MICROBIOLOGY HOMEWORK SET B (E) Enterotoxigenic E.

coli (ETEC)

NAME: D___4. A 40yo man presented with a rubeola-like rash on the

extremities, chills, fever, myalgia, and malaise 5 days after
returning from a June fishing trip in Arkansas. A history of tick
B___1. An 85yo male nursing home patient with a history bites is noted and Rocky Mountain spotted fever (RMSF) is
suspected. What is the etiologic agent of this disease?
of alcoholism suddenly developed a flu-like illness. He
complained of chills and fever and had frequent coughing (A) Babesia microti (D) Rickettsia rickettsii
spells productive of thick, bloody sputum. The attending
(B) Orientia tsutsugamushi (E) Rickettsia typhi
physician diagnosed bronchopneumonia and prescribed
antibiotics, but the patient died within a week. What is the (C) Rickettsia prowazeki
most likely cause of the patient’s pneumonia?

(A) Haemophilus infl uenzae (D) Mycoplasma pneumoniae

C___5. With reference to the above question, which
(B) Klebsiella pneumoniae (E) Streptococcus pneumoniae antimicrobial agent should be employed?

(C) Legionella pneumophila (A) Chloramphenicol (D) Penicillin G

(B) Ciprofl oxacin (E) TMP–SMZ

A___2. A bacterium was isolated from the central nervous (C) Doxycycline
system of a newborn that died of meningitis. The vagina of
the mother was colonized with the same isolate as
determined by the capsular antigen. The microbe grew D___6. Some bacteria are obligate anaerobes. Which of the
following statements best explains this phenomenon?
well on standard blood and MacConkey agar at ambient
(A) They can produce energy both by fermentation (i.e.,
atmospheric conditions. What is the most likely etiologic
glycolysis) and by respiration using the Krebs cycle and
agent?
cytochromes.
(A) Escherichia coli K1
(B) They cannot produce their own ATP.
(B) Group B Streptococcus type III capsule
(C) They do not form spores.
(C) Haemophilus infl uenzae type b
(D) They lack superoxide dismutase and catalase.
(D) Neisseria meningitidis serogroup b
(E) They do not have a capsule
(E) Streptococcus pneumoniae (encapsulated variety)

B___7. Which statement is the most accurate regarding

C___3. An adult tourist visiting a remote area of Guatemala transposons?

developed fever, prostration, malaise, dysentery, and (A) They encode enzymes that degrade the ends of the
dehydration. Based on current epidemiologic data of the bacterial chromosome.
region, a local physician reported that the causative agent
(B) They are short sequences of DNA that often encode
was probably a diarrheogenic strain of Escherichia coli and
enzymes that mediate antibiotic resistance.
did not prescribe antibiotic therapy. Presuming the
Guatemalan doctor to be correct, which type of virulent (C) They are short sequences of RNA that silence specific
regulatory genes.
E. coli is most consistent with this clinical picture?
(D) They are a family of transfer RNAs that enhance
(A) Enteroaggregative E. coli (EAEC)
mutations at “hot spots” in the bacterial genome.
(B) Enterohemorrhagic E. coli (EHEC)

(C) Enteroinvasive E. coli (EIEC)

(D) Enteropathogenic E. coli (EPEC)

C___8. Handwashing is an important means of interrupting (E) Vibrio cholerae
the chain of transmission from one person to another.
Infection by which one of the following bacteria is most
B___12. Intestinal infection with which of the following
likely to be interrupted by handwashing?
organisms should not be treated with antibiotics?
(A) Borrelia burgdorferi
(A) Clostridium diffi cile (D) Shigella sonnei
(B) Legionella pneumophila
(B) Escherichia coli O157:H7 (E) Vibrio cholera
(C) Staphylococcus aureus
(C) Salmonella typhi
(D) Streptococcus agalactiae (group B streptococcus)

(E) Treponema pallidum

A___9. Which one of the following sets of properties of
exotoxins and endotoxins is correctly matched?
(A) Exotoxins—polypeptides; endotoxins—lipopolysaccharide
(B) Exotoxins—weakly antigenic; endotoxins—highly
antigenic
(C) Exotoxins—produced only by gram-negative bacteria;
endotoxins—produced only by gram-positive bacteria
(D) Exotoxins—weakly toxic per microgram;
endotoxins—highly toxic per microgram
D___13. An 18-month-old male presents with fever, lethargy,
malaise, productive coughing, and vomiting. Culture of CSF
samples with Staph. aureus on blood agar reveals the
presence of “satellite” colonies. Serology has indicated that
the organism is polyribitol phosphate (PRP) positive. Gram
stain of the colonies indicates the presence of a
Gram-negative coccobacillus. Which one of the following
organisms is most likely responsible for the disease?
(A) Bordetella pertussis (D) Haemophilus influenzae b
(B) Campylobacter jejuni (E) Pasteurella multocida
(C) Escherichia coli

(E) Exotoxins—toxoid vaccines are ineffective;

endotoxins—toxoid vaccines are effective
C___10. Which one of the following sets consists of bacteria
both of which produce exotoxins that increase cyclic AMP
within human cells?
A___14. A 47yo woman in India is becoming blind due to
repeated infection with Chlamydia trachomatis. What is seen
in the pus draining from her eyes and stained by
immunofluorescence?
(A) Elementary bodies (D) Gram-negative diplococci

(A) Vibrio cholerae and Corynebacterium diphtheriae (B) Inclusion bodies (E) Gram-positive diplococci

(B) Clostridium perfringens and Streptococcus pyogenes (C) Negri bodies

(C) Escherichia coli and Bordetella pertussis

(D) Corynebacterium diphtheriae and Staphylococcus aureus
(E) Bacillus anthracis and Staphylococcus epidermidis
D___11. Which of the following bacterial agents has the
lowest infective dose for producing gastrointestinal disease
in the human host?
(A) Enteropathogenic Escherichia coli
(B) Enterotoxigenic Escherichia coli
(C) Salmonella (nontyphoid serotypes)
(D) Shigella fl exneri
C___15. A resident in his first week of OPD work prescribes
erythromycin for the treatment of a UTI, presumably a simple
case of E. coli. The attending physician countermands the
resident’s order and prescribes TMP– SMZ. Why is the
therapeutic choice by the attending more appropriate?
(A) Bacterial glycocalyx impedes the absorption of
erythromycin
(B) Erythromycin is likely to be inactivated by transpeptidases
(C) Macrolides are principally secreted in the feces
(D) Macrolides promote Candida overgrowth in women
(E) Oral macrolides are linked to Stevens–Johnson syndrome
C___16. A number of antivirals are termed nucleoside (C) Reverse transcriptase polymerase chain reaction
analogs. Which one of the following best describes the mode
(D) Western blot
of action of nucleoside analogs?
(E) Viral culture
(A) Insert within the helix of DNA to prevent viral replication

(B) Bind to ribosomes and prevent anticodon–codon

interactions thereby inhibiting protein synthesis A___20. As part of the initial workup of this patient, the
genotype of HCV was determined. What is the clinical
(C) Substitute for nucleosides resulting in replication
significance of genome testing?
termination (chain termination).
(A) Predicts response to therapy
(D) Bind directly to DNA polymerase binding sites on viral
genome to prevent viral replication (B) Predicts risk of cirrhosis
(E) Bind directly to RNA polymerase binding sites on viral (C) Predicts risk of extrahepatic manifestations of
genome to prevent expression of viral gene products
disease

(D) Predicts risk of hepatoma

E___17. A 28yo man was clinically diagnosed with the flu
after presenting to his physician with a fever of 102 °F, severe (E) Predicts viral load
myalgia, fatigue, and rhinorrhea of 12h duration. Local health
department reports said both AH1N1 and B viruses were
D___21. Three years following diagnosis with hepatitis C virus,
circulating in the area. Which medication did she most likely
liver biopsy from the above patient reveals sufficient
prescribe?
damage to consider antiviral therapy. With which drug
(A) Amantadine (D) Ritonavir
combination should she be treated?
(B) Foscarnet (E) Zanamivir
(A) Adefovir plus lamivudine
(C) Ribavirin
(B) Amoxicillin plus sulbactam
A___18. A 43yo man, recently infected with hepatitis C virus,
(C) Lamivudine plus zidovudine
donates blood during the window period of the infection. The
blood is screened for antibodies to HCV and other (D) Pegylated interferon and ribavirin
bloodborne agents. What is the clinical signifi cance of the
time period during which the screening was performed? (E) Trimethoprim plus sulfamethoxazole

(A) Anti-HCV antibodies would not be demonstrable

(B) His blood would be rejected for donation based on the B___22. An infant is born prematurely in February.
antibody test results Concerned about the risk of serious infection with respiratory

(C) He would be negative for antibodies to HCV by ELISA, but
positive by western blot
(D) The results of the screening test would be reported to the
health department
syncytial virus, he is treated with the monoclonal antibody
palivizumab before being released from the hospital. What is
the viral target of this monoclonal antibody?
(A) Capsid protein (D) Neuraminidase protein

(E) Viral RNA tests would be negative (B) Fusion protein (E) Matrix protein

(C) Hemagglutinin protein

C___19. A 40yo woman is found to have slightly elevated

serum liver enzymes during an insurance physical. Follow-up
investigations revealed antibodies to hepatitis C virus. What
test could be done to distinguish between current infection
and previous infection with full recovery?
(A) ELISA
(B) Indirect fl uorescent antibody
A___23. A 56yo woman in Florida dies of eastern equine
encephalitis virus. Viral activity had been detected at that
time by the local health department in which reservoir and
vector species, respectively?
(A) Birds; mosquitoes
(B) Cattle; soft bodied ticks of the following microscopic fi ndings would be most

(C) Foxes; hard bodies ticks supportive of a scabies diagnosis?

(D) Horses; mosquitoes (A) Mesocercariae (D) Nits and louse fragments

(E) Rats; fleas (B) Mite ova and scybala (E) Nurse cells and larvae

(C) Nematode microfi lariae

C___24. A 23yo heterosexual male was diagnosed with acute

retroviral syndrome. His CD4 count and viral load at the time
E___28. An HIV-positive student is considering part-time
of diagnosis were 450/μL (normal 500 to 1,500) and 80,000
work to help with living expenses. Of the following jobs,
copies, respectively. He returns in 6 weeks, and is
which would be the most suitable, especially when
asymptomatic. What changes in the CD4 count and viral load
considering the potential for contracting cryptosporidiosis?
are typically expected at this time in the infection?
(A) Assistant at an animal hospital
(A) Decrease in CD4 cells, decrease in viral load
(B) Child day care worker
(B) Decrease in CD4 cells, increase in viral load
(C) Life guard at a public pool
(C) Increase in CD4 cells, decrease in viral load
(D) Pet store attendant
(D) Increase in CD4 cells, increase in viral load
(E) Print shop worker
(E) No significant change would be expected

D___29. An 18yo woman preparing to enter college is

D___25. A 21yo man infected with herpes simplex virus-type
required to be up-to-date on vaccinations. In addition to
2 is given an antiviral drug that interferes with the production
required childhood vaccinations, students entering college
of viral early proteins. What is the function of the early
are often required to be vaccinated against which organism?
proteins in the replication of herpes viruses?
(A) Chlamydia trachomatis (D) Neisseria meningitidis
(A) Assembly
(B) Hepatitis C virus (E) Treponema pallidum
(B) Capsid formation
(C) Human papillomavirus
(C) Penetration into the nucleus
D___30. A 54yo man is being treated with anticancer drugs,
(D) Replication of viral DNA
which have reduced the production of white blood cells from
(E) Translation of viral mRNA his bone marrow. He develops an infection with an organism
that does not cause disease in immunologically healthy
individuals. What description best fits this infection?
A___26. Which of the following microbiologic properties
(A) Asymptomatic (D) Opportunistic
distinguishes Entamoeba. histolytica from nonpathogenic
(B) Chronic (E) Persistent
ameba like E. dispar?
(C) Latent
(A) Ability to produce cytotoxins

(B) Characteristic shape of the cyst

B___31. A 15yo boy with acne is being treated with a topical
(C) Colonization of the colon
antimicrobial. Which organism is associated with this disease
(D) Fecal-oral route of transmission and with which antimicrobial is he most likely being treated?

(E) Number of nuclei in the troph (A) Malassezia furfur/Ketoconazole

(B) Propionibacterium sp./Clindamycin

B___27. A resident performs a skin scraping on a child (C) Staphylococcus aureus/Cloxacillin

suspected of being infested with Sarcoptes scabiei. Which
(D) Streptococcus pyogenes/Penicillin
(E) Trichosporon sp./Clotrimazole (D) Helicobacter pylori

(E) Proteus vulgaris

E___32.A 42yo man with HIV, presenting for his regular

checkup, is found to have a CD4 cell count of 180/cmm. He is
given a prescription for TMP–SMZ for the prevention of
which opportunistic pathogen?

(A) Cryptococcus neoformans C___36. How is successful treatment of the condition in the
(B) Cryptosporidium parvum above case best determined?
(C) Histoplasma capsulatum (A) Resolution of symptoms (D) Hemoccult test
(D) Mycobacterium avium complex (B) Endoscopy (E) Stool culture
(E) Pneumocystis jiroveci (C) Urea breath test

E___33. A 67yo hospitalized woman was treated for 7 days D___37. A 14yo girl presented with an itchy, erythematous
with clindamycin and cefuroxime for a postsurgical infection
when she developed profuse, watery diarrhea, cramping rash following exposure to poison ivy. Which term describes
abdominal pain, and fever. An enzyme immunoassay of the the role of poison ivy oils in this response?
stool revealed the presence of a bacterial enterotoxin. How
(A) Allergen (D) Hapten
should this woman be treated?
(B) Carrier (E) Immunogen
(A) Continue clindamycin and cefuroxime
(C) Cytokine
(B) Amoxicillin plus clavulanate

(C) Ceftriaxone
C___38. A 4yo child has atopic dermatitis due to severe
(D) Ciprofl oxacin
allergies to dust, animal dander, and many kinds of pollens.
(E) Metronidazole Mediators released from which cell type are responsible for
the clinical manifestations immediately following exposure to
these substances?
D___34. Which virulence factor of the etiologic agent in the (A) B cells (D) Th1 cells
above case contributes to its ability to cause nosocomial (B) Macrophages (E) Th2 cells
infections? (C) Mast cells
(A) Intracellular growth (D) Spore formation

(B) Lipopolysaccharide
(C) Shiga toxin production
(E) Type III secretion system C___39. A 36yo woman with severe allergy to yellow jackets
was stung multiple times at a soccer game. Within minutes
she developed respiratory distress and became unconscious.
Which mediator is primarily responsible for this reaction?

D___35. A 57yo man complains of worsening abdominal pain (A) Complement (D) TNF
for the past 2 months, which he describes as heartburn. He
(B) IgG (E) Norepinephrin
notes that the pain improves temporarily with food, or by
taking antacids. Definitive diagnosis includes serology to (C) Histamine
detect antibodies to which organism?

(A) Adenovirus
B___40. In order for class switching from IgM to IgG to occur,
(B) Cryptosporidium parvum B cells must receive two signals, one generated following
binding to T helper cells and the other secreted
(C) Enteroaggregative Escherichia coli
by helper T cells. What are these two T helper cell-derived (B) Complement activation

molecules? (C) Direct lysis of bacterial cells

(A) Antigen and IL-2 (D) B7 and IL-7 (D) Neutralization of bacterial toxins

(B) CD40 ligand and interferon-γ (E) CD20 and IL-13 (E) Opsonization

(C) CTLA-4 and IL-4

B___45. Neutrophils are attracted to the sites of extracellular

bacterial infections by which two important chemotactic
E___41. What structural feature is uniquely found on IgA in
substances?
breast milk and not found on serum IgM?
(A) Bacterial mannose and lipopolysaccharide
(A) Fab (D) J chain
(B) Complement C5a and interleukin-8 (CXCL-8)
(B) FcR (E) Secretory piece
(C) Histamine and complement C3b
(C) Hinge region
(D) Interleukin-7 and interleukin-16

(E) Leukotriene B4 and granulocyte colonystimulating

E___42. Macrophages recognize microorganisms through the
factor (G-CSF)
interaction of microbial substances with what type of

receptors on macrophages?
C___46. The difference between tolerance and immunity
(A) Antigen receptors
depends upon the maturation status of the antigen
(B) Complement receptors presenting dendritic cells. What is the T-cell outcome of an
antigen presentation event by a mature dendritic cell?
(C) Fc receptors
(A) Anergy (D) Ignorance
(D) Membrane immunoglobulin
(B) Apoptosis (E) Suppression
(E) Pattern recognition receptors
(C) Activation

B___43. Persons with helminth infections mount

immunologic responses that involve IgE and eosinophils.
Which two cytokines are most important for these responses
to occur?
(A) IL-1 and tumor necrosis factor (TNF)
(B) IL-4 and IL-5
(C) IL-10 and transforming growth factor beta
(TGF-β)
B___47. A 67yo woman is hospitalized with a fever of
unknown origin. An elevated C-reactive protein (CRP) and
erythrocyte sedimentation rate (ESR) suggest an ongoing
systemic infl ammatory response. Which cytokine is
especially important in inducing elevations in CRP and ESR?
(A) Interleukin-4 (D) Interleukin-12
(B) Interleukin-6 (E) Interleukin-18
(C) Interleukin-10

(D) IL-12 and interferon gamma (IFN-γ)

(E) IFN-α and IFN-β
B___44. A person developed an extracellular bacterial
infection, and IgM was made in response. What is the
E___48. A 23yo female presents with fatigue, right eye pain,
right leg weakness, and sensory loss. Her mother has multiple
sclerosis (MS). Which lab test result, if found in this patient,
supports a diagnosis of MS?
(A) Elevated erythrocyte sedimentation rate

most important protective function of IgM in this infection? (B) Elevated glucose in the cerebral spinal fl uid (CSF)

(A) Antibody-dependent cell cytotoxicity (C) IgM to human herpesvirus type 6 in the serum
(D) Neutrophilic pleocytosis of CSF

(E) Oligoclonal bands of IgG in CSF

E___49. A 66yo man with advanced pancreatic cancer

develops cachexia. Which cytokine is primarily responsible

for the cachexia seen in certain patients with cancer or
debilitating infections?

(A) Interferon-α (D) Transforming growth factor-β

(B) Interleukin-7 (E) Tumor necrosis factor-α

(C) Interleukin-17

D___50. What is the most common primary immune

deficiency disorder?

(A) Bruton agammaglobulinemia

(B) Common variable immunodefi ciency

(C) Leukocyte adhesion defi ciency

(D) Selective IgA defi ciency

(E) X-linked severe combined immunodefi ciency