MMID Exam 4 - December 16 2005

Question 1 -

Other than Neisseria gonorrhoeae and Chlamydia trachomatis, what other bacteria contribute to pelvic inflammatory disease? <br>answer background flora, mixed flora, anaerobes

Question 2 - Single Best Answer

Each of the following is a possible sequelae of PID EXCEPT:

A) cystitis
B) ectopic pregnancy
C) infertility
D) chronic pelvic pain

Question 3 - Single Best Answer

A prolapsed rectum can be caused by

A) Schistosomes
B) Giardia
C) Enterobius
D) Trichuris
E) Vibrio cholerae

Question 4 - Single Best Answer

To check if your bedroom or hotel room is infested with bed bugs, what do you look for (other than the bugs, themselves, which you are not likely to see)? line blood red stains from feces

Question 5 - Single Best Answer

Which of the following does Babesia infection have in common with malaria?

A) Non-human animal reservoir (not including the vector)
B) Diagnosed by microscopic examination of blood smears
C) Neither is endemic in the United States.
D) Transmission my mosquito bites.
E) Ability to be maintained in arthropod vector without human host.

Question 6 - Single Best Answer

A 31-year-old female veterinarian complained of diarrhea that she had experienced for 2 weeks. The diarrhea was described as thin, watery, and non-bloody. The patient described 10 to 14 diarrheal stools per day, the frequency of which was not influenced by a variety of over-the-counter antidiarrheal medications. Physical examination revealed a well-developed, well-nourished woman who appeared somewhat fatigued and mildly dehydrated. The workup included a negative HIV serologic test, a normal flexible sigmoidoscope examination, and a negative stool culture for bacterial pathogens. A microscopic examination of the stool for white blood cells was negative, as was a test for Clostridium difficile toxin. A stool specimen was sent for ova and parasite examination and, after appropriate concentration measures, demonstrated acid-fast oocysts. The most likely causative agent for this woman's disease is:

A) Mycobacterium avium complex
B) Cryptosporidium parvum
C) Giardia lamblia
D) Entamoeba histolytica
E) Schistosoma japonicum

Question 7 - Single Best Answer

Each of the following would be expected to yield eosinophilia EXCEPT:

A) Ascaris
B) Hookworm
C) Strongyloides
D) Enterobius
E) Cutaneous larva migrans

Question 8 - Single Best Answer

Cysticercosis and Echinococcosis have each of the following in common EXCEPT:

A) ingestion of an egg
B) cysts in deep tissues
C) infection with a worm species for which humans are not a natural host
D) humans do not transmit the disease to other humans
E) the worms are cestodes (tapeworms)

Question 9 - Single Best Answer

A 45-year-old Egyptian man was referred for evaluation of hematuria and urinary frequency of 2 months duration. This individual had lived in the Middle East for most of his life but for the past year lived in the United States. He denied previous renal or urologic problems. His physical examination was unremarkable. A midstream urine specimen was grossly bloody. Microscopic analysis of his urine looked like the image above. Which of the following best describes the causative agent of this man's most likely disease?

A) The organism has a snail as an intermediate host.
B) The organism entered the man's body by ingestion.
C) The E. coli bacteria caused an ascending urinary tract infection.
D) The organism has a mosquito as a vector.
E) The organism is found in subtropical regions of the United States.

Question 10 - Single Best Answer

Eating undercooked freshwater fish containing larvae of Diphylobothrium latum will result in which of the following symptoms?

A) pneumonitis as the larvae pass from the blood into the lungs
B) presence of tapeworm segments in the stool
C) cysts in liver and brain from migrating worms
D) bloody urine
E) dysentery-like symptoms

Question 11 - Single Best Answer

Which of the following do Schistosomiasis and hookworm infection have in common?

A) invasion of intact epidermis by the organism
B) requirement of a non-human host
C) transmission primarily via contaminated water
D) neither is endemic to the United States
E) passing of eggs are the primary cause of symptomology

Question 12 - Single Best Answer

Each of the following contributes to the increased virulence of Plasmodium falciparum compared with P. vivax EXCEPT:

A) increased stickiness of infected RBCs to endothelium
B) infection of a wider range of erythrocytic cell types
C) ability to form gametocytes in the human host
D) infection of RBCs with multiple organisms
E) increased hemolysis and hemoglobinuria

Question 13 - Single Best Answer

A 45 year old man experiences diarrhea over a 3 week course gradually increasing in severity, ultimately with frank blood in the loose stool, tenesmus, and abdominal tenderness. He has no fever. Bacterial cultures for pathogens are negative. Sigmoidoscopy reveals ulcerative hemorrhages of the mucosa that tear and become larger on manipulation. The most important treatment for this man is:

A) Antibiotics that treat Shigella
B) Steroids
C) Mebendazole
D) Metronidazole
E) Nothing, this is a self-limiting disease process.

Question 14 - Single Best Answer

If treatment of a patient with autoinfection with Strongyloides induces hyperinfection, the patient is most likely in danger of dying from:

A) gram-negative sepsis
B) blockage of intestinal lumen with a worm mass
C) cysts in the brain or liver
D) bladder cancer
E) vitamin B12 deficiency

Question 15 - Single Best Answer

A U.S. solider stationed in the Middle East is bitten on the arm by a sand fly. Four months later upon returning to the U.S., an ulcerative lesion forms at the site of the bite. Histological analysis of a scraping of the lesion reveals intracellular protozoal forms in macrophages. If he is going to be treated, the drug will most likely be:

A) Mebendazole
B) Ampicillin plus gentamicin
C) Amphotericin B
D) Steroids
E) Ethambutol plus isoniazid

Question 16 - Single Best Answer

A 6 year old girl in day care in Connecticut was brought to the doctor because of a lesion on her arm shown in this image. The girl had no other lesions except the one on the arm and had no other symptoms. She lives on a farm and often plays with cats and dogs, in addition to walking in the woods. Name three possible DISEASES that this could be. DO NOT use one disease three times with different organisms. 0% for 1, 50% for 2, 100% for three. <br>answer Ringworm, Lyme disease, impetigo

Question 17 - Single Best Answer

A laboratory that was used to house and study bats at the University of Mississippi was destroyed by Hurricane Katrina. Students were employed to clear the debris. Within 2 weeks, six of the students who did the work required treatment for fever, chills, chest pains, and a dry cough. Several had substernal discomfort. Rales were heard on auscultation. Their disease was MOST LIKELY acquired:

A) by inhalation of mycelia that grew in the bat guano
B) by inhalation of fungal spores released by chronic infection of the bats
C) by inhalation of viruses carried by bats
D) by injection of larva from mosquitoes
E) by ingestion of bacteria in sandwiches that had become contaminated with the bat guano

Question 18 - Single Best Answer

An AIDS patient became ill following a visit to a friend who raised homing pigeons. His symptoms included headaches of one week duration that were getting progressively worse, photophobia, lethargy, and a fever of 39C. His friend who brought him to the doctor said that he fell trying to get into the car. The most likely cause of his symptoms is:

A) psittacosis
B) histoplasmosis
C) cryptococcosis
D) cryptosporidiosis
E) mucor

Question 19 - Single Best Answer

Which of the following organisms is believed to cause behavioral (mental/emotional) changes in humans?

A) Toxocara
B) Toxoplasma
C) Trichuris
D) Trichophyton
E) Trypanosoma

Question 20 - Single Best Answer

An infection with which of the following can cause a blocked bowel?

A) rotavirus
B) Salmonella
C) Entamoeba
D) Ascaris
E) Enterobius

Question 21 - Single Best Answer

A mother brought her 4-year-old son to the pediatrician. She said that the personnel at the daycare center had complained that the child was irritable, hyperactive, and inattentive to learning activities. The mother had also observed restlessness, disturbed sleep, and some loss of appetite. She had also observed the child scratching his anus. He had no fever. This child should be tested for

A) ADHD (Attention deficit hyperactive disorder)
B) meningitis
C) pinworms
D) ringworm
E) earthworms

Question 22 - Single Best Answer

All of the following cause diarrhea by inhibiting fluid adsorption or increasing fluid secretion in the gut, without apparently damaging the mucosa, EXCEPT:

A) Giardia lamblia
B) Rotavirus
C) Norwalk virus
D) Vibrio cholerae
E) Entamoeba histolytica

Question 23 - Single Best Answer

A 55-year-old male native of Sudan is brought to the hospital with a sudden onset of fever, muscle pain, and headache followed by intense weakness, vomiting, and diarrhea. The patient was admitted to an isolation ward where his condition deteriorated with hemorrhage into the skin, mucous membranes and internal organs. He died 12 hours later. He had almost died from falciparum malaria once before. It is MOST LIKELY that he died of:

A) Falciparum malaria
B) Vivax malaria
C) Ebola virus
D) Chagaís disease
E) Schistosoma haematobium

Question 24 - Single Best Answer

A 60 year old woman is seen by her internist with a complaint of an open sore on her thumb that has not healed. On physical examination, she has an ulcerative lesion on the thumb and several nodular lesions on the arm along the lymphatic chain. She is a master gardener and reports being pricked by a rose thorn 2 weeks earlier. She is MOST LIKELY infected with <br>answer Sporothrix

Question 25 - Single Best Answer

Each of the following is a dimorphic fungal pathogen EXCEPT:

A) Coccidioides immitis
B) Cryptococcus neoformans
C) Histoplasma capsulatum
D) Blastomyces dermatitidis

Question 26 - Single Best Answer

Which of the following is believed to contribute to cancer, either directly or indirectly?

A) Giardia lamblia
B) Strongyloides stercoralis
C) Echinococcus granulosis
D) Schistosoma haematobium
E) None of the above

Question 27 - Single Best Answer

Amphotericin B is selectively toxic to fungi because it binds to the membrane component <br>answer Ergosterol.

Question 28 - Single Best Answer

A 59 year old man with acute myelogenous leukemia undergoes chemotherapy.Ý Two days after becoming neutropenic (absolute neutrophil count < 500), he develops fevers.Ý AfterÝ5 days of broad spectrum antibiotics, he is still febrile, and antifungal drugs are added (fluconazole) empirically.Ý Two days later, he develops increasing shortness of breath and confusion.Ý A thin-section CT of the chest reveals a wedge-shaped pulmonary lesion in the left lower lobe and a nodular infiltrate in the left upper lobe, with a suggestion of a halo sign.Ý All blood cultures are negative for bacteria.Ý The neutrophil count is still < 500.Ý A bronchoscopy reveals necrotizing pneumonia.Ý What is the most likely finding on histopathology of a lung biopsy?

A) Right-angle branching, aseptate hyphae
B) Budding yeast with pseudohyphae
C) Gram positive diplococci
D) Acute-angle branching, septated hyphae
E) Acid fast bacilli

Question 29 - Single Best Answer

A 64 year oldÝwoman with ischemic bowel and chronic obstructive lung disease undergoes extensive bowel resection.Ý Post-operatively, sheÝrequires mechanical ventilation and cannot be weaned from the ventilator.Ý Two weeks later, she is afebrile onÝbroad spectrum antibiotics, hemodynamically stable and has a normal white blood cell count and other lab values.Ý Her CXR shows her endotracheal tube but does not reveal a pulmonary infiltrate.Ý A unit nurse sends a gram stain and culture on an endotracheal tube aspirate.Ý The gram stain shows no polymorphonuclear cells or bacteria,Ýbut does showÝa few budding yeasts.Ý You are called from the micro lab the next day because the culture is growing a budding yeast.Ý Which of the following is true?

A) The patient likely has ventilator-associated pneumonia due to Cryptococcus neoformans and requires immediate antifungal therapy.
B) The patient likely has Aspergillus pneumonia, and requires immediate antifungal therapy.
C) The patient is likely to be colonized with Candida albicans, and does not require antifungal therapy.
D) The budding yeast is likely to be mis-identified and really represents gram positive diplococci.
E) The patient is likely to be infected with a dimorphic fungus that will grow as hyphae at room temperature.

Question 30 - Single Best Answer

A patient who recently traveled to Africa presents with recurring fever, chills, and sweats (every 48 hours), malaise, and fatigue myalgia. Examination of a blood smear is shown in the figure. Which of the following drugs is most appropriate to treat this disease?

A) mebendazole
B) amphotericin B
C) ampicillin
D) chloroquine
E) ketoconazole