Final

Question 1

• The cell of gram-positive bacteria may contribute to the develpment of septic shock..*
• identify the component which is most associated with the induction of septic shock.*

Answer 1

Teichoic Acid

Teichoic acid is any of a class of strongly acidic polymers found in the cell walls*, *capsules, and membranes of all gram-positive bacteria and containing residues of the phosphates of glycerol and adonitol.

It is one of two types of polymers* present in *gram-positive bacteria, especially in the cell walls.

This acid is formed through the joining of either glycerol phosphate or ribitol phosphate groups linked together with phosphodiester bonds.

Question 2

19 year old woman comes to your office after being bitten by a bat on the ear while camping in a primative shelter. She is unable to produce a vaccination record. On physical examination, she is afibrile and appears well. Where are two small puncture marks on the pinna of her left ear. what is an appropriate vaccination strategy in this context?

a. Intravenous ribavirin
b. No vaccination
c. Rabies immunoglobulins
d. Rabies inactivated virus vaccine
e. Rabies inactivated virus vaccine plus immunoglobulins

Answer 2

E) Rabies inactivated virus vaccine

plus

immunoglobulins

In recent years, rabies virus has been most frequently transmitted by bats in the United States. Usually a bite is noted but not always. Therefore, patients who have unexpected, unmonitored (i.e., while they are asleep) close contact with bats should be told to seek medical attention and likely vaccination. A bite is a clear indication for the most effective immunization strategy involving both active (inactivated virus vaccine) and passive (human rabies immunoglobulins) immune activation unless the offending bat is captured and found to be rabies negative with further testing. The vaccination schedule for nonimmunes is intensive, with doses at 0, 3, 7, 14, and 28 days. Although there has been at least one report of successful antiviral treatment of rabies, there is no indication for prophylactic antiviral therapy.

Question 3

Define

Capsular protein

Answer 3

The bacterial capsule is a large structure of many bacteria. It is a polysaccharide layer that lies outside the cell envelope, and is thus deemed part of the outer envelope of a bacterial cell. It is a well-organized layer, not easily washed off, and it can be the cause of various diseases.

The capsule—which can be found in both gram negative and gram-positive bacteria—is different from the second lipid membrane – bacterial outer membrane, which contains lipopolysaccharides and lipoproteins and is found only in gram-negative bacteria

Most bacterial capsules are composed of polysaccharide, but some species use other materials, such as poly-D-glutamic acidin Bacillus anthracis.

The capsule is considered a virulence factor because it enhances the ability of bacteria to cause disease (e.g. prevents phagocytosis). The capsule can protect cells from engulfment by eukaryotic cells, such as macrophages.

A capsule-specific antibody may be required for phagocytosis to occur

Question 4

define

endotoxin

Answer 4

A poisonous lipopolysaccharide formed in the cell wall of a GRAM-NEGATIVE bacterium by means of which the organism causes its damage to the host.

Bacterial endotoxin, lipid A

A heat-stable lipopolysaccharide on the outer coat of gram-negative bacteria–eg, those causing cholera , meningitis , pneumonia, plague, whooping cough, et al Clinical Leukopenia, thrombocytopenia, fever, chills, hemorrhagic shock, dec resistance to infectioe

Question 5

define

Peptidoglycan

Answer 5

a polymer that is composed of polysaccharide and peptide chains and is found especially in bacterial cell walls

— called also mucopeptide, murein-

serves a structural role in the bacterial cell wall, giving structural strength, as well as counteracting the osmotic pressure of the cytoplasm. Peptidoglycan is also involved in binary fission during bacterial cell reproduction.

Question 6

define

Phospholipids

Answer 6

any of various phosphorus-containing complex lipids (such as lecithins and phosphatidylethanolamines) that are derived from glycerol and are major constituents of the membranes of cells and intracellular organelles and vesicles

NOTE: Phospholipids typically consist of a hydrophilic polar phosphate head and a hydrophobic tail of two fatty acids. In aqueous environments, phospholipids typically form semipermeable bilayers in which the hydrophilic heads point outward and the hydrophobic tails point inward toward each other.

Question 7

Name common cause of urethritis

in

Men

Answer 7

1. Mycoplasma genitalium
2. Neisserial gonorrhea
3. Trichomonal vaginalis
4. ureaplasma urealyticum
5. Chlamydia trichomonas

Question 8

what type of bacteria that cause either

a type of respiratory or a form of sexually transmitted illness?

Answer 8

Chlamydia includes certain species of bacteria that cause either a type of respiratory or a form of sexually transmitted illness in people depending on what species is involved.

The infections are caused by two different species of bacteria, Chlamydia trachomatis and Chlamydia pneumoniae that live inside the cells of the host.

Question 9

define

Gardnerella vaginalis

Answer 9

G. vaginalis is associated with bacterial vaginosis, which may be asymptomatic, or may have symptoms including vaginal discharge, vaginal irritation, and a “fish-like” odor.

In the amine whiff test, 10% KOH is added to the discharge; a positive result is indicated if a fishy smell is produced. This and other tests can be used to distinguish between vaginal symptoms related to G. vaginalis and those caused by other organisms, such as Trichomonas and Candida albicans

G. vaginalis produces a pore-forming toxin, vaginolysin, which affects only human cells

Question 10

All of the following individuals receiving tuberculin skin purified protein derivative (PPD) reactions should be treated for latent tuberculosis EXCEPT:

a. A 23-year-old injection drug user who is HIV negative has a 12-mm PPD reaction.
b. A 38-year-old fourth grade teacher has a 7-mm PPD reaction and no known exposures to active tuberculosis. She has never been tested with a PPD previously.
c. A 43-year-old individual in the Peace Corps working in sub-Saharan Africa has a 10-mm PPD reaction. Eighteen months ago, the PPD reaction was 3 mm.
d. A 55-year-old man who is HIV positive has a negative PPD result. His partner was recently diagnosed with cavitary tuberculosis.
e. A 72-year-old man who is receiving chemotherapy for non-Hodgkin’s lymphoma has a 16-mm PPD reaction.

Answer 10

B) A 38-year-old fourth grade teacher has a 7-mm PPD reaction and no known exposures to active tuberculosis. She has never been tested with a PPD previously.

The aim of treatment of latent tuberculosis is to prevent development of active disease, and the tuberculin skin test (purified protein derivative [PPD]) is the most common means of identifying cases of latent tuberculosis in high-risk groups. To perform a tuberculin skin test, 5 tuberculin units of PPD are placed subcutaneously in the forearm. The degree of induration is determined after 48 to 72 hours. Erythema only does not count as a positive reaction to the PPD. The size of the reaction to the tuberculin skin test determines whether individuals should receive treatment for latent tuberculosis. In general, individuals in low-risk groups should not be tested. However, if tested, a reaction larger than 15 mm is required to be considered as positive. School teachers are considered low-risk individuals. Thus, the reaction of 7 mm is not a positive result, and treatment is not required. A size of 10 mm or larger is considered positive in individuals who have been infected within 2 years or those with high-risk medical conditions. The individual working in an area where tuberculosis is endemic has tested newly positive by skin testing and should be treated as a newly infected individual. High-risk medical conditions for which treatment of latent tuberculosis is recommended include diabetes mellitus, injection drug use, end-stage renal disease, rapid weight loss, and hematologic disorders. PPD reactions 5 mm or larger are considered positive for latent tuberculosis in individuals with fibrotic lesions on chest radiographs, those with close contact with an infected person, and those with HIV or who are otherwise immunosuppressed. There are two situations in which treatment for latent tuberculosis is recommended regardless of the results on skin testing. First, infants and children who have had close contact with an actively infected person should be treated. After 2 months of therapy, a skin test should be performed. Treatment can be discontinued if the skin test result remains negative at that time. Also, individuals who are HIV positive and have had close contact with an infected person should be treated regardless of their skin test results.

Question 11

One goal of immunization programs is to eliminate a specific disease. In 2010, indigenous transmission of which of the following diseases had been eliminated in the United States?

a. Diphtheria
b. Mumps
c. Pertussis
d. Varicella
e. None of the above

Answer 11

a. Diphtheria

Immunization programs have the goals to control, eliminate, and eradicate disease. Disease control refers to decreases the impact of a specific illness on both health-related and societal outcomes. Examples of vaccinations that have lead to improved control of disease include the pneumococcal and influenza vaccines. Elimination can have two meanings. The first definition is to have zero cases in a defined geographic area. A second meaning is to reduce or eliminate the indigenous sustained transmission of an infection in a specific geographic area. In 2010, vaccine programs had eliminated measles, rubella, poliomyelitis, and diphtheria in the United States, although increasing numbers of cases of measles have been reported is some parts of the United States because of incomplete vaccination in children. Disease eradication is the most difficult goal to achieve. A disease can be considered eradicated when its elimination can be sustained without ongoing interventions. The only disease that has been globally eradicated at this point is smallpox. Poliomyelitis has been eradicated in most of the world although Afghanistan, Pakistan, India, and Nigeria continue to have ongoing transmission of the disease.

Question 12

A 63-year-old man has chronic obstructive pulmonary disease and presents to your office for routine follow-up. He has no complaints currently and feels well. He is being managed with tiotropium 18 μg once daily with albuterol metered-dose inhaler as needed. His most recent forced expiratory volume in 1 second (FEV1) was 55% predicted, and he is not on oxygen. He has received one dose of pneumococcal vaccine 5 years previously. He is asking if he should receive another dose of pneumococcal vaccine. According to the guidelines of the Centers for Disease Control and Prevention, what is your recommendation?

a. He does not require further vaccination unless his FEV1 drops below 50% predicted.
b. He does not require further vaccination until he reaches age 65 years.
c. He should be revaccinated today.
d. He should be revaccinated 10 years after his initial vaccine.
e. No further vaccination is recommended because a single dose is all that is required.

Answer 12

b. He does not require further vaccination until he reaches age 65 years.

Pneumococcal vaccination has been recommended for all individuals at any age with a variety of chronic medical conditions, including chronic respiratory disease, chronic heart disease, chronic liver failure, diabetes mellitus, asplenia, and chronic kidney disease. Determining when to revaccinate individuals has been somewhat controversial. The current recommendations are to revaccinate individuals ages 19 to 64 5 years after the initial vaccine if they have chronic renal failure or nephrotic syndrome, asplenia, or other immunocompromising conditions. All other individuals should receive a one-time revaccination at age 65 years and older if they were vaccinated 5 or more years previously and younger than 65 years old at the time of original vaccination.

Question 13

In which of the following patients is it appropriate to administer the vaccination against herpes zoster?

a. A 35-year-old woman who has never had varicella-zoster infection who is 12 weeks pregnant with her first child
b. A 54-year-old man who has never had varicella-zoster infection and is otherwise healthy
c. A 62-year-old man with HIV on antiretroviral therapy with a CD4+ lymphocyte count of 450/μL
d. A 64-year-old woman with dermatomyositis-associated interstitial lung disease treated with prednisone 20 mg daily and azathioprine 150 mg daily
e. A 66-year-old woman who was recently diagnosed with non-Hodgkin lymphoma

Answer 13

c. A 62-year-old man with HIV on antiretroviral therapy with a CD4+ lymphocyte count of 450/μL

The varicella-zoster vaccine is a live virus vaccine that was recently introduced for prevention of shingles in older adults. The current recommendation is all adults older than 60 years be offered the zoster vaccine regardless of whether they report a childhood history of chickenpox. As this is a live virus vaccine, it cannot be administered to anyone who has severe immunodeficiency. Specific recommendations for whom the zoster vaccine is contraindicated include:

1. Pregnancy
2. Anyone younger than 60 years
3. Patients with leukemia, lymphoma, or other malignant neoplasms affecting the bone marrow. If a patient is in remission and has not received chemotherapy or radiation therapy within 3 months, the vaccine can be given.
4. Individuals with AIDS or HIV with a CD4+ count <200/μL or ≤15% peripheral lymphocytes
5. Individuals taking immunosuppressive therapy equivalent to prednisone ≥20 mg/day, methotrexate 0.4 mg/kg/wk, or azathioprine <3 mg/kg/day
6. Anyone with suspected cellular immunodeficiency (e.g., hypogammaglobulinemia)
7. Individuals receiving a hematopoietic stem cell transplant
8. Individuals receiving recombinant human immune mediators or modulators, especially antitumor necrosis factor agents

Question 14

A 39-year-old woman received a liver transplant 2 years ago and is maintained on prednisone, 5 mg, and cyclosporine, 8 mg/kg per day. She has had two episodes of rejection since transplant, as well an episode of cytomegalovirus syndrome and Nocardia pneumonia. She intends on taking a 2-week gorilla-watching trip to Rwanda and seeks your advice regarding her health while abroad. Which of the following potential interventions is strictly contraindicated?

a. Malaria prophylaxis
b. Meningococcal vaccine
c. Rabies vaccine
d. Typhoid purified polysaccharide vaccine
e. Yellow Fever Vaccine

Answer 14

e. Yellow Fever Vaccine

Live-attenuated viruses are generally contraindicated as vaccines for immunocompromised hosts for fear of vaccine-induced disease. The most cited example of this is smallpox vaccine resulting in disseminated vaccinia infection. However, yellow fever vaccine is another example of a live virus vaccine. The other examples listed in this example are inactivated organisms (rabies, IM typhoid) or polysaccharide (meningococcal) and are therefore noninfectious. Oral typhoid vaccine is a live-attenuated strain, so the IM form is likely preferable in this host. Malaria prophylaxis currently involves chemoprophylaxis rather than vaccination. Although safe from an infectious standpoint, potential interactions with cyclosporine should be monitored.

Question 15

Which of the following diagnostic features characterizes

bacterial vaginosis?

Answer 15

A) Vaginal Fluid pH+4.5, clue cells and profouse mised microbiota on microscopic examination

The diagnosis of BV is generally made by using the Amsel criteria : This encompasses fulfilling three of the following four criteria:

(i) presence of abnormal vaginal discharge,
(ii) elevated vaginal pH (>4.5),
(iii) positive amine odor test,
(iv) presence of clue cells on vaginal Gram smear.

Question 16

Which of the following immunizations is required for entry into many countries in sub-Saharan Africa?

a. Hepatitis A
b. Cholera
c. Meningococcus
d. Typhoid fever
e. Yellow fever

Answer 16

e. Yellow fever

When traveling abroad, it is important to plan ahead and consider the potential infectious agents to which one might be exposed. The Centers for Disease Control and Prevention and the World Health Organization publish guidelines for recommended vaccinations before travel to countries around the world. Before travel, it is certainly recommended that an individual be up to date on all routine vaccinations, including measles, diphtheria, and polio. Influenza is perhaps the most common preventable illness in travelers, and the influenza vaccine should be administered per routine guidelines. There are, however, very few required vaccinations in most countries. Yellow fever is one exception, and proof of vaccination is required by many countries in sub-Saharan Africa and equatorial South America. This is especially important for individuals traveling from areas where yellow fever is endemic or epidemic. The only other required vaccinations are meningococcal meningitis and influenza vaccination to travel in Saudi Arabia during the Hajj.

Question 17

Deficits in the coplement memebrane attack complement (C5-8) are associated with infections of what variety?

Answer 17

Neisseria mengitiditis

or

Nesseria Gonorrhea

ONLY 2 colonize human mucosal surfaces- nesseria have thin cell wall and little to no glycocalyx.

Glycocalyx also known as the pericellular matrix, is a glycoprotein and glycolipid covering that surrounds the cell membranes of some bacteria, epithelia, and other cells

Question 18

define

dimorphic Fungi

Answer 18

occurring in or representing two distinct forms

Dimorphic fungi are fungi that can exist in the form of both mold and yeast

Question 19

Which of the following fungi is considered Dimorphic?

a. Apergillus Fumigatus
b. candida albicans
c. cryptococcus neoformans
d. histoplasma

Answer 19

Histoplasma

Question 20

Name

Dimorphic Fungi

which also cause what type of infections?

Answer 20

Systemic infections

Question 21

define

Herpangina

Answer 21

called mouth blisters, is a painful mouth infection caused by coxsackieviruses.

Usually, herpangina is produced by one particular strain of coxsackie virus A (and the term “herpangina virus” refers to coxsackievirus A) but it can also be caused by coxsackievirus B or echoviruses.

Most cases of herpangina occur in the summer, affecting mostly children. However, it occasionally occurs in adolescents and adults

Question 22

Match the following Viruses with their primary clinical manifistations:

a. Adenovirus
b. Coronavirus
c. human respiratory syncytial virus
d. parainfluenza
e. rhinovirus

Answer 22

a. are common viruses that cause a variety of illnesses in humans. Most commonly, they cause respiratory tract infections or conjunctivitis (inflammation of the lining of the eyes)

NOT Herpangina

b. severe acute respiratory syndrome

c. bronchiolitis in infants and young children

d. croup

e. common cold

Question 23

A 48-year-old woman is traveling to Haiti with a humanitarian aid group. What is the recommended prophylaxis against malaria for this patient?

a. Atovaquone–proguanil
b. Chloroquine
c. Doxycycline
d. Mefloquine
e. Any of the above can be used

Answer 23

e. Any of the above can be used

Malaria remains endemic in many parts of the world, and an estimated 30,000 travelers from the United States and Europe are infected with malaria during travel yearly. The areas of highest risk are in sub-Saharan Africa and Oceania with the lowest risk in South and Central America, including Haiti and the Dominican Republic. Chloroquine resistance is growing throughout the world and is especially notable in parts of South America, Africa, and Southeast Asia. However, in Haiti, the incidence of chloroquine resistant malaria is low. For a traveler to Haiti, the Centers for Disease Control and Prevention states that travelers have a choice of chloroquine, doxycycline, atovaquone–proguanil, or mefloquine. In addition, travelers should be cautioned to use appropriate techniques for malarial prevention, including protective clothing, DEET-containing insect repellants, permethrin-impregnated bednets, and screened sleeping accommodations, if possible.

Question 24

name all statements regarding

Norwalk virus gastroenteritis

that are true.

(5 statements)

Answer 24

1. fever is common
2. incubation period is typically 12-48 hours
3. infection is common worldwide
4. transmission is typically fecal-oral
5. it is major cause of nonbacterial diarrhea in infants

Question 25

A 46-year-old man wishes to travel to Kenya for a 2-week vacation. He is HIV positive and is taking antiretroviral therapy. His last CD4+ count was 625/μL and viral load was undetectable. His nadir CD4+ count was 250/μL. He has never had an AIDS-defining illness. In addition to HIV, he has a history of hypertension and is known to have proteinuria caused by to HIV-associated nephropathy. What is your recommendation to this patient regarding his travel plans? a. He should not receive the live measles vaccine before travel. b. He should receive the yellow fever vaccine before travel. c. He will be required to show proof of HIV testing upon entry into the country. d. His likelihood of response to the influenza vaccine would be less than 50%. e. With a CD4+ count greater than 500/μL, he is at no greater risk during travel than persons without HIV.

Answer 25

***e.** With a CD4+ count greater than 500/μL, he is at no greater risk during travel than persons without HIV.* Individuals with HIV are generally considered at high risk of infectious complications when traveling abroad. However, individuals who have no symptoms and a CD4+ count greater than 500/μL appear to be at no greater risk than individuals without HIV infection. Before travel, it is important to research the travel requirements for the specific country of travel. Many countries routinely deny entry for HIV-positive individuals for prolonged stays, and proof of HIV testing is required in many countries for stays longer than 3 months. Consular offices should be contacted before travel to determine if any special documentation is required. HIV-infected travelers should have all routine immunizations before travel, including influenza and pneumococcal vaccinations. The response rate to influenza in an asymptomatic HIV-positive person is greater than 80%. Generally, live-attenuated viruses are not given to HIV-infected individuals. However, because measles can be lethal in those with HIV, this vaccine is recommended unless the CD4+ count is less than 200/μL, and the expected response rate would be between 50% and 100%. In contrast, the live yellow fever vaccine is not given to HIV-infected travelers, and individuals with CD4+ counts below 200/μL should be discouraged from traveling to countries with endemic yellow fever. Some countries in sub-Saharan Africa require yellow fever vaccination. However, because this patient is traveling from a low-risk area, a medical waiver would likely be issued.

Question 26

All of the following statements regarding interferon-gamma release assays for the diagnosis of latent tuberculosis are true EXCEPT: a. There is no booster phenomenon. b. hey are more specific than tuberculin skin testing. c. They have a higher sensitivity than tuberculin skin testing in high HIV-burden areas. d. They have less cross reactivity with BCG and nontuberculous mycobacteria than tuberculin skin testing. e. They may be used to screen for latent tuberculosis in adults working in low prevalence U.S. settings.

Answer 26

***c.** They have a higher sensitivity than tuberculin skin testing in high HIV-burden areas.* *T-lymphocyte release of interferon-gamma in response to highly specific tuberculosis antigen stimulation is the basis for the commercially available interferon-gamma release assays (IGRAs). IGRAs are more specific than tuberculin skin testing caused by less cross-reactivity with non-mTB organisms, including Bacillus Calmette-Guérin and nontuberculous mycobacteria. The absolute sensitivity of IGRAs is not clearly known because of the difficulty in establishing a gold standard, but most studies demonstrate superior performance in detecting latent tuberculosis in low-incidence settings. They also are more user friendly because there is no administration expertise, interpretation is less subjective, and results do not require a second visit. The results are far less clear in settings of high tuberculosis or HIV burden. The tuberculin skin testing booster phenomenon, a spurious conversion caused by serial testing, does not occur with IGRAs; however, a tuberculin skin test may cause a false-positive IGRA result. In the United States, IGRA is preferred for most persons older than 5 years of age being screened for latent tuberculosis*

Question 27

a 25 year old woman presents with 2 days of urinary frequency, urgency and pelvic discomfort. She has no pain in her vulva on urination. She has no other medical problems and does not have fevers. she is sexually active. a microscopic examinationof her urine shows pyuria but no pathogens. after 24 hours, her urine curlture does not grow any pathogens which test will likely confirm her diagnosis?

Answer 27

*_Nucleic acid amplification_ test of urine for* *_Chlamydia trachomatis_*

Question 28

* Enteric pathogens can produce diarrheal illness thuogh a variety of mechanisms that lead to specific clinical characteristis. All of the following characterisics of diarrhea caused by _Vibrio Cholera_ **Except**?* a. Disease localized to the proximal small intestine b. fecal leukocytes c. non-bloody diarrhea d. toxin production e. watery diarrhea

Answer 28

*b. fecal leukocytes*

Question 29

20 year old woman is 36 weeks pregnant and presents for her first evaluation. she is diagnosed woth *_chlamydia trachomatis infection of the cervix_* Upon delivery, for what complication is her infant most at risk?

Answer 29

Conjunctivitis Pink eye (conjunctivitis) is an inflammation or infection of the transparent membrane (conjunctiva) that lines your eyelid and covers the white part of your eyeball. When small blood vessels in the conjunctiva become inflamed, they're more visible. This is what causes the whites of your eyes to appear reddish or pink.Pink eye is commonly caused by a bacterial or viral infection, an allergic reaction, or — in babies — an incompletely opened tear duct

Question 30

What is the common manifestation of *Clostridium difficle infection?*

Answer 30

Fever non-bloody diarrhea adynamic ileus recurrence after therapy *_(all of the above)_*

Question 31

# define ***Clostridium difficile***

Answer 31

is a germ (bacterium) that causes severe diarrhea and colitis (an inflammation of the colon). About 1 in 6 patients who get C. diff will get it again in the subsequent 2-8 weeks.

Question 32

name Respiratory viruses that are a cause of the common cold syndrome in children or adults. Except ...

Answer 32

1. Adenoviruses 2. cononaviruses 3. Human respiratory syncitial viruses 4. Rhinovirus ***EXCEPT: Enteroviruses***

Question 33

# define Enterovirus

Answer 33

a genus of *_positive-sense single-stranded RNA viruses_* Enteroviruses are named by their transmission-route through the intestine (enteric meaning intestinal) On the basis of their pathogenesis in humans and animals, the enteroviruses were originally classified into four groups, polioviruses, Coxsackie A viruses (CA), Coxsackie B viruses (CB), and echoviruses

Question 34

* all of the following statements regarding intestinal disease caused by strain of _Shiga toxin-producing and enterohemorrhagic E. coli_ are true except?* * a. antibiotic therapy lessens the risk of developing hemolytic uremic syndrome* * b. groud beef is the most common source of contamination* c. gross bloody diarrhea without fever is themost comon clinical manifiestation d. infectionis more common in industrialized than developing countries e. 0157:H7 is the most common stereotype

Answer 34

***a. antibiotic therapy lessens the risk of developing hemolytic uremic syndrome***

Question 35

a 46 year old woman travels to a rular area fo Guatemala. three days after arriveal, she develops watery diarrhea with sever abdominal cramps. she resport 2 unformed stools daily for the past 2 days. she has noticed no blood in the stool and has not experienced fever. what is the most likley cause of the patients illness? a. campylobacteri jejuni b. ETEC c. norovirus d. shigella sppl e. EHEC

Answer 35

*b. ETEC*

Question 36

define *campylobacteri jejuni*

Answer 36

Campylobacter jejuniinfection causes cramping, diarrhea, abdominal pain and fever within 2 to 5 days after a person has been exposed to the organism. Campylobacter infection occurs in the small intestine from bacteria called Campylobacter jejuni. jejuni is commonly associated with poultry, and is also commonly found in animal feces. Campylobacter is a helical-shaped, non-spore-forming, Gram-negative, microaerophilic, nonfermenting motile bacterium with a single flagellum at one or both poles,[5] which are also oxidase-positive and grow optimally at 37 to 42 °C.

Question 37

* Enterotoxigenic Escherichia coli (E. coli),* * or* * ETEC*

Answer 37

Escherichia coli is a bacterium that normally lives in the intestines of humans and other animals. Most types of E. coli are harmless, but some can cause disease. Disease-causing E. coli are grouped according to the different ways by which they cause illness. Enterotoxigenic Escherichia coli, or ETEC, is the name given to a group of E. coli that produce special toxins which stimulate the lining of the intestines causing them to secrete excessive fluid, thus producing diarrhea. The toxins and the diseases that ETEC causes are not related to E. coli O157:H7 ## Footnote ***leading cause of travelers’ diarrhea***

Question 38

Norovirus

Answer 38

Norovirus infection can cause the sudden onset of severe vomiting and diarrhea. The virus is highly contagious and commonly spread through food or water that is contaminated during preparation or through contaminated surfaces. You can also be infected through close contact with an infected person. Norovirus infection occurs most frequently in closed and crowded environments such as hospitals, nursing homes, child care centers, schools and cruise ships

Question 39

EHEC

Answer 39

***Enterohemorrhagic Escherichia coli (EHEC) serotype O157:H7*** ***EHEC*** is a strain of E. coli that produces a toxin called *_Shiga toxin._* The toxin causes damage to the lining of the intestinal wall EHEC was found as the cause of bloody diarrhea that developed after eating undercooked or raw hamburger meat contaminated with the bacteria. E. coli O157:H7 was first isolated from hamburger and cattle are considered to be the primary reservoir for EHEC O157:H7. Tissue tropism of EHEC at the rectal-anal junction and its stable colonization at this anatomical location ensures its persistence and shedding in feces

Question 40

***Shigella spp.***

Answer 40

***Shigella*** is a non-spore forming, non-motile, rod-shaped Gram-negative bacterium which aids in the facilitation of intracellular pathogens. It is able to survive the proteases and acids of the intestinal tract, which allows the bacteria to infect in very small amounts. As few as 10 cells have been reported to cause infection. Shigellosis primarily affects humans. Fecal-oral transmission is the main route of Shigella infection. Other modes of transmission include ingestion of contaminated food or water, contact with infected objects, or sexual contact. Outbreaks of Shigella infection are common in places with poor sanitation standards.

Question 41

5 healthy college roommates develop a rapid (less than 8 hrs) onset of abdominal pain, cramping, fever, to 38.5 C(101.3) vomiting and coupious nonbloody diarrhea while capming. They immediatley return for hydration and diagnosis. A stool culture grows Salmonella enteritidis. all of the statements regarding their clinical syndrome are true except? a. antibiotic therapy is not indicated b. bacteremia occurs in fewer that 10% cases c. the most likely source was undercooked eggs d. there is no vaccine available for this illness e. They have enteric (typhoid) fever

Answer 41

***e. They have enteric (typhoid) fever***

Question 42

***Typhoid fever***

Answer 42

Typhoid fever and paratyphoid fever are life-threatening illnesses caused by Salmonella serotype Typhi and Salmonella serotype Paratyphi, respectively. Most people in the United States with typhoid fever or paratyphoid fever become infected while traveling abroad, most often to countries where these diseases are common

Question 43

in the inpatient setting, *_extended specrum B-lactamase (ESBL)_* producing *_gram negative_* infections are most likely to occur after frequent use of which of the following classes of antibiotics? a. Carbapenems b. macrolides c. quinolones d. third-generation cephalosporins e. tetracyclines

Answer 43

*_d. third-generation cephalosporins_* ***_Carbapenems_****= preffered treatment*

Question 44

in march 2009, the H1N1 strain of the influenza A viruses emerged in Mexico and quickly spread worldwide love the next several months. Ultimately, more than 18.000 people died from the pandemic. THis virus had genetic components of swine influenza viruses, an avian virus, and a huam influenza virus. teh genetic process by which this pandemic strain of influenza A emerged in an example of? a. Antigenic shift b. antifenic drift c. genetic reassortment d. point mutation e. B and C

Answer 44

***a. Antigenic shift*** *Antigenic shift is a specific case of reassortment or viral shift that confers a phenotypic change. Antigenic shift is contrasted with antigenic drift , which is the natural mutation over time of known strains of influenza (or other things, in a more general sense) which may lead to a loss of immunity, or in vaccine mismatch.*

Question 45

a 25 year old woman presents to the clinic complainingof several days of worsening burning and pain with urination. she describes an increase in urinary frequiency and *_suprapubic tenderness_* but no *_fever or back pain._* she has no past medical history with the exception of 2 proir episodes similar to this in the past 2 years. Urinalasis shows *_moderate white blood cells._* which of the following is the most likely causative agent of her current symptoms. a. Candida spp b. E. coli c. Enterobacter spp d. klebsiella spp e. proteus spp

Answer 45

***b. E. coli***

Question 46

a local oncology center is concerned about the occurrency of an outbreak of cases if invasive Aspergillus in patients receiving bone marrow transplants. which of the following is themost likely siurce of Aspergillus infection? a. contaminated air source b. contaminated water source c. patient to patient spread in outpatient waiting rooms d. provider to patient spread because of poor hand washing technique e. provider to patient spread becase of poor utilization of alcohol disinfectant

Answer 46

***a. contaminated air source***

Question 47

a 21 year old college student is admitted to the hospital with *_meaningitis*_. _*CSF cultures reveal Neisseria meningitidies type B_*. The patient lives in dormatory suite with 5 other students. What TX is recommended for the close household contact?

Answer 47

*Immediate Vaccination with Conjugate vaccine* ***A conjugate meningococcal vaccine*** (MCV4) exists and is approved for use in adolescents and adults between 11 and 55 years of age. This vaccine is highly recommended to individuals traveling to countries with a high prevalence of meningococcal meningitis (e.g. meningitis belt in Africa). *_Prevention:_* *Because Neisseria Meningitidis often causes outbreaks of meningitis in crowded areas where there is close contact between people. Individuals which have come into contact with an infected individual (friends, family, etc.) are usually treated with prophylactic **rifampin** or **ciprofloxacin.***

Question 48

the *synthesis of erythorogenic toxin* by specific strains of *_group A Streptococcu_*s is determined by a/ a. bacterial chromosomal gene b. gene carried by a lysogenic phage c. specific virulence plasmid d. transposon

Answer 48

***b. gene carried by a lysogenic phage***

Question 49

A 33-year-old man sustained compound fractures of his right tibia and fibula during a car accident. Within hours, surgical debridement of the wound and a leg immobilization was completed. The patient improved until four days following the surgery, at which time he became febrile (38°C), tachycardic (120bprn) and complained that his leg was painful. After opening the cast, the lower leg was noted to be swollen, reddish-purple, and exuding a foul- smelling exudate. Crepitations were palpable over the entire gastrocnemius. A Gram-stain of the exudate revealed both Gram-negative and Gram-positive rods. What is the function of the toxin produced by Gram-positive rod most likely growing in this man's leg?

Answer 49

*Degrades lipids in host cell memebrane*

Question 50

***Antitoxin*** is an important component in the treatment of?

Answer 50

***Food-borne botulism***

Question 51

Production of diphtheria toxin is regulated by a repressor that is usually active, but in certain circumstances (such as in a patient) this repressor becomes inactive. What is the factor which causes the inhibition of the diphtheria toxin repressor?

Answer 51

***C. Iron*** Note: A and B bind to glycoprotein receptors on cel membrane

Question 52

The possession of a capsule is often considered to be an important feature of pathogenic bacteria. Which of the following organisms does not possess a capsule?

Answer 52

***D. Corynebacterium Diphtheria***

Question 53

Tracheal cytotoxin, involved in the pathogenesis of whooping cough by Bordetella pertussis, is released from the bacterial cell via which mechanism?

Answer 53

Cell wall degrading enzyme

Question 54

Scarlet fever (scarietna) is known to be caused by bacterial production of which toxin?

Answer 54

Erythrogenic toxin

Question 55

In May 2011, an outbreak of foodborne illness, presenting with bloody diarrhea and complicated in many cases by hemolytic uremic syndrome, was seen in Germany. In thousands of patients, the causative agent was identified as a lactose-fermenting, Gram- negative, oxidase-negative rod of the novel 0104:H4 serotype. Interestingly, while the pathogen causes a disease similar to that caused by the 0157:H7 strain, it does not have the attaching/effacing genes found in this latter organism. What virulence factor is most likely responsible for the similarities in clinical presentation between the new strain and the 0157:H7 strain?

Answer 55

Shiga toxin

Question 56

The capsule surrounding Streptococcus pneumoniae makes bacteria pathogenic by what mechanism?

Answer 56

*It inhibits phagocytoss by preventing activation of complement and preventing binding of C3b to bacteria*

Question 57

An 18-year-old college student presents with fever, headaches, photophobia, nuchal rigidity, and petechiae. Gram-staining of both blood cultures and cerebrospinal fluid reveals red pairs of kidney bean-shaped bacterial cells. One of the ways this organism is able to survive in the bloodstream is by evading phagocytosis. What is the general structure of the virulence factor most responsible for this ability?

Answer 57

***Surface-anchored polysaccharide***

Question 58

a 75 year old man as admitted to hospital with a 2 day history fo abdominal pains and diarrhea. he had been taking a course of amoxicillin for respiratory track infection for 1 week before the diarrhea started. on arrival he had a fever of 38 C adn his abdomen was distended and diffusely tender. an abdominal x-ray showed toxic dilatation. Which of hte following treatments is likely to be of most value in treating the cauase of his diarrhea? a. Cefotaxime b. oral ciprofloxacin c. gentamicin d. oral metronidazole e. prednisolone

Answer 58

(Clostridium difficle) ## Footnote ***D. Oral metronidazole*** *_Metronidazole_ or _vancomycin_* *and* *_fluid replacement_*

Question 59

a 23-year old man presents to his doctor with a 3 day history of worsening sore throat and pain on swallowing. examinatin revealed bilaterally enlaged tonsils with exudates. Which of the following bacterial is most likely to cause this illness? a. Haemophilus infuenzae b. Nesseria meningitides c. staphylococcus aureus d. streptococcus pneumoniae e. streptococcus pyogenes

Answer 59

***e. streptococcus pyogenes***

Question 60

a 54-year old man presented with fever and a raised white cell count. which of the following isolates is most likely to be clinically significant***?*** a. Coagulase-negative staphylococci in a wound swab b. staphylococcus aureus in a nose swab c. Escherichia coli in a faeces sample D. streptococcus pneumonia in a sputum sample e. viridans streptococci in a throat swab

Question 61

which of the following infections is not sexually transmitted? a. Chlamydia trachomatis b. gonorrhea c. hepatitis B d. rubella e. syphillis

Answer 61

***d. rubella***

Question 62

The aminoglycosides are very active group of anibacterial agents, particularly agains gram-negative bacili. identify their mode of action from the list . a. disruption of cytomplasmic membrane b. inhibition fo bacterial cel wall synthesis c. inhibition fo bactrial DNA gyrase d. inhibition of protein synthesis e. Interference with bacterial folic acid metabolism

Answer 62

***d. inhibition of protein synthesis***

Question 63

a male baby is born at 39 week gestation with a microcephaly, low birthweight, hepatosplenomegaly and bilateral cataracts. this is thought to be due to an infection acquired while the baby was still in utero. Select the condition which is most likely to cause this clinical presentation? a. cytomegalovirus b. group B streptococcus c. rubella virus d. toxoplasma gondii e. trepanema pallidum

Answer 63

***c. rubella virus***

Question 64

analysis of CSF from case of suspected memenigitis showed a great incease in protein concentration, glucose level which was 10% of the plasma concentration and predominace of granulocytes. The following organism is unlikely to be the caause? a. ECHO virus b. N. nemingitides c. Streptococus pneumoniae d. mycobacterium tuberculosis e. Haemophilus influenza

Answer 64

***ECHO virus*** ***Echovirus is one of several families of viruses that affect the gastrointestinal tract.***

Question 65

The *_antistreptolysin O tite_*r is raised in infection caused by? Paste a. Enterococcus Faecalis b. streptococcus pneumoniae c. streptococcus pyogenes d. streptococcus mutans e. streptococcus bovis

Answer 65

***streptococcus pyogenes*** The ASO titer test measures antibodies produced by your body in response to a toxin known as streptolysin O. Streptolysin O is a toxin produced by group A Streptococcus (GAS) bacteria. Your body makes the antistreptolysin O antibodies when you have a strep infection caused by GAS bacteria. *_Historically it was one of the first bacterial markers used for diagnosis and follow up of rheumatic fever or scarlet fever_*

Question 66

The following antimicrobial drug is effective against penicillinase-producing staphylococci? a. ampicilin b. benzyl-penicillin c. amoxicillin and clavulanic acid d. rifampin e. gentamicin

Answer 66

***d. rifampin***

Question 67

list below are combinations that are used to treat certain infections. Name the combination in which BOTH drugs act to inhibit the same metabolic process?

Answer 67

***Sulfonamide and trimethoprim*** Sulfonamides and trimethoprim both act the folic acid pathway but at different points creating a sequential inhibition. Sulfonamides act as false substrates for some enzymes of the pathway while trimethoprim competes with another substrate and inhibits another enzyme in the pathway.

Question 68

Methicilin-resistant Stapylococcus aureus? a. is usually sensitive to vancomycin b. never causes asymptomatic colonization c. is more likely to cause deep seated infection d. teh resistance is mediated by b-lactamases e. usually sensitive to penicillins with b-lactamases inhibitors

Answer 68

***is usually sensitive to vancomycin***

Question 69

blood cultures are often positive in cases of? a. menigococcal menngitis b. bacillary dysentery c. primary syphilis d. thrumatic fever e. gonorrhea

Answer 69

*bacillary dysentery*

Question 70

hyaluronidase production is important in the pathogenicity of. a. Clostridium perfringens b. streptococcus penumonia c. neisseria gonorrhaeae d. neisseria meningitidis e. shigella sonnei

Answer 70

***Clostridium perfringens*** * and* * Streptococcus Aureus* * Strptococcus Pyogenes*

Question 71

Which of the following vaccines contains living organisms ? a. BCG b. Diptheria c. tatnus d. Hepatitis B e. Meningococcal meningitis

Answer 71

***BCG*** * Bacillus Calmette–Guérin (BCG) vaccine is a vaccine primarily used against tuberculosis (TB).* * In countries where tuberculosis or leprosy is common, one dose is recommended in healthy babies as close to the time of birth as possible.*

Question 72

Gamma globulins are useful in the prevention of the following infections? a. rheumatic fever b. gass gangrene c. tetanus d. tuberculosis e. cholera

Answer 72

***tetanus***

Question 73

Keratoconjunctivitis may abe due to infection with ? a. orthomyxoviruses b. adenoviruses c. borrelia burgdorferi d. rotaviruses e. coxiella burnetti

Answer 73

*a. orthomyxoviruses- common cold* ***b. adenoviruses*** * c. borrelia burgdorferi - lyme disease* * d. rotaviruses - infancy diarrhea* * e. coxiella burnetti - Q-fever* *_Q fever_ is transmitted to humans by animals, most commonly sheep, goats and cattle. When you inhale barnyard dust particles contaminated by infected animals, you may become infected. High-risk occupations include farming, veterinary medicine and animal research.*

Question 74

a pet-shop owner presented to hsi doctore with general malaise, headache and fever and was found to have patchy bronchopneumonia. In teh light of his occupation, his illness is likely to be? a. mycoplasma b. legionnaires disease c. psittacosis d. haemophilus infuenzae pneumonia e. aspergillosis

Answer 74

***c. psittacosis*** *also known as _parrot fever, and ornithosis_—is a _zoonotic infectious disease in humans caused by a bacterium called Chlamydia psittaci and contracted from infected parrots, such as macaws, cockatiels, and budgerigars, and from pigeons, sparrows, ducks, hens, gulls and many other species of birds_. The incidence of infection in canaries and finches is believed to be lower than in psittacine birds.*

Question 75

consider the following statements about bacteria: * Statement 1:* most bacteria have ssDNA but lack mitochondria * Statement 2:* small subunit of ribosomes are composed fo 16S rRNA * Statement 3:* bacteria exotoxins are potent toxins which can affect humans *_Which are correct?_* a. 1,2,3 b. 1 and 3 c. 2 and 3 d. 1 and 2

Answer 75

a. 1,2,3

Question 76

Which of the following fungus is a causative agent of subcutaneous mycosis? * a. histoplasma capsulatum* * b. cryptococcus neoformans* * c. candida albicans* * d. aspergillus fumigatus* * e. sporothrix schenckii*

Answer 76

***Sporothrix schenckii*** ***Note: CDE are opportunisic*** Three common subcutaneous mycoses are those causing sporotrichosis, chromomycosis, and mycetoma. All represent disease caused by saprophytic (soil-growing) fungi that enter tissue, usually through trauma. Sporothrix schenckii is the causative agent of lymphocutaneous sporotrichosis and is the most common form of subcutaneous nodular fungal disease. Clinical presentation demonstrates lesions following lymphatic vessels, with ulceration.

Question 77

a 33 yer old male living in the US recently consumed a meal mostly consisting of raw shelfish that his girlfriend brought form her trip to Asia. 2 days later he experienced sudden onset of diarrhea and vomiting with severe abdominal cramps. The diarrhea was profuse, looked like *_rice water_* and pungent fishy odor. he soon started to experience muscle crapms and weakness, together with deep labored breathing pattern. The next day yellow bacterial colonies were observed on thiosulfate-citratee-bile salts-sucrose agar. if you were a bilogist on call, what kind of bacterial morphology would you expect to see during microscopic evaluation of a gram stain slide made from those bacterial colonies?

Answer 77

***Common shaped Rods***

Question 78

Superoxide dismutase is an enzyme that catlayzes the conversion of oxygen radicals to peroxidase. which groups of organisms do not have this enzyme? a. aerobes b. facultative anaerobes c. aerotolerant anaerobes d. microaerophiles e. obligate anaerobes

Answer 78

obligate anaerobes

Question 79

an individual that is experiencing teh convalescent phase of a typical infectious disease a. has been exposed to an infectious microorganism and the micororganism is replicatin, but microorganism numbers have not yet reached levels necessary to produce visible symptoms b. has survivald the acute phase of the disease because of an effective immune system adn or because of effective treatment c. is suffering maximum host cell damage and is manifesting clear and distinct symptoms of hte particular disease. d. none of the above

Answer 79

has survivald the acute phase of the disease because of an effective immune system adn or because of effective treatment

Question 80

Gram (-) and Gram (+) bacteria can be distinquished by the following? a. the fact that one produces endotoxin, but the other does not b that pilus compositon and structure differ in the two c. that the cell memebrane is convalntly connected to peptidoglycan in one but not in the other d. that one has 70s ribosomes adn the other has 80s ribosomes e. that one has permeases and the other has group translocation proteins

Answer 80

the fact that one produces endotoxin, but the other does not

Question 81

ethanol is one of the most commonly used disinfectants. Which concentration of ethanol is most effective for this purpose? a. 100% b. 70% c. 50% d. 30% e. 25%

Answer 81

70%

Question 82

which of the following is *_not true_* of *Clostridium perfringens* ? a. it occurs in six stereotypes: A-F b. serotype A is responsible for food poisoning in man c. it is found in the genital track of some healthy women and inestine of man d. it produces a neruotoxin e. penicillin G is the antibiotic of choice

Answer 82

***it produces a neruotoxin*** There are 5 strain types of C. perfringens, which are denoted by an A-E classification. The classification is dependent upon the type of major lethal toxin the strain is able to produce. Type A bacteria produce alpha toxin, type B bacteria produce alpha, beta, and epsilon toxins, type C bacteria produce alpha and beta toxins, type D bacteria produce alpha and epsilon toxins, and type E bacteria proteins produce alpha and iota toxins [15]. Each strain is also capable of producing secondary toxins, which include, but are not limited to enterotoxin and beta 2 toxin [9].

Question 83

*Drug* which is used in the treament of *_tuberculosis_* is ?

Answer 83

***"RIPS"*** Rifampicin isoniazid P-amino salicylic acid (PAS) Streptomycin

Question 84

all of the following are examples of *_superficial mycoses_* except? a. Tinea versicolor b. tinea nigra c. black piedra d. tinea pedis e. white piedra

Answer 84

*_tinea pedis_* = cutaneous

Question 85

What is superficial cutaneous mycoses

Answer 85

* The superficial (cutaneous) mycoses are usually confined to the outer layers of skin, hair, and nails, and do not invade living tissues.* * The fungi are called* *_dermatophytes._*

Question 86

a 5-year old kindergartener boy debelps scaling of scalp adn hair loss. after routine examination, scalp ringorm was observed. what is the most correct name of this fungal infection? a. Tinea nigra b. tinea capitis c. tinea unguium d. tinea pedis e. tinea corporis

Answer 86

*_tinea capitis_*

Question 87

all of the following *_picornavirus_* are *restistant to the acidity of the stomach* except? a. coxsackievirus A b. coxsackievirus B c. Echo virus d. Poliovirus e. Rhinovirus

Answer 87

*Rhinovirus*

Question 88

in the chronic carrier of hepatitis B virus (HBV), which positive test is most indicative of high infectivity ?

Answer 88

Hepatitis B e antigen (HbeAg)

Question 89

a young man has returned from a short trip to Mexico where he was bitten by a dog. 8 weeks after returning he developed excessive salivation, adversion to drinking water, and hallucinations and died in cardiac arrest. which measure might have prevented this death if implemented upon his return?

Answer 89

*Gamma globulin therapy* Gamma globulin injections are usually given in an attempt to temporarily boost a patient's immunity against disease. Being a product derived from bone marrow and lymph gland cells, gamma globulin injections, along with blood transfusions and intravenous drug use, can pass hepatitis C to their recipients Note; *_Rabies immune globulin_* is given to persons who have been exposed (eg, by a bite, scratch, or lick) to an animal that is known or thought to have rabies. This is called post-exposure prophylaxis. Rabies immune globulin is used only in persons who have never before received the rabies vaccine. Rabies infection is serious and often fatal.

Question 90

* Each year there are discussions about new formulatios of the vaccine for influenza A virus.* * Why?*

Answer 90

*Because mutations occur mainly in the envelope protein:* ***Hemagglutinin** and **Neuraminidase***

Question 91

*How can Flu virus change:* ***Drift** and **Shift***

Answer 91

One way influenza viruses change is called ***“antigenic drift.”*** These are small changes (or mutations) in the genes of influenza viruses that *can lead to changes in the surface proteins of the virus:* ***HA (hemagglutinin)*** and ***NA (neuraminidase)***. The ***HA*** *and* ***NA*** *surface proteins of influenza viruses are “antigens,” which means they are recognized by the immune system and are capable of triggering an immune response, including production of antibodies that can block infection.*

Question 92

A 35-year old man was addicted to intravenous drug use and has been a carrier for hepatitis B virus surface antigeh (HBsAg) for 10 yrs. He suddenly develops acute fulminant hepititis. Which laboratory test would contribute MOST to a diagnosis ?

Answer 92

Antibody to hapatitis delta antigen

Question 93

***Hepatitis D Virus Total Antibodies*** *Serum used for ?*

Answer 93

Detection of hepatitis D virus (HDV)-specific total antibodies (combined IgG and IgM) in human serum Diagnosis of concurrent HDV infection in patients with fulminant acute hepatitis B virus (HBV) infection (acute coinfection), chronic HBV infection (chronic coinfection), or acute exacerbation of known chronic HBV infection (HDV superinfection)Hepatitis D virus (HDV), also known as delta hepatitis virus, is a defective RNA virus comprised of a delta antigen and a hepatitis B surface antigen (HBsAg) as the core and protein coat of the virus. This virus cannot replicate effectively by itself as it requires the presence of hepatitis B virus (HBV) to initiate and maintain its replication in the infected liver cells.

Question 94

A 10-yr old girll has develped fever and loss of appetie. by the time she is seen by the physician she has tender sweeeling in the area of both parotid glands. What are other features typical of this infection and its agent?

Answer 94

*(Mumps)* ***it is preventable by immunization***

Question 95

Mumps define:

Answer 95

*_Mumps is a viral disease caused by the mumps virus._* ***Initial symptoms:*** non-specific, fever, headache, malaise, muscle pain, and loss of appetite-followed by painful swelling of the parotid glands, called ***parotitis***- ***Symptoms*** occur *16 to 18 days* *after exposure to the virus and _resolve_ within **two weeks***

Question 96

***Mumps*** *complications:*

Answer 96

deafness, wide range of inflammatory conditions (inflammation of the testes), breasts, ovaries, pancreas, meninges, and brain are the most common. Testicular inflammation may result in reduced fertility and, rarely, sterility.

Question 97

***Mumps*** onset duration cause risk factors diag prevent-TX/Med

Answer 97

* Usual onset*: 7–25 days after exposure * Duration:* Usually less than two weeks * Causes:* Mumps virus * Risk factors:* Exposure to someone with mumps * Diagnostic method:* Antibody testing, viral cultures, and reverse transcription polymerase chain reaction * Prevention:* Vaccination * Treatment:* Supportive * Medication:* Pain medication, intravenous immunoglobulin

Question 98

you need to decide to do a 6 month clinical rotation in a teachng hospital situated in the Indian subcontinent and will be accompanied by your spouse and a 1-year old child. your child is up to date with all the routine immunizations. in addition, you will take other recommended immunizations before traveling. which one of the following statment is true about aviral disese that may affect one of you?

Answer 98

*_Rotavirus_ infections are more common in* *infants than adults*

Question 99

A 6-week-old infant is brought to the emergency room with a 10-day history of coughing and choking spells. The white blood cell count is elevated with 80% lymphocytes. The child is gasping for breath, experiencing paroxysms of coughing, and vomits twice in the examination room. Encapsulated, gram-negative rods grow out on Bordet-Gengou media. Which of the following microorganisms is the likely cause of these symptoms?

Answer 99

*Bordetella Pertussis*

Question 100

* HAEMOPHILUS INFLUENZAE* * TYPE B*

Answer 100

HAEMOPHILUS INFLUENZAE TYPE B the major cause of infant meningitis before the Hib conjugate vaccine nearly eradicated this pathogen from the United States. Nonencapsulated strains cause otitis media in children and pneumonia in adults. This organism also has a peculiar growth requirement, requiring factor X (hematin) and factor V (NAD).

Question 101

*KLEBSIELLA PNEUMONIAE*

Answer 101

KLEBSIELLA PNEUMONIAE is a gram-negative, highly encapsulated rod that is a significant pulmonary pathogen in individuals with a compromised respiratory apparatus. It is a common cause of aspiration pneumonia and pulmonary abscesses in alcoholics and patients with chronic obstructive pulmonary disease. The organism is readily grown on standard laboratory media such as blood agar or MacConkey's enteric agar.

Question 102

*LEGIONELLA PNEUMOPHILA*

Answer 102

LEGIONELLA PNEUMOPHILA is another fastidious, gram-negative, respiratory pathogen that may cause either a fulminating disease or a mild *_"walking pneumonia-like"_* condition (i.e., an atypical pneumonia). The organism can be cultured on a *charcoal yeast extract medium*, but identification is usually accomplished by *immunofluorescent examination* of the *pulmonary specimen.*

Question 103

*MYCOPLASMA PNEUMONIAE*

Answer 103

MYCOPLASMA PNEUMONIAE is the most common cause of primary atypical pneumonia. The disease is considered *_"atypical"_* because the patients have a very mild disease with low-grade fever, little in the way of constitutional signs, and a non-productive cough. These organisms are *fastidious* and are *difficult to grow in the laboratory.* *_Diagnosis is by immunofluorescent staining_* or by *_demonstration of cold hemagglutinins and strep MG agglutinins in the serum of the patient._*