tag:blogger.com,1999:blog-11807707010558033702023-11-16T08:41:38.214-08:00Free Medical MCQ'sSolve Medical MCQ's for freeDr.Mirza Adnanhttp://www.blogger.com/profile/17089423639853021732noreply@blogger.comBlogger7125tag:blogger.com,1999:blog-1180770701055803370.post-53812912452756297712012-12-16T11:17:00.002-08:002012-12-16T11:17:49.216-08:00General Microbiology<div dir="ltr" style="text-align: left;" trbidi="on">
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<!--[if !supportLists]--><span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">•<span style="font-size: 7pt;">
</span></span><!--[endif]--><b><span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">Which organism below, if present in only one of three blood cultures
from a single patient, is most likely to represent contamination caused by poor
antiseptic technique, rather than genuine infection?<o:p></o:p></span></b></div>
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epidermidis.</b> <o:p></o:p></span></div>
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<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">B Streptococcus pneumoniae. <o:p></o:p></span></div>
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<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">C Escherichia coli. <o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">•<span style="font-size: 7pt;">
</span></span><!--[endif]--><b><span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria
meningitidis all colonize the upper respiratory tract and can spread from there
to the bloodstream and/or meninges. What essential virulence factor, that aids
such spread, is produced by all three organisms? <o:p></o:p></span></b></div>
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<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">A IgA protease.
<o:p></o:p></span></div>
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<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">B <b>Polysaccharide
capsule. </b> <o:p></o:p></span></div>
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<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">C Thick peptidoglycan. <o:p></o:p></span></div>
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<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">D Endotoxin.
<o:p></o:p></span></div>
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<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">E Exotoxin.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">•<span style="font-size: 7pt;">
</span></span><!--[endif]--><b><span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">Three days after an appendectomy, the patient develops high fever. The
patient's vital signs include a dangerously low blood pressure. The patient's
erythrocyte sedimentation rate (ESR) is above-normal. Which of the cytokines
below most directly contributed to development of these symptoms?<o:p></o:p></span></b></div>
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<b><span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"> <o:p></o:p></span></b></div>
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<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">A IL-4 <o:p></o:p></span></div>
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<o:p></o:p></span></div>
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<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">E <b>TNF-alpha <o:p></o:p></b></span></div>
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<!--[if !supportLists]--><span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">•<span style="font-size: 7pt;">
</span></span><!--[endif]--><b><span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">A patient began to receive intravenous antibiotics dissolved in
sterile saline solution developed fever within an hour. (The solution in which
antibiotics were dissolved had been sterilized by autoclaving.) The IV infusion
was stopped and the fluid cultured, but cultures on a variety of media were
sterile. Which of the following
bacterial components would have been most effective in producing the patient's
fever?<o:p></o:p></span></b></div>
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<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">A Spores <o:p></o:p></span></div>
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<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">B <b>Lipopolysaccharide.</b> <o:p></o:p></span></div>
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<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">C Capsule polysaccharide. <o:p></o:p></span></div>
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<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">D Outer membrane proteins. <o:p></o:p></span></div>
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<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">E Siderophores.
<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">•<span style="font-size: 7pt;">
</span></span><!--[endif]--><b><span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">Cells of pathogenic Gram-negative bacteria often have 'common pili'
extending from their surfaces. What process is promoted by these pili?<o:p></o:p></span></b></div>
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<b><span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"> <o:p></o:p></span></b></div>
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<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">A <b>Adherence
of bacteria to mammalian cells. <o:p></o:p></b></span></div>
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<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">B Inhibition of Complement activation. <o:p></o:p></span></div>
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<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">C Resistance to opsonization by antibodies. <o:p></o:p></span></div>
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<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">D Transfer of DNA between bacterial cells. <o:p></o:p></span></div>
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<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">E Transport of nutrients into bacterial
cells. <o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">•<span style="font-size: 7pt;">
</span></span><!--[endif]--><b><span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">Water used to prepare solutions for intravenous use must not only be
sterile, but also be free of bacterial components. After sterilization, which
bacterial component is it most important to remove?<o:p></o:p></span></b></div>
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<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">A Lipids of the plasma (inner) membrane. <o:p></o:p></span></div>
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<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">B Capsular polysaccharide. <o:p></o:p></span></div>
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<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">C Spores.
<o:p></o:p></span></div>
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<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">D <b>Lipopolysaccharide</b>. <o:p></o:p></span></div>
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<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">E Proteases which activate complement.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">•<span style="font-size: 7pt;">
</span></span><!--[endif]--><b><span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">A patient with bacterial infection of the bloodstream developed fever
and shock, produced by lipopolysaccharide (LPS). What part of LPS was
responsible for its toxic effect?<o:p></o:p></span></b></div>
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<b><span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"> <o:p></o:p></span></b></div>
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<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">A Long repeating polysaccharide (O-antigen). <o:p></o:p></span></div>
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<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">B Complex phosphorylated polysaccharide
core. <o:p></o:p></span></div>
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<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">C Unsaturated fatty acids, released by
hydrolysis. <o:p></o:p></span></div>
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<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">D <b>Disaccharide
substituted with saturated fatty acids (Lipid A).</b> <o:p></o:p></span></div>
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<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">E Protein, freed from covalent linkage to
polysaccharide by plasma proteases.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">•<span style="font-size: 7pt;">
</span></span><!--[endif]--><b><span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">Which compound is found in the envelopes of Gram-positive bacteria,
but not in Gram-negatives?<o:p></o:p></span></b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"> <o:p></o:p></span></div>
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<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">A Peptidoglycan.
<o:p></o:p></span></div>
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<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">B Porin proteins. <o:p></o:p></span></div>
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<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">C Lipid A.
<o:p></o:p></span></div>
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<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">D <b>Teichoic
acid. <o:p></o:p></b></span></div>
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<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">E Capsule<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">•<span style="font-size: 7pt;">
</span></span><!--[endif]--><b><span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">Streptococcus pneumoniae is cultured from a patient's sputum. Clinical
isolates of this species typically have thick polysaccharide capsules;
varieties without capsules seldom produce serious disease. How do capsules
increase the ability of S. pneumoniae to cause disease?<o:p></o:p></span></b></div>
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<b><span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"> <o:p></o:p></span></b></div>
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<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">A Inhibit binding of antibodies. <o:p></o:p></span></div>
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<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">B Directly toxic to phagocytic cells. <o:p></o:p></span></div>
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<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">C Inhibit activation of complement. <o:p></o:p></span></div>
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<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">D <b>Inhibit
phagocytosis by neutrophils. </b><o:p></o:p></span></div>
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<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">E Inhibit antigen presentation by MHC. <o:p></o:p></span></div>
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<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">F Not immunogenic, but mask immunogenic surface
structure<o:p></o:p></span></div>
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<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 31.5pt; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">•<span style="font-size: 7pt;">
</span></span><!--[endif]--><b><span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">In the immune response to invasive infections by Streptococcus
pneumoniae, antibodies are required for effective defense. Antibodies to which
antigen are most important?<o:p></o:p></span></b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"> <o:p></o:p></span></div>
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<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">A Teichoic acid.
<o:p></o:p></span></div>
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<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">B Peptidoglycan.
<o:p></o:p></span></div>
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<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">C C-carbohydrate. <o:p></o:p></span></div>
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<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">D Type III secretion system. <o:p></o:p></span></div>
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<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">E <b>Polysaccharide
capsule.</b><o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">•<span style="font-size: 7pt;">
</span></span><!--[endif]--><b><span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">A child develops severe pharyngitis with purulent exudate and high
fever, consistent with Group A streptococcal infection. He is treated with
Penicillin G, but his parents discontinue the antibiotic after a few days
because he feels much better and does not like to take pills. Some time later
he develops acute rheumatic fever (ARF). Which bacterial antigen provoked the
immune response which caused ARF?<o:p></o:p></span></b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<b><span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"> <o:p></o:p></span></b></div>
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<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">A Peptidoglycan.
<o:p></o:p></span></div>
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<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">B Teichoic acid.
<o:p></o:p></span></div>
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<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">C Group A carbohydrate <o:p></o:p></span></div>
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<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">D A superantigen protein exotoxin. <o:p></o:p></span></div>
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<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">E M <b>protein</b>.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">•<span style="font-size: 7pt;">
</span></span><!--[endif]--><b><span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">An important virulence factor of coagulase-positive staphylococci is
Protein A. How does Protein A aid in virulence?<o:p></o:p></span></b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"> <o:p></o:p></span></div>
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<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">A <b>Binds
the Fc region of IgG, decreases opsonization (Phagocytosis). <o:p></o:p></b></span></div>
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<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">B Hydrolyzes secretory IgA. <o:p></o:p></span></div>
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<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">C Binds Factor H, prevents activation of
complement. <o:p></o:p></span></div>
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<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">D Extracts iron from plasma proteins. <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">E Promotes tight binding of bacteria to
extracellular matrix.<o:p></o:p></span></div>
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<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 31.5pt; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">•<span style="font-size: 7pt;">
</span></span><!--[endif]--><b><span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">A notable virulence factor of pathogenic Yersinia is the ability to
paralyze phagocytes and so prevent ingestion of bacteria. What mechanism
enables Yersinia to do this?<o:p></o:p></span></b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<b><span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"> <o:p></o:p></span></b></div>
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<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">A Quorum-sensing system. <o:p></o:p></span></div>
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<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">B Two component regulatory system. <o:p></o:p></span></div>
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<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">C <b>Type III
secretion system. <o:p></o:p></b></span></div>
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<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">D Iron-acquisition system. <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">E Phase variation for adhesive pili.<o:p></o:p></span></div>
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<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 31.5pt; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">•<span style="font-size: 7pt;">
</span></span><!--[endif]--><b><span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">One week after surgery to remove an inflamed appendix the patient
develops fever, chills, and hypotension. Anaerobic blood cultures grow
Bacteroides fragilis. What was the most likely source of this infection?<o:p></o:p></span></b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
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<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">A. Home-grown tomatoes brought to the patient by
his family.<o:p></o:p></span></div>
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<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">B. Direct contact with a health care worker.<o:p></o:p></span></div>
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<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">C. Inhalation of airborne spores.<o:p></o:p></span></div>
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<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">D. Fecal contamination of food or water.<o:p></o:p></span></div>
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<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">E. <b>The
patient’s own intestinal flora.</b><o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">•<span style="font-size: 7pt;">
</span></span><!--[endif]--><b><span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">A febrile patient with E. coli sepsis develops ‘septic shock’. Which of the following is likely to have
played largest role in this reaction?<o:p></o:p></span></b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">A. A humoral immune response to bacterial surface
antigens.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">B. A cell-mediated immune response to bacteria.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">C. <b>Secretion
of cytokines by monocytes in response to stimulation by LPS [endotoxin].<o:p></o:p></b></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">D. Release of granule contents by mast cells and
basophils.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">E. Secretion of a bacterial superantigen toxin
that activates TH cells.<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 31.5pt; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">•<span style="font-size: 7pt;">
</span></span><!--[endif]--><b><span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">E. coli and Neisseria meningitidis isolated from blood cultures often
have transport systems (for acquiring metal ions from the environment) lacking
in their less-virulent relatives. Which metal is acquired by the majority of
these systems?<o:p></o:p></span></b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">A. Copper<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">B. Sodium<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">C. Potassium<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">D. Magnesium<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">E. <b>Iron</b><o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 31.5pt; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">•<span style="font-size: 7pt;">
</span></span><!--[endif]--><b><span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">A bacillus cultured from stool produces dark pink colonies on
MacConkey agar. Which of the following
organisms is most likely?<o:p></o:p></span></b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">A. <b>Escherichia
coli</b><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">B. Salmonella enterica<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">C. Listeria monocytogenes<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">D. Shigella sonnei<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">E. Shigella dysenteriae<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 31.5pt; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">•<span style="font-size: 7pt;">
</span></span><!--[endif]--><b><span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">Fresh liquid cultures of Pseudomonas aeruginosa and Streptococcus
bovis were mixed and Gram-stained. However, the safranin counter-stain was
accidentally omitted. If you looked at this preparation under the microscope,
which line below best describes what you should expect to see?<o:p></o:p></span></b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-indent: 16.05pt;">
<b><span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">Cocci
Bacilli<o:p></o:p></span></b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">A. Colorless Colorless<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">B. Blue Pink/red<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">C. <b>Blue Colorless<o:p></o:p></b></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">D. Pink/red Colorless<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">E. Pink/red Pink/red<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 31.5pt; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">•<span style="font-size: 7pt;">
</span></span><!--[endif]--><b><span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">Bacteroides fragilisis isolated from an abdominal abscess. Which
phrase below best describes infections like this one?<o:p></o:p></span></b></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 31.5pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">A. <b>Other
species of bacteria also often present.<o:p></o:p></b></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">B. Initiated by ingestion of spores.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">C. Can be successfully treated with
aminoglycosides alone.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">D. Contracted by the respiratory route.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">E. Sexually-transmitted.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 31.5pt; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">•<span style="font-size: 7pt;">
</span></span><!--[endif]--><b><span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">A young woman has a urinary tract infection caused by E. coli. By what
route are such infections most commonly acquired? <o:p></o:p></span></b></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 31.5pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">A. Respiratory route, followed by spread from the
anterior nares.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">B. Respiratory route, followed by spread from the
oro-pharyngeal region.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">C. <b>Fecal-oral
route, followed by colonization of the intestine and then the perineum.<o:p></o:p></b></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">D. Intestinal infection, followed by spread of
bacteria to the urethra via the bloodstream.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 31.5pt; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">•<span style="font-size: 7pt;">
</span></span><!--[endif]--><b><span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">Ability of E. coli and related Gram-negative rods to cause intestinal
and urinary-tract infections is promoted by ability of bacteria to adhere
tightly to epithelial cells. Which of the following bacterial structures is
primarily an organelle of adhesion?<o:p></o:p></span></b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">A. Outer membrane.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">B. Inner membrane.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">C. Peptidoglycan.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">D. Flagella.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<b><span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">E. Common
pili.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 31.5pt; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">•<span style="font-size: 7pt;">
</span></span><!--[endif]--><b><span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">A 4-year-old child is brought to the emergency room, stuperous and
unresponsive, with a temperature of 39oC. A lumbar puncture is performed and a
smearof cerebrospinal fluid is Gram-stained. Each high-power field contains
many neutrophils, red cells, and Gram-positive cocci. What does the blue color
of the cocci indicate about the structure of their envelopes?<o:p></o:p></span></b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">A. <b>Thick
peptidoglycan.<o:p></o:p></b></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">B. Thin peptidoglycan.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">C. Thick capsule.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">D. Many adhesive pili.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">E. Long O-antigen chains.<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 31.5pt; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">•<span style="font-size: 7pt;">
</span></span><!--[endif]--><b><span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">Sputum is obtained from a patient believed to have tuberculosis,
produced by infection with Mycobacterium tuberculosis, an acid-fast bacterium.
A sputumsmear is stained using the same technique used on the demonstration
slides in the lab. If the patient indeed has Tuberculosis, and the stain is
done with proper procedure, how should the bacteria appear?<o:p></o:p></span></b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">A. Cocci, which stain dark red.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">B. Cocci, which stain dark green.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">C. Cocci, which stain dark blue.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">D. <b>Bacilli,
which stain dark red.</b><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">E. Bacilli, which stain dark green.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">F. Bacilli, which stain dark blue.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 31.5pt; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">•<span style="font-size: 7pt;">
</span></span><!--[endif]--><b><span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">A six-month old boy develops bloodstream infection with a
Gram-negative bacterium and rapidly develops high fever and hypotension. There
is no pasthistory of similar infections. Which of the following was most
greatly responsible for the fever and hypotension?<o:p></o:p></span></b></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 31.5pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">A. Capsule polysaccharide, which activated
Complement by the Alternate Pathway.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">B. Binding of IgG antibodies to bacteria, which
activated Complement by the Classical Pathway.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">C. <b>Lipopolysaccharide,
which bound to Toll-like receptors.<o:p></o:p></b></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">D. Common pili, which allowed bacteria to bind
tightly to endothelial cells.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">E. Porin proteins, which allowed bacterial toxins
to exit the periplasm.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 31.5pt; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">•<span style="font-size: 7pt;">
</span></span><!--[endif]--><b><span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">Patients with bloodstream infections with Gram-positive bacteria can
develop septic shock. Which inflammatory
components are present inthe envelopes of Gram-positive bacteria?<o:p></o:p></span></b></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 31.5pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">A. Core and Lipid A of Lipopolysaccharide.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">B. O-antigen chains of Lipopolysaccharide.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">C. Porin proteins and periplasmic lipoproteins.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">D. <b>Peptidoglycan
and teichoic acids.</b><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 31.5pt; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">•<span style="font-size: 7pt;">
</span></span><!--[endif]--><b><span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">Bacteria of the genus Mycoplasmalack all envelope components external
to the plasma membrane. How would you
expect this unusual structural feature to affect their biology?<o:p></o:p></span></b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">A. Their Lipid A should produce intense
inflammation.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">B. They should be highly-resistant to osmotic
lysis.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">C. <b>They
should be resistant to penicillin and structurally-related drugs</b>.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">D. They should stain Gram-positive.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: 16.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;">E. Absence of an outer membrane means that they
must lack a respiratory chain.</span></div>
</div>
Dr.Mirza Adnanhttp://www.blogger.com/profile/17089423639853021732noreply@blogger.com4tag:blogger.com,1999:blog-1180770701055803370.post-25857394847620624172012-12-16T11:08:00.001-08:002012-12-16T11:14:11.275-08:00USMLE Step1 Microbiology <div dir="ltr" style="text-align: left;" trbidi="on">
<div class="separator" style="clear: both; text-align: center;">
</div>
1. _____ A
7-year-old patient presents with pain in the left ear. Pus is drained from the
ear and a sample sent for culture. Gram stain reveals neutrophils and small
Gram-negative bacteria. A common pathogen in this setting is Haemophilus
influenzae. However, the bacteria in the smear are so small that it is
difficult to decide whether they are really rods or cocci. What information
from the lab would allow identification of the organism as H. influenzae?<br />
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
A. Growth
on chocolate agar in elevated CO2 but not room air.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
B.
β-hemolysis around colonies on sheep blood agar.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
C. Ability
to grow in medium containing 6.5% NaCl.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
D.
Sensitivity to bacitracin and resistance to optochin.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
E. Positive
bile-esculin test.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<b>F. Growth on broth-based agar supplemented with
hemin and NAD<o:p></o:p></b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<b>(= Factors X and V).<o:p></o:p></b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
2. _____
Successful immunization against Tetanus results in production of antibodies
that prevent disease.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
By what
mechanism do these protective antibodies prevent Tetanus?<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
A. Opsonize
cells of C. tetani.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
B. Prevent
binding of C. tetani endotoxin to monocyte receptors.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
C. Bind C.
tetani flagella, prevent cell motility and access to neurons.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
D. Bind C.
tetani cells and activate complement.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
E. Bind
toxin receptors on neuron plasma membranes, prevent binding/entry of toxin.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
F. <b>Neutralize the protein exotoxin of C.
tetani.<o:p></o:p></b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
3. _____ A
15-year-old male from west-central New Jersey has been ill for five days with
fever, chills, and headache, and today woke to find a rash covering his body
and limbs, including his palms and soles.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
The rash is
composed of fine macular lesions (macule = flat spot, red but not raised).
Rocky Mountain<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
Spotted
Fever should be high on your list of possible causes. To help confirm or rule
out this possibility, you need to ask him about possible exposure to the source
of this disease.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
What should
you ask him about?<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
A. Drinking
un-chlorinated water.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
B. Eating
raw meat.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
C.
Unprotected sex.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
D. <b>Tick bites.<o:p></o:p></b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
E. Contact
with pet reptiles or birds.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<b>Questions 4-6: An elderly man with a
post-surgical infection.</b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
An
intravenous catheter was put in place for delivery of antibiotics and other
medications. He developed fever and pneumonia 3 days after surgery. Sputum
culture on sheep blood agar grew out numerous small gray α- hemolytic colonies;
about 10% of colonies were larger, white, shiny, opaque, and β-hemolytic. Only
the latter type grew from blood cultures. Both colony types contained
Gram-positive cocci. The lab reported the small colonies as ‘oral streptococci’
and the larger colonies as ‘coagulase-negative Staphylococci’.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
4. _____
What test was used to distinguish Staphylococci from Streptococci?<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
A. <b>Catalase test</b><o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
B.
Coagulase test<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
C. Oxidase
test<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
D.
Sensitivity to optochin<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
E.
Sensitivity to bacitracin<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
F. CAMP
test<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
5. _____
What does the coagulase-negative result indicate?<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
A. The
organism is more virulent than other staphylococci.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
B. The
organism is likely to produce a superantigen toxin.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
C. The
patient is in little or no danger of developing septic shock.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
D. The
Gram-positive staining was likely the result of improper laboratory procedure.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
E. <b>The catheter entry site is likely to have
been infected by normal skin flora.<o:p></o:p></b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
6. _____ An
important virulence factor of coagulase-positive staphylococci is Protein A.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
How does
Protein A aid in virulence?<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
A. <b>Binds the Fc region of IgG, decreases
opsonization</b>.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
B.
Hydrolyzes secretory IgA.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
C. Binds
Factor H, prevents activation of complement.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
D. Extracts
iron from plasma proteins.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
E. Promotes
tight binding of bacteria to extracellular matrix.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<b>Questions 7-9: An HIV-positive patient with
hemoptysis.</b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
He is 30
years old and has been referred to you because of hemoptysis (= coughing up
blood). A cavitary lesion in the right upper lobe of the lung is seen on chest
x-ray (Cavitary lesion = opaque lesion on x-ray with a central region of low
density produced by death of tissue.) A sample of sputum is obtained and a
smear is acid-fast-stained using the red dye carbol-fuchsin.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
7. _____ If
this is tuberculosis, what would you expect to observe after acid-fast stain of
sputum?<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
A. No
stained bacteria<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
B. Irregularly-staining
red branching filaments.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
C. Red
acid-fast cocci, in grape-like clusters<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
D.
Blue-staining bacilli.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
E. <b>Red-staining bacilli</b>.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
8. _____
The patient is given a tuberculin test. Three days later, there is induration
and erythema, 32 mm in diameter, at the site of injection, a positive test
result.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
What
process produced the induration and erythema?<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
A.
Activation of complement.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
B.
Induction of a primary antibody response.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
C. Invasion
and lysis of epithelial cells by bacteria.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
D. <b>Cytokine production by CD4+ T lymphocytes</b>.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
E. Release
of inflammatory cell-envelope components from bacteria.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
9.______
The sputum sample was sent for culture on Lowenstein-Jensen agar and in the
BACTEC system.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
The
probable diagnosis was readily established by x-ray, direct smear, and skin
testing.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
Why was the
labor- and time-intensive culture procedure performed?<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
A. Many
fungi stain acid-fast.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
B. Only
highly-virulent mycobacteria grow on the media used for culture.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
C. <b>Culture allows testing for antibiotic
sensitivity/resistance</b>.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
D. Rapid
growth of mycobacteria correlates with high virulence.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
Choose the
single best answer to each question.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
10. _____
Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis, and
Cryptococcus neoformans all colonize the upper respiratory tract and can spread
from there to the meninges. What essential virulence factor, that aids
meningeal spread, is produced by all four organisms?<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
A. IgA
protease<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
B. <b>Polysaccharide capsule<o:p></o:p></b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
C. Thick
peptidoglycan<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
D.
Endotoxin<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
E. Exotoxin<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
11. _____
Seven children in a third-grade class developed bloody diarrhea; one of them
was hospitalized with renal failure. Stool cultures for Gram-positive and
Gram-negative bacteria (including Campylobacter) yielded only “normal
intestinal flora” and “lactose-positive organisms” on MacConkey agar.
Epidemiologists found that, three days before the outbreak, the class had gone
to a local restaurant for a party. All children who became ill, and none who
did not, had eaten hamburgers. Later it was found that some lactose fermenters
failed to ferment sorbitol. Which organism is most strongly suggested by the
laboratory and epidemiologic data?<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
A. Bacillus
cereus<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
B.
Campylobacter jejuni<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
C.
Clostridium perfringens<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
D. <b>Escherichia coli<o:p></o:p></b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
E. Listeria
monocytogenes<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
F.
Salmonella enterica<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
G.
Staphylococcus aureus<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
H. Yersinia
enterocolitica<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
12._____ An
18-year-old man is seen in clinic for urethral discharge. Gram-stained smear of
exudate contains neutrophils and Gram-negative diplococci, many of them
intracellular. He is treated with ceftriaxone (a β-lactam) but does not get
better, and returns. On his second visit, Gram-stained smear of exudate
contains neutrophils but no bacteria are visible, and culture of exudate
produces no colonies on Sheep blood, Chocolate, or Thayer-Martin agars in
elevated CO2.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
Which two
species below are most likely to have caused his infections?<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
A.
Klebsiella pneumoniae and Chlamydia pneumoniae<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
B.
Neisseria meningitidis and Chlamydia trachomatis<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
C.
Legionella pneumophila and Mycoplasma pneumoniae<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
D.
Treponema pallidum and Ehrlichia phagocytophila<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
E. <b>Neisseria gonorrhoeae and Mycoplasma
hominis</b><o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<b>Questions 13-15: A young woman with a
post-chemotherapy infection.<o:p></o:p></b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
A
21-year-old woman with leukemia was treated with a brief intensive course of
cytotoxic drugs. Ten days after therapy began she developed fever and shortness
of breath. A CBC (complete blood count) showed her to be highly neutropenic.
Chest x-ray revealed a dense lesion in her left lung. Sputum culture grew out
“normal oral flora” plus large fuzzy colonies. Under the microscope the fuzzy
colonies contained hyphae (with septa) which branched at acute angles, and
conidia in chains. In a silver-stained biopsy of the lung lesion branching
hyphae were seen in tissue.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
13. _____
What process is most likely to have created the patient’s neutropenia?<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
A. Cytokine
production by leukemic cells.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
B. <b>Killing of dividing cells by cytotoxic
anti-cancer drugs.<o:p></o:p></b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
C. Killing
by toxins secreted by the pathogen.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
D.
Induction of apoptosis by the pathogen.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
E. A
genetic defect in neutrophil production.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
14. _____
To what genus is the pathogen most likely to belong?</div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
A.
Actinomyces<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
B. <b>Aspergillus<o:p></o:p></b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
C.
Klebsiella<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
D.
Mycobacterium<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
E.
Mycoplasma<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
F. Mucor<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
G.
Pneumocystis<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
H.
Staphylococcus<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
I.
Streptococcus<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
J. Rhizopus<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
15. _____
With what drug should the patient be treated?<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
A. Another
β-lactam<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
B. A β-lactam
plus an aminoglycoside<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
C. An
aminoglycoside alone<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
D. <b>An azole</b><o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
E. A
tetracycline<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
16. _____
Gastroscopy reveals that a patient with stomach pain has a large ulceration of
his gastric mucosa. During the procedure a biopsy of the stomach epithelium is
obtained.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
Which
observation would suggest Helicobacter pylori as the cause of illness?<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
A. <b>Curved or spiral bacteria seen in the
biopsy after silver staining.<o:p></o:p></b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
B. Biopsy
shows infiltration of gastric epithelium by lymphocytes.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
C. pH of
stomach fluid is equal to 1 (normal), rather than decreased.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
D. Ingested
isotope-labeled nitrate is converted to nitrite in the stomach.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
E. Bacteria
are found in stomach fluid, but not in contact with the gastric epithelium.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
17. _____ A
75-year-old man reports malaise, headache, and fever. On examination his neck
is mildly stiff. Gram stain of the patient's CSF reveals neutrophils and
numerous Gram-negative cocci, many in pairs. Which organism below is most
likely?<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.5in; text-indent: -0.25in;">
<!--[if !supportLists]-->•<span style="font-size: 7pt;">
</span><!--[endif]-->Pseudomonas aeruginosa<o:p></o:p></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.5in; text-indent: -0.25in;">
<!--[if !supportLists]-->•<span style="font-size: 7pt;">
</span><!--[endif]-->Klebsiella pneumoniae<o:p></o:p></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.5in; text-indent: -0.25in;">
<!--[if !supportLists]-->•<span style="font-size: 7pt;">
</span><!--[endif]-->Haemophilus influenzae<o:p></o:p></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.5in; text-indent: -0.25in;">
<!--[if !supportLists]-->•<span style="font-size: 7pt;">
</span><!--[endif]-->Escherichia coli<o:p></o:p></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.5in; text-indent: -0.25in;">
<!--[if !supportLists]-->•<span style="font-size: 7pt;">
</span><!--[endif]-->Treponema pallidum<o:p></o:p></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.5in; text-indent: -0.25in;">
<!--[if !supportLists]-->•<span style="font-size: 7pt;">
</span><!--[endif]-->Nocardia asteroides<o:p></o:p></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.5in; text-indent: -0.25in;">
<!--[if !supportLists]-->•<span style="font-size: 7pt;">
</span><!--[endif]-->Neisseria gonorrhoeae<o:p></o:p></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.5in; text-indent: -0.25in;">
<!--[if !supportLists]-->•<span style="font-size: 7pt;">
</span><!--[endif]--><b>Neisseria
meningitides<o:p></o:p></b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
18. _____ A
young man develops peritonitis following abdominal trauma. During surgery
foul-smelling purulent material is aspirated from the infected area. Gram stain
of this material contains a mixture of Gram positive cocci, Gram-positive rods,
and many Gram-negative rods. Aerobic culture on sheep blood agar yields many
colonies of enterococci and a few colonies of E. coli; culture on MacConkey
agar produces only sparse colonies of E. coli. Anaerobic culture on sheep blood
agar produces a few colonies of β-hemolytic Gram-positive rods and many
colonies of slender Gram-negative rods.</div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
Which
organism is most likely to represent the majority of the Gram-negative rods
seen when peritoneal exudate was stained?<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.5in; text-indent: -0.25in;">
<!--[if !supportLists]-->•<span style="font-size: 7pt;">
</span><!--[endif]-->Yersinia enterocolitica<o:p></o:p></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.5in; text-indent: -0.25in;">
<!--[if !supportLists]-->•<span style="font-size: 7pt;">
</span><!--[endif]-->Clostridium perfringens<o:p></o:p></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.5in; text-indent: -0.25in;">
<!--[if !supportLists]-->•<span style="font-size: 7pt;">
</span><!--[endif]-->Clostridium tetani<o:p></o:p></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.5in; text-indent: -0.25in;">
<!--[if !supportLists]-->•<span style="font-size: 7pt;">
</span><!--[endif]-->Pseudomonas aeruginosa<o:p></o:p></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.5in; text-indent: -0.25in;">
<!--[if !supportLists]-->•<span style="font-size: 7pt;">
</span><!--[endif]-->Salmonella typhi<o:p></o:p></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.5in; text-indent: -0.25in;">
<!--[if !supportLists]-->•<span style="font-size: 7pt;">
</span><!--[endif]-->Yersinia pseudotuberculosis<o:p></o:p></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.5in; text-indent: -0.25in;">
<!--[if !supportLists]-->•<span style="font-size: 7pt;">
</span><!--[endif]--><b>Bacteroides
fragilis<o:p></o:p></b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<b>Questions 19-20: A woman with neurological
illness.<o:p></o:p></b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
19. _____ A
55-year-old woman develops diplopia, one day after eating home-canned fruit.
(Diplopia = double vision, from inability to coordinate the direction of gaze
of the eyes.) A few hours later she develops difficulty speaking, bilateral
weakness of her arms, nausea, vomiting, dizziness, blurred vision, and dry
mouth. However she is alert, oriented, and has no fever.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
If this is
botulism, by what mechanism did Clostridium botulinum produce her signs and
symptoms?<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
A. Bound to
Toll-like receptors and stimulated production of inflammatory cytokines.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
B. Injected
proteins into neurons via a type III secretion system.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
C<b>. Secreted a protein toxin that enters
mammalian neurons and blocks synaptic transmission.</b><o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
D. Released
peptidoglycan and other inflammatory components of the cell envelope.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
E.
Bacteremic spread followed by infection of multiple tissues: eyes, muscle,
stomach, nervous system, salivary glands.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
20. _____
Home-canned food is a common source of botulism in adults. What property of C.
botulinum facilitates infection by this route?<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
A. <b>Produces airborne spores not easily killed
by boiling.<o:p></o:p></b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
B.
Vegetative cells grow best at cooking temperatures.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
C.
Extremely resistant to gastric acid.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
D. Thick
peptidoglycan renders cells resistant to heat, cold, and drying.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
E. Surface
proteins inhibit digestive hydrolases.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<b>Questions 21-23: Gram-positive septicemia.</b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
A
25-year-old man has high fever and elevated white count. Blood cultures are
obtained. He is treated with a broad spectrum cephalosporin plus an
aminoglycoside. The next day the laboratory reports that cultures contain
catalase positive Gram-positive cocci in clusters. Identification of the
organism and determination of antibiotic sensitivity are underway. Pending
arrival of these results, the cephalosporin is replaced with vancomycin.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
21. _____
What was the major rationale for this change?<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
A.
Cephalosporins (as a class) have a narrower spectrum of action than vancomycin.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
B<b>. The lab results suggest staphylococci,
many of which are resistant to cephalosporins.<o:p></o:p></b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
C. Lysis of
bacteria by cephalosporins may result in a massive inflammatory reaction.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
D.
Vancomycin is a bactericidal antibiotic whereas cephalosporins are only
bacteriostatic.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
The
organism is identified as Staphylococcus aureus.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
Antibiotic
sensitivity testing results are as follows:<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
Penicillin
G <b>R</b><o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
Oxacillin
(anti-staph penicillin) <b>R</b><o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
Third-generation
cephalosporin <b>R</b><o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
Vancomycin <b>s</b><o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
Erythromycin
(macrolide) <b>R</b><o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
Tobramycin
(aminoglycoside) <b>R</b><o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
Chloramphenicol <b>R</b><o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
Trimethoprim/sulfa<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
(metabolic
inhibitor) <b>s</b><o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
22. ____
What is the most likely genetic/biochemical basis of this isolate’s resistance
to oxacillin and the cephalosporin?<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
A. Small
non-conjugative plasmid that encodes a penicillinase.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
B.
Conjugative plasmid, contains transposon that encodes a broad-spectrum
β-lactamase.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
C. <b>DNA insert into chromosome, encodes a
‘penicillin-binding protein’ (= peptidoglycan cross-linking enzyme) resistant
to β-lactams.<o:p></o:p></b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
D. There is
no D-ala-D-ala in the side chains of peptidoglycan.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
E. No
peptidoglycan is present in the cell wall.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
23. ______
What essential process in Staphylococcus aureus is inhibited by Erythromycin?<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
A.
Methylation of ribosomal RNA.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
B.
Production of DNA supercoils by Topoisomerase II<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
C.
Cross-linking of peptidoglycan chains by transpeptidases.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
D.
Enzymatic activity of dihydrofolate reductase.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
E. <b>Peptide bond formation by bacterial
ribosomes.</b><o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
24. _____ A
security guard at a New Jersey Court House comes to your office with a large
lesion on his left arm. It is 10 cm in diameter and ulcerated. Surrounding
tissue is red and markedly swollen. The ulcer is healing to produce a black
scab. A swab of the ulcer contains large Gram-positive rods. After aerobic
culture on sheep blood agar these produce large β-hemolytic colonies.</div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
Which
organism is most likely?<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
A<b>. Bacillus anthracis</b><o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
B. Bacillus
cereus<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
C.
Clostridium difficile<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
D.
Clostridium perfingens<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
E.
Clostridium tetani<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
F. Listeria
monocytogenes<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
25._____ A
25-year-old medical student returns to New Jersey from Spring Break (which he
spent fishing in North Carolina). Soon afterwards, he becomes ill. He reports a
5-day history of fever, malaise, and headache. He has three “Bull’s eye”
lesions on his thighs. Lesions are 10-15 cm in diameter, oval with somewhat
irregular outlines, with 3-4 cm red borders and 2-4 cm central red areas, separated
by a belt of paler skin. Which diagnosis is most likely?<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.5in; text-indent: -0.25in;">
<!--[if !supportLists]-->•<span style="font-size: 7pt;">
</span><!--[endif]-->A dermatophyte such as Trichophyton<o:p></o:p></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.5in; text-indent: -0.25in;">
<!--[if !supportLists]-->•<span style="font-size: 7pt;">
</span><!--[endif]-->Babesiosis<o:p></o:p></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.5in; text-indent: -0.25in;">
<!--[if !supportLists]-->•<span style="font-size: 7pt;">
</span><!--[endif]--><b>Lyme disease<o:p></o:p></b></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.5in; text-indent: -0.25in;">
<!--[if !supportLists]-->•<span style="font-size: 7pt;">
</span><!--[endif]-->Relapsing fever<o:p></o:p></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.5in; text-indent: -0.25in;">
<!--[if !supportLists]-->•<span style="font-size: 7pt;">
</span><!--[endif]-->Rocky Mountain spotted fever<o:p></o:p></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.5in; text-indent: -0.25in;">
<!--[if !supportLists]-->•<span style="font-size: 7pt;">
</span><!--[endif]-->Staphylococcal scalded skin syndrome<o:p></o:p></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.5in; text-indent: -0.25in;">
<!--[if !supportLists]-->•<span style="font-size: 7pt;">
</span><!--[endif]-->Primary syphilis<o:p></o:p></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.5in; text-indent: -0.25in;">
<!--[if !supportLists]-->•<span style="font-size: 7pt;">
</span><!--[endif]-->Secondary syphilis<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
26. _____ A
12-year-old girl presents with fever, malaise, and a red, painful, swollen,
right hand and prominent lymphadenopathy of the arm and axilla. The patient has
a cat and reports that a few days ago the wretched ungrateful creature bit her
on the right hand.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
What
pathogen is most strongly suggested by the history?<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.5in; text-indent: -0.25in;">
<!--[if !supportLists]-->•<span style="font-size: 7pt;">
</span><!--[endif]-->An alpha-hemolytic Streptococcus<o:p></o:p></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.5in; text-indent: -0.25in;">
<!--[if !supportLists]-->•<span style="font-size: 7pt;">
</span><!--[endif]-->Bartonella (=Rochalimea) henselae<o:p></o:p></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.5in; text-indent: -0.25in;">
<!--[if !supportLists]-->•<span style="font-size: 7pt;">
</span><!--[endif]-->Brucella abortus<o:p></o:p></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.5in; text-indent: -0.25in;">
<!--[if !supportLists]-->•<span style="font-size: 7pt;">
</span><!--[endif]-->Ehrlichia canis<o:p></o:p></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.5in; text-indent: -0.25in;">
<!--[if !supportLists]-->•<span style="font-size: 7pt;">
</span><!--[endif]-->Francisella tularanesis<o:p></o:p></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.5in; text-indent: -0.25in;">
<!--[if !supportLists]-->•<span style="font-size: 7pt;">
</span><!--[endif]-->Legionella pneumophila<o:p></o:p></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.5in; text-indent: -0.25in;">
<!--[if !supportLists]-->•<span style="font-size: 7pt;">
</span><!--[endif]--><b>Pasteurella
multocida<o:p></o:p></b></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.5in; text-indent: -0.25in;">
<!--[if !supportLists]-->•<span style="font-size: 7pt;">
</span><!--[endif]-->Yersinia pestis<o:p></o:p></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.5in; text-indent: -0.25in;">
<!--[if !supportLists]-->•<span style="font-size: 7pt;">
</span><!--[endif]--><o:p> </o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<b>Questions 27-29: A young woman with an abscess.</b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
A
23-year-old female college student went to the Student Health Service because
of fever, myalgia, and a five-cm abscess: hot, red, swollen, and painful, with
a ‘head’ of pus forming. This was lanced, drained, and disinfected. She was
given antibiotics and acetaminophen (Tylenol). Late that day her roommate found
her disoriented and took her to the Emergency Room. Her blood pressure was
below normal and her pulse elevated. She showed no signs of meningitis but was
lethargic and reported severe muscle aches. She was admitted. The next morning
she was still hypotensive and showed signs of liver (jaundice) and kidney (poor
urine output) dysfunction. Blood levels of liver and muscle enzymes were
elevated. The preliminary diagnosis was Toxic Shock Syndrome.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
27. _____
What process damaged liver, kidney, and muscle?<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
A. Bacteria
infected these sites by gaining access to the bloodstream from the abscess.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
B. A
bacterial exotoxin acted on the central nervous system; organ damage was a
secondary result.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
C.
Lipopolysaccharide released from dying bacteria caused monocytes to produce
inflammatory cytokines.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
D. <b>A bacterial exotoxin stimulated production
of toxic levels of inflammatory cytokines by T cells</b>.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
E. Bacteria
bound to plasma membrane receptors of nerve, muscle, and kidney, and induced
apoptosis.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
28. _____
In a stained smear of pus from the abscess, what cell type would you expect to
predominate?<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
A.
Basophils<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
B.
Eosinophils<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
C. <b>Neutrophils</b><o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
D.
Lymphocytes<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
E.
Monocytes<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
29. _____
What process was most largely responsible for the swelling around the abscess?<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
A. Dilation
of small blood vessels<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
B. <b>Increase in permeability of small blood
vessels<o:p></o:p></b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
C.
Increased responsiveness of local sensory nerve endings<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
D.
Proliferation of fibroblasts<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
E.
Infiltration of tissue by inflammatory cells<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
30. _____ A
medical student doing research accidentally stabs himself in the left wrist
with a needle containing purified E. coli outer membranes. Two hours later he
arrives at the Emergency Room with a red, swollen wrist and a fever of 40oC.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
What
process would you expect to have been most effective in producing his fever?<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
A. Binding
of O-antigen by IgG antibodies<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
B<b>. Binding of Toll-like Receptors by Lipid A</b><o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
C. Binding
of magnesium ions by core polysaccharide<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
D. Binding
of peptidoglycan to macrophage ‘scavenger receptors’<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
E. Binding
of porin proteins by siderophores.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
31. _____ A
patient presented with upper back pain. MRI imaging demonstrated inflammation
of the T8-T9 vertebral bodies consistent with osteomyelitis. A bone marrow
biopsy, when cultured, produced colonies of Gram-positive cocci. Colonies on
Sheep blood agar were 3-4 mm in diameter, off-white and beta-hemolytic.
Colonies on Brain-heart infusion (BHI) agar were 2-3 mm in diameter and golden
yellow.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
Catalase
and coagulase tests were positive.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
What is the
most likely pathogen?<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.5in; text-indent: -0.25in;">
<!--[if !supportLists]-->•<span style="font-size: 7pt;">
</span><!--[endif]-->Streptococcus pyogenes<o:p></o:p></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.5in; text-indent: -0.25in;">
<!--[if !supportLists]-->•<span style="font-size: 7pt;">
</span><!--[endif]-->Streptococcus pneumoniae<o:p></o:p></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.5in; text-indent: -0.25in;">
<!--[if !supportLists]-->•<span style="font-size: 7pt;">
</span><!--[endif]-->Streptococcus mitis (or a related ‘oral streptococcus’)<o:p></o:p></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.5in; text-indent: -0.25in;">
<!--[if !supportLists]-->•<span style="font-size: 7pt;">
</span><!--[endif]-->Streptococcus agalactiae<o:p></o:p></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.5in; text-indent: -0.25in;">
<!--[if !supportLists]-->•<span style="font-size: 7pt;">
</span><!--[endif]-->Staphylococcus epidermidis (or a related skin organism)<o:p></o:p></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.5in; text-indent: -0.25in;">
<!--[if !supportLists]-->•<span style="font-size: 7pt;">
</span><!--[endif]--><b>Staphylococcus
aureus</b><o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
32. _____
Gram stain of material aspirated from a subcutaneous abscess contained huge
numbers of neutrophils and clusters of branched, weakly-staining, Gram-positive
filaments. The filaments were also weakly acid-fast. The organisms grew in
aerobic culture.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
What
organism is most likely?<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
A.
Actinomyces israelii<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
B. <b>Nocardia asteroides</b><o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
C.
Sporothrix schenckii<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
D. An
‘environmental mycobacterium’<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
E.
Corynebacterium diphtheriae<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
F. Bacillus
cereus<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
33. _____ A
food-borne outbreak of Salmonella enteritis takes place in central New Jersey
and is traced to chicken parts sold by a supermarket chain. Isolates from all
cases are of serotype O104:H6.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
What
bacterial structures correspond to “O” and “H” antigens?<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<b>
O-Antigen:
H-antigen:<o:p></o:p></b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
A. <b>Carbohydrate chains of LPS
</b>Flagella<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
B.
Polysaccharide capsule
Common or adhesive pili<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
C. Porins
of outer membrane
Conjugation pili<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
D. Peptide
chains of peptidoglycan Non-pilus
surface adhesins<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
E.
Fibrillar proteins
Teichoic acids of cell envelope<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
34. _____ A
24-year-old man comes to clinic with a severely swollen, red, and painful
pharynx. A Gram-stained smear of exudate contains abundant neutrophils and
slender Gram-negative rods. A sample is sent for culture and he is treated with
a broad-spectrum antibiotic. The Gram-negative rod grows on Chocolate agar but
not on standard Sheep blood agar when plates are cultured in room air.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
Which of
the following organisms is most likely?<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
A.
Bordetella pertussis<b><o:p></o:p></b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
B.
Chlamydia pneumoniae<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
C. <b>Haemophilus influenzae<o:p></o:p></b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
D.
Klebsiella pneumoniae<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
E.
Legionella pneumophila<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
35. ____
Isolates of Neisseria meningitidis that cause septicemia/meningitis produce
capsules. Isolates which produce less-serious disease usually lack capsules.
Infection with non-encapsulated isolates results in protective immunity to
them. The antibodies usually bind to bacterial surface proteins.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
In the
genesis of these protective antibodies, which of the following is essential?<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
A. B
lymphocytes are stimulated in a “T-independent” fashion.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
B. CD8+
lymphocytes proliferate.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
C.
Neutrophils process and present bacterial antigen to T cells.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
D. <b>Dendritic cells phagocytose and digest
bacterial proteins</b>.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
E. Peptides
from bacterial proteins appear on cell surfaces, bound to Class I MHC.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<b>Questions 36-38: Déja vu all over again.<o:p></o:p></b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
A
22-year-old college student with no significant previous illness comes to see
you after a trip to Mexico. On his third day in Cancun he developed watery
diarrhea which lasted two days. He had avoided salads and un-bottled water but
drank iced soft drinks from a stand on the beach. He did not see a physician or
take antibiotics. After returning he is well for about three weeks but again
develops diarrhea, this time bloody. He reports pain on passage of stool, which
is black and tarry. A stained smear of stool reveals many red and white cells,
amoeboid forms which contain ingested erythrocytes, and cyst forms. Endoscopy
reveals ulcerations of his colonic mucosa. He is started on an appropriate drug
but two days later develops fever and septicemia, likely produced by spread of
intestinal flora to the bloodstream from the ulcers in his colon. He is treated
with a combination of broad-spectrum antibiotics and makes a full recovery.
About a month later, he develops a second episode of bloody diarrhea. This
time, no amoeboid forms can be seen in stool smears. Gram stain of stool now
shows only ‘normal flora’.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
Culture (on
appropriate media) for bacterial pathogens is also negative.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
Answer each
question from the list of organisms below them.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
36. _____
Which organism was most likely to have caused the patient’s original episode of
watery diarrhea?<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
37. _____
Which organism is most likely to have caused the patient’s bloody diarrhea,
three weeks after returning from Mexico?<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
38. _____
His course of broad-spectrum antibiotics should raise suspicion of what
organism, as the cause of his third episode of diarrhea?<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
A.
Balantidium coli<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
B.
Campylobacter jejuni<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
C. <b>Clostridium difficile<o:p></o:p></b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
D.
Cryptosporidium parvum<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
E. <b>Entamobea histolytica<o:p></o:p></b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
F. <b>Escherichia coli</b><o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
G. Giardia
lamblia<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
H.
Salmonella enterica<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
I. Shigella
dysenteriae<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
J. Vibrio
cholerae<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<b>Questions 39-40: A young woman with white lesions
on her oral mucosa.<o:p></o:p></b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
39. _____ A
28-year old woman comes to clinic because creamy white patches have developed
on the lining of her oral cavity. A smear of a scraping from a lesion contains
budding yeast and pseudohyphae. Culture grows out creamy white colonies of
budding yeast. When yeast cells are suspended in plasma, buds elongate to form
the beginnings of hyphae.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
Which
fungus is most likely in this setting?<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
A.
Histoplasma capsulatum<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
B.
Coccidiodes immitis.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
C.<b> Candida albicans<o:p></o:p></b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
D.
Cryptococcus neoformans<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
E.
Paracoccidiodes braziliensis<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
F.
Sporothrix schenckii<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
G.
Pneumocystis carinii<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
40. _____
When the organism is examined under the microscope after culture on corn meal
agar, it appears as sketched at right.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
Which
phrase best describes these forms?<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
A. Mixture
of mold and yeast forms<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
B. Hyphae,
arthroconidia, and microconidia<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
C. Hyphae,
rhizoids, and sporangia<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
D. Hyphae,
basidia, and chains of conidia<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
E. <b>Hyphae, microconidia, and chlamydospores</b><o:p></o:p></div>
<br />
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<b>Questions 41-43: A young boy with repeated
bacterial infections.</b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
A
8-month-old boy has a middle ear infection. Exudate contains Gram-positive
cocci, many in pairs. Local lymph nodes and tonsils are barely visible; you
would have expected both to be swollen. His medical history includes numerous
similar infections caused by non-encapsulated Haemophilus influenzae,
Streptococcus pneumoniae, and Moraxella catarrhalis, a Gram-negative coccus;
pneumonia at 5 months, for which he was hospitalized; and a staphylococcal skin
infection, which responded poorly to antibiotics, at 6 months. Blood cultures
from the pneumonia grew Streptococcus pneumoniae. Family history reveals a male
cousin who died at age 14 months from pneumonia.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
41. _____
If the cause of his present illness is S. pneumoniae, what initial report would
you expect from the lab?<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
A. <b>G+ cocci, catalase-negative, α-hemolytic on
sheep blood agar<o:p></o:p></b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
B. G+
cocci, catalase-negative β-hemolytic on sheep blood agar<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
C. G+
cocci, catalase-negative, γ-hemolytic on sheep blood agar<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
D. G+
cocci, catalase-positive, α-hemolytic on sheep blood agar<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
E. G+
cocci, catalase-positive, β-hemolytic on sheep blood agar<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
42. _____
If the patient has an immunodeficiency syndrome, what aspect of the immune
system is most likely to be defective?<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
A<b>. IgM/IgG, complement, and neutrophils</b><o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
B. IgE,
mast cells, and basophils<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
C. Fucntion
of CD4+ T cells<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
D.
Proliferation and cytolysis by CD8+ cells<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
E. Natural
killer cell function<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
43. _____
The patient remained healthy until he was five months old.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
What is the
most likely reason that he did not develop infections before the age of five
months?<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
A. Babies
of that age range are not exposed to bacteria.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
B. <b>Maternal IgG provided protection.<o:p></o:p></b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
C. During
the first few months of life the phagocytic capacity of neutrophils is high,
but then declines.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
D.
Before5-6 months the intestine contains no ‘normal flora’.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
E. Factors
H and I are not produced during the first six months of life, so that
Complement is more active then than later.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
44. ____ A
20-year old college student with no previous history of significant illness
comes to clinic because of ten days of low fever, dry cough, and malaise. Chest
x-ray shows widespread diffuse inflammation of the lungs. She is given a
prescription of an erythromycin-class drug, because a common bacterial cause of
this type of illness in college students is resistant to all beta-lactam
antibiotics. Which organism below best fits this description?<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
A.
Staphylococcus aureus<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
B.
Streptococcus pneumoniae<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
C. Coxiella
burnetii<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
D. <b>Mycoplasma pneumoniae</b><o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
E. <b>Chlamydia pneumonia<o:p></o:p></b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
45. ____
Envelopes of Pseudomonas aeruginosa are much less permeable to antibiotics than
envelopes of Escherichia coli. Which of the following is most likely to account
for the difference?<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
A. Polar
vs. peritrichous flagella<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
B.
Thickness of peptidoglycan<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
C. <b>Type of porin proteins in the outer
membrane<o:p></o:p></b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
D. Presence
or absence of common pili<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
E. Type of
teichoic acid present<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
46. ____
Isolates of Streptococcus pneumoniae which cause invasive disease are
heavily-encapsulated. Isolates that lack capsules are much less virulent. How
do capsules facilitate development of invasive disease?</div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
A. Toxic to
antibody-producing plasma cells.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
B. Block
transport of protein antigens to lymph nodes.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
C. <b>Prevent phagocytosis by neutrophils.</b><o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
D. Inhibit
cytokine production by Helper T cells.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
E. Bind IgG
and prevents activation of complement.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
47. ____ An
engineer recently returned from South America develops high fevers. Fever is
nearly continuous but there is some indication that it peaks every other day. A
blood smear prepared during a febrile interval is illustrated at right.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
Which
organism is the most likely cause of this illness?<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
A.<b> Plasmodium falciparum</b><o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
B.
Plasmodium malariae<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
C.
Plasmodium ovale<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
D.
Plasmodium vixax<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
E. Babesia
microti<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
48. ____
Salmonella enterica serotype typhi, unlike most other serotypes of Salmonella,
can evade killing by macrophages. How does “S. typhi” evade killing?</div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
A. <b>Injects proteins into macrophage cytosol
with a Type III secretion system<o:p></o:p></b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
B. Secretes
a protein exotoxin that kills macrophages<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
C. Once
phagocytosed, secretes a phospholipase that destroys the membrane of the
phagosome<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
D. Produces
an extracellular adenyl cyclase that inhibits phagocytosis<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
E. Binds
tightly to the outer face of the macrophage plasma membrane<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
49. ____ A
12-year-old boy develops a heart murmur. To help confirm or rule out Acute
Rheumatic Fever, you should order a serological test for antibodies to a
specific bacterial antigen.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
In this
test, which antigen should be uses?<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
A. Protein
A of Staphylococcus aureus<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
B. <b>M protein of Streptococcus pyogenes<o:p></o:p></b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
C. α-toxin
of Clostridium perfringens<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
D.
Filamentous hemagglutinin (fha) of Bordetella pertussis<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
E.
K1-antigen of Escherichia coli<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
50. ____ A
tourist from France develops watery diarrhea produced by a local New Jersey
strain of<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
enterotoxigenic
E. coli (ETEC). How did the E. coli toxin produce diarrhea?<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
A. <b>ADP-ribosylated a large G protein,
stimulated mammalian adenyl cyclase<o:p></o:p></b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
B. Cleaved
ribosomal RNA, inhibited protein synthesis by 80S ribosomes<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
C.
Protease, cleaved surface protein of membrane vesicles in cytoplasm of
mammalian cells<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
D.
Initiated polymerization of actin filaments adjacent to intracellular bacteria<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
E. Entered
intestinal epithelial cells, synthesized cyclic GMP in cytosol<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
51. _____ A
23-year-old woman comes to your office because, for 3 days, she has experienced
burning with urination, increased frequency of urination, and a continual
feeling that she needs to urinate. She does not have vaginal discharge, fever,
or flank pain. Rapid ‘dipstick’ urine tests are consistent with uncomplicated
cystitis. Culture of urine on standard media produces a lactose-fermenting Gram
negative rod.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
In
situations such as this, what is the most likely pathogen?<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.5in; text-indent: -0.25in;">
<!--[if !supportLists]-->•<span style="font-size: 7pt;">
</span><!--[endif]-->Enterobacter faecium<o:p></o:p></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.5in; text-indent: -0.25in;">
<!--[if !supportLists]-->•<span style="font-size: 7pt;">
</span><!--[endif]--><b>Escherichia coli<o:p></o:p></b></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.5in; text-indent: -0.25in;">
<!--[if !supportLists]-->•<span style="font-size: 7pt;">
</span><!--[endif]-->Klebsiella pneumoniae<o:p></o:p></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.5in; text-indent: -0.25in;">
<!--[if !supportLists]-->•<span style="font-size: 7pt;">
</span><!--[endif]-->Proteus vulgaris<o:p></o:p></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.5in; text-indent: -0.25in;">
<!--[if !supportLists]-->•<span style="font-size: 7pt;">
</span><!--[endif]-->Pseudomonas aeruginosa<o:p></o:p></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.5in; text-indent: -0.25in;">
<!--[if !supportLists]-->•<span style="font-size: 7pt;">
</span><!--[endif]-->Serratia marcescens<o:p></o:p></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.5in; text-indent: -0.25in;">
<!--[if !supportLists]-->•<span style="font-size: 7pt;">
</span><!--[endif]-->Salmonella enterica<o:p></o:p></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.5in; text-indent: -0.25in;">
<!--[if !supportLists]-->•<span style="font-size: 7pt;">
</span><!--[endif]-->Shigella boydii (or other Shigella)<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
52. _____ A
burn patient develops infection of the burn wound. Culture of exudate on
Brain-Heart Infusion agar produces numerous green-pigmented colonies of a
Gram-negative rod. The organism grows well aerobically on standard media but
shows no evidence of acid production on differential media such as MacConkey,
Hektoen Enteric, or Triple-Sugar-Iron agars.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
What is the
most likely organism?<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
A.
Bacteroides fragilis<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
B.
Campylobacter fetus<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
C.
Francisella tularensis<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
D.<b> Pseudomonas aeruginosa<o:p></o:p></b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
E.
Escherichia coli<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
53. _____ A
female patient comes to you because of vaginal itching and discharge.
Microscopic examination of an unstained wet mount of discharge reveals squamous
epithelial cells and the motile forms illustrated at right.</div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
What organism
is this?<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
A. A
Microsporidian<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
B.
Toxoplasma gondii<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
C.
Cryptosporidium parvum<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
D. Giardia
lamblia<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
E. <b>Trichomonas vaginalis</b><o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
54. _____ A
patient develops fevers after returning to New Jersey from a safari vacation in
East Africa. A blood smear, taken at the height of an episode of fever, is
illustrated at right.</div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
Which
organism is most likely to be the cause of his fever?<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
A. Trypanosoma
brucei brucei<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
B. <b>Trypanosoma brucei rhodesiense<o:p></o:p></b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
C.
Trypanosoma brucei gambesiense<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
D.
Trypanosoma cruzi<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
E.<b> </b>A dermotropic Leishmania<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
F. A
Leishmania that produce visceral infections<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
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<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
55. _____
An HIV-positive patient develops chronic intractable diarrhea. Stool smear
contains small acid-fast cyst forms. Which organism is the most likely cause of
the patient’s diarrhea?</div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
A.
Toxoplasma gondii<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
B.
Sarcocystis hominis<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
C. <b>Cryptosporidium parvum</b><o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
D. Isospora
belli<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
E.
Mycobacterium avium-intracellulare<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
F.
Actinomyces israelii<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
56. ____ A
34-year-old man has fever and an extensive rash that extends to his palms and
soles.</div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
You order
tests to confirm or rule out secondary Syphilis. If this is indeed secondary
Syphilis, what results do you expect?<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<b>Test for anti-cardiolipin“non-treponemal”
Abs Test for antibodies specific
forTreponema pallidum<o:p></o:p></b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
A. Positive
Negative<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
B. <b>Positive
Positive<o:p></o:p></b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
C. Negative
Negative<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
D. <b> </b>Negative<b>
</b>Positive<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
57. ____ A
young woman presents with cervicitis. A stained smear of material swabbed from
the inflamed area contains cells with prominent peri-nuclear inclusions. Some
inclusions are so large that they fill nearly the entire cytoplasm. What
organism is the most likely cause of the cervicitis in this patient?<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
A.
Chlamydia pneumoniae<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
B. <b>Chlamydia trachomatis</b><o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
C.
Chlamydia psittaci<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
D.
Mycoplasma pneumoniae<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
E.
Mycoplasma hominis<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
F.
Ureaplasma urealyticum<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
58. ____
You suspect that a patient with febrile illness and rash might have infection
with a Rickettsia.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
In a
biopsy, in what cells would you would expect to find these organisms
multiplying?<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
A.
Pneumocytes (cells that line the alveoli of the lung)<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
B.
Hepatocytes (liver cells)<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
C. B
lymphocytes<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
D.
Intestinal epithelial cells<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
E. Neurons<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
F. <b>Endothelial cells<o:p></o:p></b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
59. ____ An
elderly man with chronic heart and lung disease develops Legionella pneumonia.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
By what
route was the infection most likely to have been acquired?<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
A.<b> </b>Respiratory route, from an infected
person<b>.</b><o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
B. <b>Inhalation of aerosolized water from a
source containing protozoa.<o:p></o:p></b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
C. Using
snuff that contained spores.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
D.
Inhalation of spores from moldy hay.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
E. Exposure
to livestock or animal products.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
F.
Aerosolized cat or dog saliva.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
60. ____ In
coastal Massachusetts there have been several recent cases of Tularemia,
acquired when a person operating a riding lawn mower ran over a dead or dying
rabbit, and aerosolized micro-organisms from the animal. What property of
Francisella tularensis makes possible its transmission in this bizarre fashion?</div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
A. Short
O-antigen chains on the outer membrane.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
B.
Production of an exotoxin with an extremely low lethal dose.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
C. A
lipid-rich cell envelope which makes bacteria resistant to dessication.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
D. <b>A very low infectious dose</b>.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
E. A
capsule that has the same antigenic structure as human cell-surface
oligosaccharides.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
61. ____ A
group of people eat dinner together at a local restaurant and about 1/3 of them
become ill. Several, including two pregnant women, become septicemic and one of
the women suffers a spontaneous abortion. A small, motile, aerobic,
β-hemolytic, Gram-positive rod is recovered from blood and other cultures from
many of those who became ill. It does not form spores.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
Which
organism listed below is most to be the pathogen?<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
A. Bacillus
anthracis<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
B. Bacillus
cereus<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
C.
Leptospira interrogans<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
D. Borrelia
recurrentis<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
E. <b>Listeria monocytogenes</b><o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
62. ____ A
diabetic 78-year-old man develops a necrotic ulcer on his right foot. Infection
spreads rapidly and there is gas in soft tissues. His foot is amputated at the
ankle. Gram stain of exudate from the amputation site contains large
Gram-positive rods. The bacteria grow well anaerobically, producing large
β-hemolytic colonies on sheep blood agar, but do not grow aerobically.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
What
organism is most probable in this setting?<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
A. Bacillus
anthracis<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
B. Bacillus
cereus<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
C.
Corynebacterium diphtheriae<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
D. Nocardia
asteroides<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
E.
Clostridium tetani<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
F. <b>Clostridium perfringens<o:p></o:p></b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
63. ____ A
patient presents with a slowly-developing pneumonia. Several opacities are seen
in a lung x-ray. On his second hospital day he develops high fever and
hypotension. In a stained smear of leukocytes from the buffy coat of blood tiny
intracellular yeast forms are seen. They are illustrated at right below. [When
blood is centrifuged a thick layer of red erythrocytes collects at the bottom
of the tube. Above this is a thin off-white layer that contains the white cells
- the “buffy coat”. Above the buffy coat is the clear pale-yellow plasma.]</div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
What
organism is this most likely to be?<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
A.
Coccidiodes immitis<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
B.
Blastomyces dermatitidis<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
C. <b>Histoplasma capsulatum</b><o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
D.
Cryptococcus neoformans<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
E.
Pneumocystis carinii<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
F. Candida
albicans<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
64. _____ A
patient with a Gram-negative infection is treated with a cephalosporin, a
β-lactam antibiotic.</div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
In
bacteria, what essential process is inhibited by β-lactams?<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
A.
Synthesis of disaccharide precursors of peptidoglycan.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
B.
Transport of disaccharide precursors through the plasma membrane.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
C.
Polymerization of peptidoglycan disaccharides into long chains.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
D.
Conversion of L-alanine to D-alanine.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
E.
Polymerization of the peptide side chains of peptidoglycan.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
F. <b>Cross-linking of the peptide side chains of
peptidoglycan.<o:p></o:p></b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
65. ____
For an isolate of E. coli obtained from a blood culture, the lab reports
antibiotic Minimal Inhibitory Concentrations (MIC) as follows:<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
Drug MIC (μg/ml)<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
Ampicillin
(penicilin) 3<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
Ceftazidime
(cephalosporin)
0.03<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
Tetracycline
128<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
Which
conclusion best follows from these data?<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
A. On this
isolate, ampicillin will have only a bacteriostatic effect.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
B. The
isolate is resistant to cephalosporins because it produces a TEM-type
β-lactamase<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
C. Of these
three drugs, tetracycline will be the most effective against this isolate.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
D. <b>Of these three drugs, ceftazidime will kill
this isolate at the lowest concentration.<o:p></o:p></b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
E. When
used in combination, ampicillin and tetracycline will have synergistic effects.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
</div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<b><br /></b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<b>Q:</b> 71-77</div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
Match each of the following agents with the corresponding features (choices may be used once, more than once or not at all):</div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
A. Herpes simplex 1</div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
B. Herpes simplex 2</div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
C. Varicella-zoster virus</div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
D. Cytomegalovirus</div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
E. Epstein-Barr virus (EBV)</div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
F. Human Herpesvirus 8 (HHV8)</div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
71. _____ A child born deaf.(<b>D</b>)</div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
72. _____ An AIDS patient presents with Kaposi’s Sarcoma (<b>F</b>)</div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
73. _____ A 72-year-old male presents with a red blistery rash along the distribution of the 8th and 9th thoracic spinal nerve.(<b>C</b>)</div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
74. _____ A sexually active 24-year-old patient presents with a blistery rash on the genitals.(<b>B</b>)</div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
75. _____ A patient presents with severe encephalitis.(<b>A & B</b>)</div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
76. _____ A 6-year-old child presents with severe rash and blistering on the cheeks, lips and in the mouth.(<b>A</b>)</div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
77. _____ An adolescent patient presents with fatigue, fever, sore throat, enlargement of lymph nodes and an enlarged spleen.(<b>E</b>)</div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
Q: 78-80</div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
Match each of the following agents with the corresponding features (choices may be used once, more than once or not at all):</div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
A. Clostridium tetani (<b>A</b>)</div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
B. Clostridium botulinum (<b>B</b>)</div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
C. Clostridium perfringens (<b>C</b>)</div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
</div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
78. _____ Spastic paralysis </div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
79. _____ Flaccid paralysis </div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
80. _____ Gas-gangrene </div>
<br />
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
</div>
Dr.Mirza Adnanhttp://www.blogger.com/profile/17089423639853021732noreply@blogger.com1tag:blogger.com,1999:blog-1180770701055803370.post-49398862382135129302012-07-03T11:22:00.000-07:002012-07-03T11:22:16.851-07:00AIPGME EXAMINATION QUESTIONS - 2007<div dir="ltr" style="text-align: left;" trbidi="on">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhQpdAnVa2USPh-jv8sgngWOL2WaZtQbGnmq1X2i4YwJDxvOaVMJ4Ze2JUTg3QZytat4tdvMIjQk8IojXErJN__xVnwieUwi-wkXlSfHj39i3Umf6hkB6yIP9XaUSN3mQuy9q9mrfNwRQV-/s1600/Anatomy+MCQ's.png" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhQpdAnVa2USPh-jv8sgngWOL2WaZtQbGnmq1X2i4YwJDxvOaVMJ4Ze2JUTg3QZytat4tdvMIjQk8IojXErJN__xVnwieUwi-wkXlSfHj39i3Umf6hkB6yIP9XaUSN3mQuy9q9mrfNwRQV-/s1600/Anatomy+MCQ's.png" /></a><br />
<br />
<br />
<br />
<span style="background-color: white;"><br /></span><br />
<span style="background-color: white;">1.Primordial germ cell is derived from:</span><br />
<br />
<br />
A.Ectoderm<br />
B.Mesoderm<br />
C.Endoderm<br />
D.Mesodermal sinus<br />
<br />
2.Movements of pronation & supination occurs in all the following joints except,<br />
<br />
A.Superior radio-ulnar joint<br />
B.Middle radio-ulnar joint<br />
C.Inferior radio-ulnar joint<br />
D.Radio-carpal joint<br />
<br />
3.About Posterior cruciate ligament -true statement is<br />
<br />
A.Attached to the lateral femoral condyle<br />
B.Intrasynovial<br />
C.Prevents posterior dislocation of tibia<br />
D.Relaxed in full flexion<br />
<br />
4.Structures that pass from thorax to abdomen behind the diaphragm are all except<br />
<br />
A.Azygos vein<br />
B.Aorta<br />
C.Thoracic duct<br />
D.Greater splanchnic nerve<br />
<br />
5.Most common site of Morgagni Hernia is<br />
<br />
A.Left Anterior<br />
B.Right posterior<br />
C.Right Anterior<br />
D.Left posterior<br />
<br />
6.Structures that does not cross the midline is<br />
<br />
A.Left gonadal vein<br />
B.Left renal vein<br />
C.Left branchiocephalic vein <br />
D.Hemizygos vein<br />
<br />
7.Porto-systemic shunt is not seen in<br />
<br />A.Liver<br />
B.Spleen<br />
C.Anorectum<br />
D.Gastro Esophageal<br />
<br />
8.Injury to the male urethra below the perineal membrane causes urine to accumulate in<br />
<br />
A.Superficial perineal pouch<br />
B.Deep perineal pouch<br />
C.Space of retzius<br />
D.Pouch of douglas<br />
<br />
9.All are true about the trigone of the urinary bladder except<br />
<br />
A.Mucosa is loosely associated to the underlying musculature<br />
B.Mucosa is smooth<br />
C.It is lined by transitional epithelium<br />
D.It is derived from the absorbed part of the mesonephric duct<br />
<br />
10.Supports of the uterus are all except<br />
<br />
A.Uterosacral ligament<br />
B.Braod ligament<br />
C.Mackenrodts ligament<br />
D.Levator ani<br />
<br />
11.Posterior communicating artery a branch of<br />
<br />
A.Internal carotid<br />
B.External carotid<br />
C.Middle cerebral<br />
D.Posterior superior cerebellar<br />
<br />
12.Which of the following is not a branch of Cavernous segment of Internal Carotid Artery?<br />
<br />
A.Cavernous Branch<br />
B.Inferior Hypophyseal Branch<br />
C.Meningeal branch<br />
D.Opthalmic branch<br />
<br />
13.Difference between typical cervical & thoracic vertebral<br />
<br />
A.Has a triangular body<br />
B.Has a foramen transversarium<br />
C.Superior articular facet directed backwards & upwards<br />
D.Has a large vertebral body<br />
<br />
14.Which of this part of vertebral canal will show secondary curves with concavity backwards?<br />
<br />
A.Cervical<br />
B.Thoracic<br />
C.Sacral<br />
D.Coccyx</div>Dr.Mirza Adnanhttp://www.blogger.com/profile/17089423639853021732noreply@blogger.com0tag:blogger.com,1999:blog-1180770701055803370.post-35842388842538842472012-06-20T13:25:00.002-07:002012-06-20T13:25:32.072-07:00OBG MCQ's 3<div dir="ltr" style="text-align: left;" trbidi="on">
<span style="color: #333333; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 13px; line-height: 18px;">1. A blockage in the isthmus of the uterine tube would most likely prevent which of the following processes:</span><br style="color: #333333; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 13px; line-height: 18px;" /><span style="color: #333333; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 13px; line-height: 18px;">A) Completion of meiosis I</span><br style="color: #333333; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 13px; line-height: 18px;" /><span style="color: #333333; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 13px; line-height: 18px;">B) Completion of meiosis II</span><br style="color: #333333; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 13px; line-height: 18px;" /><span style="color: #333333; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 13px; line-height: 18px;">C) Metaphase 2 of meiosis</span><br style="color: #333333; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 13px; line-height: 18px;" /><span style="color: #333333; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 13px; line-height: 18px;">D) Ovulation</span><br style="color: #333333; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 13px; line-height: 18px;" /><span style="color: #333333; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 13px; line-height: 18px;">E) Phase I of meiosis</span><br style="color: #333333; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 13px; line-height: 18px;" /><span style="color: #333333; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 13px; line-height: 18px;">2. Serum samples from a normal woman with a history of regular 28-day menstrual cycles show a peak in the serum concentrati</span><span class="text_exposed_show" style="color: #333333; display: inline; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 13px; line-height: 18px;">on of 17 β-estradiol over the past 12 hours. No progesterone is detectable. Within 3 days, which of the following is expected to occur:<br />A) Cessation of menstruation<br />B) Decreased basal body temperature<br />C) Onset of menstruation<br />D) Ovulation<br />E) Regression of the carpus luteum<br />3. What changes occurs in circulatory system during pregnancy?<br />A) Cardiac output increases<br />B) Heart muscle hypertrophies<br />C) Blood volume remains unchanged<br />D) Heart rate increases<br />4. After complete hepatectomy, the plasma level of the following increases:<br />A) Estrogen<br />B) Albumin<br />C) Conjugated bilirubin<br />D) Fibrinogen<br />5. What changes occurs in respiratory system during pregnancy:<br />A) Respiratory rate is decreased<br />B) PCO2 is increased<br />C) Minute ventilation is increased<br />D) Residual volume is increased<br />6. The substance which is unable to cross placental barrier<br />A) Amino acid<br />B) IgM<br />C) IgG<br />D) Na+<br />E) K+<br />7. Substances which cross placental membrane passively doesn’t include:<br />A) Glucose<br />B) Amino acid<br />C) Na+<br />D) K+<br />E) Ketone bodies<br />8. During pregnancy which of the following parameters is decreased<br />A) PCO2<br />B) GFR<br />C) Tidal volume<br />D) Prothrombin time<br />E) Gamma globulins<br />9. The weight of which hormone secreted during pregnancy is approximately equal to the weight of placenta<br />A) Estrogen<br />B) Progesterone<br />C) hCG<br />D) hPL<br />E) FSH<br />10. Which hormone stimulates respiration and causes the arterial PCO2 to fall during pregnancy:<br />A) Progesterone<br />B) Estrogen<br />C) Insulin<br />D) Cortisol<br />11. In pregnant woman, the most likely change in liver expected to be seen is:<br />A) Acute hepatitis<br />B) Autoimmune hepatitis<br />C) HELLP syndrome<br />D) Fatty change<br />12. Which hormone causes stromal and ductal growth in the breast:<br />A) Progesterone<br />B) Estrogen<br />C) FSH<br />D) HCG<br />E) hPL<br />13. Decrease level of FSH will lead to<br />A) Decrease level of testosterone<br />B) Decrease sperm count<br />C) Decrease level of LH<br />D) Increased level of testosterone<br />14. A primigravida came for antenatal checkup. Her labs shows 12 g% of HB: amount of iron needed by her is<br />A) 3.5 mg per day<br />B) An apple a day<br />C) Two glass of milk<br />D) 10mg of elemental iron<br />15. The hormone affecting the growth of lobules and alveoli of breast is<br />A) Progesterone<br />B) Estrogen<br />C) FSH<br />D) LH<br />16. The hormone causing the growth of ducts of breast and deposition of fat in breast is<br />A) Progesterone<br />B) Estrogen<br />C) FSH<br />D) LH<br />17. A patient who is in labor, the most important factor for initiation of labor is<br />A) ACTH<br />B) Maternal PG<br />C) Maternal oxytocin<br />D) Amniotomy<br />E) Syntocinon drip<br />18. If a woman has regular menstrual cycle of 26-28 days, the ovulation occur at<br />A) 10-12 days<br />B) 12-14 days<br />C) 14-16 days<br />D) 16-18 days<br />19. DUB is<br />A) Common in prepubertal girls<br />B) Common in early teens<br />C) Dependent on the presence of progesterone<br />D) Uncommon during the perimenopausal years<br />20. One of the following is true regarding prolactin:<br />A) Stop ovulation<br />B) Ejection of milk<br />C) Induces ovulation<br />D) Effects water balance<br />21. Fructose, a source of energy for spermatozoa, is found primarily in secretions from the<br />A) Testis<br />B) Epididymis<br />C) Prostate<br />D) Seminal vesicles</span>
</div>Dr.Mirza Adnanhttp://www.blogger.com/profile/17089423639853021732noreply@blogger.com1tag:blogger.com,1999:blog-1180770701055803370.post-60007458821417935662012-06-20T13:23:00.000-07:002012-06-20T13:23:26.354-07:00OBG MCQ's 2<div dir="ltr" style="text-align: left;" trbidi="on">
<span style="color: #333333; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 13px; line-height: 18px;">1. Which one of the following conditions is most common cause of maternal mortality in the United States?</span><br style="color: #333333; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 13px; line-height: 18px;" /><span style="color: #333333; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 13px; line-height: 18px;">a) Infection</span><br style="color: #333333; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 13px; line-height: 18px;" /><span style="color: #333333; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 13px; line-height: 18px;">b) Haemorrhage</span><br style="color: #333333; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 13px; line-height: 18px;" /><span style="color: #333333; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 13px; line-height: 18px;">c) Hypertension</span><br style="color: #333333; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 13px; line-height: 18px;" /><span style="color: #333333; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 13px; line-height: 18px;">d) Trauma</span><br style="color: #333333; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 13px; line-height: 18px;" /><span style="color: #333333; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 13px; line-height: 18px;">e) Thromboembolism</span><br style="color: #333333; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 13px; line-height: 18px;" /><span style="color: #333333; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 13px; line-height: 18px;"><br /></span><div>
<span style="color: #333333; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 13px; line-height: 18px;">2. Which of the following condition is most common cause of perinatal morbidity and mortality in the United States?</span><br style="color: #333333; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 13px; line-height: 18px;" /><span style="color: #333333; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 13px; line-height: 18px;">a) Congenital malformation</span><br style="color: #333333; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 13px; line-height: 18px;" /><span class="text_exposed_show" style="color: #333333; display: inline; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 13px; line-height: 18px;">b) Preterm delivery<br />c) IUGR<br />d) Infection<br />e) Abnormal karyotype<br /></span></div>
<div>
<span class="text_exposed_show" style="color: #333333; display: inline; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 13px; line-height: 18px;">3. Which one of the following statement regarding Naegele’s and estimated due date is true?<br />a) EDD equal to date of LMP minus 3 months plus tree days<br />b) EDD is falsely prolonged when menstrual cycle exceeds 28 days<br />c) EDD must be adjusted to the duration of the proliferative phase of cycle<br />d) EDD calculation assumes a variable follicular phase<br />e) If LMP is 4 July then EDD is February 7<br /></span></div>
<div>
<span class="text_exposed_show" style="color: #333333; display: inline; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 13px; line-height: 18px;">4. A presumptive sign of pregnancy is<br />a) Hegar’s sign<br />b) Palpation of fetal parts<br />c) Uterine enlargements<br />d) Amenorrhea<br /></span></div>
<div>
<span class="text_exposed_show" style="color: #333333; display: inline; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 13px; line-height: 18px;">5. Which one of the following condition cause the majority of birth defects:<br />a) Polygenic or multifactorial disorder<br />b) Cytogenetic disorder<br />c) Teratogenic exposure<br />d) Single gene disorder<br /></span></div>
<div>
<span class="text_exposed_show" style="color: #333333; display: inline; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 13px; line-height: 18px;">6. If 35 year old multigravida undergoes maternal serum α-fetoprotein screening during her pregnancy. Analysis shows a positive high level. Which of the following is the most likely explanation for this finding<br />a) Open neural tube defects<br />b) Ventral wall defect<br />c) Gestational age dating error<br />d) Placental bleeding<br />e) Fetal demise<br /></span></div>
<div>
<span class="text_exposed_show" style="color: #333333; display: inline; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 13px; line-height: 18px;">7. A 28 years old woman with a family history of birth defects comes to the office requesting pre-conceptional counseling regarding prevention of congenital anomalies, which one the following condition can be prevented by giving this woman folate supplementation:<br />a) Ventral wall defects<br />b) Neural tube defects<br />c) Trisomy 21<br />d) Turner syndrome<br />e) Fetal alcohol syndrome<br /></span></div>
<div>
<span class="text_exposed_show" style="color: #333333; display: inline; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 13px; line-height: 18px;">8. Which one of the following clinical parameters is most helpful in confirming accurate gestation dating?<br />a) FHT by Doppler stethoscope at 16 weeks<br />b) Multigravida report of quickening at 20 weeks<br />c) PG report of quickening at 18 weeks<br />d) FHT by fetoscope at 24 weeks<br /></span></div>
<div>
<span class="text_exposed_show" style="color: #333333; display: inline; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 13px; line-height: 18px;">9. A 26 years old woman presents to the maternity unit with preterm contractions to determine gestation age, you review the prenatal chart and find a number of prenatal ultrasound reports. Which one of the following is most accurate sonographic dating parameters:<br />a) CRL at 10 weeks<br />b) BPD at 15 weeks<br />c) AC at 25 weeks<br />d) HC at 30 weeks<br />e) FL at 35 weeks<br /></span></div>
<div>
<span class="text_exposed_show" style="color: #333333; display: inline; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 13px; line-height: 18px;">10. A 20 years old pregnant woman undergoes a 28 week obstetric ultrasound examination, decrease amniotic fluid is evident. Which one of the following fetal anomalies is most likely associated with this finding<br />a) Anencephaliy<br />b) Obstructive renal lesions<br />c) Obstructive GI lesions<br />d) Neuromuscular disorder</span></div>
</div>Dr.Mirza Adnanhttp://www.blogger.com/profile/17089423639853021732noreply@blogger.com0tag:blogger.com,1999:blog-1180770701055803370.post-82234386275040654772012-06-20T13:20:00.000-07:002012-06-20T13:20:06.283-07:00OBG MCQ's 1<div dir="ltr" style="text-align: left;" trbidi="on">
<span style="color: #333333; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 13px; line-height: 17px;">1. The sensory pain fibers to the uterus pass through which one of the following ligaments?`</span><br style="color: #333333; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 13px; line-height: 17px;" /><span style="color: #333333; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 13px; line-height: 17px;">A. C ardinal ligament</span><br style="color: #333333; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 13px; line-height: 17px;" /><span style="color: #333333; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 13px; line-height: 17px;">B. Broad ligament</span><br style="color: #333333; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 13px; line-height: 17px;" /><span class="text_exposed_show" style="color: #333333; display: inline; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 13px; line-height: 17px;">C. Round ligament<br />D. Uterosacral ligament<br />E. Utero vesical ligamen<br /></span><div>
<span class="text_exposed_show" style="color: #333333; display: inline; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 13px; line-height: 17px;">2. The relevative orientation of the ureter to the uterine artery i.e the point where they meet is which of the following positions?<br />A. Superior and posterior<br />B. Lateral and deep<br />C. Inferior and posterior<br />D. Medial and superficial<br />E. Superior and anterior<br /></span></div>
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<span class="text_exposed_show" style="color: #333333; display: inline; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 13px; line-height: 17px;">3. The regeneration of the endometrial lining arises from which of the following layers?<br />A. Zona basalis<br />B. Zona pellucidum<br />C. Zona compacta<br />D. Zona functionalis<br />E. Zona spongiosa<br /></span></div>
<div>
<span class="text_exposed_show" style="color: #333333; display: inline; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 13px; line-height: 17px;">4. All of the following provide support to the vagina except the<br />A. Perineal body<br />B. Pelvic diaphragm<br />C. Cardinal ligament<br />D. Uterosacral ligament<br />E. Infundibulopelvic ligament<br /></span></div>
<div>
<span class="text_exposed_show" style="color: #333333; display: inline; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 13px; line-height: 17px;">5. Which of the following statements regarding the gastrointestinal tract in pregnancy is correct?it results in<br />A. Increased motilin levels<br />B. Decreased gastric residual volume<br />C. Increased gastroesophageal sphinter tone<br />D. Increased peptic ulcer disease<br />E. Increased reflux esophagitis<br /></span></div>
<div>
<span class="text_exposed_show" style="color: #333333; display: inline; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 13px; line-height: 17px;">6. Which of the following structures does not derive at least partial blood supply from the uterine artery?<br />A. Oviduct<br />B. Bladder<br />C. Ovary<br />D. Cervix<br />E. Fundus<br /></span></div>
<div>
<span class="text_exposed_show" style="color: #333333; display: inline; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 13px; line-height: 17px;">7. The underlying pathogenesis of preeclampsia is<br />A. Leakage of protein into urine<br />B. Thrombocytopenia from platelet destruction<br />C. Edema from increased interstial fluid<br />D. DIC<br />E. Diffuse vasospasm<br /></span></div>
<div>
<span class="text_exposed_show" style="color: #333333; display: inline; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 13px; line-height: 17px;">8. The definitive treatment for pre eclampsia is<br />A. Bed rest in the left lateral position<br />B. Pregnancy termination<br />C. High protein diet<br />D. Daily dose of aspirin<br />E. Magnesium sulphate<br /></span></div>
<div>
<span class="text_exposed_show" style="color: #333333; display: inline; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 13px; line-height: 17px;">9. A 38 year old woman gravid 3 para 2 and gestational amenorrohea 20 weeks have history of tetrology of fallots that was surgically corrected at age of 2 years.she has no symptoms at rest but she has minor limitations with activity.her functional classification of heart disease ,according to New York heart association, is<br />A. Class 1<br />B. Class 2<br />C. Class 3<br />D. Class 4<br /></span></div>
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<span class="text_exposed_show" style="color: #333333; display: inline; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 13px; line-height: 17px;">10. All of the following conditions are risk factors for urinary tract infections in pregnancy except<br />A. DM<br />B. Gout<br />C. Chronic hypertension<br />D. Sickle cell disease<br />E. Vesicourethral reflux</span><br /></div>
</div>Dr.Mirza Adnanhttp://www.blogger.com/profile/17089423639853021732noreply@blogger.com4tag:blogger.com,1999:blog-1180770701055803370.post-9758404153293847422011-10-12T14:49:00.000-07:002011-10-12T14:55:37.434-07:00Easy Questions<div>1. Surgical removal of an inflamed gallbladder containing stones is termed</div><div> A. cholelithiasis B. cholelithotomy</div><div> C. cholelithotripsy D. cholecystectomy</div><div><br /></div><div>2. Cirrhosis is a condition involving</div><div> A. degeneration of the liver </div><div> B. inflammation of the small intestine</div><div> C. constriction of the esophagus with a tumor</div><div> D. difficulty swallowing </div><div><div><br /></div><div>3. Cholangioenterostomy describes a procedure that </div><div> A. examines the interior of the gallbladder with a lighted fiberoptic instrument </div><div> B. surgically creates an opening between the intestines and the abdominal wall </div><div> C. surgically creates a passageway between the gallbladder duct to the intestine</div><div> D. surgically removes gallstones through an opening in the abdomen </div></div><div><br /></div><div><div>4. The tonsils are masses of _____ tissue located in depressions of the mucous membranes in the wall s of the oropharynx.</div><div> A. lymphatic B. epithelial</div><div> C. muscle D. nerve</div></div><div><div><br /></div><div>5. The guaiac test is used to determine presence of</div><div> A. twisting of the small intestine B. appendicitis </div><div> C. blood in stool D. blood in vomit</div><div><br /></div><div>6. Around the oral cavity are three pairs of salivary glands except</div><div> A. parotid gland B. adrenal gland</div><div> C. submandibular gland D. sublingual gland </div></div><div><br /></div><div><div>7. The small intestine is composed of three parts except</div><div> A. duodenum B. jejunum</div><div> C. ileum D. cecum</div><div><br /></div><div>8. The condition of discharge of fat in the feces is called ___________.</div><div> A. steatorrhea B. diarrhea</div><div> C. dysentery D. leukorrhea</div></div><div><div><br /></div><div>9. Intestinal obstruction is also called</div><div> A. ileus B. ulcer</div><div> C. diverticula D. polypus</div><div><br /></div><div>10. Dysphagia is a term describing difficult, painful or abnormal </div><div> A. passing of stool B. swallowing </div><div> C. chewing of food D. emptying of the stomach</div></div><div><div><br /></div><div>11. While ice skating, Natalie fell and landed on her buttocks. She had persistent _____________ pain for a few weeks but no broken bone on x-ray examination.</div><div> A. cervical B. thoracic</div><div> C. coccygeal D. epigastric</div><div><br /></div><div>12. The procedure of crushing gallstones with shock waves rather than surgical removal is termed </div><div> A. cholecystectomy B. cholelithotripsy </div><div> C. cholelithotomy D. cholelithiasis </div></div><div><br /></div><div><div>13. A patient from a car accident has a swollen belly and the surgeon suspects bleeding into the abdomen. He/she will puncture the belly and drain any fluid looking for blood. This procedure is termed </div><div> A. laparotomy B. thoracocentesis </div><div> C. abdominocentesis D. colostomy</div></div><div><div><br /></div><div>14. A baby is born without a brain. The diagnosis would be </div><div> A. encephalitis B. anencephalic </div><div> C. encephalocele D. myelodysplasia </div><div><br /></div><div>15. The term for painful, aching joints is </div><div> A. arthritis B. arthralgia</div><div> C. hysteralgia D. neuralgia </div><div><div><br /></div><div>16. Ms. Candy has suffered from hyperglycemia for many years. This condition is also known as diabetes and can lead to long-term complications such as disease of nerves called </div><div> A. neuropathy B. gastropathy</div><div> C. uropathy D. ophthalmopathy</div><div><br /></div><div><div>17. Mr. Smith’s white blood cell count is 10 times higher than normal. Examination of his blood shows cancerous white blood cells. His diagnosis is </div><div> A. leukocytosis B. leukocytopenia</div><div> C. leukemia D. leukorrhea</div><div><div><br /></div><div>18. Bilirubin results from hemoglobin breakdown, may appear in the urine, darkening it, as an indication of __________ or ________ disease.</div><div> A. liver, gallbladder B. liver, kidney</div><div> C. kidney, urinary bladder D. urethra, gallbladder </div></div></div><div><br /></div><div><div>19.Patients with pneumonia often find it difficult or painful to take deep breaths. The term for this is </div><div> A. dyspnea B. apnea</div><div> C. tachypnea D. bradypnea</div><div><br /></div><div>20. Chondrocytes are cells found in</div><div> A. bones B. bone marrow</div><div> C. blood D. cartilage</div><div><br /></div></div><div><br /></div><div><br /></div></div></div>Dr.Mirza Adnanhttp://www.blogger.com/profile/17089423639853021732noreply@blogger.com2