34. Two months after a renal transplant, a 47-year-old man has increasing dyspnea.

X-ray film of the

chest shows an interstitial infiltrate. A photomicrograph of lung tissue obtained on biopsy is shown. Which of
the following is the most liely causal organism!
A" #ytomegalo$irus
%" &pstein-%arr $irus
#" 'epatitis % $irus
(" 'T)*-+
&" ,apilloma$irus
-" ,ar$o$irus %+.
+/. A 03-year-old woman has a fe$er and a cough producti$e of rust-colored sputum. A gram-positi$e
coccus isolated from the sputum is sensiti$e to optochin. Which of the following is the most liely causal
organism!
A" &nterococcus faecium
%" 1treptococcus agalactiae 2group %"
#" 1treptococcus pyogenes 2group A"
(" 1treptococcus pneumoniae
&" 1treptococcus sanguis
43. A pre$iously healthy +.-year-old woman comes to the medical clinic because of se$ere abdominal
pain for the past +3 hours. 1he has had increasingly fre4uent painful urination o$er the past 04 hours. 1he
is not se5ually acti$e. Temperature is 33./ # 2+6+.3 -", pulse is .67min, respirations are +47min, and blood
pressure is ++/778 mm 'g. The suprapubic area is tender on palpation. 9icroscopic e5amination of urine
shows pyuria, hematuria, and bacteriuria. Which of the following organisms is the most liely cause of these
symptoms!
A" #hlamydia trachomatis
%" &scherichia coli
#" :eisseria gonorrhoeae
(" ,seudomonas aeruginosa
&" 1taphylococcus aureus
/6. ,eriodic world-wide pandemics of respiratory infections occur because of shifts in the antigenic
properties of which of the following $iruses!
A" #orona$irus
%" ;nfluen<a A
#" ;nfluen<a %
(" ;nfluen<a #
&" ,arainfluen<a $irus
-" =espiratory syncytial $irus
>" =hino$irus
33. An unimmuni<ed +6-month-old girl is brought to the emergency department because of
temperatures to 46 # 2+64 -" and listlessness for 04 hours. &5amination shows a stiff nec. )euocyte
count is 04,6667mm3. >ram?s stain of cerebrospinal fluid shows small pleomorphic gram-negati$e bacteria
that re4uire :A( and hemin for growth. A $accine for which of the following organisms would ha$e
pre$ented this infection!
A" %ordetella pertussis
%" #lostridium tetani
#" #orynebacterium diphtheriae
(" 'aemophilus influen<ae
&" :eisseria meningitidis
-" 1almonella typhi
>" 1treptococcus pneumoniae
4+. Three wees after being bitten by a friend?s puppy in 9e5ico, a 30-year-old man has tingling at the
site of the bite followed by se$ere agitation and disorientation. The initial wound healed without
complications. The puppy died 0 wees ago. The route by which the infecting $irus entered the brain is
A" blood-borne $irions infecting cerebral capillary endothelial cells
%" blood-borne $irions infecting choroid ple5us cells
#" blood cells that cross the blood-brain barrier
(" transport within the a5ons into the central ner$ous system
&" $irions carried by lymphatic drainage to the brain
40. A 80-year-old man de$elops numerous superficial blisters o$er the scalp, face, groin, and trun.
:ew lesions de$elop o$er areas sub@ected to minimal trauma. %iopsy of one of the lesions shows an
intraepidermal blister with suprabasal acantholysis. 1erologic studies are liely to show an autoantibody
directed against which of the following!
A" Anchoring filaments
%" %asement membrane proteins
#" (esmosomal proteins
(" 'emidesmosomal proteins
&" ;ntegrins
8. Which of the following best describes how #lostridium perfringens e$ades destruction by neutrophils
in patients with clostridial myonecrosis!
A" (amaging neutrophil membranes by means of a membrane-damaging to5in
%" ,re$enting contact with neutrophils by means of a polysaccharide capsule
#" ,re$enting phagocytosis by disruption of neutrophil actin polymeri<ation
(" 1ur$i$al in the cytoplasm of a neutrophil
&" 1ur$i$al in the phagosome of a macrophage
0/.
,ictureA a big mass located in the central part of the left hemisphere, mass is encapsulated with 0 different
densities, with edema around the mass" A 30-year-old man with A;(1 has a 8-wee history of progressi$e
weaness of his right hand, e5pressi$e aphasia, and a mild headache. A #T scan of the head with contrast
is shown. Which of the following is the most liely causal organism!
A" #ryptococcus neoformans
%" #ytomegalo$irus
#" ,neumocystis carinii
(" To5oplasma gondii
&" Treponema pallidum
33. The presence of which of the following is characteristic of the infectious agent of bo$ine spongiform
encephalopathy!

=:A (:A ,rotein
A" B B B
%" B B -
#" B - B
(" B - -
&" - B B
-" - B -
>" - - -
'" - - B
43. -ig.
A 36-year-old woman with type + diabetes mellitus has increasing $ul$ar pruritus and a $aginal discharge. A
wet mount preparation of the discharge is shown. Which of the following is the most liely causal organism!
A" #andida albicans
%" #hlamydia trachomatis
#" 'erpes simple5 $irus
(" 'uman papilloma$irus
&" Trichomonas$aginalis
8. A /6-year-old man who recently immigrated to the C1A from =ussia de$elops fe$er, swelling of the
nec, and difficulty swallowing. 'is $accination history is uncertain. &5amination of the throat shows a gray
membrane across the pharyn5. The pathogen responsible for this infection most liely ac4uires its $irulence
through which of the following genetic e$ents!
A" Ac4uisition of a transposon
%" #hromosomal mutation
#" #on@ugation
(" =ecombination
&" Transduction
7. A 07-year-old woman has a +-wee history of increased urinary fre4uency, dysuria, and intermittent
suprapubic pain that ha$e become worse o$er the past 3 days. &5amination of her urine is most liely to
show
A" acid-fast organisms
%" budding yeast forms
#" fungal hyphae
(" gram-negati$e bacilli
&" gram-positi$e cocci
.. A 03-year-old man who recently emigrated from #osta =ica is admitted to the emergency
department with sei<ures. -indings on e5amination of his cerebrospinal fluid are within the reference range.
A #T scan of the head shows numerous cortical lesions with calcificationsD some ha$e surrounding edema.
The life cycle of the parasite causing these lesions in$ol$es
A" the bite of a blacfly to human
%" the bite of a mos4uito to human
#" the bite of a sandfly to human
(" passage through cows
&" passage through pigs
+.. A /-year-old boy is brought to the physician?s office because of pharyngitis. #ulture of a swab from
the throat grows a E-hemolytic gram-positi$e coccus in chains. Which of the following components of the
microbe is responsible for this organism?s shape!
A" >lycoprotein
%" )ipopolysaccharide
#" )ipoteichoic acid
(" ,eptidoglycan
&" ,olysaccharide
-" Teichoic acid
38. A 78-year-old woman has pain on the right side of the trun. &5amination shows a $esicular rash
in$ol$ing the T-+6 to T-+0 dermatomes. Which of the following is a characteristic of the most liely
organism!
A" Absence of an en$elope
%" (ouble-stranded (:A
#" :egati$e-stranded =:A
(" ,ositi$e-stranded =:A
&" ,rion-lie structure
-" 1ingle-stranded (:A
43. A bacterium harboring a +/,666-base pair 2bp" plasmid that encodes resistance to tetracycline and
ampicillin segregates mutants that lose resistance to either drug. &ach independent mutant plasmid
appears to increase in si<e by appro5imately /066 bp. Which molecular e$ent best e5plains these findings!
A" -ormation of plasmid concatemers
%" -ormation of pyrimidine dimers
#" 'omologous recombination
(" ;nsertion of a transposon
&" 1lip-stranded (:A replication errors
30. )atent infection with which of the following $iruses is associated with e5pression of some 2but not all"
$iral genes in % lymphocytes!

A " &pstein-%arr $irus

% " 'epatitis % $irus

# " 9easles $irus

( " 1imian $irus 46

& " *aricella-<oster $irus
4/. A 3/-year-old man who taes street drugs intra$enously de$elops fe$er, cough, and hemoptysis. X-
ray film of the chest shows bilateral infiltrates. &chocardiogram discloses a +-cm mass that is attached to
the tricuspid $al$e. %lood culture grows yeast. The most liely causal organism is

A " Aspergillus fla$us

% " #andida albicans

# " #ryptococcus neoformans

( " 'istoplasma capsulatum

& " 9ucor species
+0. A 86-year-old man de$elops cirrhosis. 'e had multiple blood transfusions following se$ere trauma in
+.3/. 'e has no history of @aundice or hepatitis. 1erologic tests and polymerase chain reactions on his
blood will most liely show e$idence of infection with which hepatitis $irus!
A" A
% " %
# " #
( " ( 2delta"
& " &
04. A 03-year-old woman de$elops temperatures to 3..4 # 2+63 -" and substernal chest pain 3 days
after being treated by her dentist for gingi$itis. An 5-ray film of the chest shows an enlarged cardiac
silhouette. Fn pericardiocentesis, 0/6 m) of cloudy fluid containing large numbers of neutrophils is
remo$ed. Which of the following is most liely on e5amination of the fluid!
A " Acid-fast bacilli
% " %udding yeast forms
# " (:A $irus
( " >ram-negati$e bacilli
& " >ram-positi$e cocci
08. A 4/-year-old man de$elops a fe$er 4 days after an abdominal operation. %lood cultures grow
1taphylococcus aureus. Which of the following is the most liely site of infection from which the organism
gained access to the blood stream!
A " Anterior nares
% " 1putum
# " 1tool
( " Crine
& " Wound
07. An outbrea of acute pneumonia occurs in military recruits li$ing in one barrac and only in those
persons located near the air conditioner. &pidemiologic sur$eillance results in isolation of the causal
organism from the patients and from the drip pans of the air conditioner. The organism is resistant to
penicillin, susceptible to erythromycin, and wealy gram-negati$e. The most liely organism is
A " %ordetella pertussis
% " 'aemophilus influen<ae 2nontypeable"
# " Glebsiella pneumoniae
( " )egionella pneumophila
& " 9ycobacterium tuberculosis
- " 9ycoplasma pneumoniae
> " 1taphylococcus aureus
' " 1treptococcus agalactiae 2group %"
; " 1treptococcus pneumoniae
H " 1treptococcus pyogenes 2group A"
03. A 4/-year-old man has fe$er, chills, cough, and pleuritic chest pain. #ulture of a rust-colored sputum
specimen yields many I-hemolytic colonies of lancet-shaped, gram-positi$e cocci in pairs and short chains.
The most liely causal organism is
A " Glebsiella pneumoniae
% " 9ycobacterium tuberculosis
# " 9ycoplasma pneumoniae
( " 1taphylococcus aureus
& " 1treptococcus pneumoniae
- " 1treptococcus pyogenes 2group A"
48. A +.-year-old college student de$elops hematuria and proteinuria. Appro5imately 3 wees ago, he
had superficial cellulitis of the right pro5imal thigh and buttocs. 'is condition is most liely to be secondary
to infection with
A " &scherichia coli
% " ,seudomonas aeruginosa
# " 1taphylococcus aureus
( " 1taphylococcus epidermidis
& " 1treptococcus pyogenes 2group A"