MICROBIOLOGY AND PARASITOLOGY QUESTIONS. 11.

Which one of the following is considered facultatively intracellular for

1. A newborn presents with lethargy, purpura, chorioretinitis and pulmonary human macrophages?
infiltrates. Which of the following could be a cause of this syndrome? A) Enteroinvasive Escherichia coli
(A) Amebiasis B) Enterotoxigenic Escherichia coli
(B) Candidiasis C) Salmonella typhi
(C) Cytomegalovirus D) Shigella sp.
(D) Human papillomavirus ANS: C, Salmonella typhi
ANS: C
12.. A 20-year-old female presents with severe pelvic pain, fever, nausea
2. Which one of the following is a subcellular structure that is found only in Gram and vomiting. She was on the second day of her menstrual cycle. A
negative bacteria? purulent cervical discharge was detected upon physical examination.
(A) endospores Oxidase positive, Gram-negative diplococci were isolated on Thayer
(B) lipopolysaccharide Martin agar from the endocervical swab. What is the MOST LIKELY
(C) mitochondria identity of this organism?
(D) phosphatidylethanolamine A) Bordetella pertussis
ANS: B (Micro) B) Chlamydia trachomatis
C) Haemophilus ducreyi
3. Which one of the following statements best describes a function of the D) Neisseria gonorrhoeae
peptidoglycan layer in bacteria? ANS: D, Neisseria gonorrhoeae
(A) The ability of bacteria to survive changes in the osmolarity of their environment
is due to the physical properties of the peptidoglycan layer. 13. A large outbreak of food poisoning occurred at a company picnic. Eighty
(B) The peptidoglycan layer contains all the enzymes responsible for the synthesis people reported explosive vomiting and diarrhea within 3 hours after
of membrane phospholipids. eating. All of the victims recovered within 24 hours without medical
(C) The peptidoglycan layer protects bacteria from the effects of ultraviolet light. intervention. No known bacterial or viral pathogens were isolated from
(D) The peptidolgycan layer renders Gram negative bacteria resistant to detergents. the stool of affected individuals. A survey of the food eaten at the picnic
suggested that potato salad was the common source of the poisoning.
NS: A (Micro) The individual who prepared the salad had a sty on her left eye. Which
one of the following is the MOST LIKELY cause of this outbreak?
4. Which one of the following structures is responsible for the passage of low A) Clostridium perfringens
molecular weight solutes through the outer membrane of Gram negative bacteria? B) Salmonella typhimurium
(A) capsules C) Staphylococcus aureus
(B) endospores D) Staphylococcus epidermidis
(C) flagella ANS: C, Staphylococcus aureus
(D) porins
ANS: D (Micro) 14. Gram-positive cocci and polymorphonuclear leukocytes are observed
on Gram stain of sputum from a 60-year old alcoholic with pneumonia.
5. Which one of the following is a component of the cytoplasmic membrane of Culture of the sputum reveals alpha-hemolytic, catalase-negative
Gram positive bacteria? bacteria. Which one of the following laboratory tests is the MOST
(A) Braun's lipoprotein (Murein lipoprotein) APPROPRIATE next step in the definitive identification of this
(B) capsules organism?
(C) lipopolysaccharide A) bacitracin sensitivity test
(D) phosphatidylglycerol B) beta-lactamase production test
ANS: D (Micro) C) ELEK test
D) bile solubility test
6. The inhibition of bacterial protein synthesis by the macrolide antibiotic ANS: D, bile solubility test
erythromycin is directly due to which one of the following mechanisms?
a. Covalent modification of the ribosomal S12 protein 15. A 19-year old female is admitted to an outpatient clinic with suprapubic
b. Inhibition of the charging of transfer RNA (tRNA) pain, dysuria and an urgency to urinate frequently. She is otherwise
c. Inhibition of the formation of a stable 70S initiation complex healthy. A clean catch midstream urine specimen was collected and
d. Inhibition of the peptidyl transfer reaction sent to the laboratory. Numerous neutrophils are detected in the urine
e. Inhibition of the translocation step sample. The bacteriology laboratory reports that less than 10 2 Gram-
ANS: E positive cocci and greater than 105 Gram-negative bacilli were
recovered per milliliter of urine. Which one of the following is the MOST
7. Your patient, suffering from a bacterial infection, receives a penicillin injection LIKELY cause of her infection?
and almost immediately experiences respiratory distress and loses A) Escherichia coli
consciousness. This reaction is MOST LIKELY mediated by B) Klebsiella pneumoniae
(A) complement. C) Pseudomonas aeruginosa
(B) CD8+ cytolytic T cells. D) Staphylococcus aureus
(C) macrophages. ANS: A, Escherichia coli
(D) mast cells.
ANS: D 16. A 35-year old male park ranger in rural New Mexico arrives to an
emergency room with fever and signs and symptoms of septic shock.
8. The complement component, C3b, plays an important role in the immune An enlarged lymph node is discovered under his arm upon physical
response by functioning to increase examination. Gram-negative coccobacilli that demonstrate bi-polar
(A) antibody recognition. staining were seen in both lymph node aspirate and spinal fluid from the
(B) chemotaxis. patient. Which one of the following is the MOST LIKELY etiologic agent
(C) opsonization. of this patients illness?
(D) TCR signaling. A) Brucella abortus
ANS: C B) Borrelia burgdorferi
C) Chlamydia trachomatis LGV
9. Which one of these statements explains the origin of Rh antibodies in the D) Rickettsia rickettsii
blood of an E) Yersinia pestis
Rh-negative mother? ANS: E, Yersinia pestis

a. They are naturally occurring in the blood of all Rh-negative persons. 17. A 40-year old male hog farmer complains of intermittent fever, night
b. They are received through mis-matched blood transfusions. sweats and headaches to his physician. The patient is hospitalized and
c. They are synthesized by the mother in response to Rh-positive cells from her blood and bone marrow specimens are collected. The physician
first child. requests that the laboratory incubate the cultures for at least 6 weeks.
d. They are transferred from the Rh-positive father during intercourse. Nine days after admission, Gram negative coccobacilli that require
ANS: C increased CO2 for growth are isolated from the blood and bone marrow
cultures. The patient is MOST LIKELY to be suffering from which one of
10. Which one of the following bacterial pathogens requires selective the following diseases?
culture conditions for reliable isolation from the stool, including media A) Brucellosis
with antibiotics and incubation at 42 C in increased CO2? B) Bubonic plague
A) Campylobacter jejuni C) Legionnaires disease
B) Enterohemorrhagic Escherichia coli D) Rocky Mountain spotted fever
C) Salmonella sp. ANS: A, Brucellosis
D) Shigella sp.
ANS: A, Campylobacter jejuni
 26. A 13-year old and her 10-year old brother are seen at an emergency
18. Which one of the following diseases is MOST LIKELY to respond room with complaints of double vision, difficulty swallowing, and
favorably to treatment with a -lactam antibiotic? progressive muscular weakness. A detailed history reveals that both
A) Legionellosis children attended a church picnic three days earlier but neither child has
B) Mycoplasmosis gastroenteritis. The MOST LIKELY presumptive diagnosis is
C) Syphilis A) botulism.
D) Trachoma B) Chinese rice syndrome.
ANS: C, Syphilis C) Guillan-Barr syndrome.
D) salmonellosis.
19. A 20-year old woman comes to your clinic complaining of an irritating ANS: A, botulism
vaginal discharge. Upon examination, you find that the cervix and
vaginal walls appear normal. The discharge is thin and milky, pH 5.5, 27. Epidemics of bacterial meningitis in young, previously healthy adults are
and has a fishy odor when treated with potassium hydroxide. You are MOST LIKELY caused by
unable to detect pseudohyphae, buds, or flagellates upon microscopic A) Escherichia coli K-1.
examination. A Gram stain reveals numerous curved Gram-negative B) Haemophilus influenzae type b.
rods, epithelial cells, and clue cells, but relatively few Gram-positive C) Listeria monocytogenes.
rods or WBCs. Cervical and vaginal cultures are negative for STDs. D) Neisseria meningitidis group A.
What is your diagnosis? ANS: D, Neisseria meningitidis group A.
A) Bacterial vaginosis
B) Cervicitis
C) Trichomoniasis 28. A 55-year old woman develops endocarditis following oral surgery.
D) Vaginal candidiasis Gram-positive, alpha-hemolytic, catalase-negative cocci are isolated
ANS: A, Bacterial vaginosis from a blood culture. The MOST LIKELY agent is
A) Enterococcus faecalis (group D streptococci).
20. A 75-year old man in a nursing home is treated with a broad spectrum B) Staphylococcus aureus.
antibiotic for bed sores. Two days later he develops bloody diarrhea. A C) Staphylococcus epidermidis.
stool specimen from the patient is positive in an ELISA test for a D) Streptococcus pyogenes (group A streptococci).
necrotizing cytotoxin, and his treatment is switched to vancomycin. The E) Viridans streptococci.
agent MOST LIKELY to be responsible for this clinical syndrome is ANS: E, Viridans streptococci.
A) Bacteroides fragilis.
B) Campylobacter jejuni. 29. A 2-month old infant is admitted to the hospital with fever,
C) Clostridium difficile. lymphocytosis, and bouts of violent coughing that often end in vomiting.
D) Escherichia coli O157:H7. The infants mother reveals that the child has not as yet received any
ANS: C, Clostridium difficile immunizations. The attending physician swabs the infants
nasopharynx and requests that the swab be plated on routine media as
21. Which one of the following toxins is responsible for scalded skin well as a special medium (Bordet-Gengou) that contains blood and
syndrome? glycerol. No organisms are found on blood or chocolate agar, but small
A) Alpha hemolysin Gram-negative rods are isolated on Bordet-Gengou agar. The MOST
B) Exfoliatin LIKELY cause of the infants illness is
C) Hyaluronidase A) Bordetella pertussis.
D) Staphylococcal enterotoxin B) Chlamydia pneumoniae.
ANS: B, Exfoliatin C) Moraxella catarrhalis.
D) Mycoplasma pneumoniae.
22. A 50-year old cancer patient with severe neutropenia became septic two ANS: A, Bordetella pertussis.
weeks after being admitted to the hospital. An oxidase-positive, Gram-
negative rod that did not ferment glucose was isolated from the patients 30. Which one of the following viruses establishes a chronic
blood. Which one of the following organisms is the MOST LIKELY persistent infection in humans?
cause of the patients sepsis? A) Hepatitis A virus
A) Enterobacter cloacae B) Hepatitis C virus
B) Escherichia coli C) Herpesvirus
C) Klebsiella pneumoniae D) Poliovirus
D) Pseudomonas aeruginosa ANSWER: B, Hepatitis C virus
ANS: D, Pseudomonas aeruginosa
31. Which one of the following parasitic infections is MOST LIKELY to
23. Blood culture from a 12-year old with acute osteomyelitis yields Gram- produce life-threatening anemia in children?
positive cocci that are b hemolytic and catalase positive. Which one of A) Amoebic dysentery
the following laboratory tests is the MOST APPROPRIATE next step in B) Malaria
the definitive identification of this organism? C) Hookworm disease
A) Coagulase test D) Kala azar
B) Optochin sensitivity test ANSWER: B, Malaria
C) Slide agglutination test for capsular antigen type
D) Test for capacity to grow in bile esculin 32. Which one of the following viruses is transmitted via the gastrointestinal
ANS: A, Coagulase test route?
A) Delta-associated agent
24. Activated macrophages are the effector cells in the expression of a B) Hepatitis A
protective, cell-mediated immune response against C) Hepatitis B
A) Corynebacterium diphtheriae. D) Hepatitis C
B) Haemophilus influenzae type b. ANSWER: B, hepatitis A.
C) Listeria monocytogenes.
D) Streptococcus pneumoniae. 33.
A 33-year-old pregnant woman delivered a baby boy via a normal
ANS: C, Listeria monocytogenes vaginal delivery. Neither she nor the father has a history of genital or
oral herpes. Although she had chickenpox as a child, she was exposed
25. A patient recovering from a crushing leg injury suffered during an a to a child with chickenpox about 10 days before delivery. There was no
motorcycle accident develops a temperature of 100 o F, a rapid pulse, evidence of vesicular skin lesions on either the mother or the child at
and extreme pain at the site of his the wound two days after the the time of delivery. Three days after birth, the baby now develops
accident. The skin overlying the patients sutured wound is brownish- vesicular skin lesions on his back, accompanied by a fever. Which one
white, shiny, and studded with vesicles. Gram stain of the watery of the following viruses is MOST LIKELY to be the cause of the baby's
exudate from the wound reveals Gram-positive rods, Gram-negative infection?
rods, and Gram-positive cocci. The Gram-positive rods are MOST A) Cytomegalovirus
LIKELY B) Herpes simplex virus type 1
A) Bacillus cereus. C) Herpes simplex virus type 2
B) Bacteroides fragilis. D) Human herpesvirus 6
C) Clostridium perfringens. ANSWER: C, Herpes simplex virus type 2
D) Corynebacterium ulcerans.
ANS: C, Clostridium perfringens 34. Which one of the following viruses is MOST LIKELY to infect and cause
rapid cell lysis in a fibroblast cell line culture?
A) Hepatitis B virus
B) Herpes simplex virus
C) Human papilloma virus
 D) Norwalk virus A) Borrelia recurrentis.
Answer: B, Herpes simplex virus B) Coxiella burnetti.
C) Franciscella tularensis.
35. Six months after returning from travelling in North Africa and the Middle D) Rickettsia rickettsia.
East, a graduate student experiences two episodes of intense ANS: D
headache, shaking chills, and high fever, followed by sweating and
exhaustion. The episodes occurred 48 hours apart and each lasted 44. Which one of the following organisms is the MOST COMMON cause of
about 6 hours. He appears at your clinic the day after the second bacterial diarrhea in the United States?
episode. Laboratory test results reveal low hematocrit (35%), slight A) Campylobacter jejuni
hypoglycemia, and an intraerythrocytic parasite on Giemsa-stained B) enterotoxigenic Escherichia coli
blood films. What is your diagnosis? C) Salmonella cholerasuis
A) Vivax malaria D) Shigella sonnei
B) Falciparum malaria ANS: A
C) Ovale malaria
D) Quartan malaria 45. Dissemination of Salmonella typhi from the intestine to extraintestinal sites
ANSWER: A, Vivax malaria requires survival of this pathogen in which one of the following host cells?
A) Colonic enterocytes
36. Examination by dark-field microscopy of scrapings from a genital ulcer B) Gastric epithelial cells
of 19-year old female reveals mobile, spiral-shaped organisms against a black C) M cells
background. The MOST LIKELY diagnosis is D) Macrophages
A) chancroid. ANS: D
B) Chlamydia trachomatis infection.
C) gonorrhea. 46. Gram stain of cerebrospinal fluid from a 3-year-old child with fever, petechiae,
D) syphilis. stiff neck and positive Kernig and Brudzinski's signs reveals PMNs and a few
ANS: D, syphilis Gram-negative cocci. The MOST LIKELY agent is
A) Escherichia coli.
37. To accurately determine the cause of repeated bouts of otitis media that B) Haemophilus influenzae type b.
have begun to affect a toddlers hearing, inner ear fluid is obtained by C) Neisseria meningitidis.
careful puncture of her tympanic membrane with a sterile needle. Gram D) Streptococcus agalactiae (group B streptococci ).
stain of the aspirate reveals short Gram-negative rods and ANS: C
polymorphonuclear leukocytes. No organisms are isolated on blood
agar but colonies are observed on chocolate agar. The MOST LIKELY 47. Listeria monocytogenes infection of an adult is MOST LIKELY to be acquired by
cause of this infection is A) ingestion of contaminated food.
A) Haemophilus influenzae non typable. B) inhalation of contaminated aerosals.
B) Haemophilus influenzae type b. C) inoculation with a contaminated needle.
C) Klebsiella pneumoniae. D) person-to-person contact. .
D) Streptococcus pneumoniae. ANS: A
ANS: A, Haemophilus influenzae non typable.
48. What is the mechanism of action of the antifungal drug fluconazole?
38. Gram-positive cocci are observed on a Gram stain of purulent discharge from a A) Binds to ergosterol resulting in membrane disruption
skin lesion of a 7-year-old. Culture of the exudate reveals beta-hemolytic, catalase- B) Inhibits ergosterol synthesis
positive organisms. Which one of the following laboratory tests is the MOST C) Inhibits protein synthesis
APPROPRIATE next step in the definitive identification of this organism? D) Inhibits RNA synthesis
A) Bacitracin sensitivity test E) Prevents cell wall formation by inhibiting chitin synthesis
B) Bile solubility test
C) Coagulase test 49. A 10-year-old with a dog complains of a bump on the back of his head.
D) Optochin sensitivity test He says its redness and itching have increased over the last three
ANS: C weeks. The lesion is several centimeters in diameter, with hair
involvement and scaling. Examination of several of his hairs in a KOH
39. Which one of the following descriptions is correct about cholera gravis? preparation reveals hyphae in and around the hair shafts. What is your
A) Associated with the formation of colonic ulcers diagnosis?
B) Death may occur due to dehydration, acidosis, and shock A) Actinomycosis
C) Most common clinical manifestation of Vibrio cholerae infection B) Candidiasis
D) Occurs in response to plasmid-borne heat stable (ST) toxin C) Pityriasis versicolor
ANS: B D) Tinea capitis
ANSWER: D, Tinea capitis
40. Which one of the following species or serovars of Chlamydia can be
transmitted as a zoonotic infection? 50. You are assigned to a hospital in Phoenix, Arizona. Several patients
A) Chlamydia pneumoniae have been admitted in the past week with cough, chest pain, fever, and
B) Chlamydia psittaci pneumonitis that has not responded to antibacterial therapy. You
C) Chlamydia trachomatis serovar C discover that most of the patients are new arrivals to Arizona who had
D) Chlamydia trachomatis serovar D been working outdoors during the dusty wind storms that had occurred
ANS: B over the past few weeks. The causative organism is observed in a KOH
preparation of sputum. What is your presemptive diagnosis?
41. Gram stain of synovial fluid from the knee of a 20-year-old woman with arthritis A) Blastomycosis
reveals Gram-negative cocci. To isolate the MOST LIKELY responsible agent, the B) Coccidioidomycosis
specimen should be plated on C) Histoplasmosis
A) Bordet-Gengou agar. D) Psittacosis
B) Chocolate agar. ANSWER: B, Coccidioidomycosis
C) Eosin Methylene Blue (EMB) agar.
D) MacConkey agar. 51. A 65-year-old male develops endocarditis following urinary catheterization.
ANS: B Gram-positive, catalase-negative cocci are isolated from a blood culture. The
MOST LIKELY agent is
42. The formation of colonic ulcers and absesses during Shigella dysentery is due A) Enterococcus faecalis (group D streptococci).
to B) Staphylococcus aureus.
A) ability of bacteria to survive stomach acidity because of the C) Staphylococcus epidermidis.
production of urease. D) Streptococcus pyogenes (group A streptococci).
B) bacterial survival within macrophages. ANS: A
C) invasion of enterocytes and cell-to-cell spread of the bacteria.
D) production of a superantigen by the bacillus. 52. A 10-year-old child of an instructor at the U.S. Air Force Academy develops
ANS: C marked swelling in her right inguinal lymph node with fever of 104.1EF. An aspirate
from the painful, swollen node reveals Gram-negative rods. A direct
43. An 8-year-old boy living in a wooded area of Virginia suddenly develops fever, immunofluorescent assay on the same aspirate provides a definitive diagnosis. The
headache, and myalgia. On physical exam, a rash is noted on his wrists and child is treated with streptomycin, and the aspirate is sent for culture. The culture
ankles. Within hours, the rash spreads to his trunk. Numerous arthropod bites are yields white colonies on MacConkey agar grown at room temperature. The MOST
observed on the child's extremities. No organisms are isolated from 3 sequential LIKELY agent is
blood cultures. The child is treated with tetracycline and recovers. Serological A) Brucella canis.
studies on acute and convalescent serum samples from the child are MOST B) Yersinia pestis.
LIKELY to reveal that the etiologic agent was
 C) Francisella tularensis. C. Mosquito bites
D) Haemophilus ducreyi. D. Sexual
ANS: B E. Fecal-oral

53. A 22-year-old develops an abcess in his peritoneum following rupture of his 61. Mode of transmission of Onchocerca volvulus is:
appendix. Gram stain of the exudate from his foul-smelling abcess reveals A. Exposure to infested water
numerous polymorphonuclear leukocytes, Gram-positive cocci, Gram-positive rods, B. Louse bites
and Gram-negative rods. Aerobic culture of the exudate at 37 o C on blood and C. Skin contact with larvae
MacConkey agar plates yields only enterococci (group D streptococci). The Gram- D. Blackfly bites
negative rods are MOST LIKELY E. Wound infection
A) Bacteroides fragilis.
B) Escherichia coli. 62. Mode of transmission of Leishmania mexicana is:
C) Pseudomonas aeruginosa. A. Sexual
D) Shigella dysenteriae. B. Mosquito bites
ANS: A C. Fecal-oral
D. Tick bites
54. Several people become ill within two hours after leaving a summer reunion E. Sandfly bites
picnic. The majority of people complain of vomiting and diarrhea without fever, and
recovered within 24 hours after the onset of symptoms. The contaminated food is 63. Mode of transmission of Enterobius vermicularis is:
determined to be a bowl of coleslaw prepared by someone with a stye on her left A. Sexual
eyelid. Which one of the following is the MOST LIKELY source of the food B. Blackfly bites
poisoning? C. Louse bites
A) Clostridium botulinum D. Fecal-oral
B) Staphylococcus aureus E. Deer fly bites
C) Salmonella enteriditis
D) Shigella sonnei 64. Oxygen requirements of Neisseria gonorrhoeae is:
A. Aerobic
B. Facultative anaerobe
ANS: B C. Microaerophilic
55. A 35-year-old female presents with fever, headache and a non-productive D. Obligate anaerobe
cough. The patient is prescribed penicillin and sent home. Two weeks later, she
returns with similar symptoms. A Gram stain and routine culture of the patient's 65. Mode of transmission of Borrelia burgdorferi is:
sputum reveal only normal mouth flora. Sputum is then cultured on specialized A. Direct contact with animals
medium containing sterols, and, after two days, tiny colonies were visible under a B. Conidia inhalation
microscope. Which one of the following organisms does the physician suspect is C. Sexual
the cause of the patient's pneumonia? D. Tick bites
A) Corynebacterium diphtheriae E. Transplacental
B) Haemophilus influenzae type b
C) Legionella pneumophila 66. Therapy of Vibrio cholerae is:
D) Mycoplasma pneumoniae A. TMP-SMX
ANS: D B. ORS
C. Ceftriaxone
56. A 70-year-old male, who is a chain-smoker, complains of fever, diarrhea, cough D. Erythromycin
and chest pain. Evidence of pneumonia is seen by chest X-ray. Due to the inability E. Augmentin
of the patient to produce a sputum specimen, a transtrachial aspirate is obtained.
No respiratory bacterial pathogen is isolated from aspirated fluid cultured on blood 67. Family of Measles virus is:
agar plates. However, poorly staining Gram-negative rods are isolated on buffered A. Papovaviridae
charcoal-yeast extract (BCYE) agar after three days of incubation. The physician B. Rhabdoviridae
had already begun treatment with erythromycin due to the detection of bacilli in the C. Orthomyxoviridae
aspirated fluid using a fluorescently-labeled monoclonal antibody specific for the D. Flaviviridae
causative agent. The MOST LIKELY pathogen responsible for this pneumonia is E. Paramyxoviridae
A) Haemophilus influenzae.
B) Legionella pneumophila. 68. Family of Hepatitis A virus is:
C) Mycoplasma pneumoniae. A. Papovaviridae
D) Neisseria meningitides. B. Hepadnaviridae
ANS: B, Legionella pneumophila C. Parvoviridae
D. Picornaviridae
57. Immunopathologic delayed-type hypersensitivity responses to eggs in tissue, E. Bunyaviridae
resulting in granulomas, obstruction and fibrosis is characteristic of
A. acute trichinosis. 69. Which of the following statements refers to Toxoplasma gondii:
B. Chagas' disease. A. Sandfly gut: promastigote -> amastigote
C. . schistosomiasis. B. Three major serogroups. After-infection immunity only for the
D. onchocerciasis. serougroup of the strain involved.
Answer: C C. Primary infection is usually asymptomatic. Congenital infection results in
cytomegalic inclusion disease.
58. Which one of the following fungi exhibits thermal dimorphism? D. ELISA helps distinguish from dispar - non-pathogenic.
A. Aspergillus fumigatus E. Cyst(bradyzoites) -> feline gut: schizogony/gametogony -> oocysts ->
B. Candida tropicalis. tachozoites -> cysts
C. Cryptococcus neoformans
D. Histoplasma capsulatum 70. Mode of transmission of Leishmania donovani is:
Answer: D A. Sandfly bites
B. Sexual
59. An otherwise healthy 35-year-old female florist presented to her primary care C. Exposure to infested water
physician complaining of a persistent lesion on the third digit of her left hand. This D. Spore ingestion
had been present for several weeks and showed no sign of resolving. Upon E. Fecal-oral
examination, the patient was found to have a mild fever (100 0F), the
aforementioned lesion and two nodules on her left forearm. A biopsy of the lesion 71. Phenotypic characteristic of Schistosoma hematobium is:
was performed, and the pathology report indicated the presence of numerous A. Eggs have a small lateral spine
polymorphonuclear leukocytes and a rare elongated budding yeast. What is the B. Eggs have a terminal spine
MOST LIKELY etiologic agent? C. Non-enveloped
A. Blastomyces dermatitidis D. Four suckers and circle of hooks on scolex
B. Candida albicans E. Lactose fermenter
C. Histoplasma capsulatum
D. Sporothrix schenckii 72. Therapy of Taenia solium is:
Answer: D A. mebendazole
B. TMP-SMX
60. Mode of transmission of Trichomonas vaginalis is: C. Piperacillin
A. Ingestion of infested beef D. Suramin
B. Skin contact with larvae E. niclosamide
 (C) Gram-positive, catalase negative cocci.
73. Phenotypic characteristic of Streptococcus pyogenes is: (D) Gram-positive, catalase positive cocci.
A. Alpha-hemolytic (E) Gram-positive, catalase positive rods.
B. Oxidase "+" ANS: B
C. H2S "-"
D. dsDNA 83. The blood culture of a patient with a presumptive diagnosis of endocarditis
E. Beta-hemolytic yields non-hemolytic colonies of Gram-positive cocci. The isolate is catalase
negative, can grow in 6.5% NaCl, and is resistant to penicillin. The isolate is MOST
74. Mode of transmission of Rickettsia prowazekii is: LIKELY:
A. Droplet nuclei (A) Enterococci.
B. Direct contact with animals (B) Streptococcus agalactiae (group B streptococci).
C. Louse bites (C) Streptococcus bovis.
D. Wound infection (D) Streptococcus mutans (Viridans streptoccoci).
E. Ingestion of infested canine feces (E) Streptococcus pneumoniae.
ANS: A
75. Non-toxin virulence factor of Escherichia coli is:
A. Opacity associated protein (opa) - promotes adhesion to mucosal 84. A 25-year-old, previously healthy woman develops fever within 24 hours of
surfaces delivery of an infant born 6 weeks prematurely. Blood culture of the mother reveals
B. Fimbria - adhesion Gram-positive cocci that are catalase negative, beta-hemolytic on blood agar, and
C. Fibronectin receptor resistant to bacitracin. The MOST LIKELY cause of the bacteremia is:
D. HSP-60 - possible "mimicry" inducing autoimmune response (A) Enterococci.
E. Urease - raises environmental pH (B) Staphylococcus aureus.
(C) Streptococcus agalactiae (group B streptococci).
76. Phenotypic characteristic of Gonococcus is: (D) Streptococcus pneumoniae.
A. Fastidious (E) Streptococcus pyogenes (group A streptococci).
B. Mycolic acid in cell wall ANS: C
C. Catalase "-"
D. Non-lactose fermenter 85. A 24-year-old college student comes to the emergency room with low blood
E. Alpha-hemolytic pressure. He reports that he had a recent cold, with fever and sore throat. On
physical exam, he has cervical lymphadenopathy, and an enlarged tender spleen.
77. Morbidity of Blastomyces dermatitidis is: Which virus infection is the MOST CONSISTENT with his clinical picture?
A. Urinary tract infections A) Adenovirus type 12
B. Whooping cough B) Epstein-Barr virus
C. Disseminated granulomas C) Herpes simplex virus type 1
D. Bronchopneumonia D) Rhinovirus
E. Systemic infection E) Varicella-zoster virus
Answer: B
78. Staphylococcal food poisoning is the result of
(A) a heat labile enterotoxin. 86. An HIV-infected homosexual man presents with Kaposi's sarcoma. Which viral
(B) ingestion of a pre-formed enterotoxin produced by Staphylococcus aureus genome is MOST LIKELY to be present in his tumor biopsy?
during bacterial multiplication in contaminated food. A. Herpes simplex virus tupe 1
(C) ingestion and multiplication of coagulase-negative Staphylococcus sp. B. Human cytomegalvirus
(D) multiplication of Staphylococcus aureus in the small intestine. C. Human herpesvirus type 6
(E) Staphylococcus aureus alpha toxin. D. Human herpesvirus type 8
ANS: B E. Varicella-zoster virus
Answer: D
79. A 19-year-old soldier develops fever, carditis, and migratory polyarthritis. While
taking her history, the patient remembers that she had a "sore throat" three weeks 87. Which one of the following viral infections is not effectively prevented by
previously. A throat culture of the patient yields normal flora only. The laboratory vaccination?
result MOST CONSISTENT with these findings is that the patient has high titers of A. Hepatitis B virus
antibody to: B. Poliovirus
(A) meningococcal lipooligosaccharide. C. Rhinovirus
(B) pneumococcal IgA protease. D. Rubella virus
(C) pneumococcal polysaccharide. E. Smallpox virus
(D) staphylococcal protein A. Answer: C
(E) streptolysin O.
ANS: E 88. Prions cause spongiform encephalopathies including the human disease
A. AIDS dementia complex.
80. A 65-year-old man with a colonic tumor undergoes a bowel resection. Three B. Creutzfeldt-Jacob disease.
days later, the patient develops a fever, and the drainage from the surgical site is C. scrapie.
foul smelling. The skin near the site of the drainage is markedly erythematous. D. subacute sclerosing panencephalopathy (SSPE).
Gram stain of the drainage reveals Gram-positive cocci and Gram-negative rods. E. tropical spastic paraparesis.
Aerobic culture of the drainage yields streptococci. The Gram-negative rod seen on Answer: B
Gram stain was most likely:
(A) Bacteroides fragilis 89. Congenital infection by which one of the following viruses can result in birth
(B) Clostridium perfringens defects?
(C) Escherichia coli A. Adenovirus
(D) Pseudomonas aeruginosa B. Cytomegalovirus
(E) Shigella flexneri C. Hepatitis B virus
ANS: A D. Human immunodeficiency virus
E. Human papilloma virus
81. A 50-year-old rancher scrapes his hand with clippers while shearing sheep. Two Answer: B
days later he notices an ulcer surrounded by vesicles at the site of the wound. Eight
days after the injury, the wound develops a black necrotic center (eschar) 90. Viral carditis of adolescents and adults is frequently caused by
surrounded by edematous fluid. The rancher experiences mild systemic symptoms. A. Coxsackieviruses.
The most likely cause of the infection is: B. Orthomyxoviruses.
(A) Bacillus anthracis. C. Pseudorabiesvirus.
(B) Clostridium tetani. D. Reoviruses.
(C) Neisseria meningitidis. E. Rhinoviruses.
(D) Streptococcus pyogenes (group A streptococci). Answer: A
(E) Staphylococcus aureus.
ANS: A 91. Several newborns housed in a neonatal intensive care unit have developed
nosocomial pneumonia. Most are wheezing and some have required care such as
82. A 19-year-old college sophomore dies 24 hours after the development of fever, mechanical ventilation, increased doses of oxygen, antibiotic therapy, or monitoring
petechiae, purpura, and disseminated intravascular coagulation. Culture of for apnea. A simple, rapid diagnostic test reveals a common viral antigen in nasal
cerebrospinal fluid and blood obtained from the patient on admission to the hospital wash specimens from each of the patients. The virus MOST LIKELY to be
MOST LIKELY yielded: responsible is
(A) Gram-negative, lactose fermenting rods. A. Coronavirus
(B) Gram-negative, oxidase positive diplococci. B. Echovirus B2
C. Respiratory syncytial virus 99. A 25 year-old sexually active woman complains of vaginal itching, odor, and
D. Rubeola virus (measles) discharge. The vaginal walls are red and slightly swollen, but the cervix is normal. A
E. Type A influenza virus sample of her vaginal discharge is tested with 10% KOH, which produces a strong
Answer: C fishy odor. Upon microscopic examination of the discharge, you find clue cells but
no pear-shaped flagellates or pseudohyphae. A Gram stain reveals numerous
92. A baby is born with microphthalmia, cataracts, and a holosystolic/holodiastolic Gram-negative curved rods. What is your diagnosis?
heart murmer. Infection by what virus is the MOST LIKELY cause? (A) Bacterial vaginosis
A. Cytomegalovirus (B) Pelvic inflammatory disease (PID)
B. Enterovirus (C) Syphilis
C. Human immunodeficiency virus (D) Trichomoniasis
D. Herpes simplex virus type 2 (E) Yeast infection
E. Rubella virus Answer: A
Answer: E
100. A 25 year-old male develops an ulcerative lesion of the hand and several
93. A 7 year-old newly adopted Russian child who has been in the United States 10 fluctuant nodules along the lymphatics draining that site. The patient is seen in the
days presents with fever, malaise, sore throat, and a grey membrane on the tonsils, dermatology clinic at the Naval Hospital. Case history reveals that he is a weekend
uvula, and soft palate. The child's immunization history is unknown. The physician gardener who cultivates roses as a hobby. What is the MOST LIKELY fungal
obtains a swab of the child's throat which provokes bleeding of the membrane. The disease?
swab is sent to the laboratory for routine throat culture. Two days later the (A) Chromoblastomycosis
laboratory reports only the presence of normal flora in the specimen. The MOST (B) Mycetoma
LIKELY organism responsible for this child's illness is: (C) Phaeohyphomycosis
(A) Bordetella pertussis. (D) Sporotrichosis
(B) Corynebacterium diphtheriae. (E) Zygomycosis
(C) Haemophilus influenzae type b. Answer: D
(D) Listeria monocytogenes.
(E) Streptococcus pyogenes (group A streptococci).
Answer: B

94. Soft cheese imported from Mexico was implicated as the vehicle in an outbreak
of meningitis and bacteremia that occurred among attendees of a large company
picnic. Twenty of the 40 affected individuals were pregnant women. One of the
victims had AIDS. Gram positive, non-spore forming rods were isolated from the
cheese that had been stored in the cold. The MOST LIKELY organism responsible
for this outbreak is:
(A) Bacillus cereus
(B) Clostridium difficile
(C) Clostridium perfringens
(D) Listeria monocytogenes
(E) Staphylococcus aureus
Answer: D

95. A 25 year old patient presents at a sexually transmitted disease (STD) clinic
with a painful genital ulcer. On examination, the ulcer does not appear to be typical
of herpes simplex virus. Dark field microscopy of exudate from the ulcer is negative
for spiral-shaped organisms. However, a small, gram negative rod is isolated from
culture of the exudate on chocolate agar. The organism MOST LIKELY to be
responsible for the lesion is:
(A) Chlamydia trachomatis.
(B) Haemophilus ducreyi.
(C) Neisseria gonorrhoae.
(D) Treponema pallidum.
(E) Ureoplasma urealyticum.
Answer: B

96. Which ONE of the following diseases is transmitted by lice?

(A) Epidemic typhus
(B) Ehrlichiosis
(C) Psitticosis
(D) Scrub typhus
(E) Typhoid fever
Answer: A

97. A young army recruit presents at a sexually transmitted disease (STD) clinic
clinic with acute urethritis. A Gram-stained preparation of his urethral exudate
reveals neutrophils with intracellular Gram-negative diplococci. The patient is
treated with ceftriaxone and sent home. He is requested to return in one week so
that a urethral culture can be obtained to test for proof of antibiotic cure. Which
ONE of the following culture media should be used for the follow-up culture?
(A) Blood agar
(B) Bordet Gengou agar
(C) MacConkey agar
(D) Serum tellurite agar
(E) Thayer-Martin agar
Answer: E

98. The growth in the vagina of which ONE of the following bacteria helps maintain
a protective acid pH?
(A) Bacteroides
(B) Gardnerella
(C) Lactobacillus
(D) Mobiluncus
(E) Peptostreptococcus
Answer: C