Deck 22: Microbial Diseases of the Respiratory System

Question 1

Neutrophils are inhibited from gathering at the site of infection by Mycobacterium tuberculosis by what virulence factor of the pathogen?

A) cord factor
B) kinase
C) mycolic acid
D) hemolysin
E) the capsule

Answer 1

A

Question 2

What is the primary determinant of virulence in Streptococcus pneumoniae?

A) the ability to lyse red blood cells
B) the presence of a particular Lancefield antigen
C) strain-specific teichoic acids in its cell wall
D) the presence of a polysaccharide capsule
E) the production of pneumolysin

Answer 2

D

Question 3

Which of the following statements is TRUE concerning diphtheria?

A) The pseudomembrane is easily removed by surgery.
B) The signs and symptoms of the disease are directly caused by a bacterial toxin.
C) A diffuse rash is the major sign of diphtheria.
D) A microscopic exam of bacterial samples is sufficient for conclusive diagnosis.
E) No effective vaccine is available to prevent infection.

Answer 3

B

Question 4

Which of the following allows group A streptococci to spread through tissues by breaking down blood clots?

A) streptokinase
B) a hyaluronic acid capsule
C) pyrogenic toxins
D) streptolysin
E) M proteins

Question 5

Which of the following is an opportunistic infection?

A) SARS
B) inhalation anthrax
C) whooping cough
D) primary tuberculosis
E) legionellosis

Question 6

Diphtheria toxin kills cells by interfering with which of the following processes?

A) adenylate cyclase activity
B) complement function
C) nucleic acid synthesis
D) protein synthesis
E) cytoplasmic membrane function

Question 7

The designation ʺgroup A,ʺ used to help classify Streptococcus pyogenes, refers to this bacteriumʹs

A) M protein.
B) disease associations.
C) Lancefield antigen.
D) type of streptokinase produced.
E) hemolysis pattern.

Question 8

Ornithosis, a disease of birds that can be transmitted to humans, is caused by

A) Chlamydophila pneumoniae.
B) Mycoplasma pneumoniae.
C) Klebsiella pneumoniae.
D) Yersinia pestis.
E) Chlamydophila psittaci.

Question 9

The majority of cases of pneumonia are caused by

A) Klebsiella pneumoniae.
B) Mycoplasma pneumoniae.
C) Streptococcus pneumoniae.
D) Haemophilus influenzae.
E) Chlamydophila pneumoniae.

Question 10

Pathogenic streptococci of the upper respiratory tract (such as Streptococcus pyogenes) are distinguished from non-pathogenic streptococci by

A) alpha hemolytic activity.
B) the presence of a lysogenic phage.
C) beta hemolytic activity.
D) the absence of a capsule.
E) no hemolytic activity.

Question 11

A pneumonia caused by Gram-positive diplococci is known as

A) pneumococcal pneumonia.
B) primary atypical pneumonia.
C) pneumocystic pneumonia.
D) pneumonic plague.
E) pleurisy.

Question 12

Which of the following is part of the upper respiratory system?

A) alveoli
B) trachea
C) bronchi
D) larynx
E) pharynx

Question 13

The structure indicated by the arrow connects the middle ear to what part of the respiratory system?

A) pharynx
B) larynx
C) nasal cavity
D) sinuses
E) trachea

Question 14

Which of the following statements is TRUE regarding tuberculosis?

A) It remains viable in dried aerosol droplets for up to eight months.
B) Several hundred cells are required for infection.
C) The immune system is not affected by the infection.
D) It occurs only in the lungs.
E) Only virulent strains of Mycobacterium tuberculosis produce mycolic acid.

Question 15

Inflammation of the pharynx with pus-filled abscesses and swollen tonsils is known as

A) streptococcal pharyngitis (ʺstrep throatʺ).
B) croup.
C) RSV.
D) diphtheria.
E) otitis media.

Question 16

Which of the following statements is TRUE regarding the common cold?

A) Only coronaviruses cause the common cold.
B) Cold viruses reproduce most effectively at 37°C.
C) Cold viruses are frequently spread by contaminated fomites.
D) The immune system cannot develop an effective response to cold viruses.
E) The viruses can infect both the upper and lower respiratory tracts.

Question 17

Bordetella pertussis causes whooping cough by

A) irritating the diaphragm, which leads to severe coughing attacks.
B) the development of pneumonia.
C) forming a pseudomembrane that obstructs the respiratory passages.
D) interfering with the activity of ciliated epithelial cells in the trachea.
E) suppressing mucus production.

Question 18

Which of the following Streptococcus pyogenes virulence factors kills leukocytes and erythrocytes?

A) the hyaluronic acid capsule
B) pyrogenic toxins
C) streptokinases
D) C5a peptidase
E) streptolysins

Question 19

Bordetella pertussis produces

A) adenylate cyclase toxin.
B) pyrogenic toxin.
C) dermonecrotic toxin.
D) dermonecrotic and adenylate cyclase toxins.
E) dermonecrotic, adenylate cyclase, and pyrogenic toxins.

Question 20

Which of the following is an opportunistic pathogen commonly present in the nasal cavity as a member of the microbiota?

A) Staphylococcus aureus
B) Legionella pneumophilia
C) Bordetella pertussis
D) Pneumocystis jiroveci
E) Veillonella species

Question 21

A woman who breeds parrots develops a fever and cough, and begins to have difficulty breathing. Small Gram-negative bacteria are detected inside cells of a sputum sample. Which of the following diseases is she likely to have contracted?

A) ornithosis
B) influenza
C) primary atypical pneumonia
D) inhalation anthrax
E) histoplasmosis

Question 22

Which of the following statements is TRUE regarding infection with Mycoplasma pneumoniae?

A) The causative agent attaches to ciliated cells in the respiratory tract.
B) It causes disease which is usually severe enough to require hospitalization.
C) It is extremely difficult to treat.
D) The causative agent is a fast-growing Gram-positive bacillus.
E) It is diagnosed by the appearance of typical ʺfried-eggʺ colonies on agar.

Question 23

A nursing student develops a positive reaction to the tuberculin skin test. A history reveals possible exposure to patients with tuberculosis. A sputum sample is acid-fast negative. When asked for vaccination records, the student reports that childhood vaccination records were lost when the family emigrated from a Southeast Asian country. What is the best explanation for the test results?

A) The student is not infected.
B) The student has been infected with Mycobacterium tuberculosis.
C) The student has been exposed to Mycobacterium tuberculosis.
D) The student has been exposed to Mycobacterium tuberculosis or was vaccinated with BCG vaccine.
E) No conclusion is possible with the information provided.

Question 24

Which of the following diseases is almost diagnostic for AIDS?

A) coccidioidomycosis
B) blastomycosis
C) Pneumocystis pneumonia
D) Hantavirus pulmonary syndrome
E) histoplasmosis

Question 25

Limiting exposure to rodents and their waste materials is an important means of preventing

A) bronchiolitis.
B) coccidioidomycosis.
C) histoplasmosis.
D) Hantavirus pulmonary syndrome.
E) inhalational anthrax.

Question 26

The DTaP vaccine protects against which of the following respiratory diseases?

A) anthrax
B) the common cold
C) tuberculosis
D) pertussis
E) pneumonia

Question 27

A recently retired man appears at his doctorʹs office complaining of difficulty breathing, body aches and fatigue. He is also running a high fever and has a dry cough. He reports having just returned from a trip to the Middle East where he visited several historical sites. Test results are negative for a rapid test for influenza A. No bacteria are visible in a microscopic exam of his sputum. Which of the following is a likely explanation?

A) inhalation anthrax
B) valley fever
C) pertussis
D) primary atypical pneumonia
E) coronavirus respiratory syndrome

Question 28

Inhalation anthrax is frequently fatal even with antibiotic therapy because

A) the dying cells release lipid A, triggering a severe inflammatory response.
B) it is transmitted by endospores.
C) the anthrax toxin triggers severe edema of the lungs.
D) Bacillus anthracis is resistant to a wide range of antibiotics.
E) the bacteria are enclosed within a biofilm that antibiotics cannot penetrate.

Question 29

Even though mycoplasmas pass through filters that normally trap bacteria, they are known to be bacteria, not viruses, because they

A) synthesize peptidoglycan.
B) contain both DNA and RNA.
C) synthesize peptidoglycan and divide by snapping division.
D) contain both DNA and RNA and divide by binary fission.
E) divide by binary fission.

Question 30

Why are nearly all AIDS patients at risk of developing Pneumocystis pneumonia?

A) Pneumocystis jiroveci is zoonotic in a wide range of vertebrates and exposure is unavoidable.
B) Pneumocystis jiroveci is a common member of the respiratory microbiota in humans and opportunistic pathogen.
C) Pneumocystis jiroveci is commonly found in a wide variety of soils.
D) Pneumocystis jiroveci is becoming a wide-spread contaminant in health care environments.
E) The pathogen is easily transmitted from infected persons to others.

Question 31

Exposure to large accumulations of bird dropping may result in which of the following mycoses?

A) coccidioidomycosis
B) blastomycosis
C) histoplasmosis
D) valley fever
E) Pneumocystis pneumonia

Question 32

A new vaccine for the upcoming flu season is developed from an influenza isolate designated A/Shanghai/2/2013(H7N9). This nomenclature means the isolate is

A) a hybrid of 2 type As combining 7 HA and 9 NA antigens, created in February 2013.
B) a type A with 7 HA antigens and 9 NA antigens isolated in Shanghai in February 2013.
C) a type A with antigens HA 7 and NA 9 isolated in Shanghai in February 2013.
D) the second type A strain with HA 7 and NA 9 antigens isolated in Shanghai in 2013.
E) a type B strain with antigens HA 7 and NA 9, first isolated in February 2013.

Question 33

Croup is often a result of infection with which of the following?

A) Mycoplasma pneumoniae
B) influenzavirus
C) respiratory syncytial virus
D) Bordetella pertussis
E) hantavirus

Question 34

Dust storms in arid regions of the Southwestern U.S. may lead to outbreaks of

A) Pneumocystis pneumonia.
B) histoplasmosis.
C) Hantavirus pulmonary syndrome.
D) blastomycosis.
E) valley fever.

Question 35

A young man who works on a ranch and lives in the log bunkhouse experiences sudden fever with muscle aches. A few days later he begins to cough and have difficulty breathing, and goes to an urgent care clinic. A blood sample reveals a high leukocyte count and low platelets. A Gram stain of a sputum sample shows only a few small bacteria present. Which of the following is the most likely infecting agent?

A) Hantavirus
B) Mycoplasma pneumonia
C) Histoplasma capsulatum
D) Bacillus anthracis
E) influenza

Question 36

Blastomycosis results from

A) contact with infected sputum.
B) contact with fomites.
C) inhalation of fungal spores.
D) inhalation of spherules.
E) inhalation of respiratory droplets.

Question 37

Which of the following factors is primarily responsible for the ability of Mycobacterium tuberculosis to survive long periods of time in dried droplets of respiratory aerosols?

A) pyrogenic toxin
B) the presence of LPS in the outer membrane
C) the presence of mycolic acid in the cell wall
D) formation of tubercles
E) production of cord factor

Question 38

Which of the following is a common cause of otitis media?

A) Mycobacterium tuberculosis
B) Chlamydophila pneumoniae
C) Streptococcus pneumoniae
D) Pneumocystis jiroveci
E) Blastomyces dermatitidis

Question 39

Legionella pneumophila is an opportunistic pathogen that

A) survives in the environment as an intracellular parasite of a protozoan.
B) is part of the microbiota of the lower respiratory system.
C) is a disease of birds transmissible to humans.
D) is part of the microbiota of the nasal cavity which occasionally invades the lungs.
E) is capable of forming endospores.

Question 40

The typical signs and symptoms of flu are largely a result of

A) cytokines released as part of the immune response.
B) syncytium formation.
C) the release of viral toxins.
D) the death of cells outside the lungs.
E) secondary bacterial infections.

Question 42

Specimens suspected to contain Bordetella pertussis must be inoculated onto appropriate media at the patientʹs bedside.

Question 43

The presence of distinctive spiny spores is diagnostic for the causative agent of (coccidioidomycosis/blastomycosis/histoplasmosis).

Question 44

Haemophilus influenzae is a common cause of sinus infections.

Question 45

The attachment protein for almost all rhinoviruses is (BCG/ICAM -1/IgA). (Be sure your answer is in uppercase letters.)

Question 46

The seriousness of Coccidioides infections can be attributed to the cycle of formation and rupture of spherules.

Question 47

Hantavirus pulmonary syndrome can be transmitted from person-to-person and from rodents to humans.

Question 48

Cold viruses are prevented from infecting most areas of the body because these areas are either too warm or too acidic.

Question 49

The smallest free-living microbes are (mycobacteria/mycoplasmas/Chlamydophila).

Question 50

Elongation factor, a protein required for eukaryotic (transcription/translation/expression), is the cellular target of the toxin produced by Corynebacterium diphtheriae.

Question 51

Macrophages effectively phagocytize and kill Mycobacterium tuberculosis.

Question 52

Otitis media is more common in adults than children because of differences in the anatomy of the head.

Question 53

Pneumocystis jiroveci infects only immunocompromised patients.

Question 54

Recent outbreaks of multidrug-resistant HAP are primarily caused by members of the genus (Bordetella/ Klebsiella/Mycobacteria), Gram-negative opportunists.

Question 55

ʺSyncytiumʺ is a term used to describe a mass of necrotic tissue.

Question 56

A key diagnostic sign of diphtheria is the presence of the (pseudomembrane/pharyngitis/rash/tubercle).

Question 57

Group A Streptococcus produces a class of molecules called (hemolytic/dermonecrotic/pyrogenic) toxins that stimulate leukocytes to release fever-inducing cytokines.

Question 58

Microscopic evaluation of suitable specimens is a useful way of diagnosing histoplasmosis.

Question 59

Cell death and tissue destruction result from the action of (erythrogenic/dermonecrotic/diphtheria) toxin produced by Bordetella pertussis.

Question 60

A type of pneumonia in which the alveoli and bronchioles become filled with pus is (emphysema/empyema/pleurisy).

Question 61

Why is immunity to the common cold so difficult to develop, either naturally or through vaccines?

Question 62

The mycoplasmas have been successively classified as viruses, Gram -negative bacteria, and Gram-positive bacteria largely due to the lack of cell (membranes/walls/RNA) in their structure.

Question 63

Describe the pathogenesis of tuberculosis, paying special attention to the characteristics of Mycobacterium tuberculosis that make it so pathogenic.

Question 64

Inflammation of the trachea and bronchi, commonly called (croup/pertussis/pneumonia), is frequently caused by paramyxoviruses.

Question 65

Explain the necessity of producing a new vaccine for each yearʹs flu season.

Question 66

Compare and contrast pneumococcal and mycoplasmal pneumonia.

Question 67

A major change in the surface glycoproteins of influenza A, which occurs every 10 years on average, is called (antigenic/genetic/protein) shift.

Question 68

When macrophages carry Mycobacterium tuberculosis to sites such as the bone marrow and spleen it results in (disseminated/secondary/reactivated) tuberculosis.

Question 69

Strains of Mycobacterium tuberculosis designated as (BCG/MDR/XDR) strains are resistant in vitro to three or more antitubercular drugs in addition to isoniazid and rifampin. (Be sure to use uppercase letters in your answer.)

Question 70

Numerous bacteria can cause pneumoniae in the elderly or immunocompromised. The most common ones were covered in the section ʺBacterial Diseases of the Lower Respiratory System.ʺ Devise a set of laboratory tests that could be used to distinguish between these bacteria in a clinical laboratory. Have as your goal the minimum number of tests necessary. (Hints: Try to make a dichotomous key to start. You may also need to recall material from previous chapters.)