Infectious Diseases Affecting The + Verified Test Bank Ch.17

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

Chapter 17 Infectious Diseases Affecting the Nervous System

1) Cerebrospinal fluid is found in the ________.

A) pia mater

B) dura mater

C) subarachnoid space

D) arachnoid mater

E) All of the choices are correct.

2) Place the following in order from skull to brain: 1) subarachnoid space; 2) arachnoid mater; 3) dura mater; 4) pia mater.

A) Subarachnoid space, arachnoid mater, dura mater, pia mater

B) Dura mater, arachnoid mater, subarachnoid space, pia mater

C) Dura mater, arachnoid mater, pia mater, subarachnoid space

D) Arachnoid mater, subarachnoid space, dura mater, pia mater

E) Pia mater, arachnoid mater, subarachnoid space, dura mater

3) The concept of "immunologically privileged" explains why the CNS ________.

A) has a greater immune response than the rest of the body

B) has a reduced immune response compared to the rest of the body

C) has a completely different set of immune responses

D) has more MHC markers than other tissues

E) All of the choices are correct.

4) Which type of neuroglia has phagocytic capabilities in the CNS?

A) Astrocytes

B) Schwann cells

C) Macrophages

D) Microglial cells

E) Neurons

5) What brain defense restricts substances from entering the brain by the vascular system?

A) Meninges

B) Blood-brain barrier

C) Macrophages

D) Microglia

E) Cranium

6) The normal biota of the CNS consists of ________.

A) Neisseria meningitidis

B) herpes simplex I

C) herpes simplex II

D) Streptococcus agalactiae

E) The CNS has no normal biota.

7) Meningococcemia is ________.

A) best treated with ceftriaxone, penicillin or chloramphenicol

B) associated with high fever, vascular collapse, hemorrhage, and petechiae

C) started from a nasopharyngeal infection

D) caused by a gram-negative diplococcus

E) All of the choices are correct.

8) All of the following pertain to Neisseria meningitidis except ________.

A) virulent factors include a capsule, pili, endotoxin, and IgA protease

B) causes a serious meningitis

C) reservoir is the nasopharynx of human carriers

D) more easily transmitted in day care facilities, dorms, and military barracks

E) common cause of bacterial pneumonia

9) Which of the following is a sign of meningitis?

A) Headache

B) Stiff neck

C) White blood cells in cerebrospinal fluid

D) Fever

E) All of the choices are correct.

10) Meningococci initially colonize the ________.

A) lacrimal ducts

B) oral mucosa

C) nasopharynx

D) eustachian tube

E) All of the choices are correct.

11) Neisseria meningitidis is transmitted by ________.

A) casual contact

B) close contact

C) intimate contact

D) indirect contact

E) fomites

12) Treatment for Neisseria meningitidis consists of ________.

A) vancomycin

B) penicillin G orally

C) penicillin G intravenously

D) rifampin

E) tetracycline

13) Which of the following is not true of Streptococcus pneumoniae?

A) Most frequent cause of community-acquired meningitis

B) Has a polysaccharide capsule that resists phagocytosis

C) Produces alpha-hemolysin and hydrogen peroxide

D) Small gram-positive flattened coccus

E) Responds well to penicillin

14) The virulence of Haemophilus influenzae serotype b is associated with its ________.

A) fimbriae

B) neurotoxin

C) enterotoxin

D) capsule

E) None of the choices are correct.

15) Prophylactic rifampin is indicated for individuals in close contact with patients infected by ________.

A) Neisseria menigitidis

B) Listeria monocytogenes

C) Cryptococcus neoformans

D) Coccidiodes immitis

E) Streptococcus agalactiae

16) Each of the following is true for Listeria monocytogenes except ________.

A) resistant to cold

B) fastidious

C) resistant to heat

D) resistant to salt

E) can result in septicemia

17) Which organism is a common cause of meningitis in AIDS patients and can be found in bird droppings?

A) Listeria monocytogenes

B) Haemophilus influenzae

C) Neisseria meningitidis

D) Cryptococcus neoformans

E) Streptococcus agalactiae

18) Cryptococcus neoformans is a ________.

A) virus

B) bacteria

C) prion

D) fungus

E) helminth

19) Agricultural workers and field archaeologists are exposed to this organism, which, although entering via the respiratory tract, can cause meningitis.

A) Haemophilus influenzae

B) Coccidioides immitis

C) Cryptococcus neoformans

D) Streptococcus pneumoniae

E) Neisseria meningitidis

20) Arthrospores of Coccidioides immitis develop into ________ that will release endospores into the lungs.

A) hyphae

B) capsules

C) spherules

D) capsids

E) buds

21) Although many viruses can cause meningitis, the most common viral cause is ________.

A) measles

B) cytomegalovirus

C) arbovirus

D) enterovirus

E) arenavirus

22) Neonatal meningitis is most commonly transmitted by ________.

A) breast feeding

B) hospital personnel

C) transplacental infection

D) exposure in birth canal

E) exposure from other infants

23) The organism responsible for the majority of neonatal meningitis is ________.

A) Streptococcus agalactiae

B) Escherichia coli K1

C) Listeria monocytogenes

D) Haemophilus influenzae

E) Neisseria meningitidis

24) Which of the following is not true of meningoencephalitis?

A) Causative organisms are Naegleria fowleri and Acanthamoeba

B) Infections of both the brain and meninges

C) Causative organisms are viruses

D) Modes of transmission are direct contact and swimming in warm fresh water

E) Treatment for primary amoebic meningoencephalitis is mostly ineffective

25) Which of the following is not a causative agent of acute encephalitis?

A) JC virus

B) West Nile virus

C) Herpes simplex virus

D) Toxoplasma gondii

E) California encephalitis

26) Encephalitis caused by arboviruses involves ________.

A) fever, headache, and rash

B) coma, convulsions, and paralysis in severe cases

C) myalgia and orbital pain

D) muscle aches and joint stiffness

E) All of the choices are correct.

27) Encephalitis is most commonly caused by a ________.

A) bacteria

B) protozoan

C) virus

D) helminth

E) All of the choices are correct.

28) The best defense against arboviruses is ________.

A) prophylactic rifampin

B) vector control

C) vaccination

D) prompt treatment with acyclovir

E) All of the choices are correct.

29) Which of the following has the highest mortality rate?

A) Western equine encephalitis

B) St. Louis encephalitis

C) California encephalitis

D) Eastern equine encephalitis

E) West Nile encephalitis

30) Each of the following is true for Toxoplasma gondii except ________.

A) is a flagellated parasite

B) is often fatal for AIDS patients

C) can cause stillbirth

D) has a narrow host range

E) All of the choices are true.

31) Which organism is the definitive host for Toxoplasma gondii?3

A) Cat

B) Dog

C) Mouse

D) Mosquito

E) Raccoon

32) Toxoplasmosis prevention includes ________.

A) vaccination of humans

B) vaccination of cats

C) hygienic precautions

D) vector control

E) All of the choices are correct.

33) Spongiform encephalopathies are ________.

A) associated with abnormal, transmissible protein in the brain

B) chronic, fatal infections of the nervous system

C) caused by prions

D) Creutzfeldt-Jakob disease, kuru, and Gerstmann-Straussler-Scheinker syndrome

E) All of the choices are correct.

34) Which of the following is not a prion disease?

A) Scrapie

B) Creutzfeldt-Jakob disease

C) Bovine spongiform encephalopathy

D) Subacute sclerosing panencephalitis

E) All of the choices are prion diseases.

35) Patients with Creutzfeldt-Jakob disease live ________.

A) less than 1 year post diagnosis

B) 1 to 5 years post diagnosis

C) 5 to 10 years post diagnosis

D) 10 to 20 years post diagnosis

E) greater than 25 years post diagnosis

36) Subacute encephalitis may be caused by ________.

A) Toxoplasma gondii

B) prions

C) herpes simplex virus

D) persistent measles virus

E) All of the choices are correct.

37) Which is incorrect about rabies?

A) Is a zoonotic disease

B) Wild populations of bats, skunks, raccoons, cats, and canines are primary reservoirs

C) Transmission can involve bites, scratches, and inhalation

D) Average incubation in human is 1 week

E) Symptoms include anxiety, agitation, muscle spasms, convulsions, and paralysis

38) Treatment of an animal bite for possible rabies includes ________.

A) debridement

B) washing bite with soap or detergent

C) infusing the wound with human rabies immune globulin (HRIG)

D) postexposure vaccination with inactive vaccine

E) All of the choices are correct.

39) All of the following pertain to poliomyelitis except ________.

A) summer outbreaks in the United States have been increasing recently

B) transmitted primarily by fecal-contaminated water

C) can be asymptomatic or mild with headache, sore throat, fever, and nausea

D) if virus enters the central nervous system motor, neurons can be infected and destroyed

E) caused by enterovirus

40) Polio virus initially multiplies in the ________.

A) liver

B) CNS

C) oropharynx and intestine

D) nasal mucosa

E) None of the choices are correct.

41) In paralytic polio, what structures are damaged?

A) Peripheral nerves

B) Diaphragm

C) Anterior horn cells

D) Sensory nerves

E) Brain stem

42) The preferred preventative measure for polio in the United States is ________.

A) inactivated poliovirus vaccine (IPV) developed by Jonas Salk

B) oral poliovirus vaccine (OPV) developed by Jonas Salk

C) inactivated poliovirus vaccine (IPV) developed by Albert Sabin

D) oral poliovirus vaccine (OPV) developed by Albert Sabin

43) Production of a neurotoxin that binds to target sites on spinal cord neurons responsible for inhibiting skeletal muscle contraction is a characteristic of ________.

A) Clostridium botulinum

B) Clostridium perfringens

C) Clostridium difficile

D) Clostridium tetani

E) All of the choices are correct.

44) The foodborne disease that involves neurotoxin is ________.

A) gastrointestinal anthrax

B) bacillus cereus intoxication

C) botulism

D) clostridium perfringens gastroenteritis

E) All of the choices are correct.

45) Production of a neurotoxin that prevents acetylcholine release from motor neurons at neuromuscular junctions is a characteristic of ________.

A) Clostridium botulinum

B) Clostridium perfringens

C) Clostridium difficile

D) Clostridium tetani

E) All of the choices are correct.

46) Which of the following pertains to both tetanus and foodborne botulism?

A) Occurs when spore-contaminated soil enters deep wounds

B) Caused by enterotoxins of the pathogen

C) Exotoxin blocks acetylcholine release

D) Nausea and diarrhea are symptoms

E) Treatment involves antitoxin therapy

47) Tetanus differs from botulism in that ________.

A) tetanus results in flaccid paralysis while botulism paralysis is rigid

B) tetanus results from an exotoxin; botulism results from an endotoxin

C) there is a vaccine for botulism, but not for tetanus

D) muscles cannot relax in tetanus; muscles cannot contract in botulism

E) All of the choices are correct.

48) Which is the exotoxin of botulism?

A) Hemolysin

B) Tetanospasm

C) Peroxidase

D) Factor V

E) Botulinum

49) Pneumovax is a vaccine for prevention of disease caused by strains of Neisseria meningitidis.

50) Cryptococcal meningitis is highly communicable among humans.

51) Viral meningitis normally requires aggressive antiviral treatment.

52) Subacute sclerosing panencephalitis is caused by a prion.

53) Some cases of CJD may be caused by a mutation of the PrP gene.

54) Prions can be destroyed by autoclaving.

55) In rabies, spasms of muscles for swallowing leads to a fear of water.

56) Up to 50% of persons who survived polio as children will suffer from post-polio syndrome later in life.

57) Tetanus can be prevented with the DTaP childhood immunization and boosters of the tetanus toxoid.

58) Botulism is often referred to as lockjaw.

59) In both botulism and tetanus, respiratory muscles cannot facilitate breathing and, if untreated, respiratory collapse leads to death.

60) The oral and inactivated polio vaccines are made from plant cell cultures.

61) Following vaccination, no cases of attenuated polio virus reverting to a neurovirulent strain have been documented.

62) While the nervous system is believed to be free from microbiota in the healthy state, research has shown that the gut microbiome plays an important role in the development of the nervous system.

63) Which of the following statements regarding the microbiome of the nervous system is true?

A) In the healthy state, the nervous system is believed to be free from microorganisms.

B) In its latent state, the herpesvirus is considered to be part of the microbiome of the nervous system.

C) The nervous system develops without any influence from microbes inhabiting other tissues.

D) Defense mechanisms of the CNS include competition for nutrients and space between pathogens and the normal microbiota within the tissues.

64) The Salk IPV and the Sabin OPV differ from one another in that ________.

A) the IPV contains a version of the virus that is fully inactivated, whereas the virus within the OPV is attenuated, that is, reduced virulence but still viable

B) the IPV must be administered by injection, whereas the OPV can be given orally

C) the OPV, being viable, may revert back to the neurovirulent strain and be transmitted to other susceptible individuals, whereas the IPV, being inactivated, cannot revert to a virulent strain

D) children in developing countries are administered the OPV, whereas in the USA, children are given the IPV by injection

E) All of the choices are correct.

65) Which of the following statements is incorrect regarding the characteristics of  Zika virus disease?

A) Individuals who live in mosquito-infested areas can be administered a vaccine as prevention.

B) The Zika virus can be transmitted via a mosquito vector, sexually from an infected partner, and vertically from mother to fetus during gestation.

C) Females who are infected with Zika during pregnancy are at risk of having a child with microcephaly.

D) Adults who have been infected with the Zika virus occasionally go on to develop Guillain-Barre syndrome.

E) Zika virus is an RNA virus in the family Flaviviridae.

66) In an effort to limit transmission of the Zika virus, scientists have genetically modified the Aedes mosquito.  Evaluate the statements below and determine which describes the most plausible method to minimize disease.

A) Male Aedes mosquitoes are genetically modified to have a "lethality" gene.  They are raised in the lab being fed with the antidote tetracycline. Once released into the wild, they mate with females and the offspring, without access to tetracycline, die before reproducing.

B) Male Aedes mosquitoes are genetically modified to contain a gene that codes for a bacterial toxin. Once released into the wild they die before they are able to mate with females.

C) Male Aedes mosquitoes are genetically modified to be temperature-sensitive mutants.  They are raised in the lab with air-conditioning, but once released into the wild, the heat and humidity in tropical climates causes their enzymes to denature, killing them before they can reproduce.

D) Male Aedes mosquitoes are genetically modified to produce a protein that mimics the action of DEET in insect repellants.  The males mate with females and during the mating they pass the protein to the female and both mosquitoes are killed in the process.

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 20-year-old female college student is admitted to the intensive care unit from the emergency department. The patient lives in a dormitory at her university and her roommate brought her to the hospital because "she is not acting like herself." The patient was previously healthy to the roommate's knowledge, involved in campus activities, and an excellent student. The RN collects the patient's history of present illness from her roommate. About two weeks prior, the patient began feeling ill. She had nasal congestion and was diagnosed with a sinus infection at the student health clinic. However, the patient reportedly decided against taking the prescribed antibiotics because she did not believe they were necessary. She developed high fevers and one day ago began complaining of a stiff neck. That morning, she was more lethargic, making nonsensical statements, and had a fever of 105°F. Her roommate was frightened by her change in behavior and drove her to the hospital.

67) Based upon the patient's clinical presentation and course of illness, what is the most likely diagnosis?  

A) Septicemia, secondary to sinus infection

B) Meningitis

C) Tumor of the cervical spine

D) Necrotizing encephalitis

68) A lumbar puncture is performed, which confirms a diagnosis of meningitis. The pathology report indicates that the cerebral spinal fluid sample was found to have gram-positive cocci in pairs and the patient is diagnosed with pneumococcus. What is the causative organism?

A) Streptococcus pneumoniae

B) Neisseria meningitides

C) Haemophilus influenzae

D) Listeria monocytogenes

69) What is the best measure of prevention for pneumococcus? 

A) Avoidance of crowded living spaces, such as college dormitories

B) Taking antibiotics for any cold symptoms

C) Vaccination with Pneumovax 23

D) Drink plenty of fluids

70) Which antibiotic(s) would the nurse expect the medical team to prescribe to treat pneumococcus? 

A) Vancomycin and ceftriaxone

B) Amoxicillin

C) Fluconazole

D) None of the choices are correct.

71) Based upon the patient's symptoms, which of the following tests is most important to obtain a diagnosis?

A) CT scan

B) Chest X-ray

C) Complete blood count

D) Lumbar puncture

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 75-year-old female is brought to the emergency department by ambulance after having a seizure at her home. The woman's son reports she has not been acting normally. She complained of a severe headache and he noted a hand tremor and an unsteady gait. The past few days, she developed a high fever. Upon assessment by the medical team, the woman is not responding verbally. The nurse collects the patient's history from her son, which is notable for a recent camping trip in the woods.

72) What components of the patient's history are most important for the nurse to collect during the initial triage assessment?  

A) Past medical history, mosquito exposure, allergies, medications

B) Medications, food allergies, religious preference

C) Birth history, childhood development, level of education

D) Mosquito exposure, use of DEET, level of water filtration

73) Multiple tests are performed, and the patient is diagnosed with Eastern Equine Encephalitis. What is the best initial treatment regimen?  

A) Acyclovir, antiepileptic drugs, lumbar puncture

B) Lumbar puncture, CT scan, MRI

C) Acyclovir, medical coma, heart catheterization

D) Hydration, antiepileptic drugs, antipyretics

74) The RN updates the patient's son on the plan of treatment. What is the most appropriate antibiotic to treat this illness?  

A) Vanomycin

B) Cefotaxime

C) Acyclovir

D) No antibiotic therapy is indicated.

75) The patient's son is anxious about his mother's prognosis. He asks the RN if his mother will survive the infection. What is the best response by the nurse?

A) That's a good question. You should ask the doctor next time you see him.

B) Almost all patients survive this disease. We will do our best to make sure your mother is one of them.

C) I'm sorry, but your mother will probably not survive this disease. Would you like to see a chaplain?

D) Unfortunately, we see about a 70% mortality rate for this disease. We are doing everything we can do to provide excellent care for your mother.

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 is part of a team that has traveled to sub-Saharan Africa to volunteer in a medical clinic. The clinic is in an underdeveloped rural area. A 5-year-old boy is brought into the clinic with a high fever, sore throat, body aches, and weakness. Through the translator, the nurse finds out that the boy has been sick for about a week. He is noted to be barefoot and his mother reports he plays in area ponds to stay cool.

76) Which of the following diseases should the nurse be most concerned about, considering the patient's presentation?  

A) Meningitis

B) Tetanus

C) Polio

D) Typhoid

77) The RN assists in educating the patient's mother about the diagnosis through a translator. What is the causative agent for polio?  

A) Poliovirus

B) Streptococcus pneumoniae

C) Naegleria fowleri

D) Acanthamoeba

78) How is the poliovirus transmitted?  

A) Fecal-oral

B) Arthropod

C) Respiratory droplets

D) Undercooked food

79) Serological testing on the patient's cerebral spinal fluid confirms a diagnosis of polio. What is the best treatment modality?  

A) Antibiotics and fever control

B) Acyclovir and pain control

C) Immunization and respiratory support

D) Pain control and respiratory support