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TEST BANK For Textbook of Diagnostic Microbiology, 7th

Edition By Connie Mahon, All Chapters 1 - 41 Complete,
Verified Latest Edition ISBN 9780323829977
Healthcare (Kenyatta University)

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Test Bank For Textbook Of Diagnostic Microbiology

7th Edition By Mahon Chapters 1 - 41

TABLE OF CONTENTS
Part 1: Introduction to Clinical Microbiology

Chapter 1. Bacterial Cell Structure,

Physiology, Metabolism, and Genetics

Chapter 2. Host-Parasite Interaction

Chapter 3. The Laboratory Role in Infection

Control

Chapter 4. Control of Microorganisms:

Disinfection, Sterilization, and Microbiology
Safety

Chapter 5. Performance Improvement in the

Microbiology Laboratory

Chapter 6. Specimen Collection and

Processing

Chapter 7. Microscopic Examination of

Materials from Infected Sites

Chapter 8. Use of Colony Morphology for the

Presumptive Identification of
Microorganisms

Chapter 9. Biochemical Identification of

Gram-Negative Bacteria

Chapter 10. Immunodiagnosis of Infectious

Diseases

Chapter 11. Applications of Molecular

Diagnostics

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Chapter 12. Antibacterial Mechanisms of Action and Bacterial Resistance

Mechanisms

Chapter 13. Antimicrobial Susceptibility Testing

Part 2: Laboratory Identification of Significant Isolates

Chapter 14. Staphylococci

Chapter 15. Streptococcus, Enterococcus, and Other Catalase-Negative, Gram-

Positive Cocci

Chapter 16. Aerobic Gram-Positive Bacilli

Chapter 17. Neisseria Species and Moraxella catarrhalis

Chapter 18. Haemophilus, HACEK, Legionella and Other Fastidious Gram-

Negative Bacilli

Chapter 19. Enterobacteriaceae

Chapter 20. Vibrio, Aeromonas, and Campylobacter Species

Chapter 21. Nonfermenting and Miscellaneous Gram-Negative Bacilli

Chapter 22. Anaerobes of Clinical Importance

Chapter 23. The Spirochetes

Chapter 24. Chlamydia, Rickettsia, and Similar Organisms

Chapter 25. Mycoplasma and Ureaplasma

Chapter 26. Mycobacterium tuberculosis and Nontuberculous Mycobacteria

Chapter 27. Medically Significant Fungi

Chapter 28. Diagnostic Parasitology

Chapter 29. Clinical Virology

Chapter 30. Agents of Bioterror and Forensic Microbiology

Chapter 31. Biofilms: Architects of Disease

Part 3: Laboratory Diagnosis of Infectious Diseases: and Organ System

Approach to Diagnostic Microbiology

Chapter 32. Upper and Lower Respiratory Tract Infections

Chapter 33. Skin and Soft Tissue Infections

Chapter 34. Gastrointestinal Infections and Food Poisoning

Chapter 35. Infections of the Central Nervous System

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Chapter 36. Bacteremia and Sepsis

Chapter 37. Urinary Tract Infections

Chapter 38. Genital Infections and Sexually Transmitted Infections

Chapter 39. Infections in Special Populations

Chapter 40. Zoonotic Diseases

Chapter 41. Ocular Infections

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Chapter 01: Bacterial Cell Structure, Physiology, Metabolism, and Genetics

Mahon: Textbook of Diagnostic Microbiology, 7th Edition Test Bank

MULTIPLE CHOICE

1. To survive, microbial inhabitants have learned to adapt by varying all of the following, except
a. growth rate.
b. growth in all atmospheric conditions.
c. growth at particular temperatures.
d. bacterial shape.
ANSWER: D
The chapter begins by discussing the way microbial inhabitants have had to evolve to survive
in many different niches and habitats. It discusses slow growers, rapid growers, and
replication with scarce or abundant nutrients, under different atmospheric conditions,
temperature requirements, and cell structure. Bacterial shape as a form of evolution is not
discussed.

OBJ: Level 2: Interpretation

2. Who was considered the father of protozoology and bacteriology?

a. Anton van Leeuwenhoek
b. Louis Pasteur
c. Carl Landsteiner
d. Michael Douglas
ANSWER: A
The book discusses Anton van Leeuwenhoek as the inventor of the microscope and the first
person to see the “beasties.” So they dubbed him the father of protozoology and bacteriology.
The other three individuals were not discussed.

OBJ: Level 1: Recall

3. Prokaryotic cells have which of the following structures in their cytoplasm?

a. Golgi apparatus
b. Ribosomes
c. Mitochondria
d. Endoplasmic reticulum
ANSWER: B
All the structures listed are found in eukaryotic cells, but ribosomes are the only ones that
apply to prokaryotic cells.

OBJ: Level 1: Recall

4. This form of DNA is commonly found in eukaryotic cells.

a. Linear
b. Circular
c. Plasmid
d. Colloid

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ANSWER: A
Circular and plasmid DNA are usually found only in bacteria, not eukaryotic cells. Colloid isa
property of protein molecules and is not associated with nucleotides.

OBJ: Level 1: Recall

5. The nuclear membrane in prokaryotes is

a. missing.
b. impenetrable.
c. a classic membrane.
d. a lipid bilayer membrane.
ANSWER: A
Prokaryotic cells do not have any membrane-bound structures in the cytoplasm including a
structured nucleus.

OBJ: Level 1: Recall

6. A microorganism that is a unicellular organism and lacks a nuclear membrane and true
nucleus belongs to which classification?
a. Fungi
b. Bacteria
c. Algae
d. Parasite
ANSWER: B
Fungi, algae, and parasites are unicellular eukaryotic organisms that contain a true nucleus.
Bacteria are prokaryotic and do not contain a true nucleus or nuclear membrane.
OBJ: Level 1: Recall

7. In the laboratory, the clinical microbiologist is responsible for all the following, except
a. isolating microorganisms.
b. selecting treatment for patients.
c. identifying microorganisms.
d. analyzing bacteria that cause disease.
ANSWER: B
Clinical microbiologists do not select the treatment for patients. They provide the doctor with
the name of the organism and the antibiotics that can kill the bacteria, but not in the final
selection of treatment protocols.

OBJ: Level 2: Recall

8. What enables the microbiologist to select the correct media for primary culture and optimize
the chance of isolating a pathogenic organism?
a. Determining staining characteristics
b. Understanding the cell structure and biochemical pathways of an organism
c. Understanding the growth requirements of potential pathogens at specific body site
d. Knowing the differences in cell walls of particular bacteria
ANSWER: C

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By understanding growth requirements, a microbiologist can maximize the chance of the

organism being isolated from a culture. The other three choices are used to identify a
bacterium once it has grown on media.

OBJ: Level 2: Interpretation

9. A clinical laboratory scientist is working on the bench, reading plates, and notices that a
culture has both a unicellular form and a filamentous form. What type of organism exhibits
these forms?
a. Virus
b. Fungi
c. Bacteria
d. Parasite
ANSWER: B
Viruses typically only have one form and would not grow on plate media. Bacteria have two
forms: a vegetative cell and spore form. Parasites may have trophozoite, cysts, egg, etc. Fungi
are the organism classification that may have both unicellular yeast forms and filamentous
hyphal forms in the same culture plate.

OBJ: Level 2: Interpretation

10. All of the following statements are true about viruses, except:
a. Viruses consist of DNA or RNA but not both.
b. Viruses are acellular but are surrounded by a protein coat.
c. Viruses can infect bacteria, plants, and animals.
d. Viruses do not need host cells to survive and grow.

ANSWER: D
Viruses need to have a host cell because they do not have the ability to reproduce or nourish
themselves without the host’s cellular mechanisms.

OBJ: Level 2: Interpretation

11. Diagnostic microbiologists apply placement and naming of bacterial organisms into all the
following categories, except
a. order.
b. family.
c. genus.
d. species.
ANSWER: A
Clinical microbiologists use the family, genus, and species taxonomic categories to identify
species that are important for diagnostic diseases.

OBJ: Level 1: Recall

12. Bacterial species that exhibit phenotypic differences are considered

a. biovarieties.
b. serovarieties.
c. phagevarieties.
d. subspecies.

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ANSWER: D
Biovarieties vary based on biochemical test results, serovarieties vary based on serologic test
results, and phagevarieties is a fictitious word.

OBJ: Level 2: Interpretation

13. What structure is described as a phospholipid bilayer embedded with proteins and sterols
thatregulates the type and amount of chemicals that pass in and out of a cell?
a. Cell wall
b. Mitochondria
c. Endoplasmic reticulum
d. Plasma membrane
ANSWER: D
The cell wall is the outer covering made up of lipids. The mitochondria is a cellular organelle
that is considered the powerhouse of the cell (electron transport and oxidative
phosphorylationoccur here). The endoplasmic reticulum is a cellular organelle where protein
synthesis occurs.

OBJ: Level 1: Recall

14. What makes the interior of the plasma membrane potentially impermeable to water-
solublemolecules?
a. The hydrophobic tails of the phospholipid molecules are found there.
b. The hydrophilic tails of the phospholipid molecules are found there.
c. The ion channels are found there.
d. The cholesterol molecules in the plasma membrane are found solely in the interior
of the membrane.
ANSWER: A
The plasma membrane is designed so that the hydrophilic heads of the phospholipid
molecules are positioned to make contact with the intracellular and extracellular fluids. The
hydrophobic tails of the phospholipid molecules face away from the fluids and form the
interior of the plasma membrane. The tails of the phospholipid molecules are hydrophobic,
not hydrophilic. The ion channels extend through the cellular membrane. The cholesterol
molecules also extend through the plasma membrane.

OBJ: Level 2: Interpretation

15. The function of a cell wall is to

a. regulate the transport of macromolecules in and out of the cell.
b. provide rigidity and strength to the exterior of the cell.
c. provide reserve energy to the eukaryotic cell.
d. protect the eukaryote from predators.
ANSWER: B
The plasma membrane regulates the transport of macromolecules in and out of the cell, not
the cell wall. The mitochondria provide energy to the eukaryotic cell. Cell walls are not able
to protect a eukaryotic cell from predators.

OBJ: Level 1: Recall

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16. Name the numerous short (3 to 10 μm) projections that extend from the cell surface and
areused for cellular locomotion.
a. Flagella
b. Mitochondria
c. Cilia
d. Phospholipid
ANSWER: C
By definition, cilia are short projections extending from the cell surface and are used for
locomotion, whereas flagella are longer projections used for locomotion. Mitochondria are
cellular organelles responsible for electron transport and oxidative phosphorylation.
Phospholipids are polar molecules that form the plasma membrane.

OBJ: Level 1: Recall

17. A microbiology technologist performs a traditional bacterial stain on a colony from a wound
culture that is suspected to contain bacteria from the genus Clostridium. The unstained
areasin the bacterial cell observed by the technologist are called
a. cilia.
b. ribosomes.
c. endospores.
d. mitochondria.
ANSWER: C
Ribosomes are small circular areas used for protein synthesis that are not visible on a
traditional stain. Cilia are short projections on the outside of the plasma membrane used
forlocomotion. Mitochondria are cellular organelles used for energy production.

OBJ: Level 2: Interpretation

18. This constituent of a gram-positive cell wall absorbs crystal violet but is not dissolved by
alcohol, thus giving the gram-positive cell its characteristic purple color.
a. Mycolic acid
b. Cholesterol
c. Carbolfuchsin
d. Peptidoglycan
ANSWER: D
Mycolic acid is part of the cell wall of the Mycobacterium and Nocardia spp., but does not
play a part in the Gram stain. Cholesterol is also part of the cell membrane, not the cell wall,
so it does not play a part in the Gram stain. Carbolfuchsin is a stain used in bacteriology.

OBJ: Level 2: Interpretation

19. Mycobacteria have a gram-positive cell wall structure with a waxy layer containing these two
compounds.
a. Glycolipids and mycolic acid
b. Glycolipids and phospholipids
c. Mycolic acid and lipopolysaccharides
d. Lipopolysaccharides and phospholipids
ANSWER: A

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Glycolipids are a part of the waxy layer, but phospholipids are part of the plasma membrane.
Mycolic acid is a part of the waxy layer, but lipopolysaccharides are part of a gram-negative
cell wall. Lipopolysaccharides are part of a gram-negative wall, and phospholipids are part of
a plasma membrane.

OBJ: Level 1: Recall

20. When performing a Gram stain on a gram-negative organism, the crystal violet is absorbed
into this outer cell wall layer, and then washed away with the acetone alcohol. What is the
main component of the outer layer of the cell wall?
a. Peptidoglycan
b. Mycolic acid
c. N-acetyl-D-muramic acid
d. Lipopolysaccharide
ANSWER: D
Peptidoglycan is a thinner layer under the lipopolysaccharide in a gram-negative organism,
whereas mycolic acid is the waxy layer present in a mycobacterium’s outer cell wall, and
N-acetyl-D-muramic acid is part of the peptidoglycan.

OBJ: Level 1: Recall

21. The three regions of the lipopolysaccharide include all the following, except
a. antigenic O-specific polysaccharide.
b. mycolic acid.
c. core polysaccharide.
d. endotoxin (inner lipid A).

ANSWER: B
Antigenic O-specific polysaccharide, core polysaccharide, and endotoxin are all part of the
lipopolysaccharide layer.

OBJ: Level 1: Recall

22. The outer cell wall of the gram-negative bacteria serves three important functions, which
includes all the following, except:
a. It provides an attachment site for the flagella, which will act in locomotion.
b. It acts as a barrier to hydrophobic compounds and harmful substances.
c. It acts as a sieve.
d. It provides attachment sites that enhance adhesion to host cells.
ANSWER: A
The outer cell wall of gram-negative bacteria acts as a barrier to hydrophobic compounds and
harmful substances, acts as a sieve, and provides attachment sites that enhance adhesion to
host cells. Flagella attach to the cell membrane, not to the cell wall.

OBJ: Level 1: Recall

23. Mycoplasma and Ureaplasma spp. must have media supplemented with serum or sugar
asnutrients and because
a. their cell walls contain only peptidoglycan.
b. they lack cell walls.

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c. the sterols in their cell walls are soluble in normal bacterial media.
d. their cell walls contain detoxifying enzymes.
ANSWER: B
These two genera have no cell walls, so the other choices are not appropriate. Serum
andsugar are needed nutrients and assist with osmotic balance of the media.

OBJ: Level 1: Recall

24. What is the purpose of a capsule?

a. Prevent osmotic rupture of the cell membrane
b. Make up the periplasmic space
c. Act as a virulence factor in helping the pathogen evade phagocytosis
d. Provide an attachment site for somatic antigens
ANSWER: C
The capsule acts as a virulence factor in helping the pathogen evade phagocytosis because
antibodies have difficulty attaching to the capsule of bacteria and therefore are unable to
prepare the organism for ingestion. The cell membrane is not prone to osmotic rupture when
inside a host; the periplasmic space is found between the peptidoglycan and the
lipopolysaccharide layers of the cell wall in gram-negative organisms; and somatic antigens
are found below the capsule.

OBJ: Level 1: Recall

25. The three basic shapes of bacteria include all the following, except
a. spirochetes.
b. cell wall deficient.
c. cocci.
d. bacilli.
ANSWER: B
Cell wall deficient is not one of the basic shapes of bacteria. It refers to the cell wall
composition, not the bacterial shape.

OBJ: Level 1: Recall

26. The Gram stain is a routine stain used in bacteriology to determine gram-positive and
gram-negative bacteria based on the
a. phenotypic characteristics of the organism.
b. composition of the bacterial cell wall.
c. composition of the bacterial cell membrane.
d. composition of the bacterial pili.
ANSWER: B
The composition of the bacterial cell wall is routinely used in bacteriology. The peptidoglycan
cell walls of the gram-positive bacteria retain the crystal violet (purple) stain, whereas crystal
violet stain is washed away because of the lipopolysaccharide (outer membrane) present in
thecell walls of the gram-negative cells. The outer membrane retains the Safranin (pink) with
thecounter stain.

OBJ: Level 1: Recall

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27. In what staining procedure does carbolfuchsin penetrate the bacterial cell wall through heat
ordetergent treatment?
a. Gram stain
b. Acridine orange stain
c. Endospore stain
d. Acid-fast stain
ANSWER: D
Of all the stains listed, the acid-fast stain is the only one that requires heating or detergent
treatment so that the carbolfuchsin stain can penetrate the waxy wall of acid-fast bacteria.
Gram staining uses crystal violet stain; acridine orange is used in acridine orange stain; and
the endospore stain uses malachite green.

OBJ: Level 1: Recall

28. What stain is used for medically important fungi?

a. Methylene blue
b. Acridine orange
c. Acid-fast
d. Lactophenol cotton blue
ANSWER: D
Lactophenol cotton blue is the only fungi stain listed. Methylene blue is used to stain
Corynebacterium spp.; acridine orange is used to stain all types of bacteria, living or dead;
and acid-fast is used to stain Mycobacterium spp.

OBJ: Level 1: Recall

29. All the following are types of media, except

a. selective.
b. differential.
c. fastidious.
d. transport.
ANSWER: C
Fastidious refers to the nutrient requirements of bacteria, not a type of media. Selective media
have ingredients added to grow only selected bacteria. Differential media have chemicals
added to allow visualization of metabolic differences of bacteria. Transport media are used to
keep bacteria alive during transport to the laboratory.

OBJ: Level 1: Recall

30. Which of the following environmental factors influence the growth of bacteria in the
laboratory?
a. pH
b. Temperature
c. Gaseous composition of the atmosphere
d. All of the above
ANSWER: D

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Most bacteria grow best at a pH between 7.0 and 7.5, at 35฀ C, with a requirement for the
gaseous composition of the atmosphere. Some bacteria require higher than atmospheric
moisture (humidity) levels for optimal growth (Neisseria sp.).

OBJ: Level 1: Recall

31. Some bacteria grow at 25฀ C or 42฀ C, but diagnostic laboratories routinely grow pathogenic
bacteria at what temperature?
a. 30฀ C
b. 60฀ C
c. 35฀ C
d. 10฀ C

ANSWER: C
Most pathogenic bacteria grow well at 35฀ C because it is close to body temperature; 30฀ C is
the temperature at which most medically important fungi grow well; 60฀ C is too hot for
pathogenic bacteria to grow, and 10฀ C is too cold for pathogenic bacteria to grow.

OBJ: Level 1: Recall

32. Which of these bacteria cannot grow in the presence of oxygen?

a. Obligate aerobes
b. Capnophilic organisms
c. Facultative anaerobes
d. Obligate anaerobe
ANSWER: D
An obligate anaerobe is a bacterium that is killed when exposed to normal atmospheric
conditions of oxygen and requires strict absence of oxygen. An obligate aerobe is a bacterium
that grows only in the presence of oxygen, and a capnophilic bacterium grows only in the
presence of 5% to 10% carbon dioxide.

OBJ: Level 1: Recall

33. What class of organisms, such as the Streptococcus sp., can survive in the presence of
oxygenbut do not use oxygen in its metabolic processes?
a. Microaerophilic
b. Aerotolerant anaerobe
c. Obligate anaerobe
d. Facultative anaerobe
ANSWER: B
An aerotolerant anaerobe is one that can live in the presence of oxygen but does not use
oxygen in its metabolic processes. A microaerophilic bacterium requires a reduced level of
oxygen to grow. An obligate anaerobe cannot survive in the presence of oxygen, and a
facultative anaerobe can grow either with or without oxygen.

OBJ: Level 1: Recall

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34. The laboratory receives a specimen in which the doctor suspects that the infecting organism
is Haemophilus influenzae. This organism grows best in an atmosphere that contains 5% to
10%carbon dioxide. It is therefore classified as what type of bacteria?
a. Obligate aerobe
b. Capnophilic
c. Facultative anaerobe
d. Obligate anaerobe
ANSWER: B
Capnophilic bacteria need increased carbon dioxide in the atmosphere to grow; obligate
aerobes can grow only in the presence of oxygen; facultative anaerobes can grow in the
presence or absence of air; and obligate anaerobes need an atmosphere without oxygen
togrow.

OBJ: Level 1: Recall

35. The following describes the log phase of bacterial growth:

a. Preparing to divide
b. Limited nutrients with bacteria count remaining constant
c. Number of nonviable bacterial cells exceeds the number of viable cells
d. Bacteria doubling with each generation time
ANSWER: D
As a bacterium is immersed in an environment with favorable conditions for growth, the
bacterium starts dividing; soon their numbers increase logarithmically. The growth tapers off
as the nutrients become limited; then the bacteria will begin to die as the nutrients are
exhausted.

OBJ: Level 1: Recall

36. Diagnostic schemes in the microbiology laboratory typically analyze each unknown
bacterium’s metabolic processes for all the following, except
a. utilization of a variety of substrates as carbon sources.
b. energy utilization for metabolic processes.
c. production of specific end products from specific substrates.
d. production of an acid or alkaline pH in the test medium.
ANSWER: B
The microbiologist examines production of specific end products, production of an acid or
alkaline pH in the test medium, and utilization of various carbon sources for energy to identify
bacteria. Identification schemes are based on the percentages of bacterial species that exhibit
particular metabolic processes in vitro.

OBJ: Level 1: Recall

37. Which is a biochemical process carried out by both obligate and facultative anaerobes?
a. Fermentation
b. Respiration
c. Oxidation
d. Reduction
ANSWER: A

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Fermentation takes place without oxygen. Respiration and oxidation need oxygen to occur.
Reduction is a chemical reaction that can occur independent of bacteria.

OBJ: Level 1: Recall

38. What type of fermentation produces lactic, acetic, succinic, and formic acids as the
endproducts?
a. Butanediol
b. Propionic
c. Mixed acid
d. Homolactic
ANSWER: C
Most of the fermentative processes produce only a single acid as a metabolic by-product.
Mixed acid fermentation produces several different acids: lactic, acetic, succinic, and formic.

OBJ: Level 1: Recall

39. If bacteria utilize various carbohydrates for growth, they are usually detected by
a. alkaline production and change of color from the pH indicator.
b. production of carbon dioxide.
c. production of keto acids.
d. acid production and change of color from the pH indicator.
ANSWER: D
Most bacterial identification systems examine the ability of bacteria to utilize several different
carbohydrates. The medium contains the specific carbohydrate being examined and a pH
indicator that can produce a color change: blue to yellow or red to yellow
OBJ: Level 1: Recall

40. In the medical microbiology laboratory, the ability of a gram-negative bacterium to ferment
this sugar is the first step in its identification.
a. Sucrose
b. Mannitol
c. Trehalose
d. Lactose

ANSWER: D
Media used for gram-negative bacillus that contain this sugar allow for the differentiation into
lactose fermenters and nonlactose fermenters. With this characteristic, organisms can be
placed into these two large groupings. This aids in the identification of gram-negative
organisms.

OBJ: Level 1: Recall

41. A is a single, closed, circular piece of DNA that is supercoiled to fit inside a bacterial
cell.
a. phenotype
b. chromosome
c. frame-shift mutation
d. transposon

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.
ANSWER: B
Chromosomes contain the genome of a bacterial cell. The DNA in the genome must be
compacted and wrapped around protein molecules to fit inside the cell nucleus. This
compacting, wrapping, and supercoiling makes up the chromosome.

OBJ: Level 1: Recall

42. Genes that code for antibiotic resistance are often found on small, circular pieces of DNA.
These DNA pieces are called
a. plasmids.
b. phenotypes.
c. chromosomes.
d. genomes.
ANSWER: A
Plasmids found in bacteria are small, extrachromosomal DNA. Plasmids are found in the
cytoplasm and can be replicated and passed on to daughter cells. Plasmids contain the
antibiotic resistance genes for some antibiotics.

OBJ: Level 1: Recall

43. What process involves transferring or exchanging genes between similar regions on two
separate DNA molecules?
a. IS element
b. Replication
c. Recombination
d. Transcription
ANSWER: C
Recombination is the process described. Transcription occurs when a DNA molecule makes
an RNA molecule. Replication occurs when DNA is used to make another DNA molecule. AnIS
element is a type of mutation that occurs when a small piece of DNA jumps from one area in a
chromosome to another.

OBJ: Level 1: Recall

44. A microbiologist is working with two separate cultures of the same organism. The bacteria in
one culture are resistant to penicillin, whereas the bacteria in the other culture are
susceptible to penicillin. The bacteria from both cultures are mixed together, and all the
resulting bacteriaare resistant to penicillin. What caused this phenomenon?
a. The plasmid carrying the resistance gene was transferred to the
susceptiblepopulation of bacteria.
b. The plasmid carrying the susceptibility gene was transferred to the resistant
population of bacteria.
c. An IS element was inserted into the genome of the susceptible
bacterialpopulation.
d. A frame-shift mutation occurred that allowed the susceptible population of
bacteriato develop resistance to penicillin.
ANSWER: A

Antibiotic resistance is carried by plasmids, which can easily be transferred from one
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bacterium to another. The receiving bacterium then displays the characteristics contained in
the plasmid. IS elements and frame-shift mutations occur on the chromosomes and take
longerto manifest than do plasmid transfers.

OBJ: Level 2: Interpretation

45. Diphtheria is a disease produced by Corynebacterium diphtheriae. However, not all C.

diphtheriae bacteria produce the toxin that causes this disease. To produce the toxin,
thebacteria must first become infected with a bacteriophage. The process by which
bacterialgenes are transferred to new bacteria by the bacteriophage is called
a. conjugation.
b. transduction.
c. replication.
d. transformation.
ANSWER: B
Conjugation occurs when genetic material is passed from one bacterium to another through
the use of a sex pilus or similar appendages. Replication is when DNA makes a copy of itself.
Transformation occurs when naked DNA or plasmids are taken up and incorporated into a
bacteria’s genome.

OBJ: Level 1: Recall

46. Lysogeny occurs when

a. genes present in the IS element are expressed in the bacterial cell.
b. genetic material is transferred from one bacterium to another through a sex pilus.
c. competent bacteria cells take up naked DNA
d. genes present in the bacteriophage DNA are incorporated into the bacteria’s
genome.
ANSWER: D
IS elements are small pieces of bacterial DNA that jumped from one area in a chromosome to
another area in the same chromosome. When using a sex pilus to transfer DNA, the process is
called conjugation. Competent cells taking up DNA into their genomes represent transduction.

OBJ: Level 1: Recall

47. These are enzymes that cut the bacterial DNA at specific locations.
a. Bacteriophage enzymes
b. Restriction enzymes
c. Temperate lysogeny enzymes
d. Conjugation enzymes
ANSWER: B
Restriction enzymes allow bacteria to cut a place in its genome and insert specific
sequencesof foreign DNA. Researchers also use the resulting fragments to identify identical
genomes. Bacteriophage enzymes do not cut the host bacteria DNA. Temperate lyosgeny
enzymes are associated with bacteriophage activation and conjugation enzymes assist in
transfer of DNAfrom one bacterial cell to another.

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OBJ: Level 1: Recall

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Chapter 02: Host–Parasite Interaction

Mahon: Textbook of Diagnostic Microbiology, 7th Edition

MULTIPLE CHOICE

1. Organisms that participate in a biological relationship where both benefit from one another are
called
a. parasites.
b. symbionts.
c. hosts.
d. flora.
ANSWER: B
Symbiosis is a relationship where two organisms live together and their association benefits
both organisms. Organisms that live in symbiosis are said to be symbionts. Parasites are
organisms that live off a host and harm the host. The host is the organism that provides the
nutrients to the other organisms. Flora are described as microorganisms that inhabit the
bodysites of healthy individuals.

OBJ: Level 1: Recall

2. Parasitism is
a. a biological relationship between two or more organisms in which both benefit
from one another.
b. a biological relationship between only two organisms in which there are no
beneficial or harmful effects to the host
c. a biological relationship in which one species gains benefits at the expense of the
host.
d. a synonym for mutualism.
ANSWER: C
When both organisms live together and one organism benefits at the expense of the host, this
is parasitism. When both organisms live together and both benefit, this is symbiosis. When
both organisms live together and neither benefits, this is commensalism. Mutualism and
symbiosis are synonyms.

OBJ: Level 1: Recall

3. This bacterial state occurs when a host harbors a disease-causing organism, but does not
showsigns of disease.
a. Carrier
b. Transient
c. Resident
d. Indigenous
ANSWER: A
Transient, resident, and indigenous refer to particular types of flora associated with the human
body, whereas carrier refers to the state in which pathogenic organisms establish themselves
in a host without causing disease, but the host can still transmit the infection.

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OBJ: Level 1: Recall

4. Healthy people are colonized by many different bacteria in many different sites. These
bacteria are referred to as
a. transient flora.
b. carrier flora.
c. maintenance flora.
d. indigenous flora.
ANSWER: D
Indigenous flora are usual or normal flora, whereas transient flora are microbial flora that are
present at a site temporarily. Carrier and maintenance flora are not types of microbial flora
found on the human body.

OBJ: Level 1: Recall

5. Diabetics may sometimes be infected with their own resident flora. This type of infection is
called
a. an opportunistic infection.
b. a carrier state.
c. symbiosis.
d. a parasitic infection.
ANSWER: A
Opportunistic infections occur when the host has changes in body chemistry associated with
age, disease states, and drug or antibiotic effects. Carrier states are those in which a host
doesnot show symptoms of a disease, but it can infect other hosts with pathogenic
organisms.
Symbiosis is a biological relationship that benefits the host and the organism. A parasitic
infection is one in which the parasite receives benefits, but at the expense of the host.

OBJ: Level 1: Recall

6. Mechanisms used by the skin to prevent infection and protect the underlying tissue from
invasion by potential pathogens include all the following, except
a. desquamation of the epithelium.
b. excretion of lysozyme by sweat glands.
c. antibiotics that inhibit many microorganisms.
d. mechanical separation of microorganisms from the tissues.
ANSWER: C
The skin produces fatty acids that inhibit microorganisms, not antibiotics. The remaining three
mechanisms are described in the text on page 25.

OBJ: Level 1: Recall

7. A laboratory professional is testing a new antimicrobial soap. The tech washes her forearm
then does a culture of the skin. Which organisms should she most likely expect to find
growing in the culture?
a. Diphtheroids and Bacillus spp.
b. Staphylococcus epidermidis and Propionibacterium
c. S. aureus and Propionibacterium

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d. Diphtheroids and Propionibacterium

e. None of these organisms should be found.
ANSWER: B
Superficial antisepsis of the skin does not kill the Propionibacterium and S. epidermidis that
live in the hair follicles and sebaceous glands. Diphtheroids are found in moist areas such as
the axillae and toes. S. aureus is typically a pathogen but can be found on healthy skin.
Handwashing does not remove all bacteria from the skin.

OBJ: Level 1: Interpretation

8. What mechanism allows strict anaerobes to grow in the cervices and areas between the
teethwhen plaque is present?
a. A low oxidation-reduction potential occurs at the tooth surface under the plaque.
b. The bacteria secrete sugar to nourish the strict anaerobes.
c. The normal flora secrete antibiotics to kill all the other bacteria and allow the strict
anaerobes to thrive.
d. The plaque-causing bacteria secrete an alkaline fluid and change the pH around the
tooth.
ANSWER: A
The growth of the plaque-causing bacteria on the tooth’s surface contain as many as 1011
streptococci per gram, and this amount of bacteria lowers the oxidation-reduction potential
atthe tooth surface. Strict anaerobes cannot grow in the presence of oxygen, and lowering
the oxidation-reduction potential lowers the amount of oxygen at the tooth surface. Normal
oral flora organisms do not secrete sugar, antibiotics, or alkaline fluid.

OBJ: Level 1: Recall

9. The stomach can be considered a first line of defense against microbial infections because
a. most microorganisms are susceptible to the antibiotics and alkaline pH present
inthe stomach.
b. most microorganisms are killed by the liver enzymes that are emptied into the
stomach during a meal.
c. the stomach produces proteases, which attack the lipopolysaccharide cell wall
ofthe organisms.
d. most microorganisms are susceptible to the acid pH of the stomach.

ANSWER: D
The stomach cells secrete enough acid to create an environment with a pH of approximately 1.
Bacteria that are enmeshed in food, spore-forming bacterial species in their spore phase, and
the cysts of parasites can survive the extreme pH present in the stomach. The stomach does
not produce antibiotics, and liver enzymes do not empty into the stomach during digestion.

OBJ: Level 1: Recall

10. This type of bacteria is able to live in the colon with little to no oxygen and is the predominant
organism.
a. Anaerobes
b. Facultative anaerobes
c. Facultative gram-negative rods

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d. Gram-positive cocci

ANSWER: A
Anaerobes make up over 90% of the microbial flora of the large intestine. The facultative
anaerobes, facultative gram-negative rods, and gram-positive cocci are present in the colon
inmuch smaller numbers than the anaerobes.

OBJ: Level 1: Recall

11. After perforation of the colon, surgeons must guard against infection in the because
ofleakage of the contents of the colon.
a. peritoneal cavity
b. urinary bladder
c. vaginal flora
d. renal vein
ANSWER: A
The peritoneal cavity is the space between the internal organs and the abdominal wall—a
normally sterile space. The colon contains lots of bacteria that can cause an infection in this
normally sterile space because there are no normal flora or immune system cells here to
fightoff an infection. The organisms would have no natural defenses to overcome before
causing an infection.

OBJ: Level 1: Recall

12. The human body is constantly challenged by pathogens in the environment. It is not infected
by every pathogen it encounters because the microbial flora
a. engulf the pathogenic bacteria
b. produce conditions at the microenvironmental level that block colonization.
c. prime our immune system.
d. activate and support the action of antigen-presenting cells, cytokines,
andcell-mediated immunity.
ANSWER: B
Several mechanisms are used by microbial flora to ensure that colonization of pathogenic
organisms is blocked, such as lowering the reduction-oxidation potential, lowering the pH,
producing antimicrobials, and depleting the nutrients present in a particular environment.

OBJ: Level 2: Interpretation

13. The ability of an organism to produce disease in an individual is called

a. pathogenicity.
b. iatrogenic infection.
c. parasitic infection.
d. opportunistic infection.
ANSWER: A
An iatrogenic infection occurs as the result of medical treatment or procedure. A parasitic
infection occurs when an organism invades a host and only the organism benefits from the
biological relationship. An opportunistic infection occurs when the condition of the host
changes and the resident flora cause an infection.

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OBJ: Level 1: Recall

14. A patient with an indwelling catheter develops a fever and lethargy. In addition, the urine in
the catheter bag has turned a brownish color and smells foul, which suggests an infection is
present. What type of infection does this describe?
a. Opportunistic
b. Iatrogenic
c. Pathogenic
d. Parasitic
ANSWER: B
An iatrogenic infection occurs as the result of medical treatment or procedures. In this case,
the use of an indwelling catheter to treat a medical condition has resulted in an infection. An
opportunistic infection occurs when a host’s condition changes and resident flora are able
tocause disease. Pathogenic describes the types of organisms that cause disease, but not a
typeof infection. A parasitic infection occurs when an organism invades a host and only the
organism benefits from the biological relationship.

OBJ: Level 2: Recall

15. The smaller the number of microorganisms necessary to cause infection in a competent
host,the more the microorganism.
a. opportunistic
b. parasitic
c. invasive
d. virulent
ANSWER: D
Virulence refers to the relative ability of a microorganism to cause disease; more virulent
organisms need fewer organisms to cause disease in a host. Opportunistic refers to a type of
resident flora that causes infection when the conditions in a host change. A parasitic infection
occurs when an organism invades a host and only the organism benefits from the biological
relationship. Invasive refers to entering tissue, not the degree of ease with which an organism
can cause disease.

OBJ: Level 1: Recall

16. Factors that determine the pathogenicity and increase the virulence of organisms include
allthe following, except
a. an organism’s ability to avoid phagocytosis.
b. an organism’s ability to produce exotoxins and extracellular enzymes.
c. an organism’s ability to produce infection when host conditions change.
d. an organism’s ability to survive intracellularly when phagocytized.
ANSWER: C
An organism’s ability to produce infection when the host conditions change is referred to as
an opportunistic pathogen. The other three statements refer to ways that a microorganism
cansurvive the attack of a host’s immune system and produce disease.

OBJ: Level 2: Interpretation

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17. The most common bacterial characteristic that allows for evasion of phagocytosis by the
hostis called
a. exotoxin production.
b. extracellular enzyme production.
c. pili.
d. polysaccharide capsule.
ANSWER: D
Organisms possessing a polysaccharide capsule are considered highly virulent because
theycan evade phagocytosis. Exotoxin and extracellular enzyme production and pili are
factors that can increase an organism’s virulence. The exotoxins and extracellular enzymes
may be used to survive phagocytosis, but these do not help an organism evade
phagocytosis. Pili areused to transfer plasmids that may contain the genes for antimicrobial
resistance and, therefore, help an organism survive in the host.

OBJ: Level 1: Recall

18. This is a leukocidin that is lethal to leukocytes and produced by staphylococci.

a. Panton-Valentine
b. Lancefield
c. Hemolysin
d. Adhesins
ANSWER: A
The Panton-Valentine leukocidin is lethal to leukocytes and contributes to the invasiveness of
staphylococci. Lancefield deals with classifying ฀-hemolytic streptococci on the basis of
antigens found on their outer covering. Hemolysins are produced by streptococci, and these
lyse red blood cells. Adhesins are cell-surface structures that mediate attachment to other
cells.

OBJ: Level 1: Recall

19. Changes in these host structures can result in lower virulence of a microorganism.
a. Pili
b. Adhesin receptors
c. Surface polysaccharides
d. Phagocytes
ANSWER: B
Adhesin receptors are structures found on the host cell that are necessary for attachment of
bacterial adhesins and the beginnings of an infection. Pili and surface polysaccharides are the
main bacterial structures of attachments called adhesins. Phagocytes are white blood cells
(WBCs) that engulf invading microorganisms.

OBJ: Level 1: Recall

20. After attachment to host cells, a pathogen may use the following mechanisms to
establishitself and cause disease, except:
a. Uses lactoferrin for iron
b. Produces an IgA protease that degrades the IgA at mucosal surfaces
c. Produces lysozyme to kill the host cell

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d. Circumvents host antibodies by shifting key cell-surface antigens

ANSWER: C
After engulfing bacteria, the host cell releases lysosomal contents that kill the organism. The
bacteria do not produce lysozyme.

OBJ: Level 1: Recall

21. Dissemination of a pathogen is

a. when a pathogen penetrates and grows in tissues.
b. when a pathogen multiplies intracellularly.
c. when a pathogen circumvents host antibodies by shifting key cell-surface antigens.
d. when infection with a pathogen spreads from the initial infection site to distant
sites such as organs and tissues.
ANSWER: D
Invasion of a pathogen allows the microbe to take advantage of the host’s transport system
(the blood) and seek out other areas that can be infected. This occurs only if the pathogen can
elude the host’s immune system during this journey. Invasion is when a pathogen penetrates
and grows in tissues. Intracellular multiplication of a pathogen occurs when an organism can
survive phagocytosis. When a pathogen shifts key cell-surface antigens, it is evading a host’s
immune system.

OBJ: Level 1: Recall

22. A physician notices that several patients are infected with Clostridium difficile, but only a few
of the patients are symptomatic for disease. The reason for this discrepancy is
a. only those strains of the organisms carrying the extrachromosomal DNA coding
for the toxin gene will produce toxin and cause the individuals to be symptomatic.
b. only those strains of the organism carrying DNA coding for the toxin within its
main DNA molecule will produce toxin and cause the individuals to be
symptomatic.
c. the exotoxin produced contains only the nontoxic portion.
d. the exotoxin must be produced in conjunction with extracellular enzymes to
causeproblems.
ANSWER: A
The exotoxin gene is commonly encoded for by phages, plasmids, or transposons and does
notnormally reside within an organism’s main DNA molecule. Exotoxins are highly
characterized molecules that are composed of a nontoxic subunit that binds the toxin to the
host cells, allowing attachment of the toxin. Exotoxins exhibit their effects without the aid of
extracellular enzymes. Extracellular enzymes are another factor that contributes to the
virulence and invasiveness of organisms.

OBJ: Level 2: Interpretation

23. The effects of endotoxins consist of dramatic changes in all the following, except
a. blood pressure.
b. fluid imbalance.
c. clotting.
d. body temperature.

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ANSWER: B
Unlike shock caused by fluid loss, such as that seen in severe bleeding, septic shock is
unaffected by fluid administration. An increase in body temperature occurs within an hour
after exposure. Severe hypotension occurs within 30 minutes after exposure. The endotoxin
also initiates coagulation, which can result in intravascular coagulation.

OBJ: Level 2: Interpretation

24. A patient is brought to the emergency room with the following symptoms: body temperature
of 102° F, low blood pressure, elevated WBC, and disseminated intravascular coagulation.
This person has gram-negative rods growing in the blood. What is responsible for these
symptoms?
a. Exotoxin
b. Extracellular enzymes
c. Endotoxin
d. Exfoliating toxin
ANSWER: C
Effects of the lipid A portion of the lipopolysaccharide present in the cell walls of
gram-negative bacteria include increased body temperature, hypotension,
intravascular
clotting, neutropenia, metabolic changes, changes in humoral and cellular immunity, and
changes resistance to infection.

OBJ: Level 3: Synthesis

25. Healthy skin secretes these substances to help prevent colonization by transient and
possiblypathogenic organisms.
a. Long-chain fatty acids
b. Sebaceous glands
c. Carbohydrates
d. Antibodies
ANSWER: A
Long-chain fatty acids produced by the sebaceous glands allow the skin environment to be
acidic, leading to a low pH environment. Many pathogens prefer the near-neutral environment
in the body to produce disease. Bacteriocidal substances are produced by the microbial flora
that colonize the skin, and antibodies are produced by lymphocytes.

OBJ: Level 1: Recall

26. Lysozyme is
a. an antibody produced by the skin.
b. a low-molecular-weight enzyme that hydrolyzes the peptidoglycan layer of
bacterial cell walls.
c. an exotoxin that digests the lipopolysaccharide layer of the bacterial cell wall.
d. a radical similar to hydrogen peroxide.
ANSWER: B
Antibodies are produced only by the lymphocytes. Exotoxins are produced by bacteria and are
toxic to the host. Lysozyme is a low-molecular-weight enzyme that hydrolyzes the
peptidoglycan layer of bacterial cell walls.

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OBJ: Level 1: Recall

27. Interferon is a substance produced by the body that inhibits viral replication. Interferon
accomplishes this task by
a. digesting the virus that is attempting to attach to the host cell.
b. destroying the host cell before the virus can attach and replicate.
c. binding to surface receptors that stimulate the cell to synthesize enzymes
thatinhibit viral replication over several days.
d. stimulating platelets to produce ฀-lysins.

ANSWER: C
Interferon is produced by eukaryotic cells in response to a viral infection, and it stimulates the
cell to synthesize enzymes that inhibit viral replication over several days. Interferons are not
enzymes and cannot digest viruses. Destroying the host cell before the virus can attach would
be counterproductive, because the purpose is to keep the host cells viable and free of
infection. The ฀-lysin’s cationic proteins are produced by platelets during coagulation and are
active against gram-positive bacteria, not viruses.

OBJ: Level 2: Interpretation

28. All the following activities must occur for phagocytosis to take place and be effective in host
defense, except
a. attachment of the particle to the phagocyte.
b. ingestion.
c. killing.
d. migration of lymphocytes to the area of infection (chemotaxis).

ANSWER: D
Phagocytes are neutrophils or macrophages. Lymphocytes are not phagocytic and
cannotengulf bacteria.

OBJ: Level 1: Recall

29. This process results in enhanced phagocytosis by neutrophils.

a. Opsonization
b. Chemotaxis
c. Digestion
d. Glycolysis
ANSWER: A
Chemotaxis is the process of phagocytes migrating toward the site of the infection. Digestion
is when the contents of the lysozyme are mixed with the phagocytized bacteria. Glycolysis is
a metabolic process where glucose is broken down and energy is generated.

OBJ: Level 1: Recall

30. One of the most effective defenses bacteria have against phagocytosis is
a. enzymes.
b. the capsule.
c. plasmids.

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d. lipopolysaccharide layer.

ANSWER: B
Enzymes facilitate host cell destruction but do not have any effect on phagocytosis.
Plasmidscarry small pieces of DNA that can code for toxins, enzymes, and antibiotic
resistance. The lipopolysaccharide layer acts as an endotoxin that causes septic shock.

OBJ: Level 1: Recall

31. Innate immunity consists of which of the following components?

a. Physical and chemical barriers such as the skin and mucous membranes
b. Blood proteins that act as mediators of infection
c. Cells capable of phagocytosis
d. All of the above are part of the innate immune system
ANSWER: D
Innate immunity includes (1) physical and chemical barriers, such as the skin and mucous
membranes; (2) blood proteins that act as mediators of infection; and (3) a cellular
mechanismcapable of phagocytosis, such as neutrophils and macrophages, and other
leukocytes such as natural killer cells.

OBJ: Level 2: Interpretation

32. The major constituents of the adaptive or specific immune response are
a. neutrophils.
b. macrophages.
c. monocytes.
d. lymphocytes.
ANSWER: D
Lymphocytes produce antibodies in response to specific antigens present in the blood.
Neutrophils, macrophages, and monocytes are all phagocytic cells that function in
innateimmunity, not the specific immune response.

OBJ: Level 1: Recall

33. This class of antibodies is usually found as a pentamer.

a. IgM
b. IgG
c. IgA
d. IgE
ANSWER: A
IgM is made up of five basic immunoglobulin subunits and is considered a pentamer. IgG is a
monomer, IgA is a dimer, and IgE is a monomer.

OBJ: Level 1: Recall

34. A subsequent exposure to the same antigen elicits a(n) , characterized by a rapid
increase in IgG antibody associated with higher levels, a prolonged elevation, and a more
gradual decline in antibody levels.
a. primary immune response

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b. anamnestic immune response

c. opsonin immune response
d. innate immune response
ANSWER: B
The primary immune response consists of production of IgM antibodies. The innate immune
response does not consist of antibody production but rather physical and chemical barriers
toinfection and phagocytosis.

OBJ: Level 1: Recall

35. These are low-molecular-weight proteins secreted by T cells.

a. Antibodies
b. Opsonins
c. Lymphokines
d. Lysozyme
ANSWER: C
Antibodies are produced by B cells. Opsonins are antibodies or pieces of complement that
help make a pathogen ready to be phagocytized. Lysozyme is the enzyme present in host cell
vacuoles that assist in killing a phagocytized microorganism. Lymphokines are produced by T
cells as a result of antigen binding, activation, cell division, and differentiation.

OBJ: Level 1: Recall

36. Immunity to intracellular bacterial pathogens, such as Mycobacterium tuberculosis,

isprimarily cell mediated, through the activities of
a. interferons and macrophages
b. antibodies and lymphokines.
c. lysozyme, T lymphocytes, and antibodies.
d. T lymphocytes, lymphokines, and macrophages.
ANSWER: D
T lymphocytes, lymphokines, and macrophages are used by the immune system to battle
intracellular pathogens most effectively. Interferons are useful against viruses, not
[Link] are effective against intracellular pathogens because they are
phagocytes.
Antibodies are not useful against intracellular pathogens because they cannot reach the
pathogen that lives inside the cell. Lysozyme is an enzyme that is used to kill bacteria once
they are phagocytized.

OBJ: Level 2: Interpretation

37. Pathogens can be transmitted through all the following routes, except
a. ingestion.
b. handwashing.
c. sexual contact.
d. air.
ANSWER: B
Handwashing is a major method to prevent spread of infections. Pathogens can be
transmittedby ingestion, sexual contact, and air.

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OBJ: Level 1: Recall

38. Because infections can be encountered via the air, can cause transmission of
somepathogens.
a. cuts
b. eyes
c. coughing
d. eating
ANSWER: C
Airborne infections are the most commonly encountered infections. They are transmitted by
droplets in the air that can be generated by coughing or sneezing. Cuts, eyes, and children are
not usual pathways for airborne transmission of a pathogen.

OBJ: Level 1: Recall

39. The resulting disease from this route of transmission is a disease of animals that is
transmittedto humans.
a. Sexual contact
b. Zoonotic
c. Airborne
d. Ingestion
ANSWER: B
Sexual contact, airborne, and ingestion are all routes of transmission for diseases of
humansthat are passed from person to person. Zoonotic describes diseases of animals
that infect humans.

OBJ: Level 1: Recall

.
.

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Chapter 03: The Laboratory Role in Infection Control

Mahon: Textbook of Diagnostic Microbiology, 7th Edition

MULTIPLE CHOICE

1. In acute care hospitals, transmission of pathogens as a result of treatment occurs as all

thefollowing “classifications” of infections, except
a. hand hygiene-acquired infections.
b. surgical site infections.
c. catheter-related bloodstream infections.
d. ventilator-associated pneumonias.
ANSWER: A
Although infections can be transmitted through improper hand hygiene, it is not a classification
of infection acquired in a hospital. Good handwashing technique is essential for preventing the
spread of pathogens in a health care setting, but infections are not classified as hand hygiene-
acquired infections. Surgical site infections, catheter-related bloodstream infections, and
ventilator-associated pneumonias are acquired from a treatment rendered to thepatient. For
example, catheter-related bloodstream infections usually occur when patients havesterile
catheter devices implanted into their bloodstream. Because of the invasive nature of the
catheter, bacteria can colonize on the catheter and cause sepsis. The patient did not enter the
hospital with this infection, but acquired the infection as a result of medical treatment.

OBJ: Level 1: Recall

2. An iatrogenic infection is one that

a. is caused by gram-negative bacteria.
b. occurs as a result of medical treatment.
c. is found in urinary tract infections.
d. is not subject to outbreak investigation.
ANSWER: B
The definition of an iatrogenic infection is one that is acquired in a health care setting.
Iatrogenic infections can be caused by gram-negative bacteria, but other types of bacteria may
also cause these types of infections (i.e., methicillin-resistant Staphylococcus aureus, MRSA).
Urinary tract infections can be a type of iatrogenic infection, but other types of infections are
also iatrogenic. Because an iatrogenic infection is acquired in a health care setting, outbreak
investigations are routinely conducted to determine the source of the infection so that the
bacteria can be killed and the spread of infection stopped.

OBJ: Level 1: Recall

3. This ongoing process helps public health and health care officials recognize outbreaks,
upward trends of infections, and positive effects of interventions.
a. Handwashing techniques
b. Intervention
c. Surveillance
d. Antimicrobial resistance
ANSWER: C

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Handwashing techniques help to prevent the spread of pathogens, and antimicrobial

resistanceidentifies organisms that are resistant to particular antibiotics, but these do not
identify outbreaks, upward trends of infections, or positive effects of interventions.
Intervention is an action taken to kill pathogenic bacteria-causing disease. Surveillance,
collection, and analysisof data about infections help public health officials recognize
outbreaks, upward trends of infections, and positive effects of interventions.

OBJ: Level 1: Recall

4. Iatrogenic infections are commonly associated with

a. breaks in aseptic technique.
b. preexisting infections.
c. food-borne illness.
d. respiratory aerosol transmission.
ANSWER: A
Health care-associated (nosocomial) infections occur after the patient arrives (generally not
within the first 48 hours) and were not incubating in the community before the patient arrived.
They occur because of instrumentation, increased use of antimicrobial agents, breaks in
aseptic techniques, and lack of hand hygiene.

OBJ: Level 1: Recall

5. When reviewing surgical site infections, the infection control practitioner must determine if
the patient’s infection is health care–associated by considering all the following, except
a. whether an endotracheal tube was present during surgery.
b. the length of surgery.
c. the degree of contamination of the surgical site (gunshot wound to the abdomen
versus a hernia repair).
d. whether any breaks in surgical technique occurred.
ANSWER: A
During surgery, there is a chance that bacteria present in the environment (including
instruments) can be transferred to the surgical site and cause an infection. When put under
general anesthesia, patients usually have a tube inserted to keep their airway open. This is not
unique to any particular surgery and therefore will probably not contribute to a nosocomial
infection. The length of surgery could contribute to an infection—the longer a person’s inner
tissue is exposed to the air, the more chance there is for bacteria or fungi to get into that
wound. The degree of contamination of the surgical site may contribute to a surgical site
infection because the gut contains lots of bacteria. When it is opened up, bacteria can leak into
the sterile abdominal cavity. If there were breaks in surgical technique and a contaminated
object was introduced into the sterile area, bacteria may have transferred to the wound, and
aninfection would follow.

OBJ: Level 1: Recall

6. To keep abreast of all infections that occur in the hospital, infection control practitioners set
up surveillance programs. These surveillance programs look at this parameter to determine if
there are more or fewer infections in a given period.
a. Antimicrobial susceptibility reports
b. Infection rates

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c. Handwashing rates
d. Glove usage
ANSWER: B
Antimicrobial susceptibility reports inform practitioners about the organisms that are resistant
to particular drugs. They do not address the number of infections in a health care facility.
Handwashing is an important part of preventing the spread of pathogens, but there is no one
who goes around and counts the number of times someone washes his or her hands. So this
isnot a parameter. Glove usage is assumed to be 100%, and it does not tell the practitioner
howmany infections were in the health care setting.

OBJ: Level 2: Interpretation

7. This program involves a close watch of only specific, high-risk, high-volume procedures for
nosocomial infections.
a. Baseline data
b. Total surveillance program
c. Targeted surveillance program
d. Data mining
ANSWER: C
Targeted surveillance programs look at particular programs for increases or decreases in
infection rates. Baseline data are used in a surveillance program and offer a marker for
comparison of subsequent data. Total surveillance programs look at all procedures for
increases or decreases in infection rates. Data mining uses sophisticated tools to analyze
data.

OBJ: Level 1: Recall

8. The counties surrounding yours are seeing an increase in the number of whooping cough
cases. This is important for the microbiology laboratory because
a. physicians may start sending these cases to you.
b. you will need to advise physicians to suspect such cases and to send them to
thehospitals in the surrounding counties.
c. you need to make sure that the infection control practitioners in those
countieshave baseline data.
d. you need to educate health care providers on specimen collection and
transportation, and have the specialized media ready so you can detect any cases
inyour county.
ANSWER: D
The laboratory can be proactive in educating health care providers on specimen collection and
transportation if those are unique to a specific public health concern. Awareness of infection
control activities within the public health setting allows the laboratory to acquire the necessary
media or reagents to meet emerging needs.

OBJ: Level 2: Interpretation

9. Information that the microbiology laboratory can provide to infection control practitioners
includes
a. the prevalence of a particular pathogen.
b. data on the effectiveness of handwashing techniques.

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c. information about the outbreak of meningitis cases in the surrounding counties.

d. the antibiotic ordering patterns of particular physicians.
ANSWER: A
The prevalence of a particular pathogen is another piece of information that the microbiology
laboratory can provide to the infection control practitioner. Prevalence is the number of cases
of disease that occurs in a given moment in time or specific time period in a given population.
Therefore, knowing what pathogens are isolated from a given body site and being familiar with
what pathogens are frequently isolated from a given location within a health care facilityare
important to the infection control practitioner.

OBJ: Level 1: Recall

10. A microbiology technologist is working at the bench and notices that a patient from the
cardiac intensive care unit (CICU) grows a Klebsiella pneumoniae bacterium that is an
extended-spectrum ฀-lactamase-producing isolate. This technologist would advise the
physician to
a. order any antimicrobial that is effective against gram-negative rods in general.
b. limit the use of antimicrobial agents that tend to induce the formation of
extended-spectrum ฀-lactamases.
c. draw more blood cultures, because the ones that grew that organism
arecontaminated.
d. be on the lookout for diarrhea.

ANSWER: B
Being able to recognize what pathogens are isolated from patients in a cardiac CICU may
provide the opportunity for the infection control practitioner to inform health care providers of
the effects of antibiotic preTssEuSreT
.ABsAaNnKeSxEamLpLleE, [Link]-spectrum ฀-lactamase-producing
Klebsiella pneumoniae isolates were seen in that MICU, the physicians may be advised to
limit the use of antimicrobial agents that tend to induce the formation of extended-
spectrum
฀-lactamases.

OBJ: Level 2: Recall

11. Organisms that represent public health concerns can be recovered from patients in an acute
care hospital. All of the following isolates are considered significant or major public health
concerns that are reportable to public health jurisdictions to follow up as a potential
outbreak,except
a. Neisseria meningitis.
b. West Nile virus.
c. MRSA.
d. encephalitis viruses.
ANSWER: C
Although MRSA can be an infection control issue within a health care facility, it is not yet
considered a significant public health concern. Methicillin-resistant S. aureus is usually born
and bred in a health care setting, but more cases of community-acquired MRSA are being
seen. The other organisms are spread by mosquitoes and close contact.

OBJ: Level 1: Recall

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12. Organisms that are frequently encountered as causes of health care-associated infections
inacute care settings include all the following organisms, except
a. MRSA.
b. enterococci.
c. Clostridium difficile.
d. Neisseria meningitis.
ANSWER: D
N. meningitis is usually not implicated in health care-associated infections. These infections
are usually outbreaks that occur in the community, especially in schools.

OBJ: Level 1: Recall

13. Patients in both extended care facilities and home care settings are frequently
immunosuppressed by disease or therapy and often need intravascular or other device-
relatedcare. The microbes identified in these patients are often opportunistic pathogens and
include all the following, except
a. Pseudomonas aeruginosa.
b. Neisseria meningitis.
c. Candida.
d. Acinetobacter.
ANSWER: B
Infectious etiologic agents of infection control significance identified in these patients include
P. aeruginosa, Candida, Staphylococcus aureus, Acinetobacter, Clostridium difficile,
methicillin-resistant Staphylococcus, and vancomycin-resistant enterococci.

OBJ: Level 2: Interpretation

14. Prisoners or people housed in behavioral health facilities are more likely to contract infections
with pathogens from their intimate contact with blood and body fluids. A likely pathogen may
be
a. Pseudomonas aeruginosa.
b. Hepatitis C.
c. Methicillin-resistant Staphylococcus aureus (MRSA).
d. Clostridium difficile.
ANSWER: B
People who are housed together in some form of communal living, such as prisons or
behavioral health facilities, have infection control-related infections similar to the other
settings previously described. The infectious diseases are more likely related to the activities
of the persons within the facility. As an example, MRSA is recovered from prisoners who
practice illicit tattooing with nonsterile, shared equipment, whereas lice and hepatitis C are
more frequently seen in behavioral health settings because of the community source of the
clients and their intimate contact with blood and body fluids.

OBJ: Level 1: Recall

15. An outbreak occurs when

a. numbers of isolates or infection rates increase significantly above the baseline.
b. numbers of isolates or infection rates decrease significantly below the baseline.

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c. many people in a community are infected with a particular organism.

d. the mortality rate from a particular organism increases above 2%.
ANSWER: A
When numbers of isolates or infection rates increase above the baseline or when an isolate
ofa rare or potential bioterrorism agent is recovered, an “outbreak” may have occurred. The
microbiology laboratory may be the first to recognize that event and will likely participate in
the investigation of that outbreak.

OBJ: Level 1: Recall

16. An index case is

a. an epidemiologic curve for a particular pathogen.
b. the last case described in an outbreak.
c. the first case described in an outbreak.
d. the case where the number of infections with a particular organism rises above
thebaseline.
ANSWER: C
The first case described is the index case, and the other infections that followed were to
bedetermined if they were related to that first case.

OBJ: Level 1: Recall

17. When an outbreak is suspected, all the following steps are taken in investigating that event,
except
a. establishing a case definition.
b. confirming that an outbreak exists.
c. immediately treating all persons involved with appropriate antibiotic.
d. establishing an epidemiologic curve.
ANSWER: C
First establish a case definition, and then confirm that an outbreak exists. One must be
certainthat all the suspected cases match the definition and that there are more than an
expected number of cases. Additional cases may be added to the initial number of cases.
Next, pull together as much information about the cases as possible, related to person,
place, or time, then draw an epidemiologic curve. Then form a hypothesis about the likely
reservoir, source,and means of transmission. At any point along the timeline, establish
interventions to stop theoutbreak.

OBJ: Level 1: Recall

18. In an outbreak investigation and in the collection of routine surveillance data, what sorts of
activities are critical?
a. Microbiologists’ awareness of the processes that occur in a routine investigation
b. Alerting the public health department about potential outbreaks
c. Analyzing data on antimicrobial susceptibility from pathogens in the hospital so
the health care providers understand the type of antimicrobials that must be
used
d. Collecting, processing, reporting, and reviewing pertinent cultures

ANSWER: D

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In an outbreak investigation and in the collection of routine surveillance data, the collection,
processing, reporting, and reviewing of pertinent cultures become critical. The availability of
culture reviews that may result in the initiation or termination of an outbreak investigation
cannot be overlooked in importance. These data form the basis for the decisions made at
eachstep of the investigation of an outbreak.

OBJ: Level 1: Recall

19. If a large statewide or worldwide epidemic occurs, one of the major difficulties is
a. collecting and transporting specimens from people who live out of state or around
the world.
b. determining what organism is causing the outbreak.
c. arranging to get all the people with the infections to come back to the main area of
the outbreak for an extended period.
d. making sure enough media and technologists are available to process the
largeamount of cultures associated with the outbreak investigation.
ANSWER: A
One of the major difficulties in a large outbreak is the ability to collect and transport
specimens from patients who live out of the area. Some of the individuals may have had their
cultures processed in their home state or country so that results from those cultures are
difficult to retrieve.

OBJ: Level 1: Recall

20. What is pulsed-field gel electrophoresis?

a. The process of performing various environmental cultures to aid in infection
control investigations
b. A strain-typing technique that can be an important adjunct to epidemiologic
investigations
c. A culture technique that compares the two antibiograms of an isolate with
theindex case
d. A technique that checks for water quality
ANSWER: B
Pulsed-field gel electrophoresis enables a microbiology technologist to determine the strain
ofan organism. Knowing the strain is important because, in an outbreak, the same strain of
organism is causing the problem. If the strain can be identified, the index case can be found,
and the outbreak can be stopped. This strain typing technique is more sensitive than
comparing antibiograms.

OBJ: Level 1: Recall

21. Although environmental cultures are not usually performed because the environment is rarely
implicated in disease transmission, they occasionally are useful. Samples will be taken from
all of the following, except
a. air.
b. water.
c. hands.
d. surfaces.

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ANSWER: C
Recommendations surrounding environmental infection control have been extensively
discussed in a Centers for Disease Control and Prevention (CDC) document. The environment
is rarely implicated in disease transmission, except with immunosuppressed patients. The air,
water, and surfaces are cultured when appropriate. Hands may transmit pathogens, but they
are not considered part of the environment.

OBJ: Level 1: Recall

22. Waterborne illnesses that may be associated with contaminated drinking water or
recreationwater include all the following, except
a. legionellosis.
b. hepatitis A.
c. Pseudomonas skin infection.
d. hepatitis B.
ANSWER: D
Hepatitis B is a blood-borne pathogen and cannot be contracted from contaminated water.
Waterborne diseases include respiratory illnesses (such as legionellosis), hepatitis (hepatitis
Aor hepatitis E), skin infections (from Pseudomonas or mycobacteria), and central nervous
system infections (Naegleria).

OBJ: Level 1: Recall

23. In the United States, 46 outbreaks annually owing to waterborne pathogens cause this
illnessand affect several thousand people.
a. Diarrhea
b. Hepatitis C
c. Naegleria
d. Legionnaires’ disease
ANSWER: A
These outbreaks can be due to Giardia lamblia, Escherichia coli, the Norwalk virus, Norwalk-
like viruses, and other viruses associated with diarrhea. Hepatitis C is a blood-borne
pathogen. Infection with Naegleria affects the brain and is relatively rare. Legionnaires’
disease is a respiratory illness.

OBJ: Level 1: Recall

24. The role of the microbiology laboratory is to perform cultures and provide culture results to
health care providers. The microbiology laboratory also has the responsibility to
a. report the identification or suspicion of certain infectious diseases to local,
state,and federal public health entities.
b. report any bioterrorism findings to the news media.
c. report odd infectious diseases to the CDC.
d. report any bioterrorism finding to the police.
ANSWER: A

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