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1. Infection occurs when:

A) contaminants are present on the skin
B) a person swallows microbes in/on food
C) a person inhales microbes in the air
D) pathogens enter and multiply in body tissues*
E) all of the choices are correct

2. All infectious diseases:

A) are contagious
B) only occur in humans
C) are caused by microorganisms or their products*
D) are caused by vectors
E) involve viruses as the pathogen

3. Which is not terminology used for resident flora:

A) pathogenic flora*
B) normal flora
C) indigenous flora
D) normal microflora
E) all of the choices are correct

4. Endogenous infectious agents arise from microbes that are:

A) in food
B) the patient's own normal flora*
C) on fomites
D) in the air
E) transmitted form one person to another

5. The human body typically begins to be colonized by its normal flora:

A) before birth, in utero
B) during, and immediately after birth*
C) when a child first goes to school
D) when an infant gets its first infectious disease
E) during puberty

6. Resident flora are found in/on the:

A) skin
B) mouth
C) nasal passages
D) large intestine
E) all of the choices are correct*

7. All of the following genera are considered resident flora of skin sites except:

A) Escherichia*
B) Staphylococcus
C) Corynebacterium
D) Micrococcus
E) Mycobacterium

8. Resident flora of the intestines include the following:

A) Streptococcus
B) Bacteroides
C) Staphylococcus
D) Haemophilus
E) all of the choices are correct*

9. Which genus is resident flora of the mouth, large intestine, and, from puberty to menopause, the vagina?

A) Lactobacillus*
B) Streptococcus
C) Haemophilus
D) Escherichia
E) Mycobacterium

10. Which genus is the most common resident flora of mouth surfaces?

A) Lactobacillus
B) Streptococcus*
C) Haemophilus
D) Escherichia
E) Mycobacterium

11. The body site with resident flora that produces beneficial body products, including vitamin K and several other vitamins is the:

A) skin
B) mouth
C) large intestine*
D) vagina
E) nasal passages

12. Virulence factors include all the following except:

A) capsules
B) ribosomes*
C) exoenzymes
D) endotoxin
E) exotoxin

13. STORCH is an acronym that represents the most common:

A) genera of resident flora
B) sexually transmitted diseases
C) portals of entry
D) vectors
E) infections of the fetus and neonate*

14. Microbial hyaluronidase, coagulase, and streptokinase are examples of:

A) adhesive factors
B) exotoxins
C) hemolysins
D) antiphagocytic factors
E) exoenzymes*

15. Exotoxins are:

A) proteins*
B) only released after a cell is damaged or lysed
C) antiphagocytic factors
D) secretions that always target nervous tissue
E) lipopolysaccharides

16. Enterotoxins are:

A) virulence factors
B) toxins that target the intestines*
C) proteins
D) exotoxins
E) all of the choices are correct

17. Which is mismatched?

A) fimbriae - adherence to substrate
B) capsules - antiphagocytic factor
C) coagulase - dissolve fibrin clots*
D) leukocidins - damage white blood cells
E) hemolysins - damage red blood cells

18. The stage of an infectious disease when specific signs and symptoms are seen and the pathogen is at peak activity is:

A) prodromal stage
B) convalescent stage
C) incubation period
D) period of invasion*
E) all of the choices are correct

19. The time from when pathogen first enters the body and begins to multiply, until symptoms first appear is the:

A) prodromal stage
B) convalescent stage
C) incubation period*
D) period of invasion
E) all of the choices are correct

20. The initial, brief period of early, general symptoms such as fatigue and muscle aches, is the:

A) prodromal stage*
B) convalescent stage
C) incubation period
D) period of invasion
E) all of the choices are correct

21. Which is mismatched:

A) secondary infection - infection spreads to several tissue sites*
B) mixed infection - several agents established at infection site
C) acute infection - rapid onset of severe, short-lived symptoms
D) local infection - pathogen remains at or near entry site
E) toxemia - pathogen's toxins carried by the blood to target tissues

22. The subjective evidence of disease sensed by the patient is termed:

A) syndrome
B) symptom*
C) sign
D) pathology
E) inflammation

23. The objective, measurable evidence of disease evaluated by an observer is termed:

A) syndrome
B) symptom
C) sign*
D) pathology
E) inflammation

24. Local edema, swollen lymph nodes, fever, soreness, and abscesses are indications of:

A) toxemia
B) inflammation*
C) sequelae
D) a syndrome
E) latency

25. The study of the frequency and distribution of a disease in a defined population is:

A) pathology
B) clinical microbiology
C) medicine
D) immunology
E) epidemiology*

26. The principal government agency responsible for tracking infectious diseases in the United States is:

A) Centers for Disease Control and Prevention*
B) World Health Organization
C) National Institutes of Health
D) United States Department of Agriculture
E) Infection Control Committee

27. The number of new cases of a disease in a population over a specific period of time compared with the healthy population is the:

A) mortality rate
B) morbidity rate
C) incidence rate*
D) prevalence rate
E) epidemic rate

28. A disease that has a steady frequency over time in a population is:

A) epidemic
B) endemic*
C) pandemic
D) sporadic
E) chronic

29. The primary, natural habitat of a pathogen where it continues to exist is called the:

A) fomite
B) carrier
C) vector
D) reservoir*
E) source

30. Someone who inconspicuously harbors a pathogen and spreads it to others is a:

A) fomite
B) carrier*
C) vector
D) reservoir
E) source

31. An animal, such as an arthropod, that transmits a pathogen from one host to another is a:

A) fomite
B) carrier
C) vector*
D) reservoir
E) source

32. An inanimate object that harbors and transmits a pathogen is a:

A) fomite
B) carrier
C) vector
D) reservoir
E) source

33. The intermediary object or individual from which the infectious agent is actually acquired is termed the:

A) fomite
B) carrier
C) vector
D) reservoir
E) source*

34. Reservoirs include:

A) humans
B) animals
C) soil
D) water
E) all of the choices are correct*

35. A laboratory technologist splashed a blood specimen onto his face, eyes, nose, and mouth. This specimen was from an HIV positive patient. If this blood exposure leads to HIV infection in the technologist, the transmission route is:

A) direct
B) fomite
C) vehicle+
D) droplet nuclei
E) aerosols

36. The dried residues of fine droplets from mucus or saliva that harbor and transmit pathogen are:

A) fomites
B) aerosols
C) mechanical vectors
D) droplet nuclei*
E) biological vectors

37. Animals that participate in the life cycles of pathogens and transmit pathogens from host to host are:

A) fomites
B) aerosols
C) mechanical vectors
D) droplet nuclei
E) biological vectors*

38. Nosocomial infections involve all the following except:

A) are only transmitted by medical personnel
B) often involve the patient's urinary tract and surgical incisions
C) the patient's resident flora can be the infectious agent
D) Escherichia coli and staphylococci are common infectious agents
E) medical and surgical asepsis help lower their occurrence*

39. When would Koch's Postulates be utilized:

A) determination of the cause of a patient's illness in a hospital microbiology lab
B) development of a new antibiotic in a pharmaceutical lab
C) determination of the cause of a new disease in a microbiology research lab*
D) formulation of a vaccine against a new pathogen in a genetic engineering lab
E) whenever the scientific method is used to investigate a microbiological problem

40. Most of the skin's resident flora are found in the uppermost, superficial layers of the epidermis.

A) True

41. Under certain circumstances, a person's resident flora can be opportunistic pathogens.

A) True

42. The virulence factors of a pathogen are established by how strong or weak a patient's body defenses are at the time of infection.

A) True

43. The Centers for Disease Control and Prevention assigns the most virulent microbes known to cause human disease to biosafety level 4.

A) True

44. A fetus can get an infection when a pathogen in the mother's blood is capable of crossing the placenta to the fetal circulation and tissues.

A) True

45. When an infected person is in the incubation period, that person cannot transmit the pathogen to others.

B) False

46. Septicemia means that a pathogen is present and multiplying in the blood.

A) True

47. Sentinel animals are monitored for specific diseases in order to determine the potential for human exposure to a disease.

A) True
B) False

48. Fomites, food, and air serve as indirect transmission routes of pathogens.

A) True

49. Leukopenia is the _____ in the level of white blood cells in a patient.

Decrease

50. A _____ is an infection indigenous to animals that can, on occasion, be transmitted to humans.

Vector

51. _____ carriers are shedding and transmitting pathogen while they are recovering from an infectious disease.

Convalescent

52. A _____ is the presence of small numbers of bacteria in the blood.

Bacteremia or Viremia

53. _____ are toxins that are the lipopolysaccharide of the outer membrane of gram negative cell walls.

Endotoxin

54. _____ are various bacterial enzymes that dissolve fibrin clots.

Bacterial kinases (Ex.Streptokinase, Staphylokinase)

55. The total number of deaths in a population due to a disease is the _____ rate.

Mortality

56. _____ are a set of criteria used to identify and link a specific microorganism as the etiologic agent of a new infectious disease.

Koch P.

What is an Infection?

a condition in which pathogenic microbes penetrate host defenses, enter tissues & multiply

What is a Disease?

any deviation from health, disruption of a tissue or organ caused by microbes or their products

What is Resident Flora?

*includes bacteria, fungi, protozoans, viruses and arthropods (see word document)
*most areas of the body in contact with the outside environment harbor resident microbes; large intestine has the highest numbers of bacteria
*internal organs, tissues & fluids are microbe-free
*bacterial flora benefit host by preventing overgrowth of harmful microbes

What is True pathogens

-capable of causing disease in healthy persons with normal immune defenses
-Influenza - virus, plague - bacillus, malarial - protozoan

What is an Opportunistic pathogens

-cause disease when the host's defenses are compromised or when they grow in part of the body that is not natural to them
-Pseudomonas sp & Candida albicans

List all Portal of Entries

- skin
- gastrointestinal tract
- respiratory tract
- urogenital tract

what is Infectious dose (ID)

-minimum number of microbes required for infection to proceed
-microbes with small Infectious Dose have greater virulence
-1 rickettsial cell in Q fever
-10 bacteria in TB, giardiasis
-109 bacteria in cholera (1,000,000,000)
-Lack of ID will not result in infection

List Mechanisms of adhesion

fimbrae
flagella
adhesive slimes or capsules
cilia
suckers
hooks
barbs

Virulence factors - what is exoenzymes

-digest epithelial tissues & permit invasion of pathogens
-Mucinase (amoebic dysentery), keratinase (ringworm),
Collagenase (gangrene), hyaluronidase (staph, strepto)

Virulence factors - Toxigenicity

-capacity to produce toxins at the site of multiplication

Virulence factors - exotoxins

- secreted by gram-positive and gram-negative bacteria, the cell wall stays intact (does not have to be lysed

Virulence factors - endotoxins

-secreted by gram-negative bacteria during lysis of the cell wall

Virulence factors -antiphagocytic factors

help them to kill or avoid phagocytes, include leukocidins and capsules

Patterns of infection - localized infection

microbes enters the body & remains confined to a specific tissue

Patterns of infection - focal infection

when the infectious agent breaks loose from a local infection and is carried to other tissues

Patterns of infection - systemic infection

infection spreads to several sites and tissue fluids (usually in the bloodstream)

Patterns of infection - Primary infection

initial infection, first microbe

Patterns of infection - Secondary infection

another infection at another site by a different microbe

Patterns of infection - Mixed infection

several microbes grow simultaneously at the same infectious site

Patterns of infection - Focal infection

- is an infection at 2 different sites by one organism.

Bacteremia

is the presence of bacteria in the blood. The blood is normally a sterile environment, so the detection of bacteria in the blood is considered abnormal

Septicemia

is a related medical term referring to the presence of pathogenic organisms in the bloodstream, leading to sepsis, infection in a system or two.

Sepsis

is a potentially serious medical condition that is characterized by a whole-body inflammatory state and the presence of a known or suspected infection. The body may develop this inflammatory response by the immune system to microbes in the blood, urine, lungs, skin, or other tissues. Severe sepsis is the systemic inflammatory response, plus infection, plus the presence of organ dysfunction.

Symptom

subjective evidence of disease as sensed by the patient
ex. vomiting

Sign

objective evidence of disease as noted by an observer, factual, should be recorded
ex. White blood cell count, temperature

True pathogens

capable of causing disease in healthy persons with normal immune defenses
Influenza - virus, plague - bacillus, malarial - protozoan

Opportunistic pathogens

cause disease when the host's defenses are compromised or when they grow in part of the body that is not natural to them
Pseudomonas sp & Candida albicans

List the Portals of exit

Respiratory, saliva
Skin scales
Fecal exit
Urogenital tract
Removal of blood

Sequelae

long-term or permanent damage to tissues or organs, a pathological condition resulting from a disease, injury, or other trauma, a secondary consequence or result
Latin sequēla - something that follows; a continuation

Examples. Streptococcus pyogenes, Strep throat, can lead to rheumatic fever, and kidney damage or Chronic kidney disease, for example, is sometimes a sequela of diabetes

Epidemiology

The study of the frequency and distribution of disease & health-related factors in human populations, how often a disease presents itself and where it occurs

Etiology

is the study of causation, or origin. The word is derived from the Greek αἰτιολογία, aitiologia, "giving a reason for", it can be the genetic reason for the disease

Surveillance

- collecting, analyzing, & reporting data on rates of occurrence, mortality, morbidity, and transmission of infections

Prevalence

total number of existing cases with respect to the entire population usually represented by a percentage of the population
USA - 861,533 with diabetes 293,655,405 total population = 2.9%
Canada - 95,372 with diabetes , 32,507,874 total population = .29%

Incidence

measures the number of new cases over a certain time period, as compared with the general healthy population
Down's Syndrome - 340,000 per year, 28,333 per month, 6,538 per week, 931 per day, 38 per hour, 0 per minute, 0 per second

Mortality rate

the total number of deaths in a population due to a certain disease

Morbidity rate

number of people afflicted with a certain disease per 1000, an inexact term that can mean either the incidence rate or the prevalence rate.

Sporadic

when occasional cases are reported at irregular intervals

Endemic

disease that exhibits a relatively steady frequency over a long period of time in a particular geographic locale

Epidemic

when prevalence of a disease is increasing beyond what is expected

Pandemic

(from Greek παν pan all + δήμος demos people) epidemic across continents

Describe a Pandemic

A pandemic is a global disease outbreak. A
flu pandemic occurs when a new influenza
virus emerges for which people have little or
no immunity, and for which there is no
vaccine. The disease spreads easily person-to
person, causes serious illness, and can sweep
across the country and around the world in
very short time.

Antonine Plague

165-180 BC. Possibly smallpox brought back from the Near East; killed a quarter of those infected and up to five million in all.
5,000 people a day were said to be dying in Rome

Peloponnesian War

430 BC, Typhoid fever killed a quarter of the Athenian troops and a quarter of the population over four years.

The Black Death

the bubonic plague returned to Europe, Starting in Asia, the disease reached the Mediterranean and western Europe in 1348 (possibly from Italian merchants fleeing fighting in the Crimea)
killed twenty million Europeans in six years, a quarter of the total population and up to a half in the worst-affected urban areas

Influenza

the "first" pandemic of 1510 traveled from Africa and spread across Europe, it is estimated that it killed about ten people in a thousand per day, or about 1%

Cholera

the first pandemic 1816-1826, previously restricted to the Indian subcontinent, the pandemic began in Bengal, then spread across India by 1820. It extended as far as China and the Caspian Sea before receding. The third pandemic (1852-1860) mainly affected Russia
over a million deaths

The "Spanish flu" - 1918-1919

In six months, 25 million were dead; some estimates put the total of those killed worldwide at over twice that number, An estimated 17 million died in India, 500,000 in the United States and 200,000 in the UK.

The Asian Flu

caused about 70,000 deaths in the United States

The "Hong Kong Flu

caused about 34,000 deaths in the United States

Reservoirs of infection

Any person, animal, plant, soil or substance in which an infectious agent normally lives and multiplies. The reservoir typically harbors the infectious agent without injury to itself and serves as a source from which other individuals can be infected. The infectious agent primarily depends on the reservoir for its survival. It is from the reservoir that the infectious substance is transmitted to a human or another susceptible host.

Living reservoirs may or may not have symptoms

Asymptomatic carriers - gonorrhea, genital warts
Passive carriers - health care professionals
Vectors - live animals that transmits infectious disease, ticks, fleas, mosquitoes, flies, cockroaches, birds, rats

Nonliving reservoirs

soil, water, air
bacteria, fungi, helminths, protozoa (in all forms - spores, cysts, larvae)

Patterns of transmission - Direct contact

-contact between mucous membranes &/or skin, portal of exit meets a portal of entry
-Kissing, nursing, animal bites

Patterns of transmission -Indirect contact -

-contact achieved through some intervening medium implicated in the spread of infection
-Vehicle - fomites (inanimate material), food, water, biological products
Airborne
-droplet nuclei - the dried residue formed by evaporation of droplets coughed or sneezed into the air
-Aerosols - is a suspension of airborne particles that contain living organisms or were released from living organisms

Nosocomial infections

Diseases that are acquired during a hospital stay

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