Microbiology: An Introduction, 13e (Tortora et al.)
Chapter 23 Microbial Diseases of the Cardiovascular and Lymphatic Systems
23.1 Multiple-Choice Questions
1) Which of the following statements about sepsis is FALSE?
A) Symptoms include fever and decreased blood pressure.
B) Lymphangitis may occur.
C) It most always is self-limiting
D) It usually is caused by gram-positive bacteria.
E) It may be aggravated by antibiotics.
2) Which of the following pairs is mismatched?
A) subacute bacterial endocarditis – alpha-hemolytic streptococci
B) acute bacterial endocarditis – Staphylococcus aureus
C) rheumatic fever– Streptococcus pyogenes
D) puerperal sepsis – Staphylococcus aureus
E) Burkitt’s lymphoma – Epstein-Barr virus
3) Which of the following is NOT a recognized form of anthrax?
A) cutaneous
B) inhalationial
C) septic
D) gastrointestinal
E) None of the answers are correct; all of these are recognized forms of anthrax.
4) Which of the following is NOT typically treated with penicillin?
A) serious wounds at risk for gas gangrene
B) tularemia
C) patients at risk for rheumatic fever
D) puerperal sepsis
E) rat-bite fever
5) Which of the following statements about tularemia is FALSE?
A) It is caused by Francisella tularensis.
B) The most common reservoir is rabbits.
C) It may be transmitted by arthropods.
D) It may be transmitted by direct contact.
E) It occurs only in California.
6) Which of the following is a symptom of brucellosis?
A) gastroenteritis
B) relapsing fever
C) undulant fever
D) pneumonia
E) jaundice
7) Which of the following is NOT transmitted in raw milk?
A) toxoplasmosis
B) anthrax
C) brucellosis
D) listeriosis
E) All of these can be transmitted in raw milk.
8) Which of the following is NOT a characteristic of Bacillus anthracis?
A) is aerobic
B) is gram-positive
C) forms endospores
D) found in soil
E) produces endotoxins
9) The symptoms of gas gangrene are due to all of the following EXCEPT
A) microbial fermentation.
B) necrotizing exotoxins.
C) proteolytic enzymes.
D) hyaluronidase.
E) endocarditis
10) Which of the following is NOT a bacterial pathogen transmitted by the bite of an animal?
A) Pasteurella multocida
B) Streptobacillus
C) Bartonella henselae
D) Plasmodium vivax
E) None of the answers is correct; all of these bacterial infections can be transmitted by dog or
cat bites.
11) Which of the following pairs is mismatched?
A) malaria – Anopheles (mosquito)
B) dengue – Aedes (mosquito)
C) epidemic typhus – Pediculus (louse)
D) Rocky Mountain spotted fever – Dermacentor (tick)
E) encephalitis – Ixodes (tick)
12) Unsanitary and crowded conditions increase the incidence of all of the following diseases
EXCEPT
A) plague.
B) epidemic typhus.
C) endemic murine typhus.
D) Rocky Mountain spotted fever.
E) relapsing fever.
13) Which of the following statements about toxoplasmosis is FALSE?
A) It is caused by a protozoan.
B) The reservoir is cats.
C) It is transmitted by the gastrointestinal route.
D) It typically is a severe illness in adults.
E) It can be congenital.
14) Which of the following pairs does NOT apply to Chagas’ disease?
A) causative agent – Trypanosoma cruzi
B) vector – kissing bug
C) reservoir – rodents
D) diagnosis of acute phase – serological tests for antibodies
E) treatment – nifurtimox
15) Which of the following is NOT caused by a bacterium?
A) epidemic typhus
B) tickborne typhus
C) malaria
D) plague
E) relapsing fever
16) Which is NOT considered a potential agent of bioterrorism?
A) Brucella melitensis
B) Anaplasma phagocytophilium
C) Franciella tularensis
D) Bacillus anthracis
E) All of these agents are potential bioterrorism agents.
17) Which of the following statements about puerperal sepsis is FALSE?
A) It is transmitted from mother to fetus.
B) It is caused by health care personnel.
C) It begins as a focal infection.
D) It is a complication of abortion or childbirth.
E) Its frequency of occurrence has decreased because of antibiotics and aseptic techniques.
18) Which of the following statements about schistosomiasis is FALSE?
A) The cercariae penetrate human skin.
B) The symptoms are caused by immune reactions to the eggs shed in the human host.
C) The intermediate host is an aquatic snail.
D) It is caused by a roundworm.
E) The female lives in a groove that runs down the body of the male.
19) Which of the following statements about rheumatic fever is FALSE?
A) It is a complication of a group A beta-hemolytic streptococcal infection.
B) It is an inflammation of the heart.
C) It is an inflammation of the joints.
D) Once resolved, a patient rarely experiences a reoccurrence.
E) The incidence has declined in the last ten years.
20) Which of the following pairs is mismatched?
A) Rickettsia – intracellular parasite
B) Brucella – gram-negative aerobic rods
C) Francisella – gram-positive facultatively anaerobic pleomorphic bacillus
D) Bacillus – gram-positive endospore-forming rods
E) None of the pairs is mismatched.
21) Which of the following can be transmitted from an infected mother to her fetus across the
placenta?
A) Borrelia
B) cytomegalovirus
C) Spirillum
D) anthrax
E) Yersinia
22) Which of the following pairs is mismatched?
A) Borrelia – relapsing fever
B) Yersinia – plague
C) Streptobacillus – rat-bite fever
D) Pasteurella – cat-scratch disease
E) Rickettsia- typhus.
23) A patient returning from an extended trip into Mexico has an ulcerating papule at the site of a
previous bug bite. Microscopic examination of the papule reveals nucleated amastigotes in white
blood cells. The patient most likely has
A) anthrax.
B) brucellosis.
C) leishmaniasis.
D) malaria.
E) schistosomiasis.
24) Human-to-human transmission of plague is usually by
A) rat flea.
B) dog flea.
C) the respiratory route.
D) wounds.
E) unsanitary conditions.
25) A characteristic symptom of plague is
A) small red spots on the skin.
B) swollen lymph nodes.
C) rose-colored spots.
D) recurrent fever.
E) nausea and vomiting.
26) Which of the following pairs regarding the epidemiology of malaria is mismatched?
A) vector – Ixodes
B) etiology – Plasmodium
C) enter liver cells – sporozoites
D) diagnosis – presence of merozoites
E) treatment – chloroquine when possible
27) A predisposing factor for infection by Clostridium perfringens is
A) gangrene.
B) burns.
C) debridement.
D) hyperbaric treatment.
E) an infected finger.
28) Which of the following is NOT a zoonosis?
A) puerperal sepsis
B) Hantavirus infection
C) anthrax
D) brucellosis
E) tularemia
29) Arthropods can serve as a reservoir for all of the following diseases EXCEPT
A) plague.
B) brucellosis.
C) epidemic typhus.
D) yellow fever.
E) malaria.
30) Which of the following pairs is mismatched?
A) cat-scratch disease – malignant pustule developing into septicemia
B) brucellosis – a temperature of 40°C each evening
C) tularemia – a localized infection appearing as a small ulcer
D) Borrelia – rash and flulike
E) toxoplasmosis – congenital brain damage
31) Which of the following CANNOT be transmitted to humans from domestic cats?
A) toxoplasmosis
B) plague
C) Chagas’ disease
D) Bartonella
E) None of the answers is correct; all of these diseases can be transmitted to humans from
domestic cats.
32) Which of the following is the same for both relapsing fever and undulant fever?
A) rising and falling body temperature
B) mode of transmission
C) presence of rash
D) rodent reservoir
E) treatment with tetracycline
33) Which of the following is NOT treated with antibiotics?
A) plague
B) tularemia
C) Lyme disease
D) Ebola
E) anthrax
34) Which of the following produces a permanent carrier state following infection?
A) Borrelia
B) cytomegalovirus
C) Spirillum
D) Toxoplasma
E) Yersinia
35) Epstein-Barr virus has been implicated in all of the following EXCEPT
A) endocarditis.
B) infectious mononucleosis.
C) Burkitt’s lymphoma.
D) nasopharyngeal carcinoma.
E) Hodgkin’s disease.
36) Which of the following leads to all the others?
A) subcutaneous hemorrhaging
B) presence of antirickettsial antibodies
C) blockage of capillaries
D) bacterial growth in endothelial cells
E) breakage of capillaries
37) A patient complains of fever, severe muscle and joint pain, and a rash. The patient reports
returning from a Caribbean vacation one week ago. Which of the following do you suspect?
A) Lassa fever
B) dengue
C) Hantavirus hemorrhagic fever
D) typhus
E) yellow fever
38) Which of the following pairs is NOT correctly matched for Gram reaction?
A) Lyme disease – gram-negative
B) tularemia – gram-negative
C) anthrax – gram-positive
D) Rocky Mountain spotted fever – gram-negative
E) Ehrlichia – gram-positive
39) Scrapings from a patient’s rash reveal cercariae. The disease is most likely
A) Lyme disease.
B) Rocky Mountain spotted fever.
C) relapsing fever.
D) swimmer’s itch.
E) Chagas’ disease.
40) You advise your pregnant friend to not adopt a new kitten from her neighbor because she
could contract
A) plague.
B) Burkitt’s Lymphoma.
C) toxoplasmosis.
D) listeriosis.
E) infectious mononucleosis.
41) Which of the following is evidence that the arthritis afflicting children in Lyme, Connecticut,
was due to bacterial infection?
A) treatable with penicillin
B) not contagious
C) accompanied by a rash
D) affected mostly children
E) transmitted by ticks
42) Which of the following is NOT controlled by a mosquito eradication program?
A) chikungunya fever
B) yellow fever
C) dengue fever
D) schistosomiasis
E) malaria
43) A 62-year-old man was hospitalized with an eight-day history of fever, chills, sweats, and
vomiting. His temperature on admission was 40°C (104°F). A routine peripheral blood smear
revealed ring-shaped bodies in the RBCs. What treatment would you prescribe?
A) hyperbaric oxygen
B) mefloquine
C) no treatment
D) penicillin
E) streptomycin
44) Which of the following statements about group B streptococci is FALSE?
A) They are present in healthy carriers.
B) They cause gram-positive sepsis.
C) They cause strep throat.
D) They cause neonatal sepsis.
E) They are classified as Streptococcus agalactiae.
45) Brucella bacteria are considered a potential agent of bioterrorism because
A) they are not susceptible to antibiotics.
B) they easily become airborne.
C) infection causes a fever.
D) they are endospore-forming bacteria.
E) they cause ulcerating lesions of the skin.
46) What is NOT true about gram-negative sepsis?
A) The progression to lethal stages is rapid.
B) The rapid progression is almost impossible to treat effectively.
C) Potent exotoxins cause shock.
D) LPS is released upon death of the cells.
E) The site of infection itself may not be the bloodstream.
47) Which is NOT true regarding Rocky Mountain spotted fever?
A) It is also known as tick-borne typhus.
B) It is caused by Rickettsia rickettsii.
C) It is most common in the Rocky Mountain region.
D) The organism passes from one generation of Dermacentor to the next.
E) The macular rash is sometimes mistaken for measles.
48) Yellow fever
A) is transmitted by Anopheles mosquitoes.
B) has a mortality rate of 5%.
C) was eradicated from the U.S. in the early 1900s.
D) cannot be transmitted human to human.
E) has an effective component vaccine available.
49) Which set of pairs is mismatched?
A) Dengue – Aedes aegypti
B) Chikungunya – Anopheles
C) Yellow fever – Aedes aegypti
D) Trypanosoma cruzi – Reduviid bug
E) Marburg virus -African monkeys
50) Which is NOT true concerning Babesiosis?
A) It is a tickborne disease.
B) It has rodent reservoirs.
C) It is caused by an obligate intracellular bacterium.
D) It is sometimes mistaken for malaria.
E) The parasite can be found within red blood cells in patient samples.
23.2 True/False Questions
1) All lymph that returns to the heart must pass through at least one lymph node.
2) HHV-1 is clearly associated with Burkitt’s lymphoma via empirical evidence and scientific
research.
3) Pathogens must be blood-borne in order to initiate sepsis.
4) Neonatal sepsis is most commonly caused by group A streptococci.
5) Subacute bacterial endocarditis is commonly the result of infections initially focused on the
oral cavity.
6) Rodent urine is the source of the Lassa virus.
7) Netting modified for sandflies should also be useful in preventing malaria.
8) Tularemia is considered to be a potential bioterrorism agent due its high infective dose.
9) All forms of typhus are associated with arthropod vectors.
10) The most likely primary site of replication during mononucleosis is the B lymphocyte.
23.3 Essay Questions
1) Humans are not the normal hosts for Ixodes and Xenopsylla. How, then, do humans contract
Lyme disease and plague?
2) On June 1, a 32-year-old hiker was bitten by a tick. After one week, he noticed an
erythematous ring at the location of the bite. Four weeks later, a physician found a large,
macular, centrifugally spreading ring. During the next month, it expanded to 35 cm and faded.
Over the next 2.5 years, the man experienced recurrent inflammation of a knee. Identify the
periods of incubation, prodromal, illness, and decline. What is the etiology? What caused the
symptoms? What treatment should have been administered in July? What treatment should be
administered two years later?
3) Worldwide, which disease is the most serious public health threat: malaria, Chagas’ disease, or
brucellosis? Explain why, and provide a plan to reduce the incidence of the disease.
4) Yellow fever and chikungunya fever are not currently endemic in the United States. Is it
possible that they could become established in the future? What factors would play a role? Be
sure to include a comparison of the causative agents and vectors in your answer.
5) Compare and contrast the diseases plague, Lyme disease, and Rocky Mountain spotted fever.
Include the causative agents, vectors, reservoirs, symptoms and treatments in your answer.