MMID Exam 4 - December 10 2004

Question 1 - Single Best Answer

Which of the following is <b>NOT</b> a principal risk factor for pelvic inflammatory disease?

young age
sexually active
multiple partners
antibiotics that decrease normal flora
prior sexually transmitted disease

Question 2 - Single Best Answer

Hyperinfection by Strongyloides is caused by:

administration of steroids to infected people
walking through heavily contaminated soil
administration of antibiotics
regurgitation
exposure to eggs of canine species

Question 3 - Single Best Answer

Which of the following mechanisms of action is associated with the antimycotic drug that has the most severe side effects?

binding to ergosterol in the cell membrane
blocking RNA and DNA synthesis
inhibit cytochromes involved with ergosterol synthesis
inhibiting microtubule assembly
None of the above ñ the antimycotics are all safe and have no severe side effects.

Question 4 - Single Best Answer

Which of the following does <b>NOT</b> accurately state differences between Plasmodium falciparum and Plasmodium vivax?

falciparum is more severe than vivax
falciparum can relapse, vivax usually does not
falciparum causes more capillary blockage
falciparum infects red blood cells of any age, vivax only infects reticulocytes
All of the above ARE accurate descriptions of differences between these organisms.

Question 5 - Single Best Answer

Why is a skin test for existing immunity to Histoplasma not useful in diagnosis?

Only AIDS patients get histoplasmosis, and they do not produce cell-mediated immune reactions.
Because Histoplasma uses antigenic mimicry, so even normal human hosts do not produce immune responses.
Most people in endemic areas have been exposed and will be skin test positive.
Protective immunity is mediated by antibodies, and skin cell reactivity is based on cell-mediated immunity.
Histoplasma itself is immunosuppressive, so infected individuals will not produce immune responses.

Question 6 - Single Best Answer

When a human ingests the larval cysts of a pork tapeworm in undercooked meat, the end result of the human infection is:

worms that migrate through the skin until they die.
worms that lodge in the lungs causing respiratory symptoms
worms in the intestines that release eggs
cysts that contain larvae in the lung and liver
worms in the liver that release eggs into the liver and stool

Question 7 - Single Best Answer

The major factor that determines whether a person that is infected with Candida albicans presents with cutaneous, mucocutaneous, or systemic candidiasis is:

The particular strain of C. albicans infecting the patient.
The season of the year.
The geographic location where the patient has visited.
The immune status of the patient.
The patient's body temperature.

Question 8 - Single Best Answer

Cutanaeous larva migrans is caused when:

human hookworms enter the body through tissues other than the foot.
humans ingest eggs of the pork tapeworm.
humans ingest cysts of Giardia
humans encounter larvae of dog or cat hookworms at the skin
humans are bitten by unvaccinated dogs or cats

Question 9 - Single Best Answer

An AIDS patient experiences fever, headache increasing over a three week period. He finally visits his doctor who performs a lumbar puncture, which reveals a few lymphocytes, slightly elevated protein, and slightly decreased glucose relative to serum. Microscopic examination of the CSF is most likely to reveal:

gram-positive cocci
right-angled hyphae
encapsulated yeast
acute-angled hyphae
nothing ñ this is viral meningitis.

Question 10 - Single Best Answer

Eosinophilia would be <b>LEAST</b> likely to be observed with which of the following parasites?

Strongyloides
Ascaris
Enterobius (Pinworm)
Necatur (Hookworm)
Taenia solium (Tapeworm)

Question 11 - Single Best Answer

Which of the following parasite encounters is <b>NOT CORRECT</b>?

Ascaris ñ ingestion of eggs
hookworm ñ penetration of skin by larvae
malaria ñ insect bite
Giardia ñ ingestion of cysts
All of the above <b>ARE CORRECT</b>

Question 12 - Single Best Answer

Strongyloides and hookworm are common for each of the following <b>EXCEPT</b>:

invasion of larvae through intact skin
passage of larvae through the tissues and lungs
free living form in the soil
contamination of soil with human feces
adults in intestines

Question 13 - Single Best Answer

Each of the following characteristics is <b>DIFFERENT</b> between Candida albicans and the systemic fungal pathogens (Histoplasma, Coccidioides, Blastomyces) <b>EXCEPT</b>:

cellular morphology at body temperature
being part of endogenous/normal flora of humans
having a geographically specific distribution
being dimorphic
All of the above <b>ARE</b> characteristics that are different between Candida and the other systemic fungal pathogens.

Question 14 - Single Best Answer

Which of the following differential diagnoses and relevant tests is <b>NOT</b> appropriate when considering pelvic inflammatory disease?

ectopic pregnancy - pregnancy test (quantitative human chorionic gonadotropin (HCG))
appendicitis - CT
pyelonephritis - urinalysis
adnexal accident - endovaginal ultrasound
All of the above are appropriate differential diagnoses and tests

Question 15 - Single Best Answer

The new President at the University of Florida decided that the bat house by Lake Alice had to be moved so he could build a new house for Urban Meyer and asked the football team to help. This was after the FSU game. By the time of the Peach Bowl some of the players who had helped were sick with chills, fever, cough, and respiratory distress. Chest X-rays were done and showed interstitial infiltrates. <br><br>Which of the following is the <b>MOST</b> likely diagnosis for these men?

Blastomycosis
Cryptococcosis
Histoplasmosis
Giardiasis
Candidiasis

Question 16 - Single Best Answer

Which of the following exists as a yeast in both the environment and the human host?

Blastomycetes
Cryptococcus
Histoplasma
Giardia
Trichophyton

Question 17 - Single Best Answer

The major damage in schistosomiasis is caused by:

the worms forming cysts in liver and kidney.
immune response to eggs in tissues.
migration of worms through tissues, particularly the lungs
infection of red blood cells
bleeding in the intestines

Question 18 - Single Best Answer

A liver abscess may be a sequela of which of the following?

watery diarrhea
dysentery
pelvic inflammatory disease
Trichuris
viral infection

Question 19 - Single Best Answer

A 30 year old male is gardening and gets a splinter lodged under his skin on his wrist. Three weeks later he experiences a firm nodule under his skin. The nodule eventually ruptures and another nodule appears farther up his arm. He visits his doctor, and a biopsy is taken. Elongated, cigar-shaped yeast-like structures are observed by microscopy. <br><br> The most likely causative agent is:

Sporothrix
Candida
Aspergillus
Blastomyces
Cryptococcus

Question 20 - Single Best Answer

Which of the following sometimes mimics the symptoms of appendicitis?

giardiasis
cryptococcosis
Ascaris infection
creeping eruption
pinworm infection

Question 21 - Single Best Answer

Which of the following has been most effective in limiting the scope of Schistosomiasis?

vaccination
insecticides
snail control
prophylactic anti-trematode therapy
managing wild boar populations

Question 22 - Single Best Answer

An infection that may be associated with rectal prolapse is

ringworm
pin worm
whip worm
amoeba
Schistosome

Question 23 - Single Best Answer

The most common opportunistic fungal infection is:

lung aspergillosis.
vaginal candidiasis.
tinea corporis.
lymphatic sporotrichosis.
fungus balls.

Question 24 - Single Best Answer

The most likely reason for the death of patients from systemic fungal infections is:

lack of useful anti-fungal agents.
only extremely sick individuals get these infections.
proper treatment is not given because the proper diagnosis is not made in time.
All of the above.
None of the above.

Question 25 - Single Best Answer

A person with diabetes who takes his insulin irregularly presents with ketoacidosis, a severe headache, swelling around one eye, and a black exudate from the eye. You would expect to see which of the following in a tissue sample of the infected area?

yeast forms
hyphae with 90 degree angle branching
pseudohyphae
hyphae with 45 degree angle branching
None of the above

Question 26 - Single Best Answer

Which of the following infection-behavior associations is <b>NOT</b> correct?

Toxoplasma gondii ñ jealous and suspicious men
Borna virus ñ schizophrenia
Group A Streptococcus - obsessive-compulsive disorder
Trichomonas vaginalis ñ increased sexual desire
Treponema pallidum ñ neurosis

Question 27 - Single Best Answer

A 4 year old girl in day care was brought to the doctor because of several lesions on her arm such as that shown in this picture. They were reddish and round, slightly raised and scaling. There were a few pinpoint pustules around the edge of the lesions. The girl had no other lesions except the ones on the arm and had no other symptoms. One of the lesions was scraped, and the scrapings were treated with 10% KOH and then examined microscopically. You would expect to see which of the following?

skin cells only, the bacteria would have been destroyed
fungal spores
hyphae
clue cells
worm larvae

Question 28 - Single Best Answer

A kindergarten student complains of sleeplessness and anal pruritis. A scotch tape test reveals the following on microscopic examination. This case will be treated with:

mebendazole
ketoconazole
metronidazole (flagyl)
gentamicin and clindamycin
griseofulvin

Question 29 - Single Best Answer

A 45 year old male has a chest X-ray because he fell off his bike and possibly broke a rib. The patient did not have any broken bones. However, his X ray looked like that shown on the left of this figure. The patient was upset when he saw the lesion indicated by the arrow; however, the physician said that nothing needed to be done. A biopsy was not done; however, had one been done, which of the organisms depicted in images A-E most likely would have been observed? (Note that it is the organism shown in each image that is important, not whether the image itself is from a lung biopsy.)

A
B
C
D
E

Question 30 - Single Best Answer

A 35 year old female goes on a mission trip to Ecuador. On her return to Minnesota she experiences weakness, chills, sweating, and high fevers that resolved and recurred every other day repeatedly over one week. Her urine became darkened. Which of the organisms depicted in images A-E most likely caused this illness?

A
B
C
D
E

   

  Updated: December 8, 2006