Exam Questions Infectious Diseases Affecting The Chapter 19

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

Chapter 19 Infectious Diseases Affecting the Respiratory Systems

1) Which of the following is not part of the upper respiratory tract?

A) Mouth

B) Nasal cavity

C) Trachea

D) Pharynx

E) Larynx

2) Which of the following is not part of the lower respiratory system?

A) Alveoli

B) Bronchi

C) Bronchioles

D) Trachea

E) Sinuses

3) What features of the respiratory system protect us from infection?

A) Nasal hairs

B) Cilia

C) Mucus

D) Macrophages

E) All of the choices are correct.

4) Which antibody is concentrated in the respiratory tract?

A) IgA

B) IgE

C) IgG

D) IgM

E) All of the choices are correct.

5) Normal biota of the upper respiratory tract include ________.

A) Aspergillis

B) Candida albicans

C) Haemophilus influenzae

D) Staphylococcus aureus

E) All of the choices are correct.

6) Normal biota of the upper respiratory tract include ________.

A) Streptococcus pyogenes

B) Streptococcus pneumoniae

C) Neisseria meningitidis

D) alpha-hemolytic streptococci

E) All of the choices are correct.

7) Normal biota of the lower respiratory tract include ________.

A) Corynebacterium

B) Candida albicans

C) Haemophilus influenzae

D) Staphylococcus aureus

E) None of the choices are correct.

8) What is the function of normal biota of the respiratory tract?

A) Compete with pathogens for resources and space

B) Microbial antagonism

C) Provide antibodies

D) Both compete with pathogens for resources and space and microbial antagonism are correct.

E) Compete with pathogens for resources and space, microbial antagonism, and provide antibodies are all correct.

9) The most common type of virus leading to rhinitis is ________.

A) coronavirus

B) adenovirus

C) rhinovirus

D) herpes simplex virus

E) retrovirus

10) Cold viruses are transmitted by ________.

A) droplet contact and indirect contact

B) endogenous

C) direct contact

D) None of the choices are correct.

E) All of the choices are correct.

11) The most common mode of transmission for sinusitis is ________.

A) exotoxin

B) direct contact

C) indirect contact

D) endogenous

E) droplet contact

12) Infection travels to the middle ear by way of the ________.

A) auditory canal

B) sinuses

C) nasal cavity

D) eustachian (auditory) tubes

E) subarachnoid space

13) The most common causative agent of otitis media is ________.

A) Aspergillus fumigatus

B) Haemophilus influenzae

C) Candida albicans

D) Corynebacterium

E) Streptococcus pneumoniae

14) Streptococcal pharyngitis involves all of the following except ________.

A) a purulent exudate over the tonsils

B) it can lead to scarlet fever if it is an erythrogenic toxin-producing strain

C) it can lead to serious sequelae

D) it is viral in origin

E) it causes difficulty in swallowing and fever

15) The bright red rash and fever of scarlet fever are due to ________.

A) enterotoxins

B) hemolysins

C) toxic shock syndrome toxin

D) exfoliative toxin

E) erythrogenic toxin

16) Rheumatic fever is caused by ________.

A) a primary streptococcal infection with Streptococcus pyogenes

B) a combination of infection with Streptococcus pyogenes and the rheumatic fever virus

C) a secondary streptococcal infection with a different type of streptococcus

D) an immunological cross-reaction in which anti-streptococcal antibodies target the heart

E) both a primary viral infection and a secondary streptococcal infection

17) Superantigens ________.

A) include streptolysin O

B) include erythrogenic toxin

C) induce production of tumor necrosis factor

D) can initiate a cascade of immune responses

E) All of the choices are correct.

18) Untreated streptococcal pharyngitis can lead to all of the following except ________.

A) scarlet fever

B) pertussis

C) rheumatic fever

D) glomerulonephritis

E) erythrogenic rash

19) Virulence factors of Streptococcus pyogenes include ________.

A) polysaccharides on the cell wall

B) lipoteichoic acid

C) M proteins

D) hyaluronic acid capsule

E) All of the choices are correct.

20) Which of the following is not true of Streptococcus pyogenes?

A) Group A streptococcus

B) Gram positive

C) Forms spores

D) Sensitive to bacitracin

E) Beta hemolytic

21) Formation of a pseudomembrane in the back of the throat is seen in ________.

A) diphtheria

B) pharyngitis

C) tuberculosis

D) pertussis

E) SARS

22) Which of the following pertains to diphtheria?

A) Results in meningitis

B) Symptoms include vomiting and diarrhea

C) Can be transmitted from mother's birth canal to neonate

D) Prevented by the DTaP immunization

E) All of the choices are correct.

23) The major virulence factor of Corynebacterium diphtheriae that causes serious systemic effects is ________.

A) its capsules

B) metachromatic granules

C) an exotoxin

D) endospores

E) an endotoxin

24) Diphtherotoxin targets cells in the ________.

A) pharynx and lungs

B) lungs and heart

C) heart and brain

D) heart and nerves

E) lungs and nerves

25) Pertussis has the following characteristics except ________.

A) the disease progresses through several distinct stages

B) the catarrhal stage has persistent, hacking coughs with "whoops"

C) the early stage resembles a cold with nasal discharge and sneezing

D) DTaP immunization will prevent it

E) transmission is by droplet contact

26) The causative organism of whooping cough is ________.

A) Bordetella pertussis

B) Streptococcus pneumoniae

C) Haemophilus influenzae

D) Streptococcus pyogenes

E) Corynebacterium diphtheriae

27) Which of the following is not true of whooping cough?

A) Secondary infections can occur during the convalescent phase

B) Caused by a small gram-positive rod

C) Incubation period is 3–21 days

D) Coldlike symptoms are common for the paroxysmal stage

E) An uncontrollable cough occurs during the paroxysmal stage

28) Which of the following is not a virulence factor of Bordetella pertussis?

A) Endotoxin

B) Tracheal cytotoxin

C) M protein

D) Pertussis toxin

E) Filamentous hemagglutinin

29) Respiratory syncytial virus ________.

A) causes serious disease in infants 6 months old or younger

B) is highly contagious

C) is transmitted through droplet contact and fomite contamination

D) cannot be prevented by vaccination at this time

E) All of the choices are correct.

30) The enzyme associated with the influenza virus that hydrolyzes the protective mucous coating of the respiratory tract is ________.

A) catalase

B) reverse transcriptase

C) hyaluronidase

D) neuraminidase

E) kinase

31) Symptoms of influenza include ________.

A) nasal discharge, mild fever, and absence of cough

B) fever, diarrhea, and vomiting

C) fever, myalgia, sore throat, cough, and nasal discharge

D) fever, sore throat, rash, and cough

E) fever and pneumonia

32) Influenza vaccines include all the following except ________.

A) an inactivated dead virus

B) the incorporation of usually three different strains

C) an attenuated nasal drops vaccine

D) the ability to provide lifelong immunity

E) an overall effectiveness of 70%−90%

33) Which of the following is not true of influenza?

A) It has glycoprotein spikes of hemagglutinin (H) and neuraminidase (N).

B) Antigenic drift which changes the antigens to reduce immune recognition.

C) Antigenic shift causes changes in the RNA strands.

D) Symptoms are very similar to the common cold.

E) The virus can infect both humans and swine.

34) Which is not correct about Mycobacterium species?

A) All species are human pathogens.

B) Cell walls have waxy lipids.

C) They are acid fast.

D) Usually have a slow growth rate.

E) They are long, slender rods.

35) All of the following pertain to tuberculosis except ________.

A) live bacilli can remain dormant in the lungs and reactivate later in life

B) symptoms of active TB include low-grade fever, coughing, fatigue, weight loss, and night sweats

C) lung infection can disseminate to many other organs in extrapulmonary TB

D) the BCG vaccine is used in other countries

E) antimicrobials cannot treat and cure tuberculosis

36) Tuberculin skin testing ________.

A) injects PPD intradermally

B) uses a purified protein filtrate of Mycobacterium tuberculosis

C) will be positive if the person has had previous exposure to TB

D) will be positive if the person has active TB

E) All of the choices are correct.

37) A diagnosis of tuberculosis involves a(n) ________.

A) chest X-ray

B) acid-fast stain of sputum

C) sputum culture

D) tuberculin skin test

E) All of the choices are correct.

38) Which of the following causes a noncommunicable pulmonary infection that resembles tuberculosis?

A) Mycobacterium avium complex (MAC)

B) Mycobacterium kansasii

C) Mycobacterium scrofulaceum

D) Mycobacterium fortuitum complex

E) Mycobacterium marinum

39) The tubercles formed in primary tuberculosis are caused by an influx of ________.

A) neutrophils

B) basophils

C) mononuclear cells

D) polymorphonuclear leukocytes

E) antibodies

40) Extrapulmonary TB can involve the ________.

A) kidneys

B) long bones

C) spine

D) brain

E) All of the choices are correct.

41) When the centers of tubercles break down into ________ lesions, they gradually heal by calcification that replaces normal lung tissue.

A) primary

B) secondary

C) necrotic caseous

D) granuloma

E) tertiary

42) Streptococcus pneumoniae is ________.

A) alpha-hemolytic on blood agar

B) often referred to as pneumococcus

C) a gram-positive diplococcus with a capsule

D) most likely to cause infection in older adults

E) All of the choices are correct.

43) Legionella pneumophila ________.

A) is easily killed by chlorine

B) often lives intracellularly in amoebas

C) is transmitted through the soil

D) always causes a severe pneumonia

E) is a gram-positive bacterium

44) Which disease involves transmission by aerosolized water from whirlpool spas, air conditioners, cooling towers, and supermarket vegetable misters?

A) Legionellosis

B) Pertussis

C) Brucellosis

D) Plague

E) Traveler's diarrhea

45) Characteristics of Histoplasma capsulatum include ________.

A) it grows in moist soil; rich in nitrogen from bird and bat droppings

B) it is a yeast with a capsule

C) it is commonly found in the southwestern United States

D) it always results in severe infections

E) its transmission occurs through water droplets

46) The highest incidence of histoplasmosis in the United States occurs in the ________.

A) Southeast

B) Southwest

C) East and Midwest

D) Northeast

E) Rocky Mountains

47) Inhalation of respiratory secretions is involved in the transmission of the following except ________.

A) influenza

B) rhinitis

C) legionella

D) diphtheria

E) All of the choices involve respiratory secretions.

48) Hantavirus has all of the following characteristics except ________.

A) a reservoir is human carriers

B) it is a zoonotic infection

C) the symptoms are abrupt fever, lung edema, respiratory distress, and hypotension

D) it is transmitted by aerosol transmission from rodent excreta

E) the first U.S. outbreak occurred in 1993 in the Southwest

49) This opportunist is the most frequent cause of life-threatening pneumonia in AIDS patients.

A) Cryptococcus neoformans

B) Candida albicans

C) Malassezia furfur

D) Pneumocystis (carinii) jiroveci

E) None of the choices are correct.

50) Drug-resistant strains of Streptococcus pneumoniae are now treated with ________.

A) penicillin V

B) erythromycin

C) tetracyline

D) vancomycin

E) cefuroxime

51) Influenza virus can exhibit constant mutation of viral glycoproteins called ________, or ________, a more serious phenomenon caused by the exchange of a viral gene with that of another influenza virus strain.

A) antigenic shift, antigenic drift

B) antigenic drift, antigenic shift

C) None of these are correct.

52) The primary transmission route for acquiring agents of the common cold is by contact with hands and fomites contaminated with the nasal discharges of an infected person.

53) Secondary bacterial infections may occur with the common cold.

54) Antibiotic treatment for otitis media is standard procedure today.

55) Treatment for diphtheria requires only penicillin or erythromycin.

56) Pertussis outbreaks still occur in the United States.

57) Respiratory syncytial virus is a major cause of global respiratory infection outbreaks in infants 6 months of age or younger.

58) Influenza is predominantly transmitted by the fecal-oral route.

59) People who have received the BCG immunization will generally have a negative tuberculin skin test.

60) An induration of less than 5 mm in the Mantoux test is negative for TB.

61) The major reservoir for the hantavirus is the deer mouse.

62) Legionellosis is a zoonosis.

63) A paroxysmal cough is associated with Legionnaires' disease.

64) Medical professionals actually observe MDR-TB patients take their medicine through a program called DOT.

65) Anatomical features situated below the tonsils are considered the lower respiratory tract.

66) Which of the following pairs of defense mechanisms is mismatched?

A) Complement activation - third line of defense

B) Ciliated epithelium - first line of defense

C) Secretory IgA - third line of defense

D) Antimicrobial peptides - second line of defense

E) Coughing - first line of defense

67) Assess the following statements and determine which one is incorrect regarding antigenic shift.

A) The influenza virus genome mutates over time changing the amino acid sequence of the envelope glycoproteins.  Each encounter with a new version of the virus requires activation of naive lymphocytes rather than memory cells, which is the reason we receive a new vaccination each year.

B) The influenza genome contains 10 genes distributed on 8 separate RNA strands.  These strands can be exchanged between different viruses.

C) Some virus strains infect birds and swine, some infect swine and humans.  If the strain that infects swine and humans exchanges strands with a bird flu strain while in a swine host cell, that virus can go on to infect a human who will have no recognition for the bird protein.

D) If a new strain of virus emerged from an antigenic shift event, a vaccine different to the annual flu vaccine would have to be administered because the proteins coded for by the new strain would be different to those made as a result of antigenic drift.

68) Antigenic drift differs from antigenic shift in that antigenic drift reflects the exchange of RNA strands between different virus strains within a common host cell, whereas antigenic shift is the gradual mutation over time of the glycoproteins on the viral envelope that bind to immune cells.

69) The main contributing factor to the evolution of MDR-TB is ________.

A) the slow growth of Mycobacterium tuberculosis requires antibiotic therapy for months rather than days, which is hard to sustain in some populations; cutting the regimen short allows the resistant bacteria to flourish

B) the organisms that develop multidrug resistance have a different cell wall composition to the drug-susceptible organisms

C) certain species of Mycobacterium tuberculosis are able to undergo bacterial transformation at a faster rate than other species, resulting in the transfer of resistance genes

D) the abundance of antibiotics available in the United States and other developed countries makes it a particular problem for resistant strains to emerge in those parts of the world

70) Extensively drug-resistant tuberculosis, while harder to treat because some antibiotics are ineffective, has a similar prognosis and recovery rate compared to nonresistant tuberculosis.

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 45-year-old female presents to the emergency department. She reports the onset of a sore throat, cough and rhinorrhea about five days ago. She is now experiencing weakness in her arms and difficulty breathing. She is evaluated in the emergency room and admitted to the intensive care unit. In the provider's initial assessment, the patient is noted to have gross inflammation of her pharynx and tonsils, with grayish-white patches in the pharynx. A throat swab and additional specimens are sent for microbial analysis. The patient is placed in isolation.

71) Examination of the throat swab specimen reveals distinct gram-positive club-shaped bacilli. The laboratory technician immediately contacts the medical team and begins the process of submitting specimens for PCR testing to the CDC. The suspected pathogen is ________.

A) influenza A

B) Pneumocystis (carinii) jiroveci

C) Corynebacterium diphtheriae

D) Bacillus anthracis

72) The laboratory findings are discussed with the medical team. Culturing on specialized media will be required for definitive identification of the microbe. Which medium will the technicians use to culture this suspected pathogen?  

A) Tellurite medium

B) Mannitol salt agar

C) Eosin methylene blue agar

D) None of the choices are correct.  This pathogen must be propagated using tissue culture.

73) The patient's clinical condition deteriorates rapidly. Even without laboratory confirmation of the pathogen, the provider orders which course of treatment?  

A) Administration of rimantadine to treat the patient's suspected influenza

B) Administration of trimethoprim-sulfamethoxazole to treat the patient's suspected PCP

C) Administration of ciprofloxacin to treat the patient's suspected pulmonary anthrax

D) Administration of antitoxin to treat the patient's suspected diphtheria

74) The nurse assesses the patient's medical history and notes that she has not received routine medical screening and treatment in the past 15 years. This patient could avoided this preventable disease by staying current with which vaccination?  

A) MMR

B) Influenza

C) Td

D) HPV

75) The RN educates the patient about diphtheria. In explaining the role of exotoxin in the pathogenesis of the disease, the nurse correctly states that the exotoxin ________.

A) is the major virulence factor of the disease

B) is isolated to the respiratory tract, causing upper and lower respiratory tract symptoms

C) is released in the blood, causing systemic effects

D) is the major virulence factor of the disease and is released in the blood, causing systemic effects

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.

An RN in a primary care office is caring for a 10-year-old patient experiencing fever, chills, nasal congestion, and a sore throat. The patient's mother indicates that the child had been ill for the past two days, experiencing a poor appetite and sleepiness. The nurse swabs the patient's throat for rapid microbial analysis, suspecting the patient's symptoms are due to a common pathogen.

76) The rapid microbial analysis is negative for group A Streptococcus and reveals the presence of only normal biota in the patient specimen. Based upon this information, all of the following microbes can be ruled out in the diagnosis except ________.

A) Streptococcus pyogenes

B) Staphylococcus aureus

C) Haemophilus influenzae

D) Influenza A

77) Suspecting the patient is infected with influenza, the nurse prepares to obtain which of the following specimens for rapid testing at an external laboratory?  

A) Blood

B) Cerebrospinal fluid

C) Nasal swab

D) Skin scraping

78) The laboratory findings report that the child is infected with influenza B virus. Which of the following medications would the nurse expect to be ordered for this child?   

A) Penicillin

B) No medication

C) Acyclovir

D) Oseltamivir