome: Caused by the production of an exfoliative toxin Answer: B Chapter/Section: 17.3 Learning Outcome: 17.11 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 18) Which virulence factor of Group A streptococci (GAS) is responsible for the rapid spread of tissue death in necrotizing fasciitis? A) coagulase B) hyaluronidase C) streptokinase D) coagulase and hyaluronidase E) hyaluronidase and streptokinase Answer: E Chapter/Section: 17.3 Learning Outcome: 17.12 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 19) In streptococcal toxic shock syndrome, pathology results from toxins in the bloodstream which may cause both a red skin rash, as well as A) a decrease in blood pressure leading to organ failure. B) peeling away of the epidermal layer of skin. C) degradation of connective tissue. D) formation of a blue- or green-colored pus. E) release of foul-smelling gases from the infection site. Answer: A Chapter/Section: 17.3 Learning Outcome: 17.12 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding

20) Cultures taken from an impetigo lesion reveal bacteria that are Gram-positive cocci which are catalase- and coagulase-negative and cause beta-hemolysis when cultured on blood agar. The responsible species is A) Clostridium perfringens. B) Pseudomonas aeruginosa. C) Staphylococcus aureus. D) staphylococci species other than Staphylococcus aureus. E) Streptococcus pyogenes. Answer: E Chapter/Section: 17.3 Learning Outcome: 17.13 Global LO: G2 ASM LO: 5.4 Bloom's Taxonomy: 3-4: Applying/Analyzing 21) Which patient group is least susceptible to infections by pseudomonads? A) burn patients B) cystic fibrosis patients C) competitive swimmers who train daily D) organ transplant recipients on immunosuppressive drugs E) otherwise healthy mothers in childbirth Answer: E Chapter/Section: 17.3 Learning Outcome: 17.14 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 22) Pyocyanin, a greenish-blue pigment produced by pseudomonads, acts as a virulence factor by A) breaking down reactive oxygen species. B) digesting lipids in tissues. C) forming a biofilm. D) generating reactive oxygen species. E) lysing red blood cells. Answer: D Chapter/Section: 17.3 Learning Outcome: 17.14 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding

23) A hospital burn unit has experienced ongoing problems with pseudomonad infections in multiple wards despite attention to patient hygiene and environmental sanitation. Which of the following would not be a possible source of the bacteria? A) hospital cafeteria B) hospital floral shop C) patient room cleaning supplies D) skin microbiota of staff E) therapy pool in the physical therapy department Answer: A Chapter/Section: 17.3 Learning Outcome: 17.14 Global LO: G2 ASM LO: 5.4 Bloom's Taxonomy: 3-4: Applying/Analyzing 24) Tissue necrosis caused by Clostridium perfringens may be distinguished from necrotizing fasciitis in what way? A) presence of Gram-positive, endospore forming bacilli in the affected area B) presence of Gram-positive, catalase-negative cocci in the affected area C) emission of foul-smelling gases from the damaged tissue D) emission of foul-smelling gases from the damaged tissue and presence of Gram-positive, catalase-negative cocci in the affected area E) presence of Gram-positive, endospore forming bacilli in the affected area and emission of foul-smelling gases from the damaged tissue Answer: E Chapter/Section: 17.3 Learning Outcome: 17.15 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 25) Cutaneous mycoses usually A) are not associated with changes in the normal microbiota. B) are invasive with a considerable risk of fatality. C) occur in the deeper dermal layers or in muscles. D) respond quickly to treatment with a single dose of topical antifungal medication. E) are superficial infections on the skin, hair, or nails. Answer: E Chapter/Section: 17.4 Learning Outcome: 17.16 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding

26) A contributing factor to cutaneous candidiasis might be A) dry, exposed skin. B) hyperactive immune function. C) a shift in normal microbiota. D) dry, exposed skin and hyperactive immune function. E) a shift in normal microbiota and hyperactive immune function. Answer: C Chapter/Section: 17.4 Learning Outcome: 17.17 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 27) Which does not apply to ringworm infections? A) caused by a worm B) may manifest as a round skin lesion with a scaly red margin C) may occur on the feet, groin, scalp, nails, or body D) caused by members of the normal skin biota E) can be acquired by direct or indirect contact Answer: A Chapter/Section: 17.4 Learning Outcome: 17.18 ASM LO: 5.3 Bloom's Taxonomy: 1-2: Remembering/Understanding 28) What type of infection is shown?

A) candidiasis B) impetigo C) leishmaniasis D) subcutaneous mycoses E) tinea Answer: E Chapter/Section: 17.4 Learning Outcome: 17.18 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 9 Copyright © 2023 Pearson Education, Inc.

29) Which of the following skin infections is caused by a protozoan? A) cutaneous anthrax B) cutaneous candidiasis C) dermatophytic infections D) leishmaniasis E) otitis externa Answer: D Chapter/Section: 17.5 Learning Outcome: 17.19 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 30) Which statement is not true about leishmaniasis? A) It is transmitted by sand flies. B) Over twenty different Leishmania species may cause leishmaniasis. C) It is most prevalent in the tropics and subtropics. D) It is a slow infection that can persist for months to years. E) It is preventable by a vaccine which is recommended for travelers to endemic areas. Answer: E Chapter/Section: 17.5 Learning Outcome: 17.19 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 31) Which protective mechanism of the eye is incorrectly matched with its description? A) Conjunctiva: Transparent layer which protects the iris B) Lacrimal gland: Produces tears C) Lactoferrin: Binds up free iron which some microbes require D) Lysozyme: Breaks down bacterial cell walls E) Tears: Washes away microbes and contains antimicrobial chemicals Answer: A Chapter/Section: 17.6 Learning Outcome: 17.20 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 32) The common infection known as "pink eye" is an infection of the A) conjunctiva. B) cornea. C) iris. D) retina. E) sclera. Answer: A Chapter/Section: 17.6 Learning Outcome: 17.21 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 10 Copyright © 2023 Pearson Education, Inc.

33) A small child presents to the pediatric office with a reddened sclera, itchy eyes, and a watery, clear discharge from the affected eye. The most likely diagnosis is A) bacterial conjunctivitis. B) trachoma. C) viral conjunctivitis. D) either bacterial conjunctivitis or trachoma; further tests are needed. E) cannot be distinguished between bacterial or viral conjunctivitis so antibiotic treatment is given regardless. Answer: C Chapter/Section: 17.6 Learning Outcome: 17.21 Global LO: G2 ASM LO: 5.4 Bloom's Taxonomy: 3-4: Applying/Analyzing 34) While on a medical volunteer trip to an impoverished country, you encounter a patient whose eyelids are turned inward as shown. What is the cause and the best treatment?

A) Acanthamoeba; corneal transplant will likely be necessary B) neonatal bacterial conjunctivitis; antibiotic or silver drops should have been given at birth C) onchocerciasis (river blindness); doxycycline D) trachoma; single dose of oral azithromycin E) viral conjunctivitis; no treatment but the condition will resolve with time Answer: D Chapter/Section: 17.6 Learning Outcome: 17.22 Global LO: G2 ASM LO: 5.4 Bloom's Taxonomy: 3-4: Applying/Analyzing

35) Several forms of keratitis are linked to A) day care centers. B) hospitals or other healthcare settings. C) improper handling of contact lenses. D) re-activation of a herpes virus infection. E) vertical transmission during childbirth. Answer: C Chapter/Section: 17.6 Learning Outcome: 17.23 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 36) Onchocerciasis, or river blindness, is caused by a ________ and is spread via ________. A) bacterium; gnats which swarm near the eye B) fungus; contaminated contact lens solution C) helminth; blackflies D) protozoan; contaminated water E) virus; fomites such as towels or bedding Answer: C Chapter/Section: 17.6 Learning Outcome: 17.23 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 17.2 True/False Questions 1) The numbers and types of microbes found in the normal skin microbiota are consistent across all body surfaces. Answer: FALSE Chapter/Section: 17.1 Learning Outcome: 17.2 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 2) As measles vaccination rates have declined in recent years due to concerns about the vaccine, there have been no documented outbreaks of the disease, showing that the measles virus has been successfully eliminated from the population. Answer: FALSE Chapter/Section: 17.2 Learning Outcome: 17.7 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding

3) Even though rubella is a mild, self-limiting disease, vaccination remains important to prevent severe neurological damage to babies whose mothers are exposed to rubella in utero. Answer: TRUE Chapter/Section: 17.2 Learning Outcome: 17.7 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 4) Methicillin-resistant Staphylococcus aureus (MRSA) cause the same infections as nonresistant S. aureus stains; however, the bacterium has evolved cell-wall building enzymes which do not bind with methicillin and other beta-lactam antibiotics. Answer: TRUE Chapter/Section: 17.3 Learning Outcome: 17.11 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 5) Because pseudomonads are widespread in the environment and are versatile in their metabolic capabilities, skin infections with these bacteria are common even in healthy people with no skin breaches. Answer: FALSE Chapter/Section: 17.3 Learning Outcome: 17.14 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 6) Most fungal skin infections are likely to remain superficial except in individuals who are immunocompromised. Answer: TRUE Chapter/Section: 17.4 Learning Outcome: 17.16 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 7) The eyes lack a protective normal microbiota. Answer: FALSE Chapter/Section: 17.6 Learning Outcome: 17.20 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding

8) Keratitis is an inflammation of the cornea and can be caused by members of all microbial groups except viruses. Answer: FALSE Chapter/Section: 17.6 Learning Outcome: 17.23 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 17.3 Essay Questions 1) Describe how latency contributes to the infection process of the Varicella-Zoster and Herpes simplex-1 viruses. Answer: The Varicella-Zoster virus causes chickenpox. After a 14-16 day incubation, the initial illness manifests as an itchy vesicular rash which may be widespread over the entire body. Fever may accompany the illness. After about a week, the vesicles scab over and slowly heal. At this point the virus enters latency in various peripheral nerves. The virus may re-emerge as a more limited outbreak of vesicles called shingles. Shingles lesions tend to be localized on the torso or face, and are often painful. Herpes simplex 1 (HSV-1) is responsible for a vesicular rash known as "cold sores" or "fever blisters", usually around the lips. After the initial illness, HSV-1 becomes latent in either the trigeminal nerve, or less commonly, the optic nerve. Re-activation of the virus may be caused by ultraviolet radiation, menstruation or other hormonal changes, or stressful conditions. HSV-1 may also manifest on other parts of the body such as herpes gladitorum or herpes whitlow. Chapter/Section: 17.2 Learning Outcome: 17.4 | 17.6 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding

2) Describe and contrast three types of bacterial skin infections that can lead to tissue necrosis and death. Name and characterize the causative bacteria, and describe epidemiological and clinical features of each disease. Answer: Necrosis is tissue death and is usually caused by reduced blood flow to an area. Several bacterial infections can result in localized or spreading tissue necrosis. Necrotizing fasciitis is often caused by Streptococcus pyogenes, also known as Group A streptococci (GAS). S. pyogenes produces a number of virulence factors such as hyaluronidase and lipase that break down tissue and facilitate the spread of the bacteria. M protein on the surface of the bacterium serves as a binding site for plasminogen which triggers a tissue degradation cascade. Gas gangrene is caused by Clostridium perfringens, a soil bacterium which may infect deep wounds. The low-oxygen environment of deep wounds stimulates the growth of the anaerobic clostridia which produces toxins which can lead to rapid tissue death. Cutaneous anthrax is caused by Bacillus anthracis, a bacterium found in soil and often transmitted to human through contact with infected animals or their parts. The bacteria may enter skin abrasions to form a solid, blackened skin nodule. Exotoxins kill first superficial then deeper skin cells. In most cases, the damage stays localized, but prompt treatment is required. Chapter/Section: 17.3 Learning Outcome: 17.12 | 17.15 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 3) Describe the causative agent, epidemiology, presentation, and treatment for 3 causes of infectious blindness. Answer: Trachoma, caused by Chlamydia trachomatis is the leading cause of preventable microbial blindness. The infection causes scarring of the conjunctiva lining the eyelid, causing the eyelid to turn inward. The eyelashes then scratch the cornea, leading to permanent damage. The infection is acquired by contaminated fomite or by flies which have picked up the bacteria from the environment. The preferred treatment is a single dose of azithromycin. Various microbe can cause keratitis, a severe inflammation of the cornea. Viral keratitis is caused by reactivation of Herpes simplex-1, while bacterial and fungal keratitis is often linked to poor contact lens hygiene. Acanthamoeba, or protozoan keratitis, is caused by exposure to this organisms in natural or tap water sources. Swimming or improper contact lens hygiene is the major mode of transmission. Without early treatment, corneal transplant surgery is necessary to restore site. Onchocerciasis, or river blindness, is caused by a parasitic helminth and spread by biting blackflies. The larvae of the helminth are introduced to the skin, and may migrate to the eye. The resulting inflammation damages the optic nerve. Ivermectin and doxycycline are used for treatment. Chapter/Section: 17.6 Learning Outcome: 17.22 | 17.23 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding

Microbiology: Basic & Clinical Principles, 2e (Norman-McKay) Chapter 18 Nervous System Infections 18.1 Multiple Choice Questions 1) Which of the following comprises the peripheral nervous system? A) nerves B) brain C) spinal cord D) skin E) meninges Answer: A Chapter/Section: 18.1 Learning Outcome: 18.1 Bloom's Taxonomy: 1-2: Remembering/Understanding 2) The ________ sense internal and external stimuli, and send out responses in the form of chemical messengers called ________. A) muscles; chemokines B) neurons; neurotransmitters C) meninges; axons D) cerebrospinal fluids; myelins E) dendrites; arachnoids Answer: B Chapter/Section: 18.1 Learning Outcome: 18.2 Bloom's Taxonomy: 1-2: Remembering/Understanding 3) The term "gut-brain axis" describes the complex, back-and-forth communication that occurs between all of the following except the A) endocrine system. B) immune system. C) muscular system. D) digestive system. E) nervous system. Answer: C Chapter/Section: 18.1 Learning Outcome: 18.2 Bloom's Taxonomy: 1-2: Remembering/Understanding

4) Which of the following is the layer of the meninges that has direct contact with the brain? A) dura mater B) arachnoid mater C) pia mater D) dinan mater E) geezin mater Answer: C Chapter/Section: 18.1 Learning Outcome: 18.3 Bloom's Taxonomy: 1-2: Remembering/Understanding 5) Which of the following is a function of the meninges? A) remove waste B) supply nutrients C) protect the CNS from physical shocks D) supply oxygen E) supply nutrients, remove waste, and protect the CNS from physical shocks Answer: E Chapter/Section: 18.1 Learning Outcome: 18.3 Bloom's Taxonomy: 1-2: Remembering/Understanding 6) Which type of molecule can diffuse through the blood-brain barrier? A) very small molecules B) lipophilic molecules C) glucose molecules D) very small molecules and lipophilic molecules E) hydrophilic molecules and glucose molecules Answer: D Chapter/Section: 18.1 Learning Outcome: 18.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 7) What is it called when there is only inflammation of the brain? A) encephalitis B) meningitis C) encephalomyelitis D) meningoencephalitis E) endocarditis Answer: A Chapter/Section: 18.1 Learning Outcome: 18.5 Bloom's Taxonomy: 1-2: Remembering/Understanding

8) What diagnostic tool is used to confirm a diagnosis of meningitis or encephalitis? A) throat swap B) computed tomography (CT scan) C) magnetic resonance imaging (MRI) D) lumbar puncture E) blood count Answer: D Chapter/Section: 18.1 Learning Outcome: 18.5 Bloom's Taxonomy: 1-2: Remembering/Understanding 9) Which of the following diseases cause flu-like symptoms in most people infected, but can cause muscle weakness or paralysis? A) spongiform encephalopathy B) toxoplasmosis C) tetanus D) rabies E) polio Answer: E Chapter/Section: 18.2 Learning Outcome: 18.6 Bloom's Taxonomy: 1-2: Remembering/Understanding 10) Which of the following versions of the polio vaccine is preferred in the United States? A) oral polio vaccine which is made up of an attenuated viral strain B) inactivated polio vaccine which is injected into muscle and requires several boosters C) antibiotic treatment to clear the infection D) transgenic DNA vaccine, which is made by inserting DNA for polio capsid proteins into the genome of a nonvirulent virus E) Currently no vaccine is available, and patient isolation is the preferred method of control. Answer: B Chapter/Section: 18.2 Learning Outcome: 18.6 Bloom's Taxonomy: 1-2: Remembering/Understanding

11) Which of the following about the pathogenesis of rabies is false? A) the virus slowly replicates in the muscle cells leading to a long incubation period that lasts from two months to a year B) the virus rapidly travels through neurons, replicating and spreading to the CNS C) the rabies virus lyses host cells which explains neurological symptoms including pharyngeal spasms, confusion, loss of coordination, delirium, and the characteristic hydrophobia D) a diagnostic sign of rabies is the formation of Negri bodies, small clusters of virus inside the neurons E) after invading brain cells, rabies spreads back out into the PNS where it replicates and is shed from tissues that are well supplied with nerves, including the salivary glands Answer: C Chapter/Section: 18.2 Learning Outcome: 18.7 Bloom's Taxonomy: 1-2: Remembering/Understanding 12) Patients who suspect exposure to rabies are A) injected with antirabies antibodies. B) injected with the inactivated vaccine. C) injected with the attenuated vaccine. D) injected with both antirabies antibodies and the inactivated vaccine. E) injected with both antirabies antibodies and the attenuated vaccine. Answer: D Chapter/Section: 18.2 Learning Outcome: 18.7 Bloom's Taxonomy: 1-2: Remembering/Understanding 13) Which of the following is not an arbovirus? A) West Nile B) La Crosse C) dengue D) Lyme disease E) Rabies Answer: E Chapter/Section: 18.2 Learning Outcome: 18.8 Bloom's Taxonomy: 1-2: Remembering/Understanding

14) How do arboviruses cause nervous system infections? A) The virus invades and destroys the blood vessel cells that form the blood-brain barrier. B) The virus is small enough to pass through the blood-brain barrier. C) The virus gains entry into the CNS by hijacking neurons of the PNS. D) The virus produces toxins that damage neuron connections. E) The virus is capable of crossing the blood-brain barrier by binding to transport proteins in the capillaries meant to be used for various nutrients. Answer: A Chapter/Section: 18.2 Learning Outcome: 18.8 Bloom's Taxonomy: 1-2: Remembering/Understanding 15) What is the best way to protect the population against Haemophilus influenza type b infections? A) Since the chances of complications are rare, no treatment is required. B) use of the Hib vaccine in young children C) antibiotic treatment after onset of symptoms D) antitoxin treatment when exposure has occurred E) IV fluids are commonly prescribed due to loss of fluids. Answer: B Chapter/Section: 18.3 Learning Outcome: 18.9 Bloom's Taxonomy: 1-2: Remembering/Understanding 16) Neisseria meningitidis, which causes meningococcal meningitis, is capable of triggering sporadic disease outbreaks by which of the following methods? A) hides from the immune system inside neurons B) mutations due to utilization of reverse transcriptase C) capsular switching D) infecting compromised hosts E) efficient spreading in the host by breaking down blood clots Answer: C Chapter/Section: 18.3 Learning Outcome: 18.10 Bloom's Taxonomy: 1-2: Remembering/Understanding 17) What is so particular about the onset and course of meningococcal meningitis? A) Resulting diarrhea is particularly bloody if not treated within the first 24 hours. B) Rash begins on patient extremities and spreads to the torso as patient itches. C) Bacteria are only spread through contact with sweat. D) If not treated, death can occur within hours of fever onset. E) The incubation time for this type of bacteria is always 30 days. Answer: D Chapter/Section: 18.3 Learning Outcome: 18.10 Bloom's Taxonomy: 1-2: Remembering/Understanding 5 Copyright © 2023 Pearson Education, Inc.

18) Group B Streptococcus is most likely to cause bacterial meningitis in which of the following age groups? A) newborns B) infants and children C) adolescents and young adults D) older adults E) It infects all age groups equally. Answer: A Chapter/Section: 18.3 Learning Outcome: 18.11 Bloom's Taxonomy: 1-2: Remembering/Understanding 19) Most bacterial meningitis cases in the United States are pneumococcal meningitis, caused by which of the following bacteria? A) Neisseria meningitidis B) Haemophilus influenzae C) Escherichia coli D) Listeria monocytogenes E) Streptococcus pneumoniae Answer: E Chapter/Section: 18.3 Learning Outcome: 18.11 Bloom's Taxonomy: 1-2: Remembering/Understanding 20) Why is the immune response to pneumococcal meningitis the most damaging aspect of the disease? A) An exotoxin stimulates severe inflammation and provokes host tissue damage as immune cells release oxygen radicals and enzyme-destroying proteins in response to the toxin. B) Released antibodies bind to the basal membrane of tissues which results in the damage of these tissues and the neighboring cells. C) A particularly potent endotoxin stimulates a rapid fever that typically holds at 104°C for 3-4 days unless other actions are taken. D) Blood clots are formed in the circulatory system in an effort to isolate the bacteria; however, these clots are often the cause of heart attack or stroke in patients that don't seek medical treatment. E) Neurons infected with the bacteria are identified and destroyed by the immune system resulting in paralysis or in some cases death. Answer: A Chapter/Section: 18.3 Learning Outcome: 18.11 Bloom's Taxonomy: 1-2: Remembering/Understanding

21) Which of the following is not a risk factor for contracting Listeria monocytogenes? A) elderly patients B) bedridden C) neonates D) pregnant women E) immunocompromised individuals Answer: B Chapter/Section: 18.3 Learning Outcome: 18.12 Bloom's Taxonomy: 1-2: Remembering/Understanding 22) How is Listeria monocytogenes capable of spreading in the body? A) It evades the immune system by adhering to cells, being phagocytized, and then breaking out of the phagosome into the cytoplasm. B) The bacteria initiate apoptosis in the cell and spread to other cells in the vesicles that are released from the dying cell. C) After being phagocytized, the bacteria initiates apoptosis in the cell and spreads to other cells in the vesicles that are released from the dying cell. D) The bacteria initiate apoptosis in the cell and spread to other cells in the vesicles that are released from the dying cell, and actin in the cytoskeleton propels the bacteria into an adjacent cell. E) Actin in the cytoskeleton propels the bacteria into an adjacent cell. Answer: E Chapter/Section: 18.3 Learning Outcome: 18.12 Bloom's Taxonomy: 1-2: Remembering/Understanding 23) Why is leprosy confined to the PNS? A) The immune system is able to hold its ground and protect the CNS. B) Cells of the CNS lack the necessary receptor for M. leprae to gain access. C) M. leprae are aerobic and therefore prefer having the access oxygen that living just under the tattered epidermis can provide. D) Cooler body temperatures of 30-35°C are necessary for M. leprae's growth. E) It's not, but because it grows slowly and takes decades to reach the CNS, many believe that is where it is confined. Answer: D Chapter/Section: 18.3 Learning Outcome: 18.13 Bloom's Taxonomy: 1-2: Remembering/Understanding

24) Which of the following is false about the lepromatous form of leprosy? A) The lepromatous form is more serious than the tuberculoid form. B) The lepromatous form can spread to others. C) The lepromatous form causes irreversible tissue damage in the form of macules, papules, and nodules in many places on the body. D) Without treatment, lepromatous leprosy is often fatal. E) The lepromatous form is more common than the milder tuberculoid form. Answer: E Chapter/Section: 18.3 Learning Outcome: 18.13 Bloom's Taxonomy: 1-2: Remembering/Understanding 25) Which of the following is not how botulism is contracted? A) adults eating canned vegetables such as beets, carrots, or spinach B) IV drug users who use needles contaminated with C. botulinum endospores C) Infants encounter C. botulinum endospores through wind and dust. D) Infants encounter C. botulinum endospores by eating honey. E) Elderly farmers encounter C. botulinum endospores through wind and dust. Answer: E Chapter/Section: 18.3 Learning Outcome: 18.14 Bloom's Taxonomy: 1-2: Remembering/Understanding 26) Botulinum toxin causes all of the following except A) difficulty breathing. B) constipation. C) petechial rash. D) flaccid paralysis. E) difficulty speaking. Answer: C Chapter/Section: 18.3 Learning Outcome: 18.14 Bloom's Taxonomy: 1-2: Remembering/Understanding

27) Which of the following could result in a tetanus infection? A) You order a steak when out with friends for dinner, and although it wasn't completely cooked, you ate it anyways because you didn't want to make a scene or delay anyone else from eating. B) The nurse accidently forgets to wipe your arm with an alcohol pad before giving you your flu shot. C) A fingernail of a coworker accidently scratches you. D) A two-inch piece of wood causes a deep puncture in your arm when replacing a board on your deck. E) While squeezing through to get into your car, you get a surface abrasion from a rough and rusted panel on the car next to you. Answer: D Chapter/Section: 18.3 Learning Outcome: 18.15 Global LO: G2 Bloom's Taxonomy: 3-4: Applying/Analyzing 28) Which of the follow is false concerning the tetanospasmin toxin? A) causes irreversible damage to neurons B) leads to flaccid paralysis C) blocks the release of inhibitory neurotransmitters, preventing muscle relaxation D) taken up by peripheral motor neurons and transported to the spinal cord E) causes intense muscle spasms, drooling, sweating, and irritability Answer: B Chapter/Section: 18.3 Learning Outcome: 18.15 Bloom's Taxonomy: 1-2: Remembering/Understanding 29) Which of the following paths does Cryptococcus neoformans take to get to the CNS? A) lungs → macrophages → lymphatic system → blood → NS B) stomach → intestines → blood → CNS C) skin → blood → CNS D) nose → CNS E) muscles → blood → CNS Answer: A Chapter/Section: 18.4 Learning Outcome: 18.16 Bloom's Taxonomy: 1-2: Remembering/Understanding

30) Which of the following is false about the tropical disease African sleeping sickness? A) If the disease goes untreated, it is fatal. B) It is caused by the flagellated protozoan Trypanosoma brucei. C) It is carried by a blood-sucking mosquito from host to host. D) It induces an immune system reaction so strong that host neutrophils can harm host neurons. E) Those infected cannot sleep at night and cannot stay awake during the day. Answer: C Chapter/Section: 18.4 Learning Outcome: 18.17 Bloom's Taxonomy: 1-2: Remembering/Understanding 31) Primary amoebic meningoencephalitis is caused by A) Trypanosoma brucei. B) Naegleria fowleri. C) Toxoplasma gondii. D) Cryptococcus neoformans. E) Listeria meningitis. Answer: B Chapter/Section: 18.4 Learning Outcome: 18.18 Bloom's Taxonomy: 1-2: Remembering/Understanding 32) Which of the following about Naegleria fowleri is true? A) Although debilitating, most patients live long lives. B) Infection occurs when contaminated water is ingested. C) Only the flagellated form of the protozoan is infectious. D) The organism prefers warm stagnant waters. E) This bacteria typically feeds off of nutrients in the soil. Answer: D Chapter/Section: 18.4 Learning Outcome: 18.18 Bloom's Taxonomy: 1-2: Remembering/Understanding 33) Which of the following is false about toxoplasmosis? A) It is caused by a protozoan called Toxoplasma gondii. B) Cats act as the definitive host, shedding the protozoans in their feces. C) Tachyzoites can invade tissues like the heart, muscles, eyes, and brain. D) Risk factors include eating raw or undercooked meat such as wild game, pork, and shellfish. E) Meningitis results in a majority of patients since there are currently no treatment options. Answer: E Chapter/Section: 18.4 Learning Outcome: 18.19 Bloom's Taxonomy: 1-2: Remembering/Understanding

34) Congenital toxoplasmosis can cause all of the following except A) convulsions. B) deafness. C) neurological disabilities. D) anemia. E) miscarriage or stillbirth. Answer: D Chapter/Section: 18.4 Learning Outcome: 18.19 Bloom's Taxonomy: 1-2: Remembering/Understanding 35) Which of the following is true about spongiform encephalopathies? A) Spontaneous cases of Creuztfeldt-Jakob disease may be caused by mutations during cell division in neuronal stem cells. B) The disease is tied to a normal cellular prion protein (PrPC) that is found mostly on the surface of neurons. C) Spongiform encephalopathies occur in a wide variety of mammals, but the infectious prions are species specific and do not cause disease in other species. D) When the normal prion protein encounters an abnormally shaped version of itself, PrPSC, the normal prion's shape is changed and it becomes an infectious PrPSC. E) Abnormal prions clump together and kill the affected neurons, which accounts for the spongelike appearance of brain tissue found in TSE autopsies. Answer: C Chapter/Section: 18.4 Learning Outcome: 18.20 Bloom's Taxonomy: 1-2: Remembering/Understanding 18.2 True/False Questions 1) A lumbar puncture allows for CSF analysis to differentiate between viral and bacterial meningitis. Answer: TRUE Chapter/Section: 18.1 Learning Outcome: 18.5 Bloom's Taxonomy: 1-2: Remembering/Understanding 2) Encephalitis is most often caused by a virus. Answer: TRUE Chapter/Section: 18.1 Learning Outcome: 18.5 Bloom's Taxonomy: 1-2: Remembering/Understanding 3) Rabies is the only virus that infects the PNS. Answer: FALSE Chapter/Section: 18.2 Learning Outcome: 18.6 | 18.7 Bloom's Taxonomy: 1-2: Remembering/Understanding 11 Copyright © 2023 Pearson Education, Inc.

4) The West Nile virus damages neurons by lysing them as they exit after replication or by triggering apoptosis. Answer: TRUE Chapter/Section: 18.2 Learning Outcome: 18.8 Bloom's Taxonomy: 1-2: Remembering/Understanding 5) The tetanospasmin toxin blocks normal inhibition while botulinum toxin blocks normal stimulation. Answer: TRUE Chapter/Section: 18.3 Learning Outcome: 18.14 | 18.15 Bloom's Taxonomy: 1-2: Remembering/Understanding 6) C. gattii is usually contracted from urban environments, C. neoformans is associated with natural settings. Answer: FALSE Chapter/Section: 18.4 Learning Outcome: 18.16 Bloom's Taxonomy: 1-2: Remembering/Understanding 7) Protists reproduce through sexual as well as asexual means, depending on their life stage. Answer: TRUE Chapter/Section: 18.4 Learning Outcome: 18.17 Bloom's Taxonomy: 1-2: Remembering/Understanding 8) When infected with Toxoplasma gondii, a protist, symptoms are always present within two weeks. Answer: FALSE Chapter/Section: 18.4 Learning Outcome: 18.19 Bloom's Taxonomy: 1-2: Remembering/Understanding

18.3 Essay Questions 1) A new drug for depression was developed by taking a disaccharide, sucrose, and combining several different hydrophilic functional groups onto the molecule. After hearing about its structure, you are positive that this molecule has zero direct effect on the brain. Why? Answer: The blood brain barrier is going keep this drug from coming in contact with the brain because this new drug is too large and is hydrophilic instead of lipophilic. If this drug is significantly stopping depression then it is utilizing an indirect pathway that should be studied more. Chapter/Section: 18.1 Learning Outcome: 18.4 Global LO: G2 | G8 Bloom's Taxonomy: 3-4: Applying/Analyzing 2) Why has polio been eradicated in the U.S. but is still present in developing nations, including Afghanistan and Pakistan? Answer: Although developed nations have been able to acquire and distribute vaccines against polio, certain war-torn developing nations do not have the resources to focus on vaccine initiatives. Religious or cultural practices may also influence acceptance of vaccination, as they sometimes do in the United States. However, this is a world-wide problem because as long as one person is left infected, it could quickly spread all over the world if vaccination efforts are stopped too soon. Chapter/Section: 18.2 Learning Outcome: 18.6 Global LO: G2 | G8 Bloom's Taxonomy: 3-4: Applying/Analyzing 3) Explain why children under 1 year old should not be fed honey, yet honey is okay to eat for older healthy individuals. Answer: Honey can often contain C. botulinum endospores. The gastric acids in the digestive tract trigger endospore germination, allowing a temporary production of the toxins as the C. botulinum travels through the GI tract. A survey of U.S. honey products showed that from 2 to 24 percent of them contained C. botulinum endospores. In older children and adults, a mature immune system and the healthy microbes that live in the gastrointestinal tract usually prevent C. botulinum from finding a place to grow. But infants are not fully colonized by helpful bacteria, and their immune system is still maturing so C. botulinum encounters little competition, and will readily grow and produce its toxins. Chapter/Section: 18.3 Learning Outcome: 18.14 Global LO: G2 | G8 ASM LO: 6.1 Bloom's Taxonomy: 3-4: Applying/Analyzing

Microbiology: Basic & Clinical Principles, 2e (Norman-McKay) Chapter 19 Digestive System Infections 19.1 Multiple Choice Questions 1) What is the correct order of the following eight parts of the GI tract?

A) mouth, esophagus, pharynx, stomach, small intestine, large intestine, rectum, anus B) mouth, pharynx, esophagus, stomach, small intestine, large intestine, rectum, anus C) mouth, pharynx, esophagus, stomach, large intestine, small intestine, rectum, anus D) mouth, esophagus, stomach, pharynx, small intestine, large intestine, rectum, anus E) mouth, esophagus, pharynx, stomach, large intestine, small intestine, rectum, anus Answer: B Chapter/Section: 19.1 Learning Outcome: 19.1 Bloom's Taxonomy: 1-2: Remembering/Understanding

2) Why is lymphatic tissue found all along the GI tract? A) Upon infection in a specific area of the GI tract, a response can quickly be delivered and flood the lumen of the GI tract in that region. B) Different pathogens are activated at different points along the digestive tract, and the location of the lymphatic tissue allows the host to respond according to which pathogen is activating in that area. C) Cells in these lymphatic tissues "sample" the environment by phagocytosis and present their findings to lymphocytes that may or may not need to initiate an immune response. D) When an infection occurs, these lymphatic tissues are able to quickly trigger an inflammatory response along the entire GI tract. E) When an infection occurs, these lymphatic tissues are able to quickly stop digestion and the movement of the GI contents so that the infection doesn't spread throughout the body. Answer: C Chapter/Section: 19.1 Learning Outcome: 19.2 Bloom's Taxonomy: 1-2: Remembering/Understanding 3) The ________ in ________ inhibit the growth of many bacteria. A) toxins; chyme B) lysozymes; gastric juice C) acidity; stomach mucus D) salts; bile E) fats; saliva Answer: D Chapter/Section: 19.1 Learning Outcome: 19.3 Bloom's Taxonomy: 1-2: Remembering/Understanding 4) Stool is rich in which of the following organisms? A) Actinomyces B) Fusobacterium C) Neisseria D) Streptococcus E) Bacteriodes Answer: E Chapter/Section: 19.1 Learning Outcome: 19.4 Bloom's Taxonomy: 1-2: Remembering/Understanding

5) An important source of vitamin K in the intestine comes from which species? A) Escherichia coli B) Streptococcus mutans C) Helicobacter pylori D) Vibrio cholerae E) Giardia lamblia Answer: A Chapter/Section: 19.1 Learning Outcome: 19.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 6) Dysentery can lead to ________ and/or organ failure if medical attention is not sought in time. A) diarrhea B) hypovolemic shock C) enteritis D) gastritis E) gastroenteritis Answer: B Chapter/Section: 19.2 Learning Outcome: 19.5 Bloom's Taxonomy: 1-2: Remembering/Understanding 7) Which of the following is able to identify the pathogen responsible for intestinal symptoms? A) selective and differential culture media B) microscopic examination of stool samples C) molecular techniques D) upper GI endoscopy and colonoscopy E) selective and differential culture media, molecular techniques, and microscopic examination of stool samples Answer: E Chapter/Section: 19.2 Learning Outcome: 19.6 Bloom's Taxonomy: 1-2: Remembering/Understanding 8) Which of the following does the mumps virus infect? A) lacrimal glands B) stomach C) reproductive organs D) parotid glands E) pancreas Answer: D Chapter/Section: 19.3 Learning Outcome: 19.7 Bloom's Taxonomy: 1-2: Remembering/Understanding

9) Although four of the following options describe both rotavirus and norovirus, which one specifically describes norovirus? A) RNA virus B) common in long-term care facilities C) spreads via the fecal-oral route D) symptoms include vomiting, diarrhea, and nausea E) definitive diagnosis requires detecting the RNA virus in the patient stool sample Answer: B Chapter/Section: 19.3 Learning Outcome: 19.8 Bloom's Taxonomy: 1-2: Remembering/Understanding 10) Which hepatitis virus has a genome made up of double-stranded DNA? A) hepatitis A B) hepatitis B C) hepatitis C D) hepatitis D E) hepatitis E Answer: B Chapter/Section: 19.3 Learning Outcome: 19.9 Bloom's Taxonomy: 1-2: Remembering/Understanding 11) Which hepatitis virus requires an additional hepatitis infection in order to be virulent? A) hepatitis A B) hepatitis B C) hepatitis C D) hepatitis D E) hepatitis E Answer: D Chapter/Section: 19.3 Learning Outcome: 19.9 Bloom's Taxonomy: 1-2: Remembering/Understanding 12) Which two hepatitis viruses primarily use the fecal-oral route for infection? A) hepatitis A and hepatitis E B) hepatitis B and hepatitis C C) hepatitis C and hepatitis D D) hepatitis D and hepatitis E E) hepatitis B and hepatitis D Answer: A Chapter/Section: 19.3 Learning Outcome: 19.9 Bloom's Taxonomy: 1-2: Remembering/Understanding

13) What do chronic hepatitis infections result in? A) heart failure B) constipation C) kidney failure or kidney cancer D) cirrhosis, liver failure, or hepatocellular carcinoma E) constipation, ulcers, or colon cancer Answer: D Chapter/Section: 19.3 Learning Outcome: 19.10 Bloom's Taxonomy: 1-2: Remembering/Understanding 14) Which hepatitis virus only results in acute infections? A) hepatitis A B) hepatitis B C) hepatitis C D) hepatitis D E) hepatitis E Answer: A Chapter/Section: 19.3 Learning Outcome: 19.10 Bloom's Taxonomy: 1-2: Remembering/Understanding 15) ________ is characterized by tender, swollen gums with a bright red or purplish coloration; the gums may also pull away from teeth, and bad breath and tooth loss are also frequent manifestations. A) Dental caries B) Thrush C) Periodontal disease D) Gingivitis E) Oral yeast infection Answer: C Chapter/Section: 19.4 Learning Outcome: 19.11 Bloom's Taxonomy: 1-2: Remembering/Understanding 16) Bacteria metabolize sugars and they create ________ that can eat away at the ________ to cause dental caries. A) spores; gums B) proteins; pulp C) toxins; dentin D) chemicals; pulp E) acids; enamel Answer: E Chapter/Section: 19.4 Learning Outcome: 19.11 Bloom's Taxonomy: 1-2: Remembering/Understanding 5 Copyright © 2023 Pearson Education, Inc.

17) Which of the following is not true about the interaction of biofilms on teeth? A) Brushing teeth twice daily and flossing will physically remove superficial plaque layers. B) Bacterial growth within deeper biofilm layers and new bacteria entering the mouth quickly reestablish what was removed from brushing. C) When plaque calcifies into tartar it must be scraped off the teeth. D) Limiting dietary fats reduces lactic acid production by the bacteria in dental plaque and decreases the risk for dental caries, E) Dentists recommend a twice-yearly dental cleaning and checkup to limit caries and periodontal disease, Answer: D Chapter/Section: 19.4 Learning Outcome: 19.11 Bloom's Taxonomy: 1-2: Remembering/Understanding 18) How does Helicobacter pylori cause stomach ulcers? A) The glycocalyx protects the bacteria from stomach acid as the bacteria enters a susceptible host and binds to an area of epithelial cells in the stomach with thin mucosa where toxins cause further damage and allow entry. B) Polar flagella help bacteria burrow into mucosal lining to escape stomach acid, where enzymes decrease the acidity around them, and they release a toxin to kill host cells. C) Peritrichous flagella help the bacteria squeeze through the mucosal lining to avoid stomach acid, where cytokine imposters are released which attract B cells and cause the immune response to destroy the epithelial lining of the stomach. D) Bacterial capsules allow the bacteria to survive in the acidic lumen of the stomach as it releases toxins that bind to and destroy the epithelial lining of the stomach. E) Fimbriae enable to bacteria to penetrate the mucosa and bind to the epithelial lining of the stomach where toxins are released that bind and destroy epithelial cells. Answer: B Chapter/Section: 19.4 Learning Outcome: 19.12 Bloom's Taxonomy: 1-2: Remembering/Understanding 19) Which of the following describes a case of food poisoning? A) Symptoms begin 1-5 days after exposure. B) Signs and symptoms include fever, headache, muscle aches, nausea, diarrhea, and abdominal pain. C) Recovery time can take anywhere from days to weeks. D) After ingestion, a pathogen establishes infection in the host. E) Toxins from Staphylococcus aureus, Bacillus cereus, and Clostridium perfringens are responsible. Answer: E Chapter/Section: 19.4 Learning Outcome: 19.13 Bloom's Taxonomy: 1-2: Remembering/Understanding

20) Which of the following is false of Campylobacter jejuni infections? A) It is a Gram-negative, flagellated, spiral-shaped bacterium that grows best in microaerophilic conditions. B) Infections are primarily associated with eating undercooked beef or cross-contaminating foods with raw beef juices. C) After ingestion, the bacteria burrow through the mucosal layer of the intestine and migrate through intestinal epithelial cells to multiply just beneath the epithelial layer. D) Antibodies that recognize C. jejuni's lipopolysaccharides can cross-react with sugars on neurons that trigger an autoimmune response against the nervous system called Guillain-Barré syndrome. E) Although symptoms usually resolve within a week, in immune-compromised patients the bacteria may cause bacteremia, which could lead to sepsis and possibly septic shock. Answer: B Chapter/Section: 19.4 Learning Outcome: 19.14 Bloom's Taxonomy: 1-2: Remembering/Understanding 21) Eating peanut butter, cantaloupe, chicken products, seafood, spinach, or handling a pet turtle are all sources of infection for which of the following bacteria? A) Campylobacter jejuni B) Salmonella enterica serotype Typhi C) Esherichia coli O157:H7 D) Shigella dysenteriae E) Salmonella enterica serotype Enteritidis Answer: E Chapter/Section: 19.4 Learning Outcome: 19.14 Bloom's Taxonomy: 1-2: Remembering/Understanding 22) Which of the following bacteria can thrive even if frozen? A) Esherichia coli B) Campylobacter jejuni C) Salmonella enterica D) Listeria monocytogenes E) Shigella dysenteriae Answer: D Chapter/Section: 19.4 Learning Outcome: 19.14 Bloom's Taxonomy: 1-2: Remembering/Understanding

23) Which of the following is false of Shigella infections? A) In the United States, S. sonnei accounts for about 75 percent of Shigella cases, while S. flexneri predominates in developing countries. B) It spreads from person to person and also through human fecal contamination of food, water, or environmental surfaces that are touched. C) The elderly are most likely to become infected. D) The Shiga toxin targets ribosomes to block protein synthesis and kill host cells. E) It can induce hemolytic uremic syndrome with symptoms that include hematuria, purpura, and edema. Answer: C Chapter/Section: 19.4 Learning Outcome: 19.15 Bloom's Taxonomy: 1-2: Remembering/Understanding 24) Which of the following is not a virulence factor of Shigella species? A) a system that induces host cells to endocytose the bacteria B) the manufacture of several toxins that damage intestinal cells and induce fluid efflux C) the capacity to pass between infected cells using an actin propulsion system D) the capability to cause stomach ulcers E) the ability to escape from phagocytes Answer: D Chapter/Section: 19.4 Learning Outcome: 19.15 Bloom's Taxonomy: 1-2: Remembering/Understanding 25) Why should antibiotics not be given to a patient with Escherichia coli O157:H7? A) This is not a bacterium, and therefore antibiotics would be ineffective. B) Antibiotics tend to act as a hapten with this infection and are likely to cause an allergic response. C) Antibiotics do not reduce disease and may precipitate HUS. D) This pathotype is part of the normal digestive tract of humans. E) This pathotype is only found in cattle and does not infect humans. Answer: C Chapter/Section: 19.4 Learning Outcome: 19.15 Bloom's Taxonomy: 1-2: Remembering/Understanding 26) Which of the following would not result from a cholera infection? A) pseudomembranous colitis B) mild to profuse diarrhea C) hypovolemic shock D) organ failure and death E) leg cramps Answer: A Chapter/Section: 19.4 Learning Outcome: 19.16 Bloom's Taxonomy: 1-2: Remembering/Understanding 8 Copyright © 2023 Pearson Education, Inc.

27) Which of the following would not result from a C. difficile infection? A) mild diarrhea B) pseudomembranous colitis C) toxic megacolon D) hemolytic uremic syndrome E) severe abdominal pain, fever, nausea, and abundant watery diarrhea that may progress to dysentery Answer: D Chapter/Section: 19.4 Learning Outcome: 19.17 Bloom's Taxonomy: 1-2: Remembering/Understanding 28) Which of the following is not a reason why Clostridium difficile is an increasing concern in healthcare settings? A) the bacterium can naturally escape drugs and disinfectants by retreating into a resistant spore state B) antibiotic misuse and overuse in the population C) antibiotic resistance D) additional modes of transmission have occurred in several isolated cases E) emerging superstrains that make a third type of toxin Answer: D Chapter/Section: 19.4 Learning Outcome: 19.17 Bloom's Taxonomy: 1-2: Remembering/Understanding 29) A major difference between protozoans and helminths is that protozoans are A) unicellular. B) multicellular. C) parasitic. D) archaea. E) able to survive outside of a host. Answer: A Chapter/Section: 19.5 Learning Outcome: 19.18 Bloom's Taxonomy: 1-2: Remembering/Understanding

30) Besides diagnosing giardiasis via microscopic evaluation of feces for cysts or trophozoites, it can also be diagnosed A) using PCR. B) by detecting Giardia antigens. C) by a blood sample. D) by a spinal fluid sample. E) by a urine sample. Answer: B Chapter/Section: 19.5 Learning Outcome: 19.19 Bloom's Taxonomy: 1-2: Remembering/Understanding 31) Which of the following features have not helped Giardia become the most common intestinal parasite? A) No drugs are currently available for treatment. B) A tough cyst form that resists chlorine disinfection used for municipal water treatment, UV light, and freezing. C) It lives in animals other than humans. D) Ingesting as few as 10 cysts is sufficient to establish infection. E) It can be transmitted via fecal-oral route, via contaminated fomites, or from direct contact with an infected patient. Answer: B Chapter/Section: 19.5 Learning Outcome: 19.19 Bloom's Taxonomy: 1-2: Remembering/Understanding 32) Even though 90 percent of infections are asymptomatic, why should you always treat amebiasis? A) The protozoan can cause invasive disease that affects the liver, lungs, and brain. B) Asymptomatic patients can continue to spread the disease for years before dying themselves. C) The immune system of the host can quickly become compromised. D) Exotoxin production can promote a vigorous inflammatory response in certain patients and also damage the cytoskeleton of the colon's epithelial cells. E) Pseudomembranous plaques form along the colon lining as toxins cause tissue damage in 10 percent of hosts. Answer: A Chapter/Section: 19.5 Learning Outcome: 19.19 Bloom's Taxonomy: 1-2: Remembering/Understanding

33) How are Cryptosporidium sporozoites able to evade the immune system? A) They reside inside the host cells. B) They evade phagocytosis by using a capsule. C) They attach to host cells and build a protective membrane from modified host cell membrane materials. D) They escape from phagocytes. E) Special proteins bind and inhibit antibodies from adhering to them. Answer: C Chapter/Section: 19.5 Learning Outcome: 19.19 Bloom's Taxonomy: 1-2: Remembering/Understanding 34) Which of the following describe the typical lifecycle of amebiasis? A) host makes contact with contaminated object; swallows cysts; trophozoites released from cysts; trophozoites reproduce in digestive tract; trophozoites and new cysts are released from host in feces B) host makes contact with contaminated object; swallows cysts; trophozoites released from cysts; trophozoites reproduce in digestive tract; trophozoites travel to the lungs, trophozoites form cysts, cysts are coughed up, swallowed, and released from host in feces C) host makes contact with contaminated object; swallows cysts; trophozoites released from cysts in digestive tract; trophozoites travel to and reproduce in the liver; trophozoites travel to the lungs, trophozoites form cysts, cysts are coughed up, swallowed, and released from host in feces D) host makes contact with contaminated object; swallows cysts; trophozoites released from cysts; trophozoites reproduce in digestive tract; trophozoites travel to the lungs, trophozoites form cysts, cysts are coughed up and released from host in relatively large respiratory droplets that people sneeze, cough, drip, or exhale E) host is bitten; cysts enter the bloodstream; trophozoites released from cysts in blood; trophozoites travel to and reproduce in the liver; new trophozoites circulate in blood, trophozoites are eaten by a new insect where they then form cysts Answer: A Chapter/Section: 19.5 Learning Outcome: 19.20 Bloom's Taxonomy: 1-2: Remembering/Understanding 35) Which of the following uses cows as the intermediate host? A) Taenia saginata B) Taenia solium C) Taenia asiatica D) Enterobius vermicularis E) Necator americanu Answer: A Chapter/Section: 19.5 Learning Outcome: 19.21 Bloom's Taxonomy: 1-2: Remembering/Understanding

36) Cysticercosis is a result of infection with which species? A) Ascaris lumbricoides B) Taenia solium C) Taenia asiatica D) Enterobius vermicularis E) Necator americanu Answer: B Chapter/Section: 19.5 Learning Outcome: 19.21 Bloom's Taxonomy: 1-2: Remembering/Understanding 37) How does a patient typically become infected with hookworms? A) Cysts are spread onto fomites when an infected host does not properly wash their hands and then the patient touches that object and doesn't wash their hands before eating. B) Cysts are spread via respiratory droplets when an infected host coughs or sneezes. C) Cysts are ingested when the patient eats undercooked meat. D) Eggs are ingested when the patient eats infected seafood. E) The worm penetrates the skin when the patient walks outside barefoot. Answer: E Chapter/Section: 19.5 Learning Outcome: 19.21 Bloom's Taxonomy: 1-2: Remembering/Understanding 38) Which hosts does the tapeworm Diphyllobothrium latum require to complete its lifecycle? A) pigs and mammals B) cows and humans C) ants, sheep, and mammals D) crustaceans, fish, and mammals E) snails, chickens, and mammals Answer: D Chapter/Section: 19.5 Learning Outcome: 19.21 Bloom's Taxonomy: 1-2: Remembering/Understanding 39) How do you test for a pinworm infection? A) tape adhesion test B) PCR C) screening for molecular antigens D) microscopic identification of eggs in stool E) microscopic evaluation of stool for oocyst Answer: A Chapter/Section: 19.5 Learning Outcome: 19.21 Bloom's Taxonomy: 1-2: Remembering/Understanding

40) Which of the following helminths is known for moving out of the body through the anus, nose, or mouth? A) Ascaris lumbricoides B) Schistosoma haematobium C) Trichinella spiralis D) Enterobius vermicularis E) Necator americanu Answer: A Chapter/Section: 19.5 Learning Outcome: 19.21 Bloom's Taxonomy: 1-2: Remembering/Understanding 41) Trichinellosis, also known as trichinosis, occurs when A) ingested cysts mature into adult worms and cause the host to suffer from malnutrition. B) inhaled cysts perforate the lungs as they make their way to the intestines. C) ingested cysts mature into adult roundworms and release thousands of eggs as the adult releases toxins to promote severe diarrhea. D) ingested cysts mature into adult tapeworms and release proglottids that force their way out of the anus. E) ingested cysts mature into worms in the intestines and the larvae migrate into blood and embed in muscles. Answer: E Chapter/Section: 19.5 Learning Outcome: 19.21 Bloom's Taxonomy: 1-2: Remembering/Understanding 42) What causes schistosomiasis? A) hookworm B) roundworm C) tapeworm D) blood fluke E) pinworm Answer: D Chapter/Section: 19.5 Learning Outcome: 19.21 Bloom's Taxonomy: 1-2: Remembering/Understanding

19.2 True/False Questions 1) Tonsils at the back of the throat, the appendix, and Peyer's patches of the small intestine are all examples of mucosa-associated lymphoid tissue (MALT) found along the GI tract. Answer: TRUE Chapter/Section: 19.1 Learning Outcome: 19.2 Bloom's Taxonomy: 1-2: Remembering/Understanding 2) An important source of vitamin B in the intestine comes from Escherichia coli. Answer: FALSE Chapter/Section: 19.1 Learning Outcome: 19.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 3) Upper GI and lower endoscopy are tools that can be used to identify the precise microbe responsible for GI symptoms. Answer: FALSE Chapter/Section: 19.2 Learning Outcome: 19.6 Bloom's Taxonomy: 1-2: Remembering/Understanding 4) Besides mumps causing swelling of the parotid salivary glands, it can also cause meningitis and orchitis. Answer: TRUE Chapter/Section: 19.3 Learning Outcome: 19.7 Bloom's Taxonomy: 1-2: Remembering/Understanding 5) After infection with a norovirus, the patient will be immune from all future norovirus infections. Answer: FALSE Chapter/Section: 19.3 Learning Outcome: 19.8 Bloom's Taxonomy: 1-2: Remembering/Understanding 6) Limiting dietary sugars reduces lactic acid production by the bacteria in dental plaque and decreases the risk for dental caries. Answer: TRUE Chapter/Section: 19.4 Learning Outcome: 19.11 Bloom's Taxonomy: 1-2: Remembering/Understanding

7) Oral rehydration is usually sufficient for most patients to fully recover from Vibrio cholerae. Answer: TRUE Chapter/Section: 19.4 Learning Outcome: 19.16 Bloom's Taxonomy: 1-2: Remembering/Understanding 8) Giardiasis and cryptosporidiosis are both caused by helminth infections. Answer: FALSE Chapter/Section: 19.5 Learning Outcome: 19.19 Bloom's Taxonomy: 1-2: Remembering/Understanding 19.3 Essay Questions 1) In what ways are we finding that the gut microbiota affects our health? Answer: In addition to making vitamins and competing with pathogens, our GI microbiota may impact metabolism and obesity; affect the development of depression and diseases such as diabetes; and train and modulate immune responses. Chapter/Section: 19.1 Learning Outcome: 19.4 Global LO: G8 ASM LO: 5.4 Bloom's Taxonomy: 3-4: Applying/Analyzing 2) What are the differences between a foodborne infection and food poisoning? Answer: Food poisoning is not due to a living pathogen but rather an ingested toxin which produces symptoms within 6 hours of exposure, much faster than a bacteria could due to needing to grow and reproduce. Symptoms of food poisoning are usually nausea and vomiting, and sometimes diarrhea and abdominal pain whereas an infection produces fever, headache, muscle aches, nausea, diarrhea, and or abdominal pain. Recovery is usually within 24 hours but can take several days in severe cases, whereas a foodborne infection takes days to weeks for the body to remove the bacteria. Chapter/Section: 19.4 Learning Outcome: 19.13 Global LO: G8 Bloom's Taxonomy: 3-4: Applying/Analyzing

3) In what ways do helminths overcome the challenges of maintaining such complicated lifecycles? Answer: Helminths overcome the challenges of requiring multiple hosts to complete their lifecycle by (1) producing extremely large numbers of eggs, cysts, oocysts, or larvae for an extended amount of time. By not directly or quickly killing the host, the adults can (2) produce offspring for years in some cases. By (3) triggering diarrhea or anal itching, the offspring are more likely to contaminate objects or hands and have an easier time spreading to a new host. This urgency also increases the chances of the host not making it to deposit the stool in an approved location which again increases the chances for others to become contaminated. Some helminths are not confined to living inside a host and instead (4) spend part of their lifecycle as a free-living entity until it can locate an adequate host for the next phase of its life cycle. Chapter/Section: 19.5 Learning Outcome: 19.21 Global LO: G8 Bloom's Taxonomy: 3-4: Applying/Analyzing

Microbiology: Basic & Clinical Principles, 2e (Norman-McKay) Chapter 20 Urinary and Reproductive System Infections 20.1 Multiple Choice Questions 1) Infection in the urinary tract is limited by all the following except A) the urinary microbiome. B) the slightly acidic pH of urine. C) the flushing action of urine through the ureters and urethra. D) constriction of the urethra by the prostate gland in men. E) constriction of the urethra by the prostate gland in men and the placement of the urethra near the anus in women. Answer: E Chapter/Section: 20.1 Learning Outcome: 20.1 Bloom's Taxonomy: 1-2: Remembering/Understanding 2) Anatomical factors that cause women to be at higher risk of urinary tract infections than men include A) more acidic urine in women. B) a shorter urethra positioned closer to the anus in women. C) separate openings for the urinary and reproductive tracts in women. D) the flushing of the urethra during ejaculation in men. E) antimicrobial peptides found in the seminal fluid in men. Answer: B Chapter/Section: 20.1 Learning Outcome: 20.2 Bloom's Taxonomy: 1-2: Remembering/Understanding 3) Which statement is not true about the urinary microbiome? A) Most species can be cultivated using standard laboratory techniques. B) The most consistently detected species are Lactobacillus and Streptococcus. C) The healthy urinary tract was believed to be sterile until molecular methods of analysis became available. D) Shifts in microbiome composition may be associated with physiological concerns such as incontinence. E) The species composition is consistent throughout the urinary system, across the lifespan or from person to person. Answer: A Chapter/Section: 20.1 Learning Outcome: 20.3 Global LO: G4 ASM LO: 5.1 | 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding

4) The placenta A) allows mixing of maternal and fetal blood. B) allows diffusion of nutrients, gases, and wasted between the mother and the fetus. C) consists only of maternal tissue. D) consists only of fetal tissue. E) is a site in which bacteria have never been detected. Answer: B Chapter/Section: 20.1 Learning Outcome: 20.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 5) Which is not an innate protection of the female reproductive tract? A) The vaginal lining contains ciliate cells which trap and expel bacteria from the tract. B) The vaginal lining sheds its cells every few hours. C) Lysozyme and antimicrobial peptides are present in vaginal secretions. D) Mucous secretions trap microbes. E) Normal microbiome members generate products which prevent pathogen growth. Answer: A Chapter/Section: 20.1 Learning Outcome: 20.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 6) TORCH pathogens are all characterized by A) transmission through sexual contact. B) the ability to cause intrauterine infections which are linked to infertility. C) the ability to cross the placenta to infect a developing fetus. D) transmission through sexual contact and the ability to cause intrauterine infections. E) transmission through sexual contact, the ability to cause intrauterine infections which are linked to infertility, and the ability to cross the placenta to infect a developing fetus. Answer: C Chapter/Section: 20.1 Learning Outcome: 20.5 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 7) The dominant genus in the vaginal microbiome of reproductive-age women, Lactobacillus, acts to limit infection by A) producing lactic acid by fermenting glycogen secretions, lowering pH. B) producing hydrogen peroxide, which is toxic to anaerobic pathogens. C) producing bacteriocins, a group of antimicrobial peptides. D) producing lactic acid and hydrogen peroxide. E) producing lactic acid, hydrogen peroxide, and bacteriocins. Answer: E Chapter/Section: 20.1 Learning Outcome: 20.6 ASM LO: 5.1 | 5.3 | 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 2 Copyright © 2023 Pearson Education, Inc.

8) Compared to complicated urinary tract infections (UTIs), uncomplicated UTIs are less likely to A) respond to antibiotic therapy. B) be diagnosed in otherwise healthy individuals. C) be diagnosed in women rather than men. D) recur after initial treatment. E) involve a bacterial infection. Answer: D Chapter/Section: 20.2 Learning Outcome: 20.7 Bloom's Taxonomy: 1-2: Remembering/Understanding 9) Of the following, which is the most serious condition? A) urethritis B) cystitis C) urethritis and cystitis D) ureteritis E) pyelonephritis Answer: E Chapter/Section: 20.2 Learning Outcome: 20.8 Bloom's Taxonomy: 1-2: Remembering/Understanding 10) A urine dipstick test can diagnose urinary tract infections by indicating A) the presence of glucose in the urine. B) elevated levels of leukocyte esterase. C) conversion of nitrite to nitrate in the urine. D) elevated creatine and BUN levels. E) direct detection of Gram-positive or Gram-negative bacteria. Answer: B Chapter/Section: 20.2 Learning Outcome: 20.9 Bloom's Taxonomy: 1-2: Remembering/Understanding 11) Bacterial infections that reach the kidneys can result in which serious complication? A) bacteremia as bacteria use the renal blood vessels to enter wider circulation B) impaired renal function due to scar tissue C) malignancies of the kidney D) bacteremia, impaired renal function, and malignancies E) bacteremia and impaired renal function Answer: E Chapter/Section: 20.2 Learning Outcome: 20.9 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 3 Copyright © 2023 Pearson Education, Inc.

12) Urinary catheters pose risks of causing urinary tract infections because A) they provide a surface for bacterial biofilms to establish. B) they block urine flow out of the bladder. C) they can introduce bacteria from the skin, anal, or external genital areas into the bladder. D) they provide a surface for bacterial biofilms to establish and they can introduce bacteria from the skin, anal, or external genital areas into the bladder. E) they block urine flow out of the bladder and they can introduce bacteria from the skin, anal, or external genital areas into the bladder. Answer: D Chapter/Section: 20.2 Learning Outcome: 20.10 ASM LO: 5.1 | 5.2 | 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 13) Uropathogenic E. coli can use all the following virulence factors to establish infection in the urinary tract except A) antigen mimicry. B) pili and adhesions. C) invade bladder cells to become intracellular. D) proteases and toxins. E) siderophores. Answer: A Chapter/Section: 20.2 Learning Outcome: 20.11 ASM LO: 2.3 | 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 14) The demographic group most likely to experience a urinary tract infection caused by Staphylococcus saprophyticus is A) elderly men with an enlarged prostate gland. B) elderly individuals of both sexes. C) pregnant women. D) sexually active young men. E) sexually active young women. Answer: E Chapter/Section: 20.3 Learning Outcome: 20.11 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding

15) A young woman presents to the emergency room with fever, headache, and vomiting. Food poisoning is suspected, she is given supportive care, and released. One week later she returns to the hospital in acute renal failure. A medical history reveals that she had been a volunteer at an orphanage in a rural section of a Caribbean island recently hit by a hurricane. During evacuation from the island, she had to wade through floodwaters suffered several abrasions on her legs and feet. What is the most likely pathogen based on her symptoms and history? A) BK virus B) candiduria C) leptospirosis D) Staphylococcus saprophyticus E) uropathogenic E. coli Answer: C Chapter/Section: 20.2 Learning Outcome: 20.12 Global LO: G2 ASM LO: 5.4 Bloom's Taxonomy: 3-4: Applying/Analyzing 16) A man presents to the physician's office complaining of irritation in the genital area. Examination reveals a bright red rash with raised pustules with clear fluid. Upon questioning, the man reports he has recently been sexually active. What is the most likely diagnosis based upon the appearance of the genital lesions? A) chlamydia B) genital herpes caused by HSV-2 C) genital warts caused by HPV D) gonorrhea E) syphilis Answer: B Chapter/Section: 20.3 Learning Outcome: 20.13 Global LO: G2 ASM LO: 5.4 Bloom's Taxonomy: 3-4: Applying/Analyzing 17) As with all human herpes virus infections, an important characteristic of HSV-2 infection is A) an ongoing and latent infection in peripheral nerves which can reactivate periodically. B) complete immunity once the infection has been successfully eradicated by the body. C) resistance to all anti-viral medications. D) progressively worsening outbreaks each time the virus comes out of latency. E) that it is highly dangerous even to immune-competent adults. Answer: A Chapter/Section: 20.3 Learning Outcome: 20.13 ASM LO: 2.5 | 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding

18) The more dangerous CNS and disseminated forms can be minimized through which of the following interventions? A) administration of antiviral drugs to the affected newborn B) delivery by cesarean section C) vaccination of pregnant women D) administration of antiviral drugs to the affected newborn and delivery by cesarean section E) delivery by cesarean section and vaccination of pregnant women Answer: D Chapter/Section: 20.3 Learning Outcome: 20.15 ASM LO: 2.5 | 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 19) Characteristics of the human papilloma virus include all except A) multiple strains, most of which cause asymptomatic infections. B) ubiquitous—virtually all sexually active individuals will become infected at some point. C) promote cell division in epithelial cells. D) have a high mutation rate, meaning vaccine development is challenging. E) easily spread through any kind of sexual contact. Answer: D Chapter/Section: 20.3 Learning Outcome: 20.16 ASM LO: 2.5 | 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 20) The advantages of the Pap smear as a means of cancer detection include A) it is inexpensive and easy to perform. B) it can detect reproductive tract cancers in both women and men. C) it can detect early-stage cancers and precancerous changes. D) it is inexpensive and easy to perform, and it can detect reproductive tract cancers in both women and men. E) it is inexpensive and easy to perform, and it can detect early-stage cancers and precancerous changes. Answer: E Chapter/Section: 20.3 Learning Outcome: 20.17 Bloom's Taxonomy: 1-2: Remembering/Understanding

21) Which is the true statement about vaginosis and vaginitis? A) The two conditions are always mutually exclusive. B) The two conditions are always seen together. C) Vaginitis describes vaginal inflammation while vaginosis does not. D) Vaginitis is always due to microbiome dysbiosis. E) Vaginosis is not likely to be sexually transmitted. Answer: C Chapter/Section: 20.4 Learning Outcome: 20.18 ASM LO: 5.1 | 5.3 | 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 22) Which of the following is not one of the signs assessed using Amsel's criteria to diagnose bacterial vaginosis? A) greyish-white vaginal discharge B) presence of any type of redness or rash C) vaginal pH greater than 4.5 D) fishy odor after addition of potassium hydroxide to a vaginal smear E) clue cells attached to vaginal epithelial visible upon microscopic examination Answer: B Chapter/Section: 20.4 Learning Outcome: 20.19 Bloom's Taxonomy: 1-2: Remembering/Understanding 23) Chlamydia may result in any of the following except A) urethritis in males. B) neonatal conjunctivitis. C) pelvic inflammatory disease in women. D) severe neurological disorders such as seizures, vertigo, memory and sensory impairment, and paralysis. E) pelvic pain with fever in women. Answer: D Chapter/Section: 20.4 Learning Outcome: 20.20 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding

24) Which numbered stage(s) of the Chlamydia trachomatis life cycle pictured involves the dormant elementary body?

A) 1 B) 2 C) 2 & 3 D) 5 E) 1 & 5 Answer: E Chapter/Section: 20.4 Learning Outcome: 20.21 ASM LO: 2.2 | 2.3 Bloom's Taxonomy: 1-2: Remembering/Understanding

25) Lymphogranuloma venereum differs from the infection caused by the trachoma biovar of Chlamydia trachomatis in that A) lymphogranuloma venereum is not treatable with antibiotics such as doxycycline. B) lymphogranuloma venereum is not sexually transmitted. C) lymphogranuloma venereum bacteria do not have an intracellular lifestyle. D) lymphogranuloma venereum may result in the formation of buboes and tissues necrosis. E) lymphogranuloma venereum is not treatable with antibiotics such as doxycycline and is not sexually transmitted. Answer: D Chapter/Section: 20.4 Learning Outcome: 20.22 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 26) A 48-hour old infant is brought to the clinic with signs of severe bacterial conjunctivitis (infection of the eye). The infant was born at home, with the birth assisted only by an unlicensed midwife, and no pharmaceutical interventions performed on the mother or infant. Which infectious agents is the likely culprit? A) Chlamydia trachomatis B) Neisseria gonorrhoeae C) HSV-2 D) bacterial vaginosis due to mixed anaerobic species E) Neither Chlamydia trachomatis nor Neisseria gonorrhoeae should be ruled out without further testing. Answer: E Chapter/Section: 20.4 Learning Outcome: 20.20 | 20.23 Global LO: G2 ASM LO: 5.4 Bloom's Taxonomy: 3-4: Applying/Analyzing 27) Chlamydia and gonorrhea often present a similar clinical picture except that A) only gonorrhea is implicated in pelvic inflammatory disease. B) chlamydia is more likely to be asymptomatic in women while gonorrhea is more likely to be asymptomatic in men. C) few strains of chlamydia are antibiotic-resistant while gonorrhea shows extensive antibiotic resistance. D) gonorrhea infection confers strong long-term immunity while chlamydia does not. E) only chlamydia can be passed to and affect a newborn. Answer: C Chapter/Section: 20.4 Learning Outcome: 20.20 | 20.22 Global LO: G2 ASM LO: 5.4 Bloom's Taxonomy: 3-4: Applying/Analyzing

28) Pelvic inflammatory disease is characterized by all the following except A) increased risk for ectopic pregnancy. B) a clear set of signs and symptoms that make diagnosis straightforward. C) inflammation, swelling, or abscesses in the internal reproductive organs. D) can be caused by several types of bacterial pathogens. E) treatment with antibiotic therapy. Answer: B Chapter/Section: 20.4 Learning Outcome: 20.24 Bloom's Taxonomy: 1-2: Remembering/Understanding 29) Ulcerative lesions are characteristic of which stage of syphilis? A) primary stage B) secondary stage C) tertiary stage D) secondary and tertiary stages E) primary and tertiary stages Answer: E Chapter/Section: 20.4 Learning Outcome: 20.25 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 30) Characteristics of Treponema pallidum, the bacterium which causes syphilis, include all except A) ability to avoid immune detection by varying the few antigens it carries on its surface. B) not treatable with any of type antibiotic. C) rapid invasion of host tissues from the initial infection site. D) vertical transmission to a fetus during any stage of pregnancy. E) Gram-negative spirochete. Answer: B Chapter/Section: 20.4 Learning Outcome: 20.25 ASM LO: 2.3 | 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding

31) Unlike many other STIs, chanchroid is often symptomatic with ________ resulting in quick treatment as patients actively seek medical attention. A) painful lesions B) disseminated body-wide rash C) high fever D) painful lesions and disseminated body-wide rash E) painful lesions, disseminated body-wide rash, and high fever Answer: A Chapter/Section: 20.4 Learning Outcome: 20.26 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 32) Which of the following would be observed as a result of vulvovaginal candidiasis? A) clue cells B) pus-filled lesions C) a "cottage cheese" discharge D) clue cells and a "cottage cheese" discharge E) pus-filled lesions and a "cottage cheese" discharge Answer: C Chapter/Section: 20.5 Learning Outcome: 20.27 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 33) Why is hyphal morphology (as opposed to a unicellular morphology) necessary for symptomatic vaginal candidiasis to develop? A) The hyphal form displaces the normal bacterial residents of the vagina. B) The hyphal form produces proteases that cause cellular damage which results in inflammation. C) The hyphal form is resistant to anti-fungal drugs. D) The hyphal form causes hormonal changes in the patient which promotes dysbiosis. E) The hyphal form is easily sexually-transmitted. Answer: B Chapter/Section: 20.5 Learning Outcome: 20.28 ASM LO: 2.4 | 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding

34) Trichomoniasis is characterized by A) structural morphogenesis linked to pathology. B) non-motile pathogen that forms persistent biofilms. C) many asymptomatic infections. D) the need for long-term antibiotic therapy to result in a cure. E) dysbiosis of the microbiome. Answer: C Chapter/Section: 20.5 Learning Outcome: 20.29 ASM LO: 2.4 | 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 35) A 30-year-old woman who is not pregnant presents with a foul-smelling, greenish vaginal discharge, indicating some form of vaginitis. A smear is taken, and routine tests performed. A motile, unicellular eukaryote with multiple flagella and an undulating membrane is observed in the microscope. What treatment is recommended? A) topical antifungal cream B) clindamycin C) doxycycline D) combination therapy of ceftriaxone and azithromycin E) single dose of metronidazole Answer: E Chapter/Section: 20.5 Learning Outcome: 20.29 Global LO: G2 ASM LO: 2.4 | 5.4 Bloom's Taxonomy: 3-4: Applying/Analyzing 20.2 True/False Questions 1) No bacteria have been detected in the semen of healthy men. Answer: FALSE Chapter/Section: 20.1 Learning Outcome: 20.6 ASM LO: 5.1 | 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 2) A urine dipstick test is negative for elevated nitrite, but bacteriological culturing reveals Gram-positive cocci. Uropathogenic Escherichia coli is indicated. Answer: FALSE Chapter/Section: 20.2 Learning Outcome: 20.11 ASM LO: 2.3 | 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding

3) Although HSV-1 usually causes oral lesions and HSV-2 usually causes genital lesions, it is possible that oral sexual contact can transmit HSV-1 to the genitals and HSV-2 to the mouth. Answer: TRUE Chapter/Section: 20.3 Learning Outcome: 20.14 ASM LO: 2.5 | 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 4) The majority of human papilloma virus strains are oncogenic, and most infections lead to cancer. Answer: FALSE Chapter/Section: 20.3 Learning Outcome: 20.16 ASM LO: 2.5 | 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 5) Despite the approval of several vaccines against human papilloma virus since 2006, infection rates of HPV in young women have not declined. Answer: FALSE Chapter/Section: 20.3 Learning Outcome: 20.16 ASM LO: 1.3 Bloom's Taxonomy: 1-2: Remembering/Understanding 6) Vaginosis may be experienced without accompanying vaginitis, but vaginitis always accompanies vaginosis. Answer: FALSE Chapter/Section: 20.4 Learning Outcome: 20.18 ASM LO: 5.1 | 5.3 | 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 7) A vaginal swab examined under the microscope reveals the presence of clue cells. Bacterial vaginosis is likely indicated. Answer: TRUE Chapter/Section: 20.4 Learning Outcome: 20.19 Global LO: G2 ASM LO: 2.3 | 5.4 Bloom's Taxonomy: 3-4: Applying/Analyzing 8) Men, rather than women, make up the majority of syphilis cases. Answer: TRUE Chapter/Section: 20.4 Learning Outcome: 20.25 Bloom's Taxonomy: 1-2: Remembering/Understanding 13 Copyright © 2023 Pearson Education, Inc.

20.3 Essay Questions 1) Describe the features that limit infection in the male and female urogenital systems. Answer: In both men and women, factors that limit infection in the urinary tract include the slightly acidic pH and the flushing action of the urine through the ureters and urethra. In women, the much shorter urethra and the proximity of the urethral opening to anus make women more likely than men to experience urinary tract infections (UTIs). The microbiome of the urinary tract may provide protection against infection, but the relationship is not well-understood at this time. In females, the vagina has a number of protective features. Vaginal epithelial cells shed continually, taking potential pathogens with them. Vaginal and cervical mucous traps microbes and contains antimicrobial peptides and lysozyme. The vaginal epithelium releases glycogen which nourishes the main member of the vaginal microbiome, the lactobacilli. Fermentation of the glycogen to lactic acid lowers the vaginal pH significantly. The lactobacilli also produce hydrogen peroxide and bacteriocins which are toxic to anaerobic bacteria. Chapter/Section: 20.1 Learning Outcome: 20.1|20.4 ASM LO: 5.1 | 5.3 | 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 2) Describe how to diagnose a lower urinary tract infection (UTI) and differentiate between common bacterial causes. Answer: Signs and symptoms of a lower UTI include frequent, urgent, and/or painful urination. Pyuria or hematuria may be observed. Urine may be cloudy or smell foul. The patient may experience lower abdominal pain. A urine dipstick test may be used to check for additional indicators of a UTI such as elevated white blood cells and the presence of nitrite (indicative of bacteria reducing nitrate found in urine). Urine samples can be cultured to detect bacterial growth. Uropathogenic Escherichia coli (UPEC) the most frequent cause of uncomplicated UTIs. UPEC are small, flagellated, Gram-negative rods with a variety of virulence factors including pili, adhesins, siderophores, toxins, and avoidance of immune cells by invading epithelial cells of the bladder. The most common Gram-positive cause of bacterial UTIs is Staphylococcus saprophyticus, primarily affecting young, sexually active women. This bacterium is found on the external genitalia of both males and females. It is not able to reduce nitrate to nitrite, a common marker of infection detected by the urine dipstick test. Chapter/Section: 20.2 Learning Outcome: 20.9 | 20.11 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding

3) Describe two pathologies that can result from a dysbiosis of the vaginal microbiome and describe how you could differentiae them. What factors can lead to dysbiosis? Answer: Bacterial vaginosis is a polymicrobial condition that is best defined as an absence of Lactobacillus in the vaginal microbiota. The reduction of lactobacilli is accompanied by an increase in anaerobic species such as Gardnerella vaginalis, Bacteroides species, Mobiluncus species, Ureaplasma urealyticum, and Mycoplasma hominis. Bacterial vaginosis can be diagnosed based on three out of four signs of Amsel's criteria including greyish-white vaginal discharge of uniform texture, an increase in vaginal pH above 4.5, presence of clue cells, and a positive whiff test. Gram-staining vaginal secretions confirms diagnosis. Bacterial vaginosis may increase the risk of pre-term labor in pregnant women. Vulvovaginal candidiasis, or vaginal yeast infection, is a fungal infection which occurs due to dysbiosis of the vaginal microbiome. The causative organism is Candida albicans. Signs and symptoms include vaginal itching, burning, pain, and a white "cottage cheese" discharge indicate a vaginal yeast infection. Vaginal yeast infections seemed to be triggered when C. albicans switches from the typical unicellular yeast form to a hyphal form. Dysbiosis of the vaginal microbiome is often caused by antibiotic therapy which wipes out the prominent lactobacilli species, allowing other species to become dominant. Hormonal changes, douching, or even bacteriophage introduced from a sexual partner's microbiome may also cause vaginal dysbiosis. Chapter/Section: 20.4 | 20.5 Learning Outcome: 20.19 | 20.27 ASM LO: 5.1 | 5.3 | 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding

Microbiology: Basic & Clinical Principles, 2e (Norman-McKay) Chapter 21 Cardiovascular and Lymphatic Infections 21.1 Multiple Choice Questions 1) What is the innermost layer of the heart? A) myocardium B) pericardium C) endocardium D) epicardium E) proteocardiums Answer: C Chapter/Section: 21.1 Learning Outcome: 21.1 Bloom's Taxonomy: 1-2: Remembering/Understanding 2) Which of the following describes how blood travels through the heart? A) right atrium, right ventricle, lungs, left atrium, left ventricle, rest of the body B) left atrium, left ventricle, lungs, right atrium, right ventricle, rest of the body C) right atrium, left atrium, lungs, right ventricle, left ventricle, rest of the body D) left atrium, right atrium, lungs, left ventricle, right ventricle, rest of the body E) left atrium, left ventricle, right atrium, right ventricle, lungs, rest of the body Answer: A Chapter/Section: 21.1 Learning Outcome: 21.2 Bloom's Taxonomy: 1-2: Remembering/Understanding 3) How does blood enter the heart? A) through the pulmonary arteries B) from the aorta C) as paricardial fluid D) by means of the capillaries surrounding the heart E) via the vena cava Answer: E Chapter/Section: 21.1 Learning Outcome: 21.2 Bloom's Taxonomy: 1-2: Remembering/Understanding

4) Which of the following numbers represents arterioles?

A) 1 B) 2 C) 3 D) 4 E) 5 Answer: B Chapter/Section: 21.1 Learning Outcome: 21.2 Bloom's Taxonomy: 1-2: Remembering/Understanding 5) What is lymph? A) thick carbohydrate matrix that supports cells in various tissues of the body B) protein-rich blood plasma that has left capillaries C) the layer of lipids that collects under the skin for protection and insulation D) the portion of blood that contains red blood cells E) the portion of blood that contains white blood cells and platelets Answer: B Chapter/Section: 21.1 Learning Outcome: 21.3 Bloom's Taxonomy: 1-2: Remembering/Understanding

6) After excess lymph drains from our tissues, it is shuttled to the lymph nodes and ________, where waste filtering and pathogen detection take place. A) body tissues lacking sufficient lymph B) kidneys C) spleen D) pancreas E) MALT tissue Answer: E Chapter/Section: 21.1 Learning Outcome: 21.3 Bloom's Taxonomy: 1-2: Remembering/Understanding 7) What happens if lymph is not collected? A) anemia B) liver toxicity C) hemorrhaging D) edema E) blood clots form Answer: D Chapter/Section: 21.1 Learning Outcome: 21.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 8) Which of the following is not a risk factor for developing sepsis? A) chronic health issues such as cancer, diabetes, AIDS, and cardiovascular disease B) recent surgery or invasive procedures C) nervous system disorder D) blunt force trauma E) a wound Answer: C Chapter/Section: 21.1 Learning Outcome: 21.5 Bloom's Taxonomy: 1-2: Remembering/Understanding 9) Which of the following is not a sign of sepsis? A) severe hypotension B) insomnia C) impaired respiratory function and low blood oxygen levels D) decreased urine output E) lymphangitis Answer: B Chapter/Section: 21.1 Learning Outcome: 21.5 Bloom's Taxonomy: 1-2: Remembering/Understanding

10) What is currently the most effective way of reducing incidence of dengue, yellow fever, chikungunya, and Zika? A) educating the public about safe sex and condom use B) controlling mosquito levels C) avoiding areas with high prevalence of these diseases D) providing better quality health care E) increasing the availability of current vaccines Answer: B Chapter/Section: 21.2 Learning Outcome: 21.6 Bloom's Taxonomy: 1-2: Remembering/Understanding 11) Why is the second stage of a dengue infection of concern? A) A high fever can lead to dehydration. B) Vomiting can lead to dehydration. C) Hemorrhagic features may develop and lead to shock, organ failure, and eventually death. D) Body aches and extreme abdominal pain can indicate an intestinal perforation. E) Nausea can be a symptom of the virus getting past the blood brain barrier, infecting the brain, and quickly killing the patient. Answer: C Chapter/Section: 21.2 Learning Outcome: 21.7 Bloom's Taxonomy: 1-2: Remembering/Understanding 12) Areas with a high population and low vaccination rates are susceptible to which type of transmission for yellow fever? A) jungle B) intermediate C) urban D) jungle, intermediate, and urban E) jungle and intermediate Answer: C Chapter/Section: 21.2 Learning Outcome: 21.8 Bloom's Taxonomy: 1-2: Remembering/Understanding 13) How can a chikungunya infection be differentiated from a dengue infection? A) blood tests that identify viral antigens, viral RNA, or patient antibodies to the virus B) microscopic analysis of the blood C) stool analysis D) liver biopsy E) Differentiation is based on symptoms due to the two presenting quite differently. Answer: A Chapter/Section: 21.2 Learning Outcome: 21.9 Bloom's Taxonomy: 1-2: Remembering/Understanding 4 Copyright © 2023 Pearson Education, Inc.

14) A man and woman honeymooned in Brazil and both experienced mild symptoms of a Zika infection upon returning home. How long should the couple wait to start a family based on this information? A) 3 months B) 6 months C) 1 year D) 8 weeks E) There is no need to wait. Answer: B Chapter/Section: 21.2 Learning Outcome: 21.10 Bloom's Taxonomy: 1-2: Remembering/Understanding 15) Which of the following would limit your possible exposure to the Lassa virus? A) keeping a rodent-free home B) not eating bushmeat C) not eating anything that hasn't been well cooked D) using insect repellant E) avoiding sexual intercourse Answer: A Chapter/Section: 21.2 Learning Outcome: 21.11 Bloom's Taxonomy: 1-2: Remembering/Understanding 16) The nickname "the kissing disease" refers to an infection caused by which pathogen? A) Ebola virus B) Marburg virus C) Lassa virus D) Epstein-Barr virus E) human immunodeficiency virus Answer: D Chapter/Section: 21.2 Learning Outcome: 21.12 Bloom's Taxonomy: 1-2: Remembering/Understanding 17) Burkitt's lymphoma is a possible complication of which disease? A) Lassa virus B) Marburg virus C) Ebola virus D) Epstein-Barr virus E) human immunodeficiency virus Answer: D Chapter/Section: 21.2 Learning Outcome: 21.12 Bloom's Taxonomy: 1-2: Remembering/Understanding

18) Which stage marks the progression of HIV to AIDS? A) stage I B) stage II C) stage III D) stage IV E) stage V Answer: C Chapter/Section: 21.2 Learning Outcome: 21.13 Bloom's Taxonomy: 1-2: Remembering/Understanding 19) An antiretroviral regimen usually consists of two reverse transcriptase inhibitors and a(n) A) protease inhibitor. B) integrase inhibitor. C) additional reverse transcriptase inhibitor. D) protease inhibitor or integrase inhibitor. E) protease inhibitor, integrase inhibitor, or additional reverse transcriptase inhibitor. Answer: E Chapter/Section: 21.2 Learning Outcome: 21.13 Bloom's Taxonomy: 1-2: Remembering/Understanding 20) When is the human T lymphotropic virus typically detected in a patient? A) Patient develops cancer or donates blood. B) Initial symptoms of infection are a clear indicator. C) The sores that develop in stage 2 give it away. D) It can only be detected postmortem. E) Typically screened for when memory loss symptoms present Answer: A Chapter/Section: 21.2 Learning Outcome: 21.14 Bloom's Taxonomy: 1-2: Remembering/Understanding 21) Which form of a Yersinia pestis infection can result in acral gangrene caused by intravascular coagulation? A) pneumonic plague B) bubonic plague C) septicemic plague D) hepatic plague E) cardiatic plague Answer: C Chapter/Section: 21.3 Learning Outcome: 21.15 Bloom's Taxonomy: 1-2: Remembering/Understanding

22) Which of the following figures is associated with a Yersinia pestis infection? A)

Answer: E Chapter/Section: 21.3 Learning Outcome: 21.15 Bloom's Taxonomy: 1-2: Remembering/Understanding 23) Which of the following would not be the origin of the bacteremia leading to endocarditis? A) infected gums B) skin abscesses C) urinary tract infections D) pneumonia E) venous catheters Answer: D Chapter/Section: 21.3 Learning Outcome: 21.16 Bloom's Taxonomy: 1-2: Remembering/Understanding

24) Which of the following is one of the most common agents to cause endocarditis? A) Yersinia pestis B) Staphylococcus aureus C) Rickettsia rickettsii D) Borrelia burgdorferi E) Francisella tularensis Answer: B Chapter/Section: 21.3 Learning Outcome: 21.16 Bloom's Taxonomy: 1-2: Remembering/Understanding 25) Which of the following events does not put you at risk for contracting a Francisella tularensis infection? A) a tick bite while out camping B) taking away a wounded rabbit your cat brought back for you C) cleaning a deer that you just shot D) adopting a dog from an animal shelter E) removing an injured squirrel from the road in front of your house Answer: D Chapter/Section: 21.3 Learning Outcome: 21.17 Global LO: G2 Bloom's Taxonomy: 3-4: Applying/Analyzing 26) Why are early symptoms of a Francisella tularensis infection often difficult to diagnose? A) Symptoms are often mild and go unnoticed. B) Early symptoms can vary based on how the bacteria are transmitted. C) Patient symptoms are the only indication that leads to a diagnosis. D) The bacteria do not grow in culture. E) Symptoms progress so slowly it can be months before the patient seeks medical care. Answer: B Chapter/Section: 21.3 Learning Outcome: 21.17 Bloom's Taxonomy: 1-2: Remembering/Understanding 27) Erythema migrans often develops as a result of what infection? A) Rickettsia rickettsii B) Borrelia burgdorferi C) Francisella tularensis D) Staphylococcus aureus E) Yersinia pestis Answer: B Chapter/Section: 21.3 Learning Outcome: 21.18 Bloom's Taxonomy: 1-2: Remembering/Understanding

28) Which of the following is not a reason Rocky Mountain spotted fever should be diagnosed within the first few days of an infection? A) It may cause blood vessel damage that impacts circulation to the arms and legs. B) Limb amputation may be required due to necrosis. C) A schizophrenia-like illness or mood disturbances may result. D) Fatal organ or brain bleeding may occur. E) Untreated cases can be fatal in as few as eight days. Answer: C Chapter/Section: 21.3 Learning Outcome: 21.18 Bloom's Taxonomy: 1-2: Remembering/Understanding 29) Why are ehrlichiosis and anaplasmosis of concern? A) Both are usually fatal. B) Incidence of both is increasing. C) Treatment is long and difficult for both. D) Both produce major complications that can be permanent. E) Areas of infection are spreading to other countries. Answer: B Chapter/Section: 21.3 Learning Outcome: 21.18 Bloom's Taxonomy: 1-2: Remembering/Understanding 30) Which of the following ways can candidiasis be contracted? A) surgery or central venous catheters B) central venous catheters or kidney dialysis C) kidney dialysis or intravenous lines D) intravenous lines or surgery E) surgery, central venous catheters, kidney dialysis, or intravenous lines Answer: E Chapter/Section: 21.4 Learning Outcome: 21.19 Bloom's Taxonomy: 1-2: Remembering/Understanding 31) Which of the following is not considered to be at higher risk for development of candidiasis? A) patients with cancer, diabetes, or AIDS B) pregnant patients C) patients who have extended hospital stays D) patients who are taking medications that suppress the immune system E) a post-operative patient on an antibiotic therapy Answer: B Chapter/Section: 21.4 Learning Outcome: 21.19 Bloom's Taxonomy: 1-2: Remembering/Understanding

32) Which of the following infections presents with three stages: a cold stage hallmarked by shivering and a sensation of cold, a hot stage with fever, and a sweating stage? A) malaria B) invasive candidiasis C) ehrlichiosis D) Rocky Mountain spotted fever E) Lyme disease Answer: A Chapter/Section: 21.5 Learning Outcome: 21.20 Bloom's Taxonomy: 1-2: Remembering/Understanding 33) When traveling to regions where malaria is common, what is the recommendation? A) If you get malaria buy some antimalarial drugs while traveling. B) Preventive antimalarial drugs should be taken daily while traveling in endemic areas. C) Spray your clothes with insecticide each morning you are traveling in endemic areas. D) Buy a bed net while traveling. E) Get vaccinated for malaria before traveling. Answer: B Chapter/Section: 21.5 Learning Outcome: 21.20 Bloom's Taxonomy: 1-2: Remembering/Understanding 34) Complicated malaria is more common than uncomplicated malaria in which of the following patient populations? A) those who have traveled to tropical areas B) those who have mild initial symptoms C) young adult patients D) those who have not been vaccinated for malaria E) elderly patients, as well as those who are pregnant or immunocompromised Answer: E Chapter/Section: 21.5 Learning Outcome: 21.21 Bloom's Taxonomy: 1-2: Remembering/Understanding 35) Mosquitoes infected with Plasmodium pass on which of the following to the host? A) sporozoites B) merozoites C) gametocytes D) trophozoites E) schizonts Answer: A Chapter/Section: 21.5 Learning Outcome: 21.22 Bloom's Taxonomy: 1-2: Remembering/Understanding

36) Which of the following is not a risk factor for a localized infection to develop into a systemic infection? A) antibiotic resistant bacteria causing the localized infection B) diabetes C) compromised immunity D) recent travel or camping in a remote area E) delaying treatment of the localized infection Answer: D Chapter/Section: 21.1 Learning Outcome: 21.5 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 37) Which of the following diseases is not caused by a mosquito vector-borne virus? A) Zika B) Dengue fever C) Ebola D) Chikungunya E) Yellow fever Answer: C Chapter/Section: 21.2 Learning Outcome: 21.6 | 21.11 ASM LO: 5.4 Bloom's Taxonomy: 1-2: Remembering/Understanding 38) A patient who had recently traveled to Sub-Saharan Africa presented with signs and symptoms that included fever, fatigue, and body aches for the past several days, with recent progression to vomiting with a blood-tinged cough. Which of the following viruses should be ruled out as a possible cause? A) Zika virus B) Ebola virus C) Lassa virus D) Marburg virus E) Dengue virus Answer: A Chapter/Section: 21.2 Learning Outcome: 21.9 | 21.11 Global LO: G2 ASM LO: 5.4 Bloom's Taxonomy: 3-4: Applying/Analyzing

39) A patient who had recently traveled to Southeast Asia presented with signs and symptoms that included recurrent chills, fever, fatigue, nausea and body aches interspersed with episodes of sweating every 2-3 days for the past several weeks. Examination revealed that the patient was now experiencing hypoglycemia, hypotension, and blood acidosis. Which of the following diseases is the likely cause of the patient's signs and symptoms? A) uncomplicated malaria B) complicated malaria C) Lassa virus D) second-stage Dengue virus E) first-stage Dengue virus Answer: B Chapter/Section: 21.5 Learning Outcome: 21.21 Global LO: G2 ASM LO: 5.4 Bloom's Taxonomy: 3-4: Applying/Analyzing 21.2 True/False Questions 1) Septic shock can cause disseminated intravascular coagulation that blocks blood flow and promotes organ failure and tissue necrosis. Answer: TRUE Chapter/Section: 21.1 Learning Outcome: 21.5 Bloom's Taxonomy: 1-2: Remembering/Understanding 2) Dengue fever, yellow fever and malaria are all caused by different RNA viruses. Answer: FALSE Chapter/Section: 21.2 Learning Outcome: 21.6 | 21.20 Bloom's Taxonomy: 1-2: Remembering/Understanding 3) Polyarthralgia is a condition experienced by patients with chikungunya fever. Answer: TRUE Chapter/Section: 21.2 Learning Outcome: 21.9 Bloom's Taxonomy: 1-2: Remembering/Understanding 4) The Ebola virus is a single-stranded RNA virus. Answer: TRUE Chapter/Section: 21.2 Learning Outcome: 21.11 Bloom's Taxonomy: 1-2: Remembering/Understanding

5) Endocarditis is mainly seen in people who have damaged, abnormal, or artificial heart valves or other heart defects. Answer: TRUE Chapter/Section: 21.3 Learning Outcome: 21.16 Bloom's Taxonomy: 1-2: Remembering/Understanding 6) Rocky Mountain spotted fever continues to be isolated to those states that border the Rocky Mountains. Answer: FALSE Chapter/Section: 21.3 Learning Outcome: 21.18 Bloom's Taxonomy: 1-2: Remembering/Understanding 7) Individuals more susceptible to fungal disease, such as AIDS patients, may be placed on antifungal medication as a preventive measure. Answer: TRUE Chapter/Section: 21.4 Learning Outcome: 21.19 Bloom's Taxonomy: 1-2: Remembering/Understanding 8) Mosquitoes that bite an infected patient take up gametocytes, which go through another growth cycle that culminates in the formation of the sporozoites that can perpetuate the infection cycle in another human. Answer: TRUE Chapter/Section: 21.5 Learning Outcome: 21.22 Bloom's Taxonomy: 1-2: Remembering/Understanding 9) Veins are more muscular and thicker than arteries to prevent carbon dioxide and other wastes from exiting the vessels when traveling toward the heart and lungs. Answer: FALSE Chapter/Section: 21.1 Learning Outcome: 21.2 Bloom's Taxonomy: 1-2: Remembering/Understanding 10) People are not at risk to be infected by malaria in the United States because the Anopheles mosquito vector is not present. Answer: FALSE Chapter/Section: 21.5 Learning Outcome: 21.20 ASM LO: 3.4 Bloom's Taxonomy: 1-2: Remembering/Understanding

11) The Plasmodium protozoan that causes malaria can complete its entire life cycle in a mosquito; a human host is not required. Answer: FALSE Chapter/Section: 21.5 Learning Outcome: 21.22 Bloom's Taxonomy: 1-2: Remembering/Understanding 21.3 Essay Questions 1) Describe how you would initially manage a patient with sepsis and then what additional steps you would take if the patient needed to be put on life support. Answer: Managing sepsis mainly involves reducing system-wide inflammation, regulating body temperature, stabilizing blood pressure, and increasing blood oxygen levels. If the sepsis case is caused by a nonviral pathogen, then intravenous antimicrobial drugs may also be administered. Patients with severe sepsis are often put on life support until they are fully stabilized and the condition starts to resolve. Life support care often includes intubation, mechanical ventilation, sedation, and analgesia (pain management/relief). Chapter/Section: 21.1 Learning Outcome: 21.5 Global LO: G8 ASM LO: 7.3a Bloom's Taxonomy: 3-4: Applying/Analyzing 2) What three outcomes result from a human T lymphotropic virus infection? Answer: 1. Virus-infected T cells grow abnormally and result in adult T cell leukemia or lymphoma. 2. Infected T cells may produce abundant interferon, creating inflammatory responses to the central nervous system, termed HTLV-1-associated myelopathy (HAM). 3. HTLV infection can result in unchecked or opportunistic infections due to the decrease in functioning leukocytes. Chapter/Section: 21.2 Learning Outcome: 21.14 Global LO: G8 ASM LO: 7.3a Bloom's Taxonomy: 3-4: Applying/Analyzing 3) Although uncomplicated malaria presents with mild symptoms, complicated malaria can have a number of signs. What are they? Answer: Complicated malaria can present with anemia, low blood pressure (hypotension), low blood glucose (hypoglycemia), and/or excessive acidity of the blood (acidosis). Kidney failure, acute respiratory distress syndrome, and malarial infection of the brain are also possible in severe cases. Chapter/Section: 21.5 Learning Outcome: 21.21 Global LO: G8 ASM LO: 7.3a Bloom's Taxonomy: 3-4: Applying/Analyzing 15 Copyright © 2023 Pearson Education, Inc.

4) Candidemia (invasive candidiasis) is the fourth most common healthcare-acquired infection in the United States, with a mortality rate of 25-40 percent. As a healthcare provider, what are some steps you would take to prevent and/or treat this infection in a patient who is post-operative and in an extended hospital stay? Answer: First of all, I would be sure to review the early signs and symptoms of the disease so I could catch it early if it started to develop. I would frequently check any venous catheters or intravenous lines for signs of inflammation or infection and also ask the patient to alert me if there was any pain in the area. If the patient has HIV/AIDS or is immunocompromised, I would consider placing the patient on an antifungal medication as a preventative measure. If I saw early signs and symptoms such as fever/chills or redness and pain near the exit site of an internal line or catheter, I would immediately start first-line treatments with antifungal drugs (such as echinocandin or fluconazole). The patient's blood would then be cultured every other day to determine if the candidiasis is being brought under control. Chapter/Section: 21.4 Learning Outcome: 21.19 Global LO: G8 ASM LO: 5.4 | 7.3a Bloom's Taxonomy: 3-4: Applying/Analyzing