Microbiology: iClicker, Smartwork5, Quiz 3

Iclicker #5: Which of the following diseases is carried by an insect vector? a. rabies b. West Nile encephalitis c. poliomyelitis d. meningococcal meningitis e. listeriosis

b. West Nile encephalitis

Homework #2: Tears contain a component called _____________________ that can help eliminate bacteria. lipids salt (sodium chloride) lysozyme

lysozyme

Reading Quiz #7: Kaposi's sarcoma is often associated with ___________. Choose one: A. AIDS patients B. young patients C. elderly patients D. immunocompetent patients

A. AIDS patients

Which of the following hepatitis viruses is most likely transmitted via sexual intercourse and contact? A. Hepatitis A B. Hepatitis B C. Hepatitis C D. None of these

A. Hepatitis A

RQ #2: What type of procedure is performed when a patient is suspected to have a CNS infection? Choose one: A. lumbar puncture B. CT scan C. blood test D. MRI

A. lumbar puncture

Reading Quiz #11: In males, infection of the testes is known as ___________. Choose one: A. orchitis B. cystitis C. epididymitis D. prostatitis

A. orchitis

10. A child with a violent paroxysmal cough has an impeded mucociliary escalator. If it were possible to look at tracheal epithelial cells in this child, you would see something similar to this image. The structures attached to the cilia are A. influenza viral particles. B. Bordetella cells. C. Streptococcal cells. D. Staphylococcal cells.

B. Bordetella cells

Reading Quiz #6: A pelvic examination of a 23-year-old woman showed vesicles and ulcerated lesions on her labia. Cultures were negative for Neisseria and Chlamydia; the VDRL test was negative. What is most likely the cause? Choose one: A. HIV B. HSV C. HPV D. genital warts

B. HSV

Genital warts are caused by A. herpes simplex 2. B. human papillomavirus. C. herpes simplex 1. D. human immunodeficiency virus.

B. human papillomavirus.

Reading Quiz #12: The warts shown surrounding the anus in this image are caused by

B. human papillomavirus.

Acute otitis media is infection in the A. Sinuses B. Outer ear C. Middle ear D. Inner ear

C. Middle ear

Reading Quiz #5: The vast majority of ulcers within the area of the digestive tract shown here are caused by A. spicy foods. B. a virus, hepatitis C. C. a bacterium, Helicobacter pylori. D. stress.

C. a bacterium, Helicobacter pylori.

iClicker #2: Which of the following viral infections of the respiratory tract is especially concerning for premature infants? A. rhinovirus B. Bordetella pertussis C. respiratory syncytial virus (RSV) D. otitis media E. Pseudomonas aeruginosa

C. respiratory syncytial virus (RSV)

Reading Quiz #12: Lisa visits her physician and reports ear pain. Her physician uses an otoscope to view her __________________, as shown in this figure. A. auditory ossicles B. Eustachian tube C. tympanic membrane D. pharynx

C. tympanic membrane

Chapter 20

Chapter 20

Chapter 21

Chapter 21

Chapter 22

Chapter 22

Chapter 23

Chapter 23

6. Whooping cough is caused by ________. A. Corynebacterium diphtheria B. Streptococcus pyogenes C. Haemophilus influenza D. Bordetella pertussis

D. Bordetella pertussis

Homework #1: Which of the following is a mosquito-borne infection that can lead to viral encephalitis? Choose one: A. Rabies virus B. Coxsackievirus C. Polio virus D. West Nile virus

D. West Nile virus

Reading Quiz #13: The organism shown in the circle caused the chancres shown in the lower image. This organism, transmitted by sexual contact, is called A. Neisseria gonorrhoeae. B. Herpes simplex virus 1. C. Chlamydia trachomatis. D. Treponema pallidum.

D. Treponema pallidum.

Which is true of Toxoplasmosis? A. Is caused by a protozoan B. Can infect pregnant women when cleaning the cat litter box C. Acts a s a teratogen damaging the fetus D. B and C E. All of the choices are true

E. All of the choices are true

Iclicker #1: Cerebrospinal fluid (CSF) that appears cloudy indicates the presence of which type of pathogen? a. bacteria b. virus c. prion d. aseptic meningitis e. not enough information

a. bacteria

Iclicker #3: Which of the following diseases is more common in children? a. rabies b. transmissible spongiform encephalopathies c. bacterial meningitis d. coccidioidal meningitis e. African sleeping sickness

c. bacterial meningitis

Plague is characterized by all of the following EXCEPT A. Infects by flea bite B lymph node enlargements called buboes C. Etiology is Yersinia pestis D. Sylvanic plague infects city rats only

A. Infects by flea bite

Reading Quiz #1: Receding of the gum from the tooth is a sign of ________________. A. gingivitis B. dental caries C. periodontal disease D. thrush

C. periodontal disease

RQ#3: Encephalitis is inflammation of the ____________. Choose one: A. brain B. spinal cord C. spinal nerve root D. meninges

C. spinal nerve root

All of the following are true about Candida EXCEPT: A. It is a dimorphic yeast. B. It is found in the gastrointestinal tract, vaginal tract, oral cavity, and skin. C. It is not part of the normal biota. D. It can cause serious problems in patients who are immunocompromised.

C. It is not part of the normal biota.

Red streaking under the skin is A. Lymphadenopathy B. Lymphadenitis C. Lymphangitis D. Endocarditis

C. Lymphangitis?

Reading Quiz #8: The bacterium that can cause the sequelae rheumatic fever and glomerulonephritis is________. A. Corynebacterium diphtheriae B. Streptococcus pneumoniae C. Moraxella catarrhalis D. Streptococcus pyogenes

D. Streptococcus pyogenes

9. Which of the following preventive measures is most likely to prevent viral diseases of the respiratory system? A. annual vaccines B. drinking water C. hand washing D. taking prophylactic antibiotics

C. hand washing

Ch 20: Viral Infections of the Respiratory Tract *Case History 20.1 Jacob's Runny Nose* Jacob, a rambunctious 5-year-old boy brought to the clinic by his mother, was complaining of a scratchy sore throat, a nonproductive cough (a cough that does not produce sputum), rhinorrhea (a runny nose), nasal congestion (a stopped-up nose), and a headache that started the night before. He did not have a fever.

*Case History 20.1 Jacob's Runny Nose* His complete blood count (CBC) - the number of platelets and red and white blood cells in blood, along with its differential (the different types of red and white blood cells) - was normal, as was his chest X-ray. Jacob was diagnosed with the common cold and advised to rest, drink plenty of clear liquids, and use over-the-counter cough suppressants and either ibuprofen or acetaminophen for pain.

*4.6 Case Study* When you left for school this morning your 3-month-old son was wheezing a bit and he had a slight fever of 99.8 F. Your mother is watching him while you come to school and take your a&p exam. Your pager goes off halfway through the exam. The baby's fever is rising and he is having more trouble breathing. Your mother says she is taking him to the Emergency Room. You rush over to the hospital. When you get there, he is in an examining room and the doctor is signing papers to admit him to intensive care. She says she suspects some kind of pneumonia. She mentions the type of pneumonia but you don't recognize the nameand you are too worried about your son to pin her down at this moment. you do note that she mentions that the hospital gas seen a dozen pediatric cases of this smae type of pneumonia in the past week and a half. The doctor swabs your sons nose but says the results won't be back for several days. In the meantime, they will give him supportive therapy, including an inhaled spray, but no antibacterial drugs. The doctor says that the child will recover, since, the infection was caught very early. Nontheless, after she leaves, your mother is frantic and indignant. She fires off the following questions to you. 1. What kind of pneumonia is it? 2. Why aren't they giving him antibacterial drugs? 3. How can the doctor be sure what's causing the pneumonia if she doesn't yet have test results? 4. What about your other child, who is 3 years old? Has she been exposed to the infection by being around the baby? Should the baby remain isolated when he comes home? Can the 3 year-old be vaccinated?

1. 2. 3. 4.

*3.1 Case Study* You are at your son's baseball game when another boys dad experiences dizziness and nearly faint in the stands next to you. You tell him that you are a paramedic and will walk him to your car where you have your medical equiptment. He reports that he has had a headache off and on since he had a tooth extracted four days ago. This evening he is feeling very weak. His blood pressure is normal. When you listen to his heart you note that he has a pronounced murmur. He reports having had rheumatic fever 15 years ago. You examine his fingernails and find one that has tiny petechial hemorrhages under it. 1. Which cardiovascular infectious condition is this? 2. What is the most likely causative organism and the route of transmission? 3. What's the connection, if any, with rheunmatic fever? 4. Why did you look at his fingernails? 5. What type of culture would a physician most likely order, and why? 6. What is the treatment?Is there a way to prevent the condition?

1. Bacterial endocarditis petechial 2. Staphylococcal species? (Staphylococcus) Staphorious 3. Damaged the heart valve 4. Petechial rash, in fingernail bed 5. Bacterial culture 6. Valve replacement/heart transplant, after his dental thing he should have takeing antibiotics before and during the surgery to help kill the bacteria—help prevention profliactic antibiotics.

*5.6 Case Study* You are working as a receptionist at the only family practice in a small town in Idaho while youre studying to become a physician's assistant. On a Saturday morning you are the only office worker there when a call comes in from a local church. The congregation is hosting a family that moved to the U.S. from Peru six weeks ago and is helping them find housing and work. In the meantime, the family is staying at a church-owned house and relying heavily on church members for help negotiating this new county and for translation while their English is still sketchy. The Women on the phone identifies herself as Leslie, a church member. She seems distraught. She says that the mother of the mother of tthe young family became ill yesterday and seems extremly ill now. Her symptoms started out as stomach cramps and quickly progressed to a very watery diarrhea. You hear moaning in the background and Leslie tells you that the patient is pointing to her calves and ccrying. You as Leslie how many stools the sick woman has hadin the last 12 hours. She replies that it is almost constant and that the woman can no longer leave her bed at all. When asked, Leslie says there is no blood in the excreta. It is very clear with lots of little white flecks in it. You put her on hold and run down the hall to the examining room where a physician is doing a well-baby-check. 1. When the doctor opens the door you whisper that you think there's a case of __________ on the phone. 2. The doctor's eyes widen and she asks you how you came to that conclusion. What is your reply? 3. Why was the dr initially dubious about your diagnosis and why does the patients recent immigrant status convince her that your diagnosis was correct? 4. The dr ask you to tell Leslie to call 911, the sick woman should be transported to the ER and the dr will call ahead and meet her there. What is the first intervention likely to be performed when the patient arrives? 5. The incubation period for this disease is one to four days. Can you thinkof any way that the young mother could have been infected so recently even though she has been in this country for six weeks? 6. The next day you ask the dr about the patient's status. She says that currently the patient is receiving a course of the antibiotic ciprofloxacin, thoough it won't help her. Why won't it help her and why was it prescribed if it won't?

1. Cholera 2. Clear copious diarrhea with mucous flecks but no blood—rice water stool---and the patient is recently from South Am. where this is more common. 3. She is doubtful because cholera is not seen often in North America. The few cases seen are usually from shellfish and Idaho is a landlocked state. Other cased are seen in recent immigrants and returning travelers. Cholera is epidemic in South America. 4. IV rehydration. Dehydration is also the reason for the leg cramps the woman experiences. 5. One of her family members is an asymptomatic carrier or one of the family is a convalescent carrier still shedding the bacterium for weeks to months after their own recovery. 6. Rehydration is the best treatment for the woman, but antibiotics will protect the community ensuring that any shed bacteria are dead.

*4.8 Case Study* You have just been accepted into the nursing school at a local medical center. The program requires that you have a physical, which includes a T test as well as the hepatitis B recombinant vaccine series. The nursing administering the TB skin test explains that if significant swelling occurs around the injection site, you will probably have to have a chest xray to determine if you are infected with Mycobacterium tuberculosis. One and a half days later you wake up and look at your arm, which appears swollen in an area about the size of a quarter around the skin test. It is red and tender to the touch. You are alarmed; could you have TB? 1. Why does the reaction take 36-48 hours to show up? 2. If you have a TB infection, why doesnt the whole body, or atleast the respitory tract, react when the antigen is injected during this diagnosis test? 3. You are referred for a chest xray, but the results are inconclusive. The clinic doctor prescribes a six month course of isoniazid (INH). You take the medicine according to the pharmicist's instructions. Six months later you're taking a medical microology course as a part of your nursing curriculum. On the day you study TB, you suddenly realize why you had a positive skin test. It has nothing to do with a true infection, but with the fact that you were born in the netherlands. Your family moved to the US when you were 4 years old. What do you suppose is going on here? Discuss as fully as you can. 4. You have a friend in your hometown who is HIV-positive. When you told her about your TB scare, she said that her specialist cant use the TB test, even though HIV positive people are at higher risk than the healthy population for TB. Why is the skin test not recommended for HIV-positive people?

1. Delayed hypersensitivity reaction 2. Subcutaneous. Just under the skin and doesnt get in the blood stream 3. She had the vaccine before which is why she tested positive 4. If HIV has infected cells they

Homework #9: Place the steps of a Lyme disease infection in the order in which you would expect to see them occur.

1. Initial tick bite 2. Erythema migrans 3. Malaise, joint pain and irregular heart rhythm 4. Peripheral neuropathy and encephalopathy

*3.4 Case Study* A 63-year-old international telecommunications executive visits your office with complaints of a high fever. The fever is not constant, but intermittent. When you press him for details he estimates that every three days or so he suffers these debilitating "Sweats". He usually has headaches and muscle aches during the episodes. They keep him home from work. After half a day or so he feels better. He reports that he has experienced these episodes for about two months. 1. What is the name of the condition you suspect? 2. What should be your first qeustion about the patient's history? 3. What is the most likely causative organism (genus and species)? Support your answer 4. Is this pathogen eukaryotic or prokaryotic? 5. Which is the most dangerous of the species that can cause this disease? Give some details. 6. What are the two main places in the human body that are exploited by the causative organism in this disease? 7. Can this individual transmit this infection to others? why or why not?

1. Malaria 2. Travel outside of US? 3. Plasmodium organism: most common is plasmodium malari 4. Eukaryotic 5. Plasmodium plas..?? 6. Liver and red blood cells 7. No, transmitted through a mosquito (blood transfusion or organ transplant has happened but UNLikely)

*4.2 Case Study* You and your friends are driving to the mall; it is late October. A public service announcement comes on the radio urging people to get their flu vaccinations. you are a second year nursing student and you mention that the nursing staff at your university is holding a vaccine clinic next week. your friends Susan says, "I'm not getting a flu shot! Last time I did, it gave me the flu." Others in the car agree with her. But Heather ask you if its true that the vaccine can give you the flu. 1. What should your answer to Heather's question be? 2. Heather says that because she had a flu shot last year she's going to skip it this year. Respond with an explanation. 3. What is the difference between "antigenic drift" and "antigenic shift"? 4. What is different about the vaccine from year to year? Who decides what form it will take every year? 5. Susan wants to know why you don't have to get other vaccines annually. 6. Another friend, Dru, says that even though she had the flu shot last year she got terribly sick with the stomach flu over Thanksgiving break and missed most of her vacation. What is your explanation for this?

1. No you cannot get the flu from the flu vaccine. 2. The Flu changes so you have to update for it. 3. Shift is a more major change in a virus, often when human flu crosses with a flu virus that affects animals. Drift is small changes in a virus that happen continually over time. 4.There are different strians. The CDC looks at the most prevolent strains and make a vaccine out of those. 5. Bacterial infections do not mutate as fast as some others. 6. That is was a different virus.

*4-1 Case Study:* You are a physician's assistant at a local pediatrician's office. Five-year-old Michael is brought to the office by his father. Michael is crying and complaining that his mouth hurts. His father has been at work and does not know whether the boy has had a fever during the day. Currently his temperature is 103F. The physician notices that Michael's breath smells rotten. Lymph nodes in his neck are swollen, and visual examination of the throat reveals a white packet adhearing to the left tonsil. much of the soft pallet is red. 1. What laboratory test are called for? 2. What types of infections are in the differential diagnosis? 3. Your practice has recently been overrun by sore throats and now late in the evening there are no supplies for performing the proper test. Should the physician prescribe antibodics or not? 4. In deciding whether to prescribe antibiotics, should the physician be extra careful not to prescribe an unnecessary antibiotic, or be extra careful not to let a bacterial infection go untreated? 5. What are the possible sequelae of untreated sore throats?

1. Rapid Strep Test 2. Pharyngitis, Tonsilitis, peritonsillar absecess, Infectious Mononucleosis, Diptheria, Gastroesophageal reflux disease (GERD), Thyrois Dysfunction 3. Yes! 4. If you have an infection make sure to treat because untreated can lead to sequel and death. 5. Scarlet fever, Rheumatic fever (a cardiac disease), Glomerulonephritis (kidney diease), Pancarditis (simultanious inflamation of different tissues of the heart)

*5.3 Case Study* Your sister Pam called you last night, upset about her recent visit to the pediatrician (she has a 3-year-old son). Actually, she was upset about the discussion she had afterward with her husband, who was adamantly opposed to having their son vaccinated againat hepatitis B virus (HBV). Pam called you because the doctor had convinced her that it was necessary. and indeed routine to vaccinate young children. Her husband believes that hepatitis B is mostly acquired through sexual contact and drug use and that it's ridiculous to vaccinate a 3-year-old. Pam wants your advice before continuing this discussion with her husband.

1. Yes, it can be transmitted through sexual contact and IV drug use, but can also be transmitted through normal close contact like between a mother and child or child care worker and child through saliva. 2. More serious for this age group. They have more of a chance of developing chronic infection and higher chance of liver failure. 3. Restaurant outbreaks of hepatitis are caused by hepatitis A virus, which is completely different, and the hepatitis B vaccine will not protect from the hepatitis A virus. 4. The vaccine is probably safer if genetically engineered. No blood products are used and the virus is not involved in the production of the vaccine. Instead, a gene for the surface antigen of HBV is inserted in harmless yeast cells to produce large quantities of the surface protein for vaccination.

*5.7 Case Study* You went to get a haircut yesterday and your stylist was having a conversation with another stylist in the shop. The second stylist said that her live-in boyfriend of three yeaars just got a blood test and discovered he has hepatitis C. Your stylist shrugged her shoulders and said her boyfriend has never had any symptoms so she wasn't going to worry about it. 1. After the second stylist walks away, your stylist asks you about hepatitis C. Her first question is, "Is it serious?" Answer this question as throughly as you can. 2. How is it transmitted? 3. Can she be vaccinated against it? 4. Your stylist has heard of hepatitis A and hep B, but never hep C. Is it new? Explain.

1. Yes, it is chronic and can cause liver damage. 2. Transmitted almost exclusively through blood. It is NOT transmitted through saliva, sneezing, and seldom by sex like with hepatitis B. Blood was not tested until 1992, so many acquired it through blood transfusions. Also, tattoos, body piercings, and injecting illicit drugs. 3. No vaccine for hepatitis C. 4. Hepatitis C was first established in 1988 when able to reliably detect it in the blood. Infection peaked in the 80s so it is relatively new.

*1.2 Case Study* In late September a woman brings her 14-year-old daughter, Meg, to the family physician. Meg shows the doctor the back of her thigh where there are pale red, nonraised discolorations. The rash covers a wide area of the thigh and seems to be roughly circular. The center of the circular area appears normal. Meg has no other systoms, but her mother brought her in because the rash has been present for over three weeks and it seems to be growing. The doctor questions Meg about possible exposures. Has she worn any new pants lately? Has she been in the woods? Do her joints hurt? Meg reports that she spent the month of August at summer camp in Vermont. She's been wearing mostly shorts and bathing suits and bathing suits for the past two months, none of them new. She doesn't remember any insect bites on her thigh. 1. On the basis of Meg's oral history, what is the most likely diagnosis? What would the causative microorganism look like in a Gram stain? 2. How did she most likely acquire her infection? 3.Would the diagnosis be any different if Meg had attended camp in Arizona? Explain. 4.Why does the doctor ask Meg if her joints hurt? 5. How is this infection treated? 6. Meg's mom, upon hearing the presumptive diagnosis, declares that Meg will not return to that camp, whcih she loves and had planned to attend next summer. The doctor suggest that Meg need only take some precautions. How can she protect herself from getting this infection again?

1. lyme diease—deer tic bite 2. At camp 3. Yes, lymedisease is almost non existant in Arizona 4. One of the main symptoms 5. Over a long period time of antibiotic 6. Insect repellant, Wear pants

Homework #5: Which of the following is caused by a parainfluenza virus and presents with symptoms of a seal-like bark, hoarseness, cough, fever, and respiratory distress in children? A. Croup B. Severe acute respiratory syndrome (SARS) C. Pneumonia D. Respiratory syncytial virus (RSV)

A. Croup

Homework #4: The image above shows the cells taken from a patient and stained with tissue dyes. What virus would be associated with the giant cells containing inclusion bodies like the ones shown here? A. Cytomegalovirus B. Dengue fever virus C. Epstein-Barr virus D. Chikungunya virus

A. Cytomegalovirus

Reading Quiz #5: Which of the following preventive measures is most likely to prevent viral diseases of the respiratory system? Choose one: A. hand washing B. drinking water C. taking prophylactic antibiotics D. annual vaccines

A. hand washing

Reading Quiz #4: Which of the following would be the most likely treatment for self-limiting gastrointestinal infections? Choose one: A. hydration B. proton-pump inhibitors C. antibiotics D. antivirals

A. hydration

Reading Quiz #6: A 6-month-old girl who attends day care develops a fever, chills, and respiratory wheezing. She is admitted to the local hospital where she is treated with hydration, oxygen, and bronchodilators. Her parents are distraught and feel that they could have done more to prevent their daughter's illness. The physician assures them no vaccine is currently available for her illness because the exact mechanism of the immune response has not yet been delineated. The girl is infected with ________. A. respiratory syncytial virus B. Type A influenza C. Type B influenza D. rhinovirus

A. respiratory syncytial virus

2. Which of the following would you expect to result in an influenza pandemic? A. antigenic shift within a type C influenza virus B. antigenic shift within a type A influenza virus C. antigenic drift within a type B influenza virus D. antigenic shift within a type B influenza virus

B. antigenic shift within a type A influenza virus

Reading Quiz #8: The owl's eye appearance in this giant cell indicates the presence of Choose one: A. Ebola virus. B. cytomegalovirus. C. Epstein-Barr virus. D. Dengue virus.

B. cytomegalovirus.

Reading Quiz #11: Richard, a 62-year-old businessman, receives an annual vaccine against the virus shown in this figure. What is he being vaccinated against? A. rhinovirus B. influenza C. respiratory syncytial virus D. Bordetella pertussis

B. influenza

Homework #5: The norovirus (Norwalk virus) principally affects which of the following demographic groups? A. Toddlers (2-4 years old) B. Infants (0-2 years old) C. Adults D. Immunosuppressed individuals

C. Adults

Reading Quiz #7: Julie has been experiencing a mild fever, pharyngitis, and swollen cervical lymph nodes for several days. A lab technician notices large atypical lymphocytes, as this blood smear shows. These lymphocytes are indicative of Choose one: A. Burkitt's lymphoma. B. herpes simplex virus infection. C. streptococcal infection. D. Epstein-Barr virus infection.

D. Epstein-Barr virus infection.

Homework #9: Which of the following bacterial diseases of the respiratory tract can be prevented by a vaccine? Choose one: A. Pseudomonas pneumonia B. Walking (atypical) pneumonia C. Pharyngitis D. Lobar pneumonia (pneumococcal pneumonia)

D. Lobar pneumonia (pneumococcal pneumonia)

Iclicker #1: Which of the following is not a mechanism of urinary tract infection? A. ascending infection from the urethra to the bladder B. descending infection from the kidney C. ascending infection to the kidney D. descending infection from bladder to kidney

D. descending infection from bladder to kidney

Reading Quiz #3: Infection with _______________ causes swollen parotid glands. A. rotavirus B. sapovirus C. norovirus D. mumps virus

D. mumps virus

Reading Quiz #13: The rash shown in this figure is associated with a streptococcal infection. What is the common name for this rash caused by streptococcal exotoxins? A. rheumatic fever B. streptococcal pharyngitis C. strawberry tongue D. scarlet fever

D. scarlet fever

Reading Quiz #2: ________ is noticed as a white cottage cheese-like covering in the mouth. Choose one: A. gingivitis B. dental caries C. periodontal disease D. thrush

D. thrush

Homework #4: The Contagious Football Player with GAS Dallin, a 16-year-old high school athlete, came to the clinic complaining of sore throat. He did not have a cough or any cold or flu symptoms. His cervical nodes (lymph nodes in the neck) were enlarged and tender to palpation, there was an exudate visible on his tonsils and pharynx (pharyngotonsilar region), and his temperature was 39.8°C (103.6°F). The physician assistant (PA) told Dallin that he probably had a strep throat but she could not perform a rapid strep test to confirm this because they had run out of the strips. The PA then swabbed the back of Dallin's throat and sent the sample to the lab for culture and antibiotic sensitivity testing. Dallin was given an antibiotic empirically (based on clinical experience and in the absence of definitive diagnosis). He was told that he was contagious and should rest and avoid contact with others until better. He followed the recommendations, recovered, and was back playing football in a few days. The lab isolated Streptococcus pyogenes, also called group A streptococcus (GAS), from Dallin's pharyngeal swab, confirming the diagnosis. Part 1 (1 point) Streptococcal species other than Streptococcus pneumoniae are divided into groups A-U based on what? Choose one: A. The antigenic composition of their carbohydrates B. The toxins they release C. The order in which they were discovered D. The severity of their symptoms Part 2 Some strains of Streptococcus pyogenes produce exotoxins called streptococcal pyogenic exotoxins that can cause fever and a red rash known as what? Choose one: A. Typhoid fever B. Measles C. Scarlet fever D. Shingles Part 3 How does a rapid strep test detect the presence of group A streptococci (GAS) in the throat of the patient? Choose one: A. It responds to enzymes produced by GAS bacteria. B. It responds to GAS-specific antibodies on the throat swab. C. It responds to toxins produced by the GAS bacteria. D. It responds to GAS-specific antigens on the throat swab.

Part 1: A. The antigenic composition of their carbohydrates Part 2: C. Scarlet fever Part 3: D. It responds to GAS-specific antigens on the throat swab.

Homework #6: Three weeks ago, Kathrine, a 17-year-old from Waikiki, Hawaii, developed nausea, fever, and aches. She initially thought it was the flu. She felt extremely tired, dozed through school auditorium events, and was unable to participate in golf tournaments or the school debating team. About 2 days ago, Kathrine could not keep food down and was taken to the emergency department (ED), where she was given an antinausea shot. The shot didn't work; she continued to vomit and made a second visit to the ED. She noted that her urine seemed dark in color, and she told the physician she had not been hospitalized prior to this event and had not traveled outside the United States. She denied using drugs or having any sexual partners. The practitioner noticed a yellow tinge to the white part of her eyes. A blood test showed that she was positive for anti-hepatitis A virus (HAV) antibodies. Part 1: Kathrine tested positive for antibodies against the virus that causes hepatitis A. What does the word "hepatitis" refer to? A. Hepatitis refers to the diseases caused by a specific family of viruses. B. Hepatitis refers to the symptom of inflammation of the liver. C. Hepatitis refers to any infection of the gastrointestinal tract. D. Hepatitis refers to any viral infection of the gastrointestinal tract. Part 2: What symptoms of Kathrine's infections are key indicators of hepatitis? A. That she was achy and running a fever B. That she was very tired C. Her nausea and vomiting D. Her yellow-tinged eyes and dark urine Part 3: Because Kathrine's infection is caused by the hepatitis A virus, Kathrine most likely contracted the virus through which of the following routes? Choose one: A. Via contaminated blood (such as sharing needles) B. Via kissing, sharing a drinking glass, or anything that would bring her into contact with an infected person's saliva C. Via sex with an infected individual D. Via food or drink contaminated with fecal matter from an infected person

Part 1: B. Hepatitis refers to the symptom of inflammation of the liver. Part 2: D. Her yellow-tinged eyes and dark urine Part 3: D. Via food or drink contaminated with fecal matter from an infected person

Homework #5: *Dental Procedure Leads to "Heartache"* Elizabeth was 58 years old and had a history of mitral valve prolapse (a common congenital condition in which the heart valve does not close properly). She was on immunosuppressive therapy following a kidney transplant. She had recently been admitted to the hospital complaining of fatigue, intermittent fevers for 5 weeks, and headaches for 3 weeks—symptoms the physician recognized as possible indicators of endocarditis. Elizabeth reported having a dental procedure a few weeks prior to the onset of symptoms, but forgot to take antibiotics beforehand. A sample of her blood placed in a liquid bacteriological medium grew Gram-positive cocci, which turned out to be Streptococcus mutans, a bacterial species associated with dental caries. With the finding of bacteria in the bloodstream, the diagnosis of bacterial endocarditis was confirmed. Elizabeth began a 1-month course of intravenous penicillin G and gentamicin therapy and eventually recovered to normal health. Part 1: Elizabeth had a Streptococcus mutans infection. Where did she contract this organism? A. She caught the infection from her dentist or the office staff. B. The dental tools used for her procedure were likely contaminated with the organism. C. It was already part of the normal flora of her mouth. D. She most likely acquired the infection through a tick bite. Part 2: Endocarditis is not typically associated with dental visits. What factors increased Elizabeth's risk of developing this infection? Choose one or more: A. Elizabeth had a prosthetic heart valve that made her more susceptible to infection. B. Elizabeth's valve prolapse increased the likelihood that pathogens can colonize the heart. C. Elizabeth already had an infection that she was taking antibiotics for, and that is what spread to her heart. D. Elizabeth was immunosuppressed. E. It is likely that Elizabeth is an IV drug user. Part 3: Endocarditis is usually classified as either acute or subacute. In this case Elizabeth has subacute endocarditis. Which of the following factors of her infection would classify it as subacute rather than acute? Choose one or more: A. Elizabeth's symptoms were vague (fatigue and intermittent fevers) and had been going on for several weeks. B. Elizabeth was immunosuppressed. C. The pathogen Streptococcus mutans is not particulary virulent and can live in the body without causing harm. D. Elizabeth's infection is caused by a bacterial pathogen rather than a viral or fungal pathogen.

Part 1: C. It was already part of the normal flora of her mouth. Part 2: B. Elizabeth's valve prolapse increased the likelihood that pathogens can colonize the heart. D. Elizabeth was immunosuppressed. Part 3: A. Elizabeth's symptoms were vague (fatigue and intermittent fevers) and had been going on for several weeks. C. The pathogen Streptococcus mutans is not particulary virulent and can live in the body without causing harm.

Homework #6: A Big Pain in a Little Ear Chloe is a 2-year-old generally healthy child who was brought to the clinic by her father. The child had a fever since the previous night, was irritable, and kept pulling on her left ear. Chloe also had a runny nose for the past 2 weeks. Her temperature was 38.5°C (101.3°F) at the clinic, and the physical exam showed a red and swollen ear, an erythematous (reddened) ear canal, and a bulging tympanic membrane. Chloe was diagnosed with acute otitis media and prescribed an antibiotic that she had to take for 7 days. Which of the following factors increases the likelihood a child will acquire an otitis media infection? Choose one: A. Attendance at a day-care facility B. A longer Eustachian tube C. Ear wax buildup D. Poor hygiene Part 2 (1 point)Feedback Rank the following three bacteria in order of their frequency of causing acute otitis media infections. Haemophilus influenzae, Moraxella catarrhailis, Streotococcus pneumoniae

Part1: A. Attendance at a day-care facility Part 2: 1. Streotococcus pneumoniae 2. Haemophilus influenzae 3.Moraxella catarrhailis

Quiz 3

Quiz 3

Ch 20: Bacterial Infections of the Respiratory Tract *Case History 20.4 The "Bull Neck"* Ramona, a 23-year-old Hispanic mother, brought her 3-year-old daughter into the emergency department. The child was lethargic, had a fever of 40°C (104°F), and was having trouble breathing. The mother explained that the family arrived in the United States from El Salvador the previous week. The attending physician noted an extreme swelling of the child's cervical lymph nodes, giving the girl a thick "bull neck" appearance. She also noticed the beginnings of a membranous growth at the back of the child's throat that was beginning to obstruct the trachea. It was grayish in color and bled when scraped. The distraught mother admitted that the child had mot received any vaccinations before arriving in New Mexico.

Suspecting the nature of the child's illness, the physician immediately admitted the child to the hospital and ordered administration of penicillin and a specific antitoxin. The culture results of a throat swab sent to the microbiology lab confirmed the physician's suspicion. The root of the child's disease was Corynebacterium diphtheriae, which causes diphtheria.

Iclicker #2: What is the primary method of treatment for diarrhea caused by a virus? a. rehydration therapy b. antibiotic therapy c. antitoxin therapy d. vitamins e. There is no effective therapy.

a. rehydration therapy

Iclicker #1: Which of the following bacterial infections causes an intoxication? a. listeriosis b. staphylococcal food poisoning c. salmonellosis d. Helicobacter pylori infection e. Streptococcus mutans

b. staphylococcal food poisoning

Homework #2: Which of the following images shows an example of lymphadenitis?

picture C: swelling of the lymph nodes

Homework #11: In the influenza virus, the process of RNA segment mixing produces what is called an antigenic ________________________ , which typically happens every 10 to 15 years.

shift

RQ#10: The individual in this picture was infected by Neisseria meningitidis. The larger spots seen are called A. papules. B. petechiae. C. purpura. D. hematomas.

C. purpura.

RQ #5: Hydrophobia is a diagnostic symptom of which disease? Choose one: A. polio B. West Nile C. rabies D. eastern equine encephalitis

C. rabies

Ch 20: The Ominous Cough *Scenario* It was the summer of 1918, and 20-year-old Floyd, a U.S. army private stationed in Kansas, began to feel ill. He visited the camp doctor complaining of a cough, a headache, and some chills. Within a day, Floyd's fever reached 40°C (104°F). He became incoherent and lost consciousness. When Floyd awoke, he found himself in a large barracks lying on a cot among a long line of cots filled with sick soldiers. *Signs and Symptoms* His cough was severe. Floyd saw dark, purplish brown spots appear on the face of the GI lying on the cot next to his. The soldier began to cough blood and eventually his face turned blue from lack of oxygen-a sign that death was imminent. Doctors could do little to help.

*Resolution* Fortunately, after about 2 weeks, Floyd started to improve. Many others were not so lucky and died. No one knew what caused the disease raging through the camp or how to stop it.

Reading Quiz #10: Candida causes which of the following non-sexually transmitted infections? Choose one: A. Fournier's gangrene B. herpes virus infection C. yeast infections D. bacterial vaginitis

C. yeast infections

*3.6 Case Study* A news paper report from Boston in the late 1990s described a growing fear among local residents. They were afraid to venture outdoors because of the increasing visibility of a particular infectious disease. The article reported that the number of peoplehiking in Massachusetts had recently decreased dramatically, and that many homeowners were erecting fences and spraying their yards wit pesticides. Many people who dared to venture outdoors wore white clothing and tucked their pants inside their socks. In New York, there were reports of residents simply paving over their lawns, and some people gave up gardening altogether. Although most prominent in the Northeast, similar behaviors were seen all over the country. In Montana, 10% of people surveyed felt they were at high risk for the disease, even though the Center for Disease Control and Prevention (CDC) said that the risk was very low in that state. 1. What infection disease do you suppose these cautious citizens were trying to avoid? 2.What determines which geographical region of the country carries risk of this disease for its inhabitants? 3. Another major disease in the United States is transmitted in a similar way. What is it, and what microorganism causes it? 4. Which regions of the country have a high incidence of this second tick - borne disease? 5. Which of these two dieases frequently has no skin manifestations at all?

1. Lyme disease 2. Transmitted thru deer ticks, based on deer and tic population 3. Rockey Mountain spotted fever, Rickettsia rickettsii 4. Appalachian mountains 5. lyme disease 50-75%

Homework #7: Whooping cough is a highly contagious illness that has an incubation period of 7 to 21 days, after which the disease progresses through three stages. Order these stages from beginning to end.

1.Catarrhal 2. Paroxysmal 3. Convalescent

Homework #8: A clinician will view a child's ear with an otoscope. Label the otoscopic view of a healthy tympanic membrane and an infected tympanic membrane. A. Infected tympanic membrane B. Healthy tympanic membrane

Match to pictures

Reading Quiz #5: Avoiding contact with contaminated cat feces during a pregnancy is important in preventing ________. Choose one: A. toxoplasmosis B. babesiosis C. leishmaniasis D. schistosomiasis

A. toxoplasmosis

5. Juan is being monitored by his physician for an infectious disease. As part of the monitoring process, periodic chest xrays are examined. The cavities seen in the lung tissue in this figure are due to A. tuberculosis. B. Diphtheria C. Bacterial pneumonia. D. Viral pneumonia.

A. tuberculosis.

Prions are known to cause all of the following EXCEPT: A. African sleeping sickness. B. Creutzfeldt-Jakob disease (CJD). C. scrapie. D. mad cow disease.

A. African sleeping sickness.

RQ#8: Prions are known to cause all of the following EXCEPT Choose one: A. African sleeping sickness. B. mad cow disease. C. scrapie. D. Creutzfeldt-Jakob disease (CJD).

A. African sleeping sickness.

Reading Quiz #15: A child with a violent paroxysmal cough has an impeded mucociliary escalator. If it were possible to look at tracheal epithelial cells in this child, you would see something similar to this image. The structures attached to the cilia are A. Bordetella cells. B. influenza viral particles. C. Staphylococcus cells. D. Streptococcus cells.

A. Bordetella cells.

Homework #3: Which of the following are true about characteristics associated with a Chlamydia infection? Choose one or more: A. Chlamydia species are Gram-negative, obligate intracellular bacteria. B. Chlamydial disease has three main stages of progression: primary, secondary, and tertiary. C. The reservoir for Chlamydia is the male urethra. D. Chlamydia is the major cause of nongonococcal urethritis.

A. Chlamydia species are Gram-negative, obligate intracellular bacteria. D. Chlamydia is the major cause of nongonococcal urethritis.

Homework #2: Which of the following bacterial infections can lead to pelvic inflammatory disease in women? Choose one or more: A. Chlamydia trachomatis B. Neisseria gonorrhoeae C. Haemophilus ducreyi D. Trichomonas vaginalis

A. Chlamydia trachomatis B. Neisseria gonorrhoeae D. Trichomonas vaginalis

_______ is the causative agent in 80% of UTIs. A. Escherichia coli B. Staphylococcus aureus C. Streptococcus mutans D. Streptococcus pyogenes

A. Escherichia coli

A pelvic examination of a 23-year old woman showed vesicles and ulcerated lesions on her labia. Cultures were negative for Neisseria and Chlamydia; the VDLR test was negative. What is most likely the cause? A. HSV B. genital warts C. HPV D. HIV

A. HSV

8. A 6-month-old girl who attends daycare develops a fever, chills, and respiratory wheezing. She is admitted to the local hospital where she is diagnosed with a type of pneumonia and treated with hydration, oxygen, and bronchodilators. Her parents are distraught and feel that they could have done more to prevent their daughter's illness. The physician assures them NO vaccine is currently available for her illness because the exact mechanism of the immune response has not yet been delineated. The girl is infected with ________. A. respiratory syncytial virus (RSV) B. rhinovirus C. Type A influenza D. Type B influenza

A. respiratory syncytial virus (RSV)

Reading Quiz #4: Robert, a middle-aged man living in Connecticut, decides to visit his physician because he has been experiencing general malaise and arthralgia in his large joints. Although he does not remember any tick bites or developing a "bull's-eye" rash, Robert's doctor feels he is experiencing a the second stage of the systemic bacterial disease known as________. Choose one: A. Lyme disease B. brucellosis C. tularemia D. bubonic plague

A. Lyme disease

Homework #9: Adults with a mumps infection have a 15% chance of developing which complication? Choose one: A. Meningitis B. Gastroenteritis C. Cirrhosis D. Hepatitis

A. Meningitis

Homework #3: The circulatory system includes two closed circuits. One system pumps blood out to the various tissues of the body. This blood is (A) __________ when it leaves the heart and (B) _________ when it returns. This circuit is called the (C) __________. The other circuit pumps (D) ________________ blood to the lungs and collects (E)____________________ blood back to the heart. This is called the (F) _________________.

A. oxygenated B. oxygen-depleted C. systemic circuit D. oxygen-depleted E. oxygenated F. pulmonary circuit

Hoemwork #1: One of the first and most common symptoms of the Epstein-Barr virus is (A) _______________________ because the virus initially infects (B) ______________.

A. Sore throat B. epithelial cells of the mouth and throat

Homework #1: Most cavities are caused by which of the following organisms of the human normal flora? A. Streptococcus mutans B. Candida albicans C. Aggregatibacter actinomycetemcomitans D. Staphylococcus epidermidis

A. Streptococcus mutans

Homework #7: The image above shows the areas of the world where malaria is prevalent. What makes the disease common in the red areas and rare in the tan areas? A. These regions are warmer and create an optimal breeding ground for the mosquito, which both serves as a host to the parasite and transmits it to humans. B. These areas show where water sanitation is poor, leading to easier transmission of the disease. C. The pathogen is very temperature sensitive and cannot survive in an environment where the climate is colder. D. There are genetic differences in the human populations of these regions of the world, making them more susceptible to the pathogen.

A. These regions are warmer and create an optimal breeding ground for the mosquito, which both serves as a host to the parasite and transmits it to humans.

Homework #8: What is the typical method used to prevent malaria outbreaks? A. Use insecticides and mosquito netting to prevent mosquito bites B. Make sure that people in problematic areas get antibiotics such as penicillin as soon as a mosquito bite is detected C. Require vaccinations prior to traveling to regions in which malaria is endemic D. Wear a mask during peak malaria season to prevent breathing aerosols that contain the pathogen

A. Use insecticides and mosquito netting to prevent mosquito bites

Reading Quiz #10: Which of the following bacterial diseases of the respiratory system can be prevented by vaccine? A. diphtheria B. Pseudomonas pneumonia C. pharyngitis D. bacterial sinusitis

A. diphtheria

Which of the following would be the most likely treatment for self-limiting gastrointestinal infections? A. hydration B. antivirals C. antibiotics D. proton-pump inhibitors

A. hydration

RQ#1: An infection in the CNS results in all of the following. Which occurs first? Choose one: A. inflammation of the meninges B. damage to the brain or spinal cord C. occlusion of the arachnoid villi D. an increase in CSF pressure

A. inflammation of the meninges

Homework #10: For many years, the primary way to diagnose malaria was to observe the pathogen in a blood smear. In which of the images below is the Plasmodium pathogen visible?

A: Plasmodium replicates inside red blood cells, so the images that do not include red blood cells or have the pathogen visible outside the red blood cells can be eliminated (the pathogens shown there are Rickettsia rickettsii and Trypanosoma cruzi, respectively). In malaria, the pathogen takes on a characteristic ring shape within the cells, rather than the Maltese cross shape that is characteristic of Babesia.

Reading Quiz #7: Whooping cough is caused by ________. A. Streptococcus pyogenes B. Bordetella pertussis C. Corynebacterium diphtheria D. Haemophilus influenza

B. Bordetella pertussis

RQ #11: A toxin that prevents the fusion of synaptic vesicles containing neurotransmitter with the terminal end of an axon in a motor neuron is produced by A. Listeria monocytogenes. B. Clostridium botulinum. C. Treponema pallidum. D. Escherichia coli.

B. Clostridium botulinum.

Robert, a middle-aged man living in Connecticut, decides to visit his physician because he has been experiencing general malaise and arthralgia in his large joints. Although he does not remember any tick bites or developing a "bull's-eye" rash, Robert's doctor feels he is experiencing a the second stage of the systemic bacterial disease known as ________. A. brucellosis B. Lyme disease C. bubonic plague D. tularemia

B. Lyme disease

Reading Quiz #6: Monique develops an acute staphylococcal infection in her skin after receiving scratches on her arms while removing brush from the woods behind her house. The red streak pictured on her arm indicates Choose one: A. pericarditis is occurring. B. lymphangitis is occurring. C. myocarditis is occurring. D. lymphadenopathy is occurring.

B. lymphangitis is occurring.

4. Which of the following structures is affected by acute otitis media? A. pharynx B. middle ear C. larynx D. alveoli

B. middle ear

Reading Quiz #1: Which of the following structures is affected by acute otitis media? A. alveoli B. middle ear C. larynx D. pharynx

B. middle ear

The bacteria that can cause the sequelae rheumatic fever and glomerulonephritis is ________. A. Moraxella catarrhalis B. Streptococcus pyogenes C. Streptococcus pneumoniae D. Corynebacterium diphtheriae

B. Streptococcus pyogenes

Reading Quiz #4: Why are humans susceptible to both avian and swine flu strains? A. The immune system in humans is unable to produce antibodies against either strain. B. The human respiratory tract contains cell membrane receptors that bind both strains. C. International travel puts humans in contact with flu strains in various environments. D. Humans often live in close proximity to domesticated birds and pigs.

B. The human respiratory tract contains cell membrane receptors that bind both strains.

3. Why is it easy for upper respiratory infections to spread into the middle ear? A. Lacrimal ducts lead from the nasal cavity to the middle ear. B. The middle ear is connected to the nasal cavity by the Eustachian tube. C. The immune system does not have access to the middle ear. D. The mucociliary escalator moves mucus into the middle ear.

B. The middle ear is connected to the nasal cavity by the Eustachian tube.

Reading Quiz #3: The disease known as the Black Death during the Middle Ages leads to the development of buboes in individuals bitten by infected fleas and is caused by the bacterium Choose one: A. Francisella tularensis. B. Yersinia pestis. C. Borrelia burgdorferi. D. Brucella abortus.

B. Yersinia pestis.

Reading Quiz #4: Symptomatic UTIs are commonly treated with Choose one: A. nothing;they are commonly not treated. B. antibiotics. C. liquids to flush the system. D. antifungal drugs.

B. antibiotics.

Reading Quiz #5: Genital warts are caused by Choose one: A. herpes simplex virus 1. B. human papillomavirus. C. human immunodeficiency virus. D. herpes simplex virus 2.

B. human papillomavirus.

Reading Quiz #9: A vaccine is available to prevent A. walking pneumonia. B. pneumococcal pneumonia. C. pharyngitis. D. acute otitis media.

B. pneumococcal pneumonia.

Botulism and tetanus are preventable diseases. How do we prevent botulism? A. vaccination B. properly cooking and canning food C. immunoglobulin therapy D. antibiotic treatment

B. properly cooking and canning food

RQ#7: Botulism and tetanus are preventable diseases. How do we prevent botulism? Choose one: A. vaccination B. properly cooking canned food C. immunoglobulin therapy D. antibiotic treatment

B. properly cooking canned food

iClicker #1: Which of the following sequelae can occur as a result of a streptococcal infection? A. formation of a pseudomembrane B. rheumatic fever C. encephalitis D. legionellosis E. whooping cough

B. rheumatic fever

Avoiding contact with contaminated cat feces during a pregnancy is important in preventing ________. A. babesiosis B. toxoplasmosis C. schistosomiasis D. leishmaniasis

B. toxoplasmosis

Reading Quiz #9: The treatment of HIV includes Choose one: A. antifungals. B. nothing; there are no treatment options. C. highly antiretroviral therapy. D. antibiotics.

C. highly antiretroviral therapy.

RQ #4: All of the following are reservoirs for rabies EXCEPT ____________. Choose one: A. fox B. dog C. people D. bat

C. people

7. The bacteria that can cause the sequelae rheumatic fever and glomerulonephritis is ________. A. Corynebacterium diphtheriae B. Moraxella catarrhalis C. Streptococcus pyogenes D. Streptococcus pneumoniae

C. Streptococcus pyogenes

Homework #3: The image above shows a symptom that is associated with the infection of what component of the digestive system? A. The stomach B. The pancreas C. The liver D. The intestines

C. The liver

Reading Quiz #2: Why is it easy for upper respiratory infections to spread into the middle ear? Choose one: A. The immune system does not have access to the middle ear. B. The mucociliary escalator moves mucus into the middle ear. C. The middle ear is connected to the nasal cavity by the Eustachian tube. D. Lacrimal ducts lead from the nasal cavity to the middle ear.

C. The middle ear is connected to the nasal cavity by the Eustachian tube.

Homework #8: What is the typical reason that a person would develop Clostridium difficile colitis? A. The person was eating food that had been contaminated with human feces. B. The person was eating food that had been contaminated with animal feces. C. The person was taking a high dose of broad-spectrum antibiotics. D. The person was drinking unfiltered brackish water.

C. The person was taking a high dose of broad-spectrum antibiotics.

Syphilis is caused by A. Not washing hands B. Neisseria C. Treponema pallidum D. Heamophilus ducreyi

C. Treponema pallidum

Reading Quiz #8: In males, primary syphilis presents as Choose one: A. nothing; primary syphilis is not detectable. B. a macular rash on the skin. C. a chancre on the penis D. a gumma on the face.

C. a chancre on the penis

Reading Quiz #2: An infection in the kidney would be considered what kind of infection? Choose one: A. a lower urinary tract infection B. sepsis C. an upper urinary tract infection D. cystitis

C. an upper urinary tract infection

Reading Quiz #3: A common result of lower urinary tract infections is __________. Choose one: A. sepsis B. back pain C. cystitis D. fever

C. cystitis

1. A child who has not received any childhood vaccinations is taken to the emergency room with lethargy, a temperature of 40°C, and difficulty breathing. The attending physician notes a grayish membrane partially obstructing the child's trachea and a characteristic "bull neck", similar to the neck seen in this photograph. The most likely diagnosis is A. whooping cough. B. scarlet fever. C. diphtheria. D. strep throat.

C. diphtheria.

Reading Quiz #14: A child who has not received any childhood vaccinations is taken to the emergency room with lethargy, a temperature of 40oC, and difficulty breathing. The attending physician notes a grayish membrane partially obstructing the child's trachea and a characteristic "bull neck," similar to the neck seen in this photograph. The most likely diagnosis is A. strep throat. B. whooping cough. C. diphtheria. D. scarlet fever.

C. diphtheria.

Ch 20: Bacterial Infections of the Respiratory Tract *Case History 20.3 The Contagious Football Player with GAS* Dallin, a 16-year-old high school athlete, came to the clinic complaining of sore throat. He did not have a cough or any cold or flu symptoms. His cervical nodes (lymph nodes in the neck) were enlarged and tender to palpation, there was an exudate visible on his tonsils and pharynx (pharyngotonsilar region) and his temperature was 39.8°C (103.6°F). The physician assistant (PA) told Dallin that he probably had a strep throat but she could not perform a rapid strep test to confirm because they had run out of the strips.

Case History 20.3 The Contagious Football Player with GAS The PA then swabbed the back of Dallin's throat and sent the sample to the lab for culture and antibiotic sensitivity testing. Dallin was given an antibiotic empirically (based on clinical experience and in the absence of definitive diagnosis). He was told that he was contagious and should rest and avoid contact with others until better. He followed the recommendations, recovered, and was back playing football in a few days. The lab isolated Streptococcus pyogenes, also called group A streptococcus (GAS), from Dallin's pharyngeal swab, confirming the diagnosis.

Which of the following is used in the treatment or prevention of diphtheria? A. Antibiotics B. Vaccination C. Antitoxin D. All of the above

D. All of the above

Homework #2: If you were looking in an adult patient's mouth and saw the infection shown in the image above, what health concern might you conclude your patient had? A. Plaque B. Tooth decay C. Gingivitis D. An impaired immune system

D. An impaired immune system

Homework #10: Which of the following is a characteristic of Yersinia species that increases the likelihood that they can cause infection? A. Yersinia species are halophiles (they can live in salty environments like ocean water). B. Yersinia species are not sensitive to pH, so stomach acid cannot kill it. C. Yersinia species can get inside cells, so the immune system cannot eliminate it. D. Yersinia species can grow in the refrigerator (they can grow at a temperature that would block the growth of most intestinal pathogens).

D. Yersinia species can grow in the refrigerator (they can grow at a temperature that would block the growth of most intestinal pathogens).

In which of the following ways are Epstein-Barr virus (EBV) and cytomegalovirus (CMV) similar? A. Both are considered part of the TORCH complex. B. Both are known causes of endemic Burkitt's lymphoma. C. Both are capable of crossing the placenta from an infected mother to her fetus. D. Both are capable of causing latent infections.

D. Both are capable of causing latent infections.

Reading Quiz #1: In which of the following ways are Epstein-Barr virus (EBV) and cytomegalovirus (CMV) similar? A. Both are known causes of endemic Burkitt's lymphoma. B. Both are considered part of the TORCH complex. C. Both are capable of crossing the placenta from an infected mother to her fetus. D. Both are capable of causing latent infections.

D. Both are capable of causing latent infections.

Reading Quiz #2: What is the significance of cytomegalovirus (CMV) crossing the placenta from mother to fetus? Choose one: A. The fetus will begin making antibodies against CMV and will be protected after birth. B. CMV infection of a fetus may lead to a high birth weight, resulting in complications during delivery. C. CMV transmitted through a placenta frequently cause pericarditis and myocarditis in newborns. D. CMV is associated with complications, including hearing loss and mental retardation.

D. CMV is associated with complications, including hearing loss and mental retardation.

Homework #4: The gastrointestinal tract is a warm, safe environment full of nutrients and is ideal for many types of microbes. Why would an organism capable of colonizing the intestine produce toxins that would lead to diarrhea, increasing the likelihood that it would be washed out of its habitat? A. There is no advantage to the pathogen. Diarrhea is completely due to the immune system trying to remove the pathogen, not caused by actions of the pathogen. B. Causing illness in the host makes it easier to get nutrients from the host's body. C. Causing illness in the host decreases the likelihood that the host immune system will find or destroy the pathogen. D. Diarrhea increases the dissemination of the organism into the environment, where it can encounter new hosts.

D. Diarrhea increases the dissemination of the organism into the environment, where it can encounter new hosts.

In males, primary syphilis presents as A. nothing; primary syphilis is not detectable. B. a macular rash on the skin. C. a gumma on the face. D. a chancre on the penis.

D. a chancre on the penis.

Homework #3: Cold viruses can easily spread from person to person by contact or by inhaling aerosols. In the following list, which is the only effective preventive measure against spreading a cold? A. Drinking plenty of water B. Taking antibiotics C. Consuming vitamin C D. Frequent hand washing

D. Frequent hand washing

Homework #6: This image shows bacteria in a prosthetic heart valve leading to prosthetic valve endocarditis. How was this infection most likely acquired? A. From a dental visit that introduced oral flora into the blood B. From an insect bite C. From food that the patient ingested D. From the surgical procedure to install the valve

D. From the surgical procedure to install the valve

RQ #6: A 67-year-old male patient presents with diarrhea and a fever that has progressed into a persistent headache and stiff neck. He reports eating some unpasteurized soft cheese 24 hours ago. Which of the following organisms is most likely the etiological agent? Choose one: A. N. meningitidis B. botulinum toxin C. tetanus toxin D. L. monocytogenes

D. L. monocytogenes

A 67-year old male patient presents with diarrhea and a fever that has progressed into a persistent headache and stiff neck. He reports eating some unpasteurized soft cheese 24 hours ago. Which of the following organisms is most likely the etiological agent? A. Botulism toxin B. Neisseria meningitidis C. Tetanus toxin D. Listeria monocytogenes

D. Listeria monocytogenes

Reading Quiz 14: A young woman experiencing yellow vaginal discharge is examined for sexually transmitted infections. As part of the screening process, an intracellular bacterium is found within PMNs, as this image shows. The bacterium shown is A. Chlamydia trachomatis. B. Haemophilus ducreyi. C. Treponema pallidum. D. Neisseria gonorrhoeae.

D. Neisseria gonorrhoeae.

hmwk #2: Which of the following can be done to prevent tetanus? Choose one: A. Properly cook and can food to prevent the spread of toxins B. Treat with antiviral medication (ribavirin) to prevent the spread of the toxin C. Treat the infection with antibiotics to eliminate the toxin D. Receive inoculations of tetanus booster every 10 years

D. Receive inoculations of tetanus booster every 10 years

Homework #1: Which of the following viruses presents as a common cold in adults (runny and congested nose, sore throat), but in young children presents with more serious symptoms and can lead to heart failure, low blood pressure, and seizures? A. Severe acute respiratory syndrome (SARS) B. Croup C. Influenza D. Respiratory syncytial virus (RSV)

D. Respiratory syncytial virus (RSV)

The disease known as the Black Death during the Middle Ages leads to the development of buboes in individuals bitten by infected fleas and is caused by the bacterium A. Brucella abortis. B. Franscisella tularensis. C. Borrelia burgdorferi. D. Yersinia pestis.

D. Yersinia pestis.

________ is noticed as a white cottage-cheese-like covering in the mouth. A. Gingivitis B. Periodontal disease C. Dental caries D. Thrush

D. Thrush

hmwk #3: Which of the following protozoan infections is extremely dangerous for pregnant women and is associated with handling cats, especially cat feces? Choose one: A. Trypanosoma brucei B. Naegleria fowleri C. Acanthamoeba D. Toxoplasma gondii

D. Toxoplasma gondii

Reading Quiz #3: Which of the following would you expect to result in an influenza pandemic? A. antigenic shift within a type C influenza virus B. antigenic shift within a type B influenza virus C. antigenic drift within a type B influenza virus D. antigenic shift within a type A influenza virus

D. antigenic shift within a type A influenza virus

Iclicker #2: Recurrent urinary tract infections are problematic for some women. Which of the following is not a risk factor for recurrent infections? A. being sexually active B. incomplete emptying of the bladder C. use of spermicide D. long-term antibiotic use E. none of the above

D. long-term antibiotic use

Infection with _______________ causes swollen parotid glands. A. dapovirus B. norovirus C. rotavirus D. mumps virus

D. mumps virus

The term that refers to a rash made of pin-point hemorrhages under the skin is A. Septicemia B. Lymphangitis C. Ischemia D. petichia

D. petichia

Hydrophobia is a diagnostic symptom of which disease? A. eastern equine encephalitis B. polio C. West Nile D. rabies

D. rabies

RQ #9: The bullet-shaped virus seen here is responsible for a zoonotic disease capable of infecting any mammal. This virus is A. coxsackievirus. B. West Nile virus. C. echovirus. D. rabies virus.

D. rabies virus.

Reading Quiz #1: Women are more prone to urinary tract infection than men are for all of the following reasons EXCEPT Choose one: A. sexual intercourse. B. hormonal changes. C. the proximity of the urethra to the anus. D. the length of the urethra, which is longer than in men.

D. the length of the urethra, which is longer than in men.

Ch 20: Bacterial Infections of the Respiratory Tract *Case History 20.2 A Big Pain in a Little Ear* Chloe is a 2-year-old generally healthy child who was brought to the clinic by her father. The child had a fever since the previous night, was irritable, and kept pulling on her left ear. Chloe also had a runny nose for the past 2 weeks. Her temperature was 38.5°C (101.3°F) at the clinic and the physical exam showed a red and swollen ear, an erythematous (reddened) ear canal, and a bulging tympanic membrane. Chloe was diagnosed with acute otitis media and prescribed an antibiotic that she had to take for 7 days.

Disease: Ear infections Otitis externa, Otitis media (OME) Causative agent: (OM)-Streptococcus pneumoniae, S. pyogenes, Haemophilus influenzae, Moraxella catarrhalis, various anaerobes cause chronic infection //(OE)-Staphylococcus aureus, Pseudomonas aeruginosa (swimmer's ear) or a fungus -Bacteria Organ/System: middle ear (otitis media), external ear (otitis externa) Symptoms: otitis media: pus-like exudate (otitis media with effusion-OME), fever, ear ache, some asymptomatic //otitis externa: pain, itching Method of Transmission: OM-passage of organisms from pharynx via Eustachian tube, more common in children due to anatomy of Eustachian tube //OE- swimming, constant wet ears, chlorine alters pH, removal of protective skin and wax with cotton swabs Treatment: OM-antibiotics, tubes //OE-keep ears dry, antibiotic drops

Homework #4: Jamie, a 20-year-old college student from New Mexico, was in the clinic complaining of a "growth" around her "private area." She said she had no other symptoms and denied any itching or discomfort in the affected area. Her medical history was benign. She said she likes to drink a lot and admitted to having unprotected sex with multiple partners. Physical examination showed warts near the vaginal introitus (vaginal opening) but no edema (swelling) or erythema (reddening). The doctor diagnosed genital warts and discussed different treatment options, including cryotherapy, which freezes the warts. Jamie was shocked but picked cryotherapy anyway, even though the procedure had to be repeated every 1 to 2 weeks. Her warts disappeared after the third session, but she was told to come back to the clinic every 3 months for 1 year to check for recurrence. She followed up as directed and was lucky enough to be free of any recurrence at 1 year and later. Part 1: Condylomata acuminata, commonly called genital warts, is caused by Choose one: A. Human immunodeficiency virus B. Gonorrhea C. Human papilloma virus (HPV) D. Chlamydia Part 2: Several treatment methods are available for genital warts, including which of the following? Choose one or more: A. Surgical methods B. Antibiotics C. Topical medications D. Cryotherapy Part 3: Infants born vaginally to mothers infected with HPV are likely to experience which of the following? Choose one: A. Blindness B. Recurrent skin irritation C. Genital warts D. Laryngeal or respiratory infections

Part 1: C. Human papilloma virus (HPV) Part 2: A. Surgical methods C. Topical medications D. Cryotherapy Part 3: D. Laryngeal or respiratory infections

Homework #5: Odonna, a pregnant 18-year-old woman, came to the Nassau County, New York, urgent-care clinic with a low-grade fever, malaise, and headache. She was sent home with a diagnosis of influenza. She again sought treatment 7 days later after she discovered a macular rash (flat, red) developing on her trunk, arms, palms of her hands, and soles of her feet. She thought maybe she was allergic to the new soap she was using, but the rash was not itchy or painful. Further questioning of the patient revealed that 1 year ago, she had a painless ulcer on her vagina that healed spontaneously. She was diagnosed with secondary syphilis, a stage of the disease that can mimic many other conditions. She was given a single intramuscular injection of penicillin and told that her sexual partners had to be treated as well. Part 1: Place the signs of syphilis in the order that they present. Gummas, A rash on the palms of hands and soles of feet, Painless ulcer Part 2: Which of the following organisms is responsible for the syphilis infection? Choose one: A. Neisseria gonorrhoeae B. Gardnerella vaginalis C. Haemophilus ducreyi D. Treponema pallidum Part 3: Which of the following complications may a pregnant woman expect after a secondary syphilis diagnosis if she does not receive proper treatment? Choose one or more: A. The pregnancy may end in miscarriage or stillbirth, or the baby may be born with severe neurologic problems. B. The baby may have perforated palates in the mouth. C. At birth, infected newborns may have notched teeth visible on X-ray. D. There is a very low chance that the baby will be infected with syphilis.

Part 1: Painless Ulcer, A rash on the palms of hands and soles of feet, Gummas Part 2: D. Treponema pallidum Part 3: A. The pregnancy may end in miscarriage or stillbirth, or the baby may be born with severe neurologic problems. B. The baby may have perforated palates in the mouth. C. At birth, infected newborns may have notched teeth visible on X-ray.

Quiz 4

Quiz 4

Homework #7: Gary, a 34-year-old accountant who immigrated to Nebraska from Poland 7 years ago, has, since his teenage years, been bothered periodically by episodes of epigastric pain (pain around the stomach), nausea, and heartburn, especially after he ate certain foods. Gary was told to avoid those foods and take antacids as needed. Antacids usually alleviated the symptoms. Over the years, he received several courses of treatment with cimetidine (Tagamet) or famotidine (Pepcid) to reduce acid secretion and provide relief. Recently, the physician ordered an upper-GI endoscopy, in which a long, thin tube tipped with a camera and light source was inserted into Gary's mouth and into his stomach. The view through the endoscope showed some reddened areas in the antrum (bottom part) of the stomach. The endoscope was also equipped with a small clawlike structure that obtained a small tissue sample (biopsy) from the lining of Gary's stomach. A urease test performed on the antral biopsy turned positive in 20 minutes. Histological examination of the biopsy confirmed moderate chronic active gastritis (inflammation of the stomach lining) and revealed the presence of numerous spiral-shaped organisms. Cultures of the antral biopsy were positive for the bacterium Helicobacter pylori. Part 1: When using the endoscope, the doctor saw red areas at the bottom of the stomach. Why was this area red? Choose one: A. The color was due to the neutralization of the acid in that area. B. The redness was due to the bacterial enzyme urease. C. The redness was due to inflammation of the tissue. D. Red is the natural color of the stomach lining. Part 2: Why would antacids provide (temporary) relief from the symptoms caused by a bacterial infection? Choose one: A. The antacids were blocking the growth of the bacteria and slowing the spread of the infection. B. The infection was inhibiting the stomach's ability to protect itself from the acid environment, so reducing the acid temporarily relieved the pain. C. The antacids were neutralizing the bacterial toxins that were damaging the lining of the stomach. D. The antacids were a placebo that had no real effect on what was happening in the stomach. Part 3: The first test done on the tissue biopsy sample was a urease test. Why would Helicobacter pylori need urease? Choose one: A. The enzyme digests the membrane of epithelial cells to provide nutrients for the bacteria. B. The enzyme degrades the stomach lining, and as a result the organism causes painful ulcers. C. The products created by this enzyme are alkaline and help the organism neutralize the stomach acid. D. The enzyme blocks the white blood cells of the immune system from finding the pathogen.

Part 1: C. The redness was due to inflammation of the tissue. Part 2: B. The infection was inhibiting the stomach's ability to protect itself from the acid environment, so reducing the acid temporarily relieved the pain. Part 3: C. The products created by this enzyme are alkaline and help the organism neutralize the stomach acid.

Ch 20: Bacterial Infections of the Respiratory Tract *Case History 20.5 Night Sweats in a Nursing Home* In March, James, an 80-year-old resident of a New Jersey nursing home, had a fever accompanied by a productive cough with brown sputum. James reported to the attending physician that he was short of breath, had pain on the right side of his chest, and suffered from night sweats. Blood tests revealed that his white blood cell (WBC) count was 14,000/µl (normal value 4,500-10,000), composed of 77% segmented forms (polymorphonuclear leukocytes, PMNs; normal value 40-60%) and 20% bands (immature PMNs; normal value 0-3%).

The chest radiograph revealed a right upper lobe infiltrate. From this information, the clinician made a diagnosis of pneumonia. Microscopic examination of the patient's sputum revealed Gram-positive cocci surrounded by a capsule in pairs and short chains. Bacteriological culture of his sputum and blood yielded Streptococcus pneumoniae.

Iclicker #2: Which of the following CNS infections can be foodborne? a. tetanus b. listeriosis c. rabies d. meningococcal meningitis e. Candida meningitis

b. listeriosis

Iclicker #4: For which of the following CNS diseases is a vaccine not available? a. meningococcal meningitis b. listeriosis c. tetanus d. poliomyelitis e. none of the above

b. listeriosis