Respiratory System Infections Test Bank Docx Chapter 21

Nester’s Microbiology, 9e (Anderson)

Chapter 21 Respiratory System Infections

1) The process used for identifying the different carbohydrates of streptococci is called

A) Lancefield grouping.

B) CHO typing.

C) peptidoglycan typing.

D) fermentation testing.

E) NAAT typing.

2) Rebecca Lancefield showed that almost all the strains of beta-hemolytic streptococci from human infections

A) could cause rheumatic fever.

B) had the same cell wall carbohydrate "A."

C) had variable cell wall carbohydrates.

D) responded to penicillin.

E) had the same cell wall carbohydrate "beta."

3) The scientist who developed a system of identifying the variety of strains of streptococci was

A) Hans Zimmer.

B) Donald Sutherland.

C) O. T. Avery.

D) Rebecca Lancefield.

E) Louis Pasteur.

4) Enlargement of which of the following structures may contribute to ear infections by interfering with normal drainage from Eustachian tubes?

A) Nasal chamber

B) Nasal conchae

C) Adenoids

D) Epiglottis

E) Parotid glands

5) The conjuctivae

A) have few resident bacteria.

B) are often covered with bacteria.

C) are populated with S. aureus.

D) are populated with S. pyogenes.

E) are protected by IgE.

6) The eyes are protected from infection by

A) the washing action of the tears and eyelids AND the use of contact lenses.

B) the washing action of the tears and eyelids AND the chemical action of lysozyme.

C) the chemical action of lysozyme AND the use of contact lenses.

D) the use of contact lenses AND the dryness of the eye surface.

E) the dryness of the eye surface AND the chemical action of lysozyme.

7) The cause of strep throat is

A) Staphylococcus aureus.

B) Streptococcus pyogenes—beta-hemolytic, group A.

C) Staphylococcus pyogenes—alpha-hemolytic, group B.

D) Streptococcus pneumoniae.

E) Staphylococcus aureus—beta-hemolytic, group A.

8) Which of the following is associated with the upper respiratory system?

A) Humidifying inhaled air.

B) Warming inhaled air AND drying inhaled air.

C) Cooling inhaled air AND drying inhaled air.

D) Cooling inhaled air AND humidifying inhaled air.

E) Humidifying inhaled air AND warming inhaled air

9) Rapid diagnostic tests for streptococcal infections may use

A) blood agar AND the Kirby-Bauer test.

B) antibodies AND blood agar.

C) DNA probes.

D) the Kirby-Bauer test AND DNA probes.

E) antibodies AND DNA probes.

10) Virulence factors used by S. pyogenes include all of the following EXCEPT

A) protein F.

B) M protein.

C) a capsule.

D) lipopolysaccharide

E) protein G.

11) The disease characterized by the appearance of a toxin-mediated rash that causes the tongue to look like the surface of a ripe strawberry is

A) scarlet fever.

B) measles.

C) chickenpox.

D) strep throat.

E) pharyngitis.

12) A bacteriophage is necessary for toxin production in

A) E. coli.

B) Staphylococcus aureus.

C) Corynebacterium diphtheriae.

D) Streptococcus pyogenes.

E) All of the answer choices are correct.

13) Diphtheria toxin works on

A) lysosomes.

B) mitochondria.

C) chloroplasts.

D) elongation factor 2.

E) messenger RNA.

14) Which is used in the vaccination for C. diphtheriae?

A) Protein A

B) M protein

C) Lipopolysaccharide

D) Intact bacteria

E) Exotoxin

15) The most common bacterial pathogen(s) involved with sinusitis, otitis media, and conjunctivitis is/are

A) S. aureus AND H. influenzae.

B) H. influenzae AND S. pneumoniae.

C) H. influenzae AND S. epidermidis.

D) S. pneumoniae AND S. aureus.

E) S. epidermidis AND S. pneumoniae.

16) Otitis media and sinusitis are usually preceded by a(n)

A) middle ear infection.

B) pseudomonal infection.

C) oropharyngeal infection.

D) nasopharyngeal infection.

E) gastrointestinal infection.

17) Otitis media probably develops from an infection that spread

A) from the outer ear to the middle ear.

B) from the sensory neurons of the middle ear.

C) upward through the Eustachian tube.

D) through the tympanic membrane.

E) via the meninges.

18) Most colds are probably caused by

A) rhinovirus.

B) S. aureus.

C) Pseudomonas sp.

D) E. coli.

E) varicella.

19) Rhinoviruses need to be grown

A) in living cells AND at 39°C.

B) in synthetic media AND at 39°C.

C) on blood agar AND at 33°C.

D) in live animals or plants.

E) in living cells AND at 33°C.

20) The rhinovirus contains

A) single-stranded RNA and is an enveloped virus.

B) double-stranded RNA and is an enveloped virus.

C) single-stranded RNA and and is a non-enveloped virus.

D) double-stranded RNA and is a non-enveloped virus.

E) single-stranded RNA and and is a retrovirus.

21) The reservoir of the common cold is the

A) family pet.

B) human.

C) infected fomite.

D) fruit.

E) rhinovirus.

22) A vaccine for the common cold is not possible because

A) the surface antigens of rhinovirus mutate frequently.

B) there are more than 100 types of rhinovirus.

C) the causative agent of colds is unknown.

D) the rhinovirus cannot be grown in sufficient quantities.

E) rhinoviruses are resistant.

23) Colds are effectively treated with

A) antibiotics.

B) aspirin and acetaminophen.

C) proteases.

D) nucleotide analogs.

E) None of the choices is correct.

24) Effective preventive methods for avoiding the common cold include all of the following EXCEPT

A) hand washing.

B) avoiding crowds.

C) not touching one's face.

D) avoiding close contact with people with colds.

E) prophylactic antibiotics.

25) The disease that closely resembles "strep throat" but is of viral origin is

A) adenoviral pharyngitis.

B) otitis media.

C) the common cold.

D) tonsilitis.

E) bronchitis.

26) Adenoviral pharyngitis is effectively treated with

A) antibiotics.

B) lysozyme.

C) proteases.

D) nucleotide analogs.

E) None of the choices is correct.

27) Which of the following are considered diseases of the lower respiratory tract?

A) Diphtheria and pneumonia

B) Influenza and diphtheria

C) Tuberculosis and pneumonia

D) Common cold and tuberculosis

E) Influenza and tuberculosis

28) About 60% of the bacterial pneumonias that require hospitalization of adults are caused by

A) S. pyogenes.

B) S. pneumoniae.

C) S. aureus.

D) K. pneumoniae.

E) M. pneumoniae.

29) The characteristic virulence factor of S. pneumoniae is

A) a capsule.

B) flagella.

C) pili.

D) cilia.

E) A-B toxin.

30) The key virulence factor of S. pneumoniae interferes with

A) the action of C3.

B) the action of C3b.

C) the action of C5a.

D) interferon.

E) All of the answer choices are correct.

31) The pneumococcal vaccine is directed against the

A) flagella.

B) pili.

C) cilia.

D) capsule.

E) A-B toxin.

32) Both S. pneumoniae and K. pneumoniae use this as a virulence factor.

A) Pili

B) Flagella

C) Capsules

D) Cilia

E) Toxins

33) The causative agent of the pneumonia that results in permanent lung damage, may be nosocomial, and has a high mortality if untreated is

A) S. pneumoniae.

B) K. pneumoniae.

C) S. pyogenes.

D) S. aureus.

E) M. pneumoniae.

34) The virulence of Klebsiella is due partly to the

A) motility of the organism AND exotoxin produced.

B) structure and organization of flagella.

C) structure of their pili AND exotoxin produced.

D) antiphagocytic properties of their capsules.

E) exotoxin produced AND antiphagocytic properties of their capsules.

35) The resistance of Klebsiella to antibiotics may be

A) chromosomal mediated AND lysosomal mediated.

B) plasmid mediated AND lysosomal mediated.

C) chromosomal mediated AND plasmid mediated.

D) lysosomal mediated AND capsule mediated.

E) capsule mediated AND plasmid mediated.

36) Mycoplasmal and Klebsiella pneumonias

A) have similar incubation periods.

B) have causative agents that lack cell walls.

C) are serious diseases often requiring hospitalization.

D) are both relatively mild diseases.

E) None of the choices is correct.

37) The spread of mycoplasma is through

A) inhalation of infected droplets.

B) the fecal-oral route.

C) an insect vector.

D) a fomite such as a towel.

E) opportunistic normal microbiota.

38) Which is/are true of the causative agents of coccidioidomycosis and histoplasmosis?

A) They are both photosynthetic soil fungi.

B) They are both dimorphic parasitic fungi.

C) They both cause life-threatening illnesses.

D) They both cause diseases that may be treated with antibiotics.

E) They are both dimorphic soil fungi.

39) Which antibiotics may be completely ineffective in treating a mycoplasmal infection?

A) Penicillin AND tetracycline

B) Penicillin AND cephalosporin

C) Tetracycline AND cephalosporin

D) Cephalosporin AND erythromycin

E) Erythromycin AND tetracycline

40) The sudden, violent, uncontrollable cough of pertussis is described as

A) productive.

B) contagious.

C) infective.

D) paroxysmal.

E) catastrophic.

41) The causative agent of whooping cough is

A) parvovirus.

B) M. pneumoniae.

C) B. pertussis.

D) S. aureus.

E) W. pertussis.

42) Which is FALSE about pertussis toxin?

A) It uses part B to attach to receptors on the host cell.

B) It uses part A to inactivate G protein.

C) It affects the level of cAMP in a cell.

D) It affects the level of mucus secretion.

E) It uses part A to attach to receptors on the host cell.

43) Although unusually resistant to many control factors, the tubercle bacillus is easily killed by

A) strong acids.

B) disinfectants.

C) pasteurization.

D) strong alkalis.

E) All of the answer choices are correct.

44) The resistance of the tubercle bacillus to various factors is probably due to its

A) cell wall.

B) capsule.

C) larger ribosomes.

D) ability to adhere tightly.

45) The virulence of the tubercle bacillus is due to its

A) toxin.

B) lysogenic conversion.

C) resistance to antibiotics.

D) survival within macrophages.

E) lysogenic conversion AND resistance to antibiotics.

46) The destructive nature of tuberculosis can be characterized as a(n)

A) endotoxin pyrogenic response.

B) delayed-type cell-mediated hypersensitivity reaction.

C) immune complex reaction.

D) inflammatory response.

E) inflammatory pyogenic response.

47) Influenza is caused by

A) orthomyxovirus.

B) H. influenzae.

C) cytomegalovirus.

D) adenovirus.

E) coronavirus.

48) Projecting from the outer envelope of the influenza virus are two glycoproteins called

A) leukocidin and hemolysin.

B) hyaluronidase and coagulase.

C) hemagglutinin and neuraminidase.

D) lysozyme and coagulase.

E) coagulase and gp160.

49) Antigenic shifts may be the result of

A) two different viruses infecting a cell at the same time.

B) the lysogenic conversion of two viruses.

C) conjugation of two viruses.

D) blending of a bacterial and a viral genome.

E) the lysogenic conversion of two viruses AND blending of a bacterial and viral genome.

50) Which is true of hantavirus?

A) It is a zoonosis involving mice.

B) It has three segments of single-stranded RNA.

C) The primary effect is to flood the lungs with fluid.

D) Shock and death occur in 30% of the cases.

E) All of the choices are correct.

51) Two relatively widespread North American lung mycoses are

A) candidiasis and coccidioidomycosis.

B) candidiasis and aspergillosis.

C) aspergillosis and Reyes syndrome.

D) coccidioidomycosis and histoplasmosis.

E) None of the choices is correct.

52) Streptococci are grouped by their cell wall carbohydrates.

53) Otitis media is an infection of the middle ear that is rare in the first month of life.

54) Humans are the only source of the cold virus.

55) Rhinoviruses are effectively treated with antibiotics.

56) A vaccine is available for protection from pneumococcal pneumonia.

57) Klebsiella species easily acquire and are a source of R pneumococcal pneumonia.

58) Of infectious diseases, pneumonia is a major killer in the general population.

59) Pneumonias are inflammatory diseases of the lung in which fluid fills the alveoli.

60) Mycoplasma is effectively treated with cell wall inhibiting antibiotics.

61) Histoplasmosis may mimic tuberculosis.

62) What is the most likely reason why smokers are more at risk for respiratory system infections?

A) Cigarette smoke is carcinogenic (cancer-causing), leading to a much higher incidence of lung cancer.

B) They aren't; this is just a rumor used to get people to stop smoking.

C) Smokers take in microbes from their hands into their lungs as they handle cigarettes and inhale the smoke.

D) Tobacco contains viruses that are inhaled when a person smokes; these cause respiratory infections.

E) Chemicals in cigarette smoke can impair the mucociliary escalator, preventing natural cleansing of the respiratory tract.

63) How are pleurisy and pneumonia are different?

A) Pleurisy is inflammation of the lungs (not necessarily due to a microbe), while pneumonia is microbial infection of the linings that surround the lungs. 

B) Pneumonia is active microbial infection of the lungs, while pleurisy is inflammation of the linings that surround the lungs (not necessarily due to a microbe).

C) Pleurisy is caused by viruses (single-stranded or double-stranded RNA), while pneumonia is caused by bacteria (Gram-positive only).

D) Pneumonia is caused by viruses (single-stranded or double-stranded DNA), while pleurisy is caused by bacteria (Gram-negative or Gram-positive).

E) Pneumonia is always a fatal infection and cannot be easily treated while pleurisy is not—treatment of this condition is by antiviral medications.

64) Why would it be reasonable to treat strep throat but not diphtheria with antibacterial antibiotics?

A) The signs and symptoms of diphtheria are mostly caused by the exotoxin produced by the causative agent. An antibiotic won't affect the exotoxin.

B) The signs and symptoms of strep throat are mostly from the exotoxin produced by the causative agent. An antibiotic effectively eliminates these exotoxins.

C) The causative agent of diphtheria is a virus, not a bacterium. The drug would have no effect against this infectious agent.

D) There are no antibiotics that have proven effective against the bacterium that causes diphtheria.

E) The causative agent of diphtheria is pleomorphic and does not have a cell wall. There are thus no antibiotics that would be effective against this organism.

65) The best way to speed up recovery from a common cold is

A) to dose the patient with ibuprofen to keep the fever down. Reducing fever speeds up recovery.

B) to take decongestants as a means of alleviating the symptoms of the cold.

C) to take 1,000 mg of vitamin C every day during the illness. Vitamin C destroys cold viruses.

D)  let the immune system do its job. Several of the treatments listed may actually increase the recovery time.

E) take an antibiotic such as penicillin that will rid the body of the cold virus.

66) If you are a 20-year-old healthy young adult and you have to CHOOSE a type of pneumonia to become infected with (and you will NOT get treatment for it), which would be the "best," and why?

A) Pneumococcal pneumonia; the causative agent doesn't destroy lung tissue and it is possible to recover completely from this disease.

B) Mycoplasmal pneumonia; this type of pneumonia causes the the mildest signs and symptoms and can be effectively treated when treated early.

C) Viral pneumonia; there are many antiviral medications that can be given for this type of pneumonia and are effective, with very few side effects.

D) Klebsiella pneumonia; this is the mildest form of pneumonia, can easily be treated with antibiotics, and has the shortest recovery time.

E) Fungal pneumonia; these types of pneumonia are very mild, remain latent, and are easily treated with antifungal medications in the majority of patients.

67) Why are pneumococcal pneumonia infections so dangerous in nursing homes?

A) There is a vaccine for protecting children against pneumococcal pneumonia but no vaccine available for protection of older adults.

B) There is no longer an antibiotic effective against the infection, and older adults are unable to fight the infection without medication.

C) This type of pneumonia causes permanent lung damage, and old people often have impaired lung function in the first place.

D) The immune system of older people is usually impaired, leaving them predisposed to more serious and potentially life-threatening pneumonia.

E) This question is misleading. Pneumococcal infections are not dangerous.

68) Are people infected with M. tuberculosis always highly infectious to everyone around them?

A) Yes. The infected person is constantly shedding bacteria to the environment around them in high numbers, facilitating transmission.

B) No. While in the early stages of the illness, the infected person does not have the cough required to spread the organism in respiratory droplets very easily.

C) Yes. As the mode of transmission of M. tuberculosis is direct contact, anyone or anything the infected person touches can be infected.

D) No. TB has a very high infectious dose. In the early stages of the disease, the patients aren't producing enough bacteria in their respiratory secretions to be infectious.

E) Yes. Mycobacterium tuberculosis is shed in all body secretions as well as in respiratory droplets, so is very easily spread.

69) Which is more likely to happen—antigenic DRIFT, or antigenic SHIFT—and why?

A) Antigenic DRIFT, since infection with only a single virus strain is required, and the random mutations happen as the virus replicates in the infected person's cells.

B) Antigenic SHIFT, since infection with only a single virus strain is required, and the random mutations happen as the virus replicates in the infected person's cells.

C) Antigenic DRIFT, since infection with only a single virus strain is required and random mutations occur more readily in this situation than if two virus strains are present.

D) Antigenic SHIFT, since multiple viruses in a cell at once means more RNA polymerase to copy the RNA, and therefore more possibilities for mistakes to be made (leading to mutations).

E) Antigenic drift and antigenic shift occur at the same frequency. Genetic change is just as likely to occur if one viral strain or more than one strain is/are present.

70) Which is more dangerous to human beings: antigenic DRIFT or antigenic SHIFT?

A) Antigenic DRIFT, since this produces the quickest and largest degree of changes in the virus structure  and we may not have immunity against it.

B) Antigenic SHIFT, since this produces the quickest and largest degree of changes in the virus structure and we may not have immunity against it.

C) Antigenic DRIFT; the small changes make the virus look like something we already have an immune response in place for, but we actually don't, letting the virus hide from the immune responses for a longer period of time.

D) Antigenic SHIFT; the process completely changes the virus, allowing it to jump from one species to another (such as from birds into humans). As such, we have no responses in place for the new virus.

E) These are equally dangerous. In both cases, major genetic and phenotypic changes occur in the virus, which means that people have absolutely no immune responses in place for dealing with the infection.

71) Is antigenic shift alone likely to lead to influenza pandemics?

A) Yes. ONLY antigenic shift can lead to the large-scale mixing of gene elements required to produce a pandemic flu strain.

B) Perhaps, but it would most likely be a mixture of antigenic shift AND drift that would result in a pandemic strain.

C) No. ONLY antigenic DRIFT can lead to the large-scale mixing of gene elements required to produce a pandemic flu strain.

D) No. Antigenic SHIFT is responsible for changes in the hemagglutinin protein, while antigenic DRIFT is responsible for changes in the neuraminidase protein. You need both to lead to a pandemic strain.

E) No. Antigenic SHIFT is responsible for changes in the neuraminidase  protein, while antigenic DRIFT is responsible for changes in the hemagglutinin protein. You need both to lead to a pandemic strain.

72) Which of the following indicates bacterial conjunctivitis rather than viral conjunctivitis? 

A) Increased tear production

B) Redness of conjunctiva

C) Swelling and pus

D) Sensitivity to light

E) All of the answer choices are correct.

73) Which of the following statements about otitis media is FALSE?

A) The causative organisms may form a biofilm, leading to chronic infections.

B) It is usually preceded by infections of the nasal cavity and upper pharynx.

C) It may sometimes spread to the membranes covering the brain, causing meningitis.

D) Using decongestants and antihistamines to treat otitis media is generally very effective. 

E) Otitis media during the "flu" season can be decreased by giving the flu vaccine to infants in day-care facilities.

74) Why do some otitis media cases not respond to antibiotic treatment?

A) About 30% of cases are caused by respiratory viruses—antibiotics do not help these cases.

B) Most cases are caused by bacteria that are resistant to commonly prescribed antibiotics.

C) Otitis media is caused by viruses that constantly undergo antigenic shift and/or antigenic drift.

D) The bacterial causative organisms mutate frequently, changing their antibiotic target sites.

E) Unless the exact causative organism is identified, it is impossible to prescribe the correct antibiotic.

75) Which of the following is/are not associated with strep throat?

A) Sore throat and fever.

B) Patches of pus in the throat.

C) Enlarged lymph nodes in the neck.

D) Abdominal pain and headache.

E) Cough and nasal discharge.

76) How can Streptococcus pyogenes initially be differentiated from other Streptococcus species that form part of the throat normal microbiotia?

A) By Gram staining—it is a Gram-positive organism.

B) By culturing the bacteria on nutrient agar and checking for hemolysis.

C) By morphology—the bacteria are spherical and grow in long chains.

D) By detection of the "A" carbohydrate in its cell wall using antibodies.

E) By specific disease signs and symptoms, including sore throat and fever.

77) Which of the following is a virulence factor of Streptococcus pyogenes?

A) M protein

B) Capsule

C) Endotoxin AND pili

D) M protein AND pili

E) M protein AND capsule

78) Which of the following interferes with phagocytosis of S. pyogenes?

A) Hyaluronic acid capsule

B) M protein

C) C5a peptidase

D) Protein G

E) All of the answer choices are correct.

79) Which step(s) of phagocytosis are avoided by Streptococcus pyogenes?

A) Recruitment of phagocytes AND phagolysosome formation

B) Phototaxis AND recognition and attachment

C) Recruitment of phagocytes AND recognition and attachment

D) Phagolysosome formation

E) Phagolysosome formation AND lysis

80) Which statement about S. pyogenes and strep throat pathogenesis is FALSE?

A) S. pyogenes strains that produce streptococcal pyrogenic exotoxins are lysogens.

B) Streptococcal pyrogenic exotoxins are A-B toxins that bind to host cells using the B portion.

C) Streptolysins O and S produced by S. pyogenes destroy blood cells by making holes in their cell membranes.

D) Spread of S. pyogenes is aided by streptokinase, an enzyme that breaks down blot clots.

E) The hyaluronic acid capsule of S. pyogenes helps it avoid the innate immune defenses.

81) Why are there currently no vaccines against Streptococcus pyogenes?

A) There are many antigenic types in the M protein of this organism. A vaccine against one type might not protect against another.

B) There is great variation in the polysaccharide capsule of this organism. A vaccine against one type might not protect against another.

C) Antibodies to streptococcal M protein may also recognize and bind to myosin in the heart, causing autoimmunity and leading to rheumatic fever.

D) There is great variation in the M protein of this organism. A vaccine against one M type might not protect against another AND antibodies to streptococcal M protein may also recognize and bind to myosin in the heart, causing autoimmunity and leading to rheumatic fever.

E) There is great variation in the polysaccharide capsule of this organism. A vaccine against one type might not protect against another AND antibodies to streptococcal M protein may also recognize and bind to myosin in the heart, causing autoimmunity and leading to rheumatic fever.

82) Which of the following is specifically associated with diphtheria?

A) Pseudomembrane in throat

B) General malaise

C) Fever and sore throat

D) Microhemorrhages

E) Widespread rash

83) Select the best description of the causative agent of diphtheria.

A) Pleomorphic, Gram-negative lysogen.

B) Gram-positive, spore-forming rod.

C) Gram-positive, encapsulated, spore-former.

D) Pleomorphic, Gram-positive lysogen.

E) Pleomorphic, Gram-positive, flagellated lysogen.

84) Corynebacterium diphtheriae is an invasive, toxin-producing, pleomorphic spore-forming bacterium that aggressively enters tissues and the bloodstream.

85) Which is the causative agent of the upper respiratory tract infection characterized by the formation of a pseudomembrane on the tonsils or in the throat?

A) Corynebacterium diphtheriae

B) Streptococcus pneumoniae

C) Mycobacterium tuberculosis

D) Mycoplasma pneumoniae

E) Bordetella pertussis

86) Why are some tissues damaged by diphtheria toxin while others are unaffected by it?

A) Diphtheria toxin is a superantigen. Only TH cells are affected by this type of toxin, so tissues lacking TH cells are unaffected.

B) The causative agent is inhaled into the lungs, so only lung tissue is affected by the toxin released by the organism.

C) Diphtheria toxin is an A-B toxin. Cells that do not have a receptor for the toxin are unaffected by it.

D) The causative agent is ingested, so only gastrointestinal tissue is affected by the toxin released by the organism.

E) Diphtheria is a localized infection. Only tissues in the immediate area of the bacteria are affected by the toxin.

87) Adenoviruses may cause eye infections as well as upper respiratory tract infections.

88) The signs and symptoms of adenovirus respiratory tract infections may be confused with those of 

A) pneumonia AND tuberculosis.

B) tuberculosis AND diphtheria.

C) pertussis AND pneumonia.

D) strep throat AND pneumonia.

E) strep throat AND pertussis.

89) How do adenoviruses avoid the adaptive immune system?

A) They cloak themselves with a hyaluronic acid capsule.

B) They interfere with antigen presentation on MHC class I molecules. 

C) They synthesize C5a peptidase.

D) They block interferon and antiviral protein production.

E) They interfere with antigen presentation on MHC class II molecules. 

90) Which statement regarding common colds and adenoviral respiratory tract infections is TRUE?

A) Fever is a sign of adenoviral respiratory tract infections, but is not a sign for the common cold.

B) The incubation period for adenoviral respiratory tract infections is 1–2 days, while that for common colds is 5–10 days.

C) Cold viruses are non-enveloped, double-stranded DNA viruses while adenoviruses are non-enveloped single-stranded RNA viruses.

D) Cold viruses may cause infections other than respiratory infections while adenoviruses only cause upper respiratory tract infections.

E) Adenoviral respiratory tract infections may also be caused by bacteria while the common cold is always caused by a virus of some kind.

91) Which of the following statements regarding resistance in Klebsiella species is FALSE?

A) β-lactamase confers resistance to β-lactam antibiotics such as penicillin.

B) Extended-spectrum β-lactamase (ESBL) confers resistance to many of the cephalosporins.

C) Carbapenemase confers resistance to carbapenems as well as other β-lactam drugs.

D) There are few effective treatments available for carbapenem-resistant K. pneumoniae infections.

E) Strains of Klebsiella that produce β-lactamase are resistant to penicillin but will respond to all cephalosporins.

92) Which of the following does NOT explain why a patient with Klebsiella pneumonia is more likely to die than one with pneumococcal pneumonia?

A) Treatment options for Klebsiella pneumonia are limited because the causative agent is resistant to many antibiotics. Pneumococcal pneumonia can be treated with antibiotics such as penicillin.

B) The causative agent of Klebsiella pneumonia is Gram-negative and may cause septic shock. Streptococcus pneumoniae is a Gram-positive bacterium so does not have endotoxin.

C) The most severe types of Pneumococcal pneumonia can be prevented with the PPSV23 vaccine. There is no vaccine that protects against Klebsiella pneumonia.

D) Klebsiella pneumoniae causes lung abscesses which may result in the death of the patient. Pneumococcal pneumonia does not result in permanent lung damage.

E) All of these statements explain why Klebsiella pneumonia is more frequently fatal than pneumococcal pneumonia.

93) Why is Legionella pneumophila detected using immunofluorescence? 

A) It is a virus.

B) It stains poorly with conventional dyes.

C) It is Gram-non-reactive.

D) It is an acid-fast bacterium.

E) It lacks a peptidoglycan cell wall.

94) How does Legionella pneumophila survive adverse conditions?

A) It forms endospores when in dry or hot environments.

B) It produces cysts.

C) It is acid-fast and resists dehydration.

D) It survives in protozoa that can withstand adverse conditions.

E) It is an intracellular parasite in fish.

95) Why did it take so long to understand that L. pneumophila is the cause of a respiratory tract infection?

A) It stains poorly and is difficult to detect.

B) It has fastidious growth requirements and is difficult to culture.

C) It is extremely rare in nature and is seldom present in a population.

D) It has fastidious growth requirements and is difficult to culture AND it stains poorly and is difficult to detect.

E) It is extremely small and can only be detected using electron microscopy AND it is extremely rare in nature and is seldom present in a population.

96) Why is legionellosis not treated with β-lactam medications?

A) The causative organism produces β-lactamases, so is resistant to many of these medications.

B) The medication must be able to accumulate within alveolar macrophages to be effective, which β-lactam antibiotics do poorly.

C) The causative organism produces β-lactamases, so is resistant to many of these medications AND the causative organism is acid-fast, so has mycolic acids and waxes in the cell wall that β-lactams cannot penetrate.

D) The causative organism is acid-fast, so has mycolic acids and waxes in the cell wall that β-lactams cannot penetrate AND the causative organism produces endospores so is highly resistant to these medications.

E) The medication must be able to accumulate within alveolar macrophages to be effective, which β-lactam antibiotics do poorly AND the causative organism produces β-lactamases, so is resistant to many of these medications.

97) Which of the following about Bacillus anthracis is TRUE?

A) It contains lipopolysaccharide.

B) It is flagellated.

C) It is rod-shaped.

D) It stains pink in the Gram stain.

E) It causes hemolysis on blood agar.

98) Which of the following proteins produced by B. anthracis function together to kill phagocytes?

A) Local factor, protective antigen, AND edema factor.

B) Lethal factor, protective antigen, AND edema factor.

C) Local factor, protective antibody, AND edema factor.

D) Lethal factor, protective antigen, AND endotoxin.

E) Lethal factor, protective antibody, AND endotoxin.

99) In which disease are monoclonal antibodies against PA protein used as treatment?

A) Inhalation anthrax

B) Legionellosis

C) Pertussis

D) Pneumococcal pneumonia

E) Influenza

100) Which of the following most accurately describes the pathogenesis of inhalation anthrax?

A) EF binds to host cell membranes, forming a pore that allows PA or LF to enter the cells, where they disrupt critical cell functions. This triggers a series of events that cause death of the cell resulting in pulmonary edema. 

B) PA binds to host cell membranes, forming a pore that allows EF or LF to enter the cells, where they disrupt critical cell functions. This triggers a series of events that cause death of the cell resulting in pulmonary edema. 

C) LF binds to host cell membranes, forming a pore that allows EF or PA to enter the cells, where they disrupt critical cell functions. This triggers a series of events that cause death of the cell resulting in pulmonary edema. 

D) PA and EF bind to host cell membranes, forming a pore that allows LF to enter the cells, where they disrupt critical cell functions. This triggers a series of events that cause death of the cell resulting in pulmonary edema. 

E) EF and LF bind to host cell membranes, forming a pore that allows PA to enter the cells, where it disrupts critical cell functions. This triggers a series of events that cause death of the cell resulting in pulmonary edema. 

You are an RN working in the emergency department (ED) at a major hospital in New York City. During one shift, you see two patients who are exhibiting coughing with blood-containing sputum, and shortness of breath. Both patients report that they have experienced headaches, muscle aches, high fever, confusion, and shaking chills in the days preceding their ED visit. One of the patients also has some digestive tract symptoms including diarrhea, abdominal pain, and vomiting. You discover that the patients live in the same apartment building, although they do not know each other. You suspect that they have a type of pneumonia, and given the circumstances, think it may be legionellosis. You read up on this disease to refresh your memory about it.

101) Which of the following is the causative agent of legionellosis?

A) Legionella pneumophila, a fastidious Gram-negative rod.

B) Legionella pneumophila, an aerobic, Gram-positive rod.

C) Mycoplasma legionella, a pleomorphic, poorly staining coccus.

D) Acanthamoeba legionella, an acid-fast, anaerobic spirillum.

E) Acanthamoeba species, a freshwater protozoan.

102) L. pneumophila was unrecognized as the causative agent of legionellosis for a long time. Why is this?

A) L. pneumophila both stains poorly with common methods, and is difficult to culture in the laboratory.

B) The organism is fastidious and is difficult to culture in the laboratory.

C) L. pneumophila stains poorly with common methods, so is difficult to detect.

D) L. pneumophila has no surface antigens and thus cannot be stained with fluorescence.

E) There is no way to grow L. pneumophila in vitro; this organism can only be cultivated in cell cultures or viruses.

103) L. pneumophila is a facultative intracellular parasite. How does it manipulate the immune system so as to enter host cells?

A) The bacterial cells bind complement component C3b (an opsonin), enhancing phagocytosis.

B) The bacteria have macrophage invasion potentiator (Mip) that promotes their uptake by alveolar macrophages. 

C) The bacteria cause necrosis of alveolar cells, leading to an inflammatory response.

D) The bacteria survive in alveolar macrophages by preventing phagosome-lysosome fusion AND the bacteria cause necrosis of alveolar cells, leading to an inflammatory response.

E) The bacterial cells bind complement component C3b (an opsonin), enhancing phagocytosis AND the bacteria have a surface protein (Mip) that promotes their uptake by alveolar macrophages. 

104) Which of the following is/are a reservoir(s) for L. pneumophila?

A) Insects such as mosquitoes.

B) Freshwater streams AND cooling towers.

C) Animals AND animal urine.

D) Marine environments AND insect vectors.

E) Humans only.

105) Select the FALSE statement regarding legionellosis and its causative agent.

A) The causative organism survives well in the water systems of buildings, particularly in hot water systems, where chlorine levels are generally low.

B) People become infected with L. pneumophila when they inhale aerosol droplets contaminated with the organism. It is not acquired from other infected individuals.

C) L. pneumophila produces a β-lactamase, which makes it resistant to many penicillins and some cephalosporins, so is typically treated with a macrolide or a fluoroquinolone.

D) Legionella pneumophila is an obligate intracellular parasite that survives in ameba in the environment and in kupffer cells in infected people.

E) L. pneumophila prevents phagosome-lysosome fusion in phagocytes, thus avoiding destruction; the bacteria manipulate conditions to multiply within these cells. 

106) What is the likely source of the L. pneumophila in this case?

A) The cooling water tower providing feeding airconditioners in the patient's offices. 

B) The showers or faucets at the local gym where both patients regularly worked out.

C) The produce section at the grocery store where vegetables are sprayed with water for freshness.

D) The water tank in the patient's building that provides hot water to apartments.

E) Further investigation by an agency such as the CDC would be needed to determine this.

Your son comes home from school complaining that he is ill. He tells you he thinks he has the flu—he has a sore throat, runny nose, and a cough, and his eyes are very red. Everyone in your family received a influenza vaccine about a month ago, and as the CDC reports that this year's vaccine is approximately 70% effective, you think it is unlikely that your son does in fact have this disease. In addition, your son does not seem to have muscle aches or a headache, which generally occur with flu. Nonetheless, he does look ill and when you take his temperature, you find that he has a fever of 38.9oC. You take him to see his doctor, because you suspect that while your son likely does not have influenza, he also does not have a common cold.

107) The doctor knows that your son is unlikely to have a common cold, based on which sign/symptom?

A) Sore throat

B) Fever

C) Cough

D) Runny nose

E) Fatigue

108) The doctor checks your son's throat and notes that he has has gray-white pus on the pharynx and tonsils. He also has enlarged lymph nodes in his neck. This suggests to the doctor that your son has the bacterial infection ________, which he attempts to confirm by ________.

A) strep throat; doing a rapid antigen detection test (RADT) and throat culture.

B) pneumococcal pneumonia; doing a rapid antigen detection test (RADT) and throat culture.

C) mycoplasmal pneumonia; performing a mantoux skin test and doing a throat culture.

D) legionellosis; performing a mantoux skin test and a chest x-ray.

E) tuberculosis; doing a throat culture and rapid TB skin test.

109) The RADT and throat culture are both negative for Streptococcus pyogenes, the causative agent of strep throat. The doctor tells you that your son likely has an adenoviral respiratory tract infection. Adenoviruses are resistant to destruction by detergents and alcohol solutions. This indicates that these viruses 

A) are double-stranded RNA viruses.

B) are non-enveloped viruses.

C) are enveloped viruses.

D) are endospore-formers.

E) are also resistant to multiple antibiotics.

110) You ask the doctor whether there is a vacccine that your children can be given to prevent further adenoviral infections. He tells you

A) that there is no need for a vaccine because your son can be treated with antibiotics AND that adenovirus infections can be avoided by handwashing.

B) there is a vaccine against two adenovirus serotypes but this is only given to military recruits AND that adenovirus infections can mostly be avoided by handwashing.

C) there is a vaccine against two adenovirus serotypes but this is only given to healthcare personnel BUT that adenovirus infections are easily treated with antibiotics.

D) it is not possible to generate vaccines against any double-stranded DNA viruses AND that adenovirus infections can be avoided by handwashing.

E) it is not possible to synthesize vaccines for preventing diseases caused by RNA viruses BUT that adenovirus infections can be prevented with prophylactic antibiotics.