Session 154 – Principles of Microbiology and Infectious Disease I
1. Which of the following is the leading cause of death due to communicable diseases in the world?
Heart Disease
TB
Cancer
Lung Infections
HIV/AIDS
Answer D.
2. Which of the following terms is best described as what takes place when an organism harmfully invades?
Colonization
Infection
Toxin
Pathogen
Disease without colonization
Answer B.
3. Which of the following transmission styles would be classified as a form of contact?
Transplacental
Biting Insects
Droplets
Airborne
Food/Water
Answer A.
4. Which of the following epidemiologic terms is best defined as an infectious disease that spreads rapidly to many people?
Surveillance
Endemic
Outbreak
Epidemic
Pandemic
Answer D.
5. Coinfection with COVID-19 has caused the death rate of those with preexisting lung diseases to rise. How will this affect the incidence and prevalence?
Neither incidence or prevalence change
Incidence is unchanged, prevalence increase
Incidence is unchanged, prevalence decreases
Incidence increases, prevalence increases
Incidence decreases, prevalence decreases
Answer C.
6. A wave of anti-vaxers has led to a decrease in vaccination usage for a particular disease. How will this affect incidence and prevalence for that disease?
Neither incidence or prevalence change
Incidence is unchanged, prevalence increase
Incidence is unchanged, prevalence decreases
Incidence increases, prevalence increases
Incidence decreases, prevalence decreases
Answer D.
7. Garrett put on his yeehaw pants and went to the shooting range with his new quarantine pistol. After the first magazine, the target looks like the one pictured above. Which of the following could be said about it in relation to accuracy and precision?
It had a low accuracy and low precision
It had a low accuracy and high precision
It had a high accuracy and low precision
It had a high accuracy and high precision
He’s definitely getting robbed if he shoots like that
Answer A.
Session 155 – Principles of Microbiology and Infectious Disease II
8. Which of the following diagnostic tests indicates the likelihood that a non-sick person tests negative?
Sensitivity
Specificity
PPV
NPV
PPV:NPV ratio
Answer B.
9. Which of the following has the equation of TP/(TP+FN)?
Sensitivity
Specificity
PPV
NPV
PPV:NPV ration
Answer A.
10. Which test do you utilize when ruling IN a disease?
Sensitivity
Specificity
PPV
NPV
PPV:NPV ration
11. Within the threshold for disease application, what happens when you shift the happy medium to the left?
Decrease Specificity, Increase PPV
Increase Specificity, Increase PPV
Increase Sensitivity, Decrease PPV
Decrease Sensitivity, Decrease NPV
Decrease Specificity, Decrease NPV
Answer C.
12. Prevalence has a HUGE impact, in Atchley’s words, on which of the following diagnostic values?
Sensitivity
Specificity
PPV
NPV
Social Distancing
Answer C.
Session 156 – Microbiology Lab Diagnostics – Introduction
13. Viral hepatocyte damage would be most closely associated with which liver diagnostic test?
ALT
AST
ALP
GGT
Bilirubin
Answer A.
14. Which of the following would be the best indicator of recent alcohol consumption?
ALT
AST
ALP
GGT
Bilirubin
Answer D.
15. Which of the following would suggest an elevated white blood cell count in a CBC due to a bacterial source?
Thrombocytopenia
Polycythemia
Neutrophilia
Lymphocytosis
Neutrophilia
Answer E.
16. Which of the following urine dipstick measurements would suggest an urinary tract infection?
pH
Nitrite
Ketone
Leukocyte esterase
Glucose
Answer D.
17. Which of the following would be positive in an individual with a Hepatitis B Immunization?
HBsAg
Anti-HBsAg
HBeAg
anti-HBeAg
Anti-HBcAg
Answer B.
Session 157 – Microbiology Lab Diagnostics – Microscopy I
18. What is the correct step by step process of the gram stain?
Crystal Violet → Safrinin → Alcohol → Iodine
Iodine → Crystal Violet → Alcohol → Safrinin
Crystal Violet → Iodine → Alcohol → Safrinin
Crystal Violet → Alcohol → Iodine → Safrinin
Crystal Violet → Alcohol → Safrinin → Iodine
Answer C.
19. What color do gram negative and gram positive bacteria stain in a gram stain respectively?
Purple; Red
Blue; Purple
Red; Pink
Red; Purple
Blue; Green
Answer D.
20. Neisseria and Moraxella are two examples of ….?
Gram Positive Cocci
Gram Negative Cocci
Gram Positive Bacillus
Gram Negative Bacillus
Gram Positive Streptococci
Answer B. Nisseria and Moraxella are the only two cocci that are gram negative. All other cocci are gram positive.
21. Rickettsia and Chlamydia are two microbes that gram stain poorly due to….
Being obligate intracellular microbes
Being too thin
Having a high lipid content in their cell walls
Having no cell wall
Being too difficult to culture
Answer A. B references Treponema; C references Mycobacteria; D references Mycoplasma; E is made up.
22. A patient is suspected to have contracted the herpes virus, what process will be used to confirm your suspicions?
Acid Fast Stain
Gram Stain
Trichrome Stain
Tzanck Stain
India Ink Stain
Answer D.
Session 158 – Microbiology Lab Diagnostics – Microscopy II
23. What is the correct order for acid-fast staining?
Carbolfuchsin → Heat Fix → Acid-Alcohol → Methylene Blue
Methylene Blue → Heat Fix → Acid-Alcohol → Carbolfuchsin
Heat Fix → Carbolfuchsin → Acid-Alcohol → Methylene Blue
Heat Fix → Acid-Alcohol → Carbolfuchsin → Methylene Blue
Acid-Alcohol → Heat Fix → Carbolfuchsin → Methylene Blue
Answer C.
24. A positive Auramine-Rhodamine acid-fast test will result in staining the acid-fast organism what color?
Red
Purple
Blue
Apple Green
Silver
Answer D.
25. An acid-fast stain is used to stain what organism in particular?
Mycoplasma
Mycobacterium
Nocardia
Legionella
Cryptococcus
Answer B.
26. What is the characteristic microscopic sign that you are looking at the US parasite that is often mistaken as malaria?
Dark Halos
Maltese Crosses
Multinucleated “giant cells”
Schizonts
Trophozoites
Answer B.
27. It is important to ensure that a proper sputum sample is collected. What is a quick indicator that your patient did not collect sputum, but instead collected spit?
High levels of neutrophils
High levels of endothelial cells
Low levels of amylase
Frothy sample
Not collected within the first hour of waking
Answer B.
Session 159 – Microbiology Lab Diagnostics – Culture and Sensitivity
28. Minimum Inhibitory Concentration (MIC) is best described by which of the following?
A concentration greater than the Minimal Bactericidal Concentration (MBC)
Its value is indicated by a test tube concentration that is the most turbid
The greatest drug concentration that inhibits the bacterial replication
The minimal drug concentration that kills the bacteria
None of the above
Answer E.
29. Which of the following agar media is best for differentiating alpha, beta, and gamma hemolysis?
Blood agar
Chocolate agar
Eosin Methylene Blue agar
MacConkey agar
Mannitol salt agar
Answer A.
30. Which of the following agar media is best for differentiating Staphylococcus aureus from other coagulase negative staphylococci?
Blood agar
Chocolate agar
Eosin Methylene Blue agar
MacConkey agar
Mannitol salt agar
31. Which of the following agar media is best for differentiating lactose fermenters from non-lactose fermenters?
Blood agar
Chocolate agar
Eosin Methylene Blue agar
MacConkey agar
Mannitol salt agar
Answer D.
32. Identify the most likely pathogen from the following lab results:
Bacitracin: resistant
Blood agar: beta-hemolytic
Catalase: negative
Gram stain: purple cocci
Mannitol salt agar: no growth
E. coli
Sta. aureus
Sta. epidermidis
Str. agalactiae (GBS)
Str. pyogenes (GAS)
Answer D.
33. Identify the most likely pathogen from the following lab results:
Catalase: positive
Coagulase: negative
Gram stain: purple cocci
Mannitol salt agar: pink
E. coli
Sta. aureus
Sta. epidermidis
Str. agalactiae (GBS)
Str. pyogenes (GAS)
Answer C.
34. Identify the most likely pathogen from the following lab results:
Bacitracin: sensitive
Blood agar: beta-hemolytic
Catalase: negative
Gram stain: purple cocci
Mannitol salt agar: no growth
E. coli
Sta. aureus
Sta. epidermidis
Str. agalactiae (GBS)
Str. pyogenes (GAS)
Answer E.
35. Identify the most likely pathogen from the following lab results:
Catalase: positive
Coagulase: positive
Gram stain: purple cocci
Mannitol salt agar: yellow
E. coli
Sta. aureus
Sta. epidermidis
Str. agalactiae (GBS)
Str. pyogenes (GAS)
Answer B.
Session 160 – Microbiology Lab Diagnostics – CBC and Body Fluids
36. A 56 year-old male presents to the E/R with fever, myalgia, and an indurated, purulent nodule on his left forearm. Blood and wound cultures are taken, and blood is drawn for hematologic lab analysis. CBC with differential indicates a left shift with an abnormal increase in the patient’s WBC. Which of the following cell types would you expect to see in a greater quantity compared to normal corresponding to the left shift?
Reticulocyte
Metamyelocyte
Lymphocyte
Basophil
Megakaryocyte
37. A 26 year-old female presents to the E/R with hematuria, dysuria, pelvic inflammation, and increased urinary frequency. She claims that she just returned from a medical mission trip to Uganda where she took several “selfies” of herself wading in the Nile River. Microscopic urinalysis shows several spined-eggs in the patient’s urine belonging to the helminth, Schistosoma haematobium. Her CBC would show a spiked increase in which of the following cell types that also induces the release of histamine in such parasitic infections?
A
B
C
D
E
38. A 19 year old male presents to the E/R with sore throat, fever, night sweats, and constant fatigue. He notes that he is sexually active with multiple partners at his university and that there has been a “strep”-bug going around in his dorm. PE reveals cervical lymphadenopathy. A CBC yielded the following results where a significant portion of lymphocytes were atypical in morphology. Additional labs were ordered with their results provided below. Which of the following preliminary interpretations is the most likely given the laboratory results and patient presentation?
Rapid Strep Test :: Negative
Heterophile Antibody Test :: Negative
CSF Gram Stain :: No organisms seen (NOS)
Group A Streptococcus infection
Mononucleosis infection
Cytomegalovirus infection
Group B Streptococcus infection
Staphylococcus epidermidis infection
39. A 38 year old female presents to the E/R with mental confusion, sensitivity to light, fevers, chills, and an aching, stiff neck. Brudzinski’s neck sign is positive on physical examination. You proceed to perform a spinal tap and collect the CSF in in three tubes labeled:
Tube 1 :: Tube 2 :: Tube 3
You tell the surgical assistant to deliver the tubes to the appropriate departments in the hospital laboratory, but they have no idea where they need to go. You correctly explain to them that:
Tube 3 needs to go to Microbiology for the Cell Count and Differential.
Tube 1, the bloodiest sample, needs to go to Chemistry for Glucose and Protein analysis.
Tube 2 needs to go to Hematology for the Cell Count and Differential.
Tube 3, the least bloody sample, needs to go to Chemistry for Glucose and Protein analysis.
Tube 1 needs to go to Microbiology for the Gram Stain and Culture.
40. The CSF Gram Stain for the previous case was reported to have “Gram Positive Cocci in Pairs and Clusters.” Which of the following CSF laboratory findings would you expect to see that coincide the Gram Stain report?
Clear fluid: Normal PMNs: Marked lymph increase: Normal protein & glucose
Viscous fluid: Slight PMN increase: Marked lymph increase: Normal protein: Decreased glucose.
Cloudy fluid: Marked PMN increase: Normal lymphs: Marked protein increase: Decreased glucose.
Viscous fluid: Normal PMN: Marked lymph increase: Normal protein: Decreased glucose.
Clear fluid: Slight PMN increase: Normal lymphs, protein, & glucose.
41. What are the two most common tests for monitoring inflammation?
C-reactive protein and PT/INR
ESR and platelet count
C-reactive protein and ESR
WBC and PT/INR
WBC and C-reactive protein
Session 161 – Microbiology Lab Diagnostics – Serology
42. A patient comes in with jaundice and elevated ALT levels. You want to see if they potentially have hepatitis so you go to get a blood draw and the titers show a 1:32 concentration of Anti-HepB IgG. You ask the patient to come back in two weeks for a redraw at which time the titers show a 1:256 concentration of Anti-HepB IgG. What conclusion can be drawn?
The patient has had a past Hepatitis B infection
The patient has an acute Hepatitis B infection
The patient has been vaccinated against Hepatitis B
A mistake must have been made in the lab
The patient does not have and has never had Hepatitis B
Answer B.
43. Which of the following correctly matches the type of ELISAs with its probes?
Direct and indirect ELISA and antigen
Direct and indirect ELISA and antibody
Direct ELISA and antigen. Indirect ELISA and antibody
Direct ELISA and antibody. Indirect ELISA and antigen
Direct ELISA and antigen or antibody
Indirect ELISA and antigen or antibody
Answer C.
44. As a part of ongoing research into injecting healthy persons serum with COVID19 resistance, the above ELISA was performed to test patients for resistance to COVID-19. Wells 2-12 correspond to different participants (numbered 2-12). The A-G represents lessening concentrations of COVID19 which are halved with each dilution. If the ELISA is specific up to a concentration of 1:8, which of the following patients were most likely resistant to COVID?
Patient 1
Patient 2
Patient 3
Patient 7
Patient 9
Answer B If you chose A, read the question carefully, that row was left empty. As you move down the plate the concentration goes 1:2, 1:4, 1:8 and so on. The only column that does not go more than 1:4 is column B.
45. Your friend calls you crying because she has been trying to get pregnant and yet again the test came back negative, even after her period is five days late. She tells you this test didn’t even have one line come up like the last negative tests have. Which of the following advice should you give your friend?
The test is positive, no lines means that the HCG in her urine went all the way to the absorbing pad
The test is negative, no lines means that there is no HCG in her urine to make the line appear
See if she accidently took a fertility test instead since those tests do not have a line that shows up unless you are ovulating
The test is faulty and she should try another one
Try again in a week when she has more HCG in her body
Answer D this test didn’t even have the control line come up with anti-reporter meaning that the test itself did not work.
46. Which of the following ratios of antibody: antigen would result in the most agglutination?
1:4
1:2
1:1
2:1
4:1
Answer C. This would be the equivalence point where there would be the maximal amount of cross-linking.
Session 162 – Bacteria: Introduction
47. Which of the following is NOT a mechanism by which normal flora promote health in an individual?
Occupy space
Generate antimicrobial products
Maintain vaginal acidic environment
Increase water excretion
Produce Vitamin K
Answer D.
48. Which of the following is NOT found in or an accessory structure of a typical bacterium?
A single circular chromosome in a nucleoid
80s Ribosomes
A cell wall
A flagella made of flagellin
Conjugation pili
Answer B.
49. Which of the following are contained within the cell wall of a gram positive bacterium?
O antigen
Lipid A
Mycolic Acid Lipids
Teichoic Acids
Porin channels
Answer D.
50. What is the mechanism of action of the antibiotic Penicillin?
Bind and inactivates 70s ribosomes
Creates pores in the cell wall causing lysis
Disrupts DNA replication leading to cell death
Prevents the addition of teichoic acids
Binds and inhibits transpeptidase
Answer E.
51. Why must a physician be careful when giving antibiotics to an individual with sepsis caused by a gram negative bacteria?
Antibiotics don’t work well on gram negative bacteria due to their thin cell walls
A physician should always be careful when administering antibiotics and assess for allergies
The release of too much lipid A can cause a patient to go into shock
Antibiotics can force bacteria to form spores which can later germinate and relapse the disease state
Free floating bacterial DNA can be toxic in large amounts
Answer C.
52. Which of the following terms describe an organism that can live without oxygen but will preferentially utilize it if it is available?
Obligate aerobe
Capnophiles
Facultative anaerobe
Aerotolerant anaerobes
Obligate anaerobe
Answer C.
53. Which of the following is NOT an obligate aerobe?
Legionella
Pseudomonas
Bacteroides
Nocardia
Bacillus
Answer C.
54. Which of the following is NOT an obligate anaerobe?
Mycobacterium
Bacteroides
Fusobacterium
Clostridium
Actinomyces
Answer A.
55. During which phase of the bacterial growth curve are antibiotics the most effective/useful?
Lag phase
Log/exponential phase
Stationary phase
Death/decline phase
None of the above, everyone knows antibiotics are for viral infections
Answer B.
56. Which type of toxin could lead to flaccid paralysis of muscle?
Endotoxin
Neurotoxin
Enterotoxin
Pyrogenic exotoxin
Tissue invasive exotoxin
Answer B.
Session 163 – Bacteria: Microbial Genetics
57. This type of genetic transfer is the uptake of DNA from the environment?
Conjugation
Transformation
Transduction
HFR
Phage genetic transfer
Answer B.
58. After phage injects its DNA, what is the next step in the LYSOGENIC phase?
Transcription of phage genome
Translation of phage genome
Replication of phage genome
Integration of phage genome
Breakdown of host genome
Answer D.
59. What technique of genetic transfer was used to determine the time-of-entry mapping of genes?
Conjugation
Transformation
Transduction
HFR
Phage genetic transfer
Answer D.
60. What is the correct order for the tryptophan operon?
Cys; A; B; C; E
Cys; B; A; C; E
Cys; E; C; B; A
Cys; E; C; A; B
B; A; C; E; Cys
Answer C.
61. Which of the following toxins are genetic and are NOT bacterial toxins that are transferred to non-toxic strains via lysogenic phage?
SpeC Exotoxin
Botulinum Toxin
Shiga toxin
Verotoxin
Diplopia toxin
Answer E.
Session 164 – Bacteria: Virulence Factors
62. Which of the following does NOT have a capsule?
E. coli
H. influenzae
S. pneumoniae
N. meningitidis
S. aureus
Answer E.
63. Protein A is a key virulence factor that is found on ___ that creates a Fab cloak by binding to ___?
E. coli; IgM
E. coli; IgG
H. influenzae; IgM
H. influenzae; IgG
S. aureus; IgM
S. aureus; IgG
Answer F.
64. Which of the following is NOT a key characteristic of endotoxins?
Mostly produced by gram (-) bacteria
Highly toxic
Triggers IL-1/IL-6 release
Released from the LPS via cell lysis
Does not promote enzymatic activity
Answer B.
65. Which of the following exotoxins damages the cell by binding to the 60S ribosome without invading the cell?
B. pertussis
C. diphtheria
P. aeruginosa
Shigella
EHEC
Answer E.
66. Which of the following exotoxins inhibits GABA and glycine release which leads to ‘rigid’ muscles?
C. tetani
C. botulinum
B. pertussis
Shigella
EHEC
Answer A.
Session 165 – Bacteria: Gram Positive Cocci I
67. After isolating an unknown bacteria, you determine it to be a gram positive cocci due to its round and purple appearance. Based upon symptomatology you expect the bacteria to be Staph. Aureus. What test result will help you not only confirm it to be Staph. Aureus, but also differentiate it from other gram positive cocci?
Catalase (+)
Catalase (-)
Coagulase (+)
Coagulase (-)
Oxidase (+)
Answer C. A positive coagulase test will differentiate Aureus from the other gram positive cocci. A Catalase test will help you differentiate between Staph and Strep bacteria (Staph – Catalase (+); Strep – Catalase (-).
68. Which is an appropriate description of Staph aureus?
Alpha Hemolytic
Catalase Negative
Coagulase Negative
Mannitol Fermenter
Lactose Fermenter
Answer D. Staph Aureus is Beta Hemolytic, Catalase positive, Coagulase positive, and a Mannitol fermenter (turns yellow on mannitol salt agar)
69. A 5 y/o patient presents to your clinic with blisters and a positive Nikolsky sign with gentle touch. You recognize the presentation as one consistent with a Staph aureus exotoxin that liquifies the stratum granulosum layer of the skin. What is that exotoxin?
Panton-Valentine Leukocidin (PVL)
Exfoliatin
TSST
Enterotoxin
Scalded Skin Syndrome Toxin A
Answer B.
70. Determine the diagnosis based upon the following clues:
This infection is most commonly caused by Staph aureus
In patients with sickle cell disease this infection is most commonly caused by Salmonella
If there is direct penetrating trauma in a wet environment, Pseudomonas aeruginosa can cause this infection as well.
Toxic Shock Syndrome
Scalded Skin Syndrome
Osteomyelitis
Pharyngitis
Food Poisoning
Answer C.
71. What important gene in MRSA codes for an altered penicillin binding protein that does not allow Penicillin to bind to the bacteria?
Penicillinase
aPBP
Optochin
mecA
MRSA-1G
Answer D.
Session 166 – Bacteria: Gram Positive Cocci II
72. What test will help you differentiate Group A Strep from Group B Strep?
Coagulase
Catalase
Oxidase
Optochin
Bacitracin
Answer E.
73. A patient visits your clinic complaining of a rash that covers the majority of their body aside from the palms and head and a sore throat. Upon inspection, you also notice what can only be described as a “strawberry tongue”. What is the most likely diagnosis of this patient?
Rheumatic Fever
Scarlet Fever
Post-Streptococcal Glomerulonephritis
Rocky Mountain Spotted Fever
Cellulitis
Answer B.
74. How would one differentiate Strep pneumo from Strep viridans?
Bacitracin resistance
Optochin resistance
Amoxicillin resistance
Acid-fast stain
Hemolysis typing on blood agar
Answer B. Strep Pneumo is Optochin sensitive whereas Strep Viridans is Optochin resistant
75. When looking at a gram stain of Strep pneumo, what are you expecting to see?
Red circles
Purple circles
Purple back to back lancets
Purple rods
Red rods
Answer C.
76. Strep pneumo is the most common cause of what infection in children?
Pneumonia
Otitis Externa
Osteomyelitis
Otitis Media
Gingivitis
Answer D.
77. 4-month old Maggie is brought into the pediatrician’s office by her mother, who says that Maggie has been clutching at her left ear for the past 2 days. Upon otoscopic examination, Maggie is found to have acute otitis media, for which she is prescribed a 7-day course of amoxicillin. Which of the following is the most likely organism causing this?
Staphylococcus aureus
Streptococcus viridans
Streptococcus pneumoniae
Staphylococcus epidermidis
Answer Choice
78. Which of the following differentiates Streptococcus agalactiae from other Streptococcus species?
Optochin sensitivity
CAMP test
Bacitracin sensitivity
Coagulation testing
Answer B.
79. On your internal medicine rotation, you encounter a 55 year old male patient presenting with fever, new-onset murmur, and non-tender reddish spots on his palms and the soles of his feet. The patient’s history reveals past heroin usage. Given his history and presentation, you quickly suspect acute bacterial endocarditis and immediately order blood draw for surveillance cultures and a stat echocardiogram. Which organism is the most likely culprit?
Staphylococcus saprophyticus
Enterococcus faecium
Streptococcus pneumoniae
Staphylococcus aureus
Answer D.
80. You encounter a 77 year old male patient on a cardiology rotation who recently received an aortic valve replacement for treatment of aortic stenosis. The patient reports feeling febrile and fatigued, and you notice characteristic non-tender red spots on his hands and feet. Suspecting endocarditis, what would be the most likely causative organism?
Staphylococcus epidermidis
Staphylococcus aureus
Streptococcus pyogenes
Streptocuccus viridans
Answer A.
81. A patient at your family practice clinic presents with patchy white exudate in their throat as shown below
You suspect bacterial pharyngitis due to Strep. pyogenes, and quickly obtain a throat culture. Which of the following is NOT one of the serious sequelae that could potentially result from this infection?
Scarlet fever
Post-streptococcal glomerulonephritis
Rheumatic fever
Lobar pneumonia
Answer D.
Session 167 – Bacteria: Gram Negative Bacilli
82. Lactose fermenters typically present as which color growth on MacConkey agar?
Blue
Clear
Green
Pink
Yellow
Answer D.
83. Identify the most likely pathogen from the following lab results and physical exam:
Gram stain: red bacilli
MacConkey agar: rapidly growing purple colonies, smelling of grapes, swarmer
Patient exam: currant jelly sputum, rose spots
Aeromonas hydrophila
E. coli
Enterobacter
Klebsiella pneumoniae
Pseudomonas aeruginosa
Answer D.
84. How does the classical presentation of Salmonella typhi differ from non-typhoidal strains of Salmonella?
Rose spots
Temperature dissociation
Constipation preceding non-bloody diarrhea
Rash
All of the above
Answer E.
85. Which E. coli antigen increases the risk of meningitis in a newborn?
H antigen
K antigen
O antigen
All the above
None of the above
Answer B.
86. Which of these is slowest in lactose fermentation?
Klebsiella pneu
moniae Enterobacter
Citrobacter
Escherichia coli
Answer C.
87. Which is NOT a component of the classical triad in hemolytic uremic syndrome?
Thrombocytopenia
Gastritis
Acute renal failure
Anemia
Answer B.
88. Which of the following species is associated with development of otitis externa (swimmer’s ear)?
Serratia marcescens
Aeromonas hydrophila
Pseudomonas aeruginosa
Campylobacter jejuni
Answer C.
89. On a nephrology rotation, you encounter a patient experiencing intense flank pain radiating to their inner thigh and groin. Ultrasonography confirms the presence of a large staghorn kidney stone blocking the renal pelvis, and the patient is sent for percutaneous nephrolithotomy to remove the stone. Which of the following organisms is most likely responsible for producing the kidney stone?
Proteus mirabilis
Escherichia coli
Shigella
Salmonella enteritidis
Answer A.
90. Which of the following pathogens is found in unpasteurized milk and can cause inflammation of the appendix similar to appendicitis?
Salmonella enteritidis
Shigella dysenteriae
Yersinia enterocolitica
Campylobacter jejuni
Answer C.
91. What is the major neurological consequence of Campylobacter infection?
Tabes dorsalis
Multiple sclerosis
Guillain-Barre syndrome
Brown-Sequard syndrome
Answer C.
92. Which of the following pathogens is associated with internal jugular vein thrombophlebitis secondary to peritonsillar abscess formation?
Bacteroides fragilis
Fusobacterium necrophorum
Neisseria gonorrhoeae
Moraxella catarrhalis
Shigella dysenteriae
Answer B.
Session 168 – Bacteria: Other Gram Negative Bacteria
93. What is a potential sequelae of Chlamydia trachomatis infection in women?
Urethritis
Pelvic Inflammatory Disease
Cystitis
Cervicitis
Answer B.
94. Which of the following is not part of the classic triad of reactive autoimmune arthritis (Reiter’s syndrome) secondary to C. trachomatis infection?
Urethritis
Cystitis
Conjunctivitis
Arthritis
Answer B.
95. Which of the following serotypes of C. trachomatis can lead to lymphogranuloma venereum upon infection?
L2
B
F
K
Answer A.
96. Epiglottitis is a dangerous condition that can develop in unvaccinated children whereby the epiglottis can become inflamed and cause airway obstruction, as well as dysphagia. Infection by which pathogen is usually responsible for this?
Acinetobacter baumannii
Legionella pneumophila
Haemophilus influenzae
Moraxella catarrhalis
Answer C.
97. Which is the main site of colonization for Haemophilus influenzae?
Oropharynx
Lungs
Nasopharynx
Tonsils
Answer C.
98. Which of the following organisms causes development of painful chancroid genital ulcers following sexual intercourse?
Neisseria gonorrhoeae
Chlamydia trachomatis
Treponema pallidum
Haemophilus ducreyi
Answer D.
99. What is the required agar for growth of Legionella cultures?
MacConkey’s agar
Hektoen Enteric
BCYE
Chocolate
Answer C.
100. What electrolyte imbalance is often observed in elderly patients with Legionella infection (Legionnaires disease)?
Hypomagnesemia
Hyperkalemia
Hyponatremia
Hypocalcemia
Hypokalemia
Answer C.
101. What condition is Neisseria gonorrhoeae infection a primary cause of in sexually active adults?
Septic arthritis
Chancre
Conjunctivitis
Meningitis
Answer A.
102. What is an endocrine consequence of meningococcemia due to Neisseria meningitidis infection?
Decreased testosterone production
Decreased cortisol production
Decreased ACTH release
Increased GH release
Answer B.
Session 169 – Bacteria: Gram Positive Bacilli I
103. Which of the following is the only bacterium to possess a capsule made from D-glutamate polypeptide rather than polysaccharides?
Bacillus cereus
Bacillus anthracis
Listeria monocytogenes
Corynebacterium diphtheriae
Answer B.
104. Which is the most lethal form of anthrax infection?
Injected
Intestinal
Inhaled
Cutaneous
Answer C.
105. What is the main function of the cell-binding component (PA) of the tripartite anthrax toxin?
Prevention of phagocytosis
Cause edema
Endocytosis of EF and LF
None of the above
Answer C.
106. For lunch, a 24 year old broke-ass medical student is eating leftover brisket with reheated rice from a potluck 2 days ago. Later on at night, he experiences a rumbling in his gut and he is soon firmly planted on the john with diarrhea. Which of the following pathogens might be responsible for his current predicament?
Bacillus cereus
Clostridium difficile
Clostridium perfringens
A & C
Answer D.
107. Botox is a cosmetic treatment using isolated neurotoxin from Clostridium botulinum to paralyze muscles of the face, such as the frontalis muscle, to decrease wrinkling. What is the mechanism by which this occurs?
Increase GABA release
Decrease acetylcholine release
Decrease norepinephrine release
Increase glycine release
Answer B.
108. A 46-year old female patient with a history of IV drug use is admitted to the hospital and found to have been infected with community acquired MRSA. She is prescribed a course of clindamycin which resolves the infection. However, within 24 hours, she becomes febrile with abdominal pain and massive watery diarrhea. Stool sample examination shows presence of fecal leukocytes and she is diagnosed with pseudomembranous colitis. This would be caused by which of the following organisms?
Clostridium perfringens
Bacillus cereus
Clostridium botulinum
Clostridium difficile
Answer D.
Session 170 – Bacteria: Gram Positive Bacilli II
109. Which of the following enzymes from the alpha toxin of Clostridium perfringens is responsible for the destruction of the cell membranes in gas gangrene?
Lecithinase
Transpeptidase
Hyaluronidase
Elongase
Hemolysin
Answer A.
110. In which of the following ways is food poisoning from Clostridium perfringens different from the food poisoning caused by Staphylococcus aureus?
It is caused by an enterotoxin
It causes a bloody diarrhea
It is gram negative
It has a later onset
It disrupts blood supply
Answer D.
111. Clostridium tetani toxin interferes with which of the following neurotransmitters?
Acetylcholine
Norepinephrine
GABA/glycine
Serotonin
Dopamine
Answer C.
112. What is the mechanism of action for Corynebacterium diphtheriae?
Activates adenylate cyclase and increases cAMP
Inhibits cell signalling and causes release of TNF-a and IL-1B
Inhibits the release of neurotransmitters
Causes the increase in efflux of chloride and water follows
Inactivation of elongation factor (EF-2)
Answer E.
113. What is one of the major reasons Listeria is so good at avoiding the immune system?
It binds the Fc region of IgG to hide
It is an intracellular organism that moves cell to cell
It has an IgA protease to digest IgA
It has a polysaccharide capsule which resist phagocytosis
It enters as a spore which are difficult for the immune system to recognize before germination
Answer B.
114. Which of the following foods could be contaminated with Listeria and should be avoided during pregnancy?
Reheated rice
Raw poultry
Raw/unpasteurized milk or cheese
Raw beef
Reheated sauces
Answer C.
115. What is a major difference between Nocardia and Actinomyces?
Nocardia has branching filaments while Actinomyces does not
Nocardia undergoes spore formation while actinomyces does not
Nocardia is found in normal oral flora while Actinomyces is not
Nocardia is aerobic while Actinomyces is anaerobic
Nocardia produces yellow sulfur granules while Actinomyces does not
Answer D.
Session 171 – Bacteria: Spirochetes
116. Which of the following spirochetes causes Lyme disease?
Borrelia burgdorferi
Borrelia recurrentis
Borrelia hermsii
Treponema pallidum
Leptospira interrogans
Answer A.
117. Which spirochete is shown in the image above?
Borrelia burgdorferi
Borrelia recurrentis
Borrelia garinii
Treponema pallidum
Leptospira interrogans
Answer A.
118. Myocarditis is symptomatic in which stage of Lyme disease?
Stage 1
Stage 2
Stage 3
Stage 4
Not answer E
Answer B.
119. A patient presents to the clinic with flu-like illness (fever, headache, rigors, myalgias) and conjunctival hemorrhage. You notice spirochetes in his blood sample. What infectious agent is present in your patient?
Borrelia burgdorferi
Borrelia recurrentis
Borrelia garinii
Treponema pallidum
Leptospira interrogans
Answer E.
120. Weil’s disease (icteric type) has 2 phases, which of the following is characteristic of the leptospirotic phase?
Headache
Conjunctival injection
bradycardia
Encephalopathy
Polymorphic rashes
Answer D.
121. Utilizing a chancre fluid dark field microscopy you can identify which of the following diseases?
Lyme Disease
Syphilis
Leptospirosis
Relapsing Fever
Corona Virus
Answer B.
122. Which of the following is NOT a false positive to a syphilis diagnosis?
Leprosy
Mononucleosis
Gonorrhea
Pregnancy
Lupus
Answer C.
123. What cardiac conduction abnormality is observed in patients within the early disseminated stage (Stage 2) of Lyme disease?
Atrial flutter
3rd degree AV block
Bradycardia
Tachycardia
Atrial fibrillation
Answer B.
124. A 20 year old man presents to the family practice clinic with pronounced flu-like symptoms, jaundice, and reddened conjunctiva. In the course of taking the patient’s history, you learn that the symptoms began approximately 2 days ago after swimming in a local pond near the patient’s neighborhood. You draw up blood for serological testing, and within 24 hours confirm the diagnosis of leptospirosis. What is an appropriate antibiotic to prescribe for treatment?
Doxycycline
Amoxicillin
Penicillin G
None of the above
Answer A.
125. What is a neurological manifestation of tertiary syphilis which presents with loss of proprioception, decreased DTRs, ataxia and a wide-based gait?
Multiple sclerosis
Friedrich’s ataxia
Tabes Dorsalis
Subacute combined degeneration
Answer C.
126. What ophthalmologic abnormality involving decreased reactivity to light with normal accommodation occurs as a manifestation of tertiary syphilis?
Marcus-Gunn pupil
Argyll-Robertson pupil
Anisocoria
Nystagmus
Session 172 – Bacteria: Zoonotic I
127. The presence of a classic ‘maltese-cross’ in a blood smear would be evident in ___ transmitted by ____?
Malaria; ticks
Malaria; mosquitos
Babesia; ticks
Babesia; mosquitos
Babesia; birds
Answer C.
128. Administration of which medication is used for most animal borne-illnesses?
Penicillin
Doxycycline
Azithromycin
Streptomycin
Rifampin
Answer B.
129. Which disease is commonly caused my cat scratches and presents as red ‘stretch marks
7-10 days later?
Brucellosis
Psittacosis
Q-Fever
Bartonellosis
Tularemia
Answer D.
130. Which of the following is found in Bacillary Angiomatosis but NOT Kaposi Sarcoma?
Common in HIV/AIDS
Etiological agent is HHV-8
Lymphocyte infiltration
Raised red/purple lesions
PMN infiltration
Answer E.
131. A pet store owner who has spent hours cleaning bird cages finds themselves with a fever and headache due to which most likely illness?
Brucellosis
Psittacosis
Q-Fever
Bartonellosis
Tularemia
Answer B.
132. Which characteristic is key in distinguishing the difference between asymptomatic vs severe leptospirosis?
Conjunctival suffusion
Fever
Myalgias
Jaundice
Headache
Answer D.
Session 173 – Bacteria: Zoonotic II
133. What pertinent information from a history may clue you into the cause of your patient’s cellulitis being caused from Pasteurella Multocida?
Exposure to an armadillo
Exposure to contaminated water
Recent tick bite
Recent pet bite
Promiscuity
Answer D. Pasteurella Multocida is commonly transmitted from infected pets (cats or dogs) to humans through a bite that results in cellulitis within 24hrs.
134. A patient presents with flu-like symptoms to your clinic. A blood test reveals leukopenia and elevated liver enzymes. The patient states that he had to cut his hunting trip for white-tailed deer short because of his illness. What is the patient’s diagnosis as revealed by the Giemsa stain below?:
Babesia
Monocytic Ehrlichiosis
Malaria
Granulocytic Anaplasmosis
Borrelia Burgdorferi
Answer B. The case described and Giemsa stain both point towards Monocytic Ehrlichiosis transmitted by the “Lone Star” tick.
135. What species of tick transmits an infection that is identified by its maculopapular rash starting on the wrist and ankles and has a classic triad of headache/fever/rash?
Rhipicephalus
Dermacentor
Amblyomma
Ixodes
Sanguinis
Answer B. The infection symptoms given point to Rickettsia rickettsii or the Rocky Mountain Spotted Fever that is transmitted by the Dog Tick which belongs to the Dermacentor species.
136. Following a flea bite, your patient presents with a bubo on their neck. What would you expect to see on a Giemsa stain?
Red Coccobacilli
Morulae inside granulocytes
Morulae inside monocytes
Pushpin dense coccobacilli
Bipolar Safety Pin
Answer E. Yersinia Pestis, when observed with a Giemsa Stain, looks like a safety pin with two distinct poles.
137. What is the method of transmission for Rickettsia prowazekii?
Lice feces
Flea Bites
Tick Bites
Pet Bites
Human to Human
Answer A. Rickettsia prowazekii is transmitted through lice defecating infective feces onto skin and/or mucus membranes.
Session 174 – Introduction to Fungi and Viruses
138. As opposed to bacteria, which component of the cell membrane is unique to fungi?
Proteins
Cholesterol
Cell Wall
Chitin
Lipid Bilayer
Answer D.
139. A patient comes to the clinic with what appears to be a fungal infection of his toenails. You diagnose him with tinea unguium. You want to prescribe one of the following and make sure that the drug has the lowest possibility to cross react with cholesterol. Which of the following meets the criteria?
Azoles
Polyene
Allylamines
Terbinafine
Doxycycline
Answer B.
140. A wrestler comes to the clinic with a raised lesion on his arm. It appears to be fungal. What is the most likely type of mycoses?
Superficial
Cutaneous
Subcutaneous
Systemic
Opportunistic
Answer B.
141. Viruses can be grouped together based on which tissues they infect. Which of the following groups does SARS-CoV-2 fit in?
Pneumotropic
Dermotropic
Viscerotropic
Neurotropic
Answer A.
142. Which is the correct order for the replication of viruses?
Attachment → Biosynthesis → Penetration → Maturation → Release
Biosynthesis → Maturation → Attachment → Penetration → Release
Attachment → Penetration → Biosynthesis → Release → Maturation
Release → Maturation → Attachment → Penetration → Biosynthesis
Attachment → Penetration → Biosynthesis → Maturation → Release
Answer E.
Session 175 – Bacteria: Mycobacteria
143. Due to the lipid rich mycolic acid component of the mycobacteria cell wall, which is the preferred staining method for visualizing this class of bacteria?
Acid-fast
Gram
India ink
Potassium Hydroxide
Silver
Answer A.
144. Presence of a Ghon complex is indicative of which form of tuberculosis?
Bone and joint tuberculosis
Primary respiratory tuberculosis
Secondary respiratory tuberculosis
Tuberculosis enteritis
Tuberculosis meningitis
Answer B.
145. Tuberculosis infections typically result in dense granulomas consisting of an aggregation of which cell type?
Cytotoxic T-cells
Helper T-cells
Macrophages
Neutrophils
A and C
A and D
B and C
B and C
Answer G.
146. Which of the following is the animal reservoir for Tuberculosis leprae?
Aardvark
Anteater
Armadillo
Groundhog
Opossum
Answer C.
147. In a patient of suspected leprosy, which of the following traits leads to a differential diagnosis of tuberculoid leprosy over lepromatous leprosy?
Absence of granulomas
Hypopigmentation and loss of hair
Patches of hypopigmented skin
Severe neuropathy
Th2 response
Answer C. All other options lead to an inverse differential diagnosis, one of lepromatous leprosy rather than tuberculoid leprosy.
148. An infection with Parvo B-19 would be most devastating in what kind of patient?
Someone previously infected with another strain of Parvo B-19
Someone with Cystic Fibrosis
Someone with an allergy to Penicillin
Someone with Sickle Cell Anemia
Someone with Onychomycosis
149. The classic “Slapped Cheek” appearance in a child infected with Parvo B-19 is due to which of the following?
Pathogen colonization in the maxillary sinuses
Type 2 Hypersensitivity reaction
Type 3 Hypersensitivity reaction
Type 4 Hypersensitivity reaction
Type 1 Hypersensitivity reaction
150. A PAP smear is taken from a 38 year old woman who complains of vaginal skin changes. The collected sample is stained and Koilocytes are confirmed via microscopy. Which of the following would NOT lead to these atypical Koilocytes that lead to cervical cancer?
HPV Serotypes 6 and 11
HPV strain expressing EP6 gene
HPV Serotype 16
HPV strain expressing EP7 gene
HPV Serotype 18
Answer A.
151. A 33 year old female presents to her family physician complaining of rectal pain “unlike anything she has ever had before”. She is currently sexually active 3 men and takes the progesterone pill as daily as her birth control. Urine hCG is negative and temperature is 102oF. Physical exam shows tender, erythematous vesicles with crust on the perianal skin along with bilateral inguinal lymphadenopathy. Which of the following is true regarding the viral pathogen responsible for this infection and symptomatology?
It is a naked, ds-DNA virus that replicates in the nucleus.
It is responsible for oral herpetic cold sores in 20% of the cases.
Its site of latency is in Lymphocytes in the inguinal lymph nodes.
Tzanck smear displays Giant Cells with Basophilic Intranuclear Inclusions.
Recurrent flares routinely accompanied by fever and lymphadenopathy.
152. A 4 year old boy and his mother present to the E/R. The boy’s mother states that her son has experienced pain when peeing and that his pee is dark and “bloody” colored. A urine sample is collected to which the child shows symptoms of dysuria and the urinalysis confirms 2+ rbcs under microscopy. The patient is non-febrile. The symptomatology and laboratory findings most closely indicate which kind of infection?
An enveloped dsDNA virus, subgroup B, serotype 21
A naked ssDNA virus, subgroup A, serotype 11
Acute Hemorrhagic Cystitis
An enveloped dsDNA virus, subgroup A. serotype 11
A naked ssDNA virus, subgroup B, serotype 21
153. A 27 year old female presents to the E/R with flu-like symptoms. She states that she is 26 weeks pregnant and urinary hCG confirms pregnancy. She additionally complains of bilateral joint pain in her wrists and there is a diffuse, erythematous rash on her chest and abdomen. Serology testing for throat and sputum specimens are negative for pneumococcal pathogens. She is sent home with supportive care. 2 weeks later she experiences a spontaneous abortion. This symptomatology is most closely associated with which of the following:
HPV
Parvo B-19
Adenovirus
EBV
HHV-8
154. A 16 year old female presents to her family physician with complaining of pink eye. She just returned from a surfing competition in Honolulu and is currently doing competitive swimming at her high school pool where she has been swimming two-a-days for the past 10 days. Physical exam shows bilateral erythematous conjunctiva with a non-purulent, watery and clear discharge. PCR confirms a ds-DNA virus. Which of the following viral pathogens is best associated with the clinical symptoms and patient history?
HSV-1
Epstein-Barr Virus
Leptospirosis
Chlamydia
Adenovirus
155. A 26 year old, sexually active male presents to the E/R complaining of vision changes in their left eye. You note a crusted, healing lesion on their right vermillion border. Fluorescein application to their left eye reveals a “tree-like” ulcer with “lightning bolt-like branches.” This finding is most indicative of which of the following pathogens:
CMV
HSV-1
HHV-8
EBV
HHV-6
156. Who of the following is at the most risk for shingles?
Tommy, a 25 year old child of anti-vaxxers whose parents took him to a chicken pox party as a kid where he contracted chicken pox
Angel, a 15 year old who was vaccinated as a child and never got chicken pox.
Irene, a 68 year old who never had chicken pox and also never was vaccinated, but who grew up on a chicken farm
Marvin, a 62 year old who had chickenpox as a kid, but is not old enough for his insurance to cover a zostavax vaccine.
Mary, a 76 year old grandma who had chickenpox as a child, has not had her zostavax shot, but watched her 5 grandkids when they got the chickenpox 5 years ago.
Answer D. Someone who has had chickenpox is at risk of developing Shingles. Tommy would also be at risk, but increased age puts Marvin at a more increased risk. Angel shouldn’t ever get it. Irene would have to get chickenpox first, then she could get shingles. Living on a chicken farm does not protect her, in fact, chickens don’t even carry the disease in a form that is transmittable to humans. And Mary, although she could get it and should get her Zostavax vaccine, was around kids who had the chickenpox acting as a natural booster for her.
157. Paul, a 18 year old college student, comes into your clinic complaining of being tired all the time and says his throat has been sore but he doesn’t have a cough. He is unsure if he has had a fever. You order a Heterophile antibody test that comes back positive. Which of the following is the most likely diagnosis?
Cytomegalovirus
Syphilis
Epstein-Barr Virus infection
Oral hairy leukoplakia
Streptococcus pyogenes infection
Answer C.
158. Which of the following is false regarding CMV or EBV mononucleosis?
CMV negative transplant patients are at an increased risk of rejecting their organs if they do not receive CMV negative blood transfusions
EBV causes false positives on syphilis screenings
CMV has a negative heterophile antibody test
EBV is associated with an increased risk of nasopharyngeal carcinoma
CMV can cause deaf, blueberry muffin babies, with cataracts
Answer E.
159. Johnny is a 17 month old infant presenting to your clinic with a high fever, swollen lymph nodes and a rash on his neck, body and face. His parents said he has had the fever for about 3 days and they can’t break it, they also tell you that the rash just spread to his face this morning which is why they took him in. Which of the following is the most likely causative agent for his condition?
Herpes simplex Virus 1
Herpes simplex Virus 2
Human Herpes Virus 6
Human Herpes Virus 8
Varicella Zoster Virus
Answer C.
160. While doing an infectious disease rotation, your preceptor asks: which of the following is the most likely poxvirus seen in the US today? You respond:
Variola
Smallpox
Molluscum contagiosum
Cowpox
Chickenpox
Answer C. Variola/smallpox is the same thing and it was eradicated by vaccination in the 1970s (hopefully we will never see it again, but it could be used as a form of bioterrorism). Cowpox is hardly seen and was initially used to vaccinate against smallpox. Chickenpox is a herpesviridae not a poxvirus.
Session 178 – RNA Negative Sense Viruses
161. Which of the following RNA viruses is NOT segmented?
Reo
Arena
Orthomyxo
Paramyxo
Bunya
Answer D.
162. All negative sense RNA viruses are which of the following?
Double stranded
Enveloped
Segmented
Icosahedral
Naked
Answer B.
163. Which negative sense RNA virus replicates in the nucleus?
Retro
Pox
Orthomyxo
Paramyxo
Rhabdo
Answer C.
164. Which of the following types of viruses is it necessary to be kept in BSL-4 isolation due to its human-human transmission, high mortality rate, and lack of vaccine?
Arenaviridae
Bunyaviridae
Paramyxoviruses
Orthomyxoviruses
Filoviridae
Answer A.
165. Which of the following types of viruses causes Ebola (a thrombocytopenic hemorrhagic disease with a near 100% mortality rate)?
Arenaviridae
Bunyaviridae
Paramyxoviruses
Orthomyxoviruses
Filoviridae
Answer E.
166. Which of the following types of viruses causes the rodent-borne Hanta virus that is typically found in the four corners region (New Mexico, Arizona, Colorado, and Utah)?
Arenaviridae
Bunyaviridae
Paramyxoviruses
Orthomyxoviruses
Filoviridae
Answer B.
167. A young “chipmunk appearing” boy presents to the ED screaming, “my balls are on fire!” You condescendingly look at the mother knowing she probably didn’t get her child vaccinated against which disease?
Influenza
Rubella
Rubeola
Diphtheria
Mumps
Answer E.
168. A patient presents with a red maculopapular rash that appears to only be on their body from the trunk down. They tell you it started on their head/face and progressed downward and has now resolved from their neck up. Which of the following diseases does this individual most likely have?
Influenza
Rubella
Rubeola
Diphtheria
Mumps
Answer C.
169. Which type of influenza can infect birds, pigs, and humans but birds are the natural hosts?
A
B
C
D
E
Answer A.
170. Which type of avian influenza could potentially cause the next pandemic to effect millennials when God has decided we haven’t had enough yet?
H1N1
H3N2
H5N1
H7N3
H9N7
Answer C.
171. Which type of change occurs frequently in Influenza that requires the development of a new vaccine?
Shifts
Conjugations
Transductions
Drifts
Reassortments
Answer D.
172. Which type of virus travels in the nerves and is 100% fatal after it incubates?
Ebola
Rhabdovirus
H5N1 avian flu
Lassa fever
Hanta Virus
Answer B.
173. Lets face it. You’re a special type of weird person who thinks skunks are “cool”. So what happens? You get bit by one trying to get a selfie for instagram. After going to the ED, animal control finds the skunk that bit you and kills it to check for rabies. What are they looking for in its brain to confirm/deny that it had rabies?
Lewy bodies
Neurofibrillary tangles
Tau plaques
IgM antibodies
Negri bodies
Answer E.
Session 179 – RNA Positive Sense Viruses
174. Which of the following RNA viruses are Helical and positive sense ?
Reovirus
Dengue
Covid-19
HIV
Rubella
Answer C.
175. A patient presents with a high fever, severe muscle and bone pain after being bit by an Aedes mosquito in South America. You aren’t terribly worried and tell them it is because only second infections are fatal. What do you think your patient is infected with?
West Nile Virus
Dengue
Rubella
HTLV-1
SARS
Answer B.
176. Our current COVID-19 virus is most comparable to which of the following RNA positive sense viruses?
West Nile Virus
Dengue
Rubella
HTLV-1
SARS
Answer E.
177. Poliovirus is categorized into which of the following ?
Coronaviridae
Retroviridae
Togaviridae
Picornaviridae
Flaviviridae
Answer D.
178. This naked, positive sense ssRNA virus is the #1 cause of gastroenteritis in adults and absolutely has a field day on cruise ships?
Norovirus
Coltivirus
Rotavirus
Coxsackievirus
Echovirus
Answer A.
179. Which of the following is found in yeasts but NOT molds?
Reproduction by forming spores
‘Bacteria-like’ appearance
Formation of hyphae
‘Cotton-like’ appearance
Formation of mycelium
Answer B.
180. Which pulmonary fungal infection is NOT found in the United States?
Histoplasmosis
Blastomycosis
Coccidioidomycosis
Paracoccidioidomycocis
Sporothrix
Answer D.
181. Which fungal infection acts as a mold in cooler temperatures but a yeast at warmer temperatures?
Histoplasmosis
Blastomycosis
Coccidioidomycosis
Paracoccidioidomycocis
Sporothrix
Answer C.
182. Onychomycosis would refer to a fungal infection of which area?
Feet
Head
Groin
Nails
Back
Answer D.
183. A classic combination of hyphae and yeast cells that promotes shedding of the stratum corneum is consistent with which fungal infection?
Tinea pedis
Tinea cruris
Tinea corporis
Tinea versicolor
Tinea unguium
Answer D.
184. A positive germ tube test is a clear indicator that you are looking at which fungi?
Aspergillus Flavus
Aspergillus Fumigatus
Candida Albicans
Cryptococcus Neoformans
Mucor
Answer C.
185. If the sputum culture you collected shows a positive germ tube test, what does this tell you about your patient?
Oral Thrush
HIV/AIDS
Aspergillosis
ABPA
Cystic Fibrosis
Answer B.
186. Identify the fungi below:
Aspergillus Fumigatus
Aspergillus Flavus
Candida Albicans
Mucor
Pneumocystis Jiroveci
Answer D.
187. A patient’s india ink stain came back positive. What disease are you most concerned about this patient developing?
Pneumonia
HIV
Meningitis
Mucormycosis
Aspergilloma
Answer C.
188. Your diabetic patient presents to your clinic complaining of a headache, undulating fever, and persistent eye pain for the past two days. What should be at the top of your differential?
Aspergilloma
Mucormycosis
Candida Albicans
Pneumocystis Jiroveci
Aspergillus Fumigatus
Session 182 – Parasites: Protists
189. Which of the following protozoa is found largely in beavers, and is the #1 protozoan gastrointestinal disease in the US?
Giardia lamblia
Cryptosporidium parvum
Toxoplasma gondii
Acanthamoeba
Cyclospora
Answer A.
190. A young man comes back from vacationing in Panama and develops severe bloody diarrhea, fever and cramps. He is brought to the clinic by his father, and upon doing a physical examination you find that he exhibits extreme discomfort when you palpate McBurney’s point. Of the following, which seems to be the culprit in this young man’s discomfort?
ETEC
Giardia lamblia
Entamoeba histolytica
Toxoplasma gondii
Spontaneous appendicitis
Answer C.
191. A toddler walks into their home’s living room where they show their parents the amazing Tootsie Rolls that they found in the cat’s “sandbox”, and proceeds to eat them before the parents can intervene. Which of the following protozoa would be transmitted this way?
Entamoeba histolytica
Naeglaria fowleri
Trypanosoma cruzi
Leishmania donovani
Toxoplasma gondii
Answer E.
192. A gametocyte would point to the patient suffering from ______, whereas finding a maltese cross formation points to _______.
Babesiosis, Malaria
Trichomonas, Babesiosis
Babesiosis, Trichomonas
Malaria, Babesiosis
Toxoplasma, Babesiosis
Answer D.
193. Which arthropod causes pubic itching and burning that gets worse at night in a person who is sexually active?
Fleas
Termites
Sarcoptes scabiei
Pthirus pubis
Spiders
Answer D.
194. A 45 year old male patient presents to the family practice clinic complaining of copious flatulence for the past week, which he then proceeds to demonstrate several times during your encounter. He also mentions that when he goes to the bathroom, his stools appear oily and float on the surface of the water. After wrapping up this pleasant encounter, what do you suspect to be the causative organism?
Cryptosporidium parvum
Entamoeba histolytica
Giardia lamblia
Cyclospora cayetanensis
Answer C.
195. Which of the following is the primary host of the organism from the previous question?
Cats
Humans
Monkeys
Beavers
Answer B.
196. Which of the following is noted as a major cause of epidemic diarrhea outbreaks within a given community?
Entamoeba histolytica
Cryptosporidium parvum
Shigella dysenteriae
Giardia lamblia
Answer B.
197. Which of the following is not listed as a possible pathology caused by E. histolytica?
Diverticulitis
Brain abscess
Liver abscess
Appendicitis
Answer A.
198. A 26 year old first-time expectant mother visits the family practice clinic for her prenatal checkup. During the course of the encounter, she mentions that she and her husband own pets, including two cats. Upon learning this, you impress upon her that she should have her husband pick up the cat litter while she is pregnant. The reason for this involves avoiding infection by which of the following organisms?
Pasteurella multocida
Toxoplasma gondii
Capnocytophaga canimorsus
Toxocara cati
Answer B.
199. Which of the following tick-borne illnesses poses possible co-infection with babesiosis due to sharing a common vector?
Ehrlichiosis
Rocky Mountain Spotted Fever
Lyme Disease
Relapsing Fever
Answer C.
200. Which of the following protozoa is responsible for causing fatal primary amoebic meningoencephalitis (PAM)?
Naegleria fowleri
Entamoeba histolytica
Acanthamoeba
Trypanosoma brucei
Answer A.
Session 183 – Parasites: Helminths I
201. A patient walking barefoot through the garden is at risk of which of the following helminths entering their body through the skin?
Strongyloides sterocalis
Ancyclostoma duodenale
Necator americanus
All of the above
B and C
Answer D.
202. Which of the following helminths make their way to the lungs after entering through the skin?
Ascaris lumbricoides
Necator americanus
Strongyloides sterocalis
All of the above
B and C
Answer E.
203. Prescription of a twig is the best treatment for which of the following helminths–used for gradually pulling the female parasite out of the skin through the entry site by winding it up around the twig?
Ascaris lunmbricoides
Dracunculus medininsis
Enterobius vermicularis
Necator americanus
Strongyloides sterocalis
Answer B.
204. Trichinella spiralis enters the body via _________ and its larvae disseminate to __________ where they can remain viable for years.
Fecal-oral transmission; lungs
Skin; intestines
Skin; muscles
Undercooked meat (pig); lungs
Undercooked meat (pig); muscles
Answer E.
205. Which of the following is best diagnosed using a Scotch tape test/prep for microscopy imaging?
Giant roundworm
Hookworm
Pinworm
Threadworm
All of the above
Answer C.
Session 184 – Parasite: Helminths II
206. During your medical mission trip to Cameroon, Africa, a 36-year-old male presents to the clinic with left eye irritation and swelling. You notice a classic Calabar edema on his left infraorbital rim. Pulling the left lower eyelid inferiorly reveals a filarial worm burrowed in the patient’s sclera. What is the main vector associated with the transmission of this parasite?
Simulium fly
Loa loa
Chrysops fly
Drinking unpurified water
Buffalo gnat
207. During your medical mission trip to Haiti, a 45-year-old female presents to the clinic with gross, unilateral swelling in her right lower extremity. The skin covering the affected area is hyperpigmented and the underlying tissue is abnormally hard with non-pitting edema. Microfilariae are reported on the patient’s blood smear. What is an additional key finding associated with this infection?
Lymphocytopenia
Microcytic anemia
Left shift in the CBC with diff
Eosinophilia
Maltese-cross in erythrocytes
208. A 28-year-old male presents to the E/R with intermittent seizures. His wife states that they vacationed to Brazil 3 weeks ago where they ate the local cuisine daily. Prior to his current epileptic episodes, the patient had bouts of diarrhea that resolved shortly before he began experiencing vision changes and a constant headache. His T1-weighted MRI is shown below. What is the most likely mode of transmission that resulted in the patient’s current condition?
The patient ate the local undercooked beef infected with Taenia saginata oncospheres
The patient ingested the cysts of Taenia solium
The patient ate the local undercooked pork infected with Taenia solium oncospheres
The patient ingested the cysts of Taenia saginata
The patient ate the local undercooked lamb infected with Taenia solium oncospheres
209. A 25-year-old female presents to the clinic with right upper quadrant pain. Medical imaging reveals multiple fluid-filled cysts protruding from the patient’s liver filled with hyperechoic “sand-like” granules. Surgical removal of the cysts is decided upon as the best course of action. Why is extreme caution needed in removal of the cysts from the patient’s liver?
The cyst membrane contains an anticoagulant that could lead to prolific bleeding upon removal.
The cysts are now a major source of hematopoietic production in the patient.
Rupturing of the cysts during removal would cause the patient to go into anaphylactic shock.
The symbiotic relationship developed between the cysts and liver could lead to organ failure post surgical removal.
Cysts contain hyaluronidase that would degrade the patient’s liver if the cysts ruptured.
210. A 38 year-old-male presents to the clinic with fatigue, dyspnea on exertion, pallor, and paresthesias in his extremities. He states that he recently returned from a work conference in Japan where he ate sushi every night with his coworkers. Serology testing reports the presence of patient antibodies to Diphyllobothrium latum. What would you expect to see on the patient’s CBC with differential?
Microcytic anemia
Hypersegmented PMNs
Left Shift
Reactive lymphocytes
Thrombocytopenia
211. A 26-year-old female presents to the clinic with hematuria, dysuria, and suprapubic discomfort, and an erythematous, pruritic rash in her inguinal folds. She states that she recently returned from a vacation to Egypt and swam in the Nile river. She is sexually active with her recent boyfriend and denies using protection. Urinalysis shows several cystic eggs with lancet-shaped ends. What is the natural reservoir for the parasite responsible for your patient’s symptoms?
Nile river perch.
African Tigerfish
African soft shelled turtle
Freshwater snails
River basin mudskipper
212. A 29-year-old male presents to the clinic with sharp right upper quadrant pain and jaundice. They had recently returned to the U.S. from teaching elementary school in China for several years. Medical imaging reveals several gallstones and an inflamed pancreas. Serology testing reports the presence of patient antibodies to Clonorchis sinesis. What other condition are you concerned that your patient might develop that is commonly associated with this kind of infection?
Squamous cell carcinoma
Cholangiocarcinoma
Pancreatic cancer
Cirrhosis of the liver
Colorectal cancer
Session 185 – Hemodynamics and Shock – Bailey
213. Which of the following erroneous body responses to hypoperfusion or low blood pressure would lead to shock?
Shunting blood away from the extremities
Vasodilation of the arteries
Release of cortisol
Activation of the RAAS system
Carotid baroreceptor sending a signal to the heart
Answer B.
214. While rotating in the ER, the ambulance arrives with a 56 year old male who was just involved in a motor vehicle accident. There is no sign of external bleeding but an ultrasound revealed blood in Morrison’s pouch. The man’s vitals are rapidly dropping as he goes into which kind of shock?
Hypovolemic
Hypervolemic
Cardiogenic
Distributive
Obstructive
Answer A.
215. Laura underwent an emergency hysterectomy 10 days ago. She now presents to your office because she has been having vaginal bleeding that has not stopped, extreme bloating and weight gain. She has gained 15 lbs since her procedure. You do a CT which reveals a massive hematoma. She also is showing signs of shock. You admit her immediately and begin what treatment
Administration of IV antibiotics: this patient is experiencing septic shock
Vasopressors: this patient is experiencing cardiogenic shock
Insertion of a chest tube: this patient is experiencing obstructive shock
Perform a paracentesis: this patient is experiencing hypervolemic shock
Administration of whole blood: this patient is experiencing hypovolemic shock
Answer E.
216. Haley has been taking an antibiotic for the last 7 days for a UTI, but it hasn’t been helping and she is feeling worse. She just spiked a fever of 105. It turns out her UTI was resistant to the antibiotic that she was put on and the infection has now spread to her kidney which has started to shut down. Which of the following is the common pathway that the other forms of shock converge on in this classic case of septic shock?
Reduced right ventricle filling
Hypertension
Induction of systemic inflammation
Hypovolemia
Cardiovascular depression
Answer C
217. James was stabbed in the chest during a mugging. His lung has collapsed and his mediastinum has been displaced to the opposite side. Which of the following describes his cause of shock and correct treatment?
Administration of IV antibiotics: this patient is experiencing septic shock
Vasopressors: this patient is experiencing cardiogenic shock
Insertion of a chest tube: this patient is experiencing obstructive shock
Perform a paracentesis: this patient is experiencing hypervolemic shock
Administration of whole blood: this patient is experiencing hypovolemic shock
Answer C.
218. What is the purpose of increased venoconstriction during shock?
Increase CO
Decrease MAP
Increase preload
H2O conservation
Answer C.
219. Which of the following inflammatory mediators leads to uncontrolled vasodilation during shock?
TNFα
IL-1
NO
IL-6
Answer C.
220. What is the primary treatment for patients in hypovolemic shock?
Volume restoration
High-dose insulin
Amrinone administration
Beta blockers
Answer A.
221. Patients going into hypovolemic shock due to significant blood loss are often administered a massive transfusion protocol, consisting of packed RBCs, fresh frozen plasma, and platelets. What condition are these patients at risk for?
Cardiomyopathy
Cardiac tamponade
Disseminated intravascular coagulopathy (DIC)
Hypertensive crisis
Answer C.
222. Statistically, what is the biggest cause of cardiogenic shock?
Acute severe mitral regurgitation
Ventricular Septal Defect
Cardiac tamponade
Predominant LV failure
Answer D. Note: Most of the time, this is due to acute MI
223. A 32 year old male patient presents to the emergency department with blunt force trauma to his right chest. On his chest x-ray, he appears to have several broken ribs and a collapsed right lung. In addition, his left lung is being compressed. You immediately diagnose tension pneumothorax and perform needle decompression to relieve it. What type of shock is this classified as?
Distributive
Obstructive
Hypovolemic
Cardiogenic
Answer B.
224. What is the mainstay treatment for beta-blocker overdose?
High-dose insulin with concomitant dextrose
Amrinone lactate
Glucagon
IV fluids
Answer A.
Session 186 – Clotting and Disruption of Blood Flow I
225. Which of the following components of hemostasis is the first to occur?
Vasoconstriction/spasm
Platelet activation
Coagulation cascade
Antithrombotic activation
Fibrinolysis
Answer A.
226. Platelets/thrombocytes are derived from which precursor cell?
Myeloblast
Lymphoblast
Megakaryocyte
Normoblast
Reticuloblast
Answer C.
227. Which of the following is secreted from endothelial cells to inhibit platelet activation/aggregation?
Heparan Sulfate
Thrombomodulin
Tissue Factor Pathway Inhibitor (TFPI)
Prostacyclin
ADP
Answer D.
228. Which platelet glycoprotein receptor is only expressed once platelets have been activated and would lead to excessive clot formation if it were constitutively expressed?
GP Ib-IV-IX
GP Ia/IIa
GP VI
GP IIb/IIIa
GP Ib
Answer D.
229. Which platelet secretion can be found within the dense granules?
Thromboxane A2
Fibrinogen
Von Willebrand Factor
Clotting factor V
Calcium
Answer E.
230. How can prescribing a patient corticosteroids depressing their ability to clot effectively/efficiently?
Corticosteroids inhibit cyclooxygenase which prevents the formation of thromboxane
Corticosteroids inhibit Phospholipase A2 which prevents the formation of arachidonic acid
Corticosteroids directly block the formation of Thromboxane from endoperoxides
Corticosteroids directly block the creation of prostaglandins which activate clotting factors
Corticosteroids don’t have an effect on clotting, only on inflammation
Answer B.
231. A deficiency in which enzyme will lead to thrombotic thrombocytopenic purpura (TTP)?
Cyclooxygenase
Phospholipase A2
Thrombin
ADAMTS13
P2Y1/P2Y12
Answer D.
232. Where does ADP bind to activate platelets?
P2Y1/P2Y12
PAR
Myosin
Phosphatidylserine
GP IIb/IIIa
Answer A.
Session 187 – Clotting and Disruption of Blood Flow II
233. Apparently this is FYI, but I already wrote the question, so, which of the following drugs are classified as an ADP receptor Antagonist?
Ticagrelor
Aspirin
Atopaxar
Eptifibatide
Revacept
Answer A.
234. Which of the following clotting factors is ONLY part of the intrinsic pathway?
X
VII
XIII
XI
V
Answer D.
235. Which of the following factors does Thrombin NOT influence?
V
XI
VII
XIII
VIII
Answer C.
236. Serpin, a serine protease inhibitor, does NOT inactivate which of the following factors?
XIa
Xa
IXa
thrombin
heparan
Answer E. It binds to heparan, does not inactivate.
237. You enter your rotations and find that the patient you are speaking to is currently prescribed the anticoagulant Apixaban. Your preceptor, trying to prove that you don’t deserve to be here, asks you what clotting factor it inhibits. What do you tell them?
VIIa
Va
IXa
Xa
You contemplate if he is right and you were always told pharm was FYI
Answer D.
238. A patient has a high INR, which of the following is in your differential?
Von Willebrands
Hemophilia
Autoimmune disease
Post surgical, they’re fine
Vit K deficiency
Answer E.
239. von Willebrand’s factor (vWF) binds to exposed collagen at the site of injury to the vascular endothelium, and also bind to which of the following glycoprotein receptors on the surface of platelets?
GP Ib-V-IX
GP Ia/IIa
GP IIb/IIIa
A & C
Answer D.
240. Low-dose aspirin (81 mg) is often used as a preventative medication in people at risk for cardiovascular issues such as MI or stroke. It acts as a non-selective COX1 and COX2 inhibitor. Which of the following effects are initially expected in response to aspirin usage?
Increased platelet activation
Decreased ADP release from platelets
Decreased vasoconstriction
All of the above
Answer D. Note: Aspirin inhibits COX in both vascular endothelial cells and platelets, meaning that production of both prostacyclin (PGI2) and TXA2, respectively, are decreased, initially leading to seemingly contradictory events. However, given that platelets are only cell fragments and do not possess nuclei or protein synthesis machinery to regenerate COX, this means that TXA2 production is halted permanently, while prostacyclin production eventually recovers.
241. Abciximab (ReoPro) is a GP IIb/IIIa receptor antagonist used primarily during coronary artery angioplasty to prevent thrombus formation within the artery during the procedure, and reducing potential ischemic effects. Inhibition of which of the following events allows for this?
Platelets binding to vWF
Platelets binding to collagen
Platelets binding to fibrinogen
All of the above
Answer C.
242. Rivaroxaban (Xarelto) and apixaban (Eliquis) are relatively recently approved anticoagulant medications that have been gaining favor in treating conditions such as atrial fibrillation and deep venous thrombosis due to having fewer drug interactions than warfarin. They act as activated factor X (Xa) antagonists. Which of the following events does this directly inhibit?
Activation of Factor IX
Activation of Factor VIII
Conversion of prothrombin to thrombin
Conversion of fibrinogen to fibrin
Answer C.
243. Which of the following proteins does heparan sulfate bind in order to prevent unnecessary hemostasis?
Thrombosthenin
Antithrombin
Thrombomodulin
Protein C
Answer B.
244. Which of the following clinical tests detects a breakdown product of fibrinolysis in order to determine whether thrombus formation has recently occurred?
Activated C-Protein
D-dimer
Serum BNP
aPTT
Answer B.
245. Which of the following is NOT a cause of thrombocytopenia?
Splenectomy
B12 deficiency
Autoimmune disease
Liver disease
None of the above
Answer A.
246. Which of the following conditions can lead to increased INR?
von Willebrand’s Disease
Hemophilia
Vitamin K deficiency
DIC
None of the above