In the brain, cerebrospinal fluid flows
through
a. The subdural space
b. The subarachnoid space
c. The arachnoid mater
d. The pia mater
B
Which of the following is the most common cause of meningitis?
a. A virus
b. A bacterium
c. A protozoan
d. A fungus
A
The inflammation of the brain is called
a. Meningitis
b. Encephalitis
c. Neuritis
d. Hydrocephalus
B
Drugs can cross the blood-brain barrier only if they are:
a. Large molecular weight molecules
b. Small molecular weight molecules
c. Water soluble
d. Lipid-soluble
D
Bacteria can grow well in cerebrospinal fluid because it has low levels of circulating antibodies and
a. Water
b. Glucose
c. Complement
d. Sodium
C
In adult patients, about 80% of the cases of bacterial meningitis are now caused by Neisseria meningitidis and
a. Haemophilus influenzae type B
b. Streptococcus pneumoniae
c. Listeria monocytogenes
d. Clostridium tetani
B
Which gram-positive rod is known to cause stillbirth and neurological disease in animals?
a. Listeria monocytogenes
b. Streptococcus pneumoniae
c. Clostridium botulinum
d. Haemophilus influenzae
A
The pneumococcus is a
a. Gram-positive encapsulated streptococcus
b. Gram-positive nonencapsulated streptococcus
c. Gram-positive encapsulated diplococcus
d. Gram-positive nonencapsulated diplococcus
C
Which of the following statements about Mycobacterium leprae is FALSE?
a. Patients must be put into isolation
b. Patients transmit the disease directly
c. Patients rarely die of the disease
d. A skin biopsy sample can be used for diagnosis
A
Which of the following patients are the most susceptible to fungal infections?
a. Elderly patients
b. Infants
c. AIDS patients
d. Cardiac patients
C
Granulomatous amebic encephalitis is caused by
a. Balamuthia mandrillaris
b. Naegleria fowleri
c. Trypansoma brucei
d. Cryptococcus neoformans
A
Which of the following diseases is caused by a prion?
a. Rabies
b. Creutzfeldt-Jakob disease
c. Polio
d. Wound botulism
B
A prion is
a. An abnormally folded protein
b. A protein subunit
c. A form of a bacterium
d. A viral particle
A
Which animal disease is similar to Creutzfeldt-Jacob disease?
a. Anthrax
b. Sheep scrapie
c. Kuru
d. Transmissible spongiform encephalopathy
B
One hypothesis of the origin of mad cow
disease in cattle is believed to be
a. Cattle feed contaminated with scrapie
b. Direct contact with animals infected
with scrapie
c. Direct contact with other infected
species
d. Hormones in cattle feed
A
The clinical presentation of dementia and early neurological signs is found in
a. Classic Creutzfeldt-Jakob disease
b. Variant Creutzfeldt-Jakob disease
c. African trypanosomiasis
d. Sheep scrapie
A
Which disease has an incubation period that is usually long enough to allow immunity to develop from postexposure vaccination?
a. Polio
b. Rabies
c. Hansen's disease
d. Arboviral encephalitis
B
Most viruses affecting the nervous system enter it by
a. Blood or lymph
b. Skin
c. Peripheral nervous system
d. Respiratory system
A
A misdiagnosis of Guillain-Barré syndrome is often given to patients with
a. Arboviral encephalitis
b. Furious rabies
c. Polio
d. Paralytic rabies
D
Eastern equine encephalitis has a mortality rate of
a. 20% or more
b. 50% or more
c. 30% or more
d. 70% or more
C
Arboviral encephalitis is usually diagnosed by
a. Agglutination tests
b. ELISA tests
c. Gram stain
d. Titer
B
The tetanus vaccine is a(n)
a. Conjugated vaccine
b. Toxoid
c. Attenuated whole-agent vaccine
d. Inactivated whole-agent vaccine
B
Which of the following is true about the normal microbiota of the nervous system?
A) Only transient microbiota are present.
B) There are no normal microbiota.
C) Normal microbiota are present in the central nervous system only.
D) Normal microbiota are present in the peripheral nervous system only.
E) Only micrococci are present.
B
Encephalitis and meningitis are difficult to treat because
A) They are not caused by bacteria.
B) Antibiotics damage tissues.
C) Antibiotics cannot penetrate the blood-brain barrier.
D) The infections move along peripheral nerves.
E) They are caused by viruses.
C
Which of the following organisms does NOT cause meningitis?
A) Neisseria meningitidis
B) Haemophilus influenzae
C) Cryptococcus neoformans
D) Streptococcus pneumoniae
E) Mycobacterium leprae
E
Which of the following statements about Haemophilus influenzae is false?
A) A healthy carrier state can exist.
B) It is encapsulated.
C) It requires a blood supplement in media.
D) It usually infects children.
E) It is used in a whole bacterial vaccine.
E
Which of the following pairs is mismatched?
A) Neisseria meningitidis - cultured in a candle jar
B) Haemophilus influenzae - virulence due to capsule
C) Mycobacterium leprae - cultured in armadillos
D) Cryptococcus neoformans - acid-fast rod
E) Naegleria fowleri - causes amoebic encephalitis
D
Which of the following organisms is NOT correctly matched to the recommended treatment?
A) Neisseria meningitidis - cephalosporins
B) Haemophilus influenzae - cephalosporins
C) Cryptococcus neoformans - amphotericin B
D) Mycobacterium leprae - dapsone
E) Poliovirus - Salk vaccine
E
Which of the following statements about leprosy is false?
A) It is rarely fatal.
B) Patients with leprosy must be isolated.
C) It is transmitted by direct contact.
D) Diagnosis is based on skin biopsy.
E) The etiologic agent is acid-fast.
B
Which of the following is NOT transmitted by the respiratory route?
A) Neisseria meningitidis
B) Haemophilus influenzae
C) Listeria monocytogenes
D) Cryptococcus neoformans
E) All of the above are transmitted by the respiratory route.
C
Which of the following statements about rabies is false?
A) It is caused by Rhabdovirus.
B) Hydrophobia is an early symptom.
C) The reservoir is mainly rodents.
D) Diagnosis is based on immunofluorescent techniques.
E) It is not fatal in bats.
C
The symptoms of tetanus are due to
A) Deep puncture wounds.
B) Hemolysins.
C) Lack of oxygen.
D) Clostridial neurotoxin.
E) All of the above.
D
The treatment for tetanus is
A) Penicillin.
B) Antibodies.
C) Toxoid.
D) Cleansing the wound.
E) There is no treatment.
B
A 30-year-old woman was hospitalized after she experienced convulsions. On examination, she was alert and oriented and complained of a fever, headache, and stiff neck. Which of the following organisms could NOT be responsible for her symptoms?
A) Clostridium botulinum
B) Listeria monocytogenes
C) Naegleria fowleri
D) Streptococcus pneumoniae
E) Any of the above could be the causative agent.
A
The most effective control of a vector-borne disease is
A) Treatment of infected humans.
B) Treatment of infected wild animals.
C) Elimination of the vector.
D) Avoidance of endemic areas.
E) Treatment of uninfected humans.
C
Treatment for tetanus in an unimmunized person with a puncture wound is
A) Tetanus toxoid.
B) Tetanus immune globulin.
C) Penicillin.
D) DTaP.
E) Debridement.
B
Treatment for tetanus in an immunized person with a puncture wound is
A) Tetanus toxoid.
B) Tetanus immune globulin.
C) Penicillin.
D) DTaP.
E) Debridement.
A
The most common route of central nervous system invasion by pathogens is through
A) The skin.
B) The circulatory system.
C) The gastrointestinal system.
D) The parenteral route.
E) Direct penetration into nerves.
B
The prodromal symptom(s) of meningitis is (are)
A) Like a mild cold.
B) Fever and headache.
C) Stiff neck and back pains.
D) Convulsions.
E) Paralysis.
A
Which of the following CANNOT lead to an outbreak of botulism?
A) Killing bacteria that compete with Clostridium
B) An anaerobic environment
C) An incubation period
D) A nutrient medium with a pH below 4.5
E) Eating food from dented cans
D
The most common cause of meningitis in children is
A) Mycobacterium tuberculosis.
B) Streptococcus pneumoniae.
C) Cryptococcus neoformans.
D) Haemophilus influenzae.
E) Neisseria meningitidis.
B
Meningitis that begins as an infection of the lungs is caused by
A) Flavobacterium meningosepticum.
B) Streptococcus pneumoniae.
C) Cryptococcus neoformans.
D) Haemophilus influenzae.
E) Neisseria meningitidis.
C
Which of the following pairs is mismatched?
A) Leprosy - direct contact
B) Poliomyelitis - respiratory route
C) Meningococcal meningitis - respiratory route
D) Rabies - direct contact
E) Listeriosis - ingestion
B
A 30-year-old woman was hospitalized after she experienced convulsions. On examination, she was alert and oriented and complained of a fever, headache, and stiff neck. Which of the following is most likely to provide rapid identification of the cause of her symptoms?
A) Gram stain of cerebrospinal fluid
B) Gram stain of throat culture
C) Biopsy of brain tissue
D) Check serum antibodies
E) None of the above; it can't be diagnosed.
A
Which of the following is NOT caused by prions?
A) Sheep scrapie
B) Kuru
C) Creutzfeldt-Jakob disease
D) Elk chronic wasting disease
E) Rabies
E
An 8-year-old girl in rural Wisconsin has chills, headache, and fever and reports having been bitten by mosquitoes. How would you confirm your diagnosis?
A) ELISA test for IgM antibodies
B) Brain biopsy for inclusions
C) Gram stain of cerebrospinal fluid
D) Examination of local mosquitoes
E) Complement fixation test for IgG antibodies
A
A red rash that does NOT blanch (whiten) when pressed is characteristic of an infection by
A) Cryptococcus neoformans.
B) Haemophilus influenzae.
C) Neisseria meningitidis.
D) Streptococcus pneumoniae.
E) Mycobacterium leprae.
C
A 15-year-old girl was hospitalized with fever, lethargy, and rash. Gram-negative, oxidase-positive cocci were cultured from her cerebrospinal fluid. Her symptoms were caused by
A) A prion.
B) Clostridium tetani.
C) Mycobacterium leprae.
D) Neisseria meningitidis.
E) Lyssavirus.
D
A 15-year-old girl was hospitalized with fever, lethargy, and rash. Gram-negative, oxidase-positive cocci were cultured from her cerebrospinal fluid. Which of the following statements about the microbe responsible for her symptoms is false?
A) It may be normal in the cerebrospinal fluid.
B) It may be normal in the throat.
C) It may be treated with antibiotics.
D) It may cause epidemics.
E) It may be prevented with a vaccine.
A
On June 30, a 47-year-old man was hospitalized with dizziness, blurred vision, slurred speech, difficulty swallowing, and nausea. Examination revealed facial paralysis. The patient had partially healed superficial knee wounds incurred while laying cement. Cultures taken from the knee wounds should be incubated
A) Aerobically.
B) Anaerobically.
C) In 510% CO2.
D) In animal cell culture.
E) Any of the above will work.
B
A diagnosis of rabies is confirmed by
A) Gram stain.
B) Direct fluorescent-antibody test.
C) Patient's symptoms.
D) Passive agglutination.
E) Patient's death.
B
Which of the following is treated with antibiotics?
A) Botulism
B) Tetanus
C) Streptococcal pneumonia
D) Polio
E) All of the above
C
Which one of the following causes the most severe illness in humans, with a mortality rate of 30%?
A) Western equine encephalitis
B) Eastern equine encephalitis
C) St. Louis encephalitis
D) California encephalitis
E) West Nile encephalitis
B
Which of the following is NOT a free-living amoeba that can cause encephalitis?
A) Acanthamoeba
B) Balamuthia
C) Entamoeba
D) Naegleria
E) None of the above; free-living amoebas don't cause disease.
C
Microscopic examination of cerebrospinal fluid reveals gram-positive rods. What is the organism?
A) Haemophilus
B) Listeria
C) Naegleria
D) Neisseria
E) Streptococcus
B
On June 30, a 47-year-old man was hospitalized with dizziness, blurred vision, slurred speech, difficulty swallowing, and nausea. Examination revealed facial paralysis. The patient had partially healed superficial knee wounds incurred while laying cement. He reported eating home-canned green beans and stew containing roast beef and potatoes 24 hours before onset of symptoms. The patient should be treated with
A) Antibiotics.
B) Antitoxin.
C) Surgery.
D) Vaccination.
C
On October 5, a pet store sold a kitten that subsequently died. On October 22, rabies was diagnosed in the kitten. Between September 19 and October 23, the pet store had sold 34 kittens. Approximately 1000 people responded to health care providers following local media alerts. These people were given
A) Antibiotics.
B) Antirabies immunoglobulin.
C) Rabies vaccination.
D) Serological tests for rabies.
E) Treatment if they tested positive.
B
For which of the following is a vaccine NOT available?
A) Haemophilus meningitis
B) Neisseria meningitis
C) Tetanus
D) Rabies
E) Botulism
E
Patients with leprosy usually die from
A) Brain damage.
B) Loss of nerve function.
C) Tuberculosis.
D) Influenza.
E) Leprosy.
C
Which of the following is NOT acquired by ingestion?
A) Botulism
B) Cryptococcosis
C) Listeriosis
D) Poliomyelitis
E) Creutzfeldt-Jakob disease
B
A 1-year-old boy was listless, irritable, and sleepy. Capsulated gram-negative rods were cultured from his cerebrospinal fluid. His symptoms were caused by
A) Neisseria meningitidis.
B) Rabies.
C) Clostridium tetani.
D) Haemophilus influenzae.
E) A prion.
D
Which of the following pairs is mismatched?
A) Tetanus - blocks relaxation nerve impulse
B) Botulism - stimulates transmission of nerve impulse
C) Poliomyelitis - kills CNS cells
D) Rabies virus - grows in brain cells
E) All of the above are correctly matched.
B
Which of the following is NOT transmitted by ingestion?
A) Poliomyelitis
B) Listeriosis
C) Botulism
D) Meningococcal meningitis
E) Creutzfeldt-Jakob disease
A
Which of the following vaccines can cause the disease it is designed to prevent?
A) Tetanus toxoid vaccine
B) Oral polio vaccine
C) Inactivated polio vaccine
D) Haemophilus influenzae capsule vaccine
E) Meningococcal capsule vaccine
B
Situation 22.1
On July 5, an 11-year-old girl complained of pain in the knuckles of her left hand. During July 6-7, she had increasing pain that extended up to the left shoulder. A throat culture was obtained, and amoxicillin was prescribed. On July 9, she had difficulty walking and hallucinations. The throat culture was positive for Streptococcus pyogenes. She was treated with ceftriaxone. On July 11, she was hospitalized with a temperature of 40.7°C, and she could not drink. She developed respiratory distress and tachycardia; she died from cardiac arrest. Fluorescent-antibody testing of brain tissue revealed inclusions in the brain stem.
44) In Situation 22.1, the antibiotics did not cure her disease because the pathogen was
A) A virus.
B) Already growing in her brain.
C) Part of her normal microbiota.
D) Protected by the bloodbrain barrier.
E) Resistant to antibiotics.
A
Situation 22.1
On July 5, an 11-year-old girl complained of pain in the knuckles of her left hand. During July 6-7, she had increasing pain that extended up to the left shoulder. A throat culture was obtained, and amoxicillin was prescribed. On July 9, she had difficulty walking and hallucinations. The throat culture was positive for Streptococcus pyogenes. She was treated with ceftriaxone. On July 11, she was hospitalized with a temperature of 40.7°C, and she could not drink. She developed respiratory distress and tachycardia; she died from cardiac arrest. Fluorescent-antibody testing of brain tissue revealed inclusions in the brain stem.
The disease described in Situation 22.1 is
A) Botulism.
B) Meningitis.
C) Rabies.
D) Streptococcal sore throat.
E) Tetanus.
C
Lymphatic vessels contain lymph, which consists of
a. Serum
b. Plasma
c. Interstitial fluid
d. Blood
C
Foreign microbes entering lymph nodes encounter
a. B and T cells
b. Enzymes
c. Exotoxins
d. Endotoxins
A
An acute illness that is associated with the presence and persistence of pathogenic microorganisms or their toxins in the blood is called
a. Lymphangitis
b. Sepsis
c. Septicemia
d. Systemic inflammatory response syndrome
C
Which microorganisms are now the most common cause of sepsis?
a. Gram-negative bacteria
b. Gram-positive bacteria
c. Viruses
d. Fungi
B
Who demonstrated that puerperal sepsis was transmitted by the hands and instruments of attending physicians and midwifes?
a. Louis Pasteur
b. Ignaz Semmelweis
c. Robert Koch
d. Christian Gram
B
Rheumatic fever is an autoimmune complication from an infection of
a. Staphylococcus aureus
b. Francisella tularensis
c. Brucella melitensis
d. Streptococcus pyogenes
D
Infections of Bacillus anthracis are initiated by
a. Endospores
b. Endotoxins
c. Exotoxins
d. Capsules
A
The most dangerous form of anthrax in humans is
a. Inhalational anthrax
b. Cutaneous anthrax
c. Gastrointestinal anthrax
d. They are all equal
A
Sydenham's chorea is an unusual complication in individuals with
a. Scarlet fever
b. Rabbit fever
c. Rheumatic fever
d. Dengue fever
C
Which organism can often be transmitted by the bite of a domestic animal and causes sepsis?
a. Pasteurella multocida
b. Streptococcus moniliformis
c. Spirillum minus
d. Yersinia pestis
A
Cat-scratch disease is caused by
a. Bartonella henselae
b. Yersinia pestis
c. Borrelia burgdorferi
d. Rickettsia prowazekii
A
Which of the following are spread by the bite of an arthropod vector?
a. Bacillus anthracis
b. Rickettsia prowazekii
c. Brucella suis
d. Spirillum minus
B
Rabbit fever is caused by
a. Francisella tularensis
b. Yersinia pestis
c. Borrelia burgdorferi
d. Rickettsia rickettsii
A
In which disease does there frequently occur a fast-growing tumor of the jaw?
a. Ebola
b. Infectious mononucleosis
c. Chikungunya fever
d. Burkitt's lymphoma
D
Which virus infects pregnant women and causes birth defects?
a. Epstein-Barr virus
b. Cytomegalovirus
c. Hantavirus
d. Marburg virus
B
Ebola virus is transmitted by
a. Contact with blood
b. Inhalation
c. Arthropod vector
d. Ingestion
A
The natural reservoir for the flavivirus that causes yellow fever is the
a. Rabbit
b. Monkey
c. Bat
d. Field mice
B
Chagas' disease is caused by
a. Toxoplasma gondii
b. Trypanosoma cruzi
c. Plasmodium vivax
d. Leishmania donovani
B
Anopheles is the vector for the disease
a. Babesiosis
b. Schistosomiasis
c. Malaria
d. Swimmer's itch
C
The most dangerous malaria is caused by
a. Plasmodium ovale
b. Plasmodium malariae
c. Plasmodium falciparum
d. Plasmodium vivax
C
Which stage of the Plasmodium protozoan infects the red blood cells of humans?
a. Schizony
b. Merozoite
c. Sporozoite
d. Gametocyte
B
Currently the most promising method to control malaria is
a. Antibiotics
b. Vaccine
c. Bed nets
d. Chloroquine
C
What organism provides the reservoir for Borrelia burgdorferi?
a. Tick
b. Rabbit
c. Squirrel
d. Field mouse
D
Which of the following statements about tularemia is false?
A) It is caused by Francisella tularensis.
B) The reservoir is rabbits.
C) It may be transmitted by arthropods.
D) It may be transmitted by direct contact.
E) It occurs only in California.
E
Which of the following is a symptom of brucellosis?
A) A local infection
B) Relapsing fever
C) Undulant fever
D) Pneumonia
E) Jaundice
C
Which of the following statements about toxoplasmosis is false?
A) It is caused by a protozoan.
B) The reservoir is cats.
C) It is transmitted by the gastrointestinal route.
D) It is a severe illness in adults.
E) It can be congenital.
D
Which of the following is NOT caused by a bacterium?
A) Chicken pox, HH3
B) Tickborne typhus
C) Malaria
D) Plague
E) Relapsing fever
C
Which of the following statements about puerperal sepsis is false?
A) It is can infect both mother fetus.
B) It is transmitted by health care personnel.
C) It lives in the soil.
D) It can be complication of abortion or childbirth.
E) It is now rare because of antibiotics and aseptic techniques.
C
Which of the following statements about schistosomiasis is false?
A) The cercariae penetrate human skin.
B) The adult pair is long lived.
C) The intermediate host is an aquatic snail.
D) It has a simple life cycle.
E) The female worm is attached to the male.
D
Which of the following can be transmitted from an infected mother to her fetus across the placenta?
A) Borrelia
B) Cytomegalovirus
C) Spirillum
D) Botox
E) Yersinia
B
Human-to-human transmission of plague is usually by
A) Rat flea.
B) Dog flea.
C) The respiratory route.
D) Wounds.
E) Unsanitary conditions.
C
Which of the following is NOT a zoonosis?
A) Puerperal sepsis
B) Hantavirus infection
C) Anthrax
D) Brucellosis
E) Tularemia
A
Which of the following is NOT treated with antibiotics?
A) Plague
B) Tularemia
C) Lyme disease
D) Norovirus
E) Anthrax
D
Which of the following produces a permanent carrier state following infection?
A) Borrelia
B) Cytomegalovirus
C) Spirillum
D) Toxoplasma
E) Yersinia
B
EB virus has been implicated in all of the following EXCEPT
A) Endocarditis.
B) Infectious mononucleosis.
C) Burkitt's lymphoma.
D) Nasopharyngeal carcinoma.
E) Hodgkin's disease.
A
You advise your pregnant friend to give her cat away because
A) She could contract plague.
B) She could give the cat tularemia.
C) She could get toxoplasmosis.
D) She could get listeriosis.
E) You don't like cats and want to see your friend without one.
C