BECOM 2 Exam 5 – 2020

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?

  1. Heart Disease

  2. TB

  3. Cancer

  4. Lung Infections

  5. HIV/AIDS

 

2. Which of the following terms is best described as what takes place when an organism harmfully invades?

  1. Colonization

  2. Infection

  3. Toxin

  4. Pathogen

  5. Disease without colonization

 

3. Which of the following transmission styles would be classified as a form of contact?

  1. Transplacental

  2. Biting Insects

  3. Droplets

  4. Airborne

  5. Food/Water

 

4. Which of the following epidemiologic terms is best defined as an infectious disease that spreads rapidly to many people?

  1. Surveillance

  2. Endemic

  3. Outbreak

  4. Epidemic

  5. Pandemic

 

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?

  1. Neither incidence or prevalence change

  2. Incidence is unchanged, prevalence increase

  3. Incidence is unchanged, prevalence decreases

  4. Incidence increases, prevalence increases

  5. Incidence decreases, prevalence decreases

 

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?

  1. Neither incidence or prevalence change

  2. Incidence is unchanged, prevalence increase

  3. Incidence is unchanged, prevalence decreases

  4. Incidence increases, prevalence increases

  5. Incidence decreases, prevalence decreases

 

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?

  1. It had a low accuracy and low precision

  2. It had a low accuracy and high precision

  3. It had a high accuracy and low precision

  4. It had a high accuracy and high precision

  5. He’s definitely getting robbed if he shoots like that

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?

  1. Sensitivity

  2. Specificity

  3. PPV

  4. NPV

  5. PPV:NPV ratio

 

9. Which of the following has the equation of TP/(TP+FN)?

  1. Sensitivity

  2. Specificity

  3. PPV

  4. NPV

  5. PPV:NPV ration

 

10. Which test do you utilize when ruling IN a disease?

  1. Sensitivity

  2. Specificity

  3. PPV

  4. NPV

  5. PPV:NPV ration

 

11. Within the threshold for disease application, what happens when you shift the happy medium to the left?

  1. Decrease Specificity, Increase PPV

  2. Increase Specificity, Increase PPV

  3. Increase Sensitivity, Decrease PPV

  4. Decrease Sensitivity, Decrease NPV

  5. Decrease Specificity, Decrease NPV

 

12. Prevalence has a HUGE impact, in Atchley’s words, on which of the following diagnostic values?

  1. Sensitivity

  2. Specificity

  3. PPV

  4. NPV

  5. Social Distancing

Session 156 – Microbiology Lab Diagnostics – Introduction

13. Viral hepatocyte damage would be most closely associated with which liver diagnostic test?

  1. ALT 

  2. AST 

  3. ALP 

  4. GGT 

  5. Bilirubin

 

14. Which of the following would be the best indicator of recent alcohol consumption?

  1. ALT 

  2. AST 

  3. ALP 

  4. GGT 

  5. Bilirubin

 

15. Which of the following would suggest an elevated white blood cell count in a CBC due to a bacterial source?

  1. Thrombocytopenia 

  2. Polycythemia 

  3. Neutrophilia 

  4. Lymphocytosis 

  5. Neutrophilia

 

16. Which of the following urine dipstick measurements would suggest an urinary tract infection?

  1. pH

  2. Nitrite 

  3. Ketone 

  4. Leukocyte esterase 

  5. Glucose

 

17. Which of the following would be positive in an individual with a Hepatitis B Immunization?

  1. HBsAg 

  2. Anti-HBsAg 

  3. HBeAg 

  4. anti-HBeAg 

  5. Anti-HBcAg

Session 157 – Microbiology Lab Diagnostics – Microscopy I

18. What is the correct step by step process of the gram stain?

  1. Crystal Violet → Safrinin → Alcohol → Iodine

  2. Iodine → Crystal Violet → Alcohol → Safrinin

  3. Crystal Violet → Iodine → Alcohol → Safrinin

  4. Crystal Violet → Alcohol → Iodine → Safrinin

  5. Crystal Violet → Alcohol → Safrinin → Iodine

 

19. What color do gram negative and gram positive bacteria stain in a gram stain respectively?

  1. Purple; Red

  2. Blue; Purple

  3. Red; Pink

  4. Red; Purple

  5. Blue; Green

 

20. Neisseria and Moraxella are two examples of ….?

  1. Gram Positive Cocci

  2. Gram Negative Cocci

  3. Gram Positive Bacillus

  4. Gram Negative Bacillus

  5. Gram Positive Streptococci

 

21. Rickettsia and Chlamydia are two microbes that gram stain poorly due to….

  1. Being obligate intracellular microbes

  2. Being too thin

  3. Having a high lipid content in their cell walls

  4. Having no cell wall

  5. Being too difficult to culture

 

22. A patient is suspected to have contracted the herpes virus, what process will be used to confirm your suspicions? 

  1. Acid Fast Stain

  2. Gram Stain

  3. Trichrome Stain

  4. Tzanck Stain

  5. India Ink Stain

Session 158 – Microbiology Lab Diagnostics – Microscopy II

23. What is the correct order for acid-fast staining?

  1. Carbolfuchsin → Heat Fix → Acid-Alcohol → Methylene Blue

  2. Methylene Blue → Heat Fix → Acid-Alcohol → Carbolfuchsin

  3. Heat Fix → Carbolfuchsin → Acid-Alcohol → Methylene Blue

  4. Heat Fix → Acid-Alcohol → Carbolfuchsin → Methylene Blue

  5. Acid-Alcohol → Heat Fix → Carbolfuchsin → Methylene Blue

 

24. A positive Auramine-Rhodamine acid-fast test will result in staining the acid-fast organism what color?

  1. Red

  2. Purple

  3. Blue

  4. Apple Green

  5. Silver

 

25. An acid-fast stain is used to stain what organism in particular?

  1. Mycoplasma

  2. Mycobacterium

  3. Nocardia

  4. Legionella

  5. Cryptococcus

 

26. What is the characteristic microscopic sign that you are looking at the US parasite that is often mistaken as malaria?

  1. Dark Halos

  2. Maltese Crosses

  3. Multinucleated “giant cells”

  4. Schizonts

  5. Trophozoites

 

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?

  1. High levels of neutrophils

  2. High levels of endothelial cells

  3. Low levels of amylase

  4. Frothy sample

  5. Not collected within the first hour of waking

Session 159 – Microbiology Lab Diagnostics – Culture and Sensitivity

28. Minimum Inhibitory Concentration (MIC) is best described by which of the following?

  1. A concentration greater than the Minimal Bactericidal Concentration (MBC)

  2. Its value is indicated by a test tube concentration that is the most turbid

  3. The greatest drug concentration that inhibits the bacterial replication

  4. The minimal drug concentration that kills the bacteria

  5. None of the above

 

29. Which of the following agar media is best for differentiating alpha, beta, and gamma hemolysis?

  1. Blood agar

  2. Chocolate agar

  3. Eosin Methylene Blue agar

  4. MacConkey agar

  5. Mannitol salt agar

 

30. Which of the following agar media is best for differentiating Staphylococcus aureus from other coagulase negative staphylococci?

  1. Blood agar

  2. Chocolate agar

  3. Eosin Methylene Blue agar

  4. MacConkey agar

  5. Mannitol salt agar

 

31. Which of the following agar media is best for differentiating lactose fermenters from non-lactose fermenters?

  1. Blood agar

  2. Chocolate agar

  3. Eosin Methylene Blue agar

  4. MacConkey agar

  5. Mannitol salt agar

 

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

  1. E. coli

  2. Sta. aureus

  3. Sta. epidermidis

  4. Str. agalactiae (GBS)

  5. Str. pyogenes (GAS)

 

33. Identify the most likely pathogen from the following lab results: 

Catalase: positive

Coagulase: negative

Gram stain: purple cocci

Mannitol salt agar: pink

  1. E. coli

  2. Sta. aureus

  3. Sta. epidermidis

  4. Str. agalactiae (GBS)

  5. Str. pyogenes (GAS)

 

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

  1. E. coli

  2. Sta. aureus

  3. Sta. epidermidis

  4. Str. agalactiae (GBS)

  5. Str. pyogenes (GAS)

 

35. Identify the most likely pathogen from the following lab results: 

Catalase: positive

Coagulase: positive

Gram stain: purple cocci

Mannitol salt agar: yellow

  1. E. coli

  2. Sta. aureus

  3. Sta. epidermidis

  4. Str. agalactiae (GBS)

  5. Str. pyogenes (GAS)

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?

  1. Reticulocyte

  2. Metamyelocyte

  3. Lymphocyte

  4. Basophil

  5. 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?

  1. A

  2. B

  3. C

  4. D

  5. 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)

 

  1. Group A Streptococcus infection

  2. Mononucleosis infection

  3. Cytomegalovirus infection

  4. Group B Streptococcus infection

  5. 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:

  1. Tube 3 needs to go to Microbiology for the Cell Count and Differential. 

  2. Tube 1, the bloodiest sample, needs to go to Chemistry for Glucose and Protein analysis.

  3. Tube 2 needs to go to Hematology for the Cell Count and Differential.

  4. Tube 3, the least bloody sample, needs to go to Chemistry for Glucose and Protein analysis.

  5. 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?

  1. Clear fluid: Normal PMNs: Marked lymph increase: Normal protein & glucose

  2. Viscous fluid: Slight PMN increase: Marked lymph increase: Normal protein: Decreased glucose.

  3. Cloudy fluid: Marked PMN increase: Normal lymphs: Marked protein increase: Decreased glucose.

  4. Viscous fluid: Normal PMN: Marked lymph increase: Normal protein: Decreased glucose.

  5. Clear fluid: Slight PMN increase: Normal lymphs, protein, & glucose.

41. What are the two most common tests for monitoring inflammation?

  1. C-reactive protein and PT/INR

  2. ESR and platelet count

  3. C-reactive protein and ESR

  4. WBC and PT/INR

  5. 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?

  1. The patient has had a past Hepatitis B infection

  2. The patient has an acute Hepatitis B infection

  3. The patient has been vaccinated against Hepatitis B

  4. A mistake must have been made in the lab

  5. The patient does not have and has never had Hepatitis B

 

43. Which of the following correctly matches the type of ELISAs with its probes?

  1. Direct and indirect ELISA and antigen 

  2. Direct and indirect ELISA and antibody

  3. Direct ELISA and antigen. Indirect ELISA and antibody

  4. Direct ELISA and antibody. Indirect ELISA and antigen

  5. Direct ELISA and antigen or antibody

  6. Indirect ELISA and antigen or antibody

 

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?

  1. Patient 1

  2. Patient 2

  3. Patient 3

  4. Patient 7

  5. Patient 9

 

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?

  1. The test is positive, no lines means that the HCG in her urine went all the way to the absorbing pad

  2. The test is negative, no lines means that there is no HCG in her urine to make the line appear

  3. See if she accidently took a fertility test instead since those tests do not have a line that shows up unless you are ovulating

  4. The test is faulty and she should try another one

  5. Try again in a week when she has more HCG in her body

 

46. Which of the following ratios of antibody: antigen would result in the most agglutination?

  1. 1:4

  2. 1:2

  3. 1:1

  4. 2:1

  5. 4:1

Session 162 – Bacteria: Introduction

47. Which of the following is NOT a mechanism by which normal flora promote health in an individual?

  1. Occupy space

  2. Generate antimicrobial products

  3. Maintain vaginal acidic environment

  4. Increase water excretion 

  5. Produce Vitamin K

 

48. Which of the following is NOT found in or an accessory structure of  a typical bacterium?

  1. A single circular chromosome in a nucleoid 

  2. 80s Ribosomes

  3. A cell wall

  4. A flagella made of flagellin

  5. Conjugation pili

 

49. Which of the following are contained within the cell wall of a gram positive bacterium?

  1. O antigen

  2. Lipid A

  3. Mycolic Acid Lipids

  4. Teichoic Acids

  5. Porin channels

 

50. What is the mechanism of action of the antibiotic Penicillin?

  1. Bind and inactivates 70s ribosomes

  2. Creates pores in the cell wall causing lysis 

  3. Disrupts DNA replication leading to cell death

  4. Prevents the addition of teichoic acids

  5. Binds and inhibits transpeptidase

 

51. Why must a physician be careful when giving antibiotics to an individual with sepsis caused by a gram negative bacteria?

  1. Antibiotics don’t work well on gram negative bacteria due to their thin cell walls

  2. A physician should always be careful when administering antibiotics and assess for allergies

  3. The release of too much lipid A can cause a patient to go into shock

  4. Antibiotics can force bacteria to form spores which can later germinate and relapse the disease state

  5. Free floating bacterial DNA can be toxic in large amounts

 

52. Which of the following terms describe an organism that can live without oxygen but will preferentially utilize it if it is available?

  1. Obligate aerobe 

  2. Capnophiles

  3. Facultative anaerobe 

  4. Aerotolerant anaerobes

  5. Obligate anaerobe

 

53. Which of the following is NOT an obligate aerobe?

  1. Legionella

  2. Pseudomonas

  3. Bacteroides

  4. Nocardia

  5. Bacillus

 

54. Which of the following is NOT an obligate anaerobe?

  1. Mycobacterium

  2. Bacteroides

  3. Fusobacterium

  4. Clostridium 

  5. Actinomyces

 

55. During which phase of the bacterial growth curve are antibiotics the most effective/useful?

  1. Lag phase

  2. Log/exponential phase

  3. Stationary phase

  4. Death/decline phase

  5. None of the above, everyone knows antibiotics are for viral infections

 

56. Which type of toxin could lead to flaccid paralysis of muscle?

  1. Endotoxin

  2. Neurotoxin

  3. Enterotoxin

  4. Pyrogenic exotoxin

  5. Tissue invasive exotoxin

Session 163 – Bacteria: Microbial Genetics

57. This type of genetic transfer is the uptake of DNA from the environment?

  1. Conjugation

  2. Transformation

  3. Transduction

  4. HFR

  5. Phage genetic transfer

 

58. After phage injects its DNA, what is the next step in the LYSOGENIC phase?

  1. Transcription of phage genome

  2. Translation of phage genome

  3. Replication of phage genome

  4. Integration of phage genome

  5. Breakdown of host genome

 

59. What technique of genetic transfer was used to determine the time-of-entry mapping of genes?

  1. Conjugation

  2. Transformation

  3. Transduction

  4. HFR

  5. Phage genetic transfer

 

60. What is the correct order for the tryptophan operon?

  1. Cys; A; B; C; E

  2. Cys; B; A; C; E

  3. Cys; E; C; B; A 

  4. Cys; E; C; A; B

  5. B; A; C; E; Cys

 

61. Which of the following toxins are  genetic and are NOT bacterial toxins that are transferred to non-toxic strains via lysogenic phage?

  1. SpeC Exotoxin

  2. Botulinum Toxin

  3. Shiga toxin

  4. Verotoxin

  5. Diplopia toxin

Session 164 – Bacteria: Virulence Factors

62. Which of the following does NOT have a capsule?

  1. E. coli 

  2. H. influenzae

  3. S. pneumoniae 

  4. N. meningitidis 

  5. S. aureus

 

63. Protein A is a key virulence factor that is found on ___ that creates a Fab cloak by binding to ___?

  1. E. coli; IgM

  2. E. coli; IgG

  3. H. influenzae; IgM

  4. H. influenzae; IgG

  5. S. aureus; IgM

  6. S. aureus; IgG

 

64. Which of the following is NOT a key characteristic of endotoxins?

  1. Mostly produced by gram (-) bacteria 

  2. Highly toxic 

  3. Triggers IL-1/IL-6 release

  4. Released from the LPS via cell lysis 

  5. Does not promote enzymatic activity

 

65. Which of the following exotoxins damages the cell by binding to the 60S ribosome without invading the cell? 

  1. B. pertussis 

  2. C. diphtheria 

  3. P. aeruginosa 

  4. Shigella 

  5. EHEC

 

66. Which of the following exotoxins inhibits GABA and glycine release which leads to ‘rigid’ muscles?

  1. C. tetani 

  2. C. botulinum 

  3. B. pertussis 

  4. Shigella 

  5. EHEC

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?

  1. Catalase (+)

  2. Catalase (-)

  3. Coagulase (+)

  4. Coagulase (-)

  5. Oxidase (+)

 

68. Which is an appropriate description of Staph aureus?

  1. Alpha Hemolytic

  2. Catalase Negative

  3. Coagulase Negative

  4. Mannitol Fermenter

  5. Lactose Fermenter

 

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?

  1. Panton-Valentine Leukocidin (PVL)

  2. Exfoliatin 

  3. TSST

  4. Enterotoxin

  5. Scalded Skin Syndrome Toxin A

 

70. Determine the diagnosis based upon the following clues:

  1. This infection is most commonly caused by Staph aureus

  2. In patients with sickle cell disease this infection is most commonly caused by Salmonella

  3. If there is direct penetrating trauma in a wet environment, Pseudomonas aeruginosa can cause this infection as well. 

 

  1. Toxic Shock Syndrome

  2. Scalded Skin Syndrome

  3. Osteomyelitis

  4. Pharyngitis 

  5. Food Poisoning

 

71. What important gene in MRSA codes for an altered penicillin binding protein that does not allow Penicillin to bind to the bacteria?

  1. Penicillinase

  2. aPBP

  3. Optochin

  4. mecA

  5. MRSA-1G

Session 166 – Bacteria: Gram Positive Cocci II

72. What test will help you differentiate Group A Strep from Group B Strep?

  1. Coagulase

  2. Catalase

  3. Oxidase

  4. Optochin

  5. Bacitracin

 

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? 

  1. Rheumatic Fever

  2. Scarlet Fever

  3. Post-Streptococcal Glomerulonephritis

  4. Rocky Mountain Spotted Fever

  5. Cellulitis

 

74. How would one differentiate Strep pneumo from Strep viridans

  1. Bacitracin resistance

  2. Optochin resistance

  3. Amoxicillin resistance

  4. Acid-fast stain

  5. Hemolysis typing on blood agar

 

75. When looking at a gram stain of Strep pneumo, what are you expecting to see?

  1. Red circles

  2. Purple circles

  3. Purple back to back lancets

  4. Purple rods

  5. Red rods

 

76. Strep pneumo is the most common cause of what infection in children?

  1. Pneumonia

  2. Otitis Externa

  3. Osteomyelitis

  4. Otitis Media

  5. Gingivitis

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?

  1. Staphylococcus aureus

  2. Streptococcus viridans

  3. Streptococcus pneumoniae

  4. Staphylococcus epidermidis

Answer Choice

78. Which of the following differentiates Streptococcus agalactiae from other Streptococcus species?

  1. Optochin sensitivity

  2. CAMP test

  3. Bacitracin sensitivity

  4. Coagulation testing

 

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?

  1. Staphylococcus saprophyticus

  2. Enterococcus faecium

  3. Streptococcus pneumoniae 

  4. Staphylococcus aureus

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?

  1. Staphylococcus epidermidis 

  2. Staphylococcus aureus 

  3. Streptococcus pyogenes 

  4. Streptocuccus viridans

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?

  1. Scarlet fever

  2. Post-streptococcal glomerulonephritis

  3. Rheumatic fever

  4. Lobar pneumonia

Session 167 – Bacteria: Gram Negative Bacilli

82. Lactose fermenters typically present as which color growth on MacConkey agar?

  1. Blue 

  2. Clear

  3. Green

  4. Pink

  5. Yellow

 

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

  1. Aeromonas hydrophila

  2. E. coli

  3. Enterobacter

  4. Klebsiella pneumoniae

  5. Pseudomonas aeruginosa

 

84. How does the classical presentation of Salmonella typhi differ from non-typhoidal strains of Salmonella

  1. Rose spots

  2. Temperature dissociation

  3. Constipation preceding non-bloody diarrhea

  4. Rash

  5. All of the above

 

85. Which E. coli antigen increases the risk of meningitis in a newborn?

  1. H antigen

  2. K antigen

  3. O antigen

  4. All the above

  5. None of the above

 

86. Which of these is slowest in lactose fermentation?

  1. Klebsiella pneu

  2. moniae Enterobacter 

  3. Citrobacter 

  4. Escherichia coli

87. Which is NOT a component of the classical triad in hemolytic uremic syndrome?

  1. Thrombocytopenia

  2. Gastritis

  3. Acute renal failure

  4. Anemia

88. Which of the following species is associated with development of otitis externa (swimmer’s ear)?

  1. Serratia marcescens 

  2. Aeromonas hydrophila 

  3. Pseudomonas aeruginosa 

  4. Campylobacter jejuni

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?

  1. Proteus mirabilis 

  2. Escherichia coli 

  3. Shigella 

  4. Salmonella enteritidis

90. Which of the following pathogens is found in unpasteurized milk and can cause inflammation of the appendix similar to appendicitis?

  1. Salmonella enteritidis 

  2. Shigella dysenteriae

  3. Yersinia enterocolitica 

  4. Campylobacter jejuni

91. What is the major neurological consequence of Campylobacter infection?

  1. Tabes dorsalis 

  2. Multiple sclerosis 

  3. Guillain-Barre syndrome 

  4. Brown-Sequard syndrome

92. Which of the following pathogens is associated with internal jugular vein thrombophlebitis secondary to peritonsillar abscess formation?

  1. Bacteroides fragilis 

  2. Fusobacterium necrophorum

  3. Neisseria gonorrhoeae 

  4. Moraxella catarrhalis

  5. Shigella dysenteriae

Session 168 – Bacteria: Other Gram Negative Bacteria

93. What is a potential sequelae of Chlamydia trachomatis infection in women?

  1. Urethritis 

  2. Pelvic Inflammatory Disease 

  3. Cystitis

  4. Cervicitis

 

94. Which of the following is not part of the classic triad of reactive autoimmune arthritis (Reiter’s syndrome) secondary to C. trachomatis infection?

  1. Urethritis 

  2. Cystitis

  3. Conjunctivitis 

  4. Arthritis

95. Which of the following serotypes of C. trachomatis can lead to lymphogranuloma venereum upon infection?

  1. L2 

  2. K

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?

  1. Acinetobacter baumannii 

  2. Legionella pneumophila 

  3. Haemophilus influenzae 

  4. Moraxella catarrhalis

97. Which is the main site of colonization for Haemophilus influenzae?

  1. Oropharynx 

  2. Lungs 

  3. Nasopharynx

  4. Tonsils

98. Which of the following organisms causes development of painful chancroid genital ulcers following sexual intercourse?

  1. Neisseria gonorrhoeae 

  2. Chlamydia trachomatis 

  3. Treponema pallidum 

  4. Haemophilus ducreyi

99. What is the required agar for growth of Legionella cultures?

  1. MacConkey’s agar 

  2. Hektoen Enteric 

  3. BCYE 

  4. Chocolate

     

100. What electrolyte imbalance is often observed in elderly patients with Legionella infection (Legionnaires disease)?

  1. Hypomagnesemia 

  2. Hyperkalemia 

  3. Hyponatremia 

  4. Hypocalcemia 

  5. Hypokalemia

     

101. What condition is Neisseria gonorrhoeae infection a primary cause of in sexually active adults?

  1. Septic arthritis 

  2. Chancre 

  3. Conjunctivitis 

  4. Meningitis

102. What is an endocrine consequence of meningococcemia due to Neisseria meningitidis infection?

  1. Decreased testosterone production

  2. Decreased cortisol production

  3. Decreased ACTH release

  4. Increased GH release

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?

  1. Bacillus cereus 

  2. Bacillus anthracis 

  3. Listeria monocytogenes 

  4. Corynebacterium diphtheriae

104. Which is the most lethal form of anthrax infection?

  1. Injected 

  2. Intestinal 

  3. Inhaled 

  4. Cutaneous

     

105. What is the main function of the cell-binding component (PA) of the tripartite anthrax toxin?

  1. Prevention of phagocytosis 

  2. Cause edema 

  3. Endocytosis of EF and LF 

  4. None of the above

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?

  1. Bacillus cereus 

  2. Clostridium difficile 

  3. Clostridium perfringens 

  4. A & C

     

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?

  1. Increase GABA release 

  2. Decrease acetylcholine release 

  3. Decrease norepinephrine release 

  4. Increase glycine release

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?

  1. Clostridium perfringens 

  2. Bacillus cereus 

  3. Clostridium botulinum 

  4. Clostridium difficile

 

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?

  1. Lecithinase 

  2. Transpeptidase 

  3. Hyaluronidase

  4. Elongase 

  5. Hemolysin

 

110. In which of the following ways is food poisoning from Clostridium perfringens different from the food poisoning caused by Staphylococcus aureus?

  1. It is caused by an enterotoxin

  2. It causes a bloody diarrhea

  3. It is gram negative 

  4. It has a later onset

  5. It disrupts blood supply

 

111. Clostridium tetani toxin interferes with which of the following neurotransmitters?

  1. Acetylcholine

  2. Norepinephrine

  3. GABA/glycine

  4. Serotonin

  5. Dopamine

 

112. What is the mechanism of action for Corynebacterium diphtheriae?

  1. Activates adenylate cyclase and increases cAMP

  2. Inhibits cell signalling and causes release of TNF-a and IL-1B

  3. Inhibits the release of neurotransmitters

  4. Causes the increase in efflux of chloride and water follows

  5. Inactivation of elongation factor (EF-2)

 

113. What is one of the major reasons Listeria is so good at avoiding the immune system?

  1. It binds the Fc region of IgG to hide 

  2. It is an intracellular organism that moves cell to cell

  3. It has an IgA protease to digest IgA

  4. It has a polysaccharide capsule which resist phagocytosis

  5. It enters as a spore which are difficult for the immune system to recognize before germination

 

114. Which of the following foods could be contaminated with Listeria and should be avoided during pregnancy?

  1. Reheated rice

  2. Raw poultry

  3. Raw/unpasteurized milk or cheese

  4. Raw beef

  5. Reheated sauces

 

115. What is a major difference between Nocardia and Actinomyces?

  1. Nocardia has branching filaments while Actinomyces does not

  2. Nocardia undergoes spore formation while actinomyces does not

  3. Nocardia is found in normal oral flora while Actinomyces is not 

  4. Nocardia is aerobic while Actinomyces is anaerobic 

  5. Nocardia produces yellow sulfur granules while Actinomyces does not

Session 171 – Bacteria: Spirochetes

116. Which of the following spirochetes causes Lyme disease?

  1. Borrelia burgdorferi

  2. Borrelia recurrentis 

  3. Borrelia hermsii

  4. Treponema pallidum 

  5. Leptospira interrogans

 

117. Which spirochete is shown in the image above?

  1. Borrelia burgdorferi

  2. Borrelia recurrentis 

  3. Borrelia garinii

  4. Treponema pallidum 

  5. Leptospira interrogans

 

118. Myocarditis is symptomatic in which stage of Lyme disease?

  1. Stage 1

  2. Stage 2

  3. Stage 3

  4. Stage 4

  5. Not answer E

 

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?

  1. Borrelia burgdorferi

  2. Borrelia recurrentis 

  3. Borrelia garinii

  4. Treponema pallidum 

  5. Leptospira interrogans

 

120. Weil’s disease (icteric type) has 2 phases, which of the following is characteristic of the leptospirotic phase?

  1. Headache

  2. Conjunctival injection

  3. bradycardia

  4. Encephalopathy 

  5. Polymorphic rashes

 

121. Utilizing a chancre fluid dark field microscopy you can identify which of the following diseases?

  1. Lyme Disease

  2. Syphilis

  3. Leptospirosis

  4. Relapsing Fever

  5. Corona Virus

 

122. Which of the following is NOT a false positive to a syphilis diagnosis?

  1. Leprosy

  2. Mononucleosis

  3. Gonorrhea 

  4. Pregnancy

  5. Lupus

 

123. What cardiac conduction abnormality is observed in patients within the early disseminated stage (Stage 2) of Lyme disease?

  1. Atrial flutter 

  2. 3rd degree AV block 

  3. Bradycardia 

  4. Tachycardia 

  5. Atrial fibrillation

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?

  1. Doxycycline 

  2. Amoxicillin 

  3. Penicillin G 

  4. None of the above

125. What is a neurological manifestation of tertiary syphilis which presents with loss of proprioception, decreased DTRs, ataxia and a wide-based gait?

  1. Multiple sclerosis 

  2. Friedrich’s ataxia 

  3. Tabes Dorsalis 

  4. Subacute combined degeneration

     

126. What ophthalmologic abnormality involving decreased reactivity to light with normal accommodation occurs as a manifestation of tertiary syphilis?

  1. Marcus-Gunn pupil 

  2. Argyll-Robertson pupil 

  3. Anisocoria 

  4. Nystagmus

 

Session 172 – Bacteria: Zoonotic I

127. The presence of a classic ‘maltese-cross’ in a blood smear would be evident in ___ transmitted by ____?

  1. Malaria; ticks

  2. Malaria; mosquitos

  3. Babesia; ticks

  4. Babesia; mosquitos 

  5. Babesia; birds

 

128. Administration of which medication is used for most animal borne-illnesses?

  1. Penicillin 

  2. Doxycycline 

  3. Azithromycin 

  4. Streptomycin 

  5. Rifampin

 

129. Which disease is commonly caused my cat scratches and presents as red ‘stretch marks

 7-10 days later?

  1. Brucellosis 

  2. Psittacosis 

  3. Q-Fever 

  4. Bartonellosis 

  5. Tularemia

 

130. Which of the following is found in Bacillary Angiomatosis but NOT Kaposi Sarcoma?

  1. Common in HIV/AIDS 

  2. Etiological agent is HHV-8 

  3. Lymphocyte infiltration 

  4. Raised red/purple lesions 

  5. PMN infiltration

 

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?

  1. Brucellosis 

  2. Psittacosis 

  3. Q-Fever 

  4. Bartonellosis 

  5. Tularemia

 

132. Which characteristic is key in distinguishing the difference between asymptomatic vs severe leptospirosis?

  1. Conjunctival suffusion 

  2. Fever 

  3. Myalgias 

  4. Jaundice 

  5. Headache

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?

  1. Exposure to an armadillo

  2. Exposure to contaminated water

  3. Recent tick bite

  4. Recent pet bite

  5. Promiscuity

 

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?:

  1. Babesia

  2. Monocytic Ehrlichiosis

  3. Malaria

  4. Granulocytic Anaplasmosis

  5. Borrelia Burgdorferi

 

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?

  1. Rhipicephalus

  2. Dermacentor

  3. Amblyomma

  4. Ixodes

  5. Sanguinis

 

136. Following a flea bite, your patient presents with a bubo on their neck. What would you expect to see on a Giemsa stain?

  1. Red Coccobacilli 

  2. Morulae inside granulocytes

  3. Morulae inside monocytes

  4. Pushpin dense coccobacilli

  5. Bipolar Safety Pin

 

137. What is the method of transmission for Rickettsia prowazekii?

  1. Lice feces

  2. Flea Bites

  3. Tick Bites

  4. Pet Bites

  5. Human to Human

Session 174 – Introduction to Fungi and Viruses

138. As opposed to bacteria, which component of the cell membrane is unique to fungi?

  1. Proteins

  2. Cholesterol

  3. Cell Wall

  4. Chitin

  5. Lipid Bilayer

 

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?

  1. Azoles

  2. Polyene

  3. Allylamines

  4. Terbinafine

  5. Doxycycline

 

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?

  1. Superficial

  2. Cutaneous

  3. Subcutaneous

  4. Systemic

  5. Opportunistic

 

141. Viruses can be grouped together based on which tissues they infect. Which of the following groups does SARS-CoV-2 fit in?

  1. Pneumotropic

  2. Dermotropic

  3. Viscerotropic

  4. Neurotropic

 

142. Which is the correct order for the replication of viruses?

  1. Attachment → Biosynthesis → Penetration → Maturation → Release

  2. Biosynthesis → Maturation → Attachment → Penetration → Release

  3. Attachment → Penetration → Biosynthesis → Release → Maturation

  4. Release → Maturation → Attachment → Penetration → Biosynthesis

  5. Attachment → Penetration → Biosynthesis → Maturation → Release

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?

  1. Acid-fast

  2. Gram

  3. India ink

  4. Potassium Hydroxide

  5. Silver

 

144. Presence of a Ghon complex is indicative of which form of tuberculosis?

  1. Bone and joint tuberculosis

  2. Primary respiratory tuberculosis

  3. Secondary respiratory tuberculosis

  4. Tuberculosis enteritis

  5. Tuberculosis meningitis

 

145. Tuberculosis infections typically result in dense granulomas consisting of an aggregation of which cell type?

  1. Cytotoxic T-cells

  2. Helper T-cells

  3. Macrophages

  4. Neutrophils

  5. A and C

  1. A and D

  2. B and C

  3. B and C

 

146. Which of the following is the animal reservoir for Tuberculosis leprae?

  1. Aardvark

  2. Anteater

  3. Armadillo

  4. Groundhog

  5. Opossum

 

147. In a patient of suspected leprosy, which of the following traits leads to a differential diagnosis of tuberculoid leprosy over lepromatous leprosy?

  1. Absence of granulomas

  2. Hypopigmentation and loss of hair

  3. Patches of hypopigmented skin

  4. Severe neuropathy

  5. Th2 response

Session 176 – DNA Viruses I

148. An infection with Parvo B-19 would be most devastating in what kind of patient?

  1. Someone previously infected with another strain of Parvo B-19

  2. Someone with Cystic Fibrosis

  3. Someone with an allergy to Penicillin

  4. Someone with Sickle Cell Anemia

  5. Someone with Onychomycosis

149. The classic “Slapped Cheek” appearance in a child infected with Parvo B-19 is due to which of the following?

  1. Pathogen colonization in the maxillary sinuses

  2. Type 2 Hypersensitivity reaction

  3. Type 3 Hypersensitivity reaction

  4. Type 4 Hypersensitivity reaction

  5. 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?

 

  1. HPV Serotypes 6 and 11

  2. HPV strain expressing EP6 gene

  3. HPV Serotype 16

  4. HPV strain expressing EP7 gene

  5. HPV Serotype 18

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?

  1. It is a naked, ds-DNA virus that replicates in the nucleus.

  2. It is responsible for oral herpetic cold sores in 20% of the cases.

  3. Its site of latency is in Lymphocytes in the inguinal lymph nodes.

  4. Tzanck smear displays Giant Cells with Basophilic Intranuclear Inclusions.

  5. 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?

  1. An enveloped dsDNA virus, subgroup B, serotype 21

  2. A naked ssDNA virus, subgroup A, serotype 11

  3. Acute Hemorrhagic Cystitis

  4. An enveloped dsDNA virus, subgroup A. serotype 11

  5. 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:

  1. HPV

  2. Parvo B-19

  3. Adenovirus

  4. EBV

  5. 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?

  1. HSV-1

  2. Epstein-Barr Virus

  3. Leptospirosis

  4. Chlamydia

  5. 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: 

  1. CMV

  2. HSV-1

  3. HHV-8

  4. EBV

  5. HHV-6

Session 177 – DNA Viruses II

156. Who of the following is at the most risk for shingles?

  1. 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

  2. Angel, a 15 year old who was vaccinated as a child and never got chicken pox.

  3. Irene, a 68 year old who never had chicken pox and also never was vaccinated, but who grew up on a chicken farm

  4. Marvin, a 62 year old who had chickenpox as a kid, but is not old enough for his insurance to cover a zostavax vaccine.  

  5. 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.

 

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?

  1. Cytomegalovirus

  2. Syphilis

  3. Epstein-Barr Virus infection

  4. Oral hairy leukoplakia

  5. Streptococcus pyogenes infection

 

158. Which of the following is false regarding CMV or EBV mononucleosis?

  1. CMV negative transplant patients are at an increased risk of rejecting their organs if they do not receive CMV negative blood transfusions

  2. EBV causes false positives on syphilis screenings

  3. CMV has a negative heterophile antibody test

  4. EBV is associated with an increased risk of nasopharyngeal carcinoma

  5. CMV can cause deaf, blueberry muffin babies, with cataracts

 

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?

  1. Herpes simplex Virus 1

  2. Herpes simplex Virus 2

  3. Human Herpes Virus 6

  4. Human Herpes Virus 8

  5. Varicella Zoster Virus

 

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:

  1. Variola

  2. Smallpox

  3. Molluscum contagiosum

  4. Cowpox

  5. Chickenpox

Session 178 – RNA Negative Sense Viruses

161. Which of the following RNA viruses is NOT segmented?

  1. Reo

  2. Arena

  3. Orthomyxo

  4. Paramyxo

  5. Bunya

 

162. All negative sense RNA viruses are which of the following?

  1. Double stranded

  2. Enveloped 

  3. Segmented 

  4. Icosahedral

  5. Naked

 

163. Which negative sense RNA virus replicates in the nucleus?

  1. Retro

  2. Pox

  3. Orthomyxo

  4. Paramyxo

  5. Rhabdo

 

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?

  1. Arenaviridae

  2. Bunyaviridae

  3. Paramyxoviruses

  4. Orthomyxoviruses 

  5. Filoviridae

 

165. Which of the following types of viruses causes Ebola (a thrombocytopenic hemorrhagic disease with a near 100% mortality rate)?

  1. Arenaviridae

  2. Bunyaviridae

  3. Paramyxoviruses

  4. Orthomyxoviruses 

  5. Filoviridae

 

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)?

  1. Arenaviridae

  2. Bunyaviridae

  3. Paramyxoviruses

  4. Orthomyxoviruses 

  5. Filoviridae

 

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?

  1. Influenza

  2. Rubella

  3. Rubeola

  4. Diphtheria

  5. Mumps

 

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?

  1. Influenza

  2. Rubella

  3. Rubeola

  4. Diphtheria

  5. Mumps

 

169. Which type of influenza can infect birds, pigs, and humans but birds are the natural hosts?

  1. A

  2. B

  3. C

  4. D

  5. E

 

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?

  1. H1N1

  2. H3N2

  3. H5N1

  4. H7N3

  5. H9N7

 

171. Which type of change occurs frequently in Influenza that requires the development of a new vaccine?

  1. Shifts

  2. Conjugations

  3. Transductions

  4. Drifts

  5. Reassortments

 

172. Which type of virus travels in the nerves and is 100% fatal after it incubates?

  1. Ebola

  2. Rhabdovirus

  3. H5N1 avian flu

  4. Lassa fever

  5. Hanta Virus

 

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?

  1. Lewy bodies

  2. Neurofibrillary tangles 

  3. Tau plaques 

  4. IgM antibodies

  5. Negri bodies

Session 179 – RNA Positive Sense Viruses

174. Which of the following RNA viruses are Helical and positive sense ?

  1. Reovirus

  2. Dengue

  3. Covid-19

  4. HIV

  5. Rubella

 

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?

  1. West Nile Virus

  2. Dengue

  3. Rubella

  4. HTLV-1

  5. SARS

 

176. Our current COVID-19 virus is most comparable to which of the following RNA positive sense viruses?

  1. West Nile Virus

  2. Dengue

  3. Rubella

  4. HTLV-1

  5. SARS

 

177. Poliovirus is categorized into which of the following ?

  1. Coronaviridae 

  2. Retroviridae

  3. Togaviridae

  4. Picornaviridae

  5. Flaviviridae

 

178. This naked, positive sense ssRNA virus is the #1 cause of gastroenteritis in adults and absolutely has a field day on cruise ships?

  1. Norovirus

  2. Coltivirus

  3. Rotavirus

  4. Coxsackievirus

  5. Echovirus

Session 180 – Fungi I

179. Which of the following is found in yeasts but NOT molds?

  1. Reproduction by forming spores 

  2. ‘Bacteria-like’ appearance 

  3. Formation of hyphae 

  4. ‘Cotton-like’ appearance 

  5. Formation of mycelium

 

180. Which pulmonary fungal infection is NOT found in the United States?

  1. Histoplasmosis 

  2. Blastomycosis 

  3. Coccidioidomycosis 

  4. Paracoccidioidomycocis  

  5. Sporothrix

 

181. Which fungal infection acts as a mold in cooler temperatures but a yeast at warmer temperatures?

  1. Histoplasmosis 

  2. Blastomycosis 

  3. Coccidioidomycosis 

  4. Paracoccidioidomycocis 

  5. Sporothrix

 

182. Onychomycosis would refer to a fungal infection of which area?

  1. Feet  

  2. Head  

  3. Groin  

  4. Nails 

  5. Back

 

183. A classic combination of hyphae and yeast cells that promotes shedding of the stratum corneum is consistent with which fungal infection?

  1. Tinea pedis 

  2. Tinea cruris 

  3. Tinea corporis 

  4. Tinea versicolor 

  5. Tinea unguium

Session 181 – Fungi II

184. A positive germ tube test is a clear indicator that you are looking at which fungi?

  1. Aspergillus Flavus

  2. Aspergillus Fumigatus

  3. Candida Albicans

  4. Cryptococcus Neoformans

  5. Mucor

 

185. If the sputum culture you collected shows a positive germ tube test, what does this tell you about your patient?

  1. Oral Thrush

  2. HIV/AIDS

  3. Aspergillosis

  4. ABPA

  5. Cystic Fibrosis

186. Identify the fungi below:

 

  1. Aspergillus Fumigatus

  2. Aspergillus Flavus

  3. Candida Albicans

  4. Mucor

  5. Pneumocystis Jiroveci

 

187. A patient’s india ink stain came back positive. What disease are you most concerned about this patient developing?

  1. Pneumonia

  2. HIV

  3. Meningitis

  4. Mucormycosis

  5. Aspergilloma

 

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?

  1. Aspergilloma

  2. Mucormycosis

  3. Candida Albicans

  4. Pneumocystis Jiroveci

  5. 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?

  1. Giardia lamblia

  2. Cryptosporidium parvum

  3. Toxoplasma gondii

  4. Acanthamoeba

  5. Cyclospora

 

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?

  1. ETEC

  2. Giardia lamblia

  3. Entamoeba histolytica

  4. Toxoplasma gondii

  5. Spontaneous appendicitis

 

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?

  1. Entamoeba histolytica

  2. Naeglaria fowleri

  3. Trypanosoma cruzi

  4. Leishmania donovani

  5. Toxoplasma gondii

 

192. A gametocyte would point to the patient suffering from ______, whereas finding a maltese cross formation points to _______.

  1. Babesiosis, Malaria

  2. Trichomonas, Babesiosis

  3. Babesiosis, Trichomonas

  4. Malaria, Babesiosis

  5. Toxoplasma, Babesiosis

 

193. Which arthropod causes pubic itching and burning that gets worse at night in a person who is sexually active?

  1. Fleas

  2. Termites

  3. Sarcoptes scabiei

  4. Pthirus pubis

  5. Spiders

 

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?

  1. Cryptosporidium parvum 

  2. Entamoeba histolytica 

  3. Giardia lamblia 

  4. Cyclospora cayetanensis

195. Which of the following is the primary host of the organism from the previous question?

  1. Cats 

  2. Humans 

  3. Monkeys 

  4. Beavers

     

196. Which of the following is noted as a major cause of epidemic diarrhea outbreaks within a given community?

  1. Entamoeba histolytica

  2. Cryptosporidium parvum

  3. Shigella dysenteriae

  4. Giardia lamblia

197. Which of the following is not listed as a possible pathology caused by E. histolytica?

  1. Diverticulitis

  2. Brain abscess

  3. Liver abscess

  4. Appendicitis

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?

  1. Pasteurella multocida

  2. Toxoplasma gondii

  3. Capnocytophaga canimorsus

  4. Toxocara cati

199. Which of the following tick-borne illnesses poses possible co-infection with babesiosis due to sharing a common vector?

  1. Ehrlichiosis

  2. Rocky Mountain Spotted Fever

  3. Lyme Disease

  4. Relapsing Fever

200. Which of the following protozoa is responsible for causing fatal primary amoebic meningoencephalitis (PAM)?

  1. Naegleria fowleri

  2. Entamoeba histolytica

  3. Acanthamoeba

  4. Trypanosoma brucei

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?

  1. Strongyloides sterocalis

  2. Ancyclostoma duodenale

  3. Necator americanus

  4. All of the above

  5. B and C

 

202. Which of the following helminths make their way to the lungs after entering through the skin?

  1. Ascaris lumbricoides

  2. Necator americanus

  3. Strongyloides sterocalis

  4. All of the above

  5. B and C

 

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?

  1. Ascaris lunmbricoides

  2. Dracunculus medininsis

  3. Enterobius vermicularis

  4. Necator americanus

  5. Strongyloides sterocalis

 

204. Trichinella spiralis enters the body via _________ and its larvae disseminate to __________ where they can remain viable for years.

  1. Fecal-oral transmission; lungs

  2. Skin; intestines

  3. Skin; muscles

  4. Undercooked meat (pig); lungs

  5. Undercooked meat (pig); muscles

 

205. Which of the following is best diagnosed using a Scotch tape test/prep for microscopy imaging?

  1. Giant roundworm

  2. Hookworm

  3. Pinworm

  4. Threadworm

  5. All of the above

 

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?

  1. Simulium fly

  2. Loa loa

  3. Chrysops fly

  4. Drinking unpurified water

  5. 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?

  1. Lymphocytopenia

  2. Microcytic anemia

  3. Left shift in the CBC with diff

  4. Eosinophilia

  5. 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?

  1. The patient ate the local undercooked beef infected with Taenia saginata oncospheres

  2. The patient ingested the cysts of Taenia solium

  3. The patient ate the local undercooked pork infected with Taenia solium oncospheres

  4. The patient ingested the cysts of Taenia saginata

  5. 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?

  1. The cyst membrane contains an anticoagulant that could lead to prolific bleeding upon removal.

  2. The cysts are now a major source of hematopoietic production in the patient.

  3. Rupturing of the cysts during removal would cause the patient to go into anaphylactic shock.

  4. The symbiotic relationship developed between the cysts and liver could lead to organ failure post surgical removal.

  5. 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?

  1. Microcytic anemia

  2. Hypersegmented PMNs

  3. Left Shift

  4. Reactive lymphocytes

  5. 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?

  1. Nile river perch.

  2. African Tigerfish

  3. African soft shelled turtle

  4. Freshwater snails

  5. 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?

  1. Squamous cell carcinoma

  2. Cholangiocarcinoma

  3. Pancreatic cancer

  4. Cirrhosis of the liver

  5. 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?

  1. Shunting blood away from the extremities

  2. Vasodilation of the arteries

  3. Release of cortisol

  4. Activation of the RAAS system

  5. Carotid baroreceptor sending a signal to the heart

 

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?

  1. Hypovolemic 

  2. Hypervolemic

  3. Cardiogenic

  4. Distributive

  5. Obstructive

 

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

  1. Administration of IV antibiotics: this patient is experiencing septic shock 

  2. Vasopressors: this patient is experiencing cardiogenic shock

  3. Insertion of a chest tube: this patient is experiencing obstructive shock

  4. Perform a paracentesis: this patient is experiencing hypervolemic shock

  5. Administration of whole blood: this patient is experiencing hypovolemic shock

 

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?

  1. Reduced right ventricle filling

  2. Hypertension

  3. Induction of systemic inflammation

  4. Hypovolemia 

  5. Cardiovascular depression

 

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?

  1. Administration of IV antibiotics: this patient is experiencing septic shock 

  2. Vasopressors: this patient is experiencing cardiogenic shock

  3. Insertion of a chest tube: this patient is experiencing obstructive shock

  4. Perform a paracentesis: this patient is experiencing hypervolemic shock

  5. Administration of whole blood: this patient is experiencing hypovolemic shock

218. What is the purpose of increased venoconstriction during shock?

  1. Increase CO

  2. Decrease MAP

  3. Increase preload

  4. H2O conservation

219. Which of the following inflammatory mediators leads to uncontrolled vasodilation during shock?

  1. TNFα

  2. IL-1

  3. NO

  4. IL-6

220. What is the primary treatment for patients in hypovolemic shock?

  1. Volume restoration

  2. High-dose insulin

  3. Amrinone administration

  4. Beta blockers

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?

  1. Cardiomyopathy

  2. Cardiac tamponade

  3. Disseminated intravascular coagulopathy (DIC)

  4. Hypertensive crisis

 222. Statistically, what is the biggest cause of cardiogenic shock?

  1. Acute severe mitral regurgitation

  2. Ventricular Septal Defect

  3. Cardiac tamponade

  4. Predominant LV failure

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?

  1. Distributive

  2. Obstructive

  3. Hypovolemic

  4. Cardiogenic

 224. What is the mainstay treatment for beta-blocker overdose?

  1. High-dose insulin with concomitant dextrose

  2. Amrinone lactate

  3. Glucagon

  4. IV fluids

Session 186 – Clotting and Disruption of Blood Flow I

225. Which of the following components of hemostasis is the first to occur?

  1. Vasoconstriction/spasm

  2. Platelet activation

  3. Coagulation cascade

  4.  Antithrombotic activation

  5.  Fibrinolysis

 

226. Platelets/thrombocytes are derived from which precursor cell?

  1. Myeloblast

  2. Lymphoblast

  3. Megakaryocyte

  4. Normoblast

  5. Reticuloblast

 

227. Which of the following is secreted from endothelial cells to inhibit platelet activation/aggregation?

  1. Heparan Sulfate

  2. Thrombomodulin

  3. Tissue Factor Pathway Inhibitor (TFPI)

  4. Prostacyclin

  5. ADP

 

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?

  1. GP Ib-IV-IX

  2. GP Ia/IIa

  3. GP VI

  4. GP IIb/IIIa

  5. GP Ib

 

229. Which platelet secretion can be found within the dense granules?

  1. Thromboxane A2

  2. Fibrinogen

  3. Von Willebrand Factor

  4. Clotting factor V

  5. Calcium

 

230. How can prescribing a patient corticosteroids depressing their ability to clot effectively/efficiently?

  1. Corticosteroids inhibit cyclooxygenase which prevents the formation of thromboxane

  2. Corticosteroids inhibit Phospholipase A2 which prevents the formation of arachidonic acid

  3. Corticosteroids directly block the formation of Thromboxane from endoperoxides

  4. Corticosteroids directly block the creation of prostaglandins which activate clotting factors

  5. Corticosteroids don’t have an effect on clotting, only on inflammation

231. A deficiency in which enzyme will lead to thrombotic thrombocytopenic purpura (TTP)?

  1. Cyclooxygenase 

  2. Phospholipase A2

  3. Thrombin

  4. ADAMTS13

  5. P2Y1/P2Y12

 

232. Where does ADP bind to activate platelets?

  1. P2Y1/P2Y12

  2. PAR

  3. Myosin

  4. Phosphatidylserine

  5. GP IIb/IIIa

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?

  1. Ticagrelor

  2. Aspirin

  3. Atopaxar

  4. Eptifibatide

  5. Revacept

 

234. Which of the following clotting factors is ONLY part of the intrinsic pathway?

  1. X

  2. VII

  3. XIII

  4. XI

  5. V

 

235. Which of the following factors does Thrombin NOT influence?

  1. V

  2. XI

  3. VII

  4. XIII

  5. VIII

 

236. Serpin, a serine protease inhibitor, does NOT inactivate which of the following factors?

  1. XIa

  2. Xa

  3. IXa

  4. thrombin

  5. heparan

 

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?

  1. VIIa

  2. Va

  3. IXa

  4. Xa

  5. You contemplate if he is right and you were always told pharm was FYI

 

238. A patient has a high INR, which of the following is in your differential?

  1. Von Willebrands 

  2. Hemophilia

  3. Autoimmune disease

  4. Post surgical, they’re fine

  5. Vit K deficiency

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?

  1. GP Ib-V-IX

  2. GP Ia/IIa

  3. GP IIb/IIIa

  4. A & C

     

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?

  1. Increased platelet activation

  2. Decreased ADP release from platelets

  3. Decreased vasoconstriction

  4. All of the above

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?

  1. Platelets binding to vWF

  2. Platelets binding to collagen

  3. Platelets binding to fibrinogen

  4. All of the above

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?

  1. Activation of Factor IX

  2. Activation of Factor VIII

  3. Conversion of prothrombin to thrombin

  4. Conversion of fibrinogen to fibrin

243. Which of the following proteins does heparan sulfate bind in order to prevent unnecessary hemostasis?

  1. Thrombosthenin

  2. Antithrombin

  3. Thrombomodulin

  4. Protein C

244. Which of the following clinical tests detects a breakdown product of fibrinolysis in order to determine whether thrombus formation has recently occurred?

  1. Activated C-Protein

  2. D-dimer

  3. Serum BNP

  4.  aPTT

245. Which of the following is NOT a cause of thrombocytopenia?

  1. Splenectomy

  2. B12 deficiency

  3. Autoimmune disease

  4. Liver disease

  5. None of the above

246. Which of the following conditions can lead to increased INR?

  1. von Willebrand’s Disease

  2. Hemophilia

  3. Vitamin K deficiency

  4. DIC

None of the above