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Study Guide for Microbiology Test 4/Skin Diseases

by: Mickell Harris

Study Guide for Microbiology Test 4/Skin Diseases BIOL 2300

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Mickell Harris
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Skin Infections, Respiratory Infections, Urogenital and Alimentary Infections
Hanan Lea El-Mayas (P)
Study Guide
50 ?





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This 45 page Study Guide was uploaded by Mickell Harris on Wednesday April 20, 2016. The Study Guide belongs to BIOL 2300 at Georgia State University taught by Hanan Lea El-Mayas (P) in Fall 2015. Since its upload, it has received 10 views. For similar materials see MICROBIOLOGY & PUBLIC HEALTH in Biology at Georgia State University.


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Date Created: 04/20/16
Skin Infections Multiple Choice 1.  The Rickettsial disease that killed Howard Ricketts and Stanislaus Prowazek was a. louse­borne typhus. b. tick­borne typhus. c. yellow fever. d. bubonic plague. 2.  Which of the following is considered an important function of the skin? a. hold muscle to bone b. manufacture blood cells c. produce antibodies d. control body temperature 7.  The antimicrobial aspect(s) of the skin is/are a. dryness. b. saltiness. c. acidity. d. toxicity. e. all of the above 8.  Which of the following organisms is not normally found on the skin? a. staphylococci b. diptheroids c. Candida spp. d. Malassezia spp. 9.  Diphtheroids a. are part of the normal flora of the skin. b. are responsible for body odor. c. include P. acnes. d. include Malassezia spp.. e. a, b and c 10.  Which of the following normal skin flora is a small yeast? a. staphylococci b. diphtheroids c. Candida spp. d. Malassezia spp. 11.  The growth of  P. acnes within hair follicles, in many individuals, leads to a. eczema. b. carbuncles. c. boils. d. acne. 12.  The principal species of Staphylococcus found on the skin is a. aureus. b. acnes. c. pyogenes. d. epidermidis. 13.  The bacteria that appear to maintain balance between the members of the normal flora and  play a vital role in limiting colonization by pathogens are a. staphylococci. b. diptheroids. c. Candida spp. d. Malassezia spp. 14.  Which of the following may be added to normal media to make it more selective for  staphylococci? a. 7.5% salt b. 0.5% HCl c. 1.0 % glucose d. 5.0% mannose 15.  The member of the normal flora sometimes considered responsible for tinea versicolor is  a. staphylococci. b. diptheroids. c. Candida spp. d. Malassezia spp. 16.  Which is deemed the most serious staphylococcal skin infection? a. tinea versicolor b. folliculitis c. furuncles d. carbuncles 17.  A protein associated with a more virulent form of Staphylococcus is a. leukocidin. b. mannose. c. streptokinase. d. coagulase. 18.  The protein produced by S. aureus that interferes with phagocytosis is a. protein M. b. collagen. c. protein A. d. capsular protein. 19.  The preferred habitat of S. aureus is the  a. throat. b. urethra. c. bladder. d. nasal chamber. 21.  Approximately 90% of S. aureus strains are resistant to a. methicillin. b. tetracyclin. c. polymyxin B. d. penicillin. 22.  The S. aureus product that causes scalded skin syndrome is/are a. exfoliative toxin. b. lipases. c. leukocidins. d. protein M. e. all of the above 23.  A frequent complication of scalded skin syndrome is a secondary infection caused by a. M. luteus. b. S. pyogenes. c. S. epidermidis. d. Pseudomonas spp. 24.  In addition to S. aureus, impetigo may also involve a. M. luteus. b. S. pyogenes. c. S. epidermidis. d. Pseudomonas spp. 25.  In S. pyogenes, which of the following interferes with phagocytosis? a. M protein  b. protein A c. collagen d. pilin 26.  In which of the following does a rash start on the palms and soles and progress toward the  trunk? a. epidemic typhus b. typhoid c. Lyme disease d. impetigo e. Rocky Mountain spotted fever 27.  The major vector of Rocky Mountain spotted fever in the western U.S. is a. Rickettsia rickettsi. b. Rickettsia prowazeki. c. Borrelia burgdorferi. d. Dermacentor andersoni. 28.  Rocky Mountain spotted fever is an example of a(n) a. animalosis. b. tickonosis. c. plantonosis. d. zoonosis. 29.  After being bitten by an infected tick, transfer of the rickettsial organism occurs a. immediately. b. within 5 minutes. c. within 20 minutes. d. within 4­10 hours. 30.  The causative agent of Lyme disease is a. Rickettsia rickettsi. b. Rickettsia prowazeki. c. Borrelia burgdorferi. d. Dermacentor andersoni. 31.  The unique characteristic of Lyme disease is a. erythema migrans. b. induration. c. carbuncle. d. furuncle. 32.  Which of the following is an obligate intracellular parasite? a. M. luteus b. S. pyogenes c. Rickettsia rickettsi d. Pseudomonas spp. 33.  The stage of Lyme disease that is characterized by arthritis is the a. primary. b. third. c. second. 34.  The most important vector of Lyme disease in the eastern U.S. is  a. Dermacentor virabilis. b. Dermacentor andersoni. c. Staphylococcus aureus. d. Ixodes scapularis. 35.  Which of the following pertains to Borrelia burgdorferi? a. coccus b. bacillus c. spirochete d. filament 37.  The growth stage of the vector that is mainly responsible for transmitting Lyme disease is the a. nymph stage. b. larva. c. adult. d: all of t he above e: a and c 40.  Many childhood diseases caused by viral infections of the upper respiratory tract can usually  be diagnosed by a. inspection of the rash. b. the type of cough. c. the type of fever. d. the incubation period. 41.  The varicella virus is a member of which virus family? a. paramyxo b. toga c. papilloma d. herpes 42.  Reactivation of chickenpox is called  a. shingles. b. herpes zoster. c. pneumonia. d. exanthems. e. a and b  43.  Rubella, rubeola and varicella­zoster are all only acquired via a. the gastrointestinal route. b. the respiratory route. c. wounds. d. blood transfusions. 44.  An important diagnostic sign of measles is  a. Koplik’s spots. b. giant cells. c. fever. d. swollen lymph nodes. 45.  The MMR vaccine is used to protect against a. mononucleosis, mange, rubeola. b. measles, mange, rubeola. c. mononucleosis, mumps, rubella. d. measles, mumps, rubella. 46.  The most serious consequence of rubella is a. encephalitis. b. meningitis. c. deafness. d. birth defects. 47.  Rubella is a member of which virus family? a. paramyxo virus b. herpes c. toga virus d. papovavirus 48.  Warts are caused by a. papillomavirus. b. parvovirus. c. papovavirus. d. herpes virus. True/False 51.   Diphtheroids are responsible for body odor. (True) 52.  Coagulase­positive S. aureus is often involved in disease. (true) 53.   Borrelia burgdorferi is a spirochete with a number of axial filaments. (true) 54.   Varicella is a member of the herpes family of viruses and produces a latent infection. (true) 55.  Humans are the only reservoir for varicella­zoster. (true) 56. Complications of measles may include pneumonia and encephalitis. (true) 57.   Chickenpox and measles are both acquired by the respiratory route.(true) 58.   The MMR vaccine is used to protect against measles, mumps, rubella. (true) 59.   Diseases caused by fungi are called mycoses. (true) 60. T  The skin­invading molds are collectively called termed dermatophytes. (true) Wound Infections Multiple Choice 1.  The normal habitat of Clostridium tetani is a. humans. b. animals. c. plants. d. soil and dust. 2.  Wound healing can be slowed by the presence of a. normal flora. b. antiseptic ointments. c. sweat. d. foreign matter. 3.  A wound created by a knife can be classified as a. puncture. b. incised. c. lacerated. d. contused. 4.  Factor(s) not found in abscesses is/are a.  pus. b. dead leukocytes. c.  tissue remnants. d. blood vessels. 5.  An important feature of many wounds that may lead to more serious problems is that they are a. well aerated. b. well fed. c. sterile. d. relatively anaerobic. 6.  Which of the following are involved in coating Staphylococcus with host proteins? a. clumping factor b. coagulase c. protein A d. leukocidin e. a, b and c 7.  Which of the following has been associated with the flesh­eating organism? a. H. lechter b. Pseudomonas aeruginosa c. Staphylococcus aureus d. Streptococcus pyogenes 8.  The exotoxin produced by C. tetani is a. tetanoxin. b. exotetanus. c. tetanospasmin. d. endospasmin. 9.  The disease that involves the muscles and often manifests itself first with spasms of the jaw  muscles is a. polio. b. rabies. c. tetanus. d. gastritis. 10.  Tetanus prevents the release of neurotransmitters from a. muscle cells. b. excitatory neurons. c. inhibitory neurons. d. tetano cells. 11.  The toxin implicated in C. perfringens toxicity is a. tetanospasmin. b. exoenzyme S. c. alpha­toxin.phospholipase d. endoenzyme T. 12.  Effective treatment of gas gangrene primarily involves a. use of an antitoxin. b. use of immune globulins. c. vaccination with inactivated toxin. d. surgical removal of dead and infected tissues. 13. The disease most feared to develop after an animal bite is a. tetanus. b. rabies. c. gas gangrene. d. actinomycosis. 14.  Wound infections may result in a. delayed healing. b. abscess formation. c. extension of bacteria or their products into surrounding tissues or bloodstream.  d. aerobic conditions. e. a, b and c True / False Questions The very low humidity of the desert would lead to rapid evaporation of sweat and sebum from an individual's skin. Bacteria need these secretions for a nutrient source. Without them, bacteria would be found in much lower numbers on the skin of a person in the desert than the skin of the person in the tropics. True False Diphtheroids are responsible for body odor. True False Coagulase-positive S. aureus is often involved in disease. True False Borrelia burgdorferi is a spirochete with a number of axial filaments. True False Varicella is a member of the herpes family of viruses and produces a latent infection. True False Humans are the only reservoir for varicella-zoster. True False Complications of measles may include pneumonia and encephalitis. True False Chickenpox and measles are both acquired by the respiratory route. True False The MMR vaccine is used to protect against measles, mumps, and rubella. True False Diseases caused by fungi are called mycoses. True False The skin-invading molds are collectively called dermatophytes. True False When Lyme disease was first being investigated, the observation that frequently only 1 person in a household was infected was a clue leading to the discovery that the disease was spread by arthropod bites. Why was this so? If the infection is spread by the bite of an arthropod, it wouldn't spread easily by respiratory secretions, direct contact, or sexual contact between individuals within the family. Mosquitoes (an example of arthropods) are never inside a house. They are strictly outdoor animals, so they couldn't spread the infection inside the household Mosquitoes (an example of arthropods) only bite once in their life cycle. As such, they can only transmit the illness once before they die. Even if an infected mosquito was inside a house, it could therefore only infect one human. True -False If the infection is spread by the bite of an arthropod, it wouldn't spread easily by respiratory secretions, direct contact, or sexual contact between individuals within the family. True False Arthropods lose their mechanical ability to bite a human after a single bite, much like certain bees that lose their stinger after a single sting. This prevents them from transmitting the infection to more than one individual in a household. True False 3- What is the epidemiological significance of shingles? It shows that, as a latent viral infection, there is always a possible reservoir available to reinfect new susceptible individuals AND it shows that our fight for long-term eradication of varicella zoster virus will be a very long fight, depending on immunizing all newly-born individuals until all the people that had ever contracted the illness have died. It shows that, as a latent viral infection, there is always a possible reservoir available to reinfect new susceptible individuals. True False It shows that we must always be vigilant against this deadly and highly infectious secondary infection in elderly and immunocompromised individuals True False It shows that, as a chronic viral infection, individuals infected are always infectious to others around them, even when they do not show outward symptoms. True Talse It shows that our fight for long-term eradication of varicella zoster virus will be a very long fight, depending on immunizing all newly-born individuals until all the people that had ever contracted the illness have died T true False It shows that, as a latent viral infection, there is always a possible reservoir available to reinfect new susceptible individuals AND it shows that our fight for long-term eradication of varicella zoster virus will be a very long fight, depending on immunizing all newly-born individuals until all the people that had ever contracted the illness have died. True Fase Respiratory System Infections Adenoviral pharyngitis is effectively treated with A. antibiotics. B. lysozyme. C. proteases. D. nucleotide analogs. E. None of the choices is correct. . 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 . 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. pneumonia. . The characteristic virulence factor of S. pneumoniae is A. a capsule. B. flagella. C. pili. D. cilia. . Both S. pneumoniae and K. pneumoniae use this as a virulence factor. A. pili B. flagella C. capsules D. cilia . The causative agent of the pneumonia that causes 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. . The virulence of Klebsiella is due partly to the A. motility of the organism. B. exotoxin produced. C. engorgement of blood vessels. D. antiphagocytic properties of their capsules. E. exotoxin produced AND antiphagocytic properties of their capsules. . The resistance of Klebsiella to antibiotics may be A. chromosomal mediated. B. plasmid mediated. C. lysosomal mediated. D. capsule mediated. E. chromosomal mediated AND plasmid mediated. . Mycoplasmal and klebsiellal 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. . The spread of mycoplasma is through A. inhalation of infected droplets. B. the fecal-oral route. C. an insect vector. D. a fomite. . Which antibiotics may be completely ineffective in treating a mycoplasmal infection? A. penicillin B. cephalosporin C. tetracycline D. erythromycin E. penicillin AND cephalosporin . The sudden, violent, uncontrollable cough of pertussis is described as A. productive. B. contagious. C. infective. D. paroxysmal. . The causative agent of whooping cough is A. parvovirus. B. M. pneumoniae. C. B. pertussis. D. S. aureus. . Pertussis toxin A. uses part B to attach to receptors on the host cell. B. uses part A to inactivate G protein. C. affects the level of cAMP in a cell. D. affects the level of mucus secretion. E. All of the choices are correct. . Although unusually resistant to many control factors, the tubercle bacillus is easily killed by A. strong acids. B. disinfectants. C. pasteurization. D. strong alkalis. . The resistance of the tubercle bacillus to various factors is probably due to its A. capsule. B. larger ribosomes. C. ability to adhere tightly. D. cell wall. . 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. . The destructive nature of tuberculosis can be characterized as a(n) A. endotoxin pyrogenic response. B. immune complex reaction. C. inflammatory response. D. delayed hypersensitivity reaction. . Influenza is caused by A. orthomyxovirus. B. H. influenza. C. cytomegalovirus. D. adenovirus. . 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. . 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. . True / False Questions Otitis media is an infection of the middle ear that is rare in the first month of life. True False Humans are the only source of the cold virus. True False Rhinoviruses are effectively treated with antibiotics. True False Of infectious diseases, pneumonia is a major killer in the general population. True False A vaccine is available for protection from pneumococcal pneumonia. True False Klebsiella easily acquire and are a source of R factors. True False Pneumonias are inflammatory diseases of the lung in which fluid fills the alveoli. True False Mycoplasma is effectively treated with cell wall inhibiting antibiotics. True False Pneumonias are inflammatory diseases of the lung in which fluid fills the alveoli. True False Mycoplasma is effectively treated with cell wall inhibiting antibiotics. True False . What is the most likely reason why smokers are more at risk for respiratory system infections? Cigarette smoke is carcinogenic (cancer-causing), leading to a much higher incidence of lung cancer. True False They aren't-this is just a rumor used to get people to stop smoking True False. Chemicals in cigarette smoke can impair the mucociliary escalator, preventing natural cleansing of the respiratory tract. True False Smokers take in microbes from their hands into their lungs as they handle cigarettes and inhale the smoke. True False. Why would it be reasonable to treat strep throat with antibacterial antibiotics, but not diphtheria? The illness in diphtheria is largely from the exotoxin produced. An antibiotic won't clear out the exotoxin. True False The illness in strep throat is largely from the exotoxin produced. An antibiotic effectively eliminates exotoxins True False. The causative agent of diphtheria is a virus, not a bacterium. The drug would have no effect. True False There are no antibiotics that have proven effective against the bacterium that causes diphtheria True False The best way to speed up recovery from a common cold is to dose the patient with ibuprofen to keep the fever down. True False to take decongestants as a means of alleviating the symptoms of the cold True False to take 1,000 mg of vitamin C every day during the illness. True False None of the above-in fact, the only way to clear out a cold is to let your immune system do its job. Several of the treatments above may actually INCREASE the time needed to get over the illness. True False 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? Pneumococcal pneumonia-it doesn't destroy lung tissue and can be completely recovered from. True Flase Klebsiella pneumonia-it has the shortest recovery time. True False Mycoplasmal pneumonia-it has the mildest symptoms and is generally easily cleared out True False Viral pneumonia-there are many antiviral medications you can take for this version with very few side effects. True False Why are pneumococcal pneumonia infections so dangerous in nursing homes? There is no vaccine available for protection. True False There is no longer an antibiotic effective against the infection. True False This type of pneumonia causes permanent lung damage, and old people often have impaired lung function in the first place. True False While this type of pneumonia does NOT cause permanent lung damage, the immune system of older people is usually impaired, leaving them predisposed to more serious and potentially life-threatening pneumonia infections. True False People infected with M. tuberculosis are always highly infectious to everyone around them-true or false, and why? they are constantly shedding bacteria to the environment around them in high numbers, facilitating transmission. True False -while in the early stages of the illness, their tissues are not irritated and damaged to induce the cough required to spread the organism in respiratory droplets very easily. True False as the mode of transmission is direct contact, anyone or anything they touchcan be infected. True False since TB requires 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. True False Which is more likely to happen-antigenic DRIFT, or antigenic SHIFT- and why? True False Antigenic SHIFT-since infection with only a single virus is required, and the random mutations happen as the virus replicates in the infected person's cells. True False Antigenic DRIFT-since random mutations occur more readily when only 1 virus is infecting a cell at a given time. True FalsE Antigenic SHIFT-since multiple viruses in a cell at once means more RNA polymerase to copy the RNA, and therefore more possibilities for much larger mistakes to be made in the copying (leading to mutations). True False Which is more dangerous to human beings-antigenic DRIFT or antigenic SHIFT-and why? Antigenic DRIFT-since this produces the quickest and largest degree of changes in the virus structure. True False Antigenic SHIFT-since this produces the quickest and largest degree of changes in the virus structure. True False 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. This lets the virus hide from the immune responses needed to clear it out for a longer period of time. True False _Antigenic SHIFT-the process completely changes the virus, 100%, allowing it to jump into different species (i.e. from birds into humans). As such, we have no responses in place for the new virus. True False True/False  Streptococci are grouped by their cell wall carbohydrates. (True) Otitis media is an infection of the middle ear that is rare in the first month of life. (True)  Humans are the only source of the cold virus. (True) Rhinoviruses are effectively treated with antibiotics. (False) Of infectious diseases, pneumonia is a major killer in the general population. (True) A vaccine is available for protection from pneumococcal pneumonia. (True) Pneumonias are inflammatory diseases of the lung in which fluid fills the alveoli. (True) Mycoplasma is effectively treated with cell wall inhibiting antibiotics. (False) Case studies 1­ three year old developed a series of blister like lesions around her nose and  mouth. The lesions remained localized to the area and began to scab over the  next couple of days. However the parents grew concerned when the second child developed the same kind of lesions Impetigo Numerous gram positive cocci in chain and numerous pus cells Culture shows large number of group A  beta hemolytic streptococci and a few Staph  aureus What is the most likely diagnosis of the disease ? A­ Tinea versicolor B­ Scalded skin syndrome C­ Impetigo D­ Furuncles E­ Carbuncles 2­ A 2­year­old girl is admitted to the hospital with massive tissue destruction along her  right arm. The skin is a violet color and large fluid­filled blisters are present. The  patient has a fever, a rapid heart rate, low blood pressure, and seems confused.  Her mother informs the physician that the child had been recovering from  chickenpox, and, for the past two days, had frequently been scratching at  chickenpox lesions on that area of her arm. Once the area appeared to have  become infected, the infection spread very rapidly. A Gram­stain of exudate from  the infected tissue reveals Gram­positive cocci in chains. The physician suspects that her infection is being caused by _______________. a. Clostridium perfringens b. Clostridium tetani c. Staphylococcus aureus d. Streptococcus pneumoniae e. Streptococcus pyogenes (Group A strep) 3­ An 80­year­old female is transferred from a nursing home to the hospital because she is suspected of having pneumonia. She is experiencing chest pain, chills, fever, and  shortness of breath. She has a productive cough (meaning that she is coughing up  sputum). A Gram­stain of the sputum reveals numerous white blood cells and numerous  Gram­positive diplococci. Upon receipt of the Gram­stain report, the physician treats the  patient for a pneumonia caused by _______________. a. Haemophilus influenzae b. Staphylococcus aureus c. Streptococcus agalactiae (Group B strep) d. Streptococcus pneumoniae e. Streptococcus pyogenes (Group A strep) 4­ ­ Over a period of three weeks, a total of five newborns in the hospital nursery  developed staphylococcal infections with S.aureus bacterimia . The isolates had the  same colony morphology and hemolytic properties and identical antimicrobial  susceptibility patterns, suggesting that they were the same. Later molecular methods  showed the isolates were identical. Which of the following hould be done now? A­ Prophylactic treatments of all newborns with intravenous Vancomycin B­ Protective isolation of all new born C­ Closing the nursery and referring pregnant women to another hospital D­ Hiring new staff for the hospital nursery  E­ Culture using mannitol salt agar of the anterior nostrils of the physicians nurses  and others who cared for the infected babies 5­ ­  An 8­year old boy falls while playing and abrades the skin over his thigh and  rib. The injury does not appear serious and no effort is made to clean the wound or apply antibiotic creams.The wound of the hip worsens after 3 days with  inflammation and small amount of purulence. That evening the child develop a high fever ,40 C (105 F), headache and a diffuse rash. By the time the child arrives to  the hospital he is hypotensivecomplains of severe myagias, and has diarrhea. After one more day his skin desquamats (including his palms and soles) and he  develops renal and hepatic abnormalities.  Which toxin is most likely responsible for his illness A­ Alpha toxin B­ Enterotoxin A C­ Exfoliatin toxin D­ Leukocidin E­ Toxic shock syndrome toxin­1 6­ A sputum gram stain of an elderly person with cough and fever shows gram positive  cocci in pairs. What is the most likely organism? A Haemophilus influenzae B Streptococcus pyogenes C Enterobacter species D Streptococcus pneumonia 7­ Over the course of 1 week, a 6­year­old boy develops 0.5­ to 1.0­cm pustules on his  face. During the next 2 days, some of the pustules break, forming shallow erosions  covered by a dry golden­colored crust. New lesions then form around the crust. The  boy's 40­yearold uncle develops similar lesions after visiting for 1 week during the child's illness. The photograph shows a particularly severe case of impetigo bullosa. It is  highly contagious and frequently seen in otherwise healthy children and  occasionally in adults who are in poor health. The blood agar plate shows  colonied with beta hemolysis typical of Staphylococcus aureus. The  organism is catalase and coagulase positive. A positive coagulase test is  shown. Most organisms that cause imptetigo are antiobiotic sensitive. The  technique for perfoming antiobiotic sensitivity is illustrated. Examples of  antiobiotic sensitive and methicillin resistant Staph aureus are shown. 2a­ What is the MOST LIKELY diagnosis          Impetigo 2bThe Gram stain from a skin pustule showed gram positive cocci in clusters. The  organism grew on sheep blood agar (SBA) and was catalase positive. What is the most  likely microorganism? A. Staphylococcus aureus B. Staphylococcus epidermidis C. Streptococcus pyogenes D. Streptococcus pneumoniae 8­ A 25­year­old man is involved in an accident in which he is ejected from the vehicle.  He sustains a compound fracture of the left humerus and undergoes open reduction with internal fixation of the humeral fracture.  Several days later, he has marked swelling of  the left arm and crepitus Crackling, bubbling sound) On the arms, there is marked swelling and tissue destruction with black  discoloration. Boxcar shaped gram positive rods are seen in the  gangrenous tissue. The organism requires anaerobic culture conditions  and egg yolk agar for growth What is the most likely organism Fusobacterium nucleatum (a fungus) Bacteroides fragilis Clostridium perfringens Peptostreptococcus spp 9­A 4­year­old female had a gradual onset of fever, productive cough, anorexia and  diarrhea about eleven days prior to death. The breath sounds were harsh, and a few  cracking rales were heard over the right base posteriorly. Sputum smear showed acid fast bacilli. Sputum cultures results became available four weeks after death, showing the presence of slow­growing  colonies. The lungs showed fibrinous exudates over the pleural surfaces.  The cut surface of the lung revealed innumerable small, gray­white  nodules 1­4 mm in size. A large caseous tubercle of 0.5 cm was present  in the left lower lobe, eroding into a large pulmonary vessel. A lower power examination reveals numerous poorly defined tubercles  approximately of the same size and same stage of development. These  tubercles show a slight caseous necrosis and consist predominantly of  mononuclear cells, epithelioid cells, and a few giant cells. In alveoli there is a moderate amount of mononuclear cell infiltration. Some lymphocyte and  plasma cell infiltration is diffusely present in the alveolar septa.. Based on these clinical findings, what is the likely causative agent? Mycobacterium Tuberculosis 10­ A 45­year­old male became ill approximately 2 to 3 weeks ago following an alcoholic spree. He had nausea, vomiting, dehydration, confusion and high fever. He died  suddenly shortly after admission Gram stain of sputum obtained before death shows Gram positive cocci  in pairs. The right lung was heavy weighing 700 grams. Its lower lobe  showed diffuse gray consolidation. The trachea and bronchi contained a  great deal of mucus, and the mucosa was dark red. The alveoli are distended and contain a large amount of inflammatory  exudate, which consists of many polymorphonuclear leukocytes, a few  RBC's, macrophages and strands of fibrin. Many RBC's have been  phagocytosed by the macrophages and are undergoing disintegration. The alveolar septa are delicate and well preserved, but markedly congested. What is the MOST LIKELY diagnosis AND the likely causative agent? Lobar Pneumonia caused by Streptococcus pneumoniae 11­ A 66­year­old man incurs extensive thermal burns to his skin and undergoes skin  grafting procedures in the surgical intensive care unit.  Two weeks later, he has  increasing respiratory distress.  Laboratory studies show hemoglobin of 13.1 g/dL,  hematocrit 39.2%, platelet count 222,200/mm , and WBC count 4520/mm  with 15%  monocytes A chest radiograph shows extensive bilateral infiltrates with patchy areas of  consolidation There is a thick purulent exudate on the skin surface. Cultures of the  wound on MacConkey and sheep blood agar (SBA) showed aerobic,  lactose­negative, Gram­negative bacterium.  MacConkey (shows growth of gram negative bacteria and if colonies are colored pink, it shows bacteria is positive for  lactose  fermentation) Based on these clinical findings, what is the likely causative agent? Pseudomona Aeruginosa 12­ A suspicious envelope arrived for sorting at rural post office. The envelope was  opened and found to contain white powder. Approximately two days later, the postal  worker who handled the letter developed cutaneous boils, which were and 1 to 5 cm in  diameter with central necrosis and eschars. He and his wife also developed a mild  nonproductive cough with fatigue, myalgia for 72 hours, followed by severe dyspnea,  diaphoresis and cyanosis.  Temperature of 39.5°C, pulse 105/min, respiration 25/min,  and blood pressure 85/45mm Hg.  Crackles were heard at the lung bases. A chest xray  shows a widened mediastinum and small pleural effusions. WBC count of 13,130/mm ,  3 hemoglobin 13.7g/dL, hematocrit 41.2%, MCV 91 um , and platelet count 244,000/mm .  3 Both died despite antibiotic therapy. Several cattle, horses, and sheep on the postal  worker's farm also died A­ Bacillus anthracis B­ Herpes simplex virus C­ Mycobacterium leprae D­ Staphylococcus aureus E­ Yersinia pestis Honor Students  only must also answer case studies  from Go to student edition and select case studies 1 to 6. Alimentary System Infections Multiple choice 1.  The passage from the mouth to the anus is termed the a. gut canal. b. oral cavity. c. grand canal. d. alimentary canal. 2.  Collections of bacteria that adhere to the surfaces of the teeth are called a. dental caries. b. dental plaque. c. halitosis. d. periodontal disease. 3.  The most common infectious disease of humans is  a. the common cold. b. dental caries. c. hepatitis A. d. halitosis 4.  The principal cause of dental caries is a. S. mutans. b. S. salivarius. c. S. mitis. d. S. sanguis. 5.  Part of the ability of S. mutans to produce dental caries depends on its ability to a. invade plaque and dissolve the gums. b. convert sucrose to lactic acid. c. convert proteins to sugars. d. attach to the gums. 6.  This mineral, typically added to drinking water, makes enamel more resistant to dissolving in  acid. a. calcium b. chlorine c. chloramine d. fluoride 7.  The chronic inflammatory process involving the gums and tissues around the teeth is called a. dental caries. b. periodontal disease. c. dental plaque. d. root caries. 8.  H. pylori is, in part, able to survive in the stomach by its ability to produce a. lactic acid from sugar. b. fatty acids from sebum. c. neutralizing proteins from glucans. d. ammonia from urea. 9.  H. pylori appears to have some connection with a. acid reflux disease. b. ulcers. c. dental caries. d. stomach cancer. e. b and d 10.  Where in the body does the latent, non­infectious non­replicating, form of the herpes simplex  virus persist? a. motor neurons b. red blood cells c. cranial nerves d. sensory nerves 11.  A painful finger infection attributable to herpes virus is known as a(n) a. finger sore. b. abrasion lesion. c. furuncle. d. herpetic whitlow. 12.  Which of the following has shown some effectiveness in treating a herpes infection? a. AZT b. protease inhibitors c. acyclovir d. cephalosporin 13.  The viral disease that characteristically infects the parotid glands is a. measles. b. herpes. c. chickenpox. d. mumps. 15.  Almost all bacterial intestinal infections may be attributed to a. Vibrio spp. b. C. jejuni. c. Salmonella spp. d. enterobacteria. e. all of the above 16.  The initial attachment required for establishment of a bacterial intestinal infection is by a. flagella. b. cilia. c. pseudopodia. d. pili. 17.  The toxins involved in intestinal infections typically a. kill cells by inhibiting protein synthesis. b. modify cell physiology resulting in increased secretion of water and electrolytes. c. modify cell physiology resulting in decreased secretion of water and electrolytes. d. kill cells by inhibiting DNA synthesis. e. a and b 18.  Cholera is the classic example of a(n) a. food­borne illness. b. zoonosis. c. opportunist. d. very severe form of diarrhea. 19.  The diarrhea of cholera has been described as a. a viscous fluid. b. small in volume. c. somewhat watery. d. a rice water stool. 20.  The symptoms of cholera are due to the action of a. an endotoxin. b. modified mucus. c. flagella. d. an exotoxin. 21.  A common source of cholera infection is a. acid rain. b. unpasteurized milk. c. fecal contaminated material, especially water. d. boiled water. e. a and d 22.  The primary treatment for cholera is a. the administration of antibiotics. b. vaccination. c. by blood transfusion. d. simply rehydration. e. b and c 23.  Shigella and cholera toxin both a. have an A­B arrangement. b. work through ADP ribosylation. c. increase cAMP levels. d. prevent protein synthesis. 24.  Shigella a. are themselves nonmotile. b. may be pushed from cell to cell by actin tails. c. utilize pili to move. d. utilize flagella to move. e. a and b 25.  Which of the following groups contain diarrhea­causing E. coli? a. enterotoxigenic   b. enteroinvasive c. enteropathogenic d. enterohemorrhagic e. all of the above 26.  Which of the following groups give rise to a disease similar to that caused by Shigella sp.? a. enterotoxigenic   b. enteroinvasive c. enteropathogenic d. enterohemorrhagic e. all of the above 27.  Which group produces a toxin somewhat similar to that produced by Shigella dysenteriae? a. enterotoxigenic   b. enteroinvasive c. enteropathogenic d. enterohemorrhagic e. all of the above 28.  V. cholera and most salmonellas are a. killed by acid conditions. b. stimulated by acid conditions. c. killed by low concentrations of salt. d. killed by neutral conditions. 29.  Most cases of Salmonella gastroenteritis have a(n)  a. water source. b. human source. c. plant source. d. animal source. 30.  The food products most commonly contaminated with Salmonella strains are a. meat and seafood. b. milk and cheese. c. fruit and vegetables. d. eggs and poultry. 31.  The animal(s) often associated with Salmonella strains is/are a. turtles. b. iguanas. c. baby chickens. d. ducks. e. all of the above 32.  In which of these organs does a carrier of typhoid bacilli maintain the bacteria? a. liver b. gallbladder c. Peyer’s patches d. colon e. a and c 33.  The most notorious typhoid carrier was a. Typhoid Tilly. b. Typhoid Tom. c. Typhoid Mary. d. Typhoid Mark. 34.  Which of these bacteria require a special medium and microaerophilic conditions? a. E. coli b. Pseudomonas c. S. aureus d. C. jejuni 35.  A mysterious sequel to C. jejuni infections is a. Reye’s syndrome. b. Tourette’s syndrome. c. Pasteur’s syndrome. d. Guillian­Barré syndrome. 36. The animal(s) most often associated with C. jejuni is/are a. turtles. b. iguanas. c. chickens. d. ducks. e. all of the above 37.  Viral gastroenteritis in infants and children is most commonly caused by a. herpes. b. hepatitis b. c. Norwalk virus. d. rotavirus. 38.  Viral gastroenteritis in children and adults is most commonly caused by a. herpes. b. hepatitis B. c. Norwalk virus. d. rotavirus. 39. Hepatitis A spreads via  a. the respiratory route. b. blood transfusion. c. body fluids. d. the fecal­oral route. 40.  HBV is mainly spread by a. blood. b. blood products. c. semen. d. saliva. e. a, b and c True/False  The bacteria primarily responsible for dental caries is Streptococcus mutans. (True)   Sucrose is one of the major contributors to the development of dental caries. (True)  H. pylori appears connected to stomach cancer and ulcers. (True)    The saliva of asymptomatic carriers of herpes simplex is commonly infectious. (True)    The infectious dose of cholera is much larger than that for Shigella. (True) Case Studies                                                                                                                                  . A three year old developed a series of blister like lesions around her nose and mouth. The  lesions remained localized to the area and began to scab over the next couple of days. However  the parents grew concerned when the second child developed the same kind of lesions Numerous gram positive cocci in chain and numerous pus cells Culture shows large number of group A  beta hemolytic streptococci and a few Staph aureus What is the most likely diagnosis of the disease ? . Your patient has a subacute bacterial endocarditis caused by the a number of the viridans group of Streptococci. Which one of the following sites is MOST likely to be the source of the organism  A­ Skin B­ Colon C­ Oropharynx D­ Urethra . A 19­year­old female visits the clinic complaining of a frequent, urgent desire to urinate, a burning sensation during urination, and pain above her pubic bone. The physician suspects  cystitis and arranges for the patient to collect a clean­catch, mid­stream urine specimen. The  urine is cloudy and tinged with blood. In the laboratory, a colony count confirms that the patient  does have a urinary tract infection. The pathogen causing the infection is producing pink colonies  on MacConkey agar. Which one of the following pathogens do you suspect is causing this  patient’s cystitis? a. Chlamydia trachomatis b. Escherichia coli c. Neisseria gonorrhoeae d. Proteus mirabilis e. Staphylococcus saprophyticus . A 2­year­old girl is admitted to the hospital with massive tissue destruction along her right arm. The skin is a violet color and large fluid­filled blisters are present. The patient has a fever, a  rapid heart rate, low blood pressure, and seems confused. Her mother informs the physician that  the child had been recovering from chickenpox, and, for the past two days, had frequently been  scratching at chickenpox lesions on that area of her arm. Once the area appeared to have  become infected, the infection spread very rapidly. A Gram­stain of exudate from the infected  tissue reveals Gram­positive cocci in chains. The physician suspects that her infection is being  caused by _______________. a. Clostridium perfringens b. Clostridium tetani c. Staphylococcus aureus d. Streptococcus pneumoniae e. Streptococcus pyogenes (Group A strep) 3. A 16­year­old female is admitted to the hospital with severe abdominal cramps and  bloody diarrhea. She has a fever of 102 F. She has been experiencing her symptoms for the past three days, since several hours after eating at a fast food restaurant with a group of her friends.  She recalls that the hamburger she ate was not very well cooked. (It is later learned that the meat being used in that restaurant to prepare hamburgers has been recalled due to bacterial  contamination.) All of the following organisms can cause diarrhea, but which is the most likely  cause of her illness? a. A species of Salmonella b.  A species of Shigella c. Escherichia coli O157:H7 d. Staphylococcus aureus e. Vibrio cholerae 4. A 20­year­old male is admitted to the hospital with fever, headache, stiff neck, sore  throat, and vomiting. The attending physician suspects that the patient has meningitis and  immediately performs a lumbar puncture. A cerebrospinal fluid (CSF) specimen is rushed to the  laboratory, where it is processed immediately. After centrifuging an aliquot of the specimen, the  sediment is spread onto a microscope slide, fixed, and Gram­stained. Microscopic examination of the Gram­stained specimen reveals numerous white blood cells and numerous Gram­negative  diplococci. This information is telephoned to the attending physician, who will now treat the  patient for a meningitis caused by _______________. a. Haemophilus influenzae b. Neisseria meningitidis c. Streptococcus agalactiae (Group B strep) d. Streptococcus pneumoniae e. Streptococcus pyogenes (Group A strep) 5. An 80­year­old female is transferred from a nursing home to the hospital because she is  suspected of having pneumonia. She is experiencing chest pain, chills, fever, and shortness of  breath. She has a productive cough (meaning that she is coughing up sputum). A Gram­stain of  the sputum reveals numerous white blood cells and numerous Gram­positive diplococci. Upon  receipt of the Gram­stain report, the physician treats the patient for a pneumonia caused by  _______________. a. Haemophilus influenzae b. Staphylococcus aureus c. Streptococcus agalactiae (Group B strep) d. Streptococcus pneumoniae e. Streptococcus pyogenes (Group A strep) 6­ A three year old developed a series of blister like lesions around her nose and mouth. The  lesions remained localized to the area and began to scab over the next couple of days. However  the parents grew concerned when the second child developed the same kind of lesions Numerous gram positive cocci in chain and numerous pus cells Culture shows large number of group A  beta hemolytic streptococci and a few Staph aureus What is the most likely diagnosis of the disease ? Skin 7­ Over a period of threeweeks, atotal of five newbornsin the hospital nursery developed  staphylococcal infections with S.aureus bacterimia . The isolates hd the same colony morphology and hemolytic properties and identical antimicrobial susceptibility patterns, suggesting that they  were the same. Later molecular methods showed the isolates were identical. Which of the  following hould be done now? F­ Prophylactic treatments of all newborns with intravenous Vancomycin G­ Protective isolation of all new born H­ Closing the nursery and referring pregnant women to another hospital I­ Hiring new staff for the hospital nursery  J­ Culture using mannitol salt agar of the anterior nostrils of the physicians nurses and  others who cared for the infected babies 8­A seven –year old girl sees her pediatrician for a cutaneous pustule on her armat the site where her kitten had scrachedher 1 week prior to the appointment, Her mother has also noticed an  enlargementof the right axillary lymph nodes.. The girl has low grade fever and complains that  she is tired. The pediatricians collects cultures of the pustule, lymph nodes and blood.But all the  results are negative after 1 week. Which organisms is most likely for this infection A­ Bartonella Hanselae B­ Klebsiella granulomatis C­ Pasteurella multicoda D­ Escherichia E­ fusobacterium 9 An 8­year old boy falls while playing and abrades the skin over his thigh and rib. The injury  does not appear serious and no effort is made to clean the wound or apply antibiotic creams.The  wound of the hip worsens after 3 days with inflammation and small amount of purulence. That  evening the child develop a high fever ,40 C (105 F), headache and a diffuse rash. By the time  the child arrives to the hospital he is hypotensivecomplains of severe myagias, and has diarrhea.  After one more day his skin desquamats (including his palms and soles) and he develops renal  and hepatic abnormalities.  Which toxin is most likely responsible for his illness F­ Alpha toxin G­ Enterotoxin A H­ Exfoliatin toxin I­ Leukocidin J­ Toxic shock syndrome toxin­1 Complaint A 42­year­old woman complains of diarrhea, abdominal pain and fever for the past 72 hours. She  describes her stools as liquid consistency and voluminous. She denies melena or hematochezia  and says her symptoms came on rapidly 3 days ago. Her symptoms have been getting steadily  worse. The woman denies any recent sick contacts. History The patient recently finished a 2­week course of ampicillin for a bout of sinusitis. Her sinus  symptoms have resolved. The patient's past medical history is otherwise unremarkable, and she  denies any weight loss or recent travel history. She has no past history of gastrointestinal  problems other than those related to her current complaints. She does not drink alcohol, smoke,  or use illicit drugs and is not sexually active. Family history is remarkable only for heart disease. Physical Exam The patient has a fever and appears acutely ill. Abdominal exam reveals mild, diffuse tenderness, with no signs of peritonitis. Rectal exam reveals watery stool that tests negative for occult blood.  No skin rashes are appreciated. Tests Leukocyte count: 16,400/μL (normal 4500­11,000/μL) Liver function tests: normal Stool analysis: no pathogenic bacteria, ova, or protozoa detected; no white blood cells seen;  positive for exotoxin Sigmoidoscopy: yellowish­white plaques scattered over the colonic mucosa Questions  Which organism is likely responsible for this patient's diarrhea, given the recent history of  antibiotic use and clinical and laboratory findings? What is the name of this woman's  clinical condition, which is confirmed by the sigmoidoscopy findings?  Clostridium Difficile Diarrhea  How does this organism cause diarrhea?                Complication of Ampicillin Use Complaint A 41­year­old woman complains of nausea and vomiting. She also reports that her eyes have  "turned yellow," her abdomen is sore, and her urine has turned dark. The patient first felt ill 3 to 4  days ago. She mentions that she went to a seafood restaurant 3 weeks ago. Apparently, all her  dinner partners from that night also are experiencing fatigue and nausea and vomiting History The woman is usually healthy. She takes no regular medications; is monogamous; and does not  smoke, drink alcohol, or use illicit drugs. Physical Exam A low­grade fever is present, and the patient is jaundiced. Abdominal exam reveals right upper  quadrant tenderness and mild hepatomegaly. Tests Hemoglobin: 14 g/dL (normal 12­16 g/dL) Alanine aminotransferase (ALT): 100 IU/L (normal 1­21 IU/L) Aspartate aminotransferase (AST): 98 IU/L (normal 7­27 IU/L) Bilirubin, total: 3.2 mg/dL (normal 0.1­1.0 mg/dL) Bilirubin, direct: 1.6 mg/dL (normal 0.1­0.4 IU/L) Alkaline phosphatase: 42 IU/L (normal 13­39 IU/L) Urinalysis: elevated urobilinogen; negative for glucose, protein, and bacteria Hepatitis A IgM: positive Hepatitis B panel: negative Hepatitis C IgM antibody: negative Hepatitis D IgM antibody: negative Questions  Given her history and lifestyle, how many of the four hepatitis viruses listed would the  woman be unlikely to contract?   What is the route of spread of hepatitis A? Is there a chronic carrier state for this virus?  Critical Thinking                                                                                                                            1. You are with some friends in a crowded movie theater during the middle of the flu season.  Some of the people seated around you are coughing and sneezing. Some of your friends develop influenza as a result of their movie­going experience. But, you don’t! Cite some reasons why you  were one of the fortunate movie­goers. 2. A group of your friends is discussing some recent meat recalls that involved E. coli  O157:H7. They say that, in the future, they are going to avoid hamburgers in fast food  establishments and eat salads only. Explain to them why this will not necessarily protect them  from E. coli O157:H7 food poisoning. 3. One of your friends is complaining about her sore throat. You suggest that she get  checked for strep throat. She is reluctant. Step up your advice by listing as many complications of streptococcal infections as possible. 4. A friend of yours has read that there is a connection between HIV infection and  immunosuppression. However, she doesn’t have a clue as to how the two events are connected.  Explain to her the mechanism by which HIV­infected individuals become immunosuppressed, and why AIDS patients die of overwhelming infections due to a variety of different types of pathogens. Genitourinary Infections Multiple Choice 1.  The urinary tract above the bladder usually shows  a. E. coli. b. S. aureus. c. P. vulgaris. d. no bacteria. e. a and b 2.  The normal flora of the lower urethra may show  a. Lactobacillus. b. Staphylococcus. c. Corynebacterium. d. Bacteroides. e. all of the above Answer: e 3.  The normal flora of the genital tract of women is  a. affected by estrogen levels. b. dependent on the activity of Lactobacillus. c.  unchanging. d. typically composed of E. coli.  e. a and b 6.  Pregnant women with bacterial vaginosis are at risk of a. placental insufficiency. b. being unable to nurse. c. being unable to deliver vaginally. d. having a premature baby. Answer: d 7.  The genital tract infection characterized by an unpleasant odor and an increase in clue cells is a. trichomoniasis. b. candidiasis. c. amoebiasis. d. bacterial vaginosis. 8.  Among the major causes of vulvovaginal candidiasis is/are a. sexual promiscuity. b. intense antibacterial treatment. c. disruption of normal flora. d. the use of oral contraceptives. e. b, c and d 9.  Staphylococcus aureus is the causative agent of a. bacterial vaginosis. b. puerperal fever. c. toxic shock syndrome. d. gas gangrene. e. a and b 12.  Gonococci are parasites of   a. cows. b. iguanas. c. sheep. d. humans. e. a and c 3.  Gonococci selectively attach to certain epithelial cells by a. pili. b. flagella. c. cilia. d. actin bridges. e. b and c Answer: a 14.  Untreated gonorrhea in males may lead to a. sterility. b. urinary tract infections. c. prostatic abscesses. d. orchitis. e. all of the above 15.  A frequent complication of untreated gonorrhea in women is a. pelvic inflammatory disease. b. syphilis. c. dysuria. d. vaginal discharge. 16.  The treatment of neonates with drops of erythromycin directly into the eyes is to p


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