Ch16 Test Bank + Answers Infectious Diseases Affecting The

Microbiology Fundamentals: A Clinical Approach, 3e (Cowan)

Chapter 16 Infectious Diseases Affecting the Skin and Eyes

1) The integument includes all of the following except ________.

A) skin

B) hair

C) nails

D) sweat glands

E) surface capillaries

2) Blood vessels are found in the ________.

A) stratum corneum

B) dermis

C) stratum basale

D) subcutaneous layer

E) dermis and subcutaneous layer

3) Blisters ________.

A) are confined to the epidermis

B) originate in the dermis

C) originate in the subcutaneous layer

D) result from a separation of epidermis from dermis

E) None of the choices are correct.

4) Protective features of the skin include all but ________.

A) keratinized surface

B) resident biota

C) antimicrobial peptides

D) high pH

E) lysozyme

5) What material in skin cells provides protection from abrasions, water damage, and microorganism entry?

A) Lysozyme

B) Keratin

C) Sweat

D) Sebum

E) Salt

6) What group of microorganisms do not usually call the skin "home"?

A) Streptococcus

B) Corynebacterium

C) Propionibacterium

D) Yeasts

E) All of the choices are correct.

7) What enzyme is not found in Staphylococcus epidermidis but is found in Staphylococcus aureus?

A) Peroxidase

B) Catalase

C) Lysozyme

D) Coagulase

E) Lipase

8) All species of Staphylococcus ________.

A) lack spores

B) are motile

C) have capsules

D) produce coagulase

E) All of the choices are correct.

9) The enzyme that coagulates plasma is ________.

A) catalase

B) coagulase

C) hyaluronidase

D) staphylokinase

E) kinase

10) Staphylococcus can be differentiated from Streptococcus by the ________.

A) Gram stain

B) coagulase test

C) catalase test

D) fermentation of mannitol

E) None of the choices are correct.

11) All Staphylococci can be differentiated from all Streptococci because only Staphylococci produce the enzyme ________ that is easily detected in the lab.

A) staphylokinase

B) exfoliative toxin A

C) exfoliative toxin B

D) catalase

E) lactase

12) Which of the following is the most common form of microbe transmission in impetigo?

A) Fomites

B) Direct contact

C) Mechanical vectors

D) Blood

E) Body fluids

13) Impetigo is caused by ________.

A) Propionibacterium acnes

B) Corynebacterium diphtheriae

C) Staphylococcus aureus

D) Streptococcus pyogenes

E) both Staphylococcus aureus and Streptococcus pyogenes

14) MRSAs are Staphylococcus aureus strains that are ________.

A) resistant to mupirocin

B) responsive to mupirocin

C) resistant to penicillin derivatives

D) responsive to penicillin derivatives

E) related to Streptococcus pyogenes

15) The toxin of Staphylococcus aureus strains that causes blisters and desquamation of skin in scalded skin syndrome is ________.

A) enterotoxin

B) hemolysin

C) toxic shock syndrome toxin

D) exfoliative toxin

E) erythrogenic toxin

16) Infections caused by Staphylococcus aureus include all of the following except ________.

A) meningitis

B) furuncles and carbuncles

C) impetigo

D) scalded skin syndrome

E) acne

17) All of the following pertain to Streptococcus pyogenes except ________.

A) is often from an endogenous source

B) secretes streptokinase

C) causes impetigo

D) coats itself with host proteins

E) causes gas gangrene

18) Streptococcus pyogenes causes all of the following except ________.

A) necrotizing fasciitis

B) erysipelas

C) impetigo

D) scarlet fever

E) scalded skin syndrome

19) Which of the following is not true of cellulitis?

A) Caused by Staphylococcus aureus or Streptococcus pyogenes

B) Occurs in the epidermis

C) Causes pain, tenderness, swelling, and warmth

D) Lymphangitis may occur

E) Treated with cephalexin

20) Which of the following is not true of staphylococcal scalded skin syndrome (SSSS)?

A) Affects mostly newborns and babies

B) An exotoxin-mediated disease

C) Toxin causes bullous lesions

D) Split in skin occurs between the dermis and epidermis

E) Split in skin occurs within the epidermis

21) The smallpox vaccine uses the ________ virus.

A) smallpox

B) herpes simplex

C) vaccinia

D) herpes virus 6

E) None of the choices are correct.

22) Smallpox is a disease ________.

A) in which fever, prostration, rash, and possible toxemia and shock occur

B) in which the virus becomes latent in ganglia of sensory neurons

C) in which recurrent episodes are called shingles

D) that can only be transmitted by direct skin contact with skin crusts

E) All of the choices are correct.

23) Chickenpox ________.

A) is transmitted by droplet contact

B) lesion distribution is centripetal

C) has an incubation of 10 to 20 days

D) has fever and vesicular rash that occurs in successive crops

E) All of the choices are correct.

24) Varicella zoster virus (human herpesvirus-3) ________.

A) uses the respiratory epithelium as its portal of entry

B) becomes latent in dorsal root ganglia that serve specific dermatomes

C) has humans as its reservoir

D) causes chickenpox and shingles

E) All of the choices are correct.

25) If a person who has never been infected with the varicella zoster virus comes in contact with a person who has shingles, the first person will come down with ________.

A) herpes labialis

B) shingles

C) chickenpox

D) infectious mononucleosis

E) herpes keratitis

26) Human herpesvirus 6 (HHV-6) has the following characteristics except ________.

A) starts with a high fever

B) causes roseola in infants and young children

C) appears as a mononucleosis-like illness in adults

D) a rash appears on the fourth day

E) it is a very rare form of herpesvirus

27) Oral lesions called Koplik's spots are seen in patients with ________.

A) croup

B) mumps

C) influenza

D) measles (rubeola)

E) rubella

28) Which is incorrect about the MMR immunization?

A) Contains attenuated virus

B) Contains toxoids

C) Is given in early childhood

D) Protects against three different viral diseases

E) None of the choices are correct.

29) All of the following pertain to measles (rubeola) except ________.

A) it is transmitted by direct contact with the rash

B) humans are the only reservoir for the pathogen

C) secondary bacterial otitis media and sinusitis can occur

D) it involves a fatal complication called subacute sclerosing panencephalitis (SSPE)

E) dry cough, sore throat, fever, and conjunctivitis are symptoms

30) Measles is described as a ________ skin lesion.

A) purpura

B) bulla

C) papule

D) macule

E) maculopapular

31) Measles is also known as ________.

A) rubella

B) shingles

C) rubeola

D) fifth disease

E) varicella

32) Which of the following is not true of rubeola?

A) Causative agent is a member of the Morbillivirus genus

B) It is a single-stranded, nonenveloped RNA virus

C) It is in the Paramyxovirus family

D) Causes cell membranes to fuse to form syncytia

E) Transmitted by respiratory droplets

33) This febrile disease with a rash has a pathogen that can cross the placenta and cause serious fetal damage.

A) Croup

B) Mumps

C) Influenza

D) Measles (rubeola)

E) Rubella

34) Rubella is ________.

A) caused by the measles virus (Morbillivirus)

B) a very contagious disease

C) associated with congenital transmission causing miscarriage, deafness, and cardiac and mental defects

D) seen as high fever, severe sore throat, severe cough, and myalgia

E) All of the choices are correct.

35) Fifth disease ________.

A) is caused by Parvovirus B19

B) is a childhood febrile disease with a bright red rash on the cheeks

C) cannot be prevented at this time with vaccination

D) has a maculopapular rash that lasts for days to weeks

E) All of the choices are correct.

36) Which form of anthrax involves a black eschar on the skin?

A) Pulmonary

B) Gastrointestinal

C) Cutaneous

D) All of the choices are correct.

E) None of the choices are correct.

37) Transmission of the pathogen of Leishmaniasis is by the ________.

A) reduviid "kissing" bug

B) tsetse fly

C) anopheles mosquito

D) sand fly

E) hard-bodied tick

38) Which of the following is mismatched?

A) Tinea capitis - ringworm of the beard

B) Tinea pedis - ringworm of the foot

C) Tinea cruis - ringworm of the groin

D) Tinea corporis - ringworm of the body

E) Tinea unguium - ringworm of the nails

39) Transmission of tineas includes ________.

A) human to human

B) animal to human

C) soil to human

D) fomites to human

E) All of the choices are correct.

40) Which of the following is not a causative agent of cutaneous mycoses?

A) Malassezia

B) Trichophyton

C) Microsporum

D) Epidermophyton

E) All of the choices are correct.

41) Which of the following is the causative agent of tinea versicolor?

A) Malassezia

B) Trichophyton

C) Microsporum

D) Epidermophyton

E) None of the choices are correct.

42) Which of the following provides the eye with its best defense against microorganisms?

A) Conjunctiva

B) Eyelids

C) Lymphocytes

D) Tears

E) Eyelashes

43) Which of the following is not true of bacterial conjunctivitis?

A) Transmitted through both direct and indirect contact

B) Can be caused by Streptococcus pyogenes or Streptococcus pneumoniae

C) Treatment is with a broad-spectrum topical antibiotic

D) Has a clear discharge

E) Can be caused by Staphylococcus aureus, Haemophilus influenzae, or Neisseria gonorrhoeae

44) Which is true of viral conjunctivitis?

A) Caused by Chlamydia trachomatis or Neisseria gonorrhoeae

B) Has a mucopurulent discharge

C) Caused by adenoviruses

D) Must be treated with topical and oral antibiotics

E) Caused by Moraxella

45) Keratitis is usually caused by ________.

A) Streptococcus pyogenes

B) Staphylococcus aureus

C) herpes simplex

D) Neisseria gonorrhoeae

E) All of the choices are correct.

46) The eye's best defense is/are the ________.

A) optic nerve

B) eyelid

C) eyelashes

D) tear film

E) cornea

47) What is the only way to prevent conjunctivitis?

A) Wear insect repellent

B) Good hygiene

C) Trifluridine or acyclovir treatment

D) Ivermectin treatment

E) Prophylactic antibiotics

48) Propionibacterium acnes are part of the microbiome of the skin's sebaceous glands.

49) Smallpox is caused by an orthopoxvirus.

50) Varicella and herpes zoster are caused by the same virus.

51) Herpesviruses are double-stranded, nonenveloped DNA viruses.

52) The most serious teratogenic effects of intrauterine rubella infection occur if it is acquired during the third trimester.

53) Mottled, discolored pigmentation is seen in patients with tinea versicolor.

54) Impetigo involves itching papules that break and form a very contagious yellow crust.

55) The eye generally has a large percentage of normal biota present.

56) Herpes keratitis is an infection of the eye.

57) Staphylococcus epidermidis is a component of the eye microbiota.

58) The Human Microbiome Project revealed ________.

A) vast numbers of organisms are found on expansive, dry areas of the skin

B) high salt areas of the skin limit bacterial growth

C) the skin microbiota changes constantly over time

D) the skin microbiome is much more varied than previously thought

E) All of the choices are correct.

59) Tears are produced in the ________ and drain into the ________.

A) lacrimal gland; lacrimal duct

B) lacrimal duct; sclera

C) cornea; conjunctiva

D) conjunctiva; lacrimal duct

E) lacrimal gland; sclera

60) The exposed surfaces of the eye that are the most vulnerable to infections are the ________.

A) conjunctiva and cornea

B) sclera and iris

C) iris and conjunctiva

D) retina and sclera

E) pupil and cornea

61) The parts of the eye that are the most susceptible to microbial infection are the sclera and the iris.

62) The eye differs from other parts of the body with reference to defense mechanisms in that ________.

A) innate defenses, such as inflammation and phagocyte influx, would impair vision and are therefore limited

B) they are not vulnerable to infection so they do not require natural defenses

C) the primary defense mechanism is the lymphocyte response to epitopes on the pathogen surface

D) the third line of defense is the most essential

63) The Human Microbiome Project revealed what important information regarding the microbiota of the eye?

A) Previously thought to be sparsely populated, the eye has been found to have a robust, diverse population of microbiota.

B) Previously thought to be sparsely populated, the HMP showed the eye to be sterile.

C) The HMP showed that the eye contains only one species of bacteria; Corynebacterium.

D) The eye contains a unique population of bacteria, not found anywhere else on the body.

64) Which of the following statements is incorrect regarding keratitis?

A) Keratitis can be caused by bacteria or viruses, but not eukaryotic organisms.

B) Infection of the cornea by microbes can lead to destruction of the cornea and blindness.

C) Infection of the cornea can occur through sexual transmission.

D) Latent HSV-1, that reactivates during times of stress, enters the ophthalmic nerve causing keratitis instead of cold sores.

NCLEX Prep - Test Bank Question:  Please read the clinical scenario, and then answer the questions that follow to become familiar with the traditional NCLEX question format.

A mother brings her 7-year-old daughter to her pediatrician's office. It is written in the patient's chart that she is not immunized. The child has approximately 50 lesions, mainly concentrated on her trunk. Most of the lesions are vesicular, but a few have scabbed over. According to the mother, her daughter was previously healthy and developed this rash about five days ago. She denies any fevers and the rash appears to be persistently itchy. The RN observes the child itch open a vesicle, revealing a clear fluid.

65) Based upon the patient's symptoms, the most likely diagnosis is ________.

A) smallpox

B) chickenpox

C) shingles

D) measles

66) A staff member in the office is concerned that the state health department needs to be notified of a suspected case of smallpox infection. The RN caring for the child discusses the distinct differences between the symptoms of chickenpox and smallpox. Which of the following is not true concerning the two diseases?  

A) Smallpox features deep lesions mainly on the extremities, whereas chickenpox features superficial lesions mainly on the trunk.

B) Smallpox patients exhibit a prodromal fever, whereas chickenpox patients do not.

C) Smallpox lesions are filled with clear fluid, whereas chickenpox lesions are filled with a thick, opaque liquid and are distinctly indented in the center.

D) Smallpox is caused by the variola virus, whereas chickenpox is caused by varicella-zoster virus.

67) The mother requests antibiotics to treat her daughter's infection. What is the most appropriate action by the RN?  

A) Advocate that the physician write a prescription for oral amoxicillin because the spread of the infectious lesions can be slowed by a broad-spectrum antibiotic.

B) Inform the mother that her daughter needs an antiviral prescription, not an antibiotic, to treat the infection.

C) Educate the mother she can purchase a triple-antibiotic ointment to apply to the lesions three times daily.

D) Educate the mother that chickenpox does not respond to antibiotics, but is self-limiting and will heal on its own.

68) The child shares a bedroom with her younger brother, who has not been vaccinated against or infected with chickenpox. He is supposed to go to summer camp in one week. The mother asks if it is safe to let him go to camp. How would the nurse best respond?

A) Yes, it is safe for him to go. Since chickenpox has an incubation period of 3–5 days, he would have exhibited symptoms of the disease already if he had contracted it.

B) Yes, it is safe for him to go. Chickenpox is rarely contracted by children younger than 7 years of age.

C) No, it is not safe for him to go. Since chickenpox has an incubation period of 10–20 days, he could begin exhibiting symptoms at camp.

D) No, it is not safe for him to go. Since he was exposed to his sister, he will be contagious to other kids at camp even without exhibiting symptoms.

NCLEX Prep - Test Bank Question:  Please read the clinical scenario, and then answer the questions that follow to become familiar with the traditional NCLEX question format.

 A mother brings her 8-year-old daughter into an urgent care clinic. The child has a dry, flaky, and peeling rash around her mouth. The mother states she has treated the rash with a number of different lotions, but the lesions persist. She is looking for information on how to make her daughter stop licking her lips, as she thinks this is causing the lesions. Upon assessment, the nurse notes circumoral blisters and honey-colored crusts. In the medical history, the mother reports her daughter has not had any other symptoms, including fever, nausea, vomiting, and malaise.

69) The provider orders a specimen to be obtained for microbial analysis. What is the most appropriate site to culture in this case?  

A) The lesion itself, since there seems to be a superficial infection.

B) The posterior pharynx, since the tonsils are likely the primary source of infection.

C) The blood, since the infection was probably carried systemically.

D) The urine, since the kidneys are probably removing bacterial casts from the body.

70) In the lab, the specimen is Gram-stained and inoculated onto blood agar. Microscopic analysis of the slide reveals gram-positive cocci arranged in grapelike clusters, while the blood agar produces round, creamy colonies with clear areas of hemolysis. Which of the following would be the most likely causative organism?

A) Streptococcus pyogenes

B) Staphylococcus aureus

C) Human herpesvirus 3

D) Pseudomonas aeruginosa

71) The lab results indicate that the coagulase test was performed. Which result would be consistent with a diagnosis of S. aureus infection?

A) The sample remains liquid

B) The sample completely coagulates

C) The sample turns yellow and coagulates

D) The sample turns yellow and remains liquid

72) The lesions are diagnosed as S. aureus impetigo. The nurse is educating the mother about why her daughter's affected skin seems so fragile and blisters easily. Which of the following statements is most appropriate? 

A) The constant exposure to moisture makes your daughter's skin very fragile, and blistering is the natural response.

B) Your daughter's scratching irritates the skin, making it very fragile and irritable.

C) The blood beneath the surface of the skin is broken down by waste products from S. aureus, and superficial blisters are the clinical sign.

D) An exotoxin produced by S. aureus targets a protein responsible for cell-to-cell binding, and blisters are the result.

NCLEX Prep - Test Bank Question:  Please read the clinical scenario, and then answer the questions that follow to become familiar with the traditional NCLEX question format.

A school nurse at a public elementary school notes a number of students presenting to his office with similar symptoms. The students are complaining of itchy, watery eyes with white, milky drainage. They appear to have red and inflamed sclera and conjunctiva. Some students report the symptoms in both eyes, while others are experiencing it in one eye. A number of the students report that they woke up the feeling that their eyes were "glued-shut."

73) Based on the reported symptoms and clinical findings, which of the following is the most likely diagnosis?  

A) Keratitis

B) Neonatal conjunctivitis

C) Bacterial conjunctivitis

D) Viral conjunctivitis

E) The discharge must be cultured to make a diagnosis.

74) What is the nurse's priority intervention?

A) Send the students home

B) Educate the affected students about hand hygiene practices

C) Obtain prescriptions of antibiotic drops for the affected students

D) Coordinate thorough cleaning of the classrooms

75) The nurse calls the parents of the affected students to report the finding of conjunctivitis. One parents questions why antibiotics would be ordered without a culture and identification of a specific organism. Which of the following statements by nurse is correct?  

A) Antibiotics are effective at clearing viral and bacterial infections.

B) Antibiotics are given prophylactically, even if viral conjunctivitis is suspected because we use clinical signs for diagnosis.

C) Antibiotics are given to prevent superinfection while the eye's natural defenses are compromised.

D) Antibiotics are given while we wait for the child to be seen by a physician for more extensive diagnostic workup.