Micro 58 and 59 Flashcards

In the environment, an endemic dimorphic fungus grows in which form?

A. Encapsulated budding yeast
B. Intracellular endospores
C. Filamentous septate hyphae
D. Nonseptate tissue spherules

The environmental growth form of a dimorphic fungus is called which phase?

A. Saprobic phase
B. Parasitic phase
C. Latent phase
D. Disseminated phase

Where is the saprobic phase typically found?

A. Human macrophages
B. Cerebrospinal fluid
C. Pulmonary granulomas
D. Soil or decaying vegetation

After entering a human host, a dimorphic fungus transitions into which phase?

A. Sporulating phase
B. Parasitic phase
C. Saprobic phase
D. Teleomorphic phase

The parasitic phase of endemic fungi grows optimally at which temperature?

A. 25°C
B. 30°C
C. 37°C
D. 42°C

How does the parasitic phase reproduce?

A. Asexually
B. Sexually
C. By conjugation
D. By meiosis only

Why does conversion into larger yeast benefit dimorphic fungi?

A. It improves environmental sporulation
B. It increases airborne transmission
C. It provides a survival advantage
D. It prevents thermal conversion

Histoplasmosis is classically endemic to which regions?

A. California and Arizona
B. Great Lakes
C. Latin America
D. Mississippi and Ohio Valleys

A pulmonary fungal infection occurs near the Great Lakes. Which endemic mycosis is most likely?

A. Histoplasmosis
B. Blastomycosis
C. Coccidioidomycosis
D. Paracoccidioidomycosis

Blastomycosis is endemic primarily in which area?

A. Eastern and Central United States
B. Southwestern United States
C. Mississippi Delta only
D. Central and South America

A patient from Arizona develops a pulmonary fungal infection. Which disease is most likely?

A. Blastomycosis
B. Histoplasmosis
C. Paracoccidioidomycosis
D. Coccidioidomycosis

Coccidioidomycosis is endemic to which region?

A. Great Lakes region
B. Southwestern United States
C. Mississippi River Valley
D. Northeastern United States

Which state is particularly associated with coccidioidomycosis?

A. California
B. Ohio
C. Michigan
D. Maine

Paracoccidioidomycosis is endemic primarily to which region?

A. Eastern Europe
B. Southern Africa
C. Latin America
D. Southeast Asia

Coccidioidomycosis characteristically may disseminate to which tissues?

A. Liver and pancreas
B. Bone and skin
C. Retina and cornea
D. Thyroid and adrenal glands

A patient with coccidioidomycosis develops tender red leg nodules. Which finding is present?

A. Erythema nodosum
B. Kaposi sarcoma
C. Tinea corporis
D. Ecthyma gangrenosum

Which additional inflammatory rash may accompany coccidioidomycosis?

A. Erythema migrans
B. Pityriasis rosea
C. Erythema multiforme
D. Livedo reticularis

Joint pain accompanying coccidioidomycosis is termed what?

A. Myalgia
B. Arthralgia
C. Neuralgia
D. Pleuritis

Disseminated coccidioidomycosis may cause which serious CNS complication?

A. Encephalomalacia
B. Myelitis
C. Brain abscess
D. Meningitis

A tissue biopsy shows multiple buds surrounding a large yeast. Which organism is suggested?

A. Histoplasma capsulatum
B. Blastomyces dermatitidis
C. Paracoccidioides species
D. Coccidioides immitis

The characteristic budding pattern of Paracoccidioides is called what?

A. Captain’s wheel
B. Broad-based budding
C. Pilot wheel
D. Rosette conidia

How does Paracoccidioides yeast compare with erythrocytes?

A. Smaller than erythrocytes
B. Similar in size
C. Slightly smaller
D. Much larger

BAD1 is an important virulence factor of which fungus?

A. Histoplasma capsulatum
B. Blastomyces dermatitidis
C. Coccidioides immitis
D. Paracoccidioides brasiliensis

BAD1 promotes adhesion of blastomyces yeast to which cells?

A. Macrophages
B. Erythrocytes
C. Keratinocytes
D. Neutrophils

Macrophage adhesion mediated by BAD1 helps produce what?

A. Capsule formation
B. Arthroconidia production
C. Host immune response
D. Hyphal extension

BAD1 suppresses production of which inflammatory cytokine?

A. IL-4
B. IFN-γ
C. IL-10
D. TNF-α

High surface expression of BAD1 is associated with what cell-wall finding?

A. Thick β-glucan layer
B. Thin 1,3-α-glucan layer
C. Absent chitin layer
D. Thick ergosterol membrane

What relationship exists between BAD1 and 1,3-α-glucan?

A. Direct relationship
B. No relationship
C. Inverse relationship
D. Cyclic relationship

The outer wall of Coccidioides immitis contains which proteins?

A. Cysteine-rich hydrophobins
B. Histidine-rich adhesins
C. Glycine-rich porins
D. Proline-rich enzymes

Hydrophobins are located primarily in which fungal structure?

A. Nuclear membrane
B. Inner mitochondrial wall
C. Endospore cytoplasm
D. Outer cell wall

What is the principal virulence function of coccidioidal hydrophobins?

A. Promote binary fission
B. Resist phagocytosis
C. Produce ammonia
D. Digest collagen

The saprobic form of Coccidioides occupies which environmental niche?

A. Decaying hardwood
B. Bird droppings
C. Alkaline desert soil
D. Freshwater vegetation

Which pulmonary cells readily ingest coccidioidal endospores?

A. Alveolar macrophages
B. Type I pneumocytes
C. Bronchial goblet cells
D. Pulmonary fibroblasts

What happens after coccidioidal endospores are phagocytosed?

A. They are immediately destroyed
B. They undergo extracellular budding
C. They form bacterial endospores
D. They survive intracellularly

Which enzyme hydrolyzes urea during coccidioidal infection?

A. Catalase
B. Urease
C. Elastase
D. Coagulase

Urease initially converts urea into which products?

A. Ammonia and carbamate
B. Carbon dioxide and nitrate
C. Uric acid and ammonium
D. Citrate and bicarbonate

Carbamate breakdown ultimately generates additional amounts of what?

A. Sulfate
B. Lactate
C. Ammonia
D. Pyruvate

Maximum coccidioidal urease protein is found in which structure?

A. Mature arthroconidia
B. Germinating hyphae
C. Resting spherules
D. Endosporulating spherules

Peak ammonia production correlates with which fungal stage?

A. Endosporulating developmental stage
B. Environmental hyphal stage
C. Dormant conidial stage
D. Early attachment stage

The association of urease and ammonia is strongest during which process?

A. Yeast budding
B. Endospore development
C. Clamp formation
D. Hyphal fragmentation

What substrates can the coccidioidal alkaline proteinase digest?

A. Viral nucleic acids
B. Fungal ergosterol
C. Bacterial peptidoglycan
D. Structural proteins

During what portion of coccidioidal disease is the alkaline proteinase believed to be secreted?

A. Initial exposure
B. Entire disease course
C. Dissemination
D. Convalescence

A patient develops pulmonary coccidioidomycosis after exposure to desert dust. What is the usual mode of infection?

A. Ingestion of environmental spherules
B. Inhalation of arthroconidia
C. Traumatic implantation of yeast
D. Mosquito inoculation of conidia

Which environmental fungal particle initiates human infection with Coccidioides immitis?

A. Budding yeast cells
B. Intracellular endospores
C. Mature tissue spherules
D. Environmental arthroconidia

After inhalation, the yeast phase of Histoplasma capsulatum primarily resides within which cells?

A. Macrophages
B. Neutrophils
C. Keratinocytes
D. Alveolar epithelial cells

Histoplasma capsulatum avoids innate immune activation by concealing which immunostimulatory cell-wall component?

A. Chitin
B. Galactomannan
C. β-glucans
D. Ergosterol

Which receptor is primarily responsible for detecting fungal β-glucans?

A. Dectin-1
B. TLR4
C. CD14
D. Mannose receptor

Concealment of β-glucans allows H. capsulatum to avoid activation of which receptor?

A. CCR5
B. CD4
C. TLR2
D. Dectin-1

Following phagocytosis, which phagolysosomal change promotes intracellular survival of H. capsulatum?

A. Decreased oxygen concentration
B. Increased phagolysosomal pH
C. Increased lysosomal acidity
D. Decreased intracellular calcium

The pH modification used by H. capsulatum occurs within which intracellular compartment?

A. Nucleus
B. Endoplasmic reticulum
C. Phagolysosome
D. Golgi apparatus

Intracellular iron is limited within macrophages. How does H. capsulatum acquire this nutrient?

A. Degrading host hemoglobin
B. Producing iron-binding siderophores
C. Importing host ferritin directly
D. Activating host transferrin receptors

The siderophores produced by H. capsulatum primarily chelate which form of iron?

A. Ferric iron
B. Ferrous iron
C. Elemental iron
D. Heme-bound iron

What results when fungal siderophores bind ferric iron?

A. Insoluble iron precipitates
B. Host ferritin is destroyed
C. Iron enters fungal nuclei
D. Soluble iron complexes form

How does surface α-glucan promote H. capsulatum virulence?

A. It stimulates neutrophil migration
B. It increases fungal sporulation
C. It prevents immune recognition
D. It promotes phagolysosomal acidification

Certain strains of H. capsulatum naturally lacking α-glucan are found in which region?

A. North America
B. South America
C. Southeast Asia
D. Southern Africa

A patient with disseminated paracoccidioidomycosis develops painful oral ulcers. Which manifestation is characteristic of this disease?

A. Isolated nail destruction
B. Black palmar macules
C. Mucosal lesions
D. Diffuse scalp alopecia

Disseminated paracoccidioidomycosis most often produces mucosal lesions at which sites?

A. Eyes, ears, and scalp
B. Bladder, urethra, and kidney
C. Esophagus, stomach, and colon
D. Mouth, nose, sometimes gastrointestinal tract

Which group contains the four principal polysaccharides in the Paracoccidioides brasiliensis cell wall?

A. Cellulose, mannan, dextran, glycogen
B. Galactomannan, α-glucan, β-glucan, chitin
C. Chitosan, cellulose, starch, glycogen
D. Peptidoglycan, chitin, mannan, cellulose

Which P. brasiliensis cell-wall component is expressed only during the yeast phase?

A. Galactomannan
B. Chitin
C. 1,3-β-glucan
D. 1,3-α-glucan

Expression of yeast-phase 1,3-α-glucan in P. brasiliensis correlates with what?

A. Increased virulence
B. Reduced thermal tolerance
C. Decreased tissue adhesion
D. Increased sexual reproduction

The gp43 antigen of P. brasiliensis binds which host extracellular matrix protein?

A. Fibronectin
B. Collagen IV
C. Laminin-1
D. Elastin

Binding of laminin-1 by gp43 may promote adhesion of P. brasiliensis to which structure?

A. Vascular endothelium
B. Host basement membrane
C. Erythrocyte membranes
D. Pulmonary surfactant

Which organism is the most common opportunistic fungal pathogen?

A. Candida
B. Coccidioides
C. Blastomyces
D. Paracoccidioides

Endogenous candidiasis often originates from colonization of which site?

A. Respiratory alveoli
B. Keratinized nail plates
C. Subcutaneous connective tissue
D. Gastrointestinal mucosa

Candida albicans hyphae can follow surface grooves and penetrate pores. What is this growth response called?

A. Chemotropism
B. Thigmotropism
C. Phototropism
D. Thermotropism

What pathogenic advantage does Candida hyphal thigmotropism provide?

A. Increased spore production
B. Resistance to antifungal drugs
C. Infiltration of epithelial surfaces
D. Avoidance of thermal conversion

When grown at 20°C, Candida albicans typically demonstrates which forms?

A. Budding yeasts and pseudohyphae
B. Germ tubes and spherules
C. Arthroconidia and sporangia
D. Capsules and clamp connections

Incubating Candida albicans at 37°C promotes formation of which structure?

A. Sporangiospores
B. Germ tubes
C. Clamp connections
D. Endospores

Which surface property characterizes C. albicans germ tubes?

A. Hydrophobic
B. Hydrophilic
C. Negatively charged
D. Heavily encapsulated

Which surface property characterizes Candida blastoconidia?

A. Hydrophobic
B. Lipid soluble
C. Hydrophilic
D. Acid resistant

Which two enzymes are primarily secreted by Candida?

A. Catalase and urease
B. Aspartyl proteinases and phospholipases
C. Phenoloxidase and coagulase
D. Elastase and collagenase

Candida can rapidly alternate between budding yeast, pseudohyphae, and hyphae. What is this ability called?

A. Phenotype switching
B. Antigenic drift
C. Thermal inactivation
D. Heterologous interference

Phenotype switching is an important virulence property of which organism?

A. Candida albicans
B. Cryptococcus neoformans
C. Aspergillus fumigatus
D. Coccidioides immitis

Which description best characterizes Cryptococcus neoformans?

A. Nonencapsulated filamentous mold
B. Heavily encapsulated yeast
C. Intracellular dimorphic fungus
D. Nonseptate environmental mold

How is Cryptococcus neoformans usually acquired?

A. Traumatic skin implantation
B. Contaminated food ingestion
C. Arthropod inoculation
D. Inhalation of aerosolized organisms

After pulmonary acquisition, C. neoformans commonly spreads through which route?

A. Retrograde axonal transport
B. Direct tissue extension
C. Lymphatic obstruction
D. Hematogenous dissemination

Hematogenous cryptococcal dissemination shows a particular tropism for which site?

A. Nail beds
B. Intestinal villi
C. Meninges
D. Skeletal muscles

The cryptococcal capsule impairs host defense by interfering with which process?

A. Complement synthesis
B. Neutrophil production
C. Antigen presentation
D. Antibody class switching

The capsule of C. neoformans limits host-cell production of which antimicrobial molecule?

A. Hydrogen peroxide
B. Hypochlorous acid
C. Superoxide dismutase
D. Nitric oxide

Which fungal enzyme catalyzes melanin production?

A. Phospholipase
B. Aspartyl proteinase
C. Phenoloxidase
D. Urease

The alpha-mating phenotype of C. neoformans is associated with which gene?

A. BAD1
B. STE12alpha
C. Dectin-1
D. gp43

Which disease is the most common invasive mold infection worldwide?

A. Cryptococcosis
B. Candidiasis
C. Mucormycosis
D. Aspergillosis

Which Aspergillus toxin suppresses both macrophage and T-cell functions?

A. Aflatoxin
B. Endotoxin
C. Gliotoxin
D. Ergotamine

Gliotoxin directly inhibits which macrophage function?

A. Phagocytosis
B. Antigen synthesis
C. Antibody secretion
D. Histamine release

In addition to macrophage inhibition, gliotoxin suppresses which lymphocyte activities?

A. B-cell class switching
B. T-cell activation and proliferation
C. NK-cell antibody production
D. Neutrophil maturation and migration

Aspergillus fumigatus can adhere to which two host molecules?

A. Collagen and elastin
B. Fibronectin and keratin
C. Chitin and glucan
D. Fibrinogen and laminin

The laminin bound by A. fumigatus is located in which pulmonary structure?

A. Bronchial mucus layer
B. Pulmonary surfactant
C. Alveolar basement membrane
D. Pleural connective tissue

Which hematologic abnormality is strongly associated with invasive aspergillosis?

A. Neutropenia
B. Eosinophilia
C. Thrombocytosis
D. Polycythemia

Why does profound neutropenia predispose patients to invasive aspergillosis?

A. Neutrophils activate fungal growth
B. Neutrophils produce fungal capsules
C. Neutrophils normally damage hyphae
D. Neutrophils generate fungal spores

Aspergillus possesses which hydrogen peroxide–degrading enzyme?

A. Coagulase
B. Urease
C. Catalase
D. Phenoloxidase

Catalase acts on hydrogen peroxide to produce which effect?

A. Increased fungal pigmentation
B. Enhanced T-cell activation
C. Increased hydrogen peroxide
D. Hydrogen peroxide degradation

Which medications can increase susceptibility to invasive Aspergillus growth?

A. Antihistamines
B. Corticosteroids
C. Beta blockers
D. Antacids

Most mycotoxicoses result from which exposure?

A. Eating contaminated foods
B. Inhaling fungal hyphae
C. Traumatic spore implantation
D. Person-to-person transmission

Aflatoxin exposure most commonly originates from which foods?

A. Stored grains and nuts
B. Fresh fruits and vegetables
C. Undercooked meat and fish
D. Unpasteurized milk products

Which fungal genus commonly produces aflatoxins?

A. Candida
B. Aspergillus
C. Cryptococcus
D. Pneumocystis

Chronic dietary aflatoxin exposure increases the risk of which malignancy?

A. Renal cell carcinoma
B. Pancreatic adenocarcinoma
C. Hepatocellular carcinoma
D. Colorectal adenocarcinoma

Which environmental reservoir is strongly associated with Cryptococcus neoformans?

A. Pigeon-dropping–enriched soil
B. Alkaline desert soil
C. Decaying rose thorns
D. Stored grains and nuts

Which group contains the four recognized primary endemic fungal pathogens?

A. Candida, Cryptococcus, Aspergillus, Mucor
B. Histoplasma, Candida, Rhizopus, Fusarium
C. Blastomyces, Coccidioides, Histoplasma, Paracoccidioides
D. Aspergillus, Coccidioides, Candida, Cryptococcus

Blastomyces, Coccidioides, Histoplasma, and Paracoccidioides belong primarily to which fungal phylum?

A. Ascomycota
B. Basidiomycota
C. Mucoromycota
D. Microsporidia

The four classic endemic fungal pathogens share which growth property?

A. Obligately intracellular growth
B. Exclusive yeast morphology
C. Nonseptate hyphal growth
D. Thermal dimorphism

Which organisms are generally opportunistic fungal pathogens?

A. Blastomyces, Histoplasma, Coccidioides
B. Candida, Cryptococcus, Aspergillus
C. Paracoccidioides, Histoplasma, Blastomyces
D. Coccidioides, Fusarium, Histoplasma

Opportunistic fungi commonly cause infection after which event?

A. Development of strong Th1 immunity
B. Skin or mucosal barrier disruption
C. Increased neutrophil production
D. Formation of antifungal antibodies

Besides barrier damage, what predisposes patients to opportunistic fungal disease?

A. Excessive antibody production
B. Increased complement activation
C. Enhanced epithelial turnover
D. Defective innate immunity

Which ability is crucial for survival of endemic dimorphic fungi?

A. Formation of bacterial endospores
B. Transformation at body temperature
C. Growth only below 20°C
D. Permanent environmental sporulation

After thermal transformation, endemic fungi must replicate to colonize which tissue?

A. Intestinal epithelium
B. Keratinized skin
C. Genital mucosa
D. Respiratory mucosa

After reaching the alveoli, Blastomyces conidia transform into what?

A. Larger yeast cells
B. Tissue arthroconidia
C. Encapsulated spherules
D. Septate environmental hyphae

The temperature-dependent transformation of Blastomyces is termed what?

A. Phenotype switching
B. Antigenic variation
C. Thermal dimorphism
D. Heterologous interference

A BAD1-knockout Blastomyces strain would most likely show what?

A. Reduced virulence
B. Increased virulence
C. Increased spore production
D. Enhanced macrophage adhesion

Which immune response provides better protection against Blastomyces?

A. Th2 response
B. Treg response
C. Humoral response only
D. Th1 response

A dominant Th2 response to Blastomyces is associated with what?

A. Chronic infection
B. Rapid fungal clearance
C. Sterilizing immunity
D. Reduced tissue damage

In the saprobic phase, Coccidioides conidia have which surface property?

A. Hydrophilic
B. Hydrophobic
C. Strongly acidic
D. Heavily encapsulated

What consequence results from hydrophobic Coccidioides conidia?

A. They aerosolize readily
B. They remain water-bound
C. They lose infectivity rapidly
D. They remain inside soil roots

Hydrophobic surface molecules also help Coccidioides avoid what?

A. Antibody production
B. Complement synthesis
C. Thermal conversion
D. Phagocytosis

The saprobic form of Coccidioides inhabits which environment?

A. Acidic forest soil
B. Bird-dropping–enriched soil
C. Decaying river vegetation
D. Alkaline desert soil

Coccidioides creates what local chemical environment around itself?

A. Acidic halo
B. Alkaline halo
C. Hypoxic halo
D. Iron-depleted halo

Which enzyme generates the protective alkaline environment?

A. Catalase
B. Phenoloxidase
C. Urease
D. Phospholipase

The alkaline halo helps Coccidioides resist which host cells?

A. Macrophages
B. Erythrocytes
C. Platelets
D. B lymphocytes

Coccidioides proteinases can digest which structural proteins?

A. Keratin and fibrinogen
B. Actin and myosin
C. Tubulin and laminin
D. Collagen and elastin

Which blood protein can be degraded by Coccidioides proteinases?

A. Albumin
B. Hemoglobin
C. Transferrin
D. Fibrinogen

Which immunoglobulins are cleaved by Coccidioides proteinases?

A. IgM and IgE
B. IgD and IgM
C. IgG and IgA
D. IgE and IgD

Degradation of collagen, immunoglobulins, and hemoglobin promotes what?

A. Survival on host mucosa
B. Environmental spore formation
C. Sexual fungal reproduction
D. Production of clamp connections

After inhaled Histoplasma conidia enter tissue, which form survives primarily inside host macrophages?

A. Septate hyphae
B. Small yeast cells
C. Endospore-filled spherules
D. Encapsulated blastoconidia

Intracellular H. capsulatum resists phagocyte killing partly by producing which factors?

A. Host cytokine receptors
B. Bacterial capsule proteins
C. Antibody-cleaving ribosomes
D. Oxidative-stress defense enzymes

H. capsulatum manipulates its intracellular compartment toward which condition?

A. Nearly neutral pH
B. Strongly acidic pH
C. Strongly alkaline pH
D. Complete lysosomal rupture

Which compartment has its pH modified by intracellular Histoplasma?

A. Mitochondrion
B. Endoplasmic reticulum
C. Phagolysosome
D. Host-cell nucleus

Why does maintaining a less acidic phagolysosome benefit H. capsulatum?

A. It promotes sexual reproduction
B. It enhances intracellular survival
C. It produces airborne conidia
D. It activates macrophage killing

Virulence-associated 1,3-α-glucan occurs in Blastomyces and most strains of which fungus?

A. Histoplasma capsulatum
B. Cryptococcus neoformans
C. Aspergillus fumigatus
D. Candida albicans

Which host cells commonly ingest P. brasiliensis yeast?

A. Neutrophils
B. Keratinocytes
C. Erythrocytes
D. Macrophages

Symptomatic adult paracoccidioidomycosis is markedly more common in which sex?

A. Females
B. Males
C. Both equally

What helps protect adult women from paracoccidioidomycosis?

A. Estrogen
B. Progesterone
C. Testosterone
D. Cortisol

Which antigen is secreted by the yeast phase of P. brasiliensis?

A. BAD1
B. gp43
C. SOWgp
D. Gliotoxin

Which description best characterizes Cryptococcus neoformans?

A. Heavily encapsulated yeast
B. Nonseptate filamentous mold
C. Intracellular dimorphic fungus
D. Endospore-forming spherule

Which population is at greatest risk for severe cryptococcosis?

A. Immunocompromised patients
B. Healthy young athletes
C. Patients with hypertension
D. Individuals with iron deficiency

Which cells form the first pulmonary defense against inhaled Cryptococcus?

A. Circulating B lymphocytes
B. Alveolar macrophages
C. Intestinal macrophages
D. Epidermal dendritic cells

Which recruited cells provide another innate defense against cryptococcosis?

A. Inflammatory phagocytic cells
B. Resting erythrocytes
C. Intestinal epithelial cells
D. Platelet-derived cells

Which adaptive defenses contribute to cryptococcal control?

A. T-cell and B-cell responses
B. Erythrocyte and platelet responses
C. Fibroblast and keratinocyte responses
D. Osteoblast and chondrocyte responses

What is the principal protective function of the cryptococcal capsule?

A. Accelerate yeast budding
B. Produce fungal melanin
C. Resist host phagocytosis
D. Bind alveolar laminin

Besides resisting phagocytosis, the cryptococcal capsule helps the fungus do what?

A. Evade broader immune responses
B. Produce airborne arthroconidia
C. Invade blood vessels directly
D. Digest host collagen

Which pulmonary cells normally ingest and kill Aspergillus conidia?

A. Neutrophils
B. Alveolar macrophages
C. B lymphocytes
D. Type I pneumocytes

After Aspergillus conidia germinate, which cells primarily attack the resulting hyphae?

A. Neutrophils
B. Erythrocytes
C. Plasma cells
D. Mast cells

Why are neutrophils particularly important in invasive aspergillosis?

A. They prevent conidial inhalation
B. They generate fungal antibodies
C. They adhere to and kill hyphae
D. They inhibit macrophage recruitment

Hyphae escaping immune killing may invade which pulmonary structures?

A. Bronchial mucus and vasculature
B. Pulmonary tissue and vasculature
C. Pleural fluid and pulmonary mucus

Vascular invasion by Aspergillus can directly cause what?

A. Thrombosis
B. Hypercalcemia
C. Hemolysis
D. Bronchospasm

Occlusion of invaded pulmonary vessels may produce which local consequence?

A. Tissue necrosis
B. Increased mucus clearance
C. Alveolar hyperplasia
D. Pulmonary calcification

After entering pulmonary blood vessels, Aspergillus may spread by which route?

A. Retrograde axonal transport
B. Direct mucosal extension
C. Hematogenous dissemination
D. Fecal-oral transmission

Which organ is an important target of disseminated invasive aspergillosis?

A. Brain
B. Thyroid
C. Gallbladder
D. Appendix

A. fumigatus conidia bind which soluble host protein?

A. Hemoglobin
B. Fibrinogen
C. Albumin
D. Transferrin

A. fumigatus also binds which basement-membrane protein?

A. Laminin
B. Keratin
C. Actin
D. Myosin

The laminin bound by A. fumigatus is located primarily where?

A. Alveolar basement membrane
B. Bronchial mucus layer
C. Pulmonary surfactant
D. Pleural cavity

Binding fibrinogen and laminin provides Aspergillus with which advantage?

A. Enhanced pulmonary adherence
B. Increased toxin ingestion
C. Reduced conidial germination
D. Improved sexual reproduction

Chronic granulomatous disease strongly predisposes patients to which fungal infection?

A. Dermatophytosis
B. Invasive aspergillosis
C. Tinea versicolor
D. Tinea nigra

What immune defect underlies chronic granulomatous disease?

A. NADPH oxidase deficiency
B. Complete neutrophil absence
C. Antibody class-switching failure
D. Terminal complement deficiency

NADPH oxidase deficiency primarily impairs production of what?

A. Reactive oxygen species
B. Antiviral antibodies
C. Complement proteins
D. Histamine granules

The increased Aspergillus risk in CGD reflects defective function of which cells?

A. Phagocytes
B. Erythrocytes
C. Hepatocytes
D. Fibroblasts