TEST BANK for Visualizing Microbiology 1st Edition by Rodney P. Anderson

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Visualizing Microbiology 1st Edition Anderson Test Bank Chapter 1 – Microbial Word 1.1 The Microbes EASY 1. Which of the following is a reason that Microbiology is a unique part of the study of life? a. microorganisms are too small to be seen with the naked eye b. microorganisms are our planet’s dominant life form c. microorganisms live in and on other macroorganisms like humans d. microorganisms occupy most ecological niches on Earth.

E. all of these are correct reasons.

MEDIUM 2. Named in order of increasing level of complexity, the 3 major groups of microorganisms are .

A. noncellular, prokaryotes and eukaryotes b. viruses, bacteria, and protozoa c. prions, viruses, and bacteria d. eukaryotes, prokaryotes and viruses HARD 3. Which of the following statements BEST describes the major difference between the noncellular infectious particles?

A. Viruses have either DNA or RNA, viroids have only RNA, and prions have neither DNA or RNA b. Viruses have both DNA and RNA, viroids have only RNA and prions have proteins c. Viruses have either DNA or RNA, Viroids have only DNA and prions have proteins and RNA d. Viruses have both DNA and RNA, viroids have only RNA and prions have only DNA MEDIUM 4. The majority of prokaryotes have A. presence of internal structures that lack membranes, and have a plasma cell membrane and cell wall b. presence of membrane-bound organelles such as nucleus, have a plasma cell membrane and cell wall c. no internal structures, but have a plasma cell membrane and cell walls d. presence of internal structures that lack membranes, and have a plasma cell membrane but have no cell walls

2 EASY 5. Match the prokaryote structure or characteristic with its function: Plasma membrane C a. small circles of DNA with genes not essential for life Nucleoid D b. uncomplicated cell replication Plasmids A c. selectively determines what enters or leaves the cell Binary fission B d. large loop of DNA with genes essential for life EASY 6. Size matters in Microbiology. As described in the text, what is the correct order of increasing size of these organisms?

A. Rabies virus, Streptococcus pneumoniae bacterium, Trypanosoma brucei protozoan b. Streptococcus pneumoniae bacterium, Rabies virus, Trypanosoma brucei protozoan c. Streptococcus pneumoniae bacterium, Trypanosoma brucei protozoan, Rabies virus d. Trypanosoma brucei protozoan, Streptococcus pneumoniae bacterium, Rabies virus MEDIUM 7. Members of the Archaea a. are ancient Eukaryotes that have many similarities with Prokaryotes b. live in diverse and harsh environments where other living cells would perish c. are thought to have been the first forms of cellular life on Earth d. include algae, fungi, and helminthes E. b and c are correct EASY 8. Microbes are the dominant life form on Planet Earth because a. at an estimated 5x1030 bacteria are the most abundant life form b. microbial species are estimated to number between 10 million and 1 billion c. microbes occupy all ecological niches on the planet d. all microbes are Eukaryote cells E. a, b, and c are correct MEDIUM 9. Match the Eukaryote organism with its description Eukaryote Description Fungi D a. carry out photosynthesis Algae A b. animal-like characteristic of locomotion Protozoa B c. eggs and juvenile stages are viewed with a microscope Helminths C d. Cell walls made of chitin HARD 10. Considering the fact that there is more diversity among Eukaryote organisms such as protozoa, fungi, algae and helminths than there is among Prokaryotes such as bacteria and Archaea, why are “microorganisms” considered the dominant life form? a. there are more species of microorganisms than multicellular organisms b. microorganisms include both Prokaryotes and Eukaryotes

3 c. microorganisms may be found in all ecological niches d. only answer a and b are correct E. all of these are correct EASY 11. How did ancient photosynthetic microbes change the course of evolution on Earth? a. production of oxygen gas combined with UV light in stratosphere produced Ozone layer that shielded planet from sun’s excess UV rays b. presence of oxygen gas allows for evolution of aerobic respiration in thus producing more ATP for cellular activity c. terrestrial life forms evolved because of shielding ozone layer D. all of these are correct 1.2 The Conflicts MEDIUM 12. Key differences between antiseptics and disinfectants include: a. antiseptics are less toxic and may be used on human and animal tissues b. disinfectants are more toxic and are used only on inanimate objects c. antiseptics are more toxic to human pathogens than are disinfectants D. answers a and b are correct e. answers a and c are correct EASY 13. What factors must be controlled in order to promote microbial growth in the lab? a. optimal food resources according to what the microbe prefers b. pH levels c. ideal temperature d. oxygen requirements E. all of these are correct HARD 14. In the human body, our physiological processes work to maintain homeostasis. Likewise we have to maintain homeostasis of microbial cultures in a lab setting in order to promote growth. So what can we do to interrupt microbial growth that is causing disease in the human body? a. disrupt homeostasis by eliminating factors that promote growth like body temperature b. change pH and oxygen levels c. increase food sources D. answers a and b are correct e. answers a, b, and c are correct MEDIUM 15. Which of the following is NOT used in the identification of microbes in a lab? a. staining of cells for observation under the microscope

4 b. testing of microbial metabolism utilizing biochemicals in the media C. assaying antibody reactions to the absence of their specific pathogen in agglutination reactions d. all are used to aid in microbial identification MEDIUM 16. The innate portions of the Immune System are non-specific, i.e. the same processes are used regardless of microbe type. The innate portions in their efforts to destroy invading pathogens.

A. usually involve proteins and some of the leukocytes b. does not utilize phagocytosis or “cell-eating” to engulf and kill off foreign microbes c. rarely produces inflammatory reactions d. involves lymphocytes HARD 17. Highly specific reactions are the basis of true immunity that is learned during a person’s lifetime. This provides long-lasting immunity to a specific microbe and is termed the adaptive response. This adaptive portion of the Immune System . a. does not involve phagocytic leukocytes B. involves B lymphocytes that produce special proteins called antibodies in response to the pathogen. c. creates inflammatory reactions d. does not provide the basis for vaccination because it isn’t innate EASY 18. What does the term “pathogenesis” mean?

A. development of an infectious disease b. development of a pathogen c. development of any disease process d. development of a noncommunicable disease MEDIUM 19. Which is the correct order of the five basic steps of pathogenesis? a. pathogen entry into host, thwarting immune defenses, pathogen attachment, host damage, and pathogen exit B. pathogen entry into host, pathogen attachment, thwarting immune defenses, host damage, and pathogen exit c. pathogen entry into host, thwarting immune defenses, host damage, pathogen attachment and pathogen exit d. pathogen entry into host, pathogen attachment, host damage, thwarting immune defenses, and pathogen exit EASY 20. How do pathogens gain entry into the human body? a. nose b. mouth

5 c. breaks in skin D. all of these are correct e. only a and b are correct MEDIUM 21. Why must a pathogen attach itself to target tissues in the body?

A. without attachment pathogen may be washed away by body fluids b. unattached pathogens may be eaten by phagocytic cells in fluids c. extracellular pathogens may be targeted by B lymphocytes d. intracellular pathogens may be targeted by T lymphocytes MEDIUM 22. How do microbes try to evade our immune defenses? a. hide inside target cells b. preserve gene expression in the host cell c. production and secretion of enzymes, toxins and other by-products that help target tissues D. adhere to target internal tissues to avoid being washed away by body fluids 1.3 Infectious Disease MEDIUM 23. Hand washing is the Number #1 way to prevent the spread of pathogens from host to host.

What is the correct order of the steps in this process?

1. wetting hands and lathering with soap while rubbing hands and arms 2. Clean knuckles and use them to scrub inside of palm 3. Scrubbing tops of hands being sure to wash between fingers 4. Rinse with clean water and dry thoroughly A. 1, 3, 2, and 4 b. 1, 2, 3, and 4 c. 2, 1, 3, and 4 d. 2, 3, 1 and 4 HARD 24. Which of the following statements concerning the chain of pathogen transmission is accurate according to your text? a. effectiveness of handwashing is increased by reduction in washing time. b. Nurses have a 60% rate of noncompliance with good hand-washing techniques C. 100% of surgeons failed to scrub their hands for the full 5 minutes necessary to remove most transients and help reduce surgical site infections. d. patients are not routinely screened for MRSA or other antibiotic-resistant bacteria.

MEDIUM 25. What is the role of Microbiology versus Epidemiology in the efforts to prevent major disease outbreaks? a. Microbiology studies the pathogen while Epidemiology estimates how it is spread

6 B. Microbiology seeks to identify the pathogen while Epidemiology analyzes the demographic and geographic data of patients infected with the pathogen c. Microbiology identifies the pathogen while Epidemiology studies treatments that work d. Microbiology suggests effective treatments while Epidemiology provides suggestions to prevent the pathogen’s spread MEDIUM 26. What is the difference in morbidity versus mortality rates in tracing disease progression in a population within a geographic area? a. morbidity is the incidence rate of a disease within a population b. mortality is the number of deaths in patients diagnosed with the disease in a specific area within a specific time period c. mortality is a subset of the morbidity rate of a disease D. all of these is correct EASY 27. Which of the following is NOT an example of Health care-associated infections (HAIs)? a. Urinary Tract Infections (UTIs) b. Surgical site infections c. Respiratory infections d. Skin infections E. Ear infections EASY 28. How are hospitalized patients protected from HAIs or nosocomial infections? a. Hand washing b. MRSA screening of patients c. daily disinfection of frequently touched surfaces d. special laundry collection E. all of these is correct EASY 29. How are health care workers protected from hospital acquired pathogens? a. use of personal protective equipment (PPE) b. use of universal precautions when dealing with body fluids c. hand washing D. all of these is correct MEDIUM 30. Examples of human immune system multilevel defenses against pathogens include all of the following except: a. skin and mucous membranes b. washing action of tearing, sweating and urination c. increase in body temperature D. vomiting and diarrhea e. chemical defenses like salt from sweat and acidic secretions

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MEDIUM 31. Your normal microbiota help protect you against pathogenic transient microbes by using each of the following except: a. provide competition for space in and on the body’s microhabitats b. tie up nutrients normally needed by pathogens c. produce metabolic byproducts that prevent pathogen colonization D. produce natural antibiotics that kill off potential pathogens e. provide acidic environments and by products that discourage pathogens EASY 32. What is the first step in diagnosing and treating a disease caused by a pathogenic microbe?

A. Accurate identification of the pathogen b. diagnosis of the infectious disease c. testing of appropriate antibiotics in bacterial diseases d. DNA analysis of the pathogen’s genotype HARD 33. How does MALDI TOF mass spectrometry help a patient with an acute infection? a. can identify pathogens in 1 hour versus 24-28 hours using conventional lab methods b. produces a patient sample spectrum that may be compared to an existing instrument database c. can identify pathogens using a number of microbial colonies growing on a plate D. only answers a and b are correct e. only answers b and c are correct HARD 34. Which of the following are an accurate assessment of the benefits and limitations of MALDI TOF? a. difficulty distinguishing closely related microbial species b. low equipment costs c. single colony specimen use D. both a and c are correct e. both a and b are correct MEDIUM 35. Based on epidemiological data in your text, what infectious disease process is the #1 killer of humans worldwide each year? a. diarrheal disease B. lower respiratory disease c. HIV d. Malaria e. Tetanus

EASY 36. What factors will increase the risk of EIDs (emerging infectious diseases) in the future?

8 a. misuse of antibiotics b. modern transportation c. human movement into new habitats d. continued evolution of microbes E. all of these MEDIUM 37. What are the major problems encountered in the worldwide effort to eradicate polio? a. increased risk of viral transmission in refuge camps b. disruption of preventive medical programs including childhood vaccinations c. inability to deploy health care workers to refuge camps D. answers a and b are correct e. answers b and c are correct

1.4 Microbial Ecology and Commercial Applications HARD 38. Why are biogeochemical cycles crucial to the maintenance of our planet’s ecosystems? a. unusable forms of elements such as carbon, sulfur and nitrogen are converted to forms usable by living organisms b. decomposition of dead organisms releases minerals back into the ecosystem for reuse by other dead organisms c. breakdown of living organisms waste materials puts bacteria back into the environment d. these cycles supply nutrients to specific simple communities of organisms E. answers a and b are correct EASY 39. Which of the following statements BEST describes the symbiotic relationship between Rhizobium and leguminous plants such as peanuts? a. serves as basis for crop rotation every five years b. Rhizobium receives nitrogen from plant roots c. Leguminous plants receive usable form of carbohydrate D. Rhizobium creates usable form of nitrogen gas that is absorbed via plant roots while it receives sugar in return MEDIUM 40. Besides providing nutrients for this year’s crop of soybeans, peanuts or other legumes, what does the symbiotic relationship with Rhizobium do for NEXT year’s crop?

A. enriches soil with nitrogenous compounds that may be used by next year’s crop without the need for additional fertilizer. b. enriches soil with decaying organic matter from bacterium c. enriches soil with proteins and nucleic acids made with nitrogen d. enriches soil with carbohydrates made from glucose created by plant HARD

9 41. Fungi often live in symbiotic relationships with plant roots. What specific nutrient do they help supply that will help a plant that produces fruits? a. nitrogen needed for amino acids and nucleic acids B. phosphorus needed for producing flowers c. calcium needed for muscle function d. sodium and potassium for nerve function MEDIUM 42. Microbial bioremediation of pollutants was used to help cleanup what recent environmental disaster?

A. Deepwater Horizon crude oil spill in Gulf of Mexico b. contamination of river water with cholera in Haiti following the earthquakes c. Deepwater Horizon crude oil spill in Antarctica d. contamination of drinking water in Flint, Michigan EASY 43. Why are some bacteria able to eat unusual foods like crude oil?

A. they have a diversity of chemical reactions that can turn materials into carbon and energy sources. b. they can carry out cellular respiration c. they can carry out fermentation d. they make a diversity of enzymes that can catalyze chemical reactions MEDIUM 44. Match the following industrial examples of microbial use with their products Industrial Use Product Alternative fuels C a. Fermented beverages Bioreactors D b. Pharmaceutical products Yeast A c. Ethanol, hydrogen and methane Genetically modified microbes B d. Vitamins, alcohol, citric acid EASY 45. How has the use of microorganisms helped human health? a. provided safe drinking alternatives to contaminated water b. supplied foods that don’t need refrigeration like yogurt and cheese c. through fermentation modified foods that otherwise could not be eaten d. provided edible nutrition with cooked products like bread E. all of these are correct MEDIUM 46. How has Pasteurization made milk and other dairy products safer to consume? a. kills pathogenic microbes without spoiling nutrient value and taste b. sterilizes milk and other dairy products c. kills only the most heat resistant pathogens without killing the others d. answers a, b, and c are correct E. only answers a and c are correct

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HARD 47. Which of the following diseases is NOT caused by contamination and consumption of unpasteurized milk? a. Brucellosis b. Diphtheria c. Q fever D. polio e. Gastroenteritis EASY 48. Commercial food preparation focuses on eliminating disease-causing and spoilage-causing microbes via a. use of high pressure for canning b. heat for pasteurization and canning c. use of chemical preservatives like sugar and salt d. use of ionizing radiation to scramble microbial DNA E. all of these are correct CRITICAL THINKING 49. What is the ONE characteristic that applies to all of the microorganisms that you have studied in this chapter and thus defines the study of Microbiology? a. They are all Prokaryotes. b. They are all Eukaryotes. c. They all cause infectious diseases in humans and other animals.

D. They all are too small to be seen with the naked eye at some point in their life cycle.

50. Given how useful microorganisms are in helping crops grow, providing us with food to eat, and cleaning up the environment, how concerned should we be about the microbes that are pathogenic? a. We shouldn’t be concerned because the benefits of living with microbes outweigh the risks of infectious disease.

B. We should be concerned because with increased population levels humans are moving into new habitats and encountering emerging diseases for which we have no natural immunity. c. We shouldn’t be concerned because of the newly emerging genetically modified drugs and vaccines that will either make us well again or protect us from infection. d. We shouldn’t be concerned because modern health practices and information gained from epidemiology provide us with the knowledge to protect ourselves.

CH. 2 – The Biochemistry of Macromolecules MEDIUM 1. Proteins, carbohydrates, lipids and nucleic acids are the 4 major groups of organic macromolecules that are necessary for living cells whether they are Prokaryotes or Eukaryotes. What major characteristics do these 4 groups share? a. all have a carbon atom as their backbone b. each group has nonspecific monomers that are joined together by covalent bonds c. monomers are bonded to each other via hydrolysis reactions d. all of these is correct EASY 2. Match the macromolecule with the correct examples: Macromolecule Examples Proteins C a. nucleotide monomers Carbohydrates D b. fatty acid monomers Lipids B c. amino acid monomers Nucleic Acids A d. monosaccharide monomers

2.1 Proteins EASY 3. What are the major characteristics of a protein? a. made of amino acid monomers that contain nitrogen b. each of the 20 naturally occurring amino acids has an amino group, a carboxyl group and a “R=residue” or side chain c. the side chain is different for each of the 20 amino acids D. all of these is correct MEDIUM 4. How are amino acids classified? a. names may be abbreviated with five letter words b. 4 groups of amino acids according to amino group: basic, acidic, nonpolar or uncharged polar C. names may be abbreviated with a single capital letter d. all of these is correct EASY 5. Match the protein structure with the correct description Protein Structure Description Primary D a. stable 3-dimensional conformation Secondary C b. 2 or more tertiary polypeptides joined together Tertiary A c. alpha helix or beta pleated sheet Quaternary B d. linear sequence of amino acids joined by peptide bonds MEDIUM 6. Which of the following correctly describes the two basic biochemical reactions in cells a. dehydration synthesis and hydrolysis b. dehydration synthesis adds a molecule of water and hydrolysis removes one c. dehydration polymerization and hydrolytic degradation d. oxidation and reduction

HARD 7. The structure of a secondary or higher protein is dependent upon . Thus this determines the functionality of the protein. a. the hydrophobic or hydrophilic nature of the amino acids in the primary structure b. the electrostatic attractions between the R or side chains of the amino acids in the primary structure c. the interaction of the sulfhydryl groups that produce disulfide bridges D. all of these is correct EASY 8. Denaturation of the secondary or tertiary structure of a protein may be caused by a. changes in environmental conditions such as temperature or pH b. may be temporary as in the use of a curling iron on human hair c. may be permanent as in the use of chemical solutions on human hair d. usually involves ligands E. only a, b, and c are correct MEDIUM 9. Match the protein with its function Protein Function Antibody C a. protein in RBCs that transports oxygen throughout the body Insulin D b. contractile protein needed in muscle cells Myosin B c. produced by immune system and initiates destruction of pathogens Hemoglobin A d. hormone that facilitates glucose uptake in cells

2.2 Enzymes EASY 10. Which of the following statements about enzymes is NOT true? a. special class of tertiary structure proteins that act as catalysts in biochemical reactions B. increase the activation energy (Ea) needed to make a normally occurring reaction happen faster c. when hydrolysis reactions are catalyzed by enzymes, energy needed for cell survival is released d. living cells cannot use heat to speed up reactions because it would denature proteins so enzymes are used instead e. enzymes are highly specific to the substrate to which they can bind MEDIUM 11. What is the correct order of steps in the use of an enzyme in a biochemical reaction?

1. Induced fit distorts the substrate making it more reactive and lowering Ea 2. Substrate binds to active site of enzyme like a lock and key 3. Substrate converted to product because of change in shape, size and charge 4. Enzyme-substrate binding energy contributes to catalysis a. 1, 2, 4, 3

B. 2, 1, 4, 3

c. 1, 2, 3, 4

d. 2, 4, 1, 3

e. 2, 3, 1, 4

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MEDIUM 12. Match the enzyme to the reaction catalyzed: Enzyme Catalyzed Reaction Amylase B a. joins 2 DNA strands together Catalase D b. digests starch DNA ligase A c. breaks down peptidoglycan in bacterial cell walls Lysozyme C d. degrades hydrogen peroxide into water and oxygen

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HARD 13. What factor is not true and will NOT influence the rate of enzymatic reactions?

A. a prosthetic group is another protein that binds to the enzyme and makes it work better b. higher temperatures will increase enzymatic reactions up to the point of denaturation c. lower temperatures will decrease enzymatic reactions down to the point of freezing d. enzyme regulation by substrate availability e. competitive inhibition of enzymes EASY 14. Regulation of enzymes allows a cell to be responsive to physiological needs. This may be accomplished by these processes: a. negative feedback inhibition loop b. noncompetitive enzyme inhibition c. competitive enzyme inhibition D. all of these are correct

2.3 Carbohydrates EASY 15. The characteristics of carbohydrates includes a. monosaccharides serve as the building blocks for these polymers b. monosaccharides are joined together by covalent bonds known as glycosidic links c. monosaccharides are joined by hydrolytic reactions d. all of these are correct E. only a and b are correct EASY 16. Match the term with the correct definition: Term Definition Monosaccharide D a. three to 20 monomers Disaccharide C b. long chains of simple sugars Oligosaccharide A c. two monomers covalently bouynd Polysaccharide B d. found predominantly in stable ring structure MEDIUM 17. Why are carbohydrates such excellent molecules for energy storage? a. they are composed of three basic atoms: carbon, hydrogen and oxygen B. hydrolysis of glycosidic links releases energy used in many parts of the cell c. energy is easily stored in their covalent bonds d. carbon may form bonds with up to four different chemicals

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HARD 18. What is the correct sequence of events in the maintenance of homeostasis in blood glucose levels?

1. Hypoglycemia stimulates glucagon production -> 3. glucagon makes liver and muscle cells release glucose -> 4. hyperglycemia stimulates insulin production -> 2. insulin makes body cells take up glucose -> 5. blood glucose levels fall below homeostasis level a. 1, 2, 3, 4, 5 B. 1, 3, 4, 2, 5 c. 5, 1, 2, 3, 4 d. 3, 4, 2, 5, 1 HARD 19. Emergency injection of a. glucose b. glycogen

c. insulin

into a diabetic with severe hypoglycemia will revive the patient.

D. glucagon

EASY 20. While polysaccharides such as starch serve as storage for energy, other polysaccharides like serve as structural materials in cells. a. cellulose b. chitin c. keratin D. a and b are correct e. b and c are correct

2.4 Lipids EASY 21. The most important forms of lipids in living cells include A. steroids, triglycerides and phospholipids b. steroids, phospholipids and waxes c. phospholipids, triglycerides and waxes d. triglycerides, steroids and waxes MEDIUM 22. The covalent bond created by dehydration synthesis that links the three fatty acids with a glycerol molecule is called . a. peptide bond b. hydrolytic bond C. ester bond d. nonpolar bond EASY 23. Examples of unsaturated fats include a. olive oil b. corn oil c. canola oil

that are liquid at room temperature.

D. all of these are correct

MEDIUM 24. Saturated fats are not a healthy choice in human diets because a. they are solid at room temperature b. every binding site on the carbons is occupied by hydrogens that result is a solid straight chain C. they result in an increased chance of heart disease d. they are usually found in animal fats e. all of these are correct HARD 25. The lipase excreted by the bacterium commonly responsible for acne breaks down the sebum naturally produced by the glandular cells in the hair follicles and is a good example of . a. triglyceride b. fatty acid chain c. steroid D. tertiary structure protein

MEDIUM

26. The androgen sex hormones produced in high amounts in adolescents belong to this group of lipids: a. phospholipids B. steroids c. waxes d. triglycerides EASY 27. Phospholipids are called part isn’t.

A. amphipathic b. bipathic

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molecules because one part is attracted to water and the other c. hydrophilic

d. hydrophobic

HARD 28. If you had a measuring cup of phospholipids and poured this into a bowl of water, what would you expect to see form? a. individual phospholipids surrounds by water molecules B. spheres made of phospholipid bilayers floating in the water c. phospholipid sheets floating on the water d. phospholipid double helices hanging in the water EASY 29. Phospholipids are formed when a triglyceride. a. phosphorus B. phosphate group

is substituted for one of the fatty acid tails of a c. phosphorus/sterol

d. phosphorus/hydroxyl

MEDIUM 30. The fluidity of cell membranes can be attributed to presence of some A. unsaturated fatty acids b. saturated fatty acids c. phosphate groups

d. sterols

EASY 31. One of the more common sterols is , that can be both beneficial to cells but also implicated in heart disease because of the arterial plaque formations. a. wax b. cortisol C. cholesterol d. triglycerides MEDIUM 32. Waxes have many functions in multicellular organisms including: a. waterproof coating on surfaces that inhibit water evaporation b. waterproof coating on surfaces that inhibits water penetration c. waterproof compounds that strengthen bacterial cell walls D. all of these are correct e. only a and b are correct EASY 33. The basic structure of steroids includes a. 2 fatty acid tails with a sterol hydrocarbon ring attached b. 3 fatty acid tails with a sterol hydrocarbon ring attached C. four fused hydrocarbon rings d. three fused hydrocarbon rings

MEDIUM

34. Mycolic acid is a waxy material that gets its name “myco-“ from fungi and means fungus-like. It is particularly found in members of the Genus Mycobacterium. Because of the waterproof nature of mycolic acid, which staining technique must be used to identify these bacteria under the microscope? a. Gram stain B. Ziehl-Neelson Acid-fast stain c. Endospore stain d. capsule stain HARD 35. Steroids and their derivatives serve important functions in human physiology. Match the steroid with its function.

Steroid Function Cholesterol B a. essential for health of skeletal bones Cortisol D b. regulates cell membrane fluidity Vitamin D A c. development of secondary sex characteristics in males Testosterone C d. stress hormone that increase glucose levels in the blood 2.5 Nucleic Acids EASY 36. DNA may be described as a. a macromolecule made of monomers called nucleotides b. the hereditary material of cells that is passed one generation to the next c. a double helix composed of small packets of information called genes d. a master blueprint for the production of all proteins needed by the cell E. all of these are correct EASY 37. The major differences between DNA and RNA are A. DNA has a deoxyribose sugar while RNA has a ribose sugar b. The nucleotides used in DNA include adenine, uracil, guanine and cytosine, while those used in RNA include adenine, thymine, guanine and cytosine. c. DNA is never used in protein synthesis while RNA is used to make proteins on the ribosomes. d. DNA exists in a double helix while RNA exists either in a single strand or a double helix.

MEDIUM 38. Purines differ from pyrimidines in these characteristics: a. purines have a double ring structure while pyrimidines have a single ring structure b. in DNA the purines include cytosine and uracil c. in RNA the purines include cytosine and thymine d. in both DNA and RNA the purines are adenine and guanine E. both a and d are correct MEDIUM 39. The backbone of the DNA helix is composed of the alternating pentose sugars and phosphates that are bonded from one to the other. a. these are hydrogen bonds b. these are covalent bonds called dipeptide bonds c. these are ionic bonds D. these are covalent bonds called phosphodiester bonds HARD 40. The ladder-like structure of the DNA helix occurs because

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A. rails of the ladder are made of alternating pentose and phosphates b. rungs of the ladder are made of complementary base paired purines c. adenine pairs with thymine via double hydrogen bonds d. cytosine pairs with guanine via triple hydrogen bonds e. the 2 helices run in the same 3’ to 5’ direction

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MEDIUM 41. Adenosine triphosphate has these characteristics: a. adenine nucleotide bonded with two more phosphate groups b. because the adjacent phosphate groups carry negative charges, the molecules are unstable and their bond is easily broken c. the breaking of this bond releases 5 kcal/mol of energy that may be used for cellular “work” D. only a and b are correct EASY 42. DNA replication while protein synthesis . a. is semiconservative/occurs in 2 stages b. makes copies of the chromosomes containing one original strand and one new strand/copies DNA into RNA c. passes genetic information to the next generation of cells/creates new proteins using DNA as the blueprint D. all of these are correct EASY 43. Match the following terms with the correct description.

Term Description a. using template strand of DNA to make a complementary strand of messenger Gene D RNA Transcription A b. translation of mRNA into appropriate amino acids on a ribosome Translation B c. read in three-base sequences of mRNA and code for appropriate amino acid Genetic Code C d. specific sequence of DNA that provides the blueprint for making a protein MEDIUM 44. Which is the best definition of a gene? a. specific sequence of DNA that provides the blueprint for making a protein using RNA and a ribosome b. specific sequence of DNA that encodes the hereditary material passed from one generation to the next c. packet of genetic information that is needed as pattern in protein synthesis d. packet of genetic information that is part of a cell’s chromosome(s) E. all of these is correct HARD 45. What is the difference between the events in transcription versus translation?

A. in transcription DNA is rewritten as mRNA, while in translation the language of nucleotides encoded in mRNA is translated into the language of amino acids encoded in the newly built protein b. in transcription DNA is written as another strand of DNA, while in translation DNA is translated into mRNA c. in transcription DNA is rewritten as mRNA, while in translation mRNA is rewritten as tRNA d. in transcription DNA is written as tRNA, while in translation tRNA is rewritten as mRNA EASY 46. Transcribe this “gene” into mRNA: TAG GAT TAT CAC

A. AUC CUA AUA GUG b. ATC CTA ATA GTG EASY 47. Using semiconservative replication, write the complementary strand of DNA for this segment: TAT GCG GAG CAT A. ATA CGC CTC GTA b. AUA CGC CUC GUA CRITICAL THINKING 48. Why is ATP the ideal macromolecule to serve as the energy currency of the cell?

A. instability of adjacent negatively charged phosphate groups make bonds easy to break b. phosphate group is an ancient chemical found in fossils c. more energy can be stored between the 2nd and 3rd phosphate groups d. release of energy from broken bonds provides energy for cellular processes 49. From an evolutionary hypothesis, why is DNA the hereditary material instead of RNA? a. double helix is a more stable structure b. complementary base structure of 2 helices allows for repairing of one strand using the other as a pattern. c. RNA is single-stranded and cannot easily be repaired D. all of these are correct 50. Why are proteins said to control everything in the life of a cell? a. proteins may be either structural or functional in nature b. proteins may be enzymes that catalyze cellular reactions c. proteins may be hormones that influence cellular processes d. proteins may be integral or peripheral and participate in selectivity of the cell membrane E. all of these are correct

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CH. 3 – Microscopy 3.1 Principles of Microscopy EASY 1. In the history of microscopy, who is considered the “Father of Microbiology”? a. Hans Jansen b. Zacharias Jansen C. Antonie van Leeuwenhoek d. Ernst Ruska MEDIUM 2. Match the scientist with their contribution to the history of microscopy: Scientist Contribution Hans and Zacharias Jansen D a. developed electron microscope Ernst Ruska A b. developed scanning tunneling microscope Robert Hooke C c. First to use the term “cell” Gerd Binning and Heinrich Roher B d. invented first compound microscope EASY 3. What two features of a microscope are essential for a microbiologist?

A. magnification and resolution b. magnification and oil immersion c. resolution and oil immersion d. objectives and oculars MEDIUM 4. What is the definition of the term “magnification”? a. ratio of the size of the bacterium to the size of the object b. ratio of the size of the protozoan to the size of the objective C. ratio of the size of the image to the size of the object d. ratio of the size of the objective to the size of the microorganism HARD 5. Which of the following best defines the term “resolution”? a. the degree to which a microscope shows two images very far apart b. the degree to which a microscope shows two or more cells as being distinct c. the degree to which a microscope shows two or more cells as being close together D. the degree to which a microscope shows two very close objects as being separate and apart EASY 6. Match the part of the Compound Light Microscope with its purpose: Microscope Part Purpose Iris diaphragm D a. focuses light on specimen Condenser A b. separately magnify specimen Objective and Ocular B c. holds the specimen in place Stage C d. controls light intensity via adjustable opening

2 EASY 7. What is the correct order of microscope parts from the base to the ocular?

A. base, illuminator, condenser lens, iris diaphragm, stage, objective lens, ocular lens b. base, condenser lens, illuminator, iris diaphragm, objective lens, stage, ocular lens c. base, iris diaphragm, stage, illuminator, condenser lens, objective lens, ocular lens d. base, stage, condenser lens, illuminator, objective lens, stage, iris diaphragm, ocular lens MEDIUM 8. What two things determine magnification of a microscope? a. strength of objective X strength of ocular B. degree of lens curvature and physics of how light refracts in its movement through different media c. degree of lens curvature X strength of objective d. degree of lens curvature X strength of objective X strength of ocular HARD 9. What is the significance of the wavelength of light used for RP (resolving power)? a. since blue, indigo and violet light have the shortest wavelengths, they influence the resolution or RP b. since red, orange, and yellow have the longest wavelengths, they influence the resolution or RP C. the resolution or RP of a microscope is directly related to which wavelength of light is utilized d. the resolution or RP of a microscope is directly related to the number of wavelengths of light used MEDIUM 10. What is meant by the “refractive index” of the medium? a. resolution is affected by light that passes through a medium b. a light passes through a medium it is referred to as refractive index c. a direct proportion between refractive index and RP: greater the RI, then the better the RP and the amount of detail that can be seen.

D. all of these are correct EASY 11. What is the effect of using immersion oil plus oil immersion objective? a. RP is increased because immersion oil has same RI of glass b. Glass -> oil -> glass sandwich passes light directly into objective without losing light c. increases both magnification and RP of microscope d. magnification increases from 1000X to 4500X E. answers a, b, and c are correct

3.2 Microscopy Used for Clinical Diagnosis EASY 12. Match the type of microscope used in clinical settings with its principle description: Microscope Description Bright-field B a. fluorescent portions of specimen become visible Dark-field C b. simplest, most common type Fluorescence A c. bright image against dark background

3 MEDIUM: 13. What are the disadvantages of Bright-field microscopy? a. staining is required to make specimens visible b. limits for magnification and resolution up to 1000X c. images of very small specimens only show lots of detail, not overall organism D. a and b are correct e. a, b, and c are correct MEDIUM 14. What are the advantages of Dark-field microscopy? a. may be used for living microbes b. may be used for hard-to-stain microbes c. highlights only surfaces of microbes D. a and b are correct e. a, b, and c are correct HARD 15. Fluorescence microscopy depends on fluorescent dyes along with within the microorganisms on the slide.

A. monoclonal antibodies/fluorescent molecules b. autoclonal antibodies/fluorescent molecules c. fluorescent antibodies/monoclonal molecules d. monoclonal antibodies/auto clonal molecules

and is limited to

MEDIUM 16. Match the microscope used in clinical labs with the description of its light source.

Microscope Light Source Bright-field Microscopy C a. uses a hollow cone of light Dark-field microscopy A b. uses ultraviolet Fluorescence microscopy B c. light source provides a bright background EASY 17. What dyes are used most often with fluorescence microscopy? a. malachite green and carbol fuschin B. fluorescein and rhodamine c. Fluorescein and crystal violet d. crystal violet and safranin HARD 18. Which of the following statements is TRUE concerning Direct Fluorescent Antibody (DFA) Assay use in microscopy? a. monoclonal antibodies bind to dyes and are then bond to pathogens b. antibody-dye conjugates glow under UV light and show presence of pathogen c. fluorescein and rhodamine are dyes most commonly used a they glow green and red D. all of these are correct statements e. only a and b are correct statements

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3.3 Microscopy Used for Research Investigations EASY 19. Match the type of Research Microscopy with the its correct description: Type of Research Microscopy Description a. electrically charged nanoprobe scans surface of Confocal Microscopy B metal-coated specimen Phase Contrast Microscopy C b. 3-dimensional images generated by assembling scanned regions Transmission Electron Microscopy D c. unstained cellular structures enhanced using refractive indices Scanning Electron Microscopy A d. ultrathin specimen penetrated by electron beam passing through it to show very good magnification and detailed resolution EASY 20. The very complex microscopes used in research are classified according to a. how large and complex they are B. how they generate a magnified image c. type of stain required d. whether they make use of probes

.

MEDIUM 21. What is the incorrect match below? a. light microscope/visible light and glass lenses b. electron microscope/electron beam and electromagnets C. nanoprobe microscope/ very large probes d. confocal microscope/illuminate one focal plane at a time MEDIUM 22. Why was the confocal microscope developed?

A. to correct limitation of fluorescence microscopy in which entire specimen is illuminated b. to illuminate all focal planes of a specimen at one time c. to eliminate the necessity of using ultraviolet light d. to make all parts of the specimen glow at the same time HARD 23. Which of the following is a major characteristic of super-resolution microscopy? a. extends resolution of transmission electron microscopy b. increases resolution limit from less than 10 nm to more than 200 nm C. extends fluorescence microscopy to provide extraordinarily sharp resolutions d. makes use of only dead cells EASY 24. What are the major characteristics of phase contrast microscopy? a. the true structure of living specimens may be viewed without distortion of staining b. converts differences in refractive indices to differences in color via use of prisms c. special filters make waves of light passing through specimen out of phase with waves through background

d. only answers a and b are correct E. all answers are correct

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MEDIUM 25. Which of the following statements about Scanning Tunneling Microscopy is incorrect? a. utilizes electrically charged nanoprobe to scan surface of metal-coated specimen b. measures changes in voltage detected by nanoprobe c. voltage changes are converted to an image D. resolution is not good enough to see anything at the atomic level e. Gerd Binning and Heinrich Roher received Nobel Prize in Physics for development of this microscope HARD 26. Which of the following statements about Atomic Force Microscopy is true?

A. fine-tipped probe is dragged across surface of molecules like proteins b. movements of probe are amplified to produce an image c. heights of structures cannot be delineated by this means of microscopy D. only a and b are true e. only b and c are true MEDIUM 27. Differential Interference Contrast Microscopy (DIC) makes use of these features to enable microbiologists to view a living specimen. a. the image as viewed has pseudo 3-dimensional relief shading b. changes in light waves as they pass through the living specimen are out of phase with each other c. utilizes a bright-field microscope with special filters d. only a and c are correct answers E. all of these are correct answers EASY 28. What of the following is an incorrect statement about the major differences between electron and light microscopes? a. Electron microscopes use beams of electrons and electromagnetic lenses while light microscopes use visible light waves and glass lenses. b. Electron microscopes can show images at the level of the cellular organelles while light microscopes cannot do this.

C. Magnetic lenses bend electron beams in a different way than do glass lenses with a light beam. d. Electron microscopes produces images on a photographic plate while light microscopes produce images through the ocular lens.

EASY 29. What is a major disadvantage of using Transmission Electron Microscopy (TEM) in the lab? a. sample preparation is extensive and expensive b. specimens have to be stained with harsh chemicals that may distort cellular features c. some specimens have to go through cryofixation D. All of these are disadvantages

MEDIUM 30. What is the major difference between TEM and SEM?

a. TEM uses light waves and electrons while SEM uses only electron beams b. TEM uses electromagnetic condenser lens as well as electromagnetic objective lens while SEM uses 2 electromagnetic lenses c. TEM uses a projector lens while SEM uses a photomultiplier D. TEM projects a 2-dimensional cross section of a microbe while SEM projects a 3-dimensional image with surface details.

3.4 Specimen Preparation and Staining EASY 31. What may be observed in viewing a living specimen under the microscope? a. movement b. feeding behavior c. responses to stimuli D. all of these are correct EASY 32. What does the hanging drop method entail? a. liquid drop suspended from slide B. depression microscope slide c. drop hangs captured in dip in center of slide d. all of these are correct MEDIUM 33. What is the correct order of steps in smear preparation?

1. Apply suspension of cells on slide 2. spread over surface of slide 3. heat fix or chemical fix specimen on slide 4. air dry a. 1, 2, 3, 4

B. 1, 2, 4, 3

c. 1, 3, 2, 4

d. 3, 2, 1, 2

EASY 34. Simple Stains have this characteristic: a. one dye is used b. will show size, shape and arrangement of cells c. use a decolorizer D. a and b are correct e. all of these are correct MEDIUM 35. Positive Staining technique a. shows clear cells against a darkly stained background b. uses stains that are acidic and have a negative charge c. has a negative charge that is repelled by negative charge of carbohydrates and glycoproteins D. uses basic dyes like Methylene Blue and Crystal Violet MEDIUM 36. Among the characteristics of Positive Staining are a. cells are colored against a clear background b. positive charge of stain is attracted to negatively charges on DNA and surface proteins c. examples include nigrosin and India ink D. answers a and b are correct

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e. answers b and c are correct MEDIUM 37. Negative staining a. shows clear cells against darkly stained background b. uses stains that are acidic and have a negative charge c. works because the negative charge is repelled by negative charge of carbs and glycoproteins on bacterial surfaces d. answers a and b are correct E. answers a, b and c are correct EASY 38. Differential staining requires: a. preparation of a smear b. application of 2 or more different positive stains c. decolorizing chemical D. all of these are correct EASY 39. Which of the following are examples of differential staining? a. Gram stain b. Acid-fast stain c. Endospore stain d. Flagella staining E. answers a, b, and c are correct HARD 40. Complete the following Table on Differential Staining. Choose the correct answers from the choices below: a. ethanol b. acidified alcohol c. water d. acid Procedure Name Decolorizer Gram A Acid-Fast B Endospore C HARD 41. Complete the following Table on Differential Staining. Choose the correct answers from the choices below: a. Crystal violet b. Safranin c. Carbol fushin d. Malachite Green e. Methylene Blue Procedure Name Primary Stain Gram A Acid-Fast C Endospore D

HARD

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42. Complete the following Table on Differential Staining. Choose the correct answers from the choices below: a. Crystal violet b. Safranin c. Carbol fushin d. Malachite Green e. Methylene Blue Procedure Name Gram Acid-Fast Endospore

Counterstain B E B

MEDIUM 43. Capsule staining shows background.

capsules surrounding

cells against a

A. clear/colored/colored b. colored/clear/colored c. colored/colored/clear d. clear/colored/clear HARD 44. Flagella staining requires a. dye only in a single layer b. dye plus mordent in a single layer of dye c. mordent only in a single layer D. dye plus mordant in multiple layers EASY 45. Flagella staining discloses a. presence of flagella b. location of flagella c. number of flagella D. all of these are correct

to make the flagella more visible.

as a tool in bacterial identification.

MEDIUM 46. In an acid-fast staining of a sputum sample from a suspected case of Mycobacterium tuberculosis A. the mycolic acid makes cells difficult to colorize b. the stain on the slide is boiled for 15 minutes c. the primary stain looks bright blue d. the counterstain is bright red CRITICAL THINKING 47. Microbiology is the study of things too small to be seen with the naked eye. So microbiologists use the relative size of specimens viewed under the microscope as an identifying feature. Which of the following is an incorrect match between the microbe and its relative size range? a. viruses/10 nm – 100 nm b. bacteria/ 1 um – 10 um C. protozoans/ 10 mm – 100 mm

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48. Which one step in microscopy is the most critical in a clinical lab setting?

A. smear preparation b. care of microscope c. use of oil immersion objective d. choice of stains used

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CH. 4 – Prokaryote Organisms 4.1 The Prokaryote’s Place in the Living World EASY 1. How do bacteria help us as humans? a. normal microbiota protect us from infection b. aid digestion and produce vitamins c. degrade environmental contaminants d. increase soil fertility E. All of these EASY 2. Which of the following statements is not true?

A. A large % of microbes are pathogenic. b. Genetically altered bacteria make pesticides, biofuels and medications. c. Bacteria are used to store hack-proof data. d. Bacteria are used to manufacture cheese, yogurt, pickles and chocolate. e. All of these are true.

MEDIUM 3. Which statement is correct?

A. For every one pathogen, there are 30,000 beneficial bacteria. b. Less than 10% of prokaryotes may be grown in a laboratory environment. c. Bacteria out number Eukaryotes by a ratio of 10:1. d. More than 25% of living bacteria may be considered pathogens.

HARD 4. Why is it important to learn about both Prokaryote and Eukaryote pathogens? a. Prokaryotes have unique physical traits that allow administration of drugs that are target-specific. b. Because all Eukaryote cells show similar features, drugs to treat Eukaryote infections must be selectively toxic to the pathogen. c. Viruses are not host-specific and will attack both Prokaryotes and Eukaryotes equally.

D. Only a and b answers are correct. e. Answers a, b, and c are correct HARD 5. Prokaryotes are the dominant life form on our planet because A. Archaea and bacteria inhabit almost every environment on Earth. b. Total prokaryote biomass is 100,000 times greater than the biomass of all living humans. c. There are 10 thousand times more Archaea in oceans than there are stars in the visible universe. d. 10X more bacteria living in and on use than there are cells in our bodies.

MEDIUM 6. How do Prokaryotes sustain life as we know it on Earth? a. Photosynthetic Prokaryotes produce glucose and oxygen gas used by all other aerobic organisms. b. Only Prokaryotes can perform nitrogen fixation. c. NH4 generating bacteria live within roots of legumes and other plants. d. Prokaryotes live in symbiotic relationships in stomachs of grazing animals to give them nutrients for from plant material.

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E. All of these are correct.

EASY 7. What atoms are cycled between living and nonliving organisms? a. carbon b. oxygen c . phosphorus d. sulfur E. only a, b and d are correct EASY 8. Which of the following is NOT a feature of Prokaryotes Cells?

A. 80s ribosome b. no true membrane-bound organelles c. replication via binary fission d. structurally complex cell wall.

MEDIUM 9. Which of the following is the correct estimated number of species on earth? a. plants – 1,000,000 b. Fungi – 2,000,000 c. animals – 10,000,000 D. bacteria - 1,000,000,000 EASY 10. Match the Prokaryote feature with its function.

Prokaryote Feature Nucleoid C Peptidoglycan D Binary Fission A 70s Ribosome B

Function a. simple cell division b. responsible for protein synthesis c. one circular chromosome d. helps form structurally complex cell wall

HARD 11. Which of the following represents a mutualistic symbiotic relationship?

A. Rhizobium and bean roots b. Enterococcus in colon c. Agrobacterium tumefaciens and plant cells d. Zika virus and mosquitos MEDIUM 12. What is the correct definition of commensalism? a. type of symbiosis in which neither organism benefits nor is harmed B. type of symbiosis in which one organism benefits but the other is unaffected c. type of symbiosis in which both organisms benefit d. type of symbiosis in which one organism benefits and the other is harmed

4.2 Bacterial Shapes and Arrangements HARD 13. Match the species-specific modification to the description.

Species-specific Modification Description Angular Cocci B a. curved rods Elongated Bacilli D b. diamond shaped circles

Vibrios A Screw-like Spirals C

c. flexible spirochetes d. slender rods with angular ends

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MEDIUM 14. Which of the following is a bacterial form that looks similar to a fungus? a. bacilli with clubs b. bacilli and tapered ends C. filamentous in chains d. bump-like projections EASY 15. What part of the bacterium maintains the shape or form of the cell? a. capsule b. slime layer C. cell wall d. cytoplasmic membrane EASY 16. Bacteria that demonstrate have slight variations of shapes within the same species and may appear on a slide with these different shapes. a. neomorphism B. pleiomorphism c. polymorphism d. micromorphism EASY 17. What are the most common species-specific arrangements of bacterial cells as seen under a microscope? a. pairs b. chains c. clusters d. single cells E. all of these are correct MEDIUM 18. How are species-specific arrangements of bacterial cells produced?

A. daughter cells dividing in different planes and remaining attached to each other b. daughter cells dividing in the same plane and remaining attached to each other c. daughter cells dividing in the same plane but separating d. daughter cells dividing in the same plane but only partially separating MEDIUM 19. In a clinical microbiology lab, what is the first step in identification of a pathogen from a patient sample? a. Simple Stain to determine cell size, shape and arrangement b. Negative stain to determine presence of capsule C. Gram stain for morphological analysis of cell wall plus size, shape and arrangement d. Flagellar stain to determine presence of flagella EASY 20. Match the basic bacterial shape with its meaning.

Basic Bacterial Shape Bacillus D Vibrio C Spirillum B Coccus E Spirochete A EASY 21. Match the grouping term with its meaning.

Grouping Diplo- B Strepto- E Staphylo- D Tetrad A Sarcinae C

Meaning

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a. coiled hair b. coil c. wave d. staff e. kernel

Meaning a. group of four b. double c. bundle d. cluster e. twisted chain

4.3 The Bacterial Cell Wall EASY 22. In terms of the life of a bacterium, what is the purpose of the cell wall? a. determines cell shape b. prevents cell lysis in hypotonic environments c. prevents cell shrinking in hypertonic environments d. a, b, and c are all correct E. only a and b are correct HARD 23. On the molecule level, peptidoglycan contains a. disaccharides linked to peptide chains b. peptidoglycan monomers joined to form glycan chains c. formation of 3-dimensional network via tetrapeptide side chains with or without pentaglycine bridges D. all are correct MEDIUM 24. How do molecules pass through peptidoglycan to get into the cell?

A. simple diffusion through pores in peptidoglycan that formed as a result of incomplete crosslinking b. active transport through protein pores c. facilitated diffusion through protein pores d. endocytosis across the peptidoglycan barrier EASY 25. Knowledge of the chemical structure of peptidoglycan is used to manufacture antibiotics to destroy bacterial cell walls. Likewise chemicals produced by the human body will do the same thing. An example of a specific antibiotic or natural chemical that will do this is . a. Vancomycin b. Penicillin c. Lysozyme D. All of these EASY 26. What are the main characteristic of a Gram-positive cell wall?

a. 6 to 12 layers of glycan sheets to produce a thick wall b. chains of teichoic acids c. outer membrane of lipopolysaccharides D. only a and b are correct e. All are correct HARD 27. How do chains of teichoic acids benefit the Gram-positive cell? a. regulation of cation flow b. attachment to host tissues in some pathogens like Streptococci c. provide protection from negatively charged phagocytic cells d. regulation of cell growth and division E. all are correct MEDIUM 28. How does peptidoglycan in Gram-negative cells differ from that in Gram-positive cells? a. only 1 to 3 layers of glycan sheets are used b. no teichoic acids are present c. no direct crosslinkage between tetrapeptide side chains D. only a and b are correct e. all are correct MEDIUM 29. A unique feature of the Gram-negative cell wall is the presence of an outer membrane. Which statement is true concerning this feature? a. derived from cell membrane B. contains Lipid A, a pathogenic endotoxin c. membrane consists of two layers of phospholipids d. membrane consists of two layers of lipopolysaccharides EASY 30. With two membranes and an inner peptidoglycan layer, how does a Gram-negative cell move molecules into the cell? a. active transport B. facilitated diffusion through porin proteins c. use of small microvesicles containing autolysin d. all of these are correct EASY 31. Atypical cell walls a. are found in acid-fast bacteria b. often include mycolic acids c. contain lipid layers d. require porins for transportation of hydrophilic molecules E. all of these are correct

EASY 32. Ureaplasmas and Mycoplasmas

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a. have no cell wall b. are intracellular pathogens c. can only live in hypertonic environments D. a and b are correct e. all are correct

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4.4 External Structure of Bacterial Cells EASY 33. Proper dental hygiene requires both brushing and flossing to remove plaque and prevent dental disease.

Why is the glycocalyx of many oral bacteria responsible for these problems? a. capsule of Streptococcus mutans allows it to attach to tooth surface b. attachment of bacteria formal oral biofilms known as plaque c. fermentation of sucrose by bacterial cells produces acid that causes tooth decay or cavities D. all of these are correct MEDIUM 34. How does the pilus differ from fimbriae? a. more numerous with 100-400 per cell function in attachment to cells c. found in both Gram-positive and Gram-negative bacteria D. found in most Gram-negative but only found in a few species of Gram-positive EASY 35. Match the flagellar arrangement with its correct description.

Flagellar Arrangement Description Monotrichous D a. flagella arranged all over the cell’s exterior Amphitrichous C b. tuft of flagella found at one end of cell c. either a single flagellum or tuft of flagella found at Lophotrichous B both ends of the cell Peritrichous A d. one flagellum found at one end of cell HARD 36. E. coli is the most common bacterium found in the human gut. It is characterized by this arrangement of flagella: a. monotrichous b. amphitrichous c. lophotrichous D. peritrichous EASY 37. Bacterial flagella work like a small outboard engine on a small boat to move the bacterium. This movement includes a. chemotaxis b. phototaxis c. runs and tumbles d. clockwise and counter-clockwise movement E. all of these HARD 38. Which of the following statements is not correct?

a. The bacterial flagellum is made of a filament, hook and basal body. b. Internal flagella called axial filaments enable spirochetes to move through thick mucous.

C. Bacteria with flagella are less pathogenic because they cannot invade host tissues. d. Flagella must be coated with special stains to increase their diameter if they are to be seen with a light microscope.

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4.6 Internal Structures of Bacterial Cells EASY 39. Cytoplasm is an often-overlooked feature of internal portion of bacterial cell. Its unique features include: a. Viscous gel-like solution that slows rate of diffusion within cells b. Mixture of soluble ions, metabolites and macromolecules c. Filamentous proteins that make up cytoskeleton d. Water that holds water-soluble chemicals E. All of these are correct EASY 40. Internal structures of bacteria do not include a. plasma membrane b. nucleoid c. ribosomes D. mitochondria e. cytoskeleton EASY 41. Transport mechanisms across bacterial plasma membranes do not include a. simple diffusion b. facilitated diffusion c. active transport D. endocytosis MEDIUM 42. Unlike Eukaryote plasma membranes, bacterial ones contain these special proteins: A. Enzymes and enzyme-complexes responsible for cellular respiration b. Transport proteins c. Integral proteins d. Peripheral proteins EASY 43. Which of the following statements about the bacterial chromosome is incorrect? a. It has between 0.5-10 million base pairs.

B. It is contained in the nucleus. c. Transcription only occurs on the outer surface of the coiled chromosome. d. 800 genes are needed to produce essential cellular enzymes and structural components.

EASY 44. As the site of protein synthesis, bacterial ribosomes are a. smallest functional structures

b. have about 50 different r-proteins in their 2 subunits c. have 5 rRNAs to help in translation d. all are correct E. only a and b are correct MEDIUM 45. During periods of rapid growth, bacteria like E. coli have all of the following except a. 200,000 ribosomes per cell b. utilize 90% of cellular ATP in protein synthesis C. have 4 tRNAs to help assemble amino acids into proteins d. assemble r-proteins on rRNA scaffolding EASY 46. Match the bacterial inclusion bodies with their special functions.

Inclusion Body Function Glycogen C a. allows aquatic cyanobacteria to stay afloat Gas Vesicle A b. provides phosphorus for synthesis of ATP Thylakoid D c. carbohydrate source for synthesis of ATP Polyphosphate granules B d. converts CO2 into glucose MEDIUM 47. What is not a major characteristic of a plasmid? a. carry from 1-100s of genes not necessary for daily life.

B. only 1 or 2 found in a single bacterial cell c. provide a selective advantage in unusual environments d. replicate independently of chromosomes EASY 48. Inclusion bodies a. are large cellular structures b. are membrane-bound organelles C. act as molecule stockpiles d. contain only inorganic chemicals MEDIUM 49. Endospores produced by the genera Bacillus and Clostridium are of clinical concern because they have all of the following features except a. responsible for infections such as anthrax, food poisoning, gas gangrene, botulism and tetanus b. have thick protein walls resistant to disinfectants and antibiotics c. are highly resistant to harsh environmental conditions.

D. are more easily removed with alcohol-based gels than regular soap and water because of their keratin outer coat

HARD 50. The correct order of steps in the process of sporulation are: 1. nucleoid replication 2. formation of forespore

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3. peptidoglycan laid down between membrane layers of spore septum 4. thick protective protein coat forms exterior to peptidoglycan 5. host cell undergoes lysis to release endospore 6. free endospore created a. 1, 3, 2, 4. 5, 6

b. 2, 1, 4, 3, 5, 6

c. 1, 4, 2, 3, 6, 5

D. 1, 2, 3, 4, 5, 6

EASY 51. Which of the following is not true of endospore formation? a. begins when environmental conditions deteriorate b. takes only 6 to 8 hours C. does not result in destruction of the original cell d. is a survival process EASY 52. Endospores are all of the following except a. heat and chemical resistant b. survive after being frozen for 10,000 years c. survive after fossilization in amber for 25 million years D. easily killed by boiling

4.6 Prokaryote Evolution and Classification MEDIUM 53. According to the hypothesis of the evolution of life on earth, the common ancestor cell must have had all of these characteristics except: a. selectively permeable plasma membrane B. only DNA for genetic information c. ATP for energy source d. basic metabolic pathways EASY 54. We classify living organisms by using which feature in order to put them into similar groups: a. structure b. biochemical makeup c. sequence of DNA d. sequence in gene that codes for 16S rRNA of small ribosomal unit E. all of these are correct HARD 55. The Three Domain System as proposed by Carl Woese and his colleagues suggests that there are two groups of Prokaryotes – the Bacteria and the Archaea. What about the Eukarya?

A. They diverged from Archaea b. They diverged from Bacteria c. They diverged from a now extinct line of cells d. They evolved form bacteria that ate other bacteria.

MEDIUM 56. A phylogenetic tree shows a. branching diagram b. relationships between organisms based on DNA sequence analysis

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c. proposed relatedness to a common ancestor d. only a and c are correct E. a, b, and c are correct EASY 57. In combining a more traditional classification system based on phylum, class, order, family, genus and species with the Three Domain Tree of Life, the most Inclusive grouping is the A. domain b. phylum c. genus d. species e. kingdom EASY 58. The A. species b. genus c. family d. kingdom e. domain

is the fundamental unit of classification in biology.

HARD 59. The biological definition of a species is A. a group of actually or potentially interbreeding populations. b. a group of genetically similar individuals adapted for life in similar environments c. a group of genetically similar individuals who actually interbreed. d. a group of genetically similar individual who actually interbreed and are adapted to similar environments.

HARD 60. In Prokaryotes the current classification system defines a species as . a. members who show 80% or greater DNA relatedness and less than 10% variation in the use of Guanine and Cytosine nitrogenous base pairings in their DNA b. members who show 90% or greater DNA relatedness and less than 2% variation in the use of Adenine and Thymine nitrogenous base pairings in their DNA C. members who show 70% or greater DNA relatedness and less than 5% variation in the use of Guanine and Cytosine nitrogenous base pairings in their DNA d. members who show 60% or greater DNA relatedness and less than 5% variation in the use of Adenine and Thymine nitrogenous base pairings in their DNA MEDIUM 61. Approximately a. 1 million/10 million

species of Prokaryotes have been identified but b. 500,000/1 million C. 10,000/10 million

MEDIUM 62. Large bacterial species are often subdivided into a. subspecies b. strains C. subspecies further subdivided into strains

are estimated to exist. d. 10,000/1 million

d. strains further subdivided into subspecies HARD 63. A serotype a. is a strain of bacteria identified by response of specific antibodies to molecules called antigenic determinants on the surfaces of bacteria b. is a strain of bacteria identified by response to differential staining techniques c. uses blood serum to identify a strain of bacteria identified by response of specific serum antibodies to molecules called antigenic determinants on the surfaces of bacteria d. is important to identify because they are often pathogens E. both c and d are correct MEDIUM 64. Clinical classification of bacteria uses these features to establish a “dichotomous key” for rapid identification of a pathogenic bacterium: a. cell shape and arrangement b. cell wall construction c. metabolic biochemical properties D. a, b, and c are correct e. only b and c are correct CRITICAL THINKING 65. Why is rapid identification of a pathogenic bacterium isolated from a patient important? a. bacteria do not live very long in the lab b. rapid identification of the pathogen will speed up the patient’s diagnosis c. accurate diagnosis is important to proper treatment d. a, b, and c are correct E. b and c and correct

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CH. 5 – Eukaryotic Organisms 5.1 The Eukaryotic Cell EASY 1. How long ago did Eukaryotic cells evolve? a. 1 billion years ago B. 1.7 billion years ago

c. 2 billion years ago

d. 2.4 billion years ago

MEDIUM 2. Why is it critical in Microbiology to understand Eukaryotic microorganisms? a. because phytoplankton are the foundation of every aquatic food web b. because photosynthetic Eukaryotes produce oxygen gas as a by-product thereby providing it for aerobic organisms c. because all Eukaryotic microbes are pathogens to humans, other animals and plants D. only answers a and b are correct e. all are correct EASY 3. Which of the following descriptions of Eukaryotes is not true? a. They are 10-100X larger than Prokaryotes. b. They possess numerous membrane-bound organelles. c. They have a membrane-bound nucleus.

D. Their typical size is 100 to 1000 micrometers.

MEDIUM 4. Why can small cells carry out diffusion better than larger cells? a. smaller surface area relative to internal volume B. greater surface area relative to internal volume c. surface area is relatively equal to internal volume d. surface area is 4X as great as internal volume HARD 5. What added feature of a cell can substantially increase a cell’s surface area available for diffusion without changing the internal volume very much? a. increase in number of internal membrane-bound organelles b. decrease in number of internal membrane-bound organelles C. creation of long thin projections of cell membrane d. addition of flagella or cilia to outside of microorganism EASY 6. Match the Eukaryotic organelle with its function: Organelle SER C a. production of rRNA Mitochondrion E b. protein synthesis 80s ribosomes B c. lipid biosynthesis Nucleolus A d. photosynthesis Chloroplast D e. aerobic respiration

Function

2 MEDIUM 7. You will find this membrane-bound organelle present in plant cells only: A. central vacuole b. mitochondrion c. SER d. Golgi apparatus HARD 8. What is the correct order of creation of secretory proteins?

1. nucleolus -> rRNA 2. rRNA and proteins -> ribosomes 3. vesicles modified -> Golgi apparatus 4. membrane-bound ribosomes on ER -> protein vesicles 5. vesicles released from maturing face of Golgi -> fusion with cell membrane A. 1, 2, 4, 3, 5

b. 1, 4, 2, 3, 5

c. 1, 3, 4, 2, 5

d. 2, 1, 3, 4, 5

MEDIUM 9. What is the purpose of the Golgi apparatus? a. addition of sugar units to crude proteins b. proteins refined by series of enzymes in different Golgi cisterna c. modification and export of newly built proteins d. regulation of protein synthesis E. all of these with the exception of answer D are correct EASY 10. Which of these represent a type of endocytosis? a. phagocytosis b. pinocytosis c. amoebacytosis d. only a and c are correct E. only a and b are correct EASY 11. All of these are accurate descriptions of the lysosome and its function except a. are produced by the Golgi apparatus b. are loaded with acid hydrolases C. produce acid hydrolases that only work outside the lysosome d. are responsible for degradation of bacterial pathogens e. fuse with phagosomes to form secondary lysosomes MEDIUM 12. Which of the following is not a correct match? a. lysosome/produce acid hydrolase B. peroxisome/produce hydrogen peroxide c. peroxisome/produce catalase d. lysosome/internal pH of 5

EASY 12. Match the Eukaryote organism with its type of vacuole: Organism Vacuole and Function Animals and Protozoans B a. Central vacuole for storage of pigments and small molecules Protozoans C b. Food vacuole for nutrient acquisition c. Contractile vacuole for elimination of excess water to prevent cell Plants A explosion MEDIUM 12. The endomembrane system is characterized by all of these except a. composed of membranous organelles that are connected in some way b. composed of membranous organelles who participate in enzymatic modification of molecules c. composed of membranous organelles who participate in transport of materials in and out of cells D. represent only a structural component of Eukaryote cells e. represent a structural and functional component of Eukaryote cells HARD 13. All of these statements about the commonalities between mitochondria and chloroplasts are true except a. They are enclosed by double membranes. b. They have 70S ribosomes of their own and a nucleoid. c. They can divide via binary fission.

D. They are found in all Eukaryote cells.

EASY 14. These descriptions are indicative of this type of fibrous protein found in the cytoskeleton: two intertwined protein strands/involved with muscle contraction/help maintain cell shape A. Microfilaments b. Intermediate filaments c. Microtubules d. Centrioles MEDIUM 15. Match the fibrous protein structure with the correct description: Protein structure Description Microfilament D a. locomotion , directed vesicle transport Intermediate filament B b. anchor cellular structures in fixed positions Microtubule A c. participate in cell division Centriole C d. cytoplasmic streaming EASY 16. What is the major difference between an animal cell and a plant cell when viewed from the exterior? a. presence of external structures b. presence of pili c. presence of double membrane D. presence of cell wall because only plant cells have these

MEDIUM

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17. Match the external structure with its function: External Structure Cell wall of plants, protozoans, and algae D ECM of Animal cells A Flagellum and cilium of animals, plants, protozoans and algaes E Middle lamella of plants B Pseudopodia of protozoans B

4 Function a. cellular signaling b. cellular adhesion c. communication and transport d. support and protection e. locomotion and feeding

5.2 The Origins of Eukaryotic Organelles and Organisms EASY 18. Which of the following is not part of the autogenous hypothesis ? a. began with invagination of plasma membrane and creation of the nucleus b. movement of invaginated plasma membrane continued with creation of the endoplasmic reticulum c. internalized membranes also created Golgi apparatus, lysosomes and peroxisomes D. mitochondria resulted from invagination of plasma membrane surrounding key proteins e. name indicates that it was largely a “do-it-yourself process EASY 19. The endosymbiotic hypothesis a. explains the evolution of mitochondria and chloroplasts b. demonstrates one solution for obtaining limited resources c. illustrates the results of the first germ warfare in which prokaryotes devoured other prokaryotes d. Only answers a and b are correct E. All answers are correct MEDIUM 20. Mitochondria share all of these Prokaryotic features with bacteria except a. similar in size to a bacillus b. contain a nucleoid and a 80S ribosome C. undergo mitosis d. have cytochromes of electron transport chain imbedded in plasma membrane HARD 21. Study of the 18S rRNA gene sequences in Eukaryotes has suggested that a. multicellular Eukaryotes are monophyletic b. members of each of the major groups – animals, plants and fungi – all descended from a single ancestor.

C. both answers a and b are correct d. only answer a is correct e. only answer b is correct

MEDIUM

22. Further analysis of rRNA has shown that a. the first single celled Eukaryotes named Protozoa all evolved from a common ancestor b. all of the photosynthetic Eukaryote microorganisms diverged from a single common ancestor c. photosynthetic Eukaryotes like Algae evolved before the Protozoa D. most single-celled Eukaryotes evolved from many different ancestral forms HARD 23. The concept of a conserved gene means that a. it has a base sequence that is almost the same between different species b. it is probably the blueprint for a critical protein that is essential for survival c. mutation is almost always beneficial D. answers a and b are correct e. all answers are correct

5.3 The Algae MEDIUM 24. Which of the following descriptions is true of algae? a. They are the major photosynthetic organisms on Planet Earth. b. Because of their extreme abundance, algae are a major source of glucose, which is the foundation of the food web of the oceans. c. The oxygen gas produced and exported by these photosynthetic microbes makes life possible for all organisms using aerobic respiration. d. Only answers b and c are correct E. All of these are correct EASY 25. Algae are an extremely diverse group because a. they may live singly or in colonies b. they may measure size in micrometers or over 100 meters in length c. they inhabit a wide variety of habitats including saltwater, freshwater, and polar ice caps d. they have a variety of cell walls E. all of these are correct.

HARD 26. Match the Algal Group name with a distinguishing feature.

Algal Group Feature Brown Algae D a. Land plant ancestors Dinoflagellates E b. glass walls used as filtration material Diatoms B c. source of agar Red Algae d. largest photosynthetic organisms, form kelp Green Algae A e. phytoplankton EASY 27. What is a major feature of agar as used for making plates in the microbiology lab? a. source is the cell walls of red algae b. cannot be digested by microbes c. maintains solid state up to boiling point d. helps in identification of pathogenic bacteria

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E. all of these are correct

6

MEDIUM 28. In studying pathogenic algae that cause intoxications or infections, which of the following is an incorrect match? a. dinoflagellates/red tides b. fish food poisoning/ciguatoxin c. amnesic shellfish poisoning/domoic acid D. human protothecosis/brown algae

5.4 The Protozoans MEDIUM 29. Which of the following statements about Protozoans is not true? a. They are unicellular Eukaryote that demonstrate animal-like characteristics in both food consumption and motility.

B. Their complex relationships with hosts is always parasitism. c. They have cellular features like flagella, cilia and pseudopodia that help attain food and aid movement. d. They may have complex life cycles alternating between cyst and trophozoite stages.

EASY 30. Reproduction in Protozoans a. often involves trophozoite and cyst stages b. transfer from one host to another usually occurs in the cyst stage c. cysts are sometimes utilized as survival mechanisms when environmental conditions go downhill d. trophozoites are usually motile while cysts are not E. all of these are correct EASY 31. Because of their extensive diversity among the more than 20,000 species of Protozoans, major groups are often classified according to a. reproduction b. trophozoite versus cyst stages C. locomotion or movement d. relationship with other organisms as in parasitism or mutualism e. salt or fresh water habitats MEDIUM 32. Match the Protozoan category with its description.

Protozoan Description Apicomplexans C a. Parasitic species live in mouth or intestines of animals Amoebas A b. Use short hair-like projections to move nutrients towards oral groove Ciliates B c. Human pathogens, no independent movement Flagellates D d. Three subcategories contain significant human pathogens

HARD

33. Which matching of Protozoan species and infection caused is incorrect? a. Trypanosoma cruzi/Chagas disease b. Plasmodium spp./Malaria c. Trichomonas vaginalis/protozoal vaginitis D. Giardia lamblia/short-term diarrhea e. Naegleria fowleri/ primary amoebic meingoencephalitis

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5.5 The Fungi EASY 34. General characteristics of Fungi include all of the following except: a. They are known as saprobes because they acquire nutrients from surrounding environment by secreting hydrolytic enzymes. b. They are major decomposers in the environment contributing to the ecosystem.

C. Most species are facultative anaerobes. d. They are tolerant of low pH, moisture levels and temperature.

EASY 35. Special features of Fungi include a. cell wall composed of chitin, a complex polysaccharide that contains a molecule also found in bacterial cell walls. b. plasma membrane that contains ergosterol, a steroid type of lipid c. ability to survive in terrestrial and aquatic habitats d. may be pathogens of both animals and plants E. all of these are correct HARD 36. What features of Sabouraud Dextrose Agar make it the medium of choice in trying to culture a fungal pathogen in the microbiology lab? a. low pH of 5.6 that will inhibit many bacteria b. contains dextrose and peptones for fungal nutrients that are not easily used by bacteria c. includes an antibiotic to discourage growth of Gram-positive bacteria. d. all of these are correct.

E. only answers a and b are correct MEDIUM 37. Descriptions of the morphology of the Fungi include all but a. There are 3 primary body plans: unicellular, hyphae and mycelium B. Hyphae are made of cells that growth in clusters. c. The mycelium is a tangle of hyphae that produces mushroom and bracket fungi. d. Yeasts are unicellular and may reproduce asexually via budding.

HARD

38. Match the fungal group with the description: Fungal Group Chytridiomycetes D Zygomycetes A Ascomycetes B Basidiomycetes C

8 Description a. food spoilers and decomposers b. yeasts with asexual budding c. puffballs and mushrooms d. oldest members of Kingdom Fungi

MEDIUM 39. Which of these fungal groups is responsible for the formation of mycorrhizae, a mutually symbiotic relationship with almost 80% of seed plants?

A. Glomeromyetes b. Chytridiomycetes c. Zygomycetes d. Basidiomycetes e. Ascomycetes HARD 40. In the evolution of terrestrial ecosystems, the breakdown of rock into soil is an important step that often depends on the appearance of lichens. Which of these statements about lichens is incorrect? a. represents a fungal symbiosis b. is composed of a mutualistic relationship between a fungus and a blue-green or green alga c. algae are protected from drying out while fungus receives a steady supply of nutrients D. acids from the alga break down the rock into soil with minerals such as phosphorus e. all of these statements are correct EASY 41. Many fungi are pathogens that a. infect both plants and animals including humans b. are difficult to treat because they are Eukaryotes c. require medications that target fungal features that differ from other Eukaryotes D. a, b, and c are correct e. only b and c are correct MEDIUM 42. Which of the following statements concerning fungal infections is not true? a. The respiratory system is at greatest risk because of inhalation of airborne fungal spores.

B. The skin is at least risk because it cannot be breached easily. c. Most fungal infections are opportunistic. d. Patients who are immunocompromised are at greatest risk for fungal infections.

HARD 43. Match the human body system and the appropriate fungal infection: Human Body System Fungal Infection Respiratory System D a. Tinea Skin A b. Yeast infection Nervous System E c. Ergotism Gastrointestinal System C d. Histoplasmosis Genitourinary System B e. Cryptococcosis

5.6 The Helminths

9 EASY 44. The major characteristics of Helminths include all of the following except a. bilateral symmetry on an elongated body over 1 mm in length b. lack of backbone C. over 125,000 currently existing species d. simple as well as specialized organ systems e. prevalent in most ecological habitats EASY 45. The Platyhelminthes have a very thin ribbon-like body. Which of these features is correct? a. human endoparasites may be subdivided into the tapeworms and flukes b. require no circulatory system because diffusion carries nutrients and oxygen across thin flat body c. have receptors for attachment to host tissues d. all are correct E. all are correct except answer c MEDIUM 46. The Cestodes or Tapeworms have a complex life cycle in which are released and pass out of human host in feces. Intermediate hosts like farm animals become infected via contaminated food and/or water. Humans become hosts again by consuming .

A. proglottids/larvae in undercooked meat b. fertilized eggs/mature worms in undercooked meat c. larvae/mature worms in undercooked meat d. proglottids/mature worms in undercooked meat HARD 47. Trematodes like the liver fluke Schistosoma spp. have an even more complex live cycle involving passage through these human organ systems in what order?

1. skin 2. urinary tract 3. lungs 4. intestinal tract 5. liver 6. circulatory system a. 1, 2, 3, 4, 5, 6

b. 1, 3, 2, 4, 5, 6

C. 1, 3, 5, 6, 2, 4

d. 1, 4, 3, 5, 6, 2

MEDIUM 48. Leeches come from the group of helminthes called Annelids. Unlike tapeworms and flukes they are ectoparasites because they suck blood from an incision they have made in their host’s skin. In modern medicine leeches are sometimes use purposely on patients because a. leech secretion of oxcytocin increases oxygenated blood flow to wound or surgical site b. leech secretion of hirudin increases oxygenated blood flow to wound or surgical site c. leech secretion of oxcytocin decreases blood flow to wound thus reducing swelling and pain d. leech secretion of hirudin decreases blood flow to wound thus reducing swelling and pain E. both answers b and d are correct

EASY

49. Match the species name of the pathogenic helminth with the infection it causes.

Pathogenic helminth Infection caused Enterobius vermicularis D a. tapeworms Taenia spp. A b. Elephantiasis Fasciola hepatica C c. liver fluke Wuchereria bancrofti B d. pinworms

5.7 The Arthropods EASY 50. Which of the key features of members of the Phylum Arthropoda listed below is incorrect? a. most evolutionarily successful group of animals B. have an endoskeleton made of chitin and protein c. have been in existence for 535 million years d. have a body plan that includes jointed appendages for multiple daily tasks EASY 51. Arthropods that possess chelicerae a. have fangs or pincers b. lack antennae c. have 4 pairs of walking legs d. include mites and ticks that parasitize humans and other organisms E. all are correct MEDIUM 52. While most arthropods serve only as vectors of infectious diseases, a few serve as pathogens themselves including those that cause all of these diseases except a. head lice b. scabies c. body and pubic lice D. toe and fingernail lice EASY 53. Insects belong to the subgroup Hexapoda, meaning 3 pairs of jointed appendages, and serve as a. vectors b. endoparasites c. ectoparasites D. all of correct HARD 54. Flies serve as vectors for all of these infections except a. Leishmaniasis b. Trypanosomiasis C. Chagas disease d. Loiasis e. Tularemia MEDIUM

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55. Mosquitos are significant vectors of human disease causing these infections. Which of the following is of special concern for pregnant women living in tropical areas of the Western Hemisphere? a. Dengue fever B. Zika virus disease c. Eastern Equine Encephalitis d. West Nile fever EASY 56. Match the arthropod vector with the infection: Vector Flea B Mosquito D Tick A Kissing bug C

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Infection a. Lyme disease b. Plague c. Chagas disease d. Yellow fever

MEDIUM 57. Mechanical transmission is A. physical transmission of a pathogen from a source to another object b. biological transmission of a pathogen form one host to another through a bite c. contact transmission of a pathogen by touching the vector d. indirect transmission of a pathogen by touching the object contaminated by the vector HARD 58. Which of the following infections is now associated with bee stings or spider bites?

A. arthropod-vectored bacteria like MRSA b. arthropod-vectored viruses like Zika c. arthropod-vectored fungi like Rhizopus d. arthropod-vectored protozoa like Plasmodium

Critical Thinking 59. In reviewing the topics covered in this chapter on Eukaryotes, what do you think are the most significant points in terms of human health? a. inherent problem in treating diseases caused by pathogens who like us are Eukaryotes b. evolutionary success of Eukaryote vectors like insects and helminths that carry and spread diseases to humans c. complexity of Eukaryotes when compared to Prokaryotes d. wide diversity of potential pathogens E. answers a and b have the most significance to human health 60. Considering all that you have learned in this chapter, which hypothesis on the evolution of Eukaryotes do you think has the most evidence in its favor? a. Endosymbiont Hypothesis b. Autogenous Hypothesis c. both have their pros and cons d. neither presents a complete explanation (answer choice is for the student or instructor to make)

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CHAPTER 6 TEST BANK QUESTIONS

LEARNING OBJECTIVE: 6.1.1 Describe the basic molecular composition and shapes of viruses.

QUESTION: Viruses are not generally referred to as living things, because they a. grow too slow. b. lack nucleic acids. c. lack standard cell structure. d. grow too fast.

Correct answers: c Difficulty: Easy LEARNING OBJECTIVE: 6.1.1 Describe the basic molecular composition and shapes of viruses.

QUESTION: The core of virus particle can contain all of the follow nucleic acids EXCEPT a. single stranded RNA. b. DNA and RNA. c. single stranded DNA. d. double Stranded DNA. Correct answers: b Difficulty: Meduim LEARNING OBJECTIVE: 6.1.1 Describe the basic molecular composition and shapes of viruses.

QUESTION: The core of a virus particle contains a(n) a. envelope. b. capsid. c. bacteriophage. d. nucleic acid.

Correct answers: d Difficulty: Easy

LEARNING OBJECTIVE: 6.1.1 Describe the basic molecular composition and shapes of viruses.

QUESTION: A virus that only has a nucleocapsid is referred to as what type of virus? a. virion b. naked c. capsomere d. combination Correct answers: b Difficulty: Easy LEARNING OBJECTIVE: 6.1.1 Describe the basic molecular composition and shapes of viruses.

QUESTION: The viral capsid is made primarily of a. protein. b. carbohydrate. c. triglyceride. d. nucleic acid.

Correct answers: a Difficulty: Easy LEARNING OBJECTIVE: 6.1.1 Describe the basic molecular composition and shapes of viruses.

QUESTION: Which of the following viral shapes would contain the most capsomeres? a. complex b. helical c. polyhedral d. peplomers Correct answers: c Difficulty: Medium LEARNING OBJECTIVE: 6.1.2 Identify the main characteristics used to classify viruses.

QUESTION: The system of viral taxonomy classifies viruses primarily on the virus a. RNA or DNA. b. proteins. c. triglycerides. d. shape.

Correct answers: a Difficulty: Easy

LEARNING OBJECTIVE: 6.1.2 Identify the main characteristics used to classify viruses.

QUESTION: Which of the following are considered acceptable standards used to classify viruses? Select all that apply. a. genetic similarities b. structure c. which type of host they infect d. chemical composition Correct answers: a,b,d Difficulty: Hard LEARNING OBJECTIVE: 6.1.2 Identify the main characteristics used to classify viruses.

QUESTION: The term Adenoviridae indicates a reference to a virus a. species. b. strain. c. genus. d. family.

Correct answers: d Difficulty: Medium

LEARNING OBJECTIVE: 6.2.1 Describe the five basic steps of the virus replication cycle and the variations in the cycles of DNA and RNA viruses.

QUESTION: Indicate the correct order of the viral replication cycle. a. adsorption, penetration, uncoating, self-assembly, release b. adsorption, uncoating, penetration, self-assembly, release c. adsorption, penetration, uncoating, release, self-assembly d. adsorption, uncoating, penetration, release, self-assembly Correct answers: a Difficulty: Medium LEARNING OBJECTIVE: 6.2.1 Describe the five basic steps of the virus replication cycle and the variations in the cycles of DNA and RNA viruses.

QUESTION: The binding of attachments on the viral surface with receptor sites on the host cell membrane is referred to as a. uncoating. b. endocytosis. c. adsorption. d. fusion.

Correct answers: c Difficulty: Easy LEARNING OBJECTIVE: 6.2.1 Describe the five basic steps of the virus replication cycle and the variations in the cycles of DNA and RNA viruses.

QUESTION: Most of the viruses with DNA as their nucleic acid replicate in the host’s a. membrane. b. nucleus. c. golgi apparatus. d. cytoplasm.

Correct answers: b

Difficulty: medium LEARNING OBJECTIVE: 6.2.1 Describe the five basic steps of the virus replication cycle and the variations in the cycles of DNA and RNA viruses.

QUESTION: Most of the viruses with RNA as their nucleic acid replicate in the host’s a. membrane. b. nucleus. c. golgi apparatus. d. cytoplasm.

Correct answers:

d

Difficulty: Medium LEARNING OBJECTIVE: 6.2.1 Describe the five basic steps of the virus replication cycle and the variations in the cycles of DNA and RNA viruses.

QUESTION: Fill in the appropriate blanks: A retrovirus is any of a group of viruses that insert a copy of their genome into the host cell in order to reproduce. a. DNA; DNA b. DNA; RNA c. RNA; DNA d. RNA; RNA Correct answers: c Difficulty: Medium LEARNING OBJECTIVE: 6.2.2 Compare and contrast the lytic and lysogenic cycles of a bacteriophage.

QUESTION: Which step is NOT present in the bacteriophage replication cycle, but IS present in viruses that infect eukaryotic cells? a. adsorption

b. penetration c. uncoating d. release Correct answers: c Difficulty: Hard LEARNING OBJECTIVE: 6.2.2 Compare and contrast the lytic and lysogenic cycles of a bacteriophage.

QUESTION: In which viral replication cycle does viral DNA integrate into the host genome, and subsequently duplicated during host cell divisions? a. lytic b. lysogenic c. lysozyme d. static Correct answers: b Difficulty: Easy

LEARNING OBJECTIVE: 6.2.2 Compare and contrast the lytic and lysogenic cycles of a bacteriophage.

QUESTION: Which of the following does NOT trigger induction during the lysogenic cycle? a. favorable host cell conditions b. exposure to UV radiation c. reduced host cell nutrition d. contact with specific chemicals Correct answers: a

Difficulty: Medium LEARNING OBJECTIVE: 6.2.2 Compare and contrast the lytic and lysogenic cycles of a bacteriophage.

QUESTION: How do viruses that infect eukaryotes differ from bacteriophages? a. Bacteriophages can infect human cells. b. Bacteriophages can infect prokaryotes. c. Bacteriophages can infect plant cells. d. All of these statements are correct.

Correct answers: b Difficulty: Easy LEARNING OBJECTIVE: 6.2.2 Compare and contrast the lytic and lysogenic cycles of a bacteriophage.

QUESTION: Unlike lytic viruses, lysogenic viruses do not a. inject their genetic material into the host cell. b. enter the lytic cycle. c. lyse the host cell right away. d. infect host cells.

Correct answers: Medium Difficulty: c

LEARNING OBJECTIVE: 6.3.1 Evaluate the use of eggs, living animals, and cell cultures for cultivating animal viruses.

QUESTION: Which of the following defines the nature of viruses? a. facultative intracellular saprobes b. obligate intracellular pathogens

c. obligate extracellular pathogens d. facultative extracellular pathogens Correct answers: b Difficulty: Medium LEARNING OBJECTIVE: 6.3.1 Evaluate the use of eggs, living animals, and cell cultures for cultivating animal viruses.

QUESTION: In the process of viral cultivation, a. bacterial b. viral c. animal d. plant

cells are used as hosts.

Correct answers: c Difficulty: Easy

LEARNING OBJECTIVE: 6.3.2 Compare and contrast the impact of various viral infections on human health.

QUESTION: What is the most frequent type of human pathogen? a. viruses b. bacteria c. fungi d. protozoa Correct answers: a Difficulty: Easy LEARNING OBJECTIVE: 6.3.2 Compare and contrast the impact of various viral infections on human health.

QUESTION: Which strain of the flu was responsible for more than 20 million deaths in 1918 worldwide? a. rhinovirus b. H1N1 c. H2N5 d. coronavirus Correct answers: b Difficulty: Medium LEARNING OBJECTIVE: 6.3.3 Describe the role of a provirus in recurrent infections and malignancy development.

QUESTION: When viral DNA enters a eukaryotic host, what term is used to describe the state of the viral DNA? a. lysogenic virus b. postvirus c. previrus d. provirus Correct answers: d Difficulty: Medium LEARNING OBJECTIVE: 6.3.3 Describe the role of a provirus in recurrent infections and malignancy development.

QUESTION: Shinges is the result of reactivated a. provirus. b. prions. c. viroids. d. bacteriophages.

Correct answers: a

Difficulty: Hard LEARNING OBJECTIVE: 6.3.3 Describe the role of a provirus in recurrent infections and malignancy development.

QUESTION: Sometimes proviruses can convert normal cells into malignant cells. Viruses that cause this malignancy are referred to as what type of viruses? a. influenza A b. oncoviruses c. protoviruses d. influenza B Correct answers: b Difficulty: Medium

LEARNING OBJECTIVE: 6.3.3 Describe the role of a provirus in recurrent infections and malignancy development.

QUESTION: Which of the following is not typically characterized as a latent viral infection? a. varicella-zoster (chicken pox) b. herpes simplex 1 c. influenza d. herpes simplex 2 Correct answers: c Difficulty: Medium LEARNING OBJECTIVE: 6.4.1 Describe effective ways to prevent viral infections.

QUESTION: Which if the following is the LEAST effective way to prevent the spread of viruses? a. washing your hands before eating b. using alcohol sanitizers instead of soap

c. only shaking hands with healthy-looking people d. sneezing into the crook of your arm Correct answers: c Difficulty: Easy LEARNING OBJECTIVE: 6.4.1 Describe effective ways to prevent viral infections.

QUESTION: Which of the following are targets of antiviral medications? Select all that apply. a. mutating the genes of the viruses b. preventing entry of the virus into the host cell c. preventing release of new virions d. inhibiting viral enzymes Correct answers: b,c,d Difficulty: Hard LEARNING OBJECTIVE: 6.4.2 Explain the challenges associated with treating viral infections.

QUESTION: Which of the following are the most pressing problems with treating viral infections? Select all that apply. a. finding the proper antibiotic to fit the virus b. the rapid rate of viral mutations c. finding the source of the viruses d. the limited number of targets to attack the virus Correct answers: b,d Difficulty: Hard LEARNING OBJECTIVE: 6.4.3 Describe the different ways that viral infections can influence bacterial infections.

QUESTION:

In specialized transduction, the resistance gene comes from the a. bacteriophage. b. virus. c. human host cell. d. bacterial genome.

Correct answers: d Difficulty: Medium

LEARNING OBJECTIVE: 6.4.3 Describe the different ways that viral infections can influence bacterial infections.

QUESTION: Lysogenic conversion can cause the host bacterium to become more virulent to human patients because a. bacteriophage genes can destroy the bacterial genes. b. bacteriophage genes can replace the bacterial genes. c. bacteriophage genes can alter the bacterial genes, thus causing a potential increase in the production of toxic bacterial substances. d. bacterial genes can alter the bacteriophage genes, thus causing a potential increase in the production of toxic bacterial substances.

Correct answers: c Difficulty: medium LEARNING OBJECTIVE: 6.4.3 Describe the different ways that viral infections can influence bacterial infections.

QUESTION: What is the purpose of phage therapy? a. to use bacteriophages to destroy disease-causing bacteria b. to use bacteria to destroy disease-causing bacteriophages c. to use bacteria to destroy disease-causing bacteria d. to use bacteriophages to destroy disease causing bacteriophages Correct answers: a Difficulty: Easy

LEARNING OBJECTIVE: 6.4.3 Describe the different ways that viral infections can influence bacterial infections.

QUESTION: Select all the reasons why antibiotics are not effective substances to specifically treat viral infections. Select all that apply. a. Viruses are the source of most antibiotics. b. The viral cell wall and organelles are smaller than that of bacteria. c. Antibiotics were designed specifically for prokaryotes. d. Viruses lack the cell structure targets that antibiotics affect.

Correct answers: c,d Difficulty: Medium LEARNING OBJECTIVE: 6.5.1 Describe viroid structure, routes of host cell infection, replication, and symptoms of infection.

QUESTION: The structure of viroids can be characterized as a. Double-stranded circular RNA. b. Single-stranded circular RNA. c. Double-stranded linear DNA. d. Single-stranded linear DNA. Correct answers: b Difficulty: Medium

LEARNING OBJECTIVE: 6.5.2 Compare and contrast the structures and replication strategies of satellite viruses and virusoids, providing an example of each.

QUESTION: Which of the following are found to have the ability to infect mammals?

Select all that apply. a. prions b. viroids c. satellites d. viruses

Correct answers: a,c,d Difficulty: Hard LEARNING OBJECTIVE: 6.5.2 Compare and contrast the structures and replication strategies of satellite viruses and virusoids, providing an example of each.

QUESTION: Which of the following requires another virus to aid in its own replication? a. prions b. viroids c. satellites d. bacteriophages Correct answers: c Difficulty: Medium LEARNING OBJECTIVE: 6.5.2 Compare and contrast the structures and replication strategies of satellite viruses and virusoids, providing an example of each.

QUESTION: Which of the following structures lacks protein? a. prions b. viroids c. satellites d. viruses Correct answers: b Difficulty: hard LEARNING OBJECTIVE: 6.5.3 Describe normal prion structure, indicating where it is located and how the misfolded form acts as a pathogen to cause neurodegeneration.

QUESTION: Prions are made of a. carbohydrates. b. triglycerides.

c. proteins. d. DNA or RNA. Correct answers: c Difficulty: Easy LEARNING OBJECTIVE: 6.5.3 Describe normal prion structure, indicating where it is located and how the misfolded form acts as a pathogen to cause neurodegeneration.

QUESTION: What is the normal function of PrPc, or prion protein in mammal cells? a. degrade toxic chemicals b. guard against degeneration of neurons c. halt protein synthesis of neurons d. increase the rate of degeneration of neurons Correct answers: b Difficulty: Medium LEARNING OBJECTIVE: 6.5.3 Describe normal prion structure, indicating where it is located and how the misfolded form acts as a pathogen to cause neurodegeneration.

QUESTION: The misfolded form of prion protein, or PrPsc, causes degeneration by a. converting PrPc into PrPsc. b. converting Prpc into HBV. c. converting PrPsc into PrPc. d. converting PrPsc into HBV. Correct answers: a Difficulty: Medium LEARNING OBJECTIVE: 6.1.1 Describe the basic molecular composition and shapes of viruses.

QUESTION: Viral genomes exist in the following types. Select all that apply. a. both single and double stranded RNA b. only single stranded RNA and DNA

c. both single and double stranded DNA d. both DNA and RNA in each viral particle correct answers: a,c Difficulty: Medium LEARNING OBJECTIVE: 6.1.1 Describe the basic molecular composition and shapes of viruses.

QUESTION: Positive sense RNA viruses have genetic material that is a. read as double stranded DNA. b. the same reading structure as mRNA. c. complementary to mRNA. d. converted to DNA before it can be used as RNA to make viral proteins. correct answer: b Difficulty: Medium LEARNING OBJECTIVE: 6.1.1 Describe the basic molecular composition and shapes of viruses.

QUESTION: The nucleocapsid refers to the a. viral genome and the protective protein coat. b. capsomeres and nucleic acids. c. helical shape of all viral particles. d. envelope that surrounds the viral genetic component. correct answer: a Difficulty: Easy LEARNING OBJECTIVE: 6.1.1 Describe the basic molecular composition and shapes of viruses.

QUESTION: The most sophisticated viral morphology belongs to the infectious particles that primarily infect a. plants. b. animals. c. protists.

d. bacteria. correct answer: d.

Difficulty: Medium LEARNING OBJECTIVE: 6.1.2 Identify the main characteristics used to classify viruses.

Which characteristics are used to classify viruses? a. similarity in genetic makeup b. replication method c. host range d. overall structure e. All of these choices are correct. correct answer: e Difficulty: Medium LEARNING OBJECTIVE: 6.1.2 Identify the main characteristics used to classify viruses.

Human papilloma virus classified as a. positive sense RNA virus. b. double stranded RNA naked nucleocapsid virus. c. double stranded DNA naked nucleocapsid virus. d. double stranded DNA enveloped virus. correct answer: c Difficulty: Medium LEARNING OBJECTIVE: 6.1.2 Identify the main characteristics used to classify viruses.

Hepatitis infection can be caused by which viral types? a. double stranded DNA enveloped virus b. negative sense RNA enveloped virus c. positive sense enveloped virus d. All of these choices e. None of these choices correct answer: d

Difficulty: Medium LEARNING OBJECTIVE: 6.1.2 Identify the main characteristics used to classify viruses.

Why does the viral classification system differ from that of macroscopic eukaryotes? a. Viruses are microscopic. b. Viruses rely on a host cell for replication. c. Viruses do not participate in sexual reproduction. d. Eukaryotes are charismatic.

Correct answer: c Difficulty: Medium LEARNING OBJECTIVE: 6.1.2 Identify the main characteristics used to classify viruses.

The ability to infect the same hosts is a. host range. b. host specificity. c. host selection. d. host average. correct answer: a Difficulty: Medium

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Chapter 7 Metabolism 7.1 The Role of Energy in Life EASY 1. Looking around your home, which of the following is not an example of potential energy?

A. making popcorn in the microwave b. potato chips in a bag c. gasoline in your car d. candy in a jar MEDIUM 2. In the microbiology lab, you observe an agar plate containing enriched medium covered with bacterial colonies. The enriched agar represents while the bacterial colonies represent .

Which of the following terms BEST completes this statement? a. kinetic energy/potential energy B. potential energy/kinetic energy c. source of ATP/ clonal growth d. kinetic energy/source of ATP HARD 3. We refer to ATP (Adenosine Triphosphate) as the energy money or currency of the cell. In a previous chapter you learned about the 4 groups of organic molecules critical to life. To which group does ATP belong? a. carbohydrates because of the sugar b. proteins because of the 3 dimensional structure c. lipids because of the hydrogen bonds D. nucleic acids because of the nitrogenous bases EASY 4. Catabolism is a(n) reaction resulting in the breakdown of a large macromolecule into smaller subunits with the subsequent release of energy. a. endergonic b. endothermic C. exergonic d. rapid EASY 5. The process in which a cell builds a macromolecule from smaller subunits and requires an input of energy to make the new chemical bonds is called . a. anabolism b. catabolism c. exergonic d. exothermic MEDIUM 6. Match the correct terms with its descriptive phrase: endergonic reaction B a. E.coli breaks down glucose in nutrient medium exergonic reaction D b. input of energy into synthesis reaction catabolism A c. production of proteins from amino acids anabolism C d. reduction in potential energy of molecules

7.2 Energy Production Principles EASY 7. Which sequence of terms correctly fits the following statement?

A redox reaction occurs when the removal of electrons (i.e. the addition of electrons (i.e. ) to another compound. a. reduction/oxidation B. oxidation/reduction

) from one compound results in

2 EASY 8. Redox reactions are used in cellular processes to move from one compound to another. a. phosphate groups b. energy c. hydrogen atoms d. phosphorus atoms MEDIUM 9. Which of the following are activated carriers in cellular processes? a. NAD+ and FADH b. NADH and FADH2 c. NAD+ and FADH2 D. NADH and FADH EASY 10. The energy used to create the bond that attaches the 3rd phosphate group onto ADP thus making ATP comes from . a. anabolism b. activation energy c. catabolism d. synthesis reactions MEDIUM 11. How much energy is stored in the bonds between the 2 and 3 Phosphate groups in ATP? A. 7.3 kcal/mol b. 6.3 kcal/mol c. 5.3 kcal/mol d. 8.3 kcal/mol HARD 12. What makes ATP the ideal biological molecule to serve as the “energy currency” of the cell? a. ease of breaking bonds between phosphate groups b. negative charge on three phosphate groups helps hydrolysis of terminal group c. low energy in bonds between phosphate groups D. choices A and B are correct e. choices A, B and C are correct HARD 13. Fill in the blanks in the statements below using the following terms: substrate oxidative photophosphorylation (a) In substrate –level phosphorylation the high-energy third phosphate group is transferred by an enzyme to ADP creating ATP. (b) When a series of redox reactions are initiated by the absorption of light energy this results in the photophosphorylation of ATP. (c) In aerobic respiration the energy needed for oxidative phosphorylation is provided by the activated carriers NADH and FADH2 (d) Chemiosmosis is an essential part of both photophosphorylation and oxidative phosphorylation.

MEDIUM 14. This protein is referred to as the “coupling factor” in cellular processes because it makes possible the use of the energy released from the H+ gradient with the phosphorylation of ADP. a. NADHP b. phosphorylationase C. ATP synthase d. photosynthase

7.3 Glycolysis and Fermentation MEDIUM 15. Which of the following is a characteristic of a “fuel”? a. organic molecule that stores a lot of energy released in exergonic reactions b. a highly reduced molecule that can be easily oxidized

c. in living cells, the major fuel is glucose D. all of these are correct e. only choices A and C are correct

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EASY 16. Just as in a recipe, what “ingredients” go into the universal process called glycolysis?

A. one 6-carbon glucose, two ATP, two NAD+ b. two 6-carbon glucose, two ATP, two NADH c. one 6-carbon glucose, four ATP, two NADH d. two 6-carbon glucose, four ATP, two NAD+ HARD 17. The NAD+ utilized in glycolysis and other processes actually comes from the water-soluble B vitamin Niacin. This organic carrier becomes activated when it carries energy in the form of electrons between coupled reactions. On the cellular level what do you think happens to patients who do not get good nutrition and therefore lack adequate B vitamins?

A. They will not have enough NAD+ to serve as energy carriers and subsequently will not be able to produce enough ATP to fuel cell recovery. b. They will suffer from fatigue and recuperation will be faster than expected. c. Subsequent to their malnutrition they will not have enough NAD+ to carry the electrons released and the cells will become too acidic and die. d. They will build up too much glucose in the bloodstream and will develop Diabetes Type I EASY 18. What are the results of glycolysis? a. 2 ATP net created via oxidative phosphorylation plus 2 NADH and two 3-carbon pyruvates b. 4 ATP gross created via substrate-level phosphorylation plus 4 NADH and two 3-carbon pyruvates c. 2 ATP gross created via oxidative phosphorylation plus 4 NADH and four 3-carbon pyruvates D. 2 ATP net created via substrate-level phosphorylation plus 2 NADH and two 3-carbon pyruvates MEDIUM 19. Why does glycolysis have to be followed by either fermentation or respiration? a. Because pyruvate isn’t completely formed until the Krebs Cycle B. Because NAD+ needs to be recycled from NADH so that the glycolytic pathway can start again c. So that fermentation will be able to produce more ATP using the electrons from NADH d. So that the cell can use FADH2 in the next step of aerobic respiration.

HARD 20. Which of the following statements provides one reason why glucose catabolism proceeds in multiple steps called a pathway? a. If there were only one single combustion step, too much energy would be released as heat and the cell would die. b. Energy must be released a small amount at a time in the redox reactions so that none will be lost. c. Multiple steps reduces the amount of activation energy needed and allows for the use of enzymes instead D. Choices A and C are correct e. All three choices are correct.

EASY 21. What are the two most common products of fermentation? a. pyruvate and alcohol b. carbon dioxide and alcohol c. carbon dioxide and lactic acid D. alcohol and lactic acid.

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EASY 22. What organic compound serves as final electron acceptor in glycolysis followed by fermentation? a. lactic acid b. ethanol c. carbon dioxide D. pyruvate MEDIUM 23. Fermentation is responsible for many of the foods that we eat. What is the sequence for the production of beer and bread? a. 2-step process: pyruvate -> yields CO2 gas and Lactic Acid -> reduced by NADH to form Ethanol B. 2-step process: pyruvate -> yields CO2 gas and Acetaldehyde -> reduced by NADH to form Ethanol c. 1-step process: pyruvate -> reduced to form ethanol and Lactic Acid d. 1-step process: pyruvate -> reduced to form Acetaldehyde Lactic Acid HARD 24. As pointed out in your text, fermentation is an ancient process utilized by Egyptians and other civilizations to provide cleaner beverages to drink. (It also produced safer foods like yogurt in the absence of refrigeration.) On the molecular level, why would fermentation make fluids safer to drink?

A. The presence of ethanol in the beverages would kill of many pathogens that might be present. b. The lactic acid in the beverages would make the drinks too acidic for most bacterial cells. c. The Acetaldehyde would kill many of the pathogens present. d. The recycling of NAD+ would increase electron and H+ concentration, thus making the beverages too acidic.

7.4 Aerobic Cellular Respiration HARD 25. Before entering the Krebs or Citric Acid Cycle, pyruvate must be oxidized. What is the correct order of the 3 steps of this process that links Glycolysis with the Citric Acid Cycle?

-Step A– pyruvate loses carboxyl group -> forms acetate and CO2 -Step B – CoA enzyme plus acetate -> forms Acetyl CoA -Step C – NAD+ reduced to NADH thus storing energy A. Step A -> Step C -> Step B c. Step A ->Step B -> Step C

b. Step C -> Step A -> Step B d. Step B -> Step A -> Step C

EASY 26. How many times does the oxidation of pyruvate have to occur between glycolysis and the Citric Acid Cycle? a. once B. twice c. three times d. four times MEDIUM 27. If glycolysis may be described as a pathway, the Citric Acid process described by Sir Hans Krebs and often bearing his name may be described as a cycle because it begins and ends with . a. citric acid b. pyruvate C. oxaloacetate d. succinate

5 HARD 28. The first of the three carbons in pyruvate is released before the formation of acetyl-CoA. During which of the 9 steps of the Citric Acid Cycle that follows are the remaining two carbons released as CO2 gas? a. Steps 1 and 2 b. Steps 3 and 4 C. Steps 4 and 5 d. Steps 5 and 6 EASY 29. What type of phosphorylation occurs in the Citric Acid Cycle?

A. substrate level b. oxidative c. photo d. chemiosmotic EASY 30. The CO2 gas that we exhale from our lungs is produced during . a. glycolysis b. pyruvate oxidation c. Citric Acid Cycle D. Choices B and C MEDIUM 31. Fill in the blanks in the following statement: For each molecule of glucose that enters glycolysis, the Citric Acid Cycle must make molecules of ATP. a. 1 turn/2 ATP B. 2 turns/2 ATP c. 1 turn/1 ATP d. 1 turn/6 ATP

turns producing

EASY 32. Aerobic Cellular Respiration consists of three parts in the correct order: A. Glycolysis -> Citric Acid Cycle -> Electron Transport System b. Glycolysis -> Fermentation -> Electron Transport System c. Glycolysis -> Fermentation -> Citric Acid Cycle d. Glycolysis -> Electron Transport System -> Citric Acid Cycle EASY 33. In the Electron Transport System, the oxidation of one NADH to NAD+ yields oxidation of FADH2 yields ATP a. 1/2 b. 2/2 C. 3/2 d. 3/3 MEDIUM 34. During the entire process of aerobic respiration, FADH2 are generated. a. 10/10 B. 10/2 c. 12/4 d. 12/6

ATP while the

activated carrier molecules of NADH and

EASY 35. Fill in the blanks from the choices below: In Eukaryotes the ETS occurs in the while in Prokaryotes it occurs in a. cytoplasm/cell membrane b. mitochondria/cytoplasm C. mitochondria/cell membrane d. cell membrane/cell membrane

of

.

EASY 36. Match the process with its location in a Prokaryote cell: (choices may be used more than once or not at all) Process Location in cell Glycolysis A a. Cytoplasm Krebs Cycle A b. Cell membrane ETS B c. Cell Wall

6 MEDIUM 37. Which of the following best completes this statement: The Electron Transport System consists of series of redox reactions that occur in a step-wise pathway down membrane-imbedded proteins in order to create .

A. H+ ion gradient across the membrane b. a reservoir of available NAD+ and FADH c. 34 ATP d. more activated carriers for H+ ions and electrons EASY 38. What serves as final electron acceptor in glycolysis followed by aerobic cellular respiration? a. CO2 b. H2O C. O2 d. ATP HARD 39. What is the best description of Chemiosmosis? a. conversion of potential energy stored in H+ ion gradient into reduced NADH and FADH2 B. conversion of potential energy stored in H+ ion gradient into ATP as H+ diffuses across a membrane c. conversion of kinetic energy stored in H+ ion gradient into oxidized NAD+ and FADH d. conversion of kinetic energy store in H+ ion gradient into H2O and ATP HARD 40. What 3 things provide the motive force for production of ATP in the ETS? a. imbedded membrane proteins, H+ ion concentration and chemiosmosis b. ATP Synthase enzyme, activated carriers, and H+ ion concentration c. imbedded membrane proteins, chemiosmosis and O2 D. ATP Synthase, H+ ion concentration and chemiosmosis MEDIUM 41. Where may chemiosmosis occur in a cell? a. cristae of mitochondria in Eukaryote cells b. thylakoid membrane of chloroplasts in photosynthetic Eukaryotes c. cell membranes of aerobic bacteria D. all of these are correct HARD 42. Like a tiny motor, ATP synthase facilitates the movement of H+ ions down a gradient that exists across the cristae of the mitochondria in Eukaryotes or the cell membrane of aerobic Prokaryotes. The energy in these H+ ions is used to create three steps within the ATP synthase that generate the ATP. The 3 steps in order are: A. binding, rotating and releasing b. binding, twisting and releasing c. rotating, binding and releasing d. capturing, binding and releasing HARD 43. In the total process of Glycolysis followed by Aerobic Cellular Respiration, substrate phosphorylation produces ATP while the oxidation of activated carriers NADH and FADH2 produces ATP. a. 6 ATP/32 ATP b. 2 ATP/36 ATP c. 4 ATP/32 ATP D. 4 ATP/34 ATP

7 MEDIUM 44. Glycolysis followed aerobic respiration is because of the net number of ATP produced.

A. 19 b. 16 c. 20 d. 12

times more efficient than glycolysis and fermentation

EASY 45. Many lipids contain fatty acids that are oxidized in step-wise reactions called that release energy for ATP production.

A. beta-oxidation b. alpha-oxidation c. gamma-oxidation d. delta-oxidation EASY 46. Proteins may be used for cellular fuel by the . a. creation of peptide bonds to store energy b. synthesis of amino acids to store energy c. release of energy stored in peptide bonds D. degradation of amino acids to release energy MEDIUM 47. Match the example of integrated metabolic pathways used by living cells with the correct descriptive phrase.

Gluconeogenesis B a. enzymatic addition an amine group to a molecule Animation A b. generation of glucose from pyruvate Transamination C c. transfer of amine group from amino acid to another molecule

7.5 Photosynthesis EASY 48. The three major parts of a photosystem are the core chlorophyll a and b plus a. light reflecting complex and core antenna pigments B. light harvesting complex and core antenna pigments c. carbon fixing complex and core antenna pigments d. light reflecting complex and ETS EASY 49. The pigments that absorb light energy to drive photosynthesis are: a. chlorophyll a and b b. carotenoids c. phycobilins D. all of these are correct MEDIUM 50. What are the major differences between Photosystem I and Photosystem II? a. PS I = P700 while PS II = P680 b. PS I occurs first c. PS II occurs first d. PSII produces atmospheric oxygen E. Only choices a, c, and d are correct EASY 51. Together the light-dependent photosynthetic reactions produce A. ATP, NADPH, O2 b. ATP, NADPH, CO2 c. Glucose, ATP, O2 d. ATP, NADPH, H2O

8 EASY 52. The replacement electrons for Photosystem II’s P680 reaction center come from a. Photosystem I B. splitting of water in the Hill reaction c. atmospheric oxygen d. NADPH EASY 53. Atmospheric oxygen is a produce of a. cellular respirationb. Calvin Cycle c. Photosystem I D. Hill reaction of Photosystem II HARD 54. What is the correct sequence of the seven events in the light reactions of photosynthesis? Put the following items in the correct order.

1-ATP Synthase produces ATP 2-Hill Reaction 3-substrate-level phosphorylation produces ATP 4-production of NADPH 5-P680 6-P700 7-start of redox reactions with ejection of excited electron a. 7, 6, 2, 3, 5, 4, 1

B. 7, 5, 2, 3, 6, 4, 1

c. 7, 2, 4, 6, 3, 5, 1

d. 7, 3, 4, 5, 2, 6, 1

EASY 55. is the process in which the third phosphate group is added via chemiosmosis to ADP in the light-dependent reactions of photosynthesis. a. cyclic photophosphorylation b. noncyclic phosphorylation C. noncyclic photophosphorylation d. cyclic oxidative phosphorylation MEDIUM 56. Why is carbon dioxide a key molecule in the light-independent (dark) reactions of photosynthesis? a. CO2 provides electrons to replace those lost by chlorophyll during the light-dependent reactions B. CO2 provides the carbon for the synthesis of sugars during carbon fixation c. CO2 is the major product of the light-independent reaction d. CO2 provides the energy for substrate-level phosphorylation EASY 57. The term “cycle” is used to describe the Calvin reactions because a. the same reactions occur every time b. CO2 is fixed in every turn of the cycle C. the process begins and ends with RuBP d. glucose is made during the process EASY 58. The ATP and NADPH produced during the light-dependent reactions is used in the Calvin cycle to a. reduce CO2 to glucose b. regenerate RuBP c. power reactions in production of PGAL D. All of these are correct

9 HARD 59. How many turns of the Calvin Cycle are required to fix enough CO2 to produce one molecule of glucose? a. 12 B. 6 c. 3 d. 36 MEDIUM 60. Chemoautotrophs use energy resource.

A. CO2/reduced inorganic compounds c. CO2/reduced organic compounds

as their primary carbon source and

as their

b. CO2/oxidized inorganic compounds d. CO2/oxidized organic compounds

EASY 61. Chemoheterotrophs use organic compounds as their primary carbon source and electrons from H atoms of same compounds as their energy resource. This group includes a. humans and other animals b. fungi c. most protozoa d. most bacteria E. all of these are correct CRITICAL THINKING 62. Which process probably evolved first on the ancient Planet Earth – photosynthesis or cellular respiration? a. Photosynthesis because Photosystem II provided atmospheric oxygen that facilitated evolution of aerobic organisms b. Cellular respiration because carbon dioxide from Citric Acid Cycle provided source of carbon fixation for photosynthesis.

63. ATP Synthase is the critical enzyme that couples together what 2 cellular processes? a. ETS of aerobic cellular respiration and ETS of Calvin Cycle in photosynthesis B. ETS of aerobic cellular respiration and ETS of light-dependent reactions of photosynthesis c. ETS of fermentation and ETS of light-dependent reactions of photosynthesis d. ETS of aerobic cellular respiration and ETS of light-independent reactions of photosynthesis

CH. 8 – Microbial Genetics and Genetic Engineering 8.1 DNA as the Genetic Material EASY 1. From the introduction to this chapter, what is the correct pairing of organism with the number of base pairs contained in its genome? a. Prochlorococcus/1.6 million base pairs b. oak tree/750 million base pairs C. human/1 billion base pairs EASY 2. The three fundamental functions of genetic material in a cell include: a. storage of information needed for making all the biochemical and structural parts of a living organism b. accurate replication of the information so that it may be passed on to the next generation c. opportunity for genetic variation to decrease diversity in populations so that they will have a chance to survive environmental change D. only answers a and b are correct e. all of these are correct EASY 3. The basic structure of the double DNA helix includes a. two separate nucleotide helices twisted together b. strands are held together by base pairs bonded together via hydrogen bonds c. bonding between base pairs is complementary, always pairing adenine to thymine and cytosine to guanine. d. hereditary information is stored in the sequence of bases.

E. all of these are correct MEDIUM 4. Which of the following matching of terms is incorrect? a. genome/all the genetic information in an organism B. protein synthesis/translation followed by transcription c. genes/units of heredity that code for production of either RNA or protein d. chromosomes/ threadlike structures composed of genes MEDIUM 5. DNA functions in , while RNA functions in a. translation/ transcription B. self-replication and protein synthesis/protein synthesis only c. making chromosomes/making genes d. chromosomes/plasmids

.

HARD 6. Major differences between DNA and RNA include all of these except A. DNA uses thymine while RNA substitutes cytosine b. DNA is usually found in a double helix while RNA usually is single-stranded c. DNA contains deoxyribose while RNA contains ribose

d. DNA is used in self-replication and protein synthesis, while RNA is used only in protein synthesis

2

MEDIUM 7. The primary features in protein synthesis include a. rewriting of DNA as RNA using the DNA template strand b. building the primary structure protein on the ribosome c. using tRNA as anticodon to bring nucleic acids to the ribosome D. only a and b are correct e. a, b, and c are correct MEDIUM 8. Match the Genetics term with the correct description: Genetics term Description Genotype C a. observable characteristics of an organism as determined by genes Phenotype A b. small, self-replicating rings of DNA found in bacteria Plasmid B c. entire genetic makeup of an organism Codon D d. sets of three nucleotides making up RNA HARD 9. Match the DNA replication enzyme with its function in a bacterium: DNA Replication Enzyme Function DNA Helicase B a. DNA proofreading DNA gyrase E b. unwinds double-stranded DNA at beginning DNA polymerase III A c. links Okazaki fragments together DNA polymerase I D d. removes and replaces RNA primers with nucleotides DNA ligase C e. helps DNA strands unwind, removes supercoils HARD 10. In comparing DNA semi-conservative replication in Prokaryotes versus Eukaryotes, key differences include all except A. in bacteria about 100 nucleotides are incorporated per second, while in Eukaryotes only 25 nucleotides are replicated per second b. total time for replication of bacterial chromosome is 40 minutes, while in Eukaryotes total time is several hours c. In bacteria like E. coli DNA replication begins again before its replication is complete, while in Eukaryotes DNA replication starts at thousands of sites on all the chromosomes simultaneously d. E. coli can divide under excellent conditions every 20 minutes, while in Eukaryotes cell division takes much longer.

8.2 From DNA to Protein MEDIUM 11. Match the terms used in Transcription with their descriptions: Transcription Terms Descriptions Promoter region A a. binding sites for enzymes that bind RNA polymerase to DNA, separate strands of DNA and select template strand Terminator E b. strand not used as template Coding Strand B c. strand used as pattern for mRNA using complementary base pairing RNA Polymerase D d. enzyme complex that directs building of mRNA transcript Template Strand C e. DNA sequences that bind factors to stop transcription and release newly

formed mRNA complex EASY 12. An accurate description of events in transcription includes? a. RNA polymerase binds to promoter sequence on DNA and copies the template strand b. sequences of 3 DNA nucleotides is transcribed into sequences of 3 mRNA codons c. nucleotide language of DNA is rewritten as nucleotide language of mRNA D. all of these are correct e. only a and b answers are correct EASY 13. Match the type of RNA with its function: Type of RNA Function a. transcribed from DNA template strand, coding molecules are transcribed mRNA A into proteins tRNA. D b. participates in various regulatory functions rRNA C c. structural components of ribosomes miRNA B d. involved in translation, carry amino acids to ribosomes HARD 14. What description about mRNA is incorrect? a. Bacterial mRNAs vary in size but usually have about 1000 nucleotides that code for proteins with 300 amino acids. b. Bacterial mRNA is longer and more modified than that found in Eukaryotes. c. Before leaving the nucleus, Eukaryote mRNA has to be capped, spliced and had poly (A) tails added making it shorter than Bacterial mRNA. D. Both answers b and c are incorrect. e. All 3 answers are incorrect.

MEDIUM 15. Major characteristics of the tRNA molecules include a. They are smaller than mRNA and rRNAs, ranging from about 70 to 100 nucleotides in length b. All tRNAs have the same basic structure. c. While one end of the tRNA temporarily binds a specific amino acid, the other end has the anticodon that temporarily binds to the codon on the mRNA via complementary base pairing. d. The tRNA is the bridge between the nucleotide language of the mRNA and the amino acid language of the developing protein.

E. All of these are correct.

EASY 16. The Genetic Code . Which statement is not true?

A. is written in the language of DNA b. is redundant because there is often more than one choice of codon for each amino acid c. uses AUG coding for Methionine as the start of every protein d. uses one of three codons that do not code for an amino acid to stand for “stop” at the end of the protein.

3

4 EASY 17. What are the three stages of protein synthesis? a. Transcription has three stages: initiation, elongation and termination. b. Translation has three stages: initiation, elongation and termination. c. These 3 basic stages are found in all living cells, both Prokaryotes and Eukaryotes. d. These stages are coordinated by the ribosomes.

E. All of these are correct MEDIUM 18. All of the following pertain to the transcription part of protein synthesis except …

A. Occurs on a ribosome in the cytoplasm b. Occurs before translation c. Requires RNA polymerase d. Requires a template DNA strand MEDIUM 19. Match the three sites found on the 70s ribosome with its function: Ribosome Site Function A site C a. peptidyl-tRNA is parked before it transfers its peptide to the A site P site A b. tRNA witout an amino acid attached exits the ribosome E site B c. aminoacyl-tRNA binds to ribosome providing accuracy HARD 20. Which of the following does not happen during the elongation stage of translation? a. first, the appropriate aminoacyl-tRNA with complementary anticodon fills the A site b. second, the growing peptide is transferred to make a peptidyl-tRNA with a peptide that now has one more amino acid c. third, translocation occurs in which the mRNA slides up the ribosome one codon in the 5’ direction.

D. the process continues as nucleic acids are added to the growing peptide one at a time.

EASY 21. What stops the translation process?

A. when a stop codon on the mRNA enters the A site b. when a stop codon on the mRNA enters the P site c. when a stop codon on the mRNA enters the E site d. a release factor binds to the A site and begins termination e. all of these are incorrect MEDIUM 22. What happens after the protein has been built? a. it is released from the P site and moves on to fulfill its function b. ribosome, mRNA and tRNA separate and are recycled to start the process again c. new protein will be modified using the ER and the Golgi apparatus D. all of these are correct

8.3 Sources of Genetic Variation

5 EASY 23. Which of these does not explain what drives Evolution? a. changes in inherited traits in populations of organisms B. genetic diversity within several separate populations c. genetic diversity is produced by either mutation or recombination d. all of these are correct MEDIUM 24. Which statement is correct? a. A mutation is a change in the amino acid sequence of a gene. b. A mutation is a change in the amino acid sequence of a protein.

C. A mutation is a change in the nucleotide sequence of a gene. d. A mutation is a change in the nucleotide sequence of a protein EASY 25. Spontaneous mutations . a. are common errors to occur spontaneously during DNA replication b. are inevitable because the process is not perfect c. accuracy rate is 10-9 errors per base pair or once every one billion base pairs d. mutations are usually corrected because DNA polymerase III checks every base pairing E. all are correct except for answer A MEDIUM 26. Which of the following does not accurately complete this sentence : “Induced mutations ” a. via chemicals may alter the structure of purines or pyrimidines so they no longer form complementary base pairs.

B. via nonionizing radiation may cause formation of adenine dimers c. via chemicals may add a functional group to the nucleotide thereby distorting its structure and causing errors during replication or repair. d. via ionizing radiation may damage DNA by creating reactive ions that chemically alter nucleotides.

HARD 27. Match the chemical mutagen with its source: Chemical mutagen Source Polyaromatic hydrocarbons B a. pesticides on foods, tobacco smoke and diesel engine exhaust b. carbon-containing fuels, cigarette smoke, meat cooked at high Nitrosamines/nitrosamides D temperatures Aromatic amines A c. embalming fluids and volatile gases from paints, floor finishes and cigarette smoke Formaldehyde C d. by-products from manufacture of some cosmetics, pesticides and most rubber products

HARD 28. A point mutation can be all of the following except? a. silent mutation having no effect on protein structure b. missense mutation that changes one amino acid in protein c. nonsense mutation that changes codon form an amino acid to termination codon d. frameshift mutation caused by addition only of base pair thereby shifting reading frame and changing all amino acids occurring after the frameshift.

E. all of these

6

MEDIUM 29. Mutations that were induced by UV light may be repaired by all of the following except? a. Photolyase utilizes 1 step b. Photolyase repairs DNA directly by breaking bonds to remove pyrimidine dimers c. Nucleotide excision utilizes multiple steps D. Nucleotide excision after cutting out the affected area, uses Polymerase IIII to join nucleotides together to fill the gap e. Nucleotide excision uses DNA ligase to join the repaired section of DNA to the original strand.

MEDIUM 30. Which of the following describes the Ames Test? a. measures the mutagenic potential of chemical compounds b. initially screens for potential carcinogens. c. Uses the auxotroph Salmonella typhimurium that cannot make the amino acid Methionine d. all are correct E. only answers a and b are correct EASY 31. Basically the Ames Test is a procedure that A. tests the capability of a mutagen to produce reversion mutations b. assesses the ability of methionine-requiring strains c. analyzes the mutagenic ability of Salmonella typhimurium d. screens for the presence of methionine EASY 32. Horizontal gene transfer means that a. new genetic material is produced by sexual reproduction B. bacteria can acquire genes from other bacteria c. bacteria can transfer new genes via mitosis d. bacteria can transfer new genes via meiosis EASY 33. Match the type of horizontal gene transfer with its correct description: Horizontal Gene Transfer Description Transformation C a. genes transferred from bacterium to bacterium via bacteriophage Transduction A b. movement and insertion of DNA segments to new positions within chromosome or plasmid Conjugation D c. “naked” DNA from environment taken up by bacterium Transposons B d. Formation of sex pilus allows transfer of portion of chromosome or plasmid MEDIUM

34. In the Ames test, which result will indicate that the substance being tested is a potential carcinogen? a. appearance of a few spontaneous His+ reversion mutants on control plate B. appearance of His+ reversion mutants induced by mutagen on experimental plate c. appearance of no spontaneous His+ reversion mutants on control plate d. appearance of no spontaneous His+ reversion mutants on experimental plate.

EASY 35. Which of the following is the most frequently used method of horizontal gene transfer used by bacteria? a. Transformation b. Transduction C. Conjugation d. Transposons MEDIUM 36. What type of bacteria uses conjugation most frequently?

A. Gram-negative bacteria in the gastrointestinal tract b. Gram-positive bacteria on the skin and mucous membranes c. Acid-fast bacteria in the respiratory system d. Endospore-forming bacteria in the gastrointestinal tract

8.4 Regulation of Gene Expression EASY 37. When does most of the regulation of gene expression occur in bacteria? a. during termination of transcription b. after termination of transcription C. during initiation of transcription d. during elongation of transcription MEDIUM 38. Which of the following does not describe the genes coding for proteins that regulate gene expression? a. regulatory proteins control genes by binding to regulatory sequences b. binding to regulatory sequences either stops or activates transcription c. inhibitors are called repressors D. promotors are called inducers EASY 39. What is an operon? a. set of genes controlled by a single promoter b. set of genes transcribed together into a single mRNA c. set of genes transcribed together into a single mRNA that codes for multiple proteins D. set of genes transcribed together into a single mRNA that codes for multiple proteins required in same metabolic pathway

MEDIUM

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40. One of the most studied operons is the lac operon found in the bacterium E. coli. Which of the following best describes how this operon works? a. it controls the expression of enzymes needed to transport lactose into the cell and break it down into glucose and galactose b. when no lactose is present the repressor blocks transcription of structural genes that code for enzymes that break up lactose c. when lactose is present the repressor is inactivated thereby permitting the production of enzymes that break up lactose d. in the presence of glucose lactose metabolism is not needed and another protein binds near promoter of lac operon to enhance transcription only when glucose amounts are running low E. all of these describe how the lac operon works EASY 41. In Eukaryotes how are genes regulated? a. packaging of DNA into tight or loose coils around the histone proteins either permitting or stopping transcription b. regulation of gene expression after elongation of transcription begins c. regulation after termination of transcription via capping, splicing and polyadenylation d. removal of introns and splicing together of exons.

E. all of these answers are correct except b HARD 42. In Eukaryotes, which of the following are four points at which genes may be regulated post transcription? a. RNA processing in the nucleus, mRNA capping, transportation of RNA to cytoplasm and processing of completed proteins b. RNA processing, mRNA capping, RNA splicing, and polyadenylation C. RNA processing in the nucleus, transportation of RNA to cytoplasm, blocking of protein synthesis via microRNAs, processing of completed proteins d. RNA processing in the cytoplasm, transportation of RNA to ribosomes, RNA splicing , processing of completed proteins

8.5 Recombinant DNA Technology EASY 43. Accurate descriptions of Recombinant DNA Technology include all of the following except: a. also called genetic engineering b. DNA from one organism is introduced in another organism c. new DNA combinations are copied and used to make new proteins D. only DNA from closely related organisms may be recombined in a new host MEDIUM 44. Restriction enzymes a. are used to cut DNA at specific nucleotide sequences. b. sequences are called palindromes because they are read the same either forward or backward c. may cut DNA at many sites along the chromosome or plasmid d. all of these are correct descriptions E. Only answers a and b are correct

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HARD 45. Match the Term with the correct description: Term Description Gene cloning B a. short sequence with many sites where restriction enzymes may cut Cloning vectors D b. production of multiple identical copies of a recombinant gene c. sequence recognized by DNA replication machinery to facilitate Origin Sequence C replication within the host cell Multiple Cloning Site A d. viruses, plasmids or artificial chromosomes MEDIUM 46. Gel Electrophoresis is a lab process that is used to separate DNA, RNA or proteins according to their molecular size. Which of the following description is not correct? a. molecules are separated according to size like number of nitrogenous base pairs B. large molecules travel through the gel more quickly c. DNA fragments are pulled toward the positive charge in the chamber d. finished gel is stained with dyes that may be visualized under UV light EASY 47. After being cut with the same restriction enzyme, what cellular enzyme is used to link the selected gene and the cloning vector? a. DNA polymerase I b. DNA polymerase III C. DNA ligase d. DNA helicase HARD 48. What is the correct order of steps in the process of cloning a Eukaryotic gene and inserting it into a vector like a plasmid?

1. isolate protein of interest 2. use mRNA to create artificial mRNA transcript 3. make sure to include in vector a selectable gene for antibiotic resistance 4. use enzyme reverse transcriptase to make complementary DNA from mRNA 5. insert cDNA into vector for cloning to form recombinant DNA A. 1, 2, 4, 5, 3

b. 1, 2, 3, 4, 5

c. 1, 4, 2, 3, 5

d. 1, 3, 2, 4, 5

EASY 49. How has biotechnology improved our lives? a. production of industrial enzymes used in detergents, paper production and food industry b. production of GMOs (genetically modified organisms) c. development of herbicide and pest-resistant crop plants D. all of these are correct.

MEDIUM 50. How has the application of bacterial genome techniques benefited agriculture?

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10 a. Scientists can target specific pests thus reducing the need for widespread toxin use and making the crops safer for human consumption. b. Scientists can target specific portions of the crop plants like roots to protect thereby saving the rest of the plant for harvest. c. Scientist can insert bacterial genes and promoters that are specific to the pest in question thereby killing the pest when it ingests the endotoxin produced. d. only answers a and c are correct.

E. all of these answers are correct.

EASY 51. Many people have concerns about eating Genetically Modified (GM) foods. What precautions have been taken to help allay these fears? a. by law most GM foods are labeled so that individuals with allergies will be aware of potential allergens b. most of the genes coding for specific proteins that are known to be highly allergenic are not used to produce GM foods c. regulatory bodies like the FDA (Food and Drug Administration) evaluate GM foods before they can ever be made available to consumers D. all of these are precautions taken e. only answers a and b are precautions that have been taken HARD 52. STRs (Short Tandem Repeats) are used to identify individuals based on their DNA fingerprint. Which of the following descriptions of this process is not correct?

A. 15 different regions in the human genome show significant variation individual to individual. b. STRS are DNA sections in which 2-5 base-pair sequences are repeated in tandem units several to dozens of times. c. In combining the probability of having each specific combination of STRs occur at the different STR sites a unique fingerprint is provided for each individual. d. DNA fingerprints are extremely useful in criminal investigations, parental identification and identification of dead bodies.

8.6 Genomics EASY 53. What is genomics? a. branch of genetics that maps and sequences genomes b. branch of genetics that maps and sequences genomes and then organizes and interprets results c. application of sequence data to fields of biology and medicine d. answers a and c are correct E. answers b and c are correct HARD 54. Shotgun sequencing involves all of the following except ? a. large genomes of DNA have to be cut into short pieces before sequencing begins B. sequencing is carried out on hundreds of thousands of small DNA fragments sequentially c. only FNA fragments smaller than 150 base pairs (bp) can be read d. special computer software is needed to reassemble short pieces into the original genome.

MEDIUM

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55. Which of the following statements is true? a. The fields of molecular biology and genetics examine the roles of multiple genes and sets of related genes in cell metabolism or organismal development.

B. Genomics analyzes the structure and function of an entire genome and its interrelated metabolic cellular pathways. c. Forensic genomics analyzes the sequence of DNA in DNA fingerprinting. d. The combined genomes of many organisms in a microbial community is referred to as a biogenome.

MEDIUM 56. Which of these is the best description of what the analysis of entire genomes of microbial pathogens has revealed? a. many of the genes present in microbial pathogens code for traits that allow them to survival host defenses b. comparison of pathogenic microbial genomes has shown that sets of genes related to pathogenicity are the same among pathogenic microbes. c. metabolomic analysis of the genes in biochemical pathways found in a microbial community has revealed their different identities D. answers a and b are correct e. all are good descriptions EASY 57. The applications of genomics includes which of the following? a. early detection of genetic predispositions b. in pharmacogenomics the study of individual’s genetic traits and the subsequent reaction to drugs c. Disease-related alleles are easily identified via saliva sampling d. manipulation of the human microbiome in order to improve human health E. all of these are correct

Critical Thinking MEDIUM 58. There are many ELSI (Ethical, Legal and Social Issues) that apply to genetic engineering. Which of the following do you think is the most critical? a. manufacturing of GM foods developed for human consumption b. development of microbial-based pesticides that are inserted in plant genomes c. screening of individuals for presence of potential genetic problems leading to disease d. DNA analysis of genomes present in cancer tumor cells thus allowing for design of drugs to specifically target these cells (NOTE: Student responses will vary.)

HARD 59. Which of the following techniques could you use to determine the identity of an unknown human found buried in the permafrost on a mountain in the Himalayas? a. restriction enzymes, PCR and Gel Electrophoresis to compare lengths of DNA segments b. analysis of Single Tandem Repeats (STRs) C. both would be useful because the true identity will never be known but a comparison with known samples already studied would help age the unknown victim d. neither would be useful because the cold temperatures present in the permafrost would have damaged both the cells and the DNA they contained.

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CH. 9 – Microbial Growth and Control 9.1 Requirements for Microbial Growth EASY 1. The difference in potential growth rates between cell types is amazing: it takes nine months for a human fertilized egg to develop into a human baby. But this is a creeping pace of growth when compared to a bacterium that can potentially go from 1 cell into a pile of cells the same size as a human infant in hours. a. 10 b. 12 c. 15 D. 17 e. 20 EASY 2. Microbial growth refers to a. growth in size of an individual cell b. growth in size of a cluster of cells C. growth in number of cells of regular size d. growth in number of cells of expanding size MEDIUM 3. Microbial growth either in a natural environment or in a laboratory requires these physical requirements: a. proper pH b. appropriate ambient temperature c. correct osmolarity D. all of these e. only answers a and b are correct HARD 4. Chemical requirements for microbial growth include which of the following? a. carbon source for all microbes b. oxygen source for some microbes c. nitrogen source for all microbes d. phosphorus source for all microbes E. all of these are correct MEDIUM 5. Most microorganisms belong to which of the following categories? a. photoheterotrophs b. photoautotrophs C. chemoheterotrophs d. chemoautotrophs EASY 6. The measure of acidity in a microbe’s environment is measured by pH and is important because it can affect so many of the chemical reactions inside the cell, like chemical bonding and enzyme function. Most microbes generally prefer a pH range of a. 3.0 to 8.0 B. 6.5 to 7.5 c. 5.5 to 8.5 d. 6.5 to 8.5 HARD

2 7. For thousands of years humans have utilized the principles of acidity in food items as a way of preserving food in the absence of refrigeration. Which of the following cellular processes that you have already studied produces acidic products that will preserve food?

A. Fermentation b. Aerobic respiration c. Anaerobic respiration d. Glycolysis MEDIUM 8. Which of the following microorganisms actually prefer a more optimum acidic environment of 5 to 6 pH? a. bacteria B. fungi c. protozoa d. viruses e. algae EASY 9. All of the following are correct pairings of terms and their definitions except a. minimum growth temperature/lowest temperature that supports growth b. optimum growth temperature/temperature at which the most cells are produced c. maximum growth temperature/highest temperature that supports growth D. sustained growth temperature/temperature at which growth is barely supported EASY 10. Match the term describing a microbe’s preferred temperature range with the temperature in Celsius: Preferred Temperature Range Temperature in Celsius Psychrophile C a. above 80 degrees Mesophile B b. between 15 and 30 degrees Thermophile D c. below 15 degrees Hyperthermophile A d. above 50 degrees HARD 11. Which of the following cell types cannot protect itself from bursting when placed in a hypotonic environment?

A. animal cell b. bacteria c. fungi d. protozoa e. all of these EASY 12. In a hypertonic environment, which way will water flow via osmosis? a. into the cell B. out of the cell c. neither since movement of water particles in and out of the cell will be equal d. none of these MEDIUM 13. For a bacterium, what is the advantage of being a halophile like Staphylococcus aureus on human skin? a. less competition from other microbes for space

b. availability of more nutrients for growth c. lack of toxins from other microbes D. all of these are advantages e. only a and b are correct answers HARD 14. Which answer best completes this sentence? Carbon is a. the “backbone” for all organic macromolecules. b. acquired by photosynthetic organisms in a process called carbon dioxide fixation. c. acquired by chemoautotrophs via organic processes. d. acquired by chemoheterotrophs from food they “eat”.

E. answers a and d are correct.

MEDIUM 15. Examples of the enzymes that neutralize the damaging effects of superoxide free radicals are a. superoxide dismutase b. catalase and amylase C. superoxide dismutase and catalase d. superoxide dismutase, catalase and amylase EASY 16. Match the category of microbial oxygen requirement with its description: Microbial Oxygen Requirement Description Obligate aerobe C a. may use either fermentation or aerobic respiration Facultative anaerobe A b. can only grow in anaerobic conditions Aerotolerant anaerobe E c. must have oxygen for aerobic respiration Microaerophile D d. grow at low oxygen levels (2-10%) Obligate anaerobe B e. use fermentation but are not harmed by presence of oxygen HARD 17. Although classified as a micronutrient, the iron ion Fe+3 is a key metallic ion in the Electron Transport Chain of aerobic respiration. Which of the following statements concerning Fe+3 is not true? a. The low solubility of Fe+3 makes it difficult to obtain. b. Siderophores are chemicals that take iron from other chemical complexes. c. Pathogenic bacteria “steal” Fe+3 from host cells using siderophores.

D. Host cells themselves produce iron-binding proteins that have a lower affinity for Fe+3 than do the bacterial siderophores, thus preventing bacterial acquisition.

EASY 18. When we look at the ion and micronutrients required for microbial growth, which of these statements is true? a. Phosphorus is required for production of ATP and nucleic acids b. Sulfur is required for several amino acids found in proteins c. Potassium, sodium and chloride help maintain osmotic conditions inside the cell when external changes take place in the environment.

D. All of these are true.

9.2 Bacterial Reproduction and Growth

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EASY 19. What does a bacterium have to do before cell division can take place? a. using 2000 different genes, produce more than 2 million proteins b. synthesize peptidoglycan for new cell walls c. produce or collect basic materials needed for cellular metabolism D. all of these EASY 20. What are the three processes carried out in binary fission?

1. replication of the chromosome 2. partitioning of daughter chromosomes into new cells 3. division of the new cells 4. synthesis of peptidoglycan 5. accumulation of enzymes necessary for cell life A. 1, 2, and 3 are correct b. 1, 2, and 4 are correct c. 1, 4, and 3 are correct d. 1, 2, and 5 are correct MEDIUM 21. Where does the ring of contractile proteins form in the cell undergoing binary fission? a. at the origin of replication site b. at the termination of replication site C. in the center of the cell after replication is complete d. after the septum formation HARD 22. Which of the following statements is not descriptive of bacterial binary fission? a. DNA replication begins at the origin site and rapidly migrates to opposite sides of the cell b. the end of DNA replication is the terminal site in the middle of the cell c. the origin sites attach to proteins from the cytoskeleton and are moved to the sides d. formation of the ring of contractile proteins is inhibited by the presence of the nucleoids E. the two nucleiods remain towards the center while the ring of contractile proteins is formed EASY 23. Cell division in bacteria a. occurs via the relatively simple process of binary fission b. means that the number of cells triple with each division c. the new cells produced are referred to as a generation D. only a and c are correct e. all are correct

MEDIUM 24. Why do people often become sick from eating Thanksgiving Day leftovers that were not refrigerated within two hours of the meal?

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a. the warm food sitting on the table allows bacteria to grow exponentially in the food before it is refrigerated b. the food provides a lot of nutrients for the bacteria and they achieve exponential growth c. if left out overnight, the bacteria will continue to have optimal growth D. a and b are correct, but c is not e. a and c are correct, but b is not HARD 25. In the real world bacteria theoretically live in an “open system”, i.e. there is an abundant supply of nutrients to promote optimal exponential growth. However, this rarely happens after a period of time and growth in number slows because a. nutrients start to become scarce because of the high number of cells eating them b. the high number of cells are producing waste products that are harmful to new cells C. both a and b are correct d. only a is correct e. only b is correct MEDIUM 26. How does the exponential growth of bacterial cells affect their genetic diversity?

A. the greater the number of cells, the greater the expected number of spontaneous mutations b. it does not affect genetic diversity because binary fission is an asexual means of reproduction c. spontaneous mutations are usually “fixed” by enzymatic repair mechanisms and therefore do not last long d. most spontaneous mutations are lethal therefore the mutated cells would die out and not reproduce EASY 27. Match the Bacterial Growth Phase with its description: Bacterial Growth Phase Description Lag Phase B a. may last for hours or weeks as metabolic activities of cells change b. may last from an hour to several days depending on the species of Log Phase D bacterium Stationary Phase A c. cell numbers decline but not at a constant rate d. cells are most affected by antibiotics that disrupt the enzymes used in Death Phase C metabolic pathways EASY 28. Microbial density may be determined using all of the following methods except? a. Petroff-Hausser chamber b. Spectrophotometry c. Dilution Plating D. Streak Plating e. Filtration

EASY 29. Match the method of measuring cell density with its description: Method of Measuring Cell Density Description Petroff-Hausser chamber D a. either spread plate or pour plate method used

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Spectrophotometry C Dilution Plating A Filtration B

b. concentrates low numbers of bacteria before plating c. rapid determination of cell number via measurement of light absorbance d. number of cells/ml counted from known volume of fluid pipetted

HARD 30. Which of the following methods of measuring cell density would be the best to choose when you know that you do not have a lot of bacteria present in your sample? a. Petroff-Hausser chamber because you are visually counting bacteria b. Spectrophotometry because it is sensitive to low bacterial numbers c. dilution plating because you will be able to count between 30-300 cells on a plate D. filtration because the number of bacteria may be concentrated on the filter prior to plating MEDIUM 31. Which of the following methods of measuring cell density cannot distinguish between living and dead bacterial cells and thus may not provide the data needed in an actual infection or contamination (i.e. viable cell count)?

A. Spectrophotometry b. Direct Count c. Dilution Plating d. Filtration

9.3 Laboratory Growth of Microorganisms EASY 32. Which of these is an incorrect match?

A. growth medium/natural liquid or gel with nutrients to meet a microbe’s specific growth requirements b. inoculum/small amount of microbes placed in the growth medium c. colony/visible mass of cells all descended from same original cell d. pure culture/all cells in colony descended from single ancestor cell MEDIUM 33. The streak plate method a. used to obtain a pure culture from medium containing mixed population of microbes b. used to obtain pure cultures of bacteria and fungi c. works better with low concentrations of microbes D. answers a and b are correct e. answers a, b, and c are correct EASY 34. How are growth media classified? a. physical properties b. chemical properties c. intended function D. all of these MEDIUM 35. Physical classification of media include all of these except A. broths that are oil-based b. semisolids with agar isolated from red algae as thickening agent

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c. solid media in Petri dishes d. sterile liquid, semisolid or solid media HARD 36. The major differences between chemically defined and complex media include a. in chemically defined media all concentrations of every ingredient are known while in complex media these concentrations are not known b. chemically defined media contain carbon and energy sources as well as salts for osmotic balance and sources of ions, while complex media may also contain proteins for growth c. other ingredients may be added to either chemically defined or complex to provide additional nutrients D. all of these are included EASY 37. Match the medium with its description: Microbial Medium Description Complex D a. enhances growth of one group of microbes Enriched A b. inhibit growth of unwanted bacteria Selective B c. distinguish between two different types of bacteria Differential C d. exact chemical concentrations are unknown HARD 38. The selective media modified Thayer-Martin is used for identifying a. Neiserria meningitidis B. Neiserria gonorrheae c. Escherichia coli d. Salmonella enterica MEDIUM 39. Blood agar differentiates a. Alpha-hemolytic B. Beta-hemolytic c. Gamma-hemolytic d. Delta-hemolytic

.

like Streptococcus pyogenes from other Gram-positive cocci.

HARD 40. Some media are both selective and differential. MacConkey is selective in that it inhibits Gram-positive bacteria and differential in that it distinguishes from other coliforms that don’t ferment lactose. a. Salmonella enterica b. Salmonella typhi c. Shigella dystenteriae D. Escherichia coli

EASY 41. is a complex biofilm of bacteria that stick to your teeth. a. dental caries B. plaque c. adhesions

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d. matrix MEDIUM 42. Members of the communities that form biofilms may be described as to both cause diseases and resist antibiotics when growing together. a. antagonistic b. commensal C. synergistic d. parasitic

because of their ability

HARD 43. Which of the following statements concerning fecal bacteria that cannot be easily cultured in a lab is not true? a. 30% of bacteria seen under the microscope require anaerobic conditions B. 30% of bacteria seen under the microscope require microaerophilic conditions c. only 0.1 – 10% of bacteria present in a soil or aquatic sample will grow in a lab d. if they are members of a biofilm their survival may depend on their interrelationships MEDIUM 44. Biofilms may be described as a. complex community of microorganisms that adhere to a solid surface via a matrix b. complex community of microorganisms in which one organism’s waste products may serve as a primary nutrient for another microbe c. microorganisms living near the top of a biofilm may be aerobic and use enough of the oxygen present to make the lower layers either microaerophilic or anaerobic. d. only answers a and b are correct E. all answers are correct

9.4 Microbial Cultures in Clinical Practice EASY 45. What services does a clinical microbiology lab provide physicians and their patients? a. determination if a patient’s illness is caused by a microbe b. identification of the suspected microbe c. determination of antimicrobial susceptibility to aid antibiotic therapy D. all of these are correct MEDIUM 46. Why are actual specimens preferred over swabs of a specimen? a. specimen swabs pick up only targeted microbes b. specimen swabs only carry very small volumes of the specimen c. it is difficult to separate bacterial or fungal cells from the swab fibers in order to plate them or put them into broth D. only answers b and c are correct e. all of these are correct HARD 47. Which of these statements does not accurately reflect the culture methods used in a clinical setting? a. selective and/or differential media may be used in making a preliminary identification of the pathogen b. potential pathogens may be selected and then screened using biochemical tests that produce rapid results.

C. often interim reports with preliminary identification may be completed within 48 hours

d. For a bacterium the entire lab process from specimen delivery to final report usually takes 2-3 days. e. For a fungus the entire lab process from specimen delivery to final report may require as long as two weeks.

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MEDIUM 48. Characteristics of nonculture techniques include all of these except a. completion in minutes to as little as 8 hours b. these techniques utilize tests for microbial products or DNA/RNA sequencing C. test kits often use general antibodies that target microbial antigens d. antibody-based tests include agglutination and direct fluorescent antibody assays e. ELISA tests are one type of antibody test that rely on easily seen color changes EASY 49. Match the specimen sample with the appropriate collection/transport technique: Specimen Collection/Transport Technique Specimens taken from surfaces like wounds E a. refrigerated sterile containers with secure lids Stool, sputum or urine samples A b. needle aspirates Deep infections B c. Analysis performed on 2nd of 4 collection tubes d. Sample bottles cultured aerobically and Blood samples D anaerobically Cerebrospinal Fluid e. culturettes MEDIUM 50. Because pathogenic microbes often contain unique DNA sequences, PCR or Polymerase Chain Reaction is a technique used in the lab to make many copies of short DNA sequences. The correct order of cycling steps in this process is: a. heat to 72 deg. C, cool to 55 deg. C, heat to 95 deg. C B. heat to 95 deg. C, cool to 55 deg. C., heat to 72 deg. C c. heat to 85 deg. C, cool to 50 deg. C., heat to 62 deg. C d. heat to 62 deg. C, cool to 50 deg. C., heat to 85 deg. C HARD 51. PCR is an accurate and fast way of identifying a pathogen because a. it is highly sensitive to very low concentrations of a pathogen’s DNA b. it is very specific and can detect even small amounts of a pathogen in a specimen c. it can detect RNA viruses via the production of cDNA gene using reverse transcriptase D. all of these are true e. only a and b are true

EASY 52. Which of the following statements are true? a. Protozoa and helminthes do not have to be cultured. b. Pulse-field gel electrophoresis is used to identify bacterial strains of a pathogen in an outbreak c. Immunological assays are often used in viral infections d. only a and c are correct

E. all are correct

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9.5 Controlling Microbial Growth EASY 53. Match the term with its correct definition: Term Definition Sterilization C a. reduction of infection risk on living tissue Disinfection D b. nontoxic chemicals used to inhibit growth of microbes on food Antisepsis A c. destruction or removal of all microbes Preservatives B d. destruction or removal of microbes capable of infection EASY 54. All of the following are physical methods of microbial control except a. use of high and low temperatures b. filtration c. high osmolarity D. using alcohol gel e. drying MEDIUM 55. Match the physical method of microbial control with its effect on microbes: Physical method of microbial control Effect on microbes Heating – boiling D a. pores block microbes that are too large to pass through Heating – steam under pressure E b. used to slow or stop metabolism and growth Pasteurization C c. reduction of pathogens and spoilage microbe in liquids Cooling B d. breaks H bonds denaturing proteins and nucleic acids Filtration A e. forces hot water vapor into endospores EASY 56. Fermentation and desiccation are methods that have been used for thousands of years to preserve food.

Which of the following statements concerning these methods is not true?

A. fermentation produces byproducts that raise pH thus inhibiting microbial growth on food b. desiccation removes water cellular water necessary for survival and growth in dried food like raisins c. salt and sugar can be added to food to pull out water via solution osmolarity d. fruits can be preserved as jams and jellies d. meats and fish are usually heavily salted

HARD 57. What are the major differences between Ultraviolet and Ionizing radiation? a. Both are electromagnetic radiation, but UV has wavelengths between 200-400nm while Xrays and gamma rays have wavelengths between 0.01 – 0.1 nm. b. In surface tissue UV radiation will form thymine dimers in DNA that potentially block DNA replication while Ionizing radiation like gamma rays will break up double-stranded DNA.

c. UV rays have great penetrating power, whereas Ionizing radiation will not penetrate many solids and liquids. d. answers a, b, and c are correct E. answers a and b are correct

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HARD 58. Match the class of chemical agent with its mechanism of action: Class of Chemical Agent Mechanism of Action Alcohols A a. 60-80% solutions rapidly denature proteins Surfactants C b. Loss of membrane structure or function Halogens E c. dissolve lipids and disrupt cell membranes Phenolics B d. disrupt cell membranes while denaturing essential proteins Quaternary Ammonium e. disrupt and oxidize protein and nucleic acid structure Compounds D MEDIUM 59. Cleaning with soap and water a. is often required before antisepsis because the presence of organic material may interfere with other chemicals. b. is usually accomplished manually. c. produces a friction via the scrubbing motion and this traps microbes in the debris that is rinsed off. d. often takes too long so other faster methods are substituted.

E. all of these are correct.

EASY 60. Which of the following chemicals may be used to sterilize heat-sensitive material? a. glutaradehyde sterilizes tubing b. formaldehyde preserves viral vaccines and anatomical specimens c. ethylene oxide gas sterilizes materials that are both heat and moisture sensitive D. all of these prevent normal metabolism and nucleic acid replication and thus may be used

CRITICAL THINKING MEDIUM 61. While all of these agents are at least 99% effective in removing and/or killing bacteria on human hands, according to recent research which is the most effective? a. soap b. 4% chlorhexidine gluconate c. 7.5% povidone-iodine surgical scrub d. 62% ethanol foam E. 70% isopropanol gel HARD 62. The major characteristics of chemical control agents as a group includes all of these except? a. They may be placed into 3 groups based on strength of control: sterilants, disinfectants and antiseptics b. Their primary function is to outright kill or inhibit growth of microbes C. Classes that are commonly used to control microbial growth for public health purposes do not include surfactants and alcohols.

d. They have different toxicities that govern their safe use. e. Some of these are so toxic that they must be used under strict supervision and/or restricted places

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CH. 10 – INNATE IMMUNITY 10.1 An Introduction to Immunity EASY 1. What are the three strategies demonstrated by host immunity? a. First-line defenses that are nonspecific, relying on physical and chemical barricades b. Second-line internal cellular defenses that are nonspecific, contain pathogens and destroy them c. Third-line defenses that are nonspecific and adaptive D. a and b are correct e. all are correct MEDIUM 2. While the Immune System protects us against invading pathogens, there are some undesirable potential consequences to its actions. These include all of the following except: a. autoimmune diseases like type I diabetes and multiple sclerosis b. graft and donor organ rejections c. hypersensitivity reactions known as allergies D. inflammatory responses to breaching of the skin like cuts and scrapes EASY 3. What allows the immune system to distinguish between body cells that are normal and healthy (“self”) versus foreign invaders that may be pathogens (“non-self”)?

A. protein and glycoprotein markers on cell membranes that serve as ID cards saying “Self” b. lipid molecules in cell membranes that serve as ID cards saying “Self” c. genes on the chromosomes that identify the cell as “Self” d. all of these are correct EASY 4. What are the two major types of immunity in the human body? a. adaptive and cell-mediated B. innate and adaptive c. humoral and cell-mediated d. innate and humoral MEDIUM 5. Which of the following is an incorrect match? a. first line of defense/nonspecific physical blockades and chemical deterrents b. nonspecific defenses/same no matter the type of invading pathogen C. innate/need rehearsal to become perfect defenses d. adaptive/pathogen specific and learned HARD 6. Match the form of immunity with its appropriate example: Form of Immunity Example Natural passive immunity B a. recovery from infection by specific pathogen Natural active immunity A b. immune proteins in breast milk Artificial passive immunity D c. vaccine injection Artificial active immunity C d. injection of antivenom

2 EASY 7. The skin represents which type of first-line defense?

A. physical b. chemical c. genetic d. humoral MEDIUM 8. “Washings” work because they prevent the pathogen from attaching to body tissues. Which of the following is not a type of washing? a. tears b. saliva C. mucus d. perspiration e. urination EASY 9. Chemical defenses include all of these except: a. sebaceous secretions b. perspiration c. tears d. mucus E. urination MEDIUM 10. Second-line defenses include a. dendritic cells b. neutrophils c. macrophages d. only b and c are correct E. all are correct HARD 11. What characteristics of the Innate Immunity make it so successful in fighting of any pathogen that tries to enter the human body? a. speed of response b. same intensity of protective mechanisms c. combination of physical, chemical and genetic components d. only a and b are correct E. all are correct EASY 12. The anatomy of the immune system incorporates components of which of the following: a. circulatory system b. lymphatic system c. reticuloendothelial system d. only b and c are correct E. all are correct

3 EASY 13. The circulatory system provides for use in the immune system. a. network of blood vessels b. movement of nutrients to the tissues c. removal of waste products from the tissues d. dissolved chemicals particularly electrolytes and hormones E. all of these are correct MEDIUM 14. Lymphatic vessels are blind-ended and are found everywhere in the human body except for these immune-privileged areas: a. brain and eyes b. testes and placenta C. a and b are correct d. gastrointestinal and respiratory systems e. all are correct MEDIUM 15. The reticuloendothelial system (RES) a. is also known as the MPS or mononuclear phagocyte system b. is made of a variety of nonphagocytic cells c. facilitates movement of these phagocytic cells into surrounding tissues D. only a and c are correct e. all are correct HARD 16. Match the phagocytic cell type with its location in the human body: Phagocytic Cell Type Location in Human Body Monocytes C a. Liver Neutrophils D b. Skin Dendritic Cells E c. Blood Kupffer Cells A d. Blood Langerhans Cells B e. Lymph nodes, Thymus MEDUM 17. As a secondary lymphoid organ, the spleen functions to a. filter antigens from the lymph B. filter pathogens from the blood c. eliminate pathogens the host encounters through eating d. eliminate pathogens the host encounters through breathing e. select and differentiate among T cells EASY 18. While B cells differentiate in the bone marrow of the long and flat bones, T cells differentiate in the a. Bursa of Fabricius b. MALT C. Thymus

d. spleen MEDIUM 19. What is a dendritic cell? a. principal phagocytic cell with projections from cell membrane b. leukocyte that directly eliminates ingested pathogens in innate immunity c. leukocyte that directly activates lymphocytes in adaptive immunity D. all are correct e. Only a and c are correct HARD 20. Mucosa-associated lymphoid tissue (MALT) includes all of the following except a. BALT b. GALT C. HALT d. Peyer’s Patches e. appendix

10.2 First–Line Defense Mechanisms EASY 21. What characteristics of the skin make it an effective barrier against pathogens? a. epidermis contains keratin b. cells are connected via tight junctions c. skin cells are constantly sloughed off d. mucous membranes secrete slippery mucus E. all of these are correct MEDIUM 22. In the context of Innate Immunity, washing has several different meanings. These include all of the following except a. sweat that flush away microbes on the skin b. tears that flush the eyes c. vomiting and diarrhea to quickly remove gastrointestinal pathogens D. mucociliary escalator that traps and retains microbes in the respiratory tract EASY 23. Washing often means flushing microbes out of the human body. All of these are example of washing except A. occasional urination to empty the bladder and urethra b. mucus discharge from the vagina of women c. pathogens entering the mouth are washed into the stomach to be destroyed by the acidity there d. sneezing to forcefully remove microbes and debris from the sinuses MEDIUM 24. A little bit of fever is a good thing in Innate Immunity as it a. slows bacterial pathogen growth by denaturing enzymes b. increases the number of leukocytes being produced c. stimulates the production of interferon to fight viruses

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D. all of these are correct e. only a and b are correct HARD 25. In your text a study of the correlation of fever with growth of pneumococcal meningitis in rabbits demonstrated that a. as body temperature increases so does the bacterial growth rate b. there is an inverse proportion between body temperature and bacterial growth rate c. there is a direct proportion between body temperature and bacterial growth rate d. only a and c are correct E. only b is correct EASY 26. In the Case Study on eating spicy food from your text, what bacterium was causing Jack’s ulcer? a. Salmonella typhi B. Helicobacter pylori c. Escherichia coli d. Enterobacter aerogenes MEDIUM 27. What steps are necessary for the bacterium that caused Jack’s ulcer to survive the low pH of the stomach? a. ammonia neutralizes the hydrochloric acid in the stomach b. breakdown of urea producing carbon dioxide and ammonia c. production of urease D. all of these steps are necessary e. only steps a and b are necessary HARD 28. What was the color change in the CLO Test performed in that lab that confirmed the diagnosis?

A. yellow to hot pink b. red to yellow c. red to hot pink d. yellow to blue EASY 29. Examples of chemicals produced by the body that help Innate Immunity get rid of pathogens include all of the following except a. lysozyme b. salt C. peptidoglycan d. mucus e. bile MEDIUM 30. Much as been made of the importance of your normal microbiota as part of your first and second lines of defense in Innate Immunity. As shown in your text from the Human Microbiome Project, these microbes change as we develop and age from infancy to old age. Which of the following bacteria are most often found in infants? a. Firmicutes b. Bacteroidetes

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C. Actinobacteria d. Proteobacteria HARD 31. What factor can most influence not only the species diversity of your normal microbiota but subsequently your health?

A. nutritional quality and quantity b. obesity c. heart disease d. cancer e. diabetes

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EASY 32. Recent research has shown that this feature of our modern lives may actually be decreasing the diversity of our gut microbiota resulting in an increased rate of autoimmune disorders: a. improved sanitation practices b. antibiotic use for disease control c. increased sugar consumption D. answers a and b are correct e. all are correct

10.3 Innate Cellular Defense Mechanisms EASY 33. What is the correct definition of hematopoiesis? a. process that occurs in the bone marrow to 1 in 2000 bone marrow cells b. differentiation of pluripotent stem cells into all the different types of blood cells c. process in which pluripotent stem cells are influenced by cytokines to turn on and off different genes, thereby producing erythrocytes, platelets and leukocytes D. all of these are correct e. only answer b is correct MEDIUM 34. Match the immature blood cells with their mature counterparts: Immature Blood Cells Mature Blood Cell Erythroblast D a. Platelets Megakaryoblast A b. Monocyte Monoblast B c. Neutrophil, eosinophil, basophil Myeloblast C d. Red blood cell EASY 35. Which of the following blood cells is not a granulocyte? a. neutrophil B. monocyte c. eosinophil d. basophil e. Mast cell

7 MEDIUM 36. Which of the following blood cells is the most abundant type of leukocyte with daily production of almost 10+11 ? a. basophil b. eosinophil C. neutrophil d. monocyte HARD 37. A differential blood count smear will all of the following except: a. provide information about the number of each type of leukocyte present in the sample B. need to be stained with Crystal Violet c. be scanned to observe 100 leukocytes in the sample under the microscope d. assist with the diagnosis of a patient’s condition EASY 38. Pathogen-associated molecular patterns (PAMPs) a. are the same type of molecule found on the surface of many pathogens b. include common chemicals like lipoteichoic acid and lipid A c. are recognized by NK cells, macrophages, dendritic cells and neutrophils d. answers b and c are correct E. all of these are correct MEDIUM 39. Receptors involved with PAMPs are a. Pattern Recognition Receptors (PRR) b. usually found within cells to provide optimum binding opportunities to PAMPs c. special PRRs like Toll-like receptors (TLRs) that are located in two places: both cell and phagosome membranes d. answers a and c are correct E. all of these are correct HARD 40. The binding of PRRs to PAMPs is responsible for these examples of intracellular signaling that results in elimination of the pathogen: a. granule exocytosis is utilized by NK cells b. perforin produces pores or holes in the pathogen’s membrane that allow entry of granzymes into target cell c. granzyme produces a cascade of chemical events that results in binary fusion of the pathogen D. answers a and b are correct e. all of these are correct EASY 41. These leukocytes are able to carry out phagocytosis of pathogens: a. neutrophils b. monocytes c. eosinophils d. dendritic cells

E. all are correct except c MEDIUM 42. Phagocytosis is facilitated in all of these ways except a. PAMPs bind directly to PRRs on surface of phagocyte b. opsonization occurs covering the pathogen surface with opsonins c. opsonins bind surface receptors on phagocytes triggering engulfment of the pathogen D. opsonins help produce the extracellular vesicle called a opsoninsome HARD 43. Chemical intracellular killing mechanisms generated during phagocytosis include all of the following except a. pH of 4 within phagosome b. enzymes degrade pathogen’s cell wall c. defensing proteins create pores in cell wall of pathogen D. respiratory burst from carbon dioxide oxidizes proteins and lipids e. enzyme-generated nitric oxide EASY 44. Inflammation is characterized by these signs and symptoms except a. redness B. stiffness c. swelling d. pain e. heat EASY 45. Inflammation may be triggered by a. physical trauma b. chemical damage c. pathogen attack d. exposure to allergen E. all of these MEDIUM 46. The inflammatory process promotes a. bringing phagocytic cells to site of injury b. walling off invading pathogens to keep them from further tissue penetration c. return to homeostasis by repair of tissue damage d. only a and b are correct E. all are correct HARD 47. Acute inflammatory responses may be characterized by all of the following except a. last for only 48-72 hours b. usually involve mainly neutrophils and monocytes c. include healing of infected skin abrasions D. usually involves lymphocytes, monocytes and plasma cells

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9 MEDIUM 48. The correct sequence of steps involved in the inflammatory response is 1. diapedesis of leukocytes out of capillaries and into surrounding tissues 2. enhanced blood flow to injured area with subsequent development of heat and redness 3. release of inflammatory mediators from a variety of sources triggering vasodilation 4. plasma leaves blood vessels brining various agents of help to damaged tissue 5. macrophages and lymphocytes get rid of pus and cellular debris, and homeostasis is reestablished 6. increased fluid in tissues leads to edema, pain and phagocytosis of invading pathogens A. 3, 2, 1, 4, 6, 5

b. 1, 2, 3, 4, 5

c. 1, 3, 5, 6, 4, 2

d. 2, 3, 1, 4, 6, 5

10.4 Protein-Mediated Defense Mechanisms EASY 49. The complement system a. is a series of 30+ serum and surface proteins b. works with antibodies and phagocytes by sequentially activating enzymes c. helps create transmembrane tubes that cause rupture of pathogen osmotically D. all are correct e. only a and b are correct MEDIUM 50. Which of the following statements about the complement system is false?

A. It is composed of active proteins found in the blood, interstitial fluid and lymph. b. These inactive proteins bind either to microbes or to the antibodies attached to microbes. c. The process of binding starts a pathway of events in which proteins are changed into active enzyme complexes that affect other complement proteins. d. The pieces of the chopped up proteins bind to the pathogen and generate a transmembrane tube. e. The transmembrane tube causes lysis of the pathogenic bacteria.

EASY 51. Which of the three complement pathways represent an innate immune response? a. classical b. alternative c. lectin d. classical and alternative E. alternative and lectin HARD 52. Complete this statement: While the classical pathway represents the the pathway is used when the pathway fails.

A. adaptive/lectin/alternative b. alternative/adaptive/lectin c. lectin/alternative/adaptive d. adaptive/alternative/lectin

immune response,

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EASY 53. Interferons (IFNs) a. are a big group of glycoprotein cytokines b. name comes from their ability to interfere with viral replication cycles c. provide host cell protection from viral infection D. all are correct e. only b and c are correct MEDIUM 54. Interferons (IFNs) a. are proteins made and secreted by host cell in response to viral pathogen presence b. alpha and beta interferons are known as Type II Interferons and provide antiviral defense c. gamma interferons inhibit growth of cancerous cells and stimulate inflammation d. all are correct E. only a and c are correct HARD 55. The correct sequence of events in the action of interferon is 1. viral infection of host cells causing rapid production and secretion of Type I IFNs 2. host cell produces antiviral proteins that can degrade viral RNA, inhibit protein synthesis and virion assembly and prevent viral gene expression 3. modification of neighboring cell’s gene expression induces an antiviral state 4. binding of IFNs to receptors on uninfected neighboring cells a. 1, 2, 3, 4

B. 1, 4, 3, 2

c. 2, 1, 4, 3

d. 3, 1, 4, 2

EASY 56. IFNs produced using recombinant DNA technology are being used with less side effects in patients infected with all of the following except a. Hepatitis B b. Hepatitis C c. Genital Herpes D. Hepatitis A e. HIV MEDIUM 57. Why have naturally produced IFNs proven to be relatively ineffective? a. they are unstable b. they do not remain functional long enough to work on chronic infections c. they are unable to stop viral replication in previously infected cells d. they produce many side effects ranging form annoying to dangerous E. all of these

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MEDIUM 58. Because iron acquisition is an important step in cell growth, many bacteria secrete siderophore proteins that will try to remove iron from host proteins. Which of these host proteins will not take up iron and thus make it unavailable for bacterial use? a. hemoglobin B. antiferrin c. lactoferrin d. transferrin e. ferritin HARD 59. Match the cytokine with its principal effect: Cytokine Principal Effect Histamine D a. stimulate smooth muscle contraction Leukotrienes A b. neurotransmitter Prostaglandins C c. stimulate inflammation Serotonin B d. increases vascular permeability MEDIUM 60. Which of the following is not a characteristic of antimicrobial peptides?

A. are only 55-75 amino acids in length b. seceted by epithelial cells, neutrophils, NK cells and some T cells c. bind to membranes of fungi and bacteria to open pores resulting in impaired membrane permeability d. cause osmotic cell lysis e. defensins and protegrins are common examples

CRITICAL THINKING MEDIUM 61. Which of the following adjectives may be used to accurately describe how the innate immune system protects us against infection? a. immediate – occurs quickly b. nonspecific – identity of pathogen is not important c. consistent – works same way every time without rehearsal d. a and b are correct E. all are correct

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CH. 11 – ADAPTIVE IMMUNITY 11.1 Introduction to Adaptive Immunity EASY 1. Some of the major characteristics of Adaptive Immunity include all of these except a. it is the third line of defense b. it involves the lymphocytes C. it usually results in lifelong immunity against all pathogens d. it is composed of two parts: cell-mediated and antibody-mediated responses e. it is based on specificity of pathogen MEDIUM 2. Your text talks about the “Hallmarks of Adaptive Immunity” – what does this mean? a. its specificity and memory b. specificity is the ability of an adaptive immune response to recognize and respond to a specific pathogen c. memory means that with each exposure to the same specific pathogen the immune system launches an even bigger attack D. all of these are correct HARD 3. Match the features and benefits of adaptive immunity Feature Benefit Specificity B a. elimination of autoreactive cells to prevent host damage Memory C b. targeting of unique molecular configurations to customize effective killing Self-limitation D c. response enhanced with each re-exposure to an antigen Self-tolerance A d. feedback maintains homeostasis and shuts down system when war is over EASY 4. All of these are accurate descriptions of an epitope except a. is also known as an antigenic determinant B. is a nonspecific portion of antigen that binds to and triggers adaptive immune response c. is part of a macromolecule known as an antigen d. binds 3-dimensionally to receptor on surface of T or B cell like a “lock and key” MEDIUM 5. What features of an antigen influence immunogenicity? a. size: antigens must be small enough to activate an immune response b. multiple epitopes: results in multiple different but highly specific adaptive responses c. molecular complexity: helps maintenance of shape that results in high immunogenicity D. only b and c are correct e. all are correct

MEDIUM

2 6. Evidence that differences in antigens do influence immunogenicity include all of these except a. complex molecules are more immunogenic than simpler ones because of multiple regions able to bind to lymphocytes b. complex molecules including proteins, glycoproteins, lipoproteins, nucleoproteins, lipopolysaccharides, etc., maintain their shape thereby helping binding c. macromolecules with highly repetitive portions aren’t usually good antigens because they are easily broken up into fragments that are too small for binding D. some large molecules like haptens are too big to elicit an immune response HARD 7. The following statements about conjugate vaccines are true except A. large fragments like sugars are covalently bound to a larger protein carrier b. the new complex foreign macromolecule is called a conjugated antigen c. conjugated antigens have epitopes that are now large enough to bind to receptors D. all of these are correct except a EASY 8. B and T lymphocytes mature a. in the secondary lymphoid tissue B. in the primary lymphoid tissue c. in the lymph nodes d. in the spleen MEDIUM 9.Which of the following is the correct sequence of events in the maturation of the B and T lymphocytes?

1. Immature T cells in thymus and immature B cells in bone marrow undergo rapid mitosis under influence of specific cytokines 4. Segments of genes that produce lymphocyte receptors are spliced and rearranged to produce almost 1018 different receptors.

3. Cells failing to produce a functional receptor are eliminated via apoptosis 2. Antigen receptors on immature T and B cells are screened during positive selection so that only useful receptors are generated.

5. After passing positive selection, T and B cells complete maturation process and start their patrol of the body for the presence of pathogens.

A. 1, 4, 3, 2, 5

b. 4, 1, 2, 3, 5

c. 2, 1, 4, 3, 5

d. 1, 2, 4, 3, 5

HARD 10. How do autoimmune diseases like rheumatoid arthritis, Type I diabetes and Multiple Sclerosis develop? a. when an immune system malfunction with self-destructive immune responses occur b. when some T and B cells have receptors that bind strongly to self-antigens on the surface of host cells c. when negative selection at the second checkpoint in lymphocyte maturation fails d. only a and b are correct E. all are correct EASY 11. The two checkpoints in lymphocyte maturation occur

3 A. immediately after mitotic division and at positive selection b. before mitotic division and at positive selection c. immediately after mitotic division and at negative selection d. before mitotic division and at negative selection MEDIUM 12. Clonal selection and expansion may be described as a. binding of pathogen to antigen receptor on lymphocyte initiating rapid mitosis of lymphocyte b. all members of the new “lymphocyte army” having the same epitope specificity c. dissemination of memory cells having a different epitope specificity D. only a and b are correct e. all are correct HARD 13. Secreted cytokines activate pathogen-eliminating mechanisms in the lymphocytes that include a. antibody production in B lymphocytes b. increased inflammation c. lysis of protozoan-infected cells D. only a and b are correct e. all are correct EASY 14. When clonal selection and expansion occurs in a lymph node a. the selected lymphocyte that has the receptor to bind to the pathogen undergoes rapid mitosis b. the cells resulting from this mitosis are genetically identical clones c. clonal expansion in the lymph node results in an enlarged and painful area D. all are correct e. all except c are correct MEDIUM 15. Memory cells may best be described as a. effector lymphocytes b. cells that do not become effector lymphocytes c. cells that disseminate throughout the body d. a and c are correct E. b and c are correct EASY 16. The value of having memory cells is that they can A. respond rapidly when the same pathogen tries to invade again b. rapidly become effector lymphocytes c. remember the specificity of a particular pathogen in a subsequent invasion D. only a and c are correct e. all are correct MEDIUM 17. “Memory” cells are especially effective against future invasions of the same pathogen because

4 a. they are disseminated throughout the body b. they have the capability of binding immediately to the invading pathogen c. they remember the chemical specificity of the pathogen d. they have been produced through clonal selection and expansion E. all are correct HARD 18. The Major Histocompatibility Complex (MHC) is a. a set of genes that provide the blueprint for surface proteins serving as individual identification markers on cells b. a set of genes that provide the blueprint for surface proteins that participate in the binding necessary for T-cell activation c. a set of genes with many variations in alleles that are recessively expressed d. a set of genes that can produces more than 1013 possible MHC proteins E. all of these are correct except C EASY 19. How many classes of MHC molecules participate in various immune functions?

A. There are 3 classes. b. There are 4 classes. c. There are 2 classes but one class is divided. d. There are 5 classes.

MEDIUM 20. Which of the following functions are performed by the Class I and Class II MHC molecules? a. self-identification markers on cells b. responsible for T-cell mediated rejection of transplanted tissues that do not match c. interact with T-cell receptors to activate T-cells d. help B cells recognize protein antigens E. all are correct with the exception of D EASY 21. Match the MHC Class with its correct location in the body: MHC Class Body Location IB a. In plasma and lymph II C b. Surface of all nucleated cells III A c. Surface of phagocytic cells MEDIUM 22. Match the MHC Class with its correct function in the immune system: MHC Class Function IA a. serves as a self-identification marker, helps activate T-cells II C b. promotes inflammation, serves as components of complement system c. serves as a self-identification marker, binds fragments of antigens for display to TIII B cells thus promoting activation HARD 23. What two key things must be done to decrease the possibility of transplant failure?

5 a. matching of MHC Class I molecules b. monitoring of CD45RC enzymes c. matching of MHC Class II molecules D. a and b are correct e. b and c are correct

11.2 Cell-mediated Responses EASY 22. Which of the following subsets of T-cells express CD4 surface glycoproteins? a. Helper T (TH) cells b. Regulatory T (TR) cells c. Cytotoxic T (TC) cells D. only a and b are correct e. only a and c are correct MEDIUM 23. Match the T-cell subset with its primary functions: T-Cell Subset Primary Functions TH1 D a. stimulates IgE production TH2 A b. inhibits autoimmunity TH17 E c. eliminates virus-infected cells, cancer cells and foreign cells TR B d. stimulates IgG production TC C e. promotes inflammation EASY 24. Antigen-processing pathways correlate with what cellular feature? a. location of MHC Class I molecule b. location of MHC Class II molecule C. location of foreign protein d. location of neoantigen MEDIUM 25. A neoantigen is a. formed by the binding of a processed antigen in the cleft of a Class I MHC molecule b. formed within the endoplasmic reticulum of a Eukaryote host cell c. displayed on the host cell membrane thus allowing binding to the T-Cell Receptor (TCR) and CD8 Coreceptor a Cytotoxic T cell d. an antigen fragment bound to Class I MHC molecule that allows Tc cells to bind to host cell that are “sick” E. all of these are correct

HARD 26. What single feature distinguishes the T-cell categories?

A. surface proteins that act as coreceptors assisting the TCRs with antigen binding and T-cell activation

6 b. surface proteins that act like interleukins as cell messengers c. intracelleular proteins that mediate immune responses and stimulate clonal selection and expansion d. intercellular proteins that activate leukocytes.

EASY 27. What is the role of natural killer T cells? a. stimulate clonal selection and expansion of T cells b. specifically target lipid antigens like those in Mycobacterium tuberculosis c. coordinate adaptive responses via cytokine secretion D. only b and c are correct e. only a and b are correct MEDIUM 28. What is the difference between processing of cytosolic proteins and phagocytized proteins? a. foreign proteins from viruses, intracellular bacteria or cancer cells are broken up by proteasome and associate with Class I MHC molecules b. extracellular pathogens are engulfed by phagocytic cells that break up their proteins and leftover antigen fragments bind with Class II MHC molecules C. both a and b are correct d. only a is correct e. only b is correct EASY 29. What is a proteasome and what role does it play in antigen processing? a. tubelike protein complex that recognizes and unfolds foreign proteins b. tubelike protein complex that threads foreign protein through enzymatic tube for cleavage c. tubelike protein found only in bacteria that digests foreign proteins D. a and b are correct e. a and c are correct MEDIUM 30. Adaptive responses by T cells are aimed at a. the entire pathogen b. a small pathogenic epitope from the pathogen c. protein fragment from a microbe D. b and c are correct e. a and c are correct EASY 31. Antigen-presenting cells (APCs) are most commonly a. B cells, macrophages and neutrophils b. B cells, neutrophils and eosinophils C. B cells, macrophages and dendritic cells d. B cells, dendritic cells and basophils HARD 32. Which of these does not describe a T-Cell Receptor (TCR)? a. composed of two glycoprotein chains covalently linked by extracellular disulfide bridge.

7 B. one peptide contains a constant region while the other peptide has a variable region c. each chain has a hydrophobic transmembrane region and a short hydrophilic tail extending into the cytoplasm d. variable regions differ greatly and recognize a diverse set of processed antigens.

EASY 33. What is CD3 and what is its role in message transmission? a. a dimer found on all mature T cells b. a pair of CD3 are found on either side of the TCR and are responsible for transmitting message into cytosol that antigen has bound to the T cell. c. chain reaction occurs with antigen binding to TCR causing a conformational change in receptor D. all of these are correct MEDIUM 34. Which of the following is an accurate description of “associative recognition”?

A. The TCR binds specifically to both the processed antigen held in the peptide-binding cleft and to portion of the Class I MHC molecule holding it. b. The extracellular CD8 marker binds with the Class I MHC molecule c. Modifications of the long cytosolic domains of the CD3 allows the TCR to participate in reactions that generate an intracellular signal. d. An APC displays antigen-loaded Class II MHC molecules for binding to T cells with CD4 coreceptors.

11.3 T-Cell Activation EASY 35. What is a hallmark feature of T-Cell activation? a. unique binding of the TCR to a processed antigen B. unique binding of the TCR to a neoantigen. d. combination of associative recognition plus coreceptor binding d. initiation of correct activation signal leading to a cell-mediated adaptive response MEDIUM 36. The cell-mediated adaptive response is preceded by a. combination of associative recognition plus coreceptor binding b. initiation of correct activation signal c. substantial alteration in surface protein composition D. a and b are correct e. a and c are correct

EASY 37. What are the major parts of T-Cell Activation? a. major alteration in surface protein composition within hours of antigen recognition

8 b. retention of T-cells in lymphoid organs allowing cytokine exposure necessary to continue activation process. c. enhanced migration of T cells to peripheral sites of injury and infection d. T-cell secretion of cytokines to promote the effector functions of APCs. E. all of these are major parts MEDIUM 38. What is significant about the transient production of IL-2? a. It is part of T cell activation. b. As it secreted by the T Cell, IL-2 binds with strong affinity to IL-2 receptors of the T-Cell surface c. IL-2/receptor binding inhibits cellular apoptosis and drives the cells into the final stages of activation d. IL-2 signaling triggers clonal expansion of T cells E. all of these are significant HARD 39. Which of the following statements about completion of T-Cell activation is not true? a. IL-2 signaling is the ultimate trigger for clonal expansion b. the number of T cells that target a specific epitope rises to 1 out of every 3 lymphocytes C. all of these target specific T cells are produced within one month d. TH1 and TH2 cells activate macrophages and eosinophils, increase mucosal secretions and elevate inflammatory responses e. TC effector cells target cells infected with intracellular pathogens for lysis EASY 40. Why are these T effector cells short-lived?

A. because they are so effective in eliminating the specific targeted pathogen b. because they do not have a nucleus c. because they are killed in the process d. because they do not have a cell wall to protect them MEDIUM 41. What happens to the specific T cells that do not differentiate into effectors following clonal expansion? a. they are held aside as Memory cells b. they form an “army” of epitope-specific cells that are dispersed system wide c. they are primed to undergo immediate T-Cell activation if the epitope is ever encountered again d. only b and c are correct E. all are correct

HARD 42. The Mantoux Test is used to detect possible patient exposure to Mycobacterium tuberculosis. Which of the following statements is not true?

9 a. The test utilizes a small amount of protein derived from the pathogen that is injected under the skin of the forearm.

B. A patient who has already been exposed to TB will have an instantaneous reaction. c. If within several days a bump or induration forms and measures more than 5 mm in diameter, this is considered a positive Mantoux test for TB exposure. d. The reaction is the result of Memory TH cells that have launched a strong attack to the TB pathogen.

11.4 Antibody-mediated Responses EASY 43. There are classes of molecules that can both chemically recognize the presence of antigens and participate in the resulting immune responses. a. two B. three c. four d. five EASY 44. The major characteristics of antibodies include all of the following except a. ability to bind to antigens b. ability to distinguish between similar epitopes c. ability to be either membrane-bound or free-floating in the body fluids such as plasma and lymph D. membrane-bound antibodies serve as antigen receptors on T cells e. are grouped into 5 different classes MEDIUM 45. Antibodies trigger all of the following antibody-mediated reactions except a. neutralize pathogen and/or their exotoxins b. activate the classical complement pathway c. promote opsonization D. activate T cells e. trigger cell lysis MEDIUM 46. Which of the following statements about antibodies is not true? a. the study of antibodies is known as serology because they are found in serum B. they are usually associated with the alpha-globulin class of blood proteins c. because they participate in immune responses, antibodies are also known as immunoglobulins d. their basic structure is a Y-shaped molecule with variations

HARD 47. What part of an antibody actually binds to an antigen? a. hinge region with disulfide bridges

10 b. constant region of the light chain C. variable region of the light chain at the amine termini d. constant region of the heavy chain at the carboxy termini HARD 48. Antigen-binding fragments known as Fab a. are found at the tips of the “prongs” b. have extreme specificity and affinity for antigen binding c. are hypervariable in their amino acid sequencing from one antibody to another in this area D. all are correct e. only a and b are correct MEDIUM 49. What is the purpose of the Coagulase Agglutination Assay? a. visual color identification of antibody-antigen interactions indicating a positive test result b. identification of Staphylococcus aureus in a sick patient c. positive confirmation of the presence of the antigen via production of visible clumps D. all are correct MEDIUM 50. Match the antibody class with its special features: Antibody Class Special Feature IgG C a. allergic responses and parasitic worm infections IgA B b. found in tears, saliva, sweat, mucus and colostrum IgM E c. long term immunity, crosses placenta IgE A d. B-cell receptor IgD D e. first class produced, fixes complement EASY 51. Which of the following immunoglobulins is the largest in size? a. IgG b. IgE c. IgD d. IgM MEDIUM 52. Which of the following immunoglobulins has the highest rate of production? a. IgG b. IgM c. IgD D. IgA

11.5 B-cell Activation EASY

11 53. While T cells work to eliminate intracellular pathogens, B cells work to eliminate A. extracellular pathogens b. infected cells c. viruses and intracellular parasites d. cancer cells and transplant tissue MEDIUM 54. The B-cell receptor is a. composed of surface proteins that chemically recognize and bind the antigen b. composed of surface proteins that generate an extracellular signal that initiates activation c. composed of a core with either IgM or IgD antibodies D. a and c are correct e. all are correct

HARD 55. For both antigen recognition and signal transduction to occur in B cells, often addition to the antigen-binding receptor complex. a. antibody complex b. enzyme-binding domain C. Ig-alpha and Ig-beta chains joined with extracellular disulfide bridge d. transcription factor HARD 56. An antigen is considered to be multivalent if it has transduction that results in B cell production and differentiation.

A. several sites that can bind antibodies b. several sites that can produce antibodies c. one site that can bind several epitopes on a single antigen d. one site that can bind several antigens MEDIUM 57. T-dependent antigens a. require TC cell assistance for full B-cell activation B. require TH cell assistance for full B-cell activation c. require TC cross-linking for full B-cell activation d. require TS cross-linking for full B-cell activation

MEDIUM 58. B-cell growth factors are cytokines that a. encourage a B cell to bind to the epitope b. stimulate a B cell to produce memory cells

is required in

thus leading to signal

12 C. influence the activated B cell to start rapid mitosis d. help a B cell process the antigen via phagocytosis MEDIUM 59. B-cell differentiation factors are A. cytokines that cause some of the cloned cells to differentiate into plasma cells b. cytokines that trigger enlargement of the differentiating B cell c. cytokines that ultimately produce enlargement of endoplasmic reticulum d. cytokines that encourage secretion of huge numbers of antibodies from the ER E. all of these EASY 60. Plasma cells are responsible for A. production of IgM and then IgG antibodies b. production of IgA and IgE antibodies c. production of Memory B cells d. production of IgD antibodies EASY 61. Memory B cells a. retain the “memory” of the pathogen and rapidly become activated with subsequent antigen exposure b. are the basis for true immunity c. are at the heart of vaccination protocols D. all of these are correct e. only a and b are correct MEDIUM 62. T-independent antigens in humans a. are carbohydrates that generate weak and infrequent B-cell responses b. never fail to produce memory cells c. have many of the same carbohydrate epitopes d. all of these are correct E. only a and c are correct HARD 63. Antibodies function in immunity in many ways except a. circulating throughout the body B. being secreted on dry surfaces c. blocking pathogen adsorption and infection d. binding to pathogen-secreted toxins stopping host cell injury

MEDIUM 64. Match the following antibody effector mechanisms with their courses of action: Antibody Effector Mechanism Course of Action Opsonization D a. antibody binding to pathogens and toxins blocks

13 Complement activation C Neutralization A Antibody-dependent cell-mediated cytotoxicity B

attachment to host cell receptors b. antibodies attach to infected host cell and trigger release of granzymes that mediate cell death c. triggers microbial lysis, enhanced inflammation d. promotes rapid engulfment of antigens

MEDIUM 65. The majority of IgG antibodies against a specific pathogen are produced during a. primary response of the immune system B. secondary response of the immune system c. primary and secondary responses because they are equal in the immune system d. tertiary response of the immune system EASY 66. Why does an infected patient start feeling better between 5 to 7 days after the start of their illness?

A. antibody titers are increasing and IgG antibodies are now being made b. antibody titers are increasing and IgE antibodies are now being made c. antibody titers for IgG have peaked and IgD antibodies are now being made d. antibody titers for IgB have peaked and IgA antibodies are now being made CRITICAL THINKING: 67. While a puppy or kitten is still nursing they are attaining their mother’s antibodies through her milk. Is there any benefit to the young animal of getting a vaccination for feline or canine diseases at this time? a. yes because we want to encourage production of memory cells b. yes because we want to protect the puppy or kitten from pathogens C. no because the mother’s antibodies will provide protection and the baby animal’s immune system won’t be stimulated d. no, because the baby animal’s immune response will inadequate because of their young age and immaturity

CH. 12 – Vaccination, Immunoassays, and Immune Disorders

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12.1 Vaccines and Vaccination EASY 1. Which of the following statements doesn’t support the definition of vaccination? a. A simple method of altering an immune response b. Protects against pathogens for which there aren’t effective treatments C. Administration of a virulent antigen to stimulate an adaptive response d. Subsequent exposure after vaccination prompts a protective secondary response MEDIUM 2. Who were the first to pioneer artificially acquired active immunity and how did they do it? a. Chinese physicians over 3000 years ago. b. Egyptian physicians over 5,000 years ago. c. They collected scabs from current smallpox patients and exposed patients via inhalation or skin scratching of dried powder.

D. a and c are correct e. b and c are correct HARD 3. What problems encountered with the use smallpox scabs to provide acquired immunity led to modifications of this practice when it spread to the West? a. vaccinated patients could develop active smallpox disease b. vaccinated patients could have severe smallpox disease and die c. vaccinated patients were highly infectious while they built up immunity and could spread the disease with the threat of an epidemic D. all of these are correct e. only a and b are correct MEDIUM 4. What changes to the variolation protocol did Edward Jenner make?

A. He inoculated patients with cowpox, a closely related virus. b. He inoculated patients with killed smallpox that would produce only a mild disease. c. He first inoculated milkmaids and then got samples from their lesions to use in vaccinating other patients. d. He vaccinated everyone in a household in order to provide “herd immunity”.

EASY 5. Which of the following is the most accurate description of the term “vaccine”?

A. the immunogenic material used to induce artificially acquired active immunity b. the immunogenic DNA used to induce artificially acquired active immunity c. the immunogenic protein used to induce artificially acquired active immunity d. the immunogenic antibody used to induce artificially acquired passive immunity

EASY 6. Which of the following is not a quality of a successful modern vaccine? a. activate both humoral and cell-mediated responses B. provide a short-term memory response for initial immunity c. cause minimal side effects or discomfort d. are easy to administer, require minimal doses and do not need boosters MEDIUM 7. Why does the injection of a weakened form of a viral pathogen provide long-term immunity in a patient? a. the weakened form once injected activates the immune system and generates Tc cells b. the weakened form once injected activates the immune system, thereby generating memory cells c. when subsequently exposed to the actual pathogen, the memory cells launch a rapid and strong attack against it D. b and c are correct e. a and b are correct HARD 8. Which of the following is a disadvantage of using live vaccines? a. Reproduction of viable agents cause infection without illness and triggers a natural primary response. b. Live vaccines usually provide lifetime protection against infection.

C. Live vaccines require special storage to maintain living cells. d. Live vaccines produce extremely strong cell-mediated responses.

MEDIUM 9. Match the vaccine type with its description.

Vaccine Type Description Live attenuated vaccines E a. agents cannot reproduce so multiple doses are required Inactivated vaccines A b. contains attenuated toxins but requires regular boosters Subunit vaccines D c. immunogenicity is enhanced for better vaccine protection Conjugated vaccines C d. includes pathogen fragments with high immunogenicity Toxoid vaccines B e. contains live whole agent in a weakened form EASY 10. DNA or nucleic acid vaccines represent the vaccines of the future for all of the following reasons except A. this type of vaccine is most effective against pathogens with lower mutation rates b. the complementary DNA created enters the nuclei of host cells and leads to both antibody and cellmediated protection c. it is delivered by a gene gun into muscle tissues thereby circumventing the use of needles d. it does not require refrigeration and does not require the use of needles

MEDIUM 11. One of the greatest achievements of modern medicine in the U.S. has been the elimination of childhood diseases. In the second decade of the 21st century it is hard to believe that

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a. almost one-half of children died of an infectious disease before the age of 5 b. the number of cases of measles, mumps, diphtheria and pertussis have been reduced by more than 97% c. high immunization rates within a population has created “herd immunity” that actually protects the free riders d. all are correct E. only b and c are correct

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EASY 12. The terms “herd immunity”, “free riders” and “threshold” are defined as a. “herd immunity” refers to the inadvertent protection of unimmunized individuals because most of the population is immunized b. “free riders” are those individuals within a population who for some reason cannot be vaccinated or who decline vaccination c. the herd immunity threshold varies for each pathogen: for measles it is 90-95% of the population must be vaccinated in order to protect the free riders D. all are correct MEDIUM 13. Many people avoid beneficial vaccinations because of their fear of needles. Match the following pain-free vaccination option with its description: Pain-free vaccination option Description Patch D a. Inhalation of mist directs vaccine to lymphoid tissues like tonsils Nasal spray flu vaccine A b. quick puff of helix gas inject cDNA particles into host tissues Gene gun B c. genetically modified food eaten without cooking Food vaccines C d. short microneedles are to short to stimulate pain receptors EASY 14. Reported side effects of vaccines are relatively rare because of modern safety standards. Patient complaints about vaccines are usually limited to these: a. minor discomfort at injection site lasting up to 48 hr. b. perceived ineffectiveness of vaccine c. allergic responses d. need for more than one injection E. all of these are correct HARD 15. One of the more tragic events in medical research was the publication by Dr. Andrew Wakefield of his fraudulent research into the causes of autism in children. Which of the following statement concerning Dr. Wakefield’s research and its aftermath is incorrect? a. Dr. Wakefield said there was a strong correlation between the MMR vaccine and the onset of autism in children. b. This led to parents refusing to have their children vaccinated against these virulent childhood diseases. c. Parental refusal to vaccinate children led to an increase in these diseases and child deaths especially from measles and mumps.

D. Subsequent research showed the Dr. Wakefield was wrong, but that there has been an unexplained rise in autism in the past 20 years.

12.2 Immunoassays

EASY 16. What are immunoassays? All of the following statements are true except a. tests that rely on the adaptive immune system b. used to confirm the presence of specific macromolecules like antigens and antibodies c. used to quantify the number of macromolecules present even in very small amounts D. most immunoassays are antigen-mediated e. immunoassays are part of the field of serology MEDIUM 17.Monoclonal antibodies are a. are identical antibodies all secreted by the same B cell or its clones b. are used as diagnostic tools by physicians c. are also used by scientists as tools to identify and count antigens in the lab D. all are correct e. only a and b are correct HARD 18. What is the correct order of steps in the production of monoclonal antibodies?

1. Mouse in injected with antigen 4. Hybridomas are formed 2. Plasma cells that produce antibody of interest are removed 5. Hybridomas are transferred to small wells and tested for antigen reactivity 6. Selected hybridomas are isolated for mAbs (monoclonal antibody) production 3. Long-lived myeloma cells are grown in culture a. 1, 4, 2, 5, 6, 3

b. 1, 2, 4, 5, 3, 6

C. 1, 2, 3, 4, 5, 6

d. 1, 3, 4, 2, 6, 5

MEDIUM 19. How are human Monoclonal Antibodies used in treatment of Non-Hodgkin’s Lymphoma? a. CD20 on malignant B cells antigens are used as a therapeutic target b. synthetic anti-D20 is used to destroy the malignant B cells c. STEM cells replace the destroyed B cells D. all of these are correct e. only a and b are correct EASY 20. Precipitation reactions have been replaced in clinical laboratories because a. they require large amounts of reactants b. they are very slow c. they often result in false negatives d. all of these are correct E. only a and b are correct MEDIUM 21. All of the following accurately describe agglutination reactions except a. they are similar to precipitation reactions except that the antigen is particulate, not soluble b. the antibody crosslinking of particulate antigens results in agglutination that is visible C. they quantify the serum antigen concentrations d. the reciprocal of last dilution to show visual result is known as antibody titer or concentration

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5 HARD 22. ABO blood type may be determined by performing a a. precipitation test b. agglutination test C direct agglutination test d. passive agglutination test e. modified passive agglutination test

test.

EASY 23. Neutralization is correctly described in the following statements except a. is the binding of an antibody to a harmful antigen b. prevents damaging effects of antigen c. used for many years to neutralize Clostridim tetani D. has been in existence for more than 400 years MEDIUM 24. The complement fixation assay is rarely used anymore because a. it is too complex b. it is very inconvenient to conduct c. both patient samples and sheep blood cells must be used D. all are correct e. just a and b are correct HARD 25. Which of the following descriptions of the ELISA test is incorrect? a. it uses an antibody conjugated to an enzyme as a probe B. it does not lend itself to a high-volume laboratory testing c. it uses this probe to identify and quantify the antigen via conversion of a colorless substrate into a colored product d. it is quick, easy and highly sensitive. e. it is used for testing urine samples for drugs and home pregnancy tests MEDIUM 26. Fluorescent antibody assays a. are the most colorful immunoassay tests b. may be either direct or indirect c. indirect is often used to diagnose lupus D. all are correct e. only a and b are correct

12.3 Hypersensitivities EASY 27. Match the Type of Hypersensitivity with the correct example of its disorder: Hypersensitivity Disorder

Type I Immediate C Type II Cytotoxic D Type III Antibody-antigen complex mediated A Type IV Delayed B

a. Rheumatoid arthritis b. Contact dermatitis c. Asthma, Hay fever, hives d. Hemolytic Disease of the Newborn

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EASY 28. Which of the following immunoglobulins is associated with Type I Immediate Hypersensitivity reactions? a. IgM b. IgG C. IgE d. IgD e. IgA MEDIUM 29. Match the sign or symptom of a Type I reaction with its description: Type I Reaction Sign or Symptom Description Asthma B a. inflammatory response of nasal epithelium with sneezing Anaphylaxis D b. inflammation and narrowing of bronchiole in response to allergen Urticaria C c. hives that itch intensely Allergic Rhinitis A d. systemic allergic reaction requiring immediate intervention HARD 30. Atopy is defined as a. genetic predisposition to allergic responses b. patients have infrequent inflammatory responses c. patients rarely have typical allergic responses like coughing or sneezing d. allergic responses that require desensitization treatments E. only a and d are correct MEDIUM 31. Which of the following statements best describes immunologic tolerance? a. condition in which the immune system does not respond to an antigen b. condition in which the immune system has been tricked into producing IgE instead of IgG to an allergen c. condition in which the immune system has undergone desensitization treatment D. only a and c are correct e. all are correct

HARD 32. Which of the following statements about Type I Hypersensitivities in true?

A. an allergic response cannot occur unless a patient has been previously sensitized against an allergen b. an allergic response involves the cross-linking of IgG antibodies on the surface of a basophil c. cross-linking of IgG antibodies causes the basophil to release chemical mediates including histamine d. all are correct

EASY 33. What immunoglobulins participate in Type II Cytotoxic Hypersensitivities? a. IgM B. IgG and IgM c. IgE d. IgD and IgA e. IgA MEDIUM 34. Which of these does not describe a patient with Type O blood? a. has no surface antigens present on RBCs B. will have both A and B surface antigens present c. has both anti-A and anti-B antibodies present in serum d. is often referred to as the “universal donor” EASY 35. Which of the following blood types has no antibodies present in serum and is often referred to as the “universal recipient”? a. Type A b. Type B C. Type AB d. Type O MEDIUM 36. Which of the following diseases is not associated with Type II Cytotoxic Hypersensitivities? a. Thrombocytopenic purpura b. Goodpasture’s syndrome C. Type II Diabetes d. Myasthenia gravis e. Graves’ disease EASY 37. Which of the following pairings can lead to Hemolytic Disease of the Newborn (HDN)? a. Rh- mother carrying a Rh- fetus b. RH+ mother carrying a Rh- fetus C. Rh- mother carrying a Rh+ fetus d. Rh+ mother carrying a Rh+ fetus

MEDIUM 38. Rh-negative mothers who are in their second or subsequent pregnancy will often receive this preventive treatment: a. Rhogam, an Rh immune globulin is given during pregnancy and within 72 hours of delivery. b. Rh immune globulin that attacks maternal anti-Rh IgG antibodies and keeps them from crossing the placenta c. Rh-negative immune globulin that protects the developing fetus D. only a and b are correct

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e. all are correct HARD 39. A newborn suffering from erythroblastosis fetalis will often receive one of these therapeutic interventions: a. complete blood transfusion b. phototherapy to break up excess bilirubin that produces signs of jaundice c. partial blood transfusion with Rh-positive RBCs D. a and b are correct e. all are correct EASY 40. Type III Antigen-Antibody Complex Mediated Hypersensitivity is associated with these classes of immunoglobulins: a. IgM B. IgG and IgM c. IgE d. IgD and IgA e. IgA MEDIUM 41. The steps involved in a Type III Hypersensitivity response called an Arthus reaction: 1. formation of immune complexes consisting of excess soluble antigen 4. settlement of immune complexes in basement membranes of tissues 5. degranulation of neutrophils releasing lysosomal granules 2. lysosomal granules triggers and intense and localized response 3. response included damage to skin and accompanying blood vessels.

A. 1, 4, 5, 2, 3

b. 1, 4, 3, 2, 5

HARD 42. Serum sickness is characterized by a. a systemic condition b. caused by immune complexes c. side effect caused by antisera d. a and c are correct E. all are correct

MEDIUM 43. Serum sickness is not caused by a. administration of horse antiserum B. influenza vaccine c. animal-derived pneumococcal vaccine d. immune-based cancer treatments e. some antibiotics

c. 4, 1, 5, 2, 3

d. 2, 4, 3, 1, 5

HARD 44. Autoimmune diseases are included in the Type II Hypersensitivities because a. symptoms can be attributed to deposits of immune complexes that cause inflammatory reactions b. they represent an inability of immune system to identify self-antigens resulting in an attack against body tissues c. they often result in tissue damage such as rheumatoid arthritis and systemic lupus (SLE) D. all of these are correct

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EASY 45. Type IV Delayed Cell-mediated Hypersensitivities are associated with a. activated T cells b. phagocytes c. display of sensitizing antigen on host tissues with resulting cellular damage D. all of these MEDIUM 46. Contact dermatitis is the result of A. association of a host protein with a hapten that creates a new antigen b. association of a hapten with another hapten that creates a new antigen c. association of a hapten with an exoenzyme d. association of a hapten with an endoenzyme EASY 47. Haptens are molecules that by themselves are too small to cause an immune system response. All of these are examples of haptens except a. poison ivy urushiol b. metals found in jewelry C. antibiotics d. cosmetic ingredients e. latex MEDIUM 48. Transplant rejection A. occurs when donor tissue displays foreign Class I MHC molecules that are destroyed by Cytotoxic T cells b. occurs when donor tissue displays foreign Class II MHC molecules that are destroyed by Cytotoxic T cells c. occurs when donor tissue displays foreign Class I MHC molecules that are destroyed by Helper T cells d. occurs when donor tissue displays foreign Class II MHC molecules that are destroyed by Helper T cells

12.4 Autoimmune Diseases and Immunodeficiencies EASY 49. Autoimmune diseases a. all feature a self-antigen attack b. all have a hypersensitivity component c. all manifest a hypersensitivity reaction when autoantibodies bind to self-antigens on cell surfaces D. all are correct

MEDIUM 50. Autoimmune diseases often have these characteristics with the exception of a. may demonstrate either Type II or Type III hypersensitivity reactions b. may be organ specific c. may be systemic D. only target identical self-antigens

EASY 51. Match the Autoimmune Disease with its Self-antigen Target: Autoimmune Disease Self-antigen Target Addison’s Disease A a. Adrenal cortex SLE E b. Pancreatic Beta cells Diabetes Type I B c. Brain/Myelin sheath Multiple sclerosis C d. Joints Rheumatoid arthritis D e. Double-stranded DNA HARD 52. Match the Immunodeficiency disorder with fits Defective Immune Component: Immunodeficiency Disorder Defective Immune Component SCID B a. Phagocytes Bruton’s agammaglobulinemia D b. B and T cells Chronic granulomatous disease A c. T cells AIDS C d. B cells MEDIUM 53. Which of the following statements about immunodeficiencies is not true? a. Primary disease is congenital in nature and occurs early in fetal development of that particular component of the immune cells.

B. Primary disease is more detrimental at the end of immune cell development than at their beginning. c. Secondary diseases have many causes including drug exposure, HIV infection, high levels of stress and aging. d. Secondary diseases demonstrate a once fully functioning immune system that now has a diminished capacity.

EASY 54. Match the immune system deficiency with the type of opportunistic infections most often observed: Immune System Deficiency Opportunitistic Infection Humoral B a. Intracellular pathogens Cellular C b. bacterial infections Phagocyte A c. fungal, mycobacterial, protozoan and viral infections MEDIUM 55. Severe Combined Immunodeficiency (SCID)

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a. is a life-threatening disorder b. occurs when both branches of adaptive immune system fail c. is usually genetic in origin d. a and c are correct E. all are correct

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HARD 56. Which of the following statements concerning patients with Diabetes Type I and the assessment of their Immune System function is true? a. Hyperglycemia lowers lymphocyte apoptosis and increases antibody production after pathogen exposure. b. Hyperglycemia increases C3 activation.

C. Impairment of immune system because of hyperglycemia will weaken body responses to pathogens. d. Opportunistic pathogens are less likely to affect a Diabetic Type I patient.

CRITICAL THINKING 57. Which of these demographic groups of patients is at greater risk of infection? a. young children because of immature immune systems and greater initial pathogen exposures b. pregnant adult women because of suppression of T-cell-mediated immune responses c. geriatric adults because of loss of memory B and T cells established earlier in life D. all are at equal risk and should practice good hand washing skills, stay clear of sick people, and get immunization boosters as needed.

CH. 13 – Microbial Pathogenesis 13.1 Entering and Adhering to the Host EASY 1. What is the correct order of 5 steps in the process of pathogenesis?

1. microbes enter the host 2. cause damage 3. adhere to host tissues 4. avoid destruction by host defenses 5. exit host to continue chain of transmission a. 1, 2, 3, 4, 5

B. 1, 3, 4, 2, 5

c. 1, 4, 3, 2, 5

d. 1, 3, 2, 4, 5

MEDIUM 2. Why are many aspects of pathogenesis the same no matter the identify of the microbe? a. because they share common entry and exit sites b. because innate host defenses try to fight them off the same way c. because adaptive host defenses follow the same pathways regardless of pathogen identity D. all of these are correct e. all of these are correct except c EASY 3. Match the terms with its correct description: Term Description Pathogenesis D a. natural habitat or host of pathogen until it finds a new host Reservoir A b. pathogens remain with their host and cannot be transmitted Communicable pathogens E c. infectious disease shared by animals and humans Noncommunicable pathogens B d. origin and development of a disease Zoonosis C e. pathogens may be transmitted to other hosts MEDIUM 4. What are 3 general categories of reservoirs?

A. humans, other animals, and environmental sources b. humans, other animals and inanimate objects c. humans, inanimate objects and environmental sources d. humans, environmental sources, and zoonoses EASY 5. Portals of entry include a. skin, mucous membranes, parenteral route and environmental sources b. skin, mucous membranes, and environmental sources C. skin, mucous membranes and parenteral route d. skin, parenteral route and environmental sources MEDIUM 6. Common portals of entry and exit include all of the following except a. blood, skin, urine and feces. b. milk, vaginal secretions and menstrual blood c. semen and lubricating secretions.

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d. mouth and nose E. rectum EASY 7. Pathogens have a difficult time adhering to tissues because a. urination and vaginal secretions carry would-be pathogens out of the body b. mucociliary escalator in the respiratory tract carry out trapped pathogens c. peristalsis in GI tract compacts pathogens into feces D. a and b are correct e. all are correct MEDIUM 8. All of the following are characteristic of adhesions except a. adhesin on microbe attaches to receptor on host cell B. receptor on microbe attaches or adheres to adhesin on host cell c. adhesins are usually made of a protein or glycoprotein d. shape of adhesion is complementary to receptor on surface of host cell e. host cell receptors exist to participate in normal functions of the host cell HARD 9. Match the patterns of infections as they spread in the body with the pathogen causing them: Body Patterns of Infection Pathogen Local Infection B a. Measles virus spreads systemically throughout body causing a rash Focal Infection C b. Erysipelas caused by Streptococcus pyogenes remains in primary area Systemic infection A c. Streptococcus pneumoniae moves from lungs to the heart

13.2 Transmission of Microbes EASY 10. The three basic modes of pathogen transmission from one host to another include A. contact transmission, vector-borne transmission, and common vehicle transmission b. contact transmission, indirect transmission and common vehicle transmission c. contact transmission, direct transmission and indirect transmission d. contact transmission, vector-borne transmission and indirect transmission MEDIUM 11. Match the type of contact transmission with its description: Type of Contact Transmission Description Direct contact B a. very small droplets that can travel about 1 meter Indirect contact C b. physical contact with the microbe Droplet transmission A c. involves a fomite as an intermediate between reservoir and host HARD 12. Which of the following is a mechanical vector? a. mosquito B. house fly c. tick d. flea MEDIUM 13. Which of the following is a biological vector? a. house fly b. cockroach C. tick

d. ant

3 EASY 14. All of the following are characteristics of common vehicle transmission except a. common vehicle or medium needed to carry pathogen to new host B. may lead to a very slow spread of pathogens to many people c. examples of vehicles include food, air, water or blood d. water may carry pathogens from wild animal population to human community MEDIUM 15. Water as an example of common vehicle transmission of pathogens is important because a. human populations may be contaminated with fecal pathogens from rain water runoff b. it makes proper sewage and drinking water treatment very important for municipalities c. interruption of public health services concerning drinking waste can lead to large-scale epidemics of diarrhea-causing diseases D. all of these are correct HARD 16. Which of the following statements about air as an example of common vehicle transmission is not true? a. air transmission of microbes can occur via droplets capable of remaining airborne for some period of time B. microbes suspended in droplet nuclei are very large and therefore do not easily enter the lungs c. microbes carried in the air are quite contagious because they can travel for more than 1 meter d. serving as human reservoirs, infected individuals can spread contagious microbes like tuberculosis and whooping cough via droplets in the air EASY 17. Blood may serve as a liquid vehicle for which of these pathogens? a. Hepatitis B b. Human Immunodeficiency Virus c. Malaria D. only a and b are correct e. all are correct HARD 18. Which of these is an example of vertical transmission? a. water to human host b. biological vector like mosquito C. pregnant mother to unborn fetus d. airborne tuberculosis bacterium MEDIUM 19. The term “perinatal infections” best describes a. vertically transmitted infections that occur within the first trimester of a pregnancy b. vertically transmitted infections that occur within the second trimester of a pregnancy C. vertically transmitted infections that occur between 22 weeks of pregnancy and 7 days post birth d. vertically transmitted infections that occur any time during pregnancy

EASY 20. TORCH stands for the pathogens that can cross the placental barrier during development and cause

disease in the developing fetus. Which of the following is not part of TORCH? a. Toxoplasma gondii b. Hepatitis, chickenpox, syphilis C. Rubeola d. Cytomegalovirus e. Genital herpes

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HARD 21. What is the difference between horizontal and vertical transmission of a pathogenic microbe? a. horizontal transmission is a transfer from a reservoir to human host b. most infectious diseases are transmitted horizontally c. vertical transmission is a transfer from mother to unborn child and are called congenital infections D. all of these are true e. only a and b are true MEDIUM 22. Newborn babies are in danger from vertically transmitted pathogenic microbes acquired during or after birth. Match the infectious agent acquired with the disease it causes in the newborn: Infectious Agent Acquired Disease Staphylococcus aureus C a. Neonatal ophthalmia Chlamydia trachomatis A b. Congenital persistent Hepatitis B infection Neiserria gonorrhoeae D c. Impetigo sticky eye HBV B d. Neonatal ophthalmia HARD 23. In the case study of the Cholera Epidemic in Goma, Zaire in 1994, several risk factors for this severe diarrheal disease were pointed out. Which of the following would be considered risk factors for any outbreak of cholera? a. lack of clean drinking water b. fecal pollution of drinking water c. overcrowded refuge camps d. only a and b are risk factors E. all of these are risk factors

13.3 Bypassing Host Defenses EASY 24. What specific host defenses make it difficult for a pathogen to avoid destruction once they have gained entry into the human body? a. circulating antibodies b. presence of phagocytic cells that destroy pathogens c. cytotoxic T cells that destroy invaded cells d. a and b are correct E. all are correct MEDIUM 25. Where can pathogens temporarily hide from the immune system?

a. host cells where they can multiply undetected b. in males the prostate gland c. epithelial tissues where there is no direct connection to the circulatory system d. normally protected tissues like the CNS or synovial joints E. all of these except b

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HARD 26. Why is the Gram-negative spirochete Treponema pallidum able to evade immune system detection? a. there are not very many antigenic proteins imbedded in the LPS of the outer membrane b. the single flagellum is hidden as an axial filament under the outer membrane of the cell wall c. detection can occur only after an individual cell dies leaving the living progeny able to cause disease d. T. pallidum can hide inside living cells E. all of these are correct with the exception of d EASY 27. What genetic mechanisms will allow pathogens to alter their antigens in order to avoid immune system detection? a. naturally occurring mutations b. genetic recombination via horizontal transfer C. both a and b are correct d. only a is correct e. only b is correct MEDIUM 28. Viruses, especially members of the Retroviridae like HIV, are prone to mutation-producing errors as they move through transcription backwards. Why does this characteristic increase their ability to remain undetected by the immune system? a. more mutations are produced than can be normally repaired b. HIV patients produce millions of virus mutants everyday in their Helper T cells c. antibodies are specific and will only bind to one of the millions of mutant cells D. all of these are correct e. only a and b are correct HARD 29. How does antigenic drift explain the need to get a new flu vaccine every year? a. antigenic drift is the process in which the primary viral antigens like H and N proteins slowly accumulate mutations b. H and N mutations become so numerous that the resulting proteins cannot be recognized by previously produced antibodies c. last year’s vaccine stimulated production of IgG antibodies that will recognize most H and N proteins but a booster is needed to keep IgG levels elevated d. last year’s vaccine stimulated production of specific IgG antibodies that will no longer recognize the H and N proteins on the virus E. all are true except c

HARD

30. Members of the protozoal genus Trypanosoma include species that have programmed gene switching.

This means that genes that produce primary surface antigens are shuffled to produce new combinations.

How will this affect the pathogen? a. previously produced host antibodies will not be able to recognize the antigens b. host phagocytic cells will not be able to recognize and destroy the pathogen c. some members of the species will always be able to survive the host’s immune system D. all are correct e. only a and b are correct MEDIUM 31. Which process produces more virulent pathogens, antigenic drift or antigenic shift? a. antigenic drift because mutations are accumulated rapidly b. antigenic shift because mutations are accumulated rapidly C. antigenic shift because it is the result of recombination of genomes of different viral strains d. antigenic drift because it is the result of mutations from more than one strain EASY 32. Which of the following are examples of Influenza viruses produced by antigenic shift that created pandemics? a. Spanish flu of 1918 b. H1N1 swine flu of 2009-2010 C. both are correct MEDIUM 33. Why do influenza pandemics occur? a. a hybrid virus is produced by antigenic shift b. no hosts have any previous immunity to the new hybrid produced by antigenic drift c. worldwide events facilitate the movement of hosts from one continent to another D. answers a and c are correct e. answers b and c are correct HARD 34. Match the pathogen with the part of the Host Immune System that it damages: Pathogen Host Immune System a. production of IgA protease that destroys IgA antibodies ultimately HIV D allowing virus to enter cerebrospinal fluid and cause meningitis b. infects B cells and starts conflict with activated T cells causing symptoms Rubeola (Measles) C of mononucleosis c. infects T cells and suppresses immune system for several weeks including Epstein-Barr Virus (EBV) B loss of Type IV hypersensitivity responses Meningitis bacteria A d. inhibits functions of B and T cells by infection of Helper T cells MEDIUM 35. Some microbes actually inhibit their own destruction by phagocytic leukocytes thus allowing them to survive and cause damage to host tissues. Which of the following is NOT a correct match? a. Staphylococcus aureus/produces toxin that kills Helper T cells b. Streptococcus pneumoniae/presence of capsule prevents phagocytosis C. Mycobacterium tuberculosis/inhibits capture by phagocytes to avoid being digested d. Listeria monocytogenes/splits phagolysosome membrane so it can be released into cytoplasm to replicate

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13.4 Damaging Host Tissues EASY 36. Pathogenic microbes can directly damage host cells by a variety of methods. Which of the following are intracellular parasites of host cells able to reproduce inside them and killing the host cell in the process? a. viruses using lysogenic cycle b. Chlamydia and Rickettsia are obligate intracellular pathogenic bacteria c. Yersinia pestis and Bacillus anthracis replicate inside leukocytes and are transported to lymph nodes D. only b and c are correct e. all are correct HARD 37. Match the Tissue-damaging enzyme with its activity: Tissue-damaging Enzyme Activity Hyaluronidase C a. Converts fibrinogen to fibrin, causing blood clot formation Coagulase A b. Damages connective tissue by degrading collagen, a key fiber Lipase E c. Damages connective tissues by degrading hyaluronic acid Protease D d. Degrades proteins Collagenase B e. Damages adipose tissues by degrading fats EASY 38. Staphylococcus aureus is a major Gram-positive pathogen that produces many different enzymes and toxins capable of damaging host tissues. Examples of the diseases caused by S. aureus include all of the following except a. minor infections such as impetigo, boils, and abscesses B. gastroenteritis c. pneumonia d. meningitis e. osteomyelitis MEDIUM 39. Streptococcus pyogenes is sometimes referred to as “flesh-eating” bacteria because a. it produces collagenase and hyaluronidase that digest connective tissues b. it is able to easily digest fascia and muscle often requiring surgical intervention to save lives c. it produces coagulase that causes clots that block influx of fresh nutrients and oxygen gas D. a and b are correct EASY 40. Characteristics of dermatophytes include all of the following except A. protozoans that cause superficial infections of the skin b. produce proteases that digest keratin in outer skin layers c. absorb small peptides and amino acids from keratin as nutrients d. are classified as fungal species HARD 41. Endotoxins are a. the Lipid A portion of the LPS in the cell walls of all Gram-negative bacteria

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b. lipids that cause production of interleukin-2 (IL-2) and tumor necrosis factor (TNF) in phagocytic leukocytes c. production of IL-2 and TNF may cause fever and formation of blood clots d. all are correct E. only a is correct MEDIUM 42. Which of the following statements best describes an endotoxin? a. It is a protein. b. It may be excreted by both Gram-positive and Gram-negative bacteria. c. It is often highly toxic and may be fatal D. It is pyrogenic e. Toxoids can be successfully used as vaccines.

HARD 43. What are some of the risks associated with the spread of Gram-negative bacteria in the body? a. Growth of Gram-negative bacteria in the blood can lead to septicemia. b. Overgrowth of Gram-negative bacteria and their exotoxin will induce the production of TNF in leukocytes that engulf them. c. Large amounts of TNF will damage capillaries causing the formation of blood clots, a condition known as Disseminated Intravascular Coagulation (DIC) that may lead to multisystem organ failure.

D. All are correct except answer b.

HARD 44. The development of Acute Respiratory Distress Syndrome (ARDS) may occur when a. TNF makes capillaries more permeable and increases plasma leaking out of blood vessels. b. Lung tissues becomes inflamed as a result of fluid accumulation. c. Accumulation of excess fluid in the lungs impedes intake of oxygen leading to ARDS D. All are correct.

EASY 45. Characteristics of exotoxins include all except a. They are produced by both Gram-positive and Gram-negative bacteria.

B. They are formed from a combination of proteins and lipids c. Every exotoxin has a distinct chemical structure. d. Every exotoxin damages host cells in a unique way.

MEDIUM 46. In examining the part toxins play in the disease process, which statement is false ? a. They are a key player in the pathogenesis of a specific microbe. b. Highly virulent pathogens are able to cause diseases such as anthrax, botulism, tetanus and cholera because of the toxins they produce.

C. Because they are proteins, toxins are not readily destroyed by antibodies produced by the host’s immune system. d. Inactivated toxins are the basis of vaccinations called toxoids.

HARD 47. Select the statement that does not correctly complete the following sentence. Toxoid-based vaccines work to protect us against microbial exotoxins that cause disease because

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A. exotoxins can be rendered temporarily inactive with formalin. b. changing the chemical structure of protein exotoxins makes them safe for use as vaccines. c. these chemical changes will still stimulate antibody production in a vaccinated individual. d. individuals who receive “boosters” throughout their lifetimes will always have a high level of antibodies against the specific toxin.

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EASY 48. Match the Exotoxin with the bacteria that makes them: Exotoxin Bacterial Source TSS toxin E a. Escherichia coli Heat-stable enterotoxin A b. Streptococcus pneumoniae Pneumolysin B c. Clostridium tetani Tetanospasmin C d. Vibrio cholerae Cholera toxin D e. Staphylococcus aureus HARD 49. Match the Exotoxin with the description of how it damages host tissues: Exotoxin Affected Tissues TSS B a. Neurotoxin causing a paralytic disease b. Activates T cells causing massive release of cytokines that may Hemolysin D lead to shock and multiple organ failure Botulinum toxin A c. Reversal of osmotic gradient in the large intestine Enterotoxin C d. Lyses red blood cells MEDIUM 50. Immunopathy has been defined as an abnormal immune response that will then cause a disease. It is initiated by some pathogens including: a. Staphylococcus aureus with its superantigen known as TSS toxin because it produces Toxic Shock Syndrome with a life-threatening drop in blood pressure. b. Epstein-Barr Virus with its use of cytotoxic T cells that attack infected B cells, resulting in a battle between the two branches of the immune system with resulting mononucleosis. c. Escherichia coli O157:H7 with its Shigella plasmid that produces toxins resulting in Hemolytic Uremic Syndrome.

D. Only a and b are correct. e. All are correct.

EASY 51. Sheep’s Blood Agar (SBA) is a differential medium that helps identify Gram-positive bacteria based on their ability to use blood cells as a food source. Match the bacterium with the type of hemolysis it demonstrates: Gram-positive Bacteria Type of Hemolysis Streptococcus pyogenes C a. alpha hemolysis – partial breakdown of erythrocytes Streptococcus pneumoniae A b. gamma hemolysis – no breakdown of erythrocytes Enterococcus faecalis B c. beta-hemolysis – complete breakdown of erythrocytes

13.5 Factors Influencing Disease Outcomes EASY

51. There is an interplay of microbial and host factors that work in concert to promote a disease.

What are the most important host factors you can have to keep you well? a. genetic factors b. adaptive immune defenses and nonspecific immune defenses C. health status and prior immunity d. all are correct EASY 52. What are the most important factors that a microbe must possess in order to cause disease? a. Portals of entry and microbial genetic factors b. Inoculating dose and virulence factors c. pathogen type D. b and c are correct e. all are correct MEDIUM 53. Why are healthy people susceptible only to primary pathogens? a. immune status has been found to be the major factor in determining susceptibility to a pathogen b. healthy immune systems protect individuals from opportunistic pathogens c. the immune system in healthy individuals has not been compromised by other diseases D. All of these are correct MEDIUM 54. Stress is a variable that definitely affects an individual’s predisposition to disease. Stress results in all of the following except A. decrease in key hormones b. decline in neutrophil activity c. increase in leukocyte apoptosis d. suppression of complement activity e. reduction in antibody production EASY 55. ID50 refers to , while LD50 refers to . a. infectious dose/lethal dose B. number of microbes required to cause disease in 50% of test subjects/number of microbes required to cause death in 50% in 50% of test subjects. c. number of sick test subjects/number of dead teste subjects d. effectiveness of microbes to cause disease/effectiveness of microbes to cause death HARD 56. There is an inverse ratio between infectious dose (ID50) of a microbe and its virulence. Which of the following statements is correct? a. As ID50 rises so does the microbe’s virulence. b. As ID50 decreases so does the microbe’s virulence.

C. As ID50 decreases, the microbe’s virulence increases d. ID50 is unrelated to virulence.

CRITICAL THINKING

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MEDIUM 57. What other factors that haven’t already been addressed in this chapter might determine a microbes ability to cause disease? a. Entrance through optimum Portal of Entry to ensure adherence to target tissues b. Transmission from human to human vs. other source to human because bacterium is already adapted to life in the human body c. Acquisition of additional genes that make the microbes more effective pathogens.

D. All of these could be other factors. e. Only b and c could be other factors.

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CH 14 – Antimicrobial Agents 14.1 Principles of Antimicrobial Chemotherapy EASY 1. What is the correct definition of “selective toxicity”?

A. use of drugs to kill a pathogen without harming the host b. use of drugs to kill only some pathogens without harming other pathogens c. use of drugs to inhibit some pathogens without inhibiting other pathogens d. all are correct MEDIUM 2. Prior to the discovery of antimicrobial drugs, what percentage of children with bacterial meningitis died? a. 75% B. 90% c. 80% d. 40% EASY 3. What microbes are producers of natural antibiotics? a. Yeasts like Saccharomyes cerevisiae and some species of Gram+ bacteria B. Molds and Actinomycetes and some species of Gram+ bacteria. c. Molds like Penicillium and Actinomycetes plus some species of Gram- bacteria d. Yeasts and molds as well as some species of Gram- bacteria MEDIUM 4. Naturally produced antibiotics are usually effective against what pathogens? a. Only Gram+ bacteria and some fungi b. Only Gram- bacteria and Protozoa C. Most bacteria and some fungi d. Most bacteria and some viruses HARD 5. What is the correct definition of an antibiotic? a. chemical produced by one microbe that can either kill or inhibit the growth of another similar microbe b. a method of chemical warfare waged by one microbe on another over resources like food and space c. a chemical produced by one microbe that can either kill or inhibit any other microbe D. only a and b are correct e. all are correct EASY 6. How are semisynthetic antibiotics produced? a. chemically modified natural antibiotics that have an artificial component b. naturally produced antibiotics that are artificially modified in a lab c. functional groups like carboxyl and amine are added to natural antibiotics to make them more effective D. all are correct

MEDIUM

7. Which of the following scientists first developed the concept of selective toxicity?

A. German physician Paul Ehrlich b. Scottish biologist Alexander Fleming c. English chemists Howard Florey and Ernest Chain d. German physician Robert Koch

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HARD 8. What was the drug that Dr. Ehrlich developed as a less toxic treatment for syphilis? a. mercury b. sulfanilamides C. arsphenamine d. streptomycin EASY 9. In the 1930s what drug was developed to treat Streptococcus infections? a. penicillin B. sulfanilamides c. tetracycline d. streptomycin HARD 10. What is the correct term that describes the relationship in which one microbe harms another microbe? a. antimicrobial b. antibiotic c. anti-microorganism D. antibiosis MEDIUM 11. Name the scientists who clinically purified penicillin and developed ways to produce it on a large scale as an antibiotic: A. Chain and Florey b. Fleming and Koch c. Koch and Pasteur d. Pasteur and Fleming HARD 12. Match the antibacterial agent with the bacterium it formerly targeted before the development of antibiotic resistance: Antibacterial Agent Target Bacterium Penicillin C a. Mycobacterium tuberculosis Tetracycline E b. Neisseria gonorrhoeae Streptomycin A c. Staphylococcus aureus Sulfanilamide B d. Klebsiella pneumoniae Cefotaxime D e. Shigella dysenteriae

MEDIUM

13. In an effort to combat the rapid development of drug resistance, research labs have found that adding these functional groups to natural antibiotics have created new semisynthetic antibiotics that are metabolized via different pathways in the body and therefore are active longer: a. carboxyl b. amine c. nitrogenous bases D. a and b are correct e. all are correct EASY 14. How has increased use of technology contributed to the study of new antibacterial agents? a. complex computer models test potential inhibitors of critical pathogen enzymes b. proposed enzyme inhibitors are produced and screened via automated systems c. chemical combinations with favorable results can be sped into animal testing D. all of these MEDIUM 15. The process of choosing the best antimicrobial agent to fight an infection relies on all these factors except a. agent must inhibit growth of or kill identified pathogen B. agent should be allergenic c. agent should not cause adverse reactions when used with other medications d. agent should be maintained at a therapeutic level in the body for a long period of time EASY 16. What are the potential side effects of a drug when it interacts with the human body? a. effects on the Nervous System includes seizures, dizziness, muscle weakness and/or deafness b. effects on the Gastrointestinal System include discomfort and upset from killing of residential enteric bacteria c. effects on the immune system include Type I Hypersensitivity allergic reactions d. only a and b are correct E. all of these are correct HARD 17. Match the common side effect with the antibacterial agent that causes it: Antibacterial Agent Common Side Effect Amoxicillin E a. discoloration of teeth in children Vancomycin C b. photosensitivity Aminoglycosides D c. red rash from rapid IV infusion Tetracyclines A d. headaches and dizziness Sulfonamides B e. gastrointestinal discomfort

MEDIUM

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18. What is the most frequently cited side effect when looking at antibacterial agents? a. fungal overgrowth like yeast infections in women b. headache and dizziness C. gastrointestinal discomfort d. jaundice e. rapid heartbeat

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EASY 19. It is important to determine an identified pathogen’s sensitivity or resistance to different antimicrobial agents before a drug can be prescribed to treat it. Which of the following lab tests will demonstrate the MBC (minimum bacteriocidal concentration) of the drugs tested? a. Kirby-Bauer Disk Diffusion Test b. E-strip C. Broth dilution test d. only a and b demonstrate MIC e. all are correct EASY 20. Antibiograms are summaries of a bacterium’s sensitivity to specific antimicrobial drugs. How are these used? a. used by physicians and pharmacists to develop antibacterial therapies for patient b. used by public health workers to monitor development of resistance trends within a hospital c. used to compare trends between facilities nationwide D. all of these e. only a is correct MEDIUM 21. Match the term with its description: Term Therapeutic Index (TI) C Empiric Antimicrobial Therapy B Prophylaxis D Spectrum of Activity A

Description a. range of pathogens sensitive to an antimicrobial agent b. administration of 2 or 3 broad-spectrum drugs to begin treatment before receiving ID of the pathogen c. used to determine most effective, safe drug dosage for treating an infection d. patient at high risk of acquiring an infection is given a broad-spectrum drug without any signs or symptoms

14.2 Antibacterial Agents EASY 22. Why is the cell wall a major target for antibacterial therapy? a. it is critical for cells living in a hypotonic environment b. loss of cell wall integrity allows fluid to quickly enter the cell interior c. pressure of interior fluid causes rupture of cell membrane d. loss of cell wall integrity causes cell death E. all of these MEDIUM

23. Which of the following is an incorrect match between inhibitors and their effect on cell wall synthesis? a. Beta-lactams/inhibit peptide linkage formation B. Glycopeptides/bind to internal amino acids on the side chain c. Bacitracin/inhibits release of peptidoglycan precursor from membrane’s lipid carrier EASY 24. What is a Beta-lactam antibiotic?

A. an antibiotic that contains a Beta-lactam ring as the key structural component b. an antibiotic that contains a chain of Beta-lactam as the key structural component c. an antibiotic that contains a Beta-lactam chemical that serves an a competitive enzyme d. an antibiotic that contains an enzyme that breaks down Beta-lactam in the cell wall MEDIUM 25. Match the penicillin-based antibiotic with its correct description: Penicillin-based Antibiotic Penicillin G B Ampicillin and Amoxicillin C Methicillin A

Description a. penicillinase-resistant drug that is resistant to degradation by Beta-lactamases b. a natural penicillin that is not acid-stable and therefore has to be administered IV c. semisynthetic penicillins that are acid-stable, broad-spectrum and can be taken orally

HARD 26. Which of the following is not a correct match of an antibacterial drug that inhibits cell wall synthesis with its description? a. Carbenicillin/extended-spectrum penicillin used to treat Pseudomonas infections b. Cephalosporins/Beta-lactams that can be taken orally and have low toxicity C. Carbapenems/Beta-lactams with narrowest spectrum of activity d. Vancomycin/Highly effective glycopeptide antibiotic that works against Gram-positive bacteria e. Bacitracin/cyclic polypeptide topical drug that blocks precursor release from lipid carrier in cell membrane EASY 27. Drugs that inhibit protein synthesis stop a. transcription because they stop RNA polymerase B. translation because they stop initiation on the ribosomes c. translation because they stop elongation of the mRNA d. transcription because they stop mRNA capping and splicing MEDIUM 28. Inhibition of protein synthesis includes all of these mechanisms except a. blockage of formation of 30S initiation complex b. prevention of binding of 50S subunit during initiation c. prevention of tRNAs from binding to ribosome A site D. enhancement of peptide bond formation HARD 29. Match the antibiotic with its course of action in blocking protein synthesis:

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Antibiotic Aminoglycosides C Osazolidinones D Tetracyclines B Chloramphenicol A

Course of Action in blocking Protein Synthesis a. inhibits formation of peptide bond during elongation stage b. bind to ribosome A site blocking binding of tRNA c. block start of protein synthesis by preventing formation of 30S initiation complex d. block start of protein synthesis by inhibiting binding of 50S subunit to 30S initiation complex

MEDIUM 30. Which of the following antibiotics that inhibit protein synthesis is bacteriostatic rather then bacteriocidal? a. Streptomycin b. Linezolid C. Tetracycline d. Chloramphenicol e. Azithromycin HARD 31. Which of the following drugs that inhibit protein synthesis by stopping it prematurely has to be used carefully because it has been found to encourage the overgrowth of Clostridium difficile in the intestines?

A. Clindamycin b. Erythromycin c. Azithromycin d. Streptogramins e. Ketolides EASY 32. What key characteristic of nucleic acid synthesis provides enough difference to allow it to be a target for drugs that are selectively toxic to bacteria and not human eukaryote cells? a. choice of monosaccharide in nucleotide b. choice of purines and pyrimidines as nitrogenous gases C. structure of some enzymes used in synthesis process d. amount of hydrogen bonding MEDIUM 33. Match the antibiotic with the correct mechanism for inhibition of nucleic acid synthesis: Antibiotic Mechanism for inhibition of Nucleic Acid Synthesis Quinolones B a. structural analogs of PABA that are competitive inhibitors of first enzyme in pathway for microbial THFA synthesis Trimethoprim D b. cause breaks in DNA during separation of daughter chromosomes during semi-conservative replicaton Rifamycins C c. inhibits bacterial RNA polymerase Sulfonamides A d. inhibits DHFA reductase enzyme in bacteria

EASY 34. Why are there so few drugs available that will target the bacterial plasma membrane?

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a. because these drugs have little selective toxicity and damage host cell membranes also b. because these drugs have significant side effects C. both a and b are correct d. only a is correct e. only b is correct EASY 35. Why are the Mycobacteria difficult to treat with antibiotics? a. the waxy cell wall created by the inclusion of mycolic acids is difficult for most antibiotic to permeate b. members of this genus grow very slowly requiring long-term therapy that leads to potential drug toxicity c. because appropriate antibiotics have to be taken for long periods of time patients are less likely to keep taking them D. all are correct e. only a and b are correct MEDIUM 36. An active case of tuberculosis has to be treated with a multidrug approach. Which of the following list of drugs commonly prescribed is mismatched with its mechanism of action? a. Rifampicin/can diffuse through membranes and inhibit RNA polymerase b. Isoniazid/ inhibits mycolic acid synthesis leading to cell wall damage and cell death C. Pyrazinamide/converted to a base inside the cell causing pH to rise to 10 thereby inhibiting growth d. Ethambutol/inhibits mycolic acid synthesis

14.3 Antiviral Agents EASY 37. Which of the following is NOT a major target for antiviral therapy? a. inhibition of viral entry b. inhibition of viral nucleic acid synthesis C. inhibition of ribosome assembly d. Inhibition of viral protein synthesis e. inhibition of viral assembly and release EASY 38. Understanding the first steps in establishing a viral infection of a host cell are important in the design of effective antiviral drugs. What are these steps? a. binding of naked virus to host cell surface b. fusion of viral envelope with host cell membrane c. capsid uncoating to release nucleic acid into cell D. all of these are correct e. only a and b are correct MEDIUM 39. Why do antiviral drugs typically target a specific step in the viral replication cycle? a. because viruses are obligate intracellular parasites and have to replicate within living cells b. because targeting a specific step will shut down viral replication c. antiviral agents will not work on all viruses d. all are correct E. only a and b are correct

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HARD 40. What is the difference between enveloped and nonenveloped viruses in how antiviral agents block the entry of viral nucleic acid into the host cell? a. in enveloped viruses antiviral agents prevent fusion of the viral envelope with the host plasma membrane. b. in both enveloped and nonenveloped viruses viral agents can prevent viral uncoating so that the nucleic acid cannot enter the host cell C. both a and b are correct d. only a is correct e. only b is correct MEDIUM 41. Which of the following statements about Fuzeon is not true? a. it is an anti-HIV drug that is used to treat patients with resistance to usually prescribed antiviral agents. b. it is a peptide that prevents the 3-dimensional change required for fusion of the HIV envelop to the host cytoplasmic membrane C. it is a enzyme that promotes a 3-dimensional change required for a new shape to the host cell receptor d. none of these is true EASY 42. While Fuzeon is an anti-HIV drug, the Adamantanes are a group of antiviral drugs that A. inhibit uncoating of the capsid for the Influenza A virus b. inhibit fusion of the Influenza A virus with the host cell membrane c. inhibit the 3-dimensional change required for a new host cell receptor d. inhibit the formation of the matrix proteins that attach to the RNA MEDIUM 43. Which of the following descriptions of viral nucleic acid polymerases is true? a. they may be grouped into 3 basic categories b. they may be targeted by antiviral drugs that use either competitive or noncompetitive inhibition c. they may be targeted by cell host enzymes that prevent transcription D. only a and b are correct e. all are correct HARD 44. Nucleoside analogs inhibit nucleic acid polymerization by a. acting as terminators of synthesis after being incorporated into nucleic acid of host cell b. having deleted or modified 3’ hydroxyl groups on sugar of either DNA or RNA c. after inclusion into growing DNA chain, the nucleotide analog blocks linkage of the next nucleotide d. having a greater affinity for viral polymerases than for human ones thus producing selective toxicity at therapeutic concentrations E. all of these are correct

EASY 45. Acyclovir a. is a structural analog of thymidine b. is administered in an inactive form known as valacyclovir

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c. is incorporated in the growing DNA molecule after conversion to the active form acyclovir d. stops DNA synthesis because it does not have the 3’ hydroxyl group needed for phosphate linkage E. all of these are correct except a

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MEDIUM 46. Match the Inhibitors of Viral Nucleic Acid Synthesis with the correct description: Inhibitor Description Azidothymidine (AZT) D a. used in combination therapy to treat Hepatitis B virus (HBV) Entecavir A b. Noncompetitive inhibitor of HIV reverse transcriptase Nevirapine B c. used in combination with AZT to treat all stages of HIV infection 3-thiocytidine (3TC) C d. used to prevent maternal-to-fetal transmission of HIV EASY 47. Interferon is produced naturally by some virus-infected cells in what seems like an effort to warn adjacent cells to protect themselves. Which best describes interferon administered to patients suffering from chronic Hepatitis B or Hepatitis C infection? a. subcutaneous injections of alpha-interferon are given in order to stimulate the immune system b. to prevent rapid elimination via the kidneys, Polyethylene glycol (PEG) is added to interferon c. PEGylated interferon has reduced immunogenicity along with greater solubility and stability D. all of these are correct MEDIUM 48. Match the Class of Antiviral Agents with its prescribed use Class of Antiviral Agents Use Membrane fusion inhibitors D a. anti-herpes simplex I and II viruses Nucleoside analogs A b. Anti-HIV agents use to treat all states of HIV disease Interferons E c. anti-influenza A and B virus agents Protease inhibitors B d. anti-HIV agent used to treat multidrug-resistant infections Neuroaminidase inhibitors C e. treatment of chronic HBV and HBC infections

14.4 Antifungal and Antiparasitic Agents EASY 49. Because fungi and protozoans are Eukaryotes just as Humans are, there are very few physiological differences that would make broad-spectrum antifungals and antiprotozoans drugs possible. Therefore drugs must A. target unique physiological features that make them different from humans b. target unique anatomical features that make them different from humans c. target unique features of their life styles d. target unique features of their reproductive strategies MEDIUM 50. The strategic targets for antifungal drugs are a. reproductive structures like mushrooms and spores b. extracellular substrates that must be brought into the cell for metabolism

C. unique structures within the fungal cell wall and membrane d. ribosomes used in protein synthesis

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HARD 51. Which of the following mechanisms of fungal control is improperly matched? a. cell wall/inhibition of Beta-glucan synthase causes defects in cell wall synthesis B. formation of pores/closing of membrane channels by pore-closing agents like amphotericin B c. ergosterol synthesis/inhibition of synthesis causes accumulation of toxic sterols. d. all are properly matched MEDIUM 52. Match the anti-fungal drug with its use: Anti-Fungal Drug Use Allylamines and Azoles B a. pore-forming agent used to treat invasive fungal infections b. inhibitors of fungal ergosterol synthesis needed to maintain cell Nystatin D membrane fluidity Sulfamethoxazole/trimethoprim C c. used together to inhibit fungus responsible for most HIV deaths Amphotericin B A d. topical antifungal agent used to treat mucosal candidiasis MEDIUM 53. Why is the anti-malaria drug Quinine that has been used to treat Malaria for over 300 years not the current drug of choice? a. because is works slowly b. because data has shown that its use can cause unwelcome side effects c. because the cinchona tree, whose bark is the source of the drug, is now a threatened species D. because of answers a and b e. because of answers a, b, and c HARD 54. All of the following statements describe the current problems faced with treatment of malaria worldwide except a. resistance to chloroquine is widespread in countries where malaria is now endemic b. this resistance has resulted in proliferation of mutant Plasmodium that render chloroquine useless C. use of combination drugs that target the Plasmodium’s mitochondria and ATP production are now in use in countries with low levels of chloroquine resistance. d. use of ancient Chinese herbal medicines like the fast-acting artemisinin are being used where resistance isn’t a problem so that stronger drugs may be saved for future use if needed

MEDIUM 55. Antihelminthic agents work to remove the parasitic worm from the intestinal tract by either paralyzing it or damaging its cytoskeleton. Which of the following drugs is not a correct match with its mechanism of action? a. Ivermectin/blocks ion channel necessary for nerve function

b. pyrantel/causes spastic muscle paralysis by binding to acetylcholine receptors c. mebendazole/impairs locomotion and reproduction D. all are correct matches

14.5 Antimicrobial Drug Resistance EASY 56. Match the “superbug” abbreviation with its real name: Superbug Abbreviation Name C. diff C a. Carbapenem-resistant Enterobacteriaceae MRSA D b. Vancomycin-resistant Enterococcus CRE A c. Endospore forming Clostridium difficile XDR-TB E d. Methicillin-resistant Staphylococcus aureus VRE B e. Extensively drug-resistant Mycobacterium tuberculosis MEDIUM 57. Which of the following is not a problem when dealing with health care-associated pathogens? a. bacteria will eventually become totally antibacterial resistant b. antibacterial agents that will fight them off often have serious side effects c. treatment is very costly d. infection control measures have to be stringently followed E. all of these are problems EASY 58. Where are genes for antibiotic resistance easily found?

A. in soil bacteria b. in aquatic bacteria c. in endospore-forming bacteria d. in anaerobic bacteria e. in aerobic bacteria MEDIUM 59. Bacteria may attain antibiotic-resistance via a. spontaneous mutation b. conjugation with sharing of plasmids c. naked transformation d. cDNA synthesis E. all are correct except D

HARD 60. Which statement about viral drug-resistance is not true? a. viruses with high mutation rates are more likely to produce drug-resistant mutations B. viruses with low mutation rates are more likely to produce drug-resistant mutations

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c. viruses with low overall mutation rates may show considerable drug resistance when mutations occur more frequently in genes already associated with immune system evasion d. viruses with high overall mutation rates may show considerable drug resistance when mutations occur more frequently in genes already associated with immune system evasion

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EASY 61. Mutations can lead to drug resistance when a pathogen a. changes the means of transport of a drug into the cell b. modifies the drug’s chemical structure c. changes the drug’s cellular target D. all of these are correct MEDIUM 62. Which of the following examples of altered transport or reduced permeability of a drug is incorrect? a. mycobacteria demonstrate selective permeability against most antibiotics because of the presence of mycolic acids in their cell walls b. tetracycline-resistant bacteria produce a membrane protein that pumps the drug out of the cell C. vancomycin is too large to pass through the peptidoglycan cell wall of Gram-positive bacteria d. all of these are correct HARD 63. Examples of enzymatic modification of drug structure or drug target include all of these except A. methylization of the 38S rRNA that prevents drugs from binding to inhibitory site on the ribosome b. expression of PBP2A that prevents Beta-lactam antibiotics from binding to PBP and shutting down enzymatic production of peptidoglycan c. production of Beta-lactamase that degrades Beta-lactam ring and prevents the drug from binding to PBP d. production of chloramphenicol acetyl transferase, an enzyme that chemically modifies and inactivates chloramphenicol EASY 64. Antimicrobial resistance occurs as a result of a. spontaneous mutations b. acquisition of genes for drug resistance c. misuse and overuse of antimicrobial agents that eliminate drug-sensitive strains D. all are correct e. only a and be are correct MEDIUM 65. Antimicrobial misuse includes a. prophylactic use of antibiotics in livestock feed b. antibacterial agents prescribed for viral infections c. prescribing of antibiotics when they are not needed D. all are correct e. only b and c are correct

Critical Thinking 66. Human patients contribute to the problem of antimicrobial resistance by a. failing to follow prescription instructions for proper drug use

b. self-administration of antimicrobial drugs left over from a prior infection c. asking health care providers for antimicrobial drugs when they are not needed D. all are correct e. only a and b are correct

• • • •

principles of Drug Resistance Mechanisms of Drug Resistance Human Factors Contributing to Antimicrobial Resistance Livestock-Associated Drug-Resistant S. aureus

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CH. 15 - Epidemiology and Infection Control 15.1 Epidemiology and Public Health EASY 1. Epidemiology may be defined as a. the science that studies the etiology of a disease process b. the science that studies the connection between a pathogen and a specific disease C. the science that studies the patterns, sources and spread of disease in populations d. the science that studies the patterns, sources and spread of disease in individuals MEDIUM 2. The definition of an outbreak is A. a localized increase in the number of cases of illness in a particular place and time that is higher than expected. b. a widespread increase in the number of cases of illness in a particular place and time that is higher than expected. c. a geographically widespread increase in the number of cases of illness across a continent during a specific time frame that is higher than expected. d. an internationally widespread increase in the number of cases of illness within a hemisphere during a specific time frame that is higher than expected.

MEDIUM 3. An epidemic is described as a. an outbreak of a disease that spreads across a continent, leading to more cases than would be expected during a given time period.

B. an outbreak of a disease that spreads through a large area, leading to more cases than would be expected during a given period. c. an outbreak of a disease that spreads globally, leading to more cases than would be expected during a given period. d. an outbreak of a disease the spreads person-to-person, leading to a higher rate of infection that would normally be expected.

HARD 4. Epidemiology a. is a branch of microbiology that seeks to identify the source of infection b. is a foundational science for the identification of risk factors for diseases and for testing the safety and effectiveness of drugs and medical procedures c. is a foundational science that studies infectious diseases in an effort to control outbreaks and prevent and control epidemics D. answers B and C are correct e. all are correct EASY 5. Ignaz Semmelweis became known as the “Savior of Women” because of his 1847 study of Childbed Fever.

Dr. Semmelweis demonstrated via clinical observation and data collection that A. effective hand washing could reduce the annual death rates from childbed fever from 12.1 to 1.3 % b. effective hand washing could reduce the annual death rates from childbed fever from 25.1 to 1.3% c. effective hand washing among medical students conducting autopsies and delivering babies could reduce the death rates from 26.9 to 12.5%

d. effective hand washing among medical students could reduce the death rates from 48.6 to 12.1%.

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HARD 6. Dr. John Snow, personal physician to Queen Victoria, became known as the “Father of Epidemiology” because of his work in stopping the cholera outbreak in London in 1854. Specifically Dr. Snow a. mapped out the geographical locations of the 500+ deaths that occurred in about 10 days that year b. analyzed the data on which water pumps had been most used in the Soho district where the majority of deaths occurred c. removed the water pump handle from the well that had cinfected the most patients d. answers A and B are correct E. all are correct EASY 7. In looking at the significant accomplishments of epidemiology during the 20th century, the demographic group that had the most dramatic reduction in deaths is a. young adults B. infants and children c. middle aged adults d. elderly MEDIUM 8. In 1900 the leading causes of death were a. pneumonia, diarrhea, enteritis and ulceration of the intestines b. pneumonia. tuberculosis, and diarrhea c. tuberculosis, diarrhea, enteritis and ulceration of the intestines D. pneumonia, tuberculosis and diarrhea, enteritis, and ulceration of the intestines HARD 9. One hundred and ten years later in 2010, the only infectious disease that still remains on the list as a hang over from 1900 is A. pneumonia b. tuberculosis c. diarrhea d. enteritis and ulceration of the intestines MEDIUM 10. While mortality is the death rate, morbidity is the A. incidence rate of all diseases in a population b. prevalence of all diseases in a population c. reportable occurrence of specific diseases in a population d. occurrence of a specific pathogen in a population

15.2 Epidemiological Surveillance EASY 11. What is the oldest branch of epidemiology? a. analytical epidemiology b. experimental epidemiology C. descriptive epidemiology d. clinical epidemiology MEDIUM 12. Characteristics of descriptive epidemiology include all of the following except: a. organization of health-related information by person, place and time b. identification of groups that are at greatest rick based on demographics c. descriptive data by place for information on spread of diseases D. description of data by time to reveal mortality EASY 13. Which of the following terms and definitions is an incorrect match? a. prevalence/proportion of cases in a population at a given time and place.

B. incidence/number of new cases per number of susceptible people per month c. mortality rate/number of deaths within group of disease cases d. crude rate/no consideration of age, race, gender or overall health status of population studied HARD 14. A epidemic will show a pathogen coming from a single source at a given time that affects a small number of patients.

A. point-source b. propagating c. common-source d. common-point MEDIUM 15. Disease surveillance relies on reporting data for a specific group of diseases that contribute to public health of a community. Which of the following statements is not true? a. Many infectious diseases are reportable by law to state public health agencies. b. Reportable data helps prevent spread of specific diseases by enabling health services to respond quickly C. Nationally reportable data is published monthly in the CDC’s MMWR d. An index case is the single case that initiates an epidemiological investigation.

15.3 Epidemiological Studies and Clinical Trials HARD 16. A case-control study a. evaluates whether people who have a disease were more or less likely to have been exposed to potential diseases-causing factors than people who don’t have the disease. b. has chosen cases that show selected signs and symptoms during a given time period c. has cases in which diseased individuals are very much like healthy individuals who simply do not have the disease D. all of these are true

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e. only a and b are true MEDIUM 17. Which of the following statements best describes a cohort study? a. determines risk factors for disease outcomes for a group of people b. through a period of time a group of people are followed to evaluate risk factors for disease outcomes c. evaluates two similar groups in which one is exposed to a risk factor and the other isn’t d. all are correct E. only b and c are correct EASY 18. Clinical trials are a. cohort studies specifically designed to evaluate new diagnostic procedures b. cohort studies that are designed to show outcome differences between test subjects and controls C. cohort studies that evaluate new medicines and medical interventions d. cohort studies that compare relative risks of contracting a disease when exposed to the pathogen MEDIUM 19. Several key features included in clinical trials include a. randomization of study groups b. use of double-blind procedures c. inclusion of placebo-controlled cohort d. use of matched pairing system for randomization of small groups E. all of these are correct HARD 20. Which of the following best describes a double-blind study?

A. neither participants nor researchers know who is receiving placebo or receiving the treatment b. 50% of participants receive a placebo and 50% receive treatment but no individual knows what they are receiving c. participants are told what condition they are receiving but researchers are not told so that they analysis of results cannot be skewed d. 25% of participants receive the treatment while 75% receive the placebo after being matched for randomization in small groups HARD 21. What is the correct order of steps in the approval process for new antimicrobial drugs prior to FDA approval?

1. initial design and screening 2. evaluate range of drug concentrations to determine safe dose 3. begin clinical trials in humans 4. extensive animal trials 5. evaluate new drug at low dose 6. evaluate effect of drug in large groups with disease under real-world conditions 7. evaluate effect of drug in controlled setting A. 1, 4, 3, 5, 2, 7, 6

b. 1, 5, 4, 3, 2, 7, 6

c. 1, 6, 4, 3, 5, 2, 7

d. 1, 6, 4, 3, 5, 7, 2

EASY 22. How long is the process of drug development from discovery to FDA approval? a. less than 10 years B. more than 10 years c. less than 20 years d. more than 20 years MEDIUM 23. Why is there little financial incentive for research and development of new antimicrobial agents? a. rapid rise in antibiotic resistant pathogens b. medication taken for short period of time – not a long term treatment for patient c. increase in survival rates for immunosuppressed patients d. all are correct E. only a and b are correct

15.4 Health Care-Associated Infections EASY 24. What is the definition of Health Care-Associated Infection (HAI)? a. infection acquired at a medical facility b. infection acquired through medical error c. nosocomial infection D. only a and c are correct e. all are correct MEDIUM 25. Why are hospital patients vulnerable to HAIs as secondary infections? a. they already have an immune-compromised status b. there are a higher concentration of pathogens in a hospital c. invasive procedures provide new portals of entry into the body d. they have already been taking antibiotics for a long period of time E. all are correct except d HARD 26. Match the common HAI with the common pathogen that causes it.

HAI Pathogen that causes it UTIs B a. Staphylococcus aureus Surgical Site Infections E b. E. coli Respiratory C c. Staphylococcus aureus Sepsis D d. Staphylococcus aureus Skin A e. Staphylococcus epidermidis MEDIUM 27. Surgical Site Infections (SSIs) account for what percentage of post-operative infections? a. 25% b. 32% C. 38% d. 42%

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HARD 28. At what point in the SSI control timeline do patients get a nasal screening for MRSA colonization?

A. pre-admission infection controls b. post-admission, preoperative infection controls c. infection control during surgery d. post-operative infection control e. discharge infection control HARD 29. At what point in the SSI control timeline are gloves changed every 90-150 minutes? a pre-admission infection controls b. post-admission, preoperative infection controls C. infection control during surgery d. post-operative infection control e. discharge infection control HARD 30. At what point in the SSI control timeline is a patient educated about incision care? a. pre-admission infection controls b. post-admission, preoperative infection controls c. infection control during surgery D. post-operative infection control e. discharge infection control EASY 31. Catheter-associated urinary tract infections (CAUTIs) account for approximately what percent of all HAIs? a. 22% B. 40% c. 56% d. 63% MEDIUM 32. Which of the following statements about a PICC line is not accurate? a. used when patient requires infusion of irritating drugs for extended period B. tip of catheter is positioned just below the heart in the inferior vena cava c. PICC lines are responsible for 250,000 bloodstream infections annually d. pathogen spread in bloodstream may lead to thrombophlebitis and cellulitis HARD 33. The percentage of Central Line-Associated Bloodstream Infections (CLABSIs) has increased and now 70% of patients with one are not even hospitalized in the ICU. Which of the following is not a required practice to reduce CLABSIs? a. use of maximum barrier precautions b. use of chlorhexidine for skin preparation C. use of double-lumen catheters d. avoidance of femoral insertion sites

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15.5 Preventing Pathogen Spread in Health Care Settings

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EASY 34. What is the average noncompliance rate for nurses who do not wash their hands? a. 25% B. 40% c. 45% d. 52% MEDIUM 35. After using the toilet, changing a diaper, prior to beginning food preparation, and before eating, hands should be washed with regular soap to achieve removal of of transient skin flora. a. 25-75% b. 40-70% C. 50-95% d. 60-90% MEDIUM 36. In medical settings, hands should be washed with antimicrobial soap or alcohol gel in order to remove of transient skin flora as well as resident flora that may be removed.

A. 99-99.9% b. 90-95% c. 90-99.9% d. 90-92% MEDIUM 37. Before surgical procedures, complete cleaning with antimicrobial soap and brush scrubbing plus holding hands above the level of the elbows will remove of transient and removable resident flora. a. 95.99% b. 98.99% C. 99.99% d. 97.99% EASY 38. The “5 Moments of Hand Hygiene” refers to the frequency of practicing hand hygiene during patient contact by the caregiver such as a nurse or aide. These moments include: a. prior to patient contact b. prior to performing aseptic procedures c. after working with body fluids or compromised skin d. after patient contact E. all of these HARD 39. While alcohol gel cleanser is often more effective and convenient for health caregivers, only can protect against the formation of endospores from bacteria like Clostridium and Bacillus. a. antimicrobial soap with brush scrubbing B. traditional soap and water cleansing c. chlorhexidine gluconate d. povidine iodine scrub

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EASY 40. Match the Standard Precaution with the required activity: Standard Precaution Required Activity a. Use of EPA-registered disinfectants with microbicidal activity against Hand Hygiene D pathogens most likely to contaminate patient-care environment PPE E b. Use aseptic technique to avoid contamination of sterile injection equipment.

Care of the environment A c. Handle used textiles and fabrics with minimum disturbance to avoid contamination of air, surfaces and persons d. No artificial fingernails if duties include direct contact with patients Textiles and Laundry C at high risk of infection Safe injection practices B e. Wear personal protection equipment when anticipated patient interaction indicates contact with blood or body fluids is possible MEDIUM 41. Policies that aim to protect health care workers from microbial transmission of blood-borne pathogens are commonly known as A. Universal precautions b. Standard precautions c. Personal protection precautions d. all of these are correct e. only b is correct EASY 42. Housekeeping seeks to clean daily as well as disinfect items like a. bed rails b. tray tables c. IV pump keypads D. all of the above e. only c is correct

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HARD 43. Screening for Methicillin-resistant Staphylococcus aureus (MRSA) is an important part of hospital routine. MRSA is the most commonly targeted microbe for screening because a. MRSA is also resistant to many standard antibiotics b. MRSA is a Multidrug Resistant strain that produces a “cocktail” of poisons that cause widespread tissue damage c. MRSA produces the toxin PVL that targets leukocytes for destruction, thus crippling the immune system response d. only a and b are correct E. all are correct

MEDIUM 44. With more than 500,000 + nasal swabs being utilized for MRSA testing in hospitals annually, the major factors that help determine laboratory method include a. cost

b. sensititivy c. level of automation d. time required for results E. all of these are correct

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EASY 45. Laboratory methods for MRSA screening that typically involve higher cost but are completely automated and take only 1 hour for results are called a. selective media b. chromogenic media C. molecular techniques d. differential media MEDIUM 46. Bacteria besides MRSA that justify screening because of their high mortality and morbidity rates include a. Vancomycin-resistant Enterococcus (VRE) b. Clostridium difficile c. Carbapenem-resistant Enterobacteriaceae (CRE) D. all are correct e. only a and b are correct HARD 47. Isolation procedures are determined by the pathogenicity and transmission status of the pathogen.

Which of the following modes of transmission would be the most difficult or challenging to control? a. direct contact via contaminated body fluids b. indirect contact via contaminated linens and medical equipment c. droplet transmission via respiratory droplets traveling 1 meter D. airborne transmission traveling more than 1 meter MEDIUM 48. The extra steps that must be taken if a pathogen is airborne include all of the following except: a. healthcare givers must wear N95 respirator masks and protective eyewear B. negative pressure prevents air movement in to the room when the door is opened c. room ventilation is designed to prevent pathogen escape d. air passes through HEPA filtration EASY 49. Personal Protection Equipment (PPE) provides the necessary protection against these highly pathogenic bacteria: a. MRSA b. C. difficile c. VRE D. all are correct e. only a and c are correct

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MEDIUM 50. High risk tasks for health care providers that necessitate the use of PPE include potential contact with all of the following except: a. semen and vaginal secretions b. amniotic or peritoneal fluid C. sweat secretions d. cerebrospinal or synovial fluid e. pericardial or pleural fluid

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Isolation Procedures

CH. 16 – Diseases of the Respiratory System 16.1 The Conflicts EASY 1. What is the one of the most common symptoms of a respiratory illness? a. coughing B. sneezing c. runny nose d. nasal congestion MEDIUM 2. Which of the following are characteristics of a sneeze? a. produces about 40,000 droplets that are propelled at of the nose at 40 mph b. small droplets easily inhaled by another person travel less than 39 inch c. larger mucus drops that not inhaled by others and travel up to 7 meters d. only a and b are correct E. all are correct HARD 3. What determines which tissues become infected? a. pathogens have to attach to tissues b. some pathogens can attach to multiple tissues thereby causing more serious diseases c. pathogens always have to enter tissues in order to cause disease D. only a and b are correct e. all are correct MEDIUM 4. As one of the host defenses, what characteristic does mucus have that makes it such an effective defense? a. mucus is hypertonic so it kills many pathogens via dehydration or plasmolysis b. mucus is hypotonic so it kills many pathogens via dehydration or plasmolysis c. mucus is sticky so it traps pathogens and is subsequently swept upward via mucociliary escalator d. only b and c are correct E. only a and c are correct EASY 5. How do pathogens evade host defenses? a. members of the genus Staphylococcus can grow in mucus lining the respiratory tract b. some members of the genus Streptococcus have capsules that render them antiphagocytic c. Bordetella pertussis produces toxins that damage tissue and inhibit ciliary action D. all are correct MEDIUM 6. What largely determines the type of respiratory system disease that a pathogen may cause?

A. where the pathogen attaches b. what types of toxins a pathogen produces c. what types of physical structures a pathogen possesses d. how many pathogens are required to produce an infection

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HARD 7. What role do the normal or resident microbiota have in the Respiratory System?

A. Each of the over 2000 different species of bacteria making up the normal microbiota is well adapted and can resist removal or destruction. b. Because the normal microbiota have taken up residence in the tissues of the Respiratory System they prevent other microbes from trying to move in. c. Resident microbiota that are opportunistic pathogens may cause disease if optimal conditions are present. d. all of these are correct

16.2 Bacterial diseases of the Respiratory System EASY 8. What is the mortality rate for Diphtheria?

A. 5-10% b. 8-12% c. 10-15% d. 12-16% MEDIUM 9. Is Corynebacterium diphtheriae normally pathogenic? a. Yes, it normally produces a cytotoxin that kills the tissues in the pharynx. b. Yes, it normally causes formation of a leathery pseudomembrane that causes suffocation.

C. No, it produces a tissue-killing cytotoxin only when it is infected by a lysogenic bacteriophage that expresses a toxin-producing gene. d. No, it produces a tissue-killing cytotoxin only when it is infected by a protozoan that passes on the toxinproducing gene in a plasmid.

EASY 10. How is Corynebacterium diphtheriae spread? a. it is transmitted by airborne particles B. it is transmitted by contact mode of transmission c. it is transmitted by indirect mode of transmission d. it is transmitted by common vehicle transmission HARD 11. Why is an antitoxin required to treat cases of diphtheria as well as an antibiotic?

A. antitoxin specifically binds to and inactivates the cytotoxin b. antitoxin specifically binds to and dissolves the pseudomembrane c. antitoxin specifically binds to and kills the lysogenic bacteriophage d. antitoxin specifically binds to and kills the infected tissue in the MEDIUM 12. Positive diagnosis of Diphtheria includes growing culture on this special medium: a. Eosin Methylene Blue Agar b. Mannitol Salt Agar C. Loeffler’s Agar d. MacConkey Agar EASY

13. To prevent an outbreak of Diphtheria when one patient has been positively diagnosed, several steps must be taken to protect the very young and those who immunity has decreased over time. These steps include all of the following except A. infected patient is vaccinated against C. diphtheriae b. infected patient is isolated from others b. individuals in close contact with patient are given boosters and treated with antibiotics c. throat swab of patient is performed after 2 weeks for analysis MEDIUM 14. Pertussis or Whooping Cough follows 3 sequential stages. How long will the illness last? a. less than 4 weeks b. about 4 weeks c. more than 4 weeks D. more than 4 weeks or months EASY 15. What demographic group is most at risk for severe disease caused by Bordetella pertussis? a. Children 6 to 18 mo old B. Children less than 6 mo old c. Children 2 to 5 yr d. Children 5 to 8 yr HARD 16. B. pertussis has been called “one of the most contagious” respiratory pathogens because it can be spread by all of these ways except a. respiratory droplets B. direct contact via fomites c. direct physical contact d. airborne transmission MEDIUM 17. How long may a patient remain contagious to others after contracting Whooping Cough?

A. for up to 6 weeks b. for the first 2 weeks c. for up to 8 weeks d. for up to 4 weeks HARD 18. The DTaP vaccine is a. 98% effective although immunity is lost by age 16 b. 97% effective although immunity is lost by age 14 C. 97% effective although immunity is lost by age 12 d. 95% effective although immunity is lost by age 12 EASY 19. Since B. pertussis-caused disease has been relatively rare in countries with good health-care programs, most people do not realize that this respiratory disease was a. one of the top 20 causes of death worldwide from infectious disease until 2000 B. one of the top 10 causes of death worldwide from infectious disease until 2010 c. one of the top 5 causes of death worldwide from infectious disease until 2000

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d. one of the top 10 causes of death worldwide from infectious disease until 2010 MEDIUM 20. In recent years more cases of Pertussis or Whooping Cough have occurred because of waning immunity in vaccinated individuals. This can begin within A. 7 years of the last vaccination b. 5 years of the last vaccination c. 10 years of the last vaccination d. 20 years of the last vaccination HARD 21. Some people have identified Mycobacterium tuberculosis as one of the leading killers of humans throughout history, surpassing smallpox. The history of this human pathogen may be scientifically traced by a. identifying the bacterium in corpses b. examining the classical spinal deformities of skeletal TB c. performing molecular analysis of bone and lung samples of preserved corpses D. only b and c are correct e. all are correct MEDIUM 22. Startling to U.S. citizens for whom TB is a relatively unknown disease, the World Health Organization estimates that as many as 25 to 33% of the world’s population is infected with this bacterium and millions die every year. Worldwide, TB ranks as the leading cause of death caused by an infectious microorganism. a. first b. second c. third D. fourth EASY 23. Looking at the current data on TB worldwide, all of these statements are true except a. HIV patients suffer much higher rates of TB. b. India and China lead the world in the number of new TB cases each year.

C. TB is the #10 cause of death in teenagers and young adults in South Africa. d. Drug resistance is becoming widespread due to lack of funds and medications.

EASY 24. Which of the following accurately describes Mycobacterium tuberculosis? a. It is a Gram-positive streptobacillus. b. Its cell wall contains mycolic acid, a waxy substance that makes this bacterium difficult to Gram stain. c. Mycolic acid blocks the entry into the cell of antibiotics, making this bacterium difficult to destroy. d. M. tuberculosis is an airborne pathogen.

E. all are correct

MEDIUM 25. Because it is a slow-growing bacterium, M. tuberculosis exposure may result in the following:

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a. latent tuberculosis in which patient is infected but shows no signs or symptoms as immune system makes the bacterium become latent b. only approximately 20% of those infected progress to an active infection c. M. tuberculosis may move from lungs to other body systems such as CNS, skeletal, lymphatic, genitourinary, GI and skin D. only a and c are correct e. all are correct

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EASY 26. Signs and symptoms of an active case of TB include a. productive cough b. presence of fever and night sweats c. significant and noticeable weight loss d. fatigue E. all of these MEDIUM 27. Confirming a diagnosis of active TB involves several methods except a. acid-fast stain of sputum sample b. PCR analysis C. rapid culture of bacterium d. direct DNA sequencing HARD 28. Treatment for active TB may include multiple drugs in order to a. prevent development of drug-resistance b. provide long-term therapy to kill the slow-growing bacterium c. give the best long-term prognosis for the patient D. all are correct e. only a and b are correct MEDIUM 29. TB screening is very important in health care settings in order to keep patients with suppressed immune systems from being exposed. Characteristics of this Mantoux skin test screening include a. injection of purified protein derivative (PPD) from the Mycobacterium under the skin of the inner lower arm b. based on a Type IV Hypersensitivity Reaction, the test results are read after 48-72 hr c. a positive result indicating previous exposure to the TB protein will be the presence of an induration D. all of these are correct e. only a and c are correct HARD 30. Does a positive Mantoux skin test mean that a patient has TB? a. Yes, it does and treatment is started immediately b. Probably yes, and it is followed up by a chest Xray to look for granulomas in the lungs, thus confirming the diagnosis c. Maybe no if a subsequent chest Xray shows no abnormalities and the patient has no signs and symptoms in which case it is probably latent TB

16.3 Viral Diseases of the Respiratory System

EASY 31. What are the basic differences between the common cold and influenza? a. cold viruses only attach to epithelial tissues in the nasal cavity b. influenza viruses may attach to tissues throughout the respiratory tract c. cold viruses usually may cause major diseases but are usually self-limiting d. Influenza viruses may cause serious diseases of the lower respiratory tract E. all of these are correct except c

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MEDIUM 32. Cold-causing viruses are reportedly the second most frequent reason for getting medical care for a respiratory infection after influenza. What age groups are most susceptible to these cold-causing viruses?

A. Infants and very young children b. adolescents c. young adults d. mature adults e. seniors EASY 33. Viruses that cause colds vary in origin but often belong to the Rhinovirus group and may be transmitted by a. respiratory droplets from coughing and sneezing b. direct contact between people c. indirect contact via fomites D. all are correct e. only a and b are correct HARD 34. Fomites pose a particular risk for spreading a cold virus because a. cold viruses are resistant to temperature changes b. cold viruses are resistant to some drying or lack of humidity c. cold viruses can remain infectious on fomites for some period of time D. all are correct e. only a and c are correct MEDIUM 35. People often say that individuals can “catch” a cold from becoming chilled in the winter. But what are the real reasons that colds are more easily spread in the winter months? a. The lower humidity of the air in the winter makes it easier for the cold viruses to survive. b. The lower humidity of the air dries the mucus membranes of the upper respiratory tract making them ineffectual in keeping cold viruses from attaching.

C. Both a and b are correct d. Only a is correct e. Only b is correct

HARD 36. What are the eight steps in the progression of the common cold?

1. Cold virus invades and kills nasal epithelium 2. congestion in sinus cavities leads to sinusitis 3. Cytokines cause headache and fever 4. edema leads to congestion of openings to sinus cavities 5. damaged tissue is infected by resident bacteria and becomes thick and yellow from dying leukocytes 6. Dying epithelial cells release cytokines (chemical messengers) that trigger inflammatory reaction 7. inflammation causes loss of fluid and edema in nasal tissues 8. damaged tissues are repaired a. 1, 2, 3, 4, 5, 6, 7, 8 B. 1, 6, 3, 7, 5, 4, 2, 8 c. 1, 5, 7, 4, 2, 3, 6, 8 d. 1, 6, 4, 5, 3, 2, 7, 8 EASY 37. What is the major threat from influenza?

A. when the virus attacks the lower respiratory tract and causes life-threatening pneumonia b. when the adult patient’s temperature rises above 104 deg F c. when the virus attacks the upper respiratory tract and causes sinusitis d. when the virus causes secondary bacterial bronchitis MEDIUM 38. What demographic group(s) is(are) at greatest risk from Influenza? a. mostly infants and the elderly b. only infants and young children C. mostly individuals over the age of 65 d. mostly young and mature adults EASY 39. What is the average number of deaths from Influenza each year in the U.S.? a. 100,000 b. 60,000 c. 40,000 D. 20,000 HARD 40. What is the source of pandemic Influenza A virus strains? a. Antigenic shifts in the H and N genes b. Antigenic drift in the H and N genes c. Recombination of portions of viruses between birds and mammals like swine D. both a and c are correct e. both b and c are correct

MEDIUM 41. What are the characteristics of Influenza?

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a. caused by different strains of A, B, and C Influenza viruses b. possess 8 individual segments of single-stranded RNA c. have a pleomorphic capsid d. have an envelope E. all of these HARD 42. What are the differences between the H and N proteins critical to establishment of Influenza disease? a. H = hemagglutinin protein needed for viral attachment b. N = neuraminidase needed for release of viruses from cell c. both H and N proteins are primary antigens targeted by human immune system d. both H and N are numbered according to strain and are used in identifying different strains E. all are correct EASY 43. How are influenza viruses transmitted? a. mucus droplets b. small aerosolized particles transmitted via coughing and sneezing c. indirect contact via fomites d. direct contact between individuals E. all of these MEDIUM 44. What are the signs and symptoms of Influenza? a. chills but no fever b. sore throat c. muscle aches and headache d. fatigue and nonproductive cough E. all are correct except a HARD 45. Annual flu vaccinations have been shown to be between 40-90% effective. The inactivated vaccine is reformulated each year, but usually contains a. most common strains of H1N1 and H2N3 b. most prevalent Influenza B virus strain from previous year c. most common strains of H3N2 and H2N2 D. only a and b are correct e. only b and c are correct

16.4 Diseases of the Respiratory System Caused by Multiple Pathogens MEDIUM 46. Why is sinusitis often preceded by a cold or allergic rhinitis? a. because the sinus cavities that are normally free of pathogens is connected to the nasal cavity b. because the pathogens that cause inflammation of the nasal cavity are the primary causes of sinusitis c. because symptoms of sinusitis are usually associated with the inflammatory response from tissue damage caused by viral or bacterial pathogens D. all are correct e. only a and b are correct

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EASY 46. What physical characteristic of children makes them more likely to develop Otitis Media? a. small ears b. small nasal cavity C. short Eustachian tubes d. more common colds MEDIUM 47. Children with Otitis Media often share these demographics: a. are bottle fed and use a pacifier b. have a smoker in the household c. are small for their age D. only a and b are correct e. all are correct HARD 48. Which of the following is most often the ultimate cause of Otitis Media? a. viruses (rhinoviruses) that cause the common cold B. respiratory syncytial virus (RSV) c. Streptococcus pneumoniae d. Mycoplasma pneumoniae EASY 49. What percentage of acute cases of pharyngitis (= sore throat) are caused by viruses? a. about 40% b. about 50% c. about 65% D. about 70% MEDIUM 50. Which of the following statements concerning pharyngitis is not true? a. accounts for approximately 12 million annual outpatient care visits in the U.S. b. ranks in the Top 20 of the most common primary diagnosis groups c. most often caused by an adenovirus D. prescribing antibiotics decreases likelihood of secondary bacterial infection EASY 51. Pathogens that often cause viral pharyngitis include a. cornoviruses b. rhinoviruses c. adenoviruses d. parainfluenza virus E. all of these

MEDIUM 52. Group A Beta-Hemolytic Streptococcus (GABHS)

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a. is descriptive of Streptococcus pyogenes, the cause of Strep Throat b. is descriptive of the clinical features that identify it in a microbiology lab C. both a and b are correct d. only a is correct e. only b is correct

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HARD 53. Streptococcus pyogenes is a successful pathogen because a. it produces an antiphagocytic capsule b. it produces an exotoxin that kills leukocytes c. it produces an exotoxin that enables it to survive the immune system defenses D. all are correct e. only a and b are correct EASY 54. Which demographic group is more likely to contract Strep Throat? a. infants B. children c. adolescents d. mature adults MEDIUM 55. What is the most common complication of Strep Throat? a. rheumatic heart disease B. scarlet fever c. rheumatic fever d. severely infected pharynx HARD 56. Match the disease of the respiratory tract with the correct description: Respiratory Tract Disease Description a. serious but rare pediatric bacterial inflection resulting in membrane of Laryngitis D pus and mucus Croup B b. common pediatric illness with inflammation of larynx and trachea Tracheitis A c. inflammation causes obstruction of airway resulting in hypoxia Epiglottitis C d. most commonly caused by parainfluenza virus EASY 57. Most common feature of bronchitis is A. purulent cough that persists for about 10 days b. fever accompanied by sore throat c. caused by both bacteria and viruses d. symptomatic treatment with use of antibiotics for bacterial infections only

MEDIUM 58. All of the following statements about Bronchiolitis are true except a. is an inflammation of the bronchioles due to infection

b. is a common pediatric disease C. affects 15% of children younger than age one d. is caused more than 90% of the time by Respiratory Syncytial Virus

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16.5 Pneumonia EASY 59. Statistically pneumonia accounts for a. more than 10 million respiratory infections annually in the U.S. b. more than 2 million respiratory infections annually in the U.S. c. more than 3 million respiratory infections annually in the U.S. d. more than 7 million respiratory infections annually in the U.S. MEDIUM 60. On the tissue level, pneumonia is actually A. alveolar inflammation that results in fluid accumulation in the lungs b. acute inflammation of the lower respiratory tract c. inflammation of the mucociliary escalator of the respiratory system d. acute inflammation of the bronchioles and bronchi EASY 61. Which type of pathogen can cause pneumonia? a. virus b. bacteria c. fungi d. parasites E. all of these MEDIUM 62. Patients presenting with pneumonia have these signs/symptoms a. fever and cough b. rales c. shortness of breath D. all of these are correct e. only b and c are correct HARD 63. Match the type of pneumonia with its characteristic: Type of Pneumonia Characteristic Community-acquired pneumonia (CAP) C a. develops at least 48 hr after hospital admission Health-care associated pneumonia (HCAP) D b. develops within 48 hr or inserting or removing ventilator tubes Hospital-acquired pneumonia (HAP) A c. develops in the outpatient setting Ventilator-associated pneumonia (VAP) B d. Key risk factors for acquiring drug-resistant pathogen MEDIUM 64. Match the cause of a type of pneumonia with its description: Cause of Pneumonia

Description

12 Bacterial B Viral D Fungal A Parasitic C

a. patients are usually immunosuppressed/spread by droplet transmission b. rapid onset of symptoms c. different types of internal helminths d. cause most pneumonia in children and those over 60 years

EASY 65. Which is not a characteristic of a high-quality sputum sample in a diagnosis of pneumonia? a. abnormal appearance b. contains pus C. clear specimen d. contains blood or black flecks MEDIUM 66. Because pneumonia can be life-threatening, antimicrobial therapy is prescribed early and follows all of these guidelines except a. should be a broad-spectrum antibiotic b. should include Beta-lactam and macrolide antibiotics c. use drugs to target as many possible bacterial pathogens as possible D. prohibits use of antimicrobials if viral pathogen is suspected HARD 67. Match the Emerging Pathogen causing pneumonia with its description: Emerging Pathogen Description Legionnaire’s Disease D a. caused by Sin Nombre virus b. transmitted from sick chickens to people with greater Hantavirus Pulmonary Syndrome A than 30% fatality rate Severe Acute Respiratory Syndrome (SARS) E c. first found in Saudi Arabia with 30% fatality rate Middle East Respiratory Syndrome (MERS) C d. bacterium is found in many aquatic ecosystems H5N1/Influenza B e. caused by a new variant of coronavirus

CHAPTER 17 TEST BANK QUESTIONS

LEARNING OBJECTIVE: 17.1.1 Describe the functions of the skin and how it stops invasion by pathogens.

QUESTION: Blood vessels of the skin are located in the a. stratum corneum. b. dermis. c. stratum basale. d. dermis and subcutaneous layer.

Correct answers: d Difficulty: Easy LEARNING OBJECTIVE: 17.1.1 Describe the functions of the skin and how it stops invasion by pathogens.

QUESTION: Which of the following that reflect the functions of the human skin? Select all that apply. a. thermoregulation b. vitamin D metabolism c. remove excess sugars d. remove excess salts Correct answers: a,b,d Difficulty: Medium LEARNING OBJECTIVE: 17.1.1 Describe the functions of the skin and how it stops invasion by pathogens.

QUESTION: The skin protects from microbial invasion by all EXCEPT a. high pH. b. resident microflora. c. lysozymes. d. antimicrobial peptides.

Correct answers: a Difficulty: Medium LEARNING OBJECTIVE: 17.1.1 Describe the functions of the skin and how it stops invasion by pathogens.

QUESTION: What substance in skin cells makes the skin waterproof, provides protection from abrasions, and protects against the entry of microorganisms? a. melanocytes b. keratinocytes c. monocytes d. erythrocytes Correct answers: b Difficulty: Easy LEARNING OBJECTIVE: 17.1.2 Characterize the pathogen strategies for overcoming host skin defenses and describe the principal types of skin lesions that indicate an infection.

QUESTION: Pathogens can evade the protection of the human skin in the following ways.

Select all that apply. a. microbial mutation b. altering their surface proteins c. altering the host cell proteins d. host mutation Correct answers: a,b Difficulty: Medium LEARNING OBJECTIVE: 17.1.2 Characterize the pathogen strategies for overcoming host skin defenses and describe the principal types of skin lesions that indicate an infection.

QUESTION: Macules, papules, and vesicles are examples of skin lesions associated with

a. b. c. d.

burns. infectious rashes. genetic disorders. chemical rashes.

Correct answers: b Difficulty: easy LEARNING OBJECTIVE: 17.1.3 Identify the common members of normal skin microbiota, indicating the protective role of each.

QUESTION: Which species of microorganisms are not normally found to reside on or in the human skin? a. Staphylococcus b. Micrococcus c. Corynebacterium d. All of these are normally found on the skin.

Correct answers: d Difficulty: medium LEARNING OBJECTIVE: 17.1.3 Identify the common members of normal skin microbiota, indicating the protective role of each.

QUESTION: The Human Microbiome Project (HMP) discovered that a. more microorganisms live on and in our skin than previously thought. b. fewer microorganisms live on and in our skin than previously thought.

Correct answers: a Difficulty: Easy LEARNING OBJECTIVE: 17.2.1 Correlate the symptoms of skin and soft tissue infections with the toxins and enzymes secreted by the staphylococcal and streptococcal pathogens.

QUESTION:

What enzyme is found in Staphylococcus aureus but is not found in Staphylococcus epidermidis? a. catalase b. peroxidase c. lipase d. coagulase Correct answers: d Difficulty: Medium

LEARNING OBJECTIVE: 17.2.1 Correlate the symptoms of skin and soft tissue infections with the toxins and enzymes secreted by the staphylococcal and streptococcal pathogens.

QUESTION: MRSA is a methicillin-resistant form of what common skin microorganism? a. Streptococcus b. Staphylococcus c. Streptomyces d. Salmonella Correct answers: b Difficulty: easy LEARNING OBJECTIVE: 17.2.1 Correlate the symptoms of skin and soft tissue infections with the toxins and enzymes secreted by the staphylococcal and streptococcal pathogens.

QUESTION: Erysipelas is caused by a. S. pyogenes. b. S. aureus. c. S. epidermidis. d. S. marcescens.

Correct answers: a Difficulty: Medium

LEARNING OBJECTIVE: 17.2.2 Identify the pseudomonal skin diseases, specifying which ones can cause deadly infections.

QUESTION: Which of the following is TRUE of Pseudomonas aeruginosa? a. It is cocci. b. It is gram positive. c. It generally is not found to survive on dry skin. d. It has flagella.

Correct answers: c Difficulty: easy LEARNING OBJECTIVE: 17.2.1 Correlate the symptoms of skin and soft tissue infections with the toxins and enzymes secreted by the staphylococcal and streptococcal pathogens.

QUESTION: The most common microbe to cause gangrene is a. Staphylococcus aureus. b. Clostridium perfringens. c. Pseudomonas aeruginosa. d. Proteus vulgaris.

Correct answers: b Difficulty: Medium LEARNING OBJECTIVE: 17.2.1 Correlate the symptoms of skin and soft tissue infections with the toxins and enzymes secreted by the staphylococcal and streptococcal pathogens.

QUESTION: What is the most common skin disease in the United States? a. eczema b. psoriasis c. acne d. skin cancer

Correct answers: c Difficulty: Easy LEARNING OBJECTIVE: 17.2.3 Rank the miscellaneous bacterial infections from most to least severe after reviewing the symptoms associated with each.

QUESTION: Rank the following miscellaneous bacterial infections from most severe to least severe. a. acne, erysipelas, necrotizing fasciitis b. necrotizing fasciitis, acne, erysipelas c. necrotizing fasciitis, acne, erysipelas d. necrotizing fasciitis, erysipelas, acne e. erysipelas, necrotizing fasciitis, acne Correct answers: d Difficulty: Medium LEARNING OBJECTIVE: 17.3.1 Characterize the rashes of the six common pediatric viral skin infections.

QUESTION: The Varicella Zoster Virus causes which of the following viral skin infections? a. measles b. chickenpox c. mumps d. rubella Correct answers: b Difficulty: Easy LEARNING OBJECTIVE: 17.3.1 Characterize the rashes of the six common pediatric viral skin infections.

QUESTION: Koplik Spots are synonymous with which viral skin infection? a. measles

b. chickenpox c. mumps d. rubella Correct answers: a Difficulty: Hard LEARNING OBJECTIVE: 17.3.1 Characterize the rashes of the six common pediatric viral skin infections.

QUESTION: The MMR vaccine protects against which of the following EXCEPT Select all that apply. a. mumps. b. rubella. c. malaria. d. measles. e. chickenpox. f. rheumatic fever. g. erysipelas.

Correct answers: c Difficulty: Hard LEARNING OBJECTIVE: 17.3.1 Characterize the rashes of the six common pediatric viral skin infections.

QUESTION: The morbillivirus causes a. mumps. b. chicken Pox. c. measles. d. rubella.

Correct answers: c Difficulty: Medium LEARNING OBJECTIVE:

17.3.1 Characterize the rashes of the six common pediatric viral skin infections.

QUESTION: Rubella is caused by which of the following viruses? a. rubellia b. rubivirus c. morbillivirus d. varicella zoster virus Correct answers: b Difficulty: Medium LEARNING OBJECTIVE: 17.3.1 Characterize the rashes of the six common pediatric viral skin infections.

QUESTION: The pathogen responsible for Roseola is a. parvovirus. b. coxsackievirus. c. human herpesvirus 6/7. d. human papilloma virus.

Correct answers: c Difficulty: Medium LEARNING OBJECTIVE: 17.3.1 Characterize the rashes of the six common pediatric viral skin infections.

QUESTION: Coxsackievirus is the main causative agent of a. hand, foot, and mouth disease. b. bovine spongiform encephalopathy (BSE). c. chickenpox. d. fifth disease.

Correct answers: a Difficulty: Medium

LEARNING OBJECTIVE: 17.3.2 Outline the relationship between shingles and chickenpox.

QUESTION: Shingles is a reactivation of the same virus that is responsible for also causing a. mumps. b. chickenpox. c. measles. d. rubella.

Correct answers: b Difficulty: Easy LEARNING OBJECTIVE: 17.3.2 Outline the relationship between shingles and chickenpox.

QUESTION: The symptoms of shingles are usually more painful than chicken pox because shingles blisters a. follow a nerve. b. burn the skin. c. acidic. d. destroy nerves.

Correct answers: a Difficulty: Medium

LEARNING OBJECTIVE: 17.3.3 Compare and contrast the three types of warts.

QUESTION: Warts are causes by different strains of which virus? a. parvovirus b. coxsackievirus c. human herpesvirus 6/7 d. human papilloma virus Correct answers: d

Difficulty: Easy LEARNING OBJECTIVE: 17.3.3 Compare and contrast the three types of warts.

QUESTION: Which type of warts are characterized by flattened bumps found on the face and neck? a. flat warts b. common warts c. plantar warts d. inguinal warts Correct answers: a Difficulty: easy LEARNING OBJECTIVE: 17.3.3 Compare and contrast the three types of warts.

QUESTION: Which type of warts are characterized by growth on the bottom of feet? a. flat warts b. common warts c. plantar warts d. inguinal warts Correct answers: c Difficulty: easy

LEARNING OBJECTIVE: 17.3.3 Compare and contrast the three types of warts.

QUESTION: Which type of warts are characterized by cauliflower-like bumps found on the hands? a. flat warts b. common Warts c. plantar warts d. inguinal warts

Correct answers: b Difficulty: easy LEARNING OBJECTIVE: 17.3.3 Compare and contrast the three types of warts.

QUESTION: Which statement is INCORRECT about warts? a. They are caused by human papillomaviruses (HPV). b. They are transmitted by direct contact. c. They include deep plantar warts on soles of the feet. d. They are frequently cancerous.

Correct answers: d Difficulty: Medium LEARNING OBJECTIVE: 17.3.4 Describe the pathogenesis of smallpox and the resulting rash progression.

QUESTION: The causative agent of smallpox is a. varicella zoster virus. b. variola virus. c. coxsackievirus. d. smallpoxia virus.

Correct answers: b Difficulty: Medium

LEARNING OBJECTIVE: 17.3.4 Describe the pathogenesis of smallpox and the resulting rash progression.

QUESTION: The smallpox virus replicates in the host’s a. nasopharynx. b. dermis. c. lymph nodes. d. skeletal muscle.

Correct answers: c Difficulty: Hard LEARNING OBJECTIVE: 17.4.1 Describe common skin diseases caused by fungi.

QUESTION: Candidiasis is cause by a a. virus. b. bacterium. c. fungus. d. protozoan.

Correct answers: c Difficulty: Medium LEARNING OBJECTIVE: 17.4.1 Describe common skin diseases caused by fungi.

QUESTION: Candida spp. causes which two diseases? a. oral thrush and candidasis b. oral thrush and leishmaniasis c. candidasis and leishmaniasis d. leishmaniasis and lice Correct answers: a Difficulty: Medium LEARNING OBJECTIVE: 17.4.1 Describe common skin diseases caused by fungi.

QUESTION: Tinea, or ringworm, is caused by a. protozoa. b. dermatomycoses. c. arthropods. d. yeasts.

Correct answers: b Difficulty: Medium LEARNING OBJECTIVE: 17.4.2 Describe the cause, symptoms, and treatment of leishmaniasis.

QUESTION: The main disease caused by protozoa is a. leishmaniasis. b. dermatomycoses. c. acne. d. measles.

Correct answers: a Difficulty: Medium LEARNING OBJECTIVE: 17.4.2 Describe the cause, symptoms, and treatment of leishmaniasis.

QUESTION: Those with the greatest change of acquiring leishmaniasis are a. persons in contact with mice. b. persons in contact with fleas. c. persons in contact with sand flies. d. persons in contact with fecal matter.

Correct answers: c Difficulty: Medium LEARNING OBJECTIVE: 17.4.3 Compare scabies and pediculosis.

QUESTION: Pediculus humanus captis, Pediculus humanus corpis, and Pthirus pubis are all arthropods that cause what condition? a. scabies b. lice c. rickets d. leishmaniasis

Correct answers: b Difficulty: Hard LEARNING OBJECTIVE: 17.4.3 Compare scabies and pediculosis.

QUESTION: 5% permethrin is the most common treatment for infection with which skinburrowing mite? a. scabies b. lice c. rickets d. leishmaniasis Correct answers: a Difficulty: Medium LEARNING OBJECTIVE: 17.5.1 Explain the interactions between host eye defenses and microbial pathogenesis.

QUESTION: The best defense for the eye against pathogens is/are the a. cornea. b. eyelashes. c. tears. d. eyebrows.

Correct answers: c Difficulty: Easy LEARNING OBJECTIVE: 17.5.1 Explain the interactions between host eye defenses and microbial pathogenesis.

QUESTION: Which of the following are defenses of the human eye against pathogens?

Select all that apply. a. tears b. lysozymes c. IgA antibodies

d. aqueous humor Correct answers: a,b,c Difficulty: Medium LEARNING OBJECTIVE: 17.5.1 Explain the interactions between host eye defenses and microbial pathogenesis.

QUESTION: Choose the statement below that BEST characterizes the normal biota of the eye. a. The normal biota of the eye resembles that found in the mouth. b. The normal biota of the eye only includes bacteria. c. The normal biota of the eye is large in numbers but lacks diversity. d. The normal biota of the eye is generally sparse.

Correct answers: d Difficulty: Medium LEARNING OBJECTIVE: 17.5.2 Describe the four forms of conjunctivitis.

QUESTION: Which of these statements apply to bacterial conjunctivitis? Select all that apply. a. It is caused by more than one type of bacteria. b. In children and adults, prevention is through good hygiene. c. Clear discharge is a distinguishing feature. d. Prevention is through elimination of the vector.

Correct answers: a,b Difficulty: Hard LEARNING OBJECTIVE: 17.5.2 Describe the four forms of conjunctivitis.

QUESTION: Infection of the mucous membrane of the eye, characterized by swelling, discharge, and erythema is called

a. b. c. d.

conjunctivitis. blepharitis. trichiasis. keratitis.

Correct answers: a Difficulty: Easy LEARNING OBJECTIVE: 17.5.2 Describe the four forms of conjunctivitis.

QUESTION: Which of the following do NOT represent one of the four main types of conjunctivitis? a. viral b. bacterial c. allergic d. genetic Correct answers: d Difficulty: Medium LEARNING OBJECTIVE: 17.5.3 Describe the transmission, symptoms, and treatment of blepharitis, keratitis, and helminthic eye infections.

QUESTION: Blepharitis is characterized by a. inflammation of the clear tissue on the front of the eye (cornea). b. inflammation of the eyelid that affects the eyelashes or tear production. c. inflammation or infection of the outer membrane of the eyeball and the inner eyelid. d. a parasitic, tropical disease that affects the skin and eyes.

Correct answers: b Difficulty: Medium LEARNING OBJECTIVE: 17.5.3 Describe the transmission, symptoms, and treatment of blepharitis, keratitis, and helminthic eye infections.

QUESTION: Which of the following is NOT a true statement? a. Blindness due to herpes is the leading infectious cause of blindness in the United States. b. Keratitis caused by HSV-1 is most often treated with an antibiotic. c. Keratitis can be caused by a eukaryotic organism. d. Acanthamoeba infection can cause keratitis, especially in those who wear contact lenses.

Correct answers: b Difficulty: Hard LEARNING OBJECTIVE: 17.5.3 Describe the transmission, symptoms, and treatment of blepharitis, keratitis, and helminthic eye infections.

QUESTION: Which of the following conditions would someone living in the Unites States worry about the LEAST? a. Conjunctivitis b. Blepharitis c. Trichiasis d. Onchocerciasis Correct answers: d Difficulty: Hard

CH 18 – DISEASES OF THE NERVOUS SYSTEM 18.1 The Conflicts EASY 1. What are the primary responsibilities of the Nervous System? a. controls and regulates other organs b. center for all internal communication c. center for all mental activity d. helps regulate and maintain homeostasis E. all of these are correct MEDIUM 2. Unlike other types of tissues, neurons a. are able to regenerate themselves rapidly b. are able to regenerate themselves only after hormonal stimulation C. are unable to regenerate themselves if damaged d. are unable to regenerate themselves unless activated by stem cells HARD 3. Neural defenses against both physical damage and microbial infection include all of the following except a. encasement of central nervous system with bones B. surrounding CNS with five layers of membranes c. presence of cerebrospinal fluid between the arachnoid mater and the pia mater d. all are correct e. only a and b are correct EASY 4. In order to get into the CNS, microbes have to work hard by circumnavigating host defenses. Their efforts include a. penetrating skin and mucous membranes to enter bloodstream b. surviving internal nonspecific defenses and phagocytes in the blood c. crossing the blood-brain barrier D. all are correct e. only a and b are correct MEDIUM 5. All of the following are characteristics of the blood-brain barrier except a. double-walled physical barrier b. tight junctions binding the endothelial cells in the capillary walls together C. have neurally controlled pores in the capillary walls d. layer made of support cells like astrocytes serving as a secondary barrier HARD 6. Cerebrospinal fluid (CSF) that serves as a bumper to protect the fragile CNS from physical injuries A. is produced by a special layer of tissue called the choroid plexus b. is produced by the double-walled blood-brain barrier c. is produced by the endothelial cells that line the capillaries d. is produced by the astrocytes that participate in the blood-brain barrier

2

EASY 7. Pathogens that are able to move through the skin or mucous membranes and attain entry into the PNS often have similar strategies: a. production of toxins that bind to neurons and prevent neurotransmission b. production of toxins that are pathogenic at concentrations that cannot be detected by the immune system c. loss of neural function due to chronic inflammation d. only a and b are correct E. all are correct

MEDIUM 8. In spite of the presence of the blood-brain barrier, many pathogens are able to cross this and cause disease in the CNS. One hypothesis for how this occurs proposes this mechanism: a. pathogens circulating in systemic blood cause an inflammatory response b. an inflammatory response causes the capillary walls to become more permeable c. increased permeability of the capillaries allows pathogens to enter the CNS often leading to seizures and coma D. all are correct e. only b and c are correct

18.2 Bacterial Diseases of the Nervous System EASY 9. Some bacterial pathogens cause infections in the PNS rather than the CNS. Which of the following statements about these disease processes is not true? a. bacterial pathogens produce toxins that bind to PNS neurons and change their physiology b. Clostridium botulinum causes botulism because paralyzes muscles c. Clostridium tetani causes tetanus because it makes opposing muscle groups contract continuously D. Clostridium perfringens causes gas gangrene because it paralyzes breathing oxygen MEDIUM 10. Bacterial meningitis is a life-threatening inflammation of the meninges. Although cases are rare, it is a very serious disease resulting in a death rate of about 12%. Which of the following statements about bacterial meningitis is inaccurate? a. Meningococcal meningitis/more cases are seen worldwide than in the U.S. b. HiB meningitisis/a disease of unvaccinated children because infants lack immunity C. Pneumococcal meningitis/ most common type of meningitis in adults in countries where Hib vaccine is available. d. All of the bacteria causing the diseases listed in answers a, b, and c possess an antiphagocytic capsule HARD 11. Which of the following statements about transmission of bacterial meningitis pathogens are true? a. transmission is via respiratory droplets b. healthy carriers may be asymptomatic because their strain lacks a polysaccharide capsule c. outbreaks can occur in open populations of children or young adults D. a and b are true e. all are true

EASY

12. Clinical features of acute meningitis include a. fever b. severe headache c. stiff neck d. rapid onset E. all of the above MEDIUM 13. Treatment for bacterial meningitis involves all of the following except A. rarely involves prophylactic treatment with antibiotics for family members b. usually includes Beta-lactam antibiotics c. requires hospitalization with intensive care especially for meningococcal meningitis d. is preceded by a lumbar puncture or spinal tap to obtain a CSF sample for diagnosis confirmation HARD 14. Neonatal Meningitis is characterized by a. vertical transmission from mother to baby usually during childbirth b. pathogenicity of E. coli and Strep agalactiae that are usually found in the colon but spread to the female reproductive tract c. maternal risk factors that include Asian descent and mothers older than 35 years D. only a and b are correct e. all are correct MEDIUM 15. Neonatal meningitis caused by Group B streptococcus presents with two very different clinical syndromes. Which of the following is not accurate?

A. early-onset meningitis occurs 24 hours after birth in premature infants to otherwise healthy mothers b. late-onset meningitis occurs from 1 week to 3 months post birth. c. abnormal neurological disorders are found in both types d. Only S. agalactiae may be prevented at delivery by penicillin administered prophylactically EASY 16. What are the common features of Tetanus? a. disease of nervous system in which patient has continuous muscle spasms b. begins with continuous contraction of jaw, face, and neck muscles c. caused by endospore-forming obligate anaerobe that lives in anaerobic mud d. preventable with vaccination protocol including boosters every 10 years throughout life E. all are correct MEDIUM 17. As is typical of many exotoxin caused diseases, Tetanus is treated by a 2-step protocol: a. administering antibiotic to kill bacterium b. administering antibiotic to kill the endospores c. administering HTI (human tetanus immunoglobulin) to inactivate tetanus toxin d. administering HTI (horse tetanus immunoglobulin) to inactivate tetanus toxin E. only a and c are correct

HARD

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18. The major differences between tetanus and botulism include all of these except A. Tetanus is caused by a gram-negative endospore-forming bacterium b. Botulism is caused by a gram-positive endospore-forming bacterium c, Tetanus results in continuous muscle contraction and then spasm d. Botulism results in neuroparalytic condition in which muscles lose ability to contract

4

EASY 19. In medical settings botulism toxin can bring relief from these neurological conditions: a. spasticity caused by MS, cerebral palsy or CNS injury b. blepharospasm c. hyperhidrosis D. all are correct e. only a and b are correct MEDIUM 20. The different clinical forms of botulism include a. food-borne 12 to 36 hours after toxin ingestion b. infant botulism usually from ingestion of pasteurized honey c. wound botulism especially from punctures of skin and may include overall fever d. all are correct E. only a and c are correct HARD 21. The major differences between Hansen’s Disease and the other forms of bacterial infection of the nervous system include all except: A. leprosy is an acute disease b. permanent nerve damage to PNS resulting in sensory loss c. transmission occurs via respiratory droplets d. treatment includes long-term multidrug therapy

18.3 Viral Diseases of the Nervous System EASY 22. Most viral diseases of the DNS share these characteristics: a. are rare complications of infections b. as part of normal replication cycle the pathogens that cause them are able to infect neurons c. usually are infections that originate in elsewhere in body D. all are correct e. only a and c are correct MEDIUM 23. Differences between bacterial and viral meningitis include a. unlike bacterial meningitis, viral meningitis usually resolves without complications in several weeks b. unlike bacterial meningitis, viral meningitis is referred to as “aseptic” because of lack of cellular presence in CSF c. unlike bacterial meningitis, viral meningitis is usually treated symptomatically with medication for pain and fever as well as fluids for rehydration.

D. all are correct HARD

24. Which of the following statements is not true concerning meningitis caused by enteroviruses? a. in the U.S. enteroviruses are the most common cause of viral meningitis b. approximately 30,000 to 75,000 cases are reported annually in the U.S. C. demographic group most at risk for infections are young adults during the fall and winter d. transmission is usually oral-fecal route but viruses can also be spread with respiratory droplets and fomites.

EASY 25. Among clinical features of enteroviral meningitis all of these are true except a. 50 to 80% of cases may be classified as asymptomatic B. key sign of symptomatic infection is a fever lasting for several weeks c. symptomatic infections often have upper respiratory component d. photophobia and stiff neck EASY 26. What features does encephalitis share with meningitis? a. fever b. headache c. altered mental status d. seizures and speech disturbances E. all except d MEDIUM 27. Encephalitis is a rare complication of all of these except a. enterovirus B. West Nile Virus c. HIV d. HSV e. VZV HARD 28. Descriptions of arboviral encephalitis include which of the following? a. they are mosquito-borne or tick-borne b. the virus is an enveloped polyhedral capsid surrounding a SS positive-stranded RNA molecule c. incubation lasts about two weeks d. all of these are correct E. only a and b are correct EASY 29. What are the causes of the clinical features of encephalitis? a. damage to brain tissue b. localized neuronal degeneration and necrosis c. tissue swelling D. all of these e. only a and b are correct

MEDIUM

5

30. Which of these statements about West Nile Virus is not accurate?

A. encephalitis occurs in less than 10% of infected patients b. seniors over the age of 60 are at most risk c. 20% of those infected go on to develop West Nile Virus d. sudden onset of high fever with headache, backache, muscle and joint pain HARD 31. Historical notes about West Nile Virus show all are correct except a. first isolated in Uganda in 1937 b. can infect more than 200 different bird species C. About 30% of patients with encephalitis will die d. arthropod vectors include 40 different species of mosquitoes e. entered New York City in 1999 and spread across U.S. by 2002 MEDIUM 32. Match the type of Encephalitis with the correct description Encephalitis Description Japanese encephalitis virus C a. infects horses, birds and humans along eastern and gulf coasts b. mosquito vector breeds in tree holes in forests of northcentral and St. Louis encephalitis virus D northeastern US California encephalitis virus B c. disability rate is 45% for surviving patients Eastern equine encephalitis A d. before 1999 was leading cause of vector-borne encephalitis in U.S. EASY 33. Which of the following statements about polio is not true? a. an acute viral disease with inflammation of nerve cells of brainstem and spinal cord b. spread of polio arrested by development of two types of vaccine in 1955 and 1961 c. virtually eradicated in western hemisphere by 1991 D. endemic cases found only in sub-Saharan Africa MEDIUM 34. Pathogenesis of polio virus includes all except a. an extremely small enterovirus with nonenveloped capsule B. several different serotypes with most paralytic disease caused by serotype 3 c. transmission by fecal-oral route via contaminated food or water d. acid stable virus spreads from digestive tract into lymph and blood HARD 35. Clinical features of polio virus demonstrate that a. most infections are asymptomatic b. only 1% of infections lead to meningitis c. paralysis occurs in 0.1% of cases because of damage to motor neurons in CNS d. 45% of those who recover develop postpolio syndrome 15 to 40 years later in life E. all are true except d

EASY 36. Basic information about the Rabies virus includes

6

a. a viral diseases of the CNS that is fatal without treatment b. a viral disease that is found globally with the exception of Antarctica and islands c. WHO estimates range from 50,000 to 100,000 cases annually worldwide D. CDC reports only 20-30 human cases per year e. all are correct except d

7

MEDIUM 37. Descriptions of the Rabies virus include all of the following except a. bullet or lipstick shaped capsid b. capsid is enveloped C. positive-sense single-stranded RNA d. only 5 genes HARD 38. Some of the most unique features of the Rabies virus are that a. it combines physiological changes with behavioral changes b. the virus produces extremely aggressive behavior that provides a means for exiting the patient’s body c. viral reservoirs vary with the geographic region d. vaccination of pets help determine the risk factors for human exposure E. all of these are correct EASY 39. Clinical features of Rabies that aid in diagnosis include a. presence of hydrophobia in an nonimmunized individual who has been bitten by a rabid animal b. test for presence of rabies virus with reverse transcriptase PCR assay of CSF c. presence of fever, headache, malaise plus beginning of neurological symptoms D. only a and c are correct e. a, b and c are all correct MEDIUM 40. Progression of this nearly 100% fatal disease varies according to a. incubation period which varies according to amount of rabies virus received during exposure b. location of bite or exposure on body that can increase or decrease incubation time based on distance from CNS c. speed at which rabies virus moves through PNS on its way to the brain D. only a and c are correct e. only b and c are correct HARD 41. Which of these actions does the most to promote successful treatment of a potentially fatal rabid bite? a. using passive artificial immunity via vaccination with immunoglobulins to stop the spread of virus b. using active artificial immunity via vaccination with antirabies vaccine to begin active immune response c. appropriate wound cleansing d. probably a is the most critical E. all of these are critical to a successful outcome MEDIUM 42. Match the viral disease of the Nervous System with its description: Viral Disease of the Nervous System

Description

Zika Virus Disease B Progressive Multifocal Leukoencephalopathy (PML) C Subacture Sclerosing Panencephalitis (SSPE) D HSV Encepthalitis A

a. 95% of cases begin with HSV Type I virus b. 80% of infected people are asymptomatic c. causes progressive neurological disorder in AIDS patients d. rare chronic degenerative CNS disease that occurs years after having the disease

18.4 Fungal and Protozoan Diseases of the Nervous System EASY 43. Fungal Meningitis has these unusual descriptions: a. it is usually found in immune-compromised patients with HIV and AIDS b. numbers of cases have increased because of AIDS epidemic c. opportunistic fungal pathogens are spread person to person d. outbreaks are possible but rare E. all are true except C MEDIUM 44. Cryptococcal meningitis is a. caused by an encapsulated yeast found in soil containing pigeon and chicken droppings b. usually causes active disease only in those with severe immune deficiencies c. diagnosed by negative staining of CSF sample d. prevention includes avoidance of areas carrying a high risk of exposure E. all are true HARD 45. Unlike Crytococcal meningitis, Toxoplasmosis usually resolves quickly when it causes a. fungal encephalitis in immune-competent patients who have healthy immune systems b. fungal meningitis in immune-competent patients who have healthy immune systems C. protozoan encephalitis in immune-competent patients who have healthy immune systems b. protozoan meningitis in immune-competent patients who have healthy immune systems MEDIUM 46. Toxoplasma gondii a. is an oocyst-forming sporozoan from the Protozoan group of Prokaryotes b. is often carried by domestic cats that become infected by eating diseased rodents while hunting c. oocysts are shed in feline feces and mature into sporocysts in the soil or cat litter boxes d. only b and c are correct e. all are correct

EASY 47. Humans may become infected with Toxoplasma gondii by a. accidentally eating contaminated soil on food

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b. cleaning cat litter boxes containing sporocysts c. consuming undercooked meat containing sporocysts d. transmission vertically from pregnant mother to fetus across the placenta E. all are correct EASY 48. All are true descriptions of prions except a. subviral infectious agents containing only protein B. cause nontransmissible neurodegenerative diseases in humans and some other mammals c. diseases are known as TSEs d. unlike viruses, they lack nucleic acids e. diseases caused are deadly but rare MEDIUM 49. Match the Human Prion Disease with the correct description: Human Prion Disease Description Kuru B a. linked to eating beef contaminated from infected cattle Creutzfeldt-Jakob Disease (CJD) C b. spread through ritualistic cannibalism of the dead at funerals Variant Creutzfeldt-Jakob Disease (vCJD) A c. appears usually in individuals over age 65 HARD 50. Pathogenesis of Human Prion Disease includes all of the following except a. PrP prion protein is usually localized in cell membrane B. disease-causing form has undergone conformational change in protein structure from 3% Beta-sheet to 86% Beta sheet c. prions are resistant to protease digestion d. neurons in CNS become abnormally filled with vacuoles e. PrP prion protein induces conformational change in normal proteins spreading the damage

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CH 19 – DISEASES OF THE CARDIOVASCULAR AND LYMPHATIC SYSTEMS

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19.1 The Conflicts EASY 1. What do the Cardiovascular and Lymphatic Systems have in common?

A. ability to penetrate all body tissues b. ability to carry fluid from heart to the tissues and back again c. ability to carry all types of leukocytes throughout the body d. ability to carry dissolved oxygen and carbon dioxide gasses EASY 2. Within the Cardiovascular System, diffusion of dissolved gasses, nutrients and waste products occurs a. across the arterioles B. across the capillaries because their walls are only one cell layer thick c. across the venules d. across the blood plasma MEDIUM 3. What are the two roles of the Lymphatic System? a. serves as a drainage mechanism for extra fluid called lymph, delivering it from body back to the heart b. serves as a screening mechanism for pathogens, passing them on to lymph nodes for processing by lymphocytes c. serves as storage mechanism for white blood cells, passing them on to lymph nodes as needed D. only a and b are correct e. all are correct HARD 4. Without the use of resident microbiota to provide biological protection, the Cardiovascular and Lymphatic Systems have to rely on a. systemic circulation b. pulmonary circulation c. innate immunity d. adaptive immunity E. both c and d are correct EASY 5. What is the primary mechanism by which pathogens gain access to the cardiovascular system? a. accidental cuts, scrapes, bites or abrasions B. parenteral route via invasive medical procedures c. airborne transmission d. vector transmission MEDIUM 6. What strategies do pathogens use to avoid immune systems defenses? a. they rapidly enter cells via ligand binding to specific host receptors b. avoid phagocytosis by hiding out in host cells c. escape antibodies by hiding out in host cells d. use enzymes to help escape immune system reactions

E. all are correct HARD 7. What part does antigenic drift play in helping some pathogens evade the immune system? a. viruses slowly accumulate mutations in strategic antigen genes that make them unrecognizable b. immune system cannot recognize mutated antigens c. antigenic drift forces immune system to spend a week producing new antibodies d. antigenic drift produces an immediately new pathogen that is not recognized E. all are correct except d MEDIUM 8. Which of the following statements concerning pathogen strategies in the Cardiovascular System in not true? a. MRSA produces an exotoxin that directly targets leukocytes for destruction.

B. HIV infects and destroys Cytotoxic T cells that play an important part in immune system coordination. c. Entry and attack of the Cardiovascular System is particularly dangerous because pathogens may be spread to all body systems. d. Pathogens may use blood as a liquid medium and actually reproduce in the CV System.

19.2 Sepsis and Cardiac Diseases EASY 9. How do invading pathogens get into the blood and/or lymph? a. vigorous teeth brushing b. direct contact like kissing or holding hands c. invasive medical procedure D. a and c are correct e. all are correct MEDIUM 10. Which of the following terms is mismatched with its description? a. bacteremia/ presence of viable bacteria in the bloodstream B. septicemia/reproduction of pathogens in the lymph c. sepsis/life-threatening whole-body inflammatory response to systemic inflation d. blood-borne pathogen/pathogen in human blood that cen be transmitted to others by contact with contaminated fluid.

HARD 11. Sepsis can lead to severe sepsis which can proceed to fatal septic shock when A. microbial toxins trigger a systemwide inflammatory response that causes extreme hypotension, leading to organ failure and death b. microbial toxins trigger extreme hypertension leading to stroke and potential death c. patient experiences tachycardia of over 110 beats/minute plus a WBC count of greater than 12,000 cells/mm3 d. patient experiences body temperature of over 38 deg. C with low urine output EASY 12. Organ failure is initiated by a. chain reaction of cytokine production leading to disseminated intravascular coagulation (DIC)

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b. lack of oxygen from micro-clot impaired blood flow c. capillary injury from release of inflammatory mediators impeding oxygen distribution D. all are correct e. only a and c are correct MEDIUM 13. Exactly what mechanism causes blood pressure to drop leading to septic shock? a. release of inflammatory mediators impeding oxygen distribution b. inflammatory mediators increase neutrophil activation leading to nitric oxide release c. nitric oxide is a vasodilator that causes blood pressure to drop d. only a and b are correct E. a, b, and c are all correct HARD 14. In the course of diagnosis and treatment, when can sepsis be turned around rather than following a precipitous decline leading to septic shock and death in 50% of cases? a. when blood tests show abnormal clotting, impaired kidney or liver function or poor oxygen delivery b. when biomarker PCT climbs to 100 ug/ml c. when low doses of corticosteroids and vasopressors are administered D. only a and b are correct e. all are correct EASY 15. What are the prime sites for bacterial infections in the heart? a. endocardium b. valves c. pericardium D. a and b are correct e. all are correct MEDIUM 16. The usual routes of transmission in subacute cases of endocarditis include all except a. migration of bacteria from a focal infection B. migration of bacteria from person to person contact b. migration of bacteria from lacerations, body piercings and dental procedures c. migration of bacteria from IV drug use or nonsterile parenteral procedures HARD 17. The #1 symptom of sign of subacute endocarditis is a. fever and lethargy b. weakness c. cardiac arrhythmia D. petechial rash on arms and nail beds e. pain in abdomen or side

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MEDIUM 18. Which of the following descriptions in inaccurate in describing how a biofilm that serves as a pathogen source develops? a. bacteria are attracted to damaged or abnormal surfaces as they are easy to cling to B. clotlike coating helps developing bacterial community adhere to injured tissues c. developing biofilm are protected from antimicrobial therapy d. small fragments break off biofilm and block blood vessels HARD 19. The most common symptom of pericarditis is A. sharp chest pain b. petechial rash on chest c. fever and lethargy d. high bacterial count in blood

19.3 Bacterial Diseases of the Cardiovascular and Lymphatic Systems EASY 20. Basic descriptions of Brucellosis include all of the following except a. other names include Bang’s disease, undulant fever or Malta fever b. Brucella spp. usually infect grazing livestock and wild grazers like deer, elk or bison C. primarily caused by five different species of Brucella d. CDC monitors these pathogens because they are a bioterrorism agent MEDIUM 21. One of the major problems with Brucella spp. as a pathogen is a. humans who come into contact with infected live or domestic grazing animals can get sick b. it can become airborne c. it may contaminate milk products thus spreading it to humans D. all are correct e. only a and b are correct EASY 22. What is (are) the most common symptom(s) of Brucella infection?

A. fluctuating fever referred to as undulant fever b. sweating and chills c. weight loss and weakness d. headache and muscle aches HARD 23. What is the pathogenesis of the Brucella spp. ? a. enters patient through breaks in the skin b. enters patient through damaged mucous membranes in respiratory or gastrointestinal tract c. is phagocytized by immune system cells but avoids being killed d. travels inside phagocytes via the lymphatic system to other areas of the body E. all are true except d

5 EASY 24. Which of the following descriptions about Anthrax is incorrect? a. Gram-positive aerobic rod producing centrally located endospores b. usually found in soil and infects grazing animals c. may attack GI tract, skin or respiratory system - all leading to sepsis D. gastrointestinal anthrax is most common form of infection in humans e. lesions called eschar are found in cutaneous anthrax MEDIUM 25. Which of the following forms of anthrax infection is almost always 100% fatal?

A. pulmonary anthrax b. gastrointestinal anthrax c. cutaneous anthrax d. a and b are correct e. All are correct HARD 26. Anthrax endospores or vegetative cells escape the immune system by all of the following except A. replicating within lymphocytes b. new vegetative cells are protected from immune system by amino acid capsule c. producing many different types of toxins that allow escape from phagosome d. producing anthrolysin O, a toxin that splits apart phagocytes MEDIUM 27. Although Anthrax may be identified by performing a Gram stain, positive confirmation requires a. ELISA testing b. antibody-antigen testing using agglutination tests C. direct fluorescence antibody testing d. acid-fast staining HARD 28. For Lyme Disease match the category of information with the correct description: Category of Information Correct Description a. Stage Two symptom s include Bell’s palsy, meningitis, extreme Etiology and Transmission C pain in large joints like knees Clinical Features A b. positive ELISA test confirmed with Western Blot Pathogenesis D c. Ixodes nymph accidentally attaches to humans and companion animals Diagnosis B d. as a spirochete, Borrelia burgdorferi uses endoflagellum to invade host tissues EASY 29. Which of the following statements about Borrelia burgdorferi and Lyme disease is correct? a. CDC recommends use of Erythromycin for treatment B. currently Lyme Disease is the most common tick-vectored bacterial infection worldwide c. if untreated Lyme disease progresses through four stages d. tick must feed for 72 hours before pathogen enters new host tissues

6 MEDIUM 30. Stage Three of Lyme Disease infection is dominated by all of these features except: a. symptom and signs may be experienced months to years later b. symptoms include numbness and fatigue C. also gastritis and headaches d. severe arthritis and short-term memory loss EASY 31. Prevention of exposure to the ticks carrying Borrelia burgdorferi is critical in prevention of Lyme Disease. Efforts include all of these except a. avoiding the Ixodes tick habitats b. wearing appropriate clothing in tick habitats c. using repellant with 20-30% DEET on skin and clothing D. checking body for ticks during peak months of October through March EASY 32. The history of the plague includes these descriptions: a. pandemic of 1345-1355 killed 50% of human population b. early PPE included full head covering with beak-like snout c. snout was packed with gauze soaked in rose oil d. rose oil has antibiotic action against Gram-negative bacteria like Yersinia pestis E. all of these is correct except a MEDIUM 33. Cases of plague in the US typically occur in what states? a. New Mexico b. Arizona and Colorado c. Oregon and Washington D. only a and b are correct e. al are correct HARD 34. While the vector for Y. pestis is the rat flea, which of the following are amplifying hosts that can become ill and therefore play an important link in the transmission to humans? a. mice and rats b. voles c. rabbits and ground squirrels d. only a and b are correct E. only c is correct EASY 35. Match the bacterial pathogen with the cardiovascular system disease it causes: Bacterial Pathogen Cardiovascular System Disease Ehrlichia chaffeensis C a. Human granculocytic anaplasmosis (HGA) Coxiella burnetti E b. Tularemia (Deer fly fever) Anaplasma phgocytophilum A c. Human monocytic ehrlichiosis (HME) Francisella tularensis B d. Cat scratch disease Bartonella henselae D e. Q (Query) Fever

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19.4 Viral Diseases of the Cardiovascular and Lymphatic Systems MEDIUM 36. There is a group of systemic viral diseases that a. infect only leukocytes b. are diagnosed based on cytopathic effects (CPEs) of the infected leukocytes c. include familiar diseases like infectious mononucleosis D. all are correct e. only a and c are correct EASY 37. Infectioous Mononucleosis is caused by the Epstein-Barr virus and generally infects a. neutrophils b. eosinophils C. lymphocytes d. basophils MEDIUM 38. Epstein-Barr virus is also known as A. Human Herpesvirus 4 b. Human Herpesvirus 3 c. Human Herpesvirus 2 d. Human Herpesvirus 1 EASY 39. Classic symptoms of mononucleosis occur only in a. children less than 15 years of age B. young adults age 15 to 25 years c. mature adults age 25 to 55 years d. seniors age 55 years and older MEDIUM 40. Match the following information about Infectious Mononucleosis: Classic symptoms C a. saliva in kissing Direct Contact Transmission A b. saliva-contaminated fomites Indirect Contact Transmission B c. include swollen lymph nodes in the neck Pathogenesis D d. resting Memory B cells in tonsils and adenoids HARD 41. The CPEs that are indicative of EBV infection include all except A. decreased size of lymphocytes b. lobing of the nucleus c. indentations of the cell membrane d. presence of numerous vacuoles in cytoplasm

8 EASY 42. Viruses that cause Hemorrhagic Diseases often belong to these viral families except a. Arenaviridae b. Bunyaviridae c. Filoviridae D. Poxviridae e. Flaviviridae MEDIUM 43. Signs and symptoms of Viral Hemorrhagic Diseases include a. fever b. headaches and muscle aches c. disruption of normal clotting pathways D. all are correct e. only a and c are correct HARD 44. Which of the following statements about Ebola Hemorrhagic Fever (EHF) is not true? a. EHF has a mortality rate as high as 90%. b. Its reservoir is fruit bats that are hunted for meat.

C. Transmission between humans is airborne. d. There are no effective treatments, so only supportive care may be provided.

MEDIUM 45. Match the Viral Hemorrhagic Disease with the correct description: Viral Hemorrhagic Disease Description Dengue Fever B a. monkeys are primary reservoir while humans are secondary Marburg D b. nickname is breakbone fever Yellow Fever A c. crippling joint stiffness and pain followed by arthritis Chikungunya Fever C d. 1967 outbreak had mortality rate of 25% Lassa Fever E e. African rodent population is primary reservoir EASY 46. Why are Hepatitis B and Hepatitis C infections included in a discussion of viral diseases of the Cardiovascular and Lymphatic Systems? a. they are transmitted by airborne particles and enter circulation via respiratory system b. they are transmitted via gastrointestinal trace and enter circulation across the intestinal tissues C. they are transmitted via exposure to infected body fluids d. they are transmitted via sexual exposure and enter circulation via the reproductive tract MEDIUM 47. All of these body fluids may contain Hepatitis B except a. blood B. urine c. semen d. lymph

9 HARD 48. Which of the following statements about Hepatitis B is not accurate? a. a pregnant mother can pass the virus to her unborn baby b. serological tests detect presence of IgM antibodies to HBsAG for accurate diagnosis c. prevention includes avoiding contaminated body fluids and safe sex D. Hepatitis B vaccine is an effective series of two injections given 6 months apart MEDIUM 49. Features of Hepatitis C include all of the following except a. leading cause of liver transplants in U.S. b. referred to as a “silent epidemic” because it may take 20 to 30 years of liver inflammation for the patient to experience cirrhosis, cancer or liver failure C. easily diagnosed via serological tests to detect anti-HCV antibodies d. there is a 90% cure rate if patients are treated with ledipasvir/sofosbuvir EASY 50. Chronic Hepatitis C causes a. increase of cell-mediated immunity b. virus survival in the liver c. continuous, intense liver inflammation D. only b and c are correct e. all are correct HARD 51. Studies by the CDC and other researchers show a 35% correlation between HIV and HCV or HBV infection in patients because a. HIV infections reduces body’s ability to get rid of HCV b. coinfection leads to a liver failure 3X faster than in HIV-negative patients c. liver damage is primary cause of death in AIDS patients d. only a and b are correct E. all are correct

19.5 Protozoan and Helminthic Diseases of the Cardiovascular and Lymphatic Systems EASY 52. Which of the following diseases is not caused by a protozoan that is transferred via arthropods? a. Babesiosis b. Chagas disease c. Malaria D. Elephantiasis e. Leishmaniasis MEDIUM 53. Babesiosis infections a. are spread by tick vectors b. rely on rodents as the pathogen reservoir c. may be fatal to immune-compromised patients d. only a and b are correct

E. all are correct

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HARD 54. Found primarily in Central and South American areas that are rural and economically challenged, Chagas Disease a. usually infects rodents, armadillos and opossums b. is usually spread to humans via the “kissing bug” c. is caused by the sporozoan Trypanosoma cruzi D. only a and b are correct e. all are correct EASY 55. All of the CDC statistics on Malaria are correct except A. 20% of the world’s population is infected b. there were approximately slightly less than 220 million cases in 2010 c. over 90% of infection occur in Africa d. two children die every minute from Malaria MEDIUM 56. Besides Plasmodium spp. transmission in the saliva of mosquitos, this protozoan may be transmitted via a. blood transfusion b. needle sharing c. transfer across the placenta d. only a and b are correct E. all are correct HARD 57. Malaria’s high mortality rate is due to complications that include all of the following except a. Erythrocyte destruction b. severe anemia C. destruction of leukocytes d. abnormal blood clotting e. damage to liver, kidneys and spleen MEDIUM 58. Match the Systemic Helminthic Disease with the correct description: Systemic Helminthic Disease Description Filariasis B a. caused by Schistosoma spp. flukes that enter CV system and spread rapidly throughout body resulting in life-threatening infections Cercarial dermatitis or Swimmer’s b. caused by Wuchereria bancrofti that is carried by mosquitos Itch C Schistosomiasis A c. caused by Schistosoma spp. larvae in warm fresh water and causing a self-limiting infection

WILEY – CH. 20 – DISEASES OF THE GASTROINTESTINAL SYSTEM 20.1 The Conflicts EASY 1. Match the organ in the GI Tract with its Host Defense GI Tract Organ Host Defense Mouth D a. IgA secreted into mucus coating stops pathogen binding Lining of GI Tract A b. enzymes digest microbes Stomach C c. hydrochloric acid denatures proteins and killing many microbes Small intestine B d. presence of lysozyme that breaks down peptidoglycan MEDIUM 2. Which of the following statements is true about bacterial diversity and density? a. they are very high in the mouth b. they are very high in the large intestine c. they average 10+11 bacteria per ml of saliva in the mouth D. only a and b are correct e. all are correct EASY 3. What is the greatest barrier that pathogens must overcome in order to cause disease in the GI Tract? a. finding attachment locations B. surviving high acidity of the stomach c. avoiding inflammatory response in intestinal tract d. being expelled with the feces MEDIUM 4. What steps come into play in the establishment of a disease if pathogens are able to penetrate the intestinal mucosa? a. damage to host tissues produces chemical signals b. chemical mediators trigger inflammatory response c. diarrhea is produced as a result of inflammation and tissue inability to reabsorb fluid from chime d. only a and b are correct E. all are correct HARD 5. What factor(s) contribute to the Infectious Dose (ID50) of GI pathogens? a. variations in sensitivity to stomach acid b. number of pathogens ingested c. type of pathogen ingested D. only a and c are correct e. all are correct

2 HARD 6. Match the following food or waterborne pathogens with their respective ID50: Food or Waterborne Pathogens ID50 2 Rotavirus D a. 7.5 x 10 Shigella dysenteriae A b. 1.8 x 105 Salmonella B c. 173 Crytosporidium parvum C d. 6.1 EASY 7. Why is the mouth such a great environment for bacteria to thrive? a. nutrient “leftovers” from meals and snacks b. nutrient remnants of epithelial cells from cheeks c. salivary gland secretions like amylase D. all are correct e. only a and b are correct MEDIUM 8. As humans age the makeup of the resident microbiota in the mouth changes. Which of the following descriptions is an incorrect match? a. newborn babies/ oral cavity is sterile B. nursing babies/microbiota like Streptococus mtans from mother transferred to infant c. teething babies/S. mutans and S. sanguis take up residence because they adhere to tooth surface d. adolescents/Bacteroides and spirochetes colonize oral cavity HARD 9. What types of bacteria are found in different sections of the digestive tract? a. stomach contains mostly acid-resistant bacteria b. esophagus contains bacteria consumed with food, drink and saliva c. large intestine has largest concentration of bacteria in body d. small intestine varies as to type of bacteria present based on location E. only answers b, c, and d are correct EASY 10. Where are most of the resident microbiota of the GI tract found? a. oral cavity b. upper portion of small intestine c. lower portion of small intestine D. large intestine MEDIUM 11. Which of the following statements about the bacteria present in the large intestine is not true? a. highest concentration of bacteria in the human body b. main species are anaerobic, Gram-positive bacteria c. E. coli is predominant fecal coliform bacterium D. E. coli is easily identified because it cannot ferment lactose e. E. coli is the indicator microbe for fecal contamination of water

20.2 Bacterial Diseases of the Mouth and Upper GI Tract EASY 12. All of the following describe Dental Caries except a. most common disease in the world b. caused by acid-producing bacteria that slowly destroy tooth enamel C. tooth decay begins with Streptococcus pyogenes d. S. mutans uses sucrose to produce sticky capsule that attaches to tooth surface e. S. sanguis and other bacteria stick to each other and the teeth forming plaque MEDIUM 13. The process that leads to tooth decay includes a. Streptococci and other bacteria ferment sugars with resulting acid by-products b. acid by-products slowly dissolve hard enamel c. destruction of enamel allows means for bacteria to penetrate into living pulp D. all are correct e. only a and c are correct EASY 14. What is the treatment for tooth decay? a. removal of damaged enamel and permanent filling of damaged area b. prevention of decay spreading into pulp area c. systemic broad-spectrum antibiotic treatment to target any pulp infection if needed d. only a and b are correct E. all are correct HARD 15. Why does the addition of fluoride to municipal water supplies greatly reduce tooth decay in the population? a. fluoride slows tooth demineralization by forming a veneer over the enamel b. veneer with fluoride is more resistant than natural hydroxyapatite of the enamel c. fluoride serves as a good antiseptic in reducing the number of acid-producing bacteria in the oral cavity D. only a and b are correct e. all are correct EASY 16. Characteristics of gingivitis include all of the following except: a. swollen tissues B. inflammation of the tooth-supporting structures c. red and painful tissues d. accumulation of bacterial plaque in gingival crevices MEDIUM 17. Gingivitis is caused by a. bacterial release of exotoxins that cause inflammation b. plaque buildup in the gingival crevices c. bacterial production of degradative enzymes and acids D. all are correct except a

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4 HARD 18. Risk of gingivitis may be reduced by use of mouthwashes containing A. chlorhexidine and hydrogen peroxide b. triclosan and hydrogen peroxide c. chlorhexidine and triclosan d. chlorhexidine and iodine EASY 19. Periodontal Disease a. is inflammatory disease of tooth-supporting structures b. is caused by plaque buildup on the teeth c. is caused by pool oral hygiene D. all are correct MEDIUM 20. Periodontitis a. is a less serious oral disease than gingivitis b. is an acute inflammation of structures that support and hold teeth C. is diagnosed by measuring bone loss around teeth d. is easily reduced by scraping of the teeth HARD 21. Periodontal Disease affects overall human health a. by introducing inflammation-causing bacteria to the circulatory system b. by increasing risk of heart disease and stroke by about 20% c. by allowing Streptococcus mutans to enter other tissues D. only a and b are correct e. only a and c are correct EASY 22. How does Helicobacter pylori survive in the acidic environment of the stomach? a. uses flagella to move into area of mucus coating stomach tissue b. produces enzyme urease c. breaks down urea from protein hydrolysis to release ammonia that neutralizes stomach acid d. only b and c are correct E. all are correct MEDIUM 23. How is peptic ulcer disease diagnosed? a. presence of extra carbon dioxide produced when urea is broken down b. measurement of carbon dioxide level one hour after ingestion of urea pill c. use of rapid ELISA test to detect H. pylori antigens in blood D. only a and b are correct e. all are correct

5 EASY 24. Treatment for peptic ulcer disease includes a. proton pump inhibitor b. amoxicillin c. clarithromycin d. a and b are correct E. a, b, and c are correct EASY 25. What is unique about Staphylococcus aureus Food Intoxication? All are correct except A. affects about 7,500,000 people annually b. not caused by a microbe c. caused by ingestion of a toxin d. most commonly caused by enterotoxin produced by S. aureus MEDIUM 26. Why is S. aureus so often implicated in Food Intoxication? a. can grow in environments with high osmotic pressure b. favors foods with high salt or sugar content c. enterotoxin is heat stable and thus easily destroyed by freezing d. enterotoxin is not easily degraded by proteases of digestive system E. all are correct except c HARD 27. Disease progression in S. aureus Food Intoxication include a. signs and symptoms like nausea, vomiting, and abdominal cramps b. vomiting begins within 6 to 12 hr of food ingestion c. infectious dose is extremely small d. only a and b are correct E. only a and c are correct MEDIUM 28. Prevention of S. aureus Food Intoxication includes all except a. proper hygiene habits by food handlers, the main source of contamination b. being careful with foods that require much handling in preparation and are kept warm afterwards C. use of gloves to handle foods containing meat products, mushrooms, dairy products, eggs, and mayonnaise d. maintenance of proper refrigerator and stove temperatures e. cleaning of equipment and preparation surfaces

20.3 Bacterial Diseases of the Lower GI Tract EASY 29. What causes diarrhea in the Lower GI Tract? a. pathogens are present in fecally contaminated food or water b. pathogens, especially Gram-positive Enterobacteriaceae, attach to intestinal tissues c. pathogens interrupt normal absorption of fluids from the chyme coming from the stomach d. fluids from chyme are forcefully emptied from intestines as diarrhea E. all are correct except c

6 MEDIUM 30. Typical diarrhea a. goes unidentified as far as the pathogen causing it b. may have complications such as fever, bloody stools, vomiting and abdominal pain c. resolves within several days with no further problems d. only a an c are correct E. all are correct EASY 31. What actually causes diarrhea? a. pathogens found in fecally contaminated food or water b. pathogens that attach to tissues in the intestines and interrupt normal absorption of fluids c. explusion of unabsorbed fluids in feces d. only b and c are correct E. all are correct MEDIUM 32. Why are antidiarrheal and/or antibacterial medications often NOT the best thing to take for diarrhea? a. antidiarrheal medications permit pathogen to stay in digestive tract at higher concentrations and for longer periods of time b. antibacterial medications often kill off the normal microbiota that usually limit growth of pathogens c. pathogens that stay in digestive tract for longer time period usually cause less tissue damage D. only a and b are correct e. all are correct HARD 33. What treatment(s) is (are) important for Lower GI Tract diarrhea? a. oral rehydration therapy especially in infants and young children b. antidiarrheal medications should be avoided because they keep the pathogen within the GI Tract c. instead antibacterial agents should be used to kill the pathogen D. only a and b are correct e. all are correct EASY 34. In examining the leading bacterial cause of foodborne illness in the U.S., all of these are correct except a. It is Salmonella. b. It affects more than 1 million people per year in the U.S. C. It has more than 3000 different serotypes that have the potential to cause diarrhea. d. There are Salmonella strains that may also cause Typhoid Fever.

MEDIUM 35. What are the features of gastroenteritis caused by bacteria like Salmonella? a. acute inflammation of membrane lining of stomach and intestines b. signs and symptoms include nausea watery diarrhea, vomiting and abdominal cramps c. reservoir is GI tract of vertebrates d. only a and b are correct E. all are correct

7 EASY 36. Which of the following does not describe Salmonellosis?

A. loose bloody stools b. abdominal cramping, chills, headache and muscle pain c. nausea and vomiting d. outbreaks usually associated with institutional settings e. treatment usually involves ORT MEDIUM 37. Typhoid Fever is a. caused by a species of Salmonella found in food and water with fecal contamination b. is rare where there are good sanitation systems c. diagnosed in over 10 million cases worldwide each year D. only a and b are correct e. all are correct HARD 38. Which of the following is an incorrect statement about E. coli? a. one of most abundant resident bacterial species present in the colon B. pathogenic strains account for more than 5% of cases of diarrhea c. the most pathogenic strain is E. coli O157:H7 acquired via consumption of undercooked beef d. members of this pathogenic strain produce verotoxin that causes bleeding HARD 39. HUS (Hemolytic Uremic Syndrome) is characterized by a. beginning as hemorrhagic colitis caused by E. coli O157:H7 b. targeting the kidneys where there are many receptors for verotoxin causing damage and failure c. fatality rates as high as 50% in young children d. treatment with antibacterial drugs to quickly reduce the number of bacteria E. all are correct except for d EASY 40. Campylobacteriosis a. affects about 2 million patients annually in the U.S. b. is usually caused by C. jejuni that grows best in high oxygen environments c. is often associated with undercooked poultry products.

D. only a and c are correct e. all are correct MEDIUM 41. Match the fecal culture with its correct description: Fecal Culture Description MacConkey agar D a. greenish blue colonies with black centers produce H2S like Salmonella HE agar A b. nonsorbitol fermenters like E. coli O157:H7 SMAC agar B c. gray mucoid colonies indicate C. jejuni Campylobacter agar C d. nonlactose fermenters Salmonella or Shigella

8 EASY 42. Which of the following diseases is characterized by presence of bloody diarrhea? a. Salmonellosis b. E. coli O157:H7 infections c. Campylobacteriosis d. Shigellosis E. both b and d are correct MEDIUM 43. For which of the following diseases is hand washing not a good preventative? a. Salmonellosis b. E. coli O157:H7 infections C. Campylobacteriosis d. Shigellosis MEDIUM 44. All of the following are accurate descriptions of Cholera except a. outbreaks usually occur in conjunction with natural disasters and wars B. of the more than 200 existing serotypes, modern Cholera outbreaks are caused by #10 and #0140 c. approximately 5% of infections produce severe life-threatening conditions d. infectious dose required ingesting water containing 103 to 106 Vibrio cholerae bacteria HARD 45. The major concern with Cholera is all of the following except A. release of enterotoxin that causes extensive vomiting b. release of enterotoxin that reverses absorption of fluid in the colon causing secretion versus absorption c. quick loss of “rice water” diarrhea results in rapid loss of approximately 1 liter of fluid per hour d. extensive dehydration causes death within hours in 50% of untreated cases with severe disease EASY 46. Which of the following descriptions of Listeria monocytogenes is incorrect? a. patients are often very young, over 60 yr, immunocompromised or pregnant b. infections are linked to deli meats, hot dogs, and nonpasteurized soft cheeses c. it is a soil microbe and can be ingested from improperly washed fruits and vegetables D. diagnosed from stool samples MEDIUM 47. How does an infection with Clostridium difficile develop? a. it is a commensal bacterium found in about 5% of the human population b. use of broad-spectrum antibiotics kills off normal microbiota of gut thereby allowing its growth c. because of endospore production it may be transmitted by oral-fecal route. d. endospores are acid-resistant and become vegetative cells in colon E. all are correct

HARD

48. The most effective treatment for C. difficile infection is a. use of Metronidazole to treat the infection b. use of probiotics to help reestablish normal gut microbiota C. fecal transplant from feces of healthy donor d. use of several antibiotics together

20.4 Viral Diseases of the GI System MEDIUM 49. Which of the following statements about Cold Sores is not correct?

A. caused primarily by Herpes Simplex Virus Type II b. primary infection established latent infection in ganglia of facial nerve c. use of antiviral medications can decrease healing time d. likelihood of infection increases with age EASY 50. As a childhood disease, Mumps is so common worldwide because the vaccine that prevents it is only in use in of countries reporting to the World Health Organization. a. 50% B. 60% c. 40% d. 70% HARD 51. Clinical features of the Mumps virus include all of the following except a. transmitted via contact with infected saliva b. is shed for about 7 days prior to development of parotitis c. spreads throughout body including other glandular tissues like testes D. lasts for about 2 weeks EASY 52. Match the type of Viral Gastroenteritis with its correct description: Viral Gastroenteritis Description Rotavirus D a. most common cause of adult gastroenteritis Norovirus A b. usually affects children under 2 years of age Adenovirus Serotype B c. affects infants, children and elderly during winter months Astrovirus C d. leading cause of childhood viral gastroenteritis worldwide MEDIUM 53. Demographics on Rotavirus include a. more than 110 million cases annually worldwide b. of these cases, 12.4 million require hospitalization c. children 4 to 24 mo. are at greatest risk, especially in day care settings d. only a and b are correct E. all are correct.

EASY

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10 54. Norovirus, the most common cause of gastroenteritis in adults, is such a successful pathogen for all of the following reasons except a. it is more heat and acid stable than other types of GI viruses b. it is still pathogenic after being frozen or heated to 140 degrees F c. it is resistant to 10 ppm chlorine D. the infectious dose is fewer than 10 virions MEDIUM 55. Problems in preventing the spread of Norovirus include a. immunity doesn’t last very long b. the virus may be spread in feces for several weeks post-recovery c. vomiting may cause aerosolization of the virus d. only b and c are correct E. all are correct HARD 56. Norovirus contamination may be a special threat to health care personnel so these precautions should be taken: a. using gloves and gowns to care for patients in private rooms b. using 10,000 ppm chlorine bleach on all hard services c. carefully handling soiled laundry so that virus contamination isn’t spread to the air D. only a and c are correct e. all are correct EASY 57. Of the five prominent types of Hepatitis Virus, which affect the GI tract?

A. Hepatitis A and E b. Hepatitis A and B c. Hepatitis B and C d. Hepatitis B and D e. Hepatitis C and D MEDIUM 58. Characteristics of Hepatitis A include a. usually ingested via food contaminated with feces b. sewage workers, childcare workers, humanitarian air workers and homosexual males are at highest risk in developed countries c. it is resistant to acid drying, freezing and heating up to 133 degrees F d. only a and c are correct E. all are correct HARD 59. Hepatitis A patients often experience all of the following except a. nausea, vomiting, and malaise b. dark urine and stools C. high-grade fever d. jaundice e. enlarged liver and spleen EASY

60. Hepatitis E is a disease similar to type A with these exceptions a. it is a more severe disease in pregnant women b. fatality rates for 3rd trimester pregnant women are about 20% c. it more cause spontaneous abortions D. only a and b are correct e. all are correct

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EASY 61. In looking at Protozoan Diseases of the GI System which of the following are generalized characteristics? a. reservoirs are usually animal and human fecal waste b. cysts are often acid-resistant and can escape destruction by the low pH of the stomach c. cysts also attack the lining of the intestines causing diarrhea D. only a and b are correct e. all are correct MEDIUM 62. Which of the following Protozoan Diseases of the GI System most often causes bloody diarrhea? a. Giardia lamblia B. Entamoeba histolytica c. Crytosporidium parvum HARD 63. Metronidazole is the treatment of choice for which Protozoan Diseases?

A. Giardiasis and Amoebiasis b. Giardiasis and Cryptosporidiosis c. Amoebiasis and Cryptosporidiosis d. Giardiasis, Amoebiasis and Cryptosporidiosis EASY 64. Trematodes have a geographic distribution that is the same as a. cestodes and nematodes B. their intermediate hosts the freshwater snails c. their definitive hosts in aquatic environments d. flatworms and roundworms MEDIUM 65. Match the Helminthic Disease or pathogen with its description: Helminthic Disease or Pathogen Description Schistosomiasis C a. only tapeworm that has human to human transmission Hymenolepis nana A b. frequently found in countries were contaminated raw beef is eaten Taenia saginata B c. transmission is via penetration of intact skin by a larval stage exiting the snail intermediate host in fresh water Enterobiasis D d. pinworms are most common helminth infection in U.S.

HARD 66. Which of the following Nematode Infections does not release fertilized eggs in feces? a. Ascariasis

b. Trichuriasis C. Enterobiasis d. Strongyloidiasis

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MEDIUM 67. Match the Nematode Disease with its effects on patients with severe infections: Nematode Disease Patient Effects Ascariasis B a. causes iron-deficient anemia and associated malnutrition Strongyloidiasis D b. causes nutritional deficiencies or obstruction of small intestine Trichinellosis C c. causes diarrhea, abdominal pain and vomiting Hookworm A d. causes rash, nausea and diarrhea EASY 68. All of the following are accurate descriptions of pinworm infections except a. parasitic inhabitants of the large intestine b. fertilized eggs are laid outside the human body in the perianal area C. fertilized eggs develop into viable embryos within 12 hours d. embryos are sticky and easily transferred to underwear, bedding, fingernails and hands MEDIUM 69. Hookworms have a complex life cycle between fertilized eggs and sexually mature adults that includes all except a. passage of eggs in feces B. hatching of eggs in snails c. larval penetration of human skin through hair follicles or small abrasions d. movement of larvae into bloodstream and then into the lungs e. migration from lungs up to pharynx where they are swallowed and finally reach small intestine HARD 70. Which of the following nematodes follow the same path from fertilized egg passing out into environment with feces to passage through lungs, swallowing and subsequent colonization of intestinal tract? a. Ascaris lumbricoides b. Trichuris trichiura c. Necator americanus d. answers a and b are correct E. answers a and c are correct

WILEY – CH. 21 – DISEASES OF THE UROGENITAL SYSTEM 21.1 The Conflicts EASY 1. What are the similarities between the urinary and reproductive systems? a. both have pathways for salt and water regulation B. both have exterior openings that may allow potential pathogens to gain entry c. both share common structures in both men and women d. both cannot function without the other MEDIUM 2. Which of the following are host defenses for the Urogenital System? a. mucosal cells in the urinary system are joined by tight junctions that don’t permit passage of pathogens b. mucosal cells produce mucus covering that keeps pathogens from attaching c. urine flow washes away pathogens that try to attach d. only a and b are correct E. all are correct MEDIUM 3. What features permit mucus to be characterized as a chemical weapon? a. it contains lysozyme that breaks down peptidoglycan b. it contains lactoferrin that binds up free iron so that bacteria cannot use it c. it contains IgA antibodies d. it contains salts that dry out pathogens E. all of these are correct HARD 4. Women who are in their reproductive years have what chemical defense to keep pathogens from colonizing the vagina? a. hormone levels support high levels of glycogen in the vagina b. glycogen facilitates the growth of Lactobacillus species of bacteria c. Lactobacillus secretes hydrogen peroxide and acidic by-products from fermentation and these inhibit the growth of pathogens D. all are correct e. only a and b are correct EASY 5. How do pathogens avoid the host defenses in the Urogenital System? a. bacterial pathogens like E. coli and N. gonorrhoeae have long fimbriae for mucosal attachment b. bacterial pathogens like E. coli and P. mirabilis have flagella that permit swimming through the urethra to enter the bladder between periods of urination c. viral pathogens multiply extracellularly in order to infect cell of the mucosa, cervix and skin D. only a and b are correct e. all are correct

2 MEDIUM 6. Pregnant women face the problem of vertical transmission of infective pathogens in which ways? a. pathogens may cross the placenta to infect the fetus b. pathogens may swim up the vagina to enter the uterus and infect the fetus c. vaginal pathogens can infect the newborn during delivery D. only a and c are correct e. all are correct HARD 7. Match the normal microbial species with its location in the female Urogenital System: Microbial Species Location Candida albicans D a. Cervix Streptococcus agalactiae A b. Perineum Bacteroides spp. E c. Urethra Staphylococcus aureus B d. Anterior urethra Chlamydia spp. C e. External genitalia MEDIUM 8. What happens when the levels of the normal Lactobacillus microbiota in the healthy vagina decline? a. there is a reduction in H2O2 production and acid production b. contents of the vagina become more basic c. new bacterial species like Gardnerella vaginalis take over d. bacterial vaginosis (BV) results E. all are correct EASY 9. Signs and symptoms of BV (bacterial vaginosis) include all except a. thin, gray vaginal discharge with fishy odor b. burning during urination and vaginal itching c. absence of clue cells in Gram-stained specimens D. only a and b are correct e. all are correct EASY 10. Maintenance of a balanced community of vaginal microbiota includes all of these except A. elimination of condom use b. limiting number of sexual partners c. avoidance of hot tubs and spas d. washing of genitals with pure soap and water every day e. avoidance of douching MEDIUM 11. Why is Group B Strep (GBS) colonization in a pregnant woman a problem for her newborn? a. this usually nonpathogenic bacterium may be vertically transmitted to fetus during delivery b. 1 in every 200 newborns will become sick with sepsis, pneumonia and/or meningitis c. as many as 10% of infected newborns die D. only a and b are correct e. all are correct

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21.2 Bacterial Diseases of the Urinary System EASY 12. How does a urinary tract infection (UTI) begin? a. pathogens use external opening to gain admittance to urethra b. urethra and bladder are first to become infected because of proximity to exterior of body c. most common pathogens involved are E. coli and Proteus mirabilis d. only b and c are correct E. all are correct MEDIUM 13. Which of the following statements is not true? a. urethritis is inflammation of the urethra b. ureteritis is inflammation of the ureters c. cystitis is inflammation of the bladder D. UTI is infection of the bladder, ureters and/or kidneys e. UTI is infection of the urethra, bladder, ureters and/or kidneys HARD 14. Cystitis is 8X more prevalent in females than males because of all these anatomical differences except: a. female urethra is only 25% of length of males b. shorter female urethra allows pathogens to be more easily moved into the bladder C. anal opening in females is farther way from urethral opening than that in males d. female anatomy allows urethral entry of E. coli, principal pathogen MEDIUM 15. Symptoms of cystitis include a. painful urination b. infrequent urge to urinate c. pelvic pain and cloudy urine D. only a and c are correct e. all are correct EASY 16. What role do flagellated bacteria have in initiating cystitis? a. shorter female urethra allow flagellated bacteria to swim a shorter distance in order to reach the bladder b. they have specialized adhesions on tips of their fimbriae that allow them to attach to epithelium c. attachment to epithelial tissues prevents being washed away during process of urination d. bacterial presence stimulates onset of inflammation that produces typical cystitis E. all are correct MEDIUM 17. Is drinking cranberry juice as a cystitis preventative just an old wives’ tale? a. cranberry juice contains PAC (A-type procyanodinins) b. cranberry juice is very basic and thus discourages bacterial growth c. PAC interferes with bacterial ability to use fimbriae to attach to bladder mucosa D. No, it is true because a and c are correct e. No, it is because all are correct

HARD 18. For women in particular prevention of UTIs involves a. practicing good personal hygiene wiping front to back b. frequent urination with complete bladder emptying c. consumption of lots of water to increase urine outflow D. all of these e. only a and b are correct EASY 19. For pyelonephritis, which of these descriptions is not true? a. inflammation of renal pelvis B. Proteus mirabilis is pathogen most often implicated c. often develops from untreated cystitis d. ascension of pathogens via the ureters e. a potentially life-threatening infection of kidney MEDIUM 20. The key to prevention of pyelonephritis is a. drinking lots of cranberry juice b. frequent urination C. minimizing risk of a bladder infection d. practicing good personal hygiene HARD 21. In the Case Study of Pyelonephritis in a Toddler what was the major risk factor for future UTIs? a. inadequate fluid intake, especially water B. infrequent diaper changing and cleaning of perineum c. lack of cranberry juice in diet d. infrequent urination MEDIUM 22. What makes Leptospirosis different from other infections of the Urinary System?

A. it is an infection caused by a pathogen that may be transferred to humans from animals b. it carries no risk of mortality c. it rarely cause kidney damage d. it is easily prevented EASY 23. This is not a characteristic of Leptospira interrogans: a. coiled spirochete B. obligate anaerobe that lives in freshwater habitats worldwide c. infected animals carry this spirochete in their kidneys and secrete it in urine d. invades via skin abrasions and enters circulatory system

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EASY 24. What individuals are at greatest risk for exposure to Leptospira interrogans? a. veterinarians b. livestock farmers c. pet owners d. individuals living in crowded filthy conditions withrats E. all of these

21.3 Bacterial Diseases of the Reproductive Systems EASY 25. Which of the following descriptive phrases does not describe the prostate gland in men? a. size of a walnut b. located below the bladder c. encircles the urethra D. secretes alkaline solution that makes up 50 % of semen MEDIUM 26. While prostatitis may be idiopathic in origin or the result of traumatic injury, some cases are caused by bacterial infections that a. are caused by UTI species b. enter prostate in urine that has moved via reflux through prostate and ejaculatory ducts c. enter prostate via urine that has been held too long in the bladder D. only a and b are correct e. all are correct HARD 27. How can bacterial prostatitis be avoided?

A. prompt treatment of a UTI infection b. regular emptying of the bladder c. drinking of cranberry juice daily d. annual checkups for men over 45 EASY 28. What epidemiology data is true?

A. Chlamydia is the most common bacterial STI in the US b. most cases are symptomatic c. twice as many cases are diagnosed in men as in women d. 1 in 20 sexually active females in their teen have chlamydia MEDIUM 29. Characteristics of Chlamydia include all of the following except a. obligate intracellular Gram-negative bacterium b. exists in 2 distinct forms c. inactive elementary body (EB) is highly infectious D. noninfectious reticulate body (RB) is specialized for mitosis

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HARD 30. Clinical features of Chlamydia include a. 50% of infected males and females are asymptomatic b. 25% of infected males and 75% of infected females are asymptomatic C. 50% of infected males and 75% of infected females are asymptomatic d. 75% of infected males and 25% of infected females are asymptomatic MEDIUM 31. Which of the following statements about Chlamydia is not true? a. symptomatic infected males may develop epididymitis b. symptomatic infected females may develop salpingitis C. some strains in Europe invade the lymphatic system and cause lymphogranuloma venereum d. neonates born via vaginal delivery to an infected mother may develop neonatal ophthalmia EASY 32. Gonorrhea is a silent asymptomatic STI that most often affects A. young adults ages 15 to 25 b. mature adults ages 25 to 45 c. teenagers and young adults ages 13 to 34 d. teenagers, young and mature adults ages 13 to 45 MEDIUM 33. Which of the following descriptions of Gonorrhea is an incorrect match? a. silent infection/often asymptomatic b. transmission/vaginal, anal and/or oral sex c. delivery/respiratory system of newborn d. penile pus/drip E. cervix/no discharge or pus HARD 34. What virulence factors influence Gonorrhea infections? a. long fimbriae allow attachment to columnar epithelium b. inability of host to produce adaptive immune response c. Opa proteins inactivate TH lymphocyte D. a, b, and c are correct e. only a and b are correct EASY 35. Why is Modified Thayer-Martin (MTM) agar the medium of choice for culturing N. gonorrhoeae? a. bacterium requires NAD and hemin for growth b. cocktail of antimicrobial drugs suppresses growth of other bacteria c. MTM is selective for Neisseria species d. only a and b are correct E. all are correct

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MEDIUM 36. What causes Pelvic Inflammatory Disease (PID)? a. bacteria introduced to female reproductive system via trauma or use of IUD b. change in bacterial population of vagina through use of tampons or douche c. untreated STI that migrates into upper portions of system d. most often caused by Chlamydia trachomatis E. all are correct EASY 37. On the cellular level, all of the following lead to PID except?

A. infection with Chlamydia and/or Neisseria causes severe inflammation of vagina b. infection produces inflammation c. inflammation leads to formation of scar tissue d. scar tissue may close off the opening of the fallopian tubes HARD 38. The history of syphilis as a STI was first documented at the time of a. first crusades to the Holy Land b. first colonization of Massachusetts by the Pilgrims C. first voyage of Christopher Columbus to the West Indies d. first settlement in St. Augustine, FL EASY 39. Characteristics of Treponema pallidum include all of the following except a. Gram-negative spirochete B. Aerotolerant anaerobe c. corkscrew-like motility d. obligate parasite e. affects genitals, anus or mouth MEDIUM 40. Match the stages in the clinical development of Syphilis with the symptom or sign: Stage of Syphilis Symptom or Sign Primary B a. gummas appear Secondary D b. spirochete-filled chancre present at infection site Tertiary A c. continuous nasal discharge and facial deformities Congenital C d. rash appears of soles of feet, palms of hands and entire body HARD 41. Match the diagnostic procedure with the suspected stage of a syphilis infection: Stage of Syphilis Diagnostic Procedure Primary B a. serological testing for presence of antibodies Secondary A b. visualization of spirochetes for chancre exudate Tertiary C c. serological testing for presence of antibodies

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EASY 42. Haemophilus ducreyi shares this characteristic of infection with Treponema pallidum: a. rash on soles of feet, palms of hands b. rash all over body C. chancre at site of infection d. gummas in skin, mucous membranes, cartilage, and bones

21.4 Viral Diseases of the Reproductive Systems EASY 43. Which of the following statements about viral diseases of the reproductive systems is not true? a. in the U.S. sexually transmitted viral infections are on the rise B. they can be treated with antiviral medications and cured c. they can significantly affect patient’s lifestyles d. they can be devastating when passed on from mother to newborn baby MEDIUM 44. Of the following descriptions, which does not describe genital warts? a. caused by the Human Papilloma Virus (HPV) b. most common sexually transmitted viral infection C. CDC estimates that nearly 70% of all sexually active adults will be infected at some point d. while most HPV serotypes cause common skin infections known as warts, 40 are known to cause genital wart infections HARD 45. This feature of the HPV serotypes that cause genital warts is quite problematic because A. warts may not be apparent because they can be internal and/or very tiny b. HPV may be spread via direct or indirect sexual contact c. careful and consistent use of condoms completely prevents transmission d. they are enveloped and thus are not affected by general washing of infected tissues MEDIUM 46. These serotypes cause visible warts, whereas these types generally initiate cervical cancer: a. serotypes 5 and 10 vs. types 6 and 12 b. serotypes 4 and 8 vs. types 5 and 12 c. serotypes 6 and 8 vs. types 9 and 11 D. serotypes 6 and 11 vs. types 16 and 18 EASY 47. Diagnosis of HPV can be determined by a. applying dilute solution of acetic acid to tissues to make them white and visible b. using PCR to identify specific HPV serotype c. performing a Pap test on sexually active women over age w d. only a and b are correct E. all are correct

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9 MEDIUM 48. Facts about Gardasil vaccine include all of the following except A. originally introduced in 2001 b. prevents infection with serotypes 6, 11, 16 and 18 c. current recommendations are vaccination for all girls and boys at age 11 or 12 d. vaccinations are recommended for all patients under 26 years of age EASY 49. Pap smears a. were introduced in the 1940s b. have resulted in a 70% decline in cervical cancers c. detect precancerous changes in cervical cells d. only b and c are correct E. all are correct MEDIUM 50. Molluscum contagiosum a. is a common skin infection producing firm bumps with a central dimple b. is caused by mulluscipoxvirus c. may be transferred only by direct contact D. only a and b are correct e. all are correct

21.5 HIV and AIDS EASY 51. HIV causes AIDS by A. targeting destruction of TH cells that results in loss of immune system function b. targeting destruction of B cells that are responsible for antibody production c. targeting destruction of TC cells that kill off infected cells d. targeting destruction of both B and TH cells thus bringing down the entire immune system MEDIUM 52. AIDS has such a high level of morbidity and mortality worldwide because a. active infection leads to patient death by transient pathogens due to loss of immune system function b. active infection leads to patient death by opportunistic pathogens due to immunocompromised state c. it is easily passed between infected and uninfected individuals during sexual activity D. only b and c are correct e. all are correct HARD 53. Characteristics of HIV include all except a. originated with transmission from infected chimpanzee blood due to viral mutation in the 1930s b. first confirmed case reported in Africa in 1959 C. occurs in three forms: HIV-1, HIV-2 and HIV-3 d. HIV-1 is most pathogenic strain and is found globally

10 HARD 54. On the molecular level, HIV consists of a. two single strands of positive-sense RNA with 9 genes b. capsid contains four enzymes needed for HIV replication c. two-part peplomer that bind to CD4 receptor of TH cell D. only a and c are correct e. all are correct MEDIUM 55. Transmission of HIV occurs in a. free HIV and infected leukocytes in body fluids b. sexual contact c. parenteral via IV drug users with contaminated needles d. accidental needle sticks for health care workers E. all of these EASY 56. Match the disease with the opportunistic pathogen that causes the condition in the HIV immunocompromised patient: Disease Opportunistic Pathogen Tuberculosis D a. Human Herpes Virus-8 Thrush C b. VZV Shingle B c. Candida albicans Kaposi’s sarcoma A d. Mycobacterium tuberculosis MEDIUM 57. What is the correct order of steps involved in HIV replication and pathogenicity?

1. binding of viral gp120 peplomers to CD4 receptors on host TH cells 7. fusion of viral envelope with host cell membrane 3. uncoating of viral genome and enzymes 4. reverse transcriptase synthesizes dsDNA from viral RNA template 5. integrase inserts viral DNA into host genome 8. transcription of viral DNA produces viral RNA 2. viral genome replicates 6. translation of viral RNA generates viral proteins 9. self-assembly followed by budding simultaneously release a virion and applies envelope 10. after budding, protease activity completes virion maturation a. 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 B. 1, 7, 3, 4, 5, 8, 2, 6, 9, 10 c. 1, 7, 2, 3, 8, 6, 4, 5, 9, 10 d. 1, 5, 4, 3, 7, 9, 10, 6, 7, 2

11 HARD 58. What is the process for accurately diagnosing HIV infection in a patient? a. first, a routine screening test is performed for anti-HIV antibodies b. routine screening usually involves an ELISA test or latex agglutination test c. positive results are confirmed using more rigorous western blot analysis to identify the presence of gp120 peplomers D. only a and b are correct e. all are correct EASY 59. At what point is full-blown AIDS diagnosed? a. when the TH cell count is less than 500 cells/µl blood b. one or more of the AIDS-defining illnesses is present c. when the TH cell count is less than 200 cells/µl blood d. answers a and b are correct E. answers b and c are correct MEDIUM 60. Treatment plans for HIV infection include all of the following except: a. are formulated to minimize immune system damage and prolong life B. seek to cure HIV infection in its early stages c. often involve combining two antiviral drugs that will inhibit reverse transcriptase with another drug that will inactivate protease d. administering triple drugs as HAART (highly active antiretroviral therapy) lessens chances of developing drug resistance HARD 61. Which of these statements concerning HIV treatments is not true?

A. mortality rate for patients who maintain their HAART regimens has decreased 84% b. patients are now living almost normal lifespans c. significant treatment drawbacks include nausea, diarrhea, elevated cholesterol and increased risk of heart attack d. patients who do not follow the strict treatment regimen risk promoting drug-resistant HIV strains

21.6 Fungal and Protozoan Diseases of the Reproductive Systems EASY 62. Why is it challenging to treat fungal and protozoal infections of the reproductive systems? a. because these infections are hard to diagnose b. because these infections are often subclinical C. because the pathogens are Eukaryotes and thus similar to host cells d. because humans are often asymptomatic carriers MEDIUM 63. What factors encourage the overgrowth of Candida albicans in an otherwise healthy female vagina? a. rise in pH levels because of decrease in Lactobacillus population b. contributing factors include wearing tight or wet clothing c. overuse of hot tubs

d. taking antibiotics for other infections E. all are factors EASY 64. Diagnosis of vaginal yeast infections (vulvovaginal candidiasis) includes a. pelvic exam to look for tissue inflammation and curdlike colonies b. obtaining sample of discharge that show dimorphic yeast when Gram-stained c. presence of invasive hyphae in filamentous form on a slide d. only a and b are correct E. all are correct MEDIUM 65. Characteristics of Trichomoniasis include all except a. caused by flagellated protozoan b. sexually transmitted C. 80 % of patients are asymptomatic d. most common nonviral STI HARD 66. The “hallmark symptom” of Trichomoniasis is A. copious, frothy foul-smelling vaginal discharge that is green or greenish yellow b. development of vulvovaginitis c. pain during intercourse and urination for females d. urethral itching and burning during urination in men MEDIUM 67. Complications of this flagellated protozoal infection include a. preterm delivery or low birthweight with vertical transmission from mother to fetus b. increased susceptibility to other sexually transmitted diseases c. increased chance the chronic infections may lead to permanent sterility D. all are correct EASY 68. Diagnostic procedures for Trichomoniasis include a. wet mount of female discharge or male urine for identification of swimming protozoans b. Gram stain of specimen c. PCR of specimen d. only a and b are correct E. all are correct

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WILEY – CH 22 – ENVIRONMENTAL AND INDUSTRIAL MICROBIOLOGY 22.1 Microbial Ecology EASY 1. What is the correct order in the Ecological Hierarchy from most exclusive to most inclusive?

1. individual organism 2. biosphere 3. ecosystem 4. community 5. population a. 2, 3, 4, 5, 1 B. 1, 5, 4, 3, 2 c. 1, 4, 5, 3, 2 d. 2, 4, 3, 5, 1 MEDIUM 2. Characteristics of populations include a. made up of all individuals of same species in same area b. growth rate c. intraspecific competition d. only a and b are correct E. all are correct HARD 3. How do communities differ from populations? a. made up of two or more distinct populations b. will never have coevolution between species c. different species may establish symbiotic relationships D. only a and c are correct e. all are correct MEDIUM 4. What is the difference between ecosystems and biomes? a. ecosystems include a community and the abiotic properties of the geographic area b. biomes have similar abiotic factors such as climates as well as similar biotic factors like plants and animals c. ecosystems include nutrient cycling between biotic and abiotic parts d. only a and b are correct E. all are correct EASY 5. Which of the following is not one of the Earth’s predominant ecosystems?

A. freshwater b. terrestrial c. aquatic d. atmospheric

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MEDIUM 6. Which of the following descriptions is not true of Atmospheric communities? a. there are 104 to 106 bacteria/m3 B. numbers of airborne bacteria may increase more than 75% in the heat and humidity of the summer because of rapid reproduction c. most airborne microbes come from soil, dust, and leaf surfaces d. in cities dog feces contribute to airborne microbiota HARD 7. Which air samples show a higher proportion of pathogens that may be directly transmitted between people? a. outdoor samples B. indoor samples c. underground samples d. only a and c are correct e. all are correct EASY 8. In terrestrial microbial communities, 1 gram of surface soil may contain more than a. 10 million b. 1 million C. 1 billion d. 10 billion e. 1 trillion MEDIUM 9. Why are bacterial species in soil communities so highly variable within short periods of time? a. changes in soil moisture b. changes in soil pH c. changes in ambient soil temperature d. changes in oxygen levels E. all of these HARD 10. Variability in aquatic ecosystems that may be freshwater, marine or mudflats results from a. water temperature b. nutrient and oxygen availability c. depth of water d. only a and b are correct E. all are correct

microbes.

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MEDIUM 11. In which aquatic ecosystems will the density of viruses be close to 100 billion per liter?

A. oceans b. rivers c. streams d. lakes e. mudflats EASY 12. What contributes more than 40% of Earth’s primary productivity? a. blue-green algae in freshwater habitats b. freshwater cyanobacteria in the Great Lakes C. viral infection of marine cyanobacteria d. protozoa infection of marine red algae HARD 13. What is responsible for redistribution of microbes on Earth? a. evaporation of water from Earth via the hydrologic cycle b. movement of water vapor containing microbes across long distances c. picking up of soil microbes by ground water and aquifers as they move to the surface d. only a and b are correct E. all are correct EASY 14. What is eutrophication? a. rapid growth of algae and cyanobacteria b. growth that is encouraged by excess nutrients in the water c. surface growth that reduces oxygen in the water below d. depletion of oxygen that kills fish and other obligate aerobes E. all of these MEDIUM 15. As a special type of microbial community, where are biofilms found in Earth’s ecosystems? a. plant roots b. rocks in streams c. soil around cool springs D. only a and b are correct e. all are correct HARD 16. All of the following are steps in the formation of biofilms except a. pioneer bacteria attach to surfaces coated with organic material by using their fimbriae and capsules b. these founders utilize proteins, oligosaccharides and fragments of DNA to form a sticky extracellular matrix C. the next wave of microbes that attach to the matrix may include more of the original species as well as bacteriophages d. additional layers are added to growing biofilm in same manner

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e. in mature biofilms some microbe leave to form new colonies MEDIUM 17. How does quorum sensing benefit microbial members of a biofilm? a. this chemical intercellular communication helps regulate gene expression as cell density in the biofilm changes b. chemicals can be sent throughout the colony to help individual cells adapt to changing nutrient levels c. intercellular messages help community members avoid toxins and evade immune system tactics d. only a and b are correct E. all are correct EASY 18. As a means of intercellular communication, quorum sensing works a. only between members of the same species b. between members of different species C. between all members of the biofilm d. between all members of the biofilm and any surrounding microbes in the area EASY 19. On what surfaces do biofilms tend to form? a. teeth and contact lenses b. replacement joints c. catheters and artificial heart valves d. only b and c are correct E. all are correct MEDIUM 20. What problems do biofilms present to health care professionals? a. they are responsible for 60% of chronic infections b. they are 10X-1000X more resistant to antibiotic therapy than non-communal microbes c. in biofilms members are able to modify antibiotic sensitivity D. only b and c are correct e. all are correct HARD 21. How would Peptide 1018 reduce the number of serious infections caused by biofilm formation on indwelling medical devices? a. it disables (p)ppGpp or guanosine pentaphosphate, a critical chemical signal for biofilm structure b. pretreatment of indwelling devices like catheters and stents with Peptide 1018 would dramatically reduce biofilm formation c. use of lower concentrations of Peptide 1018 as a pretreatment would actually eliminate biofilm formation D. only a and b are correct e. all are correct

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22.2 Biogeochemical Cycles EASY 22. Biogeochemical cycles may be described as a. circulation of chemical elements through the biotic and abiotic parts of the biosphere b. recycling of essential elements between living organisms and environment c. use of biochemical reactions in microbes to change unusable forms of elements from physical environment into chemical forms that can be metabolized by other living organisms D. all of these EASY 23. In the nitrogen cycle, nitrogen compounds undergo a. two b. three C. four d. five e. six

reactions.

MEDIUM 24. Which of the following statements concerning the Nitrogen Cycle is not true? a. It is an atmospheric cycle B. In nitrogen fixation, nitrogen gas is oxidized to usable ammonium NH4+ ion c. nitrogenase is the enzyme responsible for nitrogen fixation d. In ammonification NH 4+ is produced during the breakdown of amino acids by soil microbes during decomposition of organic matter.

EASY 25. Completion of the cycling of nitrogen gas from an abiotic to a biotic phase is occurs when a. NH4+ is absorbed into plants through their roots and used to make amino acids resulting in proteins b. herbivores eat the plant material c. carnivores eat the herbivores d. only a and b are correct E. all are correct HARD Q26-30. Complete the following description of the Nitrogen Cycle by filling in the blanks with these terms: a. N2 b. denitrification c. nitrogen fixation d. nitrification e. ammonification

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Microbes in the soil convert (Q26 A ) in the air and soil into usable forms via (Q27 C ) and (Q28 E ). In (Q29 D ) soil microbes generate NO2 and NO3 that moves easily into plant roots. The cycle is completed when (Q30 B ) returns the nitrogen to the atmosphere again.

EASY 31. The cycling of carbon includes a. reciprocal processes of photosynthesis and cellular respiration b. movement of CO2 through Earth limestone deposits c. absorption of CO2 from atmosphere as fossil fuels are burned D. only a and b are correct e. all are correct MEDIUM 32. Carbon dioxide gas (CO2) is released into the atmosphere when a. microorganisms carry out fermentation b. microorganisms carry out aerobic respiration c. limestone deposits are compacted D. only a and b are correct e. all are correct HARD 33. All of the following pertain to Greenhouse gases except a. include CO2, N2O, SO2 and CH4 B. form a dispersal gas layer in Earth’s atmosphere c. absorb and reflect heat back to Earth’s surface d. have increased global mean temperature by 1 deg C MEDIUM 34. Many ruminants like cows rely on bacteria in their stomachs to actually break down the cellulose in plants that they eat. This has a. produced belching and flatulence that release methane gas CH4 into the atmosphere b. more than quadrupled the atmospheric concentration of CH4 in last 100 years c. greatly effected problem of global warming as CH4 is almost 20X more powerful than CO2 in trapping atmospheric heat D. only a and c are correct e. all are correct EASY 35. Unlike the atmospheric cycles of nitrogen and carbon, phosphorus is a sedimentary cycle because A. principle reservoirs are in rock and soil b. principle reservoirs are in soil and water c. principle reservoirs are in rock and sand d. principle reservoirs are in limestone and water HARD 36. There are two pathways in the phosphorus cycle: a. slow cycling between soluble and insoluble abiotic forms trapped in rock and released by acid-secreting microbes

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b. rapid cycling between abiotic and biotic forms as part of organic molecules c. only a is correct D. both a and b are correct MEDIUM 37. Phosphorus cycles rapidly through the food web as a. microbes like Bacillus, Pseudomonas and Rhizobium covert phosphorus into soluble compounds b. plants take up the soluble compounds and pass it on to herbivores c. herbivores pass it on to carnivores d. dead organisms return phosphorus to soil and water E. all are correct EASY 38. The sedimentary sulfur cycle is similar to the a. carbon b. nitrogen C. phosphorus d. hydrogen

cycle.

MEDIUM 39. The acidic red waters of the Tinto River in Spain have a low pH of 1.5-3.1. Which of the following descriptions of this habitat is not accurate? a. the river has a high population of sulfur- and iron-metabolizing bacteria B. the sulfide-rich sediments are similar to some parts of the planet Venus c. Jarosite, a rare mineral found in the river, was also found on Mars in 2004 d. conditions needed to produce this rare mineral are generated by bacteria e. some scientists hypothesize that similar microbes may have lived on Mars at another time

22.3 Bioremediation EASY 40. Bioremediation is defined as a. use of intentionally introduced organisms to degrade and/or consume pollutants b. use of naturally occurring organisms to degrade and/or consumer pollutants c. use of organisms to decontaminate a habitat d. only a and b are correct E. all are correct MEDIUM 41. Match the Microorganism with the Pollutant it catabolizes and Its Source:

Microorganism used in Bioremediation Dechloromonas aromatic C Nitrobacter hamburgensis A Pseudomonas putida D Geobacter spp. B

Pollutant catabolized and Its Source a. Ammonium from fertilizer b. Heavy metals from Industrial spills c. Perchlorate from bleach d. Naphthalene from industrial spills

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HARD 42. Details in the bioremediation of the Cuyahoga River include all except: a. agricultural run-off and industrial dumping killed off most of the fish and other living organisms B. passage of the Ohio Clean Water Act (OCWA) in 1992 made it illegal to dump pollutants into Ohio waterways c. Bacillus, Burkholderia and Pseudomonas were bacterial species that showed bioremediation activity in the river d. different species of fish have gradually repopulated the river as water quality improved MEDIUM 43. Biostimulation does not occur with a. modification of conditions in the environment to increase microbial activity in breaking down pollutants B. decreasing pH, temperature, and moisture levels c. manipulation of nutrient availability or oxygen concentration to achieve the greatest amount of microbial growth d. production of optimal numbers of microbes to speed up decontamination EASY 44. Bioaugmentation a. is the addition of specifically chosen microbes selected because they metabolize a specific pollutant b. utilizes microbes that may be naturally occurring or are genetically modified c. speeds up the reduction of pollutants in habitats whether natural or human-made d. only a and b are correct E. all are correct MEDIUM 45. Sewage contains everything that is either flushed down the toilet or poured down a drain in our homes. All of the following are problems faced with treating this sewage and wastewater so that it can be returned to the environment except A. microbes must be added to process the waste b. the high amounts of nitrogen and phosphorus help promote habitat enrichment leading to algal blooms c. the big amounts of organic matter and high nitrogen and phosphorus present in waste need to be reduced in volume d. the BOD (biochemical oxygen demand) of microbes that digest the waste is high enough that normal oxygen levels are too low to support aquatic life

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EASY 46. Match the phase of sewage remediation with what occurs in each:

Phase of Sewage Remediation Primary B Secondary C

Tertiary A

What is occurring a. cleanest surface water disinfected with chlorine or UV light/additional processes remove excess nitrogen and phosphorous b. raw sewage pumped into holding tank/refuse and oils skimmed from surface/particulate matter settles to bottom forming a thick sludge/over 25% of BOD removed c. wastewater transferred to aeration chamber/oxidation by microbes removes 75% BOD/mechanical stirring and lots of aeration/water removed to another sedimentation tank to remove rest of small particles like sand

MEDIUM 47. What happens to the sludge produce during the first two phases of sewage processing? a. because it contains high levels of NPK and organic material, it can be recycle as agricultural fertilizer b. because it contains high levels of nutrients, sludge is converted into biofuels c. because of its contents, sludge may be converted by microbes into biogases used for heating, cooking and lighting d. only a and b are correct E. all are correct EASY 48. Municipal water supplies are carefully treated and screened to ensure that they are “potable”, i.e. safe for human consumption. Which of the following statements concerning freshwater is not true? a. Surface water picks up many pathogenic and nonpathogenic microbes from rain water contamination. b. Animal feces are a source of many microbes that are found in the guts of these animals.

C. The presence of Indicator microbes means that there are confirmed pathogenic intestinal bacteria in water supplies. d. Indicator microbes are usually “fecal coliforms” like E. coli that live in colons of animals.

HARD 49. The major steps in treating freshwater to make it potable include all except a. Reservoirs are used as large holding areas that allow particulates to settle to bottom.

B. Water is then treated with magnesium sulfate to reduce growth of photosynthetic microbes. c. Subsequently water is pumped into special tanks that filter it with various materials like rocks or sand to remove majority of bacteria, protozoa and viruses. d. The final step occurs when water is pumped to holding tanks for chlorination or other chemical or light treatments.

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22.4 Microorganisms used in Manufacturing EASY 50. Microorganisms are used to produce many valuable things for our modern society. Examples include which of the following: a. enzymes to make blue jeans look faded b. food additives like acetic acid for preservatives c. toxins for pesticide use in agriculture d. only b and c are correct E. all are correct MEDIUM 51. Match the following bacteria with the common drugs they make:

Bacterium Streptomyces B Rhizopus A GMO Escherichia C

Common Drug Produced a. steroids to reduce inflammation b. antibiotics to treat bacterial infections c. Humalog to control blood glucose levels

HARD 52. industrial fermentation utilizes a bioreactor. Accurate descriptions of this process include a. bioreactor maximizes growth and product generation b. variables such as temperature, pH, oxygen concentration and nutrient levels are all controlled c. starter culture is a community of microbes that probably contain the desirable species needed D. only a and b are correct e. all are correct EASY 53. Match the common industrial product with the microbe that makes it: Common Industrial Product Acetone A Citric Acid C Fertilizers E Hydrogen B Pesticide D

Microbe(s) that make it a. Clostridium b. Chlamydomonas, Clostridium, Enterobacter c. Aspergillus, Candida d. Bacillus (Bt) e. Bradyrhizobium, Rhizobium

HARD 54. Fermented foods often have unique flavors. Which of these descriptions is incorrect?

A. Sauerkraut, poi, kimchi and kombucha are all fermented foods that get their tangy flavor from Lactobacillus thermophilus. b. Lactobacillus gives savory flavoring to salamis and summer sausages. c. Lactococcus lactis produces buttermilk, cheese, sour cream and yogurt. d. Ricotta and cottage cheese are unripened cheeses that include the curds and whey.

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EASY 55. Yogurt production utilizes microbial fermentation of milk to lower the pH and promote the tangy flavor and texture. What is the correct order of steps in this process?

1. excess fat is skimmed off raw milk and protein content is raised with milk products 2. milk is cooled to 50 deg. C and inoculated with L. bulgaricus and L. thermophiles 3. fermentation generates formic and lactic acids that drop pH to 4.3 and coagulates milk proteins 4. contents are pasteurized and homogenized 5. additional flavorings may be added before dispensing yogurt into containers and sealing them a. 4, 2, 3, 1, 5 B. 1, 4, 2, 3, 5 c. 1, 3, 4, 2, 5 d. 1, 2, 3, 4, 5 MEDIUM 56. Which of the following terms and descriptions are mismatched? a. curds/coagulated milk proteins such as casein b. whey/milk fluid containing proteins and other nutrients C. unripened cheese/Brie d. molded curds/Camembert e. secondary cultured cheese/Swiss HARD 57. Why does wine typically have an alcohol content of approximately 12%?

A. because at this point the alcohol poisons the yeast and fermentation stops b. because the yeast runs out of a carbohydrate source, usually grapes c. because the accumulation of alcohol lowers the temperature too much to support fermentation d. because the pH is lowered at this point interfering with fermentation process MEDIUM 58. Where does the term “malting” come from in the process of making beer? a. grain is crushed to expose more starch that is the substrate for the digestive enzymes b. crushed grain is treated with hot water to increase enzyme activity c. liquid is separated from the mash and mixed with hops to add flavor d. grain is germinated to release a-amylase that breaks down starch to glucose

22.5 Safe Product Processing and Packaging EASY 59. Time between ingestion of a food and onset of gastroenteritis is often a clue as to the cause. Rapid onset of gastroenteritis usually indicates a. intoxication of food b. action of pathogen-secreted toxins into the food c. infection of the food with live pathogen

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D. only a and b are correct e. all are correct MEDIUM 60. The seven principles of HACCP (Hazard Analysis and Critical Control Point) system do not include a. Identify points where food safety could be compromised b. establish clear critical limits for cooking temperature and time, food color, texture and general appearance C. inspection of food items prior to entrance into manufacturing operations d. establish corrective actions in advance so products inadvertently made under unsafe conditions do not enter the market HARD 61. The HACCP system originated A. as a collaboration between NASA and US Army Laboratories and Pillsbury to develop a protocol to provide safe food on manned space missions b. as a collaboration between the USDA, FDA and Pillsbury to develop a protocol to provide safe food on manned space missions c. as a collaboration between the USDA, FDA and US Army Laboratories to develop a protocol to provide safe food for the US Army deployed abroad d. as a collaboration between the USDA, FDA and US Navy to develop a protocol to provide safe food on naval personnel stationed aboard ships EASY 62. Match the food item with the appropriate chemical additive for food preservation: Chemical Additive Food Items Citric, propionic and citrus acids C a. spices and nuts Sulfur dioxide D b. processed meats like bacon Alkylating agents A c. juices, soft drinks, cereals and pastries Nitrates B d. decontaminates fruit juice before wine fermentation MEDIUM 63. Which of the following physical methods of microbial control is gaining ground in popularity and public acceptance because of its effectiveness? a. chemical desiccation and dehydration B. ionizing radiation to damage microbial DNA c. high pressure treatments of 90,000 psi d. freeze-drying HIGH 64. Which of the following statements about pasteurization is not true? a. a process of heating liquid food to kill vegetative microbes that lead to spoilage b. increases length of time that heat-treated products are safe to consume c. uses an inverse ratio so that the higher the pasteurization temperature, the shorter the time to achieve this D. destroys all pathogens in the liquid food product

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EASY 65. What are signs of spoilage in improperly canned foods that provide a warning not to eat them? a. presence of bubbles b. turbidity or cloudiness of what should be a clear liquid c. bulging of can top indicating gas production d. an “off” smell of the opened container E. all of these MEDIUM 66. Which endospore-forming bacterium can cause even properly canned food to spoil when it is stored under hot conditions? a. Clostridium botulinum B. Bacillus stearothermophilus c. Clostridium tetani d. Bacillus subtilis HARD 67. Autoclaves are used in laboratories to kill microorganisms and sterilize equipment. However they are relatively ineffective in these circumstances: a. will damage heat-sensitive materials and chemicals b. cannot evenly distribute heat in solids c. inability to disinfect oily substances because they cannot mix with steam d. only a and c are correct E. all are correct EASY 68. Match the microbial control method with its intended action in health care settings:

Microbial Control Method Autoclave D Filtration C Ionizing radiation A Irradiation B

Intended Action a. indwelling medical devices before insertion into patients b. personal protective equipment c. medication for IV delivery d. sterilize reusable medical and dental instruments

MEDIUM 69. Why is UV light useful for disinfecting operating rooms in hospitals? a. UV light creates thymine dimers in microbial DNA, blocking replication b. provides surface sterilization c. kills pathogens hiding in niches and scratches d. only a and c are correct E. all are correct HARD 70. Would UV light be effective in eliminating biofilms? a. yes, because it would block DNA replication and the microbes couldn’t reproduce b. no, because it would not be able to penetrate deeply enough to reach all cells

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c. yes, if the biofilms were not very thick D. a and c are correct