230 Part Iii Immunologic Manifestations Of Infectious Diseases.docx

230 PART III Immunologic Manifestations of Infectious Diseases REVIEW QUESTIONS 1. S. pyogenes is the most common causative agent of all the following disorders and complications except: a. Pharyngitis b. Gastroenteritis c. Scarlet fever d. Impetigo 2. All the following characteristics are descriptive of M protein except: a. No known biological role b. Found in association with the hyaluronic capsule c. Inhibits phagocytosis d. Antibody against M protein provides type-specific immunity 3. Substances produced by S. pyogenes include all the following except: a. Hyaluronidase b. DNAses (A, B, C, D) c. Erythrogenic toxin d. Interferon 4. Laboratory diagnosis of S. pyogenes can be made by all the following except: a. Culturing of throat or nasal specimens b. Febrile agglutinins c. ASO procedure d. Anti–DNase B 5. False ASO results may be caused by all the following except: a. Room temperature reagents and specimens at the time of testing b. The presence of beta-lipoprotein c. Bacterial contamination of the serum specimen d. Oxidation of ASO reagent caused by shaking or aeration of the reagent vial 6. Members of the S. pyogenes species are almost always _____ hemolytic. a. Alphab. Betac. gammad. Alpha- or beta7. Long-term complications of S. pyogenes infection can include: a. Acute rheumatic fever b. Poststreptococcal glomerulonephritis c. Rheumatoid arthritis d. Both a and b 8. Particularly virulent serotypes of S. pyogenes produce proteolytic enzymes that cause __________________ in a wound or lesion on an extremity. a. Necrotizing fasciitis b. Bone degeneration c. Burning and itching d. Severe inflammation 9-11. Match the substances produced by group A streptococci with the appropriate description. 9. ____ Hyaluronidase

10. ____ Streptokinase 11. ____ Erythrogenic toxin a. Degrades DNA b. Also called spreading factor c. Responsible for characteristic scarlet fever rash d. Dissolves clots by converting plasminogen to plasmin 12. All the following characteristics of S. pyogenes are correct except: a. It is an uncommon pathogen. b. It occurs most frequently in school-age children. c. It is spread by contact with large droplets produced in the upper respiratory tract. d. It has been known to cause foodborne and milkborne epidemics. 13. The clinical manifestations of S. pyogenes– associated upper respiratory infection are: a. Mild and usually unnoticeable b. Age dependent c. Associated with cold sores d. Difficult to detect 14. The most reliable immunologic test for recent S. pyogenes skin infection is: a. ASO b. Anti–DNAse B c. Anti-NADase d. Antibody to erythrogenic toxin 15-17. Match each ASO titer situation to the appropriate description. (An answer may be used twice.) 15. ____ Rising titer 16. ____ Declining titer 17. ____ Constant (low) titer a. Increase in severity of infection b. Not a current infection, but indicates a past infection c. Trend toward recovery d. No clinical significance 18. If a streptococcal infection is suspected, but the ASO titer does not exceed the reference range, a(n) _________________ should be performed. a. Repeat titer b. Anti–DNAse B test c. Anti-NADase test d. Throat culture 19. The classic tests to demonstrate the presence of streptococcal infection are: a. ASO and anti-NADase b. ASO and anti–DNAse B c. Anti-NADase and anti-DNAse d. Both a and b 20. The highest reported levels of sensitivity testing for group A streptococci are in: a. ASO titers b. Direct latex agglutination tests c. Surface (optical) immunoassay d. Both a and b, which are equivalent

1-4. Match the Treponema-associated diseases (a-d) with the respective causative organism. 1. ____ T. pallidum 2. ____ T. pallidum (variant) 3. ____ T. pertenue 4. ____ T. carateum a. Yaws b. Syphilis c. Pinta d. Bejel 5-8. Match the following stages of syphilis with the appropriate signs and symptoms. 5. ____ Primary syphilis 6. ____ Secondary syphilis 7. ____ Latent syphilis 8. ____ Late (tertiary) syphilis a. Diagnosis only by serologic methods b. Presence of gummas c. Development of a chancre d. Hutchinsonian triad e. Generalized illness followed by macular lesions in most patients 9. Which of the following is a term for nontreponemal antibodies produced by an infected patient against components of their own or other mammalian cells? a. Autoagglutinins b. Reagin antibodies c. Alloantibodies d. Nonsyphilis antibodies 10-12. Match the following: 10. ____ FTA-ABS test 11. ____ TP-PA test 12. ____ RPR test a. Treponemal method b. Nontreponemal method 13. In the RPR procedure, a false-positive reaction can result from all the following except: a. Infectious mononucleosis b. Leprosy c. Rheumatoid arthritis d. Streptococcal pharyngitis 14. The first diagnostic blood test for syphilis was the: a. VDRL b. Wassermann c. RPR d. Colloidal gold 15. Syphilis was initially treated with: a. Fuller’s earth b. Heavy metals (e.g., arsenic) c. Sulfonamides (e.g., triple sulfa) d. Antibiotics (e.g., penicillin) 16. Direct examination of the treponemes is most often performed by: a. Light microscopy b. Darkfield microscopy c. VDRL testing d. RPR testing 17. Pathogenic treponemes _______________ cultivatable

with consistency in artificial laboratory media. a. Are b. Are not 18. In infected blood, T. pallidum does not appear to survive at 4° C (39 ° F) for longer than: a. 1 day b. 2 days c. 3 days d. 5 days 19. The primary incubation period for syphilis (T. pallidum) is usually about: a. 1 week b. 2 weeks c. 3 weeks d. 4 weeks 20. The stage of syphilis that can be diagnosed only by serologic (laboratory) methods is the: a. Incubation phase b. Primary phase c. Secondary phase d. Latent phase 21. Immunocompetent patients infected with T. pallidum produce: a. Specific antibodies against T. pallidum b. Nonspecific antibodies against the protein antigen group common to pathogenic spirochetes c. Reagin antibodies d. All of the above 1. Common vectors of Lyme disease include all the following except: a. I. pacificus b. I. scapularis c. I. ricinus d. D. variabilis 2. The only continent without Lyme disease is: a. Asia b. Europe c. Africa d. Antarctica 3. The primary reservoir in nature for B. burgdorferi is the: a. White-tailed deer b. White-footed mouse c. Lizard d. Meadowlark 4. The first B. burgdorferi antigen to elicit an antibody response is: a. Outer surface protein A b. Outer surface protein B c. Flagellar 41-kDa polypeptide d. 60-kDa polypeptide 5. On average, the incidence of infection following an I. scapularis tick bite in an endemic area is: a. 1% b. 3% c. 5% d. 10% 6. Erythema migrans: a. Occurs in all patients

b. Harbors B. burgdorferi in the advancing edge c. Is easily distinguished from other erythemas d. Is more common in the winter months 7. The predominant symptoms of Lyme meningitis are: a. Severe headache and mild neck stiffness b. Aseptic meningitis and double vision c. Cranial nerve palsies and blurred vision d. Peripheral radiculoneuritis and peripheral neuropathy 8. Cardiac involvement in Lyme disease may include: a. Murmurs b. Conduction abnormalities c. Congestive heart failure d. Vasculitis 9. Ocular involvement in Lyme disease includes all the following except: a. Cranial nerve palsies b. Conjunctivitis c. Panophthalmitis with loss of vision d. Choroiditis with retinal detachment 10. Pregnancy in Lyme disease: a. Does not result in high fetal mortality b. Has been associated with transplacental infection c. Should be terminated because of maternal risk d. Is not associated with congenital abnormalities 11. The most useful test for distinguishing between truepositive and false-positive serologic test results is: a. Enzyme-linked immunosorbent assay b. Immunofluorescence assay c. Polymerase chain reaction d. T cell assay 12. Preventive methods include all the following except: a. Wearing light-colored clothes b. Tucking pants into socks c. Applying insect repellent to skin and clothes d. All of the above 13. Lyme disease, the most common tickborne disease in the United States, is a major health hazard for: a. Dogs b. Horses and cattle c. Humans d. All of the above 14. Lyme disease is a ________ type of infection. a. Bacterial b. Parasitic c. Viral d. Fungal 15. The first Native American case of what would later be called Lyme disease occurred in: a. Connecticut b. Wisconsin c. Florida d. New York 16-19. Fill in the blanks in the chart below, choosing from the following answers. Possible answers for

question 16: Possible answers for question 17: a. 3 days a. Neurologic b. 1 week b. Rheumatoid c. 4 weeks d. 3 months c. Cutaneous (e.g., erythema migrans) d. Cardiac Possible answers for question 18: Possible answers for question 19: a. Hours to weeks a. Arthritis b. Days to weeks b. Lyme carditis c. Weeks to months d. Weeks to years c. Transplacental transmission d. Lymphocytoma 16-19. Fill in the blanks: Clinical features of Lyme disease Stage Length of Time Common Signs and Symptoms I 16. ________ (median) 17. ________ manifestation after infection II Follows a variable latent period Target organs and systems can manifest abnormalities. III 18. ________ after infection 19. _______, late neurologic complications 20. Unlike some procedures, the polymerase chain reaction (PCR) assay can be used to detect Lyme disease– causing organisms in: a. Urine b. Cerebrospinal fluid c. Synovial fluid d. Blood 21 and 22. Fill in the blanks, choosing from the possible answers (a-d). Antigen detection systems in Lyme disease testing screen for _______ (21) rather than for _______ (22) associated with the infection. a. Antibody b. Microorganisms c. Antigenic products d. An infected tick 23. A patient who has a specific Lyme disease– associated manifestation may be treated with: a. Vaccination

b. Interferon c. Antibiotic d. Analgesic 24. Ehrlichia spp. belong to the same family as the organism that causes: a. Lyme disease b. Rocky Mountain spotted fever c. Toxoplasmosis d. Infectious mononucleosis 25. One of the most common physical findings in adults with ehrlichiosis is: a. Hives b. Fever c. Erythema migrans d. Nausea 26. Definitive diagnosis of ehrlichiosis requires: a. A complete blood count b. Detection of the presence of lymphocytopenia c. Acute and convalescent serum antibody titers d. Direct microscopic observation of inclusions in leukocytes REVIEW QUESTIONS 1. The Epstein-Barr virus can cause all the following except: a. Infectious mononucleosis b. Burkitt’s lymphoma c. Nasopharyngeal carcinoma d. Neoplasms of the bone marrow 2. The primary mode of EBV transmission is: a. Exposure to blood b. Exposure to oral-pharyngeal secretions c. Congenital transmission d. Fecal contamination of drinking water 3. Infants infected with EBV are more likely to experience symptomatic infection than EBV-infected adolescents. a. True b. False 4. IgM heterophile antibody is characterized by all the following features except: a. Reacts with horse, ox, and sheep RBCs b. Absorbed by beef erythrocytes c. Absorbed by guinea pig kidney cells d. Does not react with EBV-specific antigens 5. Characteristics of EBV-infected lymphocytes include all the following except: a. B type b. Expression of viral capsid antigen c. Expression of early antigen d. Expression of EBV genome 6. Which of the following stages of infectious mononucleosis infection is characterized by antibody to Epstein-Barr nuclear antigen (EBNA)? a. Recent (acute) infection b. Past infection (convalescent) period c. Reactivation of latent infection d. Both b and c

7. Which of the following stages of infectious mononucleosis infection is (are) characterized by heterophile antibody? a. Recent (acute) infection b. Past infection (convalescent) period c. Reactivation of latent infection d. Both a and c 8. What percentage of the world’s population is exposed to EBV? a. 25% b. 50% c. 75% d. 95% 9. Infectious mononucleosis postperfusion syndrome is a primary infection resulting from a blood transfusion from a(n) _______ to a(n) _______ recipient. a. Immune; nonimmune b. Nonimmune; immune c. Infected; nonimmune d. Infected; immune 10. In infectious mononucleosis, there is no: a. Acute state b. Latent state c. Carrier state d. Reactivation 11. The incubation period of infectious mononucleosis is: a. 2 to 4 days b. 10 to 15 days c. 10 to 50 days d. 51 to 90 days 12. The use of horse erythrocytes in rapid slide tests for infectious mononucleosis increases their: a. Cost b. Sensitivity c. Specificity d. Both b and c 13. EBV-infected B lymphocytes express all the following new antigens except: a. Viral capsid antigen VCA b. Early antigen EA c. Cytoplasmic antigen (CA) d. Nuclear antigen NA 14. Anti-EBNA IgG does not appear until a patient has entered the: a. Initial phase of infection b. Primary infection phase c. Convalescent period d. Reactivation of infectious stage 15-17. Match each procedure to the appropriate description. 15. ______ Paul-Bunnell screening test 16. ______ Davidsohn differential test 17. ______ MonoSlide agglutination test a. Distinguishes between heterophile antibodies; uses beef erythrocytes, guinea pig kidney cells, and sheep erythrocytes b. Detects heterophile antibodies and uses horse erythrocytes c. Detects heterophile antibodies and uses sheep erythrocytes