Immunology Chapters 17-20

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1

Members of the Streptococcus pyogenes species are almost always ________-hemolytic.

Beta

2

A characteristic of necrotizing fasciitis is that it:

  1. is known as the “flesh-eating” bacteria.
  2. is caused by Streptococcus pyogenes.
  3. destroys the tissue covering the muscles.
  4. all of the above.

Necrotizing Fasciitis

All of the above

3

Streptolysin O is:

the most frequently used serologic indicator (antibody response) of a recent streptococcal infection.

4

Streptolysin S is:

an oxygen-stable enzyme.

5

Laboratory diagnosis of S. pyogenes can be made by:

  1. culturing of throat or nasal specimens.
  2. ASO procedure.
  3. anti–DNase B (ADN-B).
  4. all of the above.

S. pyogenes

Al of the above

6

An elevated antistreptolysin O (ASO) titer indicates:

relatively recent streptococcal infection

7

Most patients who have Streptococcus pyogenes infection begin to demonstrate a rise in antibody titer in ______days.

7

8

Serologic testing for S. pyogenes should compare acute and convalescent specimens collected ________ apart.

3 weeks

9

Shocklike symptoms can be produced by high levels of:

S. pyogenes superantigens and cytokines

10

The case definition of STSS includes serological confirmation of Group A streptococcal infection by a ____________increase against SLO and DNAse B:

fourfold

11

S. progenies is the most common causative agent of all the following disorders and complications except:

1. pharyngitis

2. gastroenteritis

3. scarlet fever

4. impetigo

Gastroenteritis

12

All of the following characteristics are descriptive of M protein except:

1. No known biological role

2. Found in association with the hyaluronic capsule

3. Inhibits phagocytosis

4. Antibody against M protein provides type-specific immunity

No known biological role

13

Substances produced by S. progenies include all of the following except:

1. Hyaluronidase

2. DNAses (A, B, C, D)

3. Erythrogenic toxin

4. Interferon

Interferon

14

Laboratory diagnosis of S. progenies can be made by all of the following except:

1. Culturing of throat or nasal specimens

2. Febrile agglutinins

3. ASO procedure

4. Anti-DNase B

Febrile agglutinins

15

False ASO results may be caused by all of the following except:

1. Room temperature reagents and specimens at the time of testing

2. The presence of beta-lipoprotein

3. Bacterial contamination of the serum specimen

4. Oxidation of ASO reagent caused by shaking or aeration of the reagent vial

Room temperature reagents and specimens at the time of testing

16

Members of the S. progenies species are almost always ______ hemolytic.

Beta-

17

Long-term complications of S. progenies infection can include:

1. Acute rheumatic fever

2. Poststreptococcal glomerulonephritis

3. Rheumatoid arthritis

4. Both a and b

Both a and b

18

Particularly virulent serotypes of S. progenies produce proteolytic enzymes that cause ________ in a wound or lesion on an extremity.

Necrotizing fasciitis

19

Also called spreading factor

Hyaluronidase

20

Dissolves clots by converting plasminogen to plasmin.

Streptokinase

21

Responsible for characteristic scarlet fever rash

Erythrogenic toxin

22

All the following characteristics of S. pyogenes are correct except:

1. It is an uncommon pathogen.

2. It occurs most frequently in school-age children.

3. It is spread by contact with large droplets produced in the upper respiratory tract.

4. It has been known to cause food borne and milk borne epidemics.

It is an uncommon pathogen.

23

The clinical manifestations of S. pyrogenes-asgociated upper respiratory infection are:

Age dependent

24

The most reliable immunologic test for recent S. pyrogenes skin infection is:

Anti-DNAse B

25

Increase in severity of infection

Rising titer

26

Trend toward recovery

Declining titer

27

Not a current infection, but indicates a past infection

Constant (low) titer

28

If a streptococcal infection is suspected, but the ASO titer does not exceed the reference range, a(an) ______ should be performed

Anti-DNAse B test

29

The classic tests to demonstrate the presence of streptococcal infection are:

ASO and anti-DNAse B

30

The highest reported levels of sensitivity testing for group A streptococci are in:

Surface (optical) immunoassay

31

Syphilis develops in which percentage of the sexual partners of persons with syphilitic lesions?

30% to 50%

32

In infected donor blood, Treponema pallidum does not appear to survive in citrated blood stored at 4° C for more than _____day(s).

3

33

Before clinical or serologic manifestations, the incubation period for syphilis usually lasts ______________________.

About 3 weeks

34

The term for nontreponemal antibodies produced by syphilis-infected patients against components of their own or other mammalian cells is:

reagin antibodies

35

The nontreponemal antibody produced by syphilis-infected patients can also be produced by patients with:

  1. other infectious diseases.
  2. leprosy, tuberculosis, leptospirosis, or malaria.
  3. autoimmune disorders, drug addiction, or old age.
  4. all of the above.

Nontreponemal Antibody

All of the above

36

Tertiary syphilis is best evaluated by using:

Cerebrospinal fluid

37

The substance detected by the RPR assay is:

a reagin

38

Untreated congential syphilis can lead to:

  1. stillbirth.
  2. neonatal death.
  3. infant disorders.
  4. all of the above.

Untreated Congenital Syphilis

All of the above

39

A biological false-positive reaction is least likely to occur with which syphilis assay?

FTA-ABS

40

Direct examination of the treponemes is most often performed by?

Darkfield microscopy

41

Yaws

T. pertenue

42

Syphilis

T. pallidum

43

Pinta

T. carateum

44

Bejel

T. pallidum (variant)

45

Diagnosis only by serological methods; noninfectious state, unless relapse patient is infectious

Latent syphilis

46

Presence of gummas (granulomas); usually seen 3-10 years

Late (tertiary) syphilis

47

Development of a chancre, multiplication of spirochetes, and highly contagious; chancre persists about 1-5 weeks and heals within 4-6 weeks

Primary syphilis

48

Generalized illness followed by macular lesions in most patients; within 2-8 weeks (up to 6 months); symptoms mimic viral infection and progresses to lymphadenopathy and skin lesions; may involve central nervous system

Secondary syphilis

49

A term for nontreponemal antibodies produced by an infected patient against components of their own or other mammalian cells

Reagin antibodies

50

Treponemal method

FTA-ABS and TP-PA test

51

Nontreponemal method

RPR test

52

In the RPR procedure, a false-positive reaction can result from all the following except:

1. Infectious mononucleosis

2. Leprosy

3. Rheumatoid arthritis

4. Streptococcal pharyngitis

Streptococcal pharyngitis

53

The first diagnostic blood test for syphilis was the:

Wasserman

54

Syphilis was initially treated with:

Heavy metals (arsenic)

55

Direct examination of the treponemes, the test of choice for primary syphilis, is most often performed by:

Darkfield microscopy

56

Pathogenic treponemes _____ cultivable with consistency in artificial laboratory media.

Are not

57

In infected blood, T. pallidum does not appear to survive at 4 degrees Celsius (39 degrees F) for longer than:

3 days

58

The primary incubation period for syphilis (T. pallidum) is usually about:

3 weeks

59

The stage of syphilis that can be diagnosed only by serologic laboratory methods is the:

Latent phase

60

Immunocompetent patients infected with T. pallidum produce:

1. Specific antibodies against T. pallidum

2. Nonspecific antibodies against the protein antigen group common to pathogenic spirochetes

3. Reagin antibodies

4. All of the above

T. pallidum

All of the above

61

Most streptococci that contain the cell wall antigens of the Lancefield group A, are the common cause of pharyngitis, may lead to scarlet fever, acute rheumatic fever, post streptococcal glomerulonephritis, or impetigo, and is the most common cause of necrotizing fasciitis and also associated with toxic shock syndrome:

Streptococcus pyogenes

62

Almost all streptococci are:

beta hemolytic

63

morphological characteristic of S. pyogenes

Gram-positive cocci

64

A cell protein found in association with the hyaluronic capsule, a major virulence factor of S. pyogenes that inhibits/impedes phagocytosis; a lack of, the organism is unable to cause infection; those that affect the throat are capable of causing rheumatic fever

M protein

65

oxygen-labile enzyme, binds to RBC's, is antigenic; antibody response is most frequently used serologic indicator of recent infection; increased antibody response; begins to rise about 7 days after onset and reaches max at 4-6 weeks; elevated titer indicates relatively recent infection

Streptolysin O (SLO)

66

oxygen-stable enzyme, responsible for beta hemolysis clearing on a blood agar plate, not antigenic; causes osmotic lysis

Streptolysin S

67

spreading factor

Hyaluronidase

68

enzyme that converts plasminogen to plasmin; is a clot buster

Streptokinase

69

causes classic rash associated with scarlet fever

Erythrogenic toxin

70

one of the most common and ubiquitous of human pathogens; found in the human respiratory tract, spread by respiratory droplets

S. pyogenes

71

S. pyogenes acute pharyngitis (strep throat) and impetigo (pyoderma)

upper respiratory infection

72

S. pyogenes skin infections

impetigo and cellulitis

73

the result of Group A strep that produces erythrogenic toxin and gives characteristic rash

Scarlet fever

74

Peak titers are seen at the time of acute poly arthritis of acute rheumatic fever, but are no longer at peak levels during carditis; can be elevated in healthy persons due to history of infections

Antistreptolysin O (ASO)

75

Most reliable measure of recent S. pyogenes skin infection; Titer levels are elevated in more than 2/3 of patients with recent streptococcal impetigo

Anti-DNAse B (ADN-B)

76

Standardized serological tests for drawing levels at acute and convalescent phases, about 3 weeks apart

ASO and ADN-B (Anti-Dnase) testing

77

elevated in acute or convalescent paired specimens in 80-85% of patients with acute rheumatic fever

ASO level

78

elevated in the remaining 15-20%

ADN-B level

79

caused by highly invasive Group A streptococcal infection and is associated with shock and organ failure; exogenous endotoxins such as TNF-a (alpha) can mediate fever, shock, and tissue injury; M protein also contributes; super antigens can create high levels of cytokine production and contribute to shock like symptoms

Streptococcal Toxic Shock Syndrome (STSS)

80

Serological confirmation of _______ infection and a fourfold rise against SLO and DNAse B; mild leukocytosis, positive blood cultures, and/or hemoglobinuria; requires immediate treatment (antibiotics)

Group A

81

caused by streptococcus agalactiae; leading cause of early-onset neonatal sepsis in the US; mothers screened at 35-37 weeks gestation for colonization

Group B Streptococcal Disease

82

Group B Streptococcal disease etiology

gram-positive cocci bacterium

83

caused by spirochete bacterium, Treponema pallidum, the most common STD in the US

Syphilis

84

the bacterium that causes syphilis; incubation period of usually 3 weeks, but can range from 10-90 days

Treponema pallidum

85

direct examination of ______ is most often performed by dark field microscopy; they remain viable up to 5 days in tissue specimens and from diseased animals and from frozen cryoprotected specimens

treponemes

86

several birth defects if untreated such as stillbirth, neonatal defects, deafness, neurologic impairments, and bone deformities

congenital syphilis

87

syphilis seen in children older than 2 who are left untreated

Hutchisonian Triad

88

syphilis involving the brain or spinal cord; headaches, stiff neck, possible stroke syndrome

meningeal neurosyphilis

89

predominant antitreponemal antibody present in early or untreated early latent syphilis

IgM

90

highest antitreponemal antibody present in secondary stage syphilis

IgG

91

nontreponemal antibodies produced by infected patients against components of their own cells; also produced against other infectious diseases and/or other conditions

reagin antibodies

92

uses fluorescent-labeled antibody conjugate to T pallidum

Direct and Indirect fluorescent antibody

93

determines the presence of reagin against cardiolipin

nontreponemal methods

94

an antibody formed against cardiolipin

reagin

95

an antigen composed of lipid remnants of damaged cells

cardiolipin

96

reagin

antibody

97

cardiolipin

antigen

98

most widely used nontreponemal serologic procedure; a flocculation or agglutination test in which soluble antigen particles form larger particles that are visible clumps when they are aggregated by antibody; contains charcoal particles to which cardiolipin containing antigen is bound for macroscopic reading to coagulate with the antibodies and show up as black clumps against the white card background, uniformly gray if antibodies are not present

Rapid Plasma Reagin (RPR) Test

99

Flocculation test, both qualitative and quantitative screening procedure; patient serum is heated to 56 Celsius for 30 minutes to inactivate complement; measures IgM and IgG

Venereal Disease Research Laboratory Test

100

tests that produce false-positives

RPR and VDRL

101

treponemal testing methods that are used to confirm reactive reagin tests; not used for primary screening methods

FTA-ABS, TP-PA, ELISA, Western Blot

102

confirmation test to confirm a nontreponemal test result; uses killed suspension of T. pallidum spirochete as the antigen, adding patient serum with suspected antibody

Fluorescent Treponemal Antibody Absorption (FTA-ABS)

103

cannot use CSF; does not differentiate between IgM and IgG antibodies

Treponema pallidum Particle Agglutination (TP-PA)

104

discriminates maternal IgG that cross placenta from IgM antibodies that may indicate an active infection in newborn

Treponema pallidum antibody, IgG by ELISA

105

do not use to determine relapse or reinfection for this test only detects IgG

Treponema pallidum antibody, IgG by immunoblot (Western blot)

106

What is the causative agent of Lyme disease?

Borrelia burgdorferi

107

Most cases of Lyme disease in the United States remain concentrated in the ________ regions.

  1. northeastern
  2. north-central
  3. Pacific coastal
  4. all of the above

US Regions

All of the above

108

In the United States, the diagnosis for Lyme Disease is usually based on:

  1. Recognition of the characteristic clinical findings
  2. History of exposure in areas where disease is endemic
  3. An antibody response to B. burdorferi
  4. All of the above

US Diagnosis

All of the above

109

A diagnostic evaluation of Human Erlichiosis can be made by visualization of intraerythrocytic organisms in thick or thin red blood cell films.

False: Intraleukocytic

110

Common vectors of Lyme disease include all the following except:

1. I. pacificus

2. I. scapularis

3. I. ricinus

4. D. variabilis

D. variabilis

111

The only continent without Lyme disease is:

Antarctica

112

The primary reservoir in nature for B. burgdorferi is the:

White-footed mouse

113

The first B. burgdorferi antigen to elicit an antibody response is:

Flagellar 41-kDa polypeptide

114

On average, the incidence of infection following an I. scapulars tick bite in an endemic area is:

3%

115

Erythema migrant:

Harbors B. burgdorferi in the advancing edge

116

The predominant symptoms of Lyme meningitis are:

Severe headache and mild neck stiffness

117

Cardiac involvement in Lyme disease may include

Conduction abnormalities

118

Ocular involvement in Lyme disease includes all the following except:

1. Cranial nerve palsies

2. Conjuctivitis

3. Panophthalmitis with loss of vision

4. Chorioditis with retinal detachment

Conjuctivitis

119

Pregnancy in Lyme disease:

Has been associated with transplacental infection

120

The most useful test for distinguishing between true-positive and false-positive serologic test results is:

Polymerase chain reaction

121

Preventive methods include all the following except:

1. Wearing light-colored clothes

2. Tucking pants into socks

3. Applying insect repellant to skin and clothes

4. All of the above

Preventative methods

All of the above

122

Lyme disease, the most common tick borne disease in the United States, is a major health hazard for:

1. Dogs

2. Horses and cattle

3. Humans

4. All of the above

Lyme disease

All of the above

123

Lyme disease is a _____ type of infection.

Bacterial

124

The first Native American case of what would later be called Lyme disease occurred in:

Wisconsin

125

Lyme Disease Stage I Length of Time

______ (median)

4 weeks

126

Lyme Disease Stage I Common Signs and Symptoms

______ manifestation after infection

Cutaneous (erythema migrans)

127

Lyme Disease Stage II Length of Time

Follows a variable latent period

128

Lyme Disease Stage II Common Signs and Symptoms

Target organs and systems can manifest abnormalities

129

Lyme Disease Stage III Length of Time

_____ after infection

Weeks to years

130

Lyme Disease Stage III Common Signs and Symptoms

______, late neurologic complications

Arthritis

131

Unlike some procedures, the polymerase chain reaction (PCR) assay can be used to detect Lyme disease-causing organisms in:

Synovial fluid

132

Antigen detection systems in Lyme disease testing screen for ______ rather than for _____ associated with the infection.

Antigenic products; Antibody

133

A patient who has a specific Lyme disease-associated manifestation may be treated with:

Antibiotic

134

Ehrliche spp. belong to the same family as the organism that causes:

Rocky mountain spotted fever

135

One of the most common physical findings in adults with ehrlichiosis is:

fever

136

Definitive diagnosis of ehrlichiosis requires:

Acute and convalescent serum antibody titers

137

In human granulocytic ehrlichiosis (anaplasmosis), the diagnosis is confirmed by seroconversion or by a single serologic titer of _____ in patients with a supporting history and clinical symptoms.

1:80

138

In the eastern United States, babesiosis is caused by:

B. microti

139

Babesiosis is characterized by:

Fever, fatigue, and hemolytic anemia

140

Babesia organisms can be found in:

Peripheral blood

141

West Nile virus causes:

Encephalitis

142

West Nile virus is transmitted by:

Mosquitoes

143

Toxoplasmosis is a _____ infection.

Parasitic

144

The definitive host of T. gondii is the:

Domestic cat

145

All the following are specific methods for preventing congenital toxoplasmosis except:

1. Avoid touching mucous membranes while handling raw meat.

2. Wash hands thoroughly after handling raw meat

3. Eliminate food contamination by flies, cockroaches, and other insects.

4. Dispose of fecally contaminated cat litter into plastic garbage bags

Dispose of fecally contaminated cat litter into plastic garbage bags.

146

The presence of IgM antibodies to T. gondii in an adult is indicative of a(n):

Active infection

147

All the following characteristics are correct regarding toxoplasmosis except:

1. It is recognized as a tissue coccidian

2. Domestic dogs are a source of the disease

3. It can be transmitted by infected blood

4. It can be transmitted transplacentally

Domestic dogs are a source of the disease

148

Toxoplasmosis is a serious health threat to:

AIDS patients

149

Congenital toxoplasmosis can cause

Central nervous system malformation

150

Antibodies to T. gondii are demonstrable _____ after infection.

Within 2 weeks

151

The method of choice for detecting IgM antibodies in toxoplasmosis is:

Enzyme-linked immunosorbent assay (ELISA)

152

The best evidence of toxoplasmosis infection is a significant change in two appropriately timed specimens (paired acute and convalescent specimens).

True

153

Diagnosis of toxoplasmosis can be made by direct observation of the parasite in stained tissue sections, cerebrospinal fluid, or other biopsy material.

True

154

An organism, such as a mosquito or tick, that carries disease-causing microorganisms from one host to another; increase in these diseases as there is increase in travel, military assignments, etc.

Vector-borne disesases

155

caused by Borrelia burgodorferi, a spirochete bacterium, transmitted by hard-bodied tick, part of the exodus tick complex; the most common vector-borne illness in the US

Lyme disease

156

the spirochete bacterium that causes Lyme disease

Borrelia birgdorferi

157

the characteristic skin condition of Lyme disease

erythema chronicum migrans (ECM)

158

Antibodies that should be present in the serum of patients with Lyme arthritis

anti-B. bergdorferi IgG

159

_____ is superior to _____ for the detection of B. burgdorferi in joint fluid

PCR; culture

160

the most practical means for confirming lyme disease infeciton

Antibody Detection

161

Standard and most widely used test method for the detection of lyme disease along with Western Blot and PCR

ELISA

162

used to directly identify the B. burgdorferi pathogen rather than the hosts immune response

PCR

163

tick borne rickettsiae (bacteria) of genus Ehrlichia; southern Mid-Atlantic and south central states during spring and summer; lone star tick vector; reservoir is white-tailed deer; also called anaplasmosis and human monocytes ehrlichiosis (HME)

Human (Granulocytic) Ehrlichiosis

164

inexpensively detects Ehrlichiosis in Wright-Giemsa stain or buffy coat smears

Intraleukocytic morulae

165

diagnosis confirmed by seroconversion by titer higher than 1:80 (fourfold rise in titer between acute and convalescent sera)

anaplasmosis

166

a tick borne disease caused by the bacterium Rickettsia rickettsii; symptoms typically begin 2-14 days after tick bite leading to fever, rash, and headache

Rocky Mountain Spotted Fever

167

the Gold Standard for diagnosing rocky mountain spotted fever, usually shows a fourfold increase in IgG titer between first and second titer

immunofluorescence assay (IFA) with ricketsii antigen

168

____ are less specific than ____ in diagnosing rocky mountain spotted fever and more likely to cause a false-positive result

IgM; IgG

169

Parasite infection of red blood cells by types of Babesia

Babesiosis

170

transmitted by the I. scapularis tick in babesiosis infections in the US; characterized by fever, massive hemolysis, hemoglobinuria, and hemoglobinemia

B. microti

171

the gold standard for detecting babesiosis; visualization of _______ organisms in thin and thick blood smear preps, but may need PCR for confirmation

intraerythrocytic

172

mosquito borne pathogenic member of the flavivirus group; IgM evident after 7 days, IgG by 3-4 weeks; screened with ELISA, confirmed by CDC or state health

West Nile Virus

173

A widespread disease in humans and animals caused by the parasite Toxoplasma gondii, a tissue coccidian; passed through raw meat, zoonotic, and congenital

Toxoplasmosis

174

resembles mononucleosis, toxoplasmosis patients have increased variant _____ on blood smear; diagnosed by detecting _____ elevated within 2 weeks, visualization of parasite, PCR, cell culture, and IFA

lymphocytes; antibodies