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Bacteriology
QUESTIONS
Select the best answer.
The next two questions are linked.
1
2 Chapter 1
(A) Exotoxin production (A) Capsule
(B) Flagella (B) H antigen
(C) Lipooligosaccharide (C) Hemolysin
(D) Pili (D) Lipid A
(E) Polysaccharide capsule (E) Lipoteichoic acid
4 Vaccination against which bacterial species has been The next two questions are linked.
most successful at reducing the number of cases of
invasive diseases, including meningitis? 7 Infected pressure sores were observed on the buttock
(A) Escherichia coli K1 of an elderly, bedridden patient recently treated for a
(B) Haemophilus influenzae b malignancy of the rectum. Some of the lesions are con-
(C) Listeria monocytogenes spicuously necrotic, exceptionally painful to the touch,
(D) Neisseria meningitidis and readily give off a musty sweet odor. Moreover,
(E) Streptococcus pneumoniae these lesions seem to have developed overnight. A
Gram stain of the watery discharge from one of the
5 A 56-year-old renal transplant patient was hospitalized lesions reveals an abundance of bacteria (shown in the
following an abrupt onset of high fever (39.6 C), con- photograph). What is the most likely diagnosis?
fusion, headache, diarrhea, a cough productive of scant
sputum, and shortness of breath. His chemistry profile
revealed hyponatremia. A chest radiograph showed lobar
infiltrates. Gram stain of sputum showed numerous neu-
trophils but failed to show any organisms. A urine anti-
gen test was positive for the causative agent. What is the
major virulence factor of the causative agent?
(A) Antiphagocytic capsule
(B) Cord factor
(C) Exotoxin production
(D) Intracellular growth
(E) Pyocyanin
(A) b-lactamase
(B) Catalase
(C) Coagulase
(D) Staphylokinase
(E) Streptokinase
(A) Actinomycetes 12 Based on these initial findings, what is the best antibi-
(B) Clostridia otic choice for the patient in the above case?
(C) Pseudomonads (A) Amoxicillin/clavulanate
(D) Staphylococci (B) Cephalexin
(E) Streptococci (C) Dicloxacillin
(D) Polymyxin B
The next three questions are linked. (E) Trimethoprimsulfamethoxazole (TMPSMZ)
10 A patient injured herself at home in the garden, and 13 A pediatric patient with a persistent cough is evalu-
after several days, the resulting skin lesion became ated for sinopulmonary disease. History and physical
infected and intensely painful and she sought medi- examination determines that the child suffers from
cal help. Culture of the wound grew Gram-positive nasal polyps and, possibly, chronic airway obstruc-
cocci that were b-hemolytic on blood agar. On nutri- tion. A sputum sample produces several bacterial spe-
ent agar, the organism produced effervescence when cies, including Haemophilus influenzae and a mucoid
hydrogen peroxide was added to the colonies (shown variety of Pseudomonas aeruginosa. Which of the fol-
in the photograph). What is the enzyme responsible lowing is the most likely diagnosis?
for this bubbling?
(A) Bronchiolitis
(B) Chronic obstructive pulmonary disease (COPD)
(C) Cystic fibrosis
(D) Interstitial pneumonia
(E) Sarcoidosis
4 Chapter 1
14 During a medical mission to tropical Latin America, a 16 With regard to the above case, which laboratory
woman presents with a chronic infection of her foot results would be most useful in confirming the clini-
as seen in the accompanying photograph. Secretions cal diagnosis?
from the lesions, upon Gram staining, clearly reveal (A) Intracytoplasmic inclusions in McCoy tissue
the presence of filamentous Gram-positive cells. culture cells
Which bacterial species is descriptive of the offending (B) Positive bacterial growth on selective and
agent? differential media
(C) Twofold increase in a WeilFelix Proteus OX-19
titer
(D) Type-specific latex agglutination antibody titer
of 1:64
(E) Visualization of bacteria in the tissue by means
of Gram stain
35 A 40-year-old man presented with a rubeola-like rash 40 What virulence factor of the organism may be associ-
on the extremities, chills, fever, myalgia, and malaise ated with induction of this cancer?
5 days after returning from a June fishing trip in (A) cagA
Arkansas. A history of tick bites is noted and Rocky (B) Heat shock protein B
Mountain spotted fever (RMSF) is suspected. What is (C) Mucinase
the etiologic agent of this disease? (D) Urease
(A) Babesia microti (E) Vacuolating cytotoxin
(B) Orientia tsutsugamushi
(C) Rickettsia prowazeki 41 Hemorrhagic colitis, hemolytic uremic syndrome, and
(D) Rickettsia rickettsii thrombotic thrombocytopenic purpura are clinical
(E) Rickettsia typhi manifestations of which bacterial species?
(A) Campylobacter jejuni
36 With reference to the above question, which antimi- (B) Escherichia coli O157:H7
crobial agent should be employed? (C) Shigella flexneri
(A) Chloramphenicol (D) Vibrio cholerae
(B) Ciprofloxacin (E) Yersinia enterocolitica
(C) Doxycycline
(D) Penicillin G
(E) TMPSMZ
8 Chapter 1
42 Over the course of a summer, several patients present
to hospitals in the northwestern United States with
complaints of fever, chills, headache, and other viral-like
symptoms. Reportedly, with many of these patients, the
fever subsides only to return with a vengeance later. Of
significance is that spirochetes are observed in peripheral
blood smears. Another common denominator is that all
patients are outdoor enthusiasts and frequently engage
in activities like camping, fishing, and hiking in moun-
tainous areas. What is the most likely etiologic agent?
(A) Borrelia hermsii
(B) Treponema pallidum
(C) Rickettsia rickettsiae
(D) Proteus vulgaris
(E) Vibrio vulnificus
(A) Bacteriologic culture
The next three questions are linked. (B) Giemsa-stained histological section
(C) Gram-stained smear
43 A 23-year-old male presents with ulcerated lesions on (D) Growth in cell culture
the penis as shown in the accompanying photograph
(E) Specific antibody test
as well as marked unilateral inguinal lymphadenopa-
thy. The lymph node, however, is not particularly 45 Assuming that the patient in the above case has no drug
painful to the touch. The patient denies abnormal dis- allergies, which antibiotic would be the best choice for
charge and any discomfort during intercourse. He is treatment?
presently afebrile. Consistent with the presentation,
(A) Ciprofloxacin
what is the probable causative etiology?
(B) Doxycycline
(C) Metronidazole
(D) Penicillin
(E) TMPSMZ
(A) Chlamydia trachomatis 47 A high school student who was appropriately immu-
(B) Haemophilus ducreyi nized with the diphtheriatetanusacellular pertussis
(C) Neisseria gonorrhoeae (DTaP) series by kindergarten, but who had received
(D) Treponema pallidum no additional boosters since, stepped on a nail while
(E) Trichomonas vaginalis walking barefoot. The nail was easily removed and
the lesion freely bled. What should the student be
44 The 20-year-old pregnant partner of the above patient given?
presented with a 2-week history of flu-like symptoms. (A) Equine tetanus antitoxin
Physical examination reveals a generalized nontender (B) Human tetanus immune globulin
lymphadenopathy and numerous discrete cutaneous (C) Prophylactic antibiotic treatment for Clostridium
hyperpigmentations on the soles of the feet as shown tetani
in the accompanying photograph. Which of the fol- (D) No treatment
lowing laboratory procedures would give you a defini- (E) Tetanus toxoid
tive diagnosis?
Bacteriology 9
The next two questions are linked. (A) Atrophic vaginitis
(B) Bacterial vaginosis
48 The Gram-stained smear of urethral exudate from a male (C) Gonorrhea
(shown in the photo) is diagnostic for which disease? (D) Group B strep colonization
(E) Trichomonas vaginalis infection
(A) Chancroid
(B) Gonorrhea
(C) Lymphogranuloma venereum
(D) Nongonococcal urethritis
(E) Primary syphilis
73 A 15-year-old boy presents with diarrhea, malaise, fever, 76 Five adults and seven children in a village in South
and abdominal pain. The stools were positive for occult Africa present over several days to a local clinic with
blood and fecal leukocytes. Microscopy of the stool also voluminous watery diarrhea containing flecks of
reveals the presence of curved bacilli that moved about mucus. They show signs of severe dehydration and are
on a slide in a darting motion. The etiologic agent, a treated with oral fluids and electrolytes. Stool cultures
Gram-negative, curved rod, grew on specialized medium grew yellow colonies on thiosulfate citrate bile salt
in microaerophilic conditions. Which one of the follow- (TCBS) media. What is the etiology of this outbreak?
ing organisms is most likely responsible for the disease? (A) Enteroinvasive Escherichia coli
(A) Campylobacter jejuni (B) Salmonella typhi
(B) Enterotoxigenic Escherichia coli (C) Shigella dysenteriae
(C) Salmonella sp. (D) Vibrio cholerae
(D) Shigella sonnei (E) Yersinia enterocolitica
(E) Vibrio cholerae
77 An outbreak of pneumonic plague occurs in the
74 A 3-year-old girl develops a wound infection on her Democratic Republic of the Congo killing over half
hand following a cat bite. Culture of wound exudate of the affected individuals. How is this form of plague
on blood agar grew a Gram-negative coccobacillus transmitted?
that is a normal flora of the cat oropharynx. What is (A) Bite of infected flea
the most likely etiologic agent? (B) Direct skin contact with bubos
(A) Bacteroides fragilis (C) Ingestion of contaminated water
(B) b-Hemolytic Streptococcus (D) Inhalation of aerosolized bacteria
(C) Capnocytophaga canimorsus (E) Introduction of bacteria into wounds while
(D) Moraxella catarrhalis butchering infected animals
(E) Pasteurella multocida
78 A 35-year-old man developed a flu-like illness that
75 A 27-year-old male was hospitalized suffering third- lasted 3 days and was followed by apparent recovery.
degree burns over 50% of his body from a house fire. Within days, he suffered a recurrence of illness with
After 6 days in the hospital, he becomes septic and symptoms of meningitis and oliguria. He was hospi-
the burn wounds show tissue necrosis in several areas. talized and diagnosed with Weil disease. Which of the
Blood and wound cultures grew an oxidase-positive, following organisms is the cause?
Gram-negative bacillus resistant to aminopenicil- (A) Bartonella quintana
lins, macrolides, and first-generation and second- (B) Chlamydia psittaci
generation cephalosporins. The organism growing on (C) Leptospira interrogans
nutrient agar is shown in the photograph. What is the (D) Mycobacterium leprae
etiology of this mans burn infection?
(E) Ureaplasma urealyticum
82 A 12-year-old girl develops a low-grade fever, malaise, 87 A 22-year-old woman is admitted to the hospital with
and tender lymphadenopathy in her right axial area. pelvic inflammatory disease. Her empiric antibiotic
On her right hand are the scratches she received 10 regimen requires coverage for anaerobes. Which anti-
days previously from her kitten. What is the most biotic would provide appropriate anaerobic coverage?
likely bacterial cause of this lymphadenopathy? (A) Azithromycin
(A) Actinomyces israelii (B) Ceftriaxone
(B) Bartonella henselae (C) Gentamicin
(C) Chlamydia psittaci (D) Linezolid
(D) Francisella tularensis (E) Metronidazole
(E) Yersinia pestis
88 A 37-year-old male is seen at a sexually transmitted
83 A 25-year-male presented with fever, dry cough, and
disease clinic for treatment of gonorrhea. Prior treat-
dyspnea. A sputum sample was induced but it failed to
ments for this disease have successfully eradicated
reveal organisms on Gram stain. The sputum also failed
the organism; however, the man has not changed his
to grow organisms when cultured on a variety of agars;
behavior and has been repeatedly reinfected. What is
however, bacteria were isolated in cultured eukaryotic
the most important strategy the organism employs
cells. What is the cause of this mans disease?
which enables it to cause repeated infections?
(A) Chlamydophila pneumoniae
(A) Antigenic variation
(B) Legionella pneumophila
(B) Induction of immune suppression
(C) Mycobacterium intracellulare
(C) Intracellular growth in alveolar macrophages
(D) Mycobacterium tuberculosis
(D) Polysaccharide capsule
(E) Mycoplasma pneumoniae
(E) Secretion of IgG protease
84 A 23-year-old female is treated for uncomplicated
pyelonephritis with an antibiotic that inhibits bacte- 89 A 76-year-old man receiving chemotherapy for can-
rial DNA gyrase. Which antibiotic did she receive? cer developed an abrupt onset of fever, chills, head-
(A) Ampicillin ache, nonproductive cough, and diarrhea. A chest
(B) Ceftriaxone radiograph suggested a diagnosis of pneumonia. The
organism, isolated from sputum and blood culture, is
(C) Ciprofloxacin
an aquatic saprophyte that infects amoebas outside of
(D) Gentamicin
the body and macrophages following infection. What
(E) TMPSMZ
is this organism?
Bacteriology 15
(A) Chlamydia pneumoniae 94 What is the major virulence factor of the organism in
(B) Legionella pneumophila the above case?
(C) Mycobacterium tuberculosis (A) Biofilm production
(D) Mycoplasma pneumoniae (B) PantonValentine leukocidin
(E) Streptococcus pneumoniae (C) Pyrogenic exotoxin
(D) Streptokinase
90 A 7-year-old child develops impetigo involving large (E) Vancomycin resistance
areas of his body. He is given an antibiotic that inhibits
cell wall synthesis. Which is the most likely antibiotic The next two questions are linked.
this child would have received?
(A) Ampicillin 95 A 5-year-old girl from an orphanage in Ukraine was
(B) Cephalexin about to leave for the United States with her adop-
(C) Ciprofloxacin tive parents when she developed a fever, sore throat,
cough, and malaise. A few days later, she was brought
(D) Clindamycin
to the emergency room in respiratory distress.
(E) Erythromycin
Physical examination revealed pronounced, bilateral
cervical lymphadenopathy, inflamed pharyngeal area,
91 A 64-year-old woman is hospitalized with communi- and a thick, grayish, leathery exudate on the tonsils
ty-acquired pneumonia. Empiric antibiotic treatment as shown in the photograph. Part of the exudate had
consists of a drug that inhibits bacterial protein syn- become loose revealing bleeding of the underlying
thesis by binding to the 50 S subunit of the bacterial mucosal tissue. The etiologic agent was isolated on
ribosome and a b-lactam antibiotic. With which of the tellurite medium. What virulence factor accounts for
following should she be treated? the pathogenesis of this infection?
(A) Ampicillin plus gentamicin
(B) Azithromycin plus ceftriaxone
(C) Imipenem plus cilastatin
(D) Piperacillin plus tazobactam
(E) Trimethoprim plus sulfamethoxazole
117 A 54-year-old HIV-infected male with a CD4 cell 119 A 60-year-old man with a history of chronic liver
count of 45/cmm presents with fever, shortness of disease develops fever, cellulitis, and bullous skin
breath, diarrhea, fatigue, night sweats, weight loss, lesions after spending 6 hours in flood waters follow-
and right upper quadrant abdominal pain of 2 weeks ing a hurricane that affected his residence along the
duration. He has refused antiretroviral therapy for the Mississippi coast. Upon admission to the hospital, he
past 2 years due to debilitating side effects. Physical is septic and hypotensive and dies the following day.
examination reveals a pale, ill appearing, cachectic Blood cultures grown on blood agar supplemented
male with hepatosplenomegaly. Lab tests reveal ele- with 1% sodium chloride grew a curved, motile,
vated transaminase and alkaline phosphatase levels. Gram-negative rod. What is the etiology of this mans
Blood cultures grew acid-fast bacilli. With which disease?
antibiotic regimen should this patient be treated? (A) Clostridium perfringens
(A) Clarithromycin plus ethambutol plus rifabutin (B) MRSA
(B) Isoniazid plus rifampin (C) Pseudomonas aeruginosa
(C) Piperacillin plus tazobactam (D) Streptococcus pyogenes
(D) Trimathoprim plus sulfamethaxazole (E) Vibrio vulnificus
(E) Vancomycin plus dalfopristin