Micro Exam #5 1994 - EXAMINA’MDN V DECEMBER 5 1994 SELECT...

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Unformatted text preview: EXAMINA’MDN V DECEMBER 5. 1994 SELECT THE SINGLE BEST ANSWER FOR THE FOLLOWING (1-31) QUESTIONS: 1. Both active immunization with an whole “visions fificatedmw ihTInnan"mEm hiasts,._ and 433351, 'vermnumzan' ' humid: hm Wmsbbulin an, ,forscfchtive pest- wwwm.“ “is; Hummus ewes! jflzs‘following vim A. hepatitis B virus B. rabies virus C. poliovirus D; varicella~zoster virus E- measles virus 2. Which of the following is £195 an "oppormnistic" disease of persons with AIDS ? A. Pnegggygtis pneumonia B. Kaposi’s sarcoma C. disseminated herpes zoster D. adult T-cell leukemia ' E. disseminated Mxoobacterium tuberculosis _ . --——\ W 3. finiagu‘a'rpfi 1994, a 2-month-old female was admitted to Kosair Hospital after gsymptoms of cough and fever had progressed to wheezing and cyanosis. Her bronchopneumonia was treated with aerosolized ribavirin, and she was discharged from the hospital seven days later. What virus was the most likely cause of her illness ? A. respiratory syncytial virus /Bf Muerto Canyon hantavirus £7 parainfluenza virus type 4 If. influenza B virus E. coronavirus % Which of the following groups of human viruses are the major cause of aseptic meningitis during the summer and early fall in the United States? flaviviruscs enteroviruses alphaviruses arenaviruses adenoviruses F’F’DF"? A farmer from Kentucky is planningfito' spend H12 anadvisor and consultant irTan fic‘xflfififlkegmn of 'y of the following immunimfions would you -- "nd for him prior so his negatefbriafijan?’ ‘ ‘ ’ * KA- a live-WW vaccine for a, hmmagig /B. vaccine. for a hemorrhagic, fever-causing C. a live-attenuated vaccine for an encephalitic D. an inactivated vaccine for an encephalitic flavivirus £7 a live-attenuated vaccine for a henmrrhagic fever-causing filovirus A livesattenuated immunodeficiency-virus (SIV) vaccine was reported in 1993 to protect rhesus monkeys from infection and illness when challenged with "wild-type" SIV. What viral gene was deleted from the "wild~type" SIV genome in order to create the replication—competent, live-attenuated virus? A. Gag B. Nef C. Pol D. Pro B. Env. _ Ammxmntmwvjnmyflmhomsufimjgmmesgts395L§9é2§ Viral disease gggill.EhQUnited.Statesarecmrentlyrexpetiencing symptoms??? fatigue, muscle, weaknessand difiicultyin breathing, These current symptoms have been attributed to this earlier viral infecfion. isthe name of this recently described clinical ? A. post—measles syndrome B. postchickenpox syndrome C. postopolio syndrome D. post~rubella syndrome E. post—mumps syndrome 8. The "C" and "H" in the "TORCH" syndrome refer to members of which of the following virus families? A. paramyxoviruses B. togaviruses ~ C. paramyxoviruses 6 D. picornaviruses E. herpesviruses 9. Immunization of infants with an inactivated vaccine containing polysacclioride conjugated to protein has significantly reduced the incidence of serious central nervous system disease due to this infectious agent X mumps virus ' lm , B. gyptococcus neoformans 0/ C. Haemgphilus influenza type B ‘1 D. inflm B virusflmthulu E. Neisseria mening'fidis 10. For which of the following viruses would the acquired immunity from natural infection be relatively short-lived (versus long-lasting or life-long) ? .4: measles virus "- B. human coronavirus ' C. coxsackie B virus <9) ,9: rubella virus E. echovirus 16 11. Specifing areinvolved in the progression of normal cervical epithelial cells to cervical carcinoma. Which of the following best describes the - presumed molecular mechanism(s) of viral oncogenesis by these human viruses? QAY' "" (5. binding of "early" viral proteins to host cell p53 and pIOS-RB proteins B’. insertional mutagenesis of c-glyg gene by integration of viral genome DNA % ,C. transcriptional transacfivation of cellular genes by viral Tax protein D. phosphorylation of cellular proteins by viral tyrosine-specific protein kinase E. induction of chromosomal lranslocation involving e-gbl gene 12. 13. 14. While in New York City for a three-day business trip, 3 Louisville businessman engaged in "unprotected" sexual intercourse with a female prostitute. When he returned to Louisville, he was worried and visited the "Specialty" (sexually- transmitted disease) Clinic, asking to be “tested for AIDS." Before this incident in NYC, he and his wife had a mutually monogamous sexual relationship for over twenty years, and neither had ever injected illegal drugs. Which of the following is the best response to this man’s request for HIV antibody testing? /i( heshouldbetestednowandalsoremrnforretestinginonemonthif ‘ the results from the first test are negative , B. he does M need to be tested because the chance of infection from a single potential exposure by vaginal intercourse is negligible he should pg; be tested at this time because of the possibility of a "false-negative" result, but should return for testing in three months /13. he should be tested now and told to refrain from future extramarital * intercourse if the test result is negative E. heshouldngbetestedatthistimebecauseofthepossibilityofa "false-positive" result, but should return for testing in one month “3°C. Cells in culture were infected with anIBNZ-subtype._.strtain‘oj_influenza A virus, and cellular and viral proteins were radiolabeled with [”S}methionine. A solubilized cell lysatewaspreparcd andmbjectedtoradioimmunoprecipitation with antiserumto purified HlNl-subtype influenza A virus. Which of the follom' g viral pgteins from the H3N2—subtype strain influenme A virus should be immunoprecipitated by the I-IlNl-specific antiserum and be detected by SDS-polyacrylamidegel electrophoresis ‘ and autoradiography: PB (RNA polymerase), NP (nucleoprotein), M (matrix), and HA (hemagglutinin) ? - Na A. PB + NP + M + HA B. PB + NP + M C. NP + HA D. only NP B. only HA Although rabies in raccoons has been increasing in incidence and has been spreading in much of the eastern United States in the last two decades, the suspected rabid animal (based upon genetic analysis of rabies viral RNA in brain tissue) responsible for the majority of indigenously-acquired human rabies cases since 1980 is the: A. dog B. cat C. bat D. fox E. skunk 15. Nasopharyngeal carcinoma. a cancer of epithelial cell origin, is most commonly found inhumansinthesouthernpartofChina. Whathumanvirushasbeen epidemiologically associated with this cancer ? A. HPV-16 B. mv-z C c EBV ~ D. HSV-l E.VZV 16. Which of the following antiviral treatments of pregnant women and their newborns has been very recently (early 1994) reported to significantly decrease viral transmission and prevent infection of the fetus or newborn? A. acyclovir treatment for women infected with herpes simplex virus type 2 C . B. ganciclovir treatment for women infected with Epstein-Barr virus ‘ C. zidovudine (AZT) ueannent for women infected with HIV D. ribavirin treatment for women infected with rubella virus E. rimantadine treatment for women infected with influenza A virus 17. All of the following are important causes of viral gastroenteritis in humans, exmt: A: adenovirus types 40 & 41 AB? human caliciviruses \ /€./human rotavinises D. coxsackie A & B viruses ‘E. Norwalk virus 18. The animal reservoir for Mug-go Canyon virus, theruqausgggfwtwhggutbrealoof syfifiume" in the United States in 1993, is their A. cotton rat /\79 B. deer mouse C. antelope D. deer E. raccoon 23. 26. Although vesicular (versus maculopapular) rashes are commonly associated with infections with HSV and VZV, vesicular rashes also occur with children infected with aspecifieRNA-contairfinghumanvirus. Whatisthishuman virus? A. measlesvirus ‘ B. coxsackieAvirus ' Which of the following is not a documented route of transmission of human immunode 016116wa Wimmwmmwmrmrw Nam—memmu augmmestrrfiif A. vaginal intercourse B. congenital and perinatal transmission C. aerosolization or contact with respiratory secretions D. sharing needles in intravenous drug abuse E. anal intercourse ChnicalmsmmeIVmfigensinhumansuahavebemdevelopeimdamusefulfor monitoring the progression of HIV infection in adults, and for testing for HIV infection of infants born to HIV-infected females. What is the HIV antigen detected in these assays ? A. p24 (Gag) B. gplZO (Env) C. p66/51 (Pol) D. p15 (Tat) E. gp41 (Env) This human influenza virus was the predominant clinical isolate in the United States during the previous influenza season (1 , and the vaccine strain of this virus has been updamd two years in a row because of detectable antigenic drift: A. influenza type A, H3N2 subtype B. influenza type A, H2N2 subtype C. influenza type A, H1N1 subtype D. influenza type B E. influenza type C 30. A. gnaw) Virus and herpes ll heye the greatest risk of serious ’Wm the A. fixstnimesterforbothmbellaandherpes B. firstnimesterforrubellaandendofthirdu'imesterforherpes C. firsttrimesterforherpesandcndofthirduimesterforrubella @ D. end ofthird trimester for both rubella and herpes E. first trimester for rubella and middle of second trimester for herpes 31. 41598 replace”?! 9f t1}; £999ng opwmleisfic W,_by foscamst '-’ “ A. cytomegalovirus retinitis B. disseminated herpes zosrer % C. genital papillomavirus infection D. measles pneumonia E. 0121 hairy leukoplalda The following set of answers (A - II listed in alphabetical order) are to be used in selecting the single best answer for Questions #32 o 37. Answers may be used once, more than once, or not at all. IF. keratoconjunctivitis 7 G. laryngotracheobronchitis - "an I ~_-H-.-—-menenueleesis I. pneumonia I)? post-infectious encephalomyelitis @’ gingivostomatitis aB'. hemorrhagic fever ~E.—-————het=pangina- 32. Measles virus was the most common cause of this clinical mdrome in the United States prior to licensing of the measles vaccine. e" if: "at ?.L:rv:u‘ - 05$p1“ fir m [9.35M Lipid-enveloped human viruses with segmented, single-stranded RNA genomes are the major cause of this clinical syndrome in adults every winter and spring in the United States. , Mtg ' xi)? 33. This clinical mdrome is the most common disease observed withrprimary infection ofchildren with herpes simplex virus type 1. ' ’ ' 35. This human clinical andmme is caused by members of two DNA-containing virus families (herpes and adeno), but not by members of RNA-containing virus families. 36. Theviralentf _ Virus genome- ww‘whfl _Wm.mmen w,.w,,n m ' f‘ r W 37. Outbreaks of this Wflmhumanshavebeendmenmdiqrficleral gagifig 0f. the filovimsfamily. 10 The following set of answers (A - J, listed in alphabetical order) are to be used in selecting the single best answer for Questions #38 - 44. Answers may be used once, more than once, or not at all. - F 38. Q 41. i: 43. A. adenovirus human immunodeficiency virus-l mumps virus parainfluenm virus rubella virus varicella-zoster virus B. c'oxsackie B virus C. cytomegalovirus D. Epstein—Barr virus E. herpes simplex virus-1 Frame “This virus causes 921.11“ msggiggmemmmdimlamnxmw s ad. ul . bur clinical symptoms can be prevented by prior vac ' ’on with an emetic-coated, live- .WAmwm-M.n.«-m M WMW.-¢.aw_tww.:;-w.smlm unkind.“ M NH . . A v, wwmmw < e ' “e ‘a‘W'-M~n~‘->-«>MNM w w 0 xiflm «firmmasnmmwammm an» “as o chyperimmun “me e human of dylj‘swehawsm a WWW” Wl‘b‘bTWjFTQ’B'r'EWw'Mfir ‘ :figlggigigfieff Mmdifis =P¢_,,myocarditis,,in the wesrern - -~———-——-—— t.__.~_. V. Orchitis is a fragile!!! va wmm— M.“ mm; m. Cmrcnfly in the this human m7 congenital transmission). Chm} Summer epidemipsmgf ,,ss=t0typcs of Transmission of this virus a -' a @[email protected]§1§,§X9m99t9n be «Themhilanzibgdxtnsgativsfi my, me, -m...t., ruewema.” y. 11 SELECT THE SINGLE BEST ANSWER FOR THE FOLLOWING QUESTIONS: Questions 45.48. A White mm “ ' - His " ‘ ’1;er W53 Wfikfifim to admisginnmmmsbmnchiauungvbiopsywww, , _ MW“. Enigma were .n9gafive- ,Awnmgaqglmgmbigmgmw Wynn w with the cc of budding east 5—7 microns in 311:). A positive culture revealed a whi fl 1d which need numerous _~ sfififiifimgfiofii’afi an occasxonally bercula 'JLIhid-ia- 45. The most likely fungal pathogen to be suspected is: m' r V 5 A denuzn-n-iis I ("NJ/+3 C B. Copwcoccus neoformans C. D. Sporathrix schenckii 46. All but one of fungi listed above an: Which is not dimorphic? W V,» _._ ,WW-«mw, ' wwrzmn .Wmm N A. Blastomyces dematizidis (B B. Crypwcoccw: neofomzans ' C. Hiszoplasma capsulawm D. Sporothrix schenckii 47- Wroclaw-bepcrfoxmediordefinifivelridemify-m organism yes‘rcsponsible for yinfecgion? a * A. nu9leie,,probe 3- mineanfigcn D C. exoantigen analysis D. all of the 48. Which of the following antifimgal agents womb: 9f..,°h9i°e in treating this fungal infcciion? A Inaconazolc B. Amphotericin B a) C. Ketoconazole D. Fluconazole 12 49. collected from an infant in the neonatal intensive care unit. Four days 12751", a positive reading was recorded on the blood culture detection system. Gram stain revealed what appeared to @mganisms, but no growth occurred on subculture. The only significant history on this child was the use of parenteral nutriu'on in the form [eff/Rid With this information. the blood culture was subculnn'ed onto WE medium, followed by overlaying the medium with olive oil. Based on this information, the most likely agent responsible for the fungernia is: .____ A. Histoplasma capsulamm fag B. Malassezia fiuj’ur \ -- C. Candida albicans D. Candida lusitanz‘ae .' 50. The enzymes, L—proline aminopeptidase and Beta-galactoaminidase, ate the primary "\ .1. 1y;- Compounds detected for the confirmation of which of the following yeasts? A. Cryptococcus neaformans ‘ B. Candida parapsilasis 76 "I" L - c Candida albicans . C. 5/5,, ,5 /" D Candida hairmziae a Ting:~ or ,_ ._ reported in the United, States but. unvetwcshpuldsll b9 awam 6Tfiniq‘iis finzgm In . , ‘0 elliptical" -—- Pacliéd Within clongated sells up. C" On a 'Ysausage" shape_,3.nd.,,it not stain well by the hematoxylin-eosin (I-I&E) method. .It is one of a ,fewrapidly growing A. Aspergtllus fiumgams ‘ B. Peniczlhum marnefii C. Fusarium D. Curvulan‘a 13 Questions 52 and 53 A 13 year old female presented to her complaining of weakness and headaches. Her blood glucose was 688 Mg/dl and serum pH was 6.88. She was admitted to a community hospital with a diagnosis of diabetic kcmamgipg,,rcagi!e§_i§§911n and fluids, and was discharged after 48 hours. Four days later she of bilateral blindness and severe head pain. She presented to the Children’s Hospital ER where a CT scan revealed slight cerebral edema. She was alert, mentally clearly..me nuchal rigidity and a temperature of 385°C. An LP revealed a protein of 65 Mg/dl, glucose of 161 Mg/dl (serum , glucose of >200 Mg/dl), and WBC count of 74 (PMNs predominating). No organisms were seen on Gram’s stain. On physical examination she had signs of acute sinusitis. An ENT fellow noted dark blood in the top of her nose. 52. Given this history and clinical findings, the primary fungal infection to be suspected is: A Aspergillosis C B Cryptococcosis C Zygomycosis D Histoplasmosis ‘ 53. Culture of the blood‘fromjhentgp of her nose yielded a rapidly growing (48 hours) mold describetas 'wooly, gra and completely filling the Peni dish. Microscopic analysis reveal; Ege aseptated', nonbranching hyphae. No rhizoids were observed. _ The most likely mold is: ' A. Aspergitlus -—\2 B Rhizapus C: Fusarium ~57 D. Mucar 54. Which of the following viruses is a member of the is known to be transmitted by the fecal-oral route, and causes acute hepatitis, recovery fiom which generally results in life-long immunity? A. HAV B. HBV // c. HCV \/ D. HDV ‘ E. REV 14 55. 56. 57. The incidence of infection with two of the three parenterally-transmitted hepatitis viruses has been greatly diminished due to availability of harmonization with recombinant viral antigen. These two viruses are: A. HAV and HBV B. HBV and HDV C. HBV and HCV D. HCV and HDV E. HAV and HCV 5A a“ The routine diagnosis of hepatitist virus (HCV), a positive-strand RNA virus, has become possible because of recently develoPed laboratory tests that detect antibodies to structural and non-structural antigens of HCV. In the case of a patient who has a hereditary to elicit an antibody response against any foreign antigen (inherited agammaglobulinemia), the only current means of laboratory diagnosis of HCV infection is by testing for viral genomic RNA in serum or plasm. Which of the following experimental procedures would you use to arrive at a rapid diagnosis in the absence of antibody production in this patient? per ELISA " B. RIBA c. lEM‘ D. RT-PCR % virus cell culture With the eradication of smallpox, the fluent of poxviruses as etiological agents for deadly diseases has been eliminated. But with the arrival of AIDS, the incidence of lesions caused by this opportunistic ponirus has significantly increased. ' Approximately 10% of AIDS patients have superficial umbilicated nodules caused by the virus. The presence of this virus can only be confirmed by histologically examining the nodules for the presence of very characteristic, large cosinophilic cytoplasmic inclusions in epithelial cells. This poxvirus is : A. variola B. vaccinia C. molluscum contagiosum D orf E cowpox 15 61. figggmrmgwhich causes acute hgg‘au'us was identified as "_H_,,_...M «W.VN‘WQ.WV. gnaw“... ..-....~.-.. on .4. w .4“ ’r’ W » ‘*Mthv—..~ _ ,— the cause in a recent outbreak of hepatitis in The virus is: hepatitis A virus hcpatitis B virus hepatitis C virus hepatitis D virus hepatitis E virus $119.05”? ¥ 17 ...
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