3. The causative agent of this disease was most Which of the following pathogens produces
likely transmitted by a: a toxin with the same mechanism of action as the
most likely agent of this infection?
A. Chigger
A. Clostridium tetani
B. Mosquito
B. Enterotoxigenic Escherichia coli (ETEC)
C. Sandfly
C. Shigella dysenteriae
D. Tick
D. Staphylococcus aureus
E. Triatomine bug
E. Vibrio cholerae
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10.1 Questions
7. One week later the boy develops complications - A 19-year-old college student returns from
from this infection. Which of the following condi- spring break in Mexico with watery diarrhea. She
tions is most likely to be observed as a result of this claims she ate in reputable restaurants and not from
complication? street venders. She admits that she brushed her teeth
A. Ascending paralysis with the faucet water in her hotel. Which of the fol-
lowing pathogens has a similar mechanism of patho-
B. Joint pain
genesis as the most likely agent of this infection?
C. Pallor
A. Bacillus cereus
D. Tonic-clonic seizures
B. Clostridioides (Clostridium) difficile
E. Violaceous pretibial nodules
C. Clostridium perfringens
D. Shigella dysenteriae
8. Growth on which of the following culture
media would best confirm the identity of the caus- E. Staphylococcus aureus
ative agent?
A. Agar enriched with X and V factors 12. Five children (age range 2-3 years old) are
sent home from a day care center with diarrhea and
B. Agar supplemented with charcoal and yeast
fever within a 2-day period. All of the children had
extract
more than 4 to 5 loose stools the day they were sent
C. Hektoen agar home. The next day, two of the day care workers call
D. MacConkey agar supplemented with sorbitol in sick with similar symptoms. One of the workers
E. Thiosulfate-citrate-bile salts-sucrose (TCBS) agar visits the urgent care clinic when she notices blood
in her stool. Which of the following is the most likely
Consider the following case for questions 9 and 1O: causative agent?
10. Which one of the following mechanisms is A. Camping trip in the mountains
most likely contributing to this infection? B. Contact with a sick dog
A. Destruction of microvilli C. Hamburger eating contest
B. Endotoxin D. Field trip to the reptile zoo
C. Enterotoxin that inactivates actin polymerization E. Vacation to Mexico
D. Exotoxin that inhibits protein synthesis
E. Invasion into host cell
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10 Infections of the Esophagus, Stomach, Small and Large Bowel/Rectum, Liver, and Biliary Tree
14. A previously healthy 25-year-old woman pres- 17. A 54-year-old man presents with diarrhea of
ents with a 3-day history of fever, abdominal cramps, 3-day duration. He has had 8 to 9 bowel movements
diarrhea, and vomiting. She denies hematochezia and per day and has been periodically vomiting. The man
has no previous medical issues. She states that about returned 4 days ago from vacation in several South
5 days ago she ate an entire batch of uncooked cookie Asian countries. His temperature is 37.2°C (98.9°F)
dough. Her temperature is 37.9°C (100.3°F). Physical and his blood pressure is 92/63 mm Hg. On examina-
examination reveals mild abdominal tenderness. tion the man seems lethargic, his eyes are sunken,
Stool culture shows black colonies on Hektoen agar, his skin feels cold and clammy, and his skin turgor
and ova and parasite examination is negative. Which is poor. Stool for culture is collected and an organ-
of the following is the most appropriate therapy for ism grows on selective media. A Gram stain from the
this patient? colonies growing on this media is shown here:
A. Azithromycin
B. Ciprofloxacin
C. Metronidazole
D. Vancomycin
E. No antibiotic therapy should be administered
19. Which one of the following factors is most Consider the following case for questions 22 to 24:
likely mediating this infection? A previously healthy 23-year-old man is admitted
A. Coagulase to the hospital following a motor vehicle collision.
One week after his admission he develops watery
B. Hyaluronidase
diarrhea. He is on several medications including
C. Protein A clindamycin. His temperature is 37.6°C (99.7°F). A
D. Superantigen CBC shows a leukocyte count of 13.8 x 109/L. Glu-
E. Exfoliative toxin tamate dehydrogenase (GOH) antigen and enzyme
immunoassay (EIA) toxin analysis from a stool speci-
20. A 23-year-old medical student wakes up in the men are positive and confirm the diagnosis. The
middle of the night with abdominal pain, cramping, patient has no history of previous infection with this
and watery diarrhea. He has had four bowel move- pathogen.
ments within 3 hours. He does not notice any blood
in his stool and he does not feel feverish and is not 22. Which of the following is the most appropriate
vomiting. While he was on clerkship rotation the therapy?
previous day, the hospital was celebrating Thanks- A. Fecal transplant
giving and he ate in the cafeteria. By early afternoon B. Levofloxacin
of the next day he is feeling better. Later, it is dis-
C. Penicillin
covered that several other employees were also ill
following the same meal. A toxin from an anaerobic D. Probiotics
gram-positive rod is identified from the tainted food. E. Vancomycin
Which of the following foods is the most likely to be
involved in the transmission of this infection? 23. The most likely causative agent of this infec-
A. Cream puffs tion produces a toxin that:
B. Gravy A. Activates T cells
C. Raweggs B. Depolymerizes actin
D. Shellfish C. Hydrolyzes lecithin
E. Soft cheese D. Inhibits protein synthesis
E. Interacts with G protein
21. A 46-year-old man suddenly feels ill and starts
vomiting at 1 :00 a.m. He continues vomiting approx- 24. Which of the following would safely and effec-
imately 2 to 3 times per hour for the next 4 hours. tively disinfect the surfaces of this patient's room?
The man had leftover Chinese takeout for dinner the
A. Hypochlorite
previous evening and consumed vegetable fried rice
and beef lo mein. By the next afternoon he is feeling B. lodophor
better. Which of the following is the most likely caus- C. Isopropanol
ative agent of this infection? D. Phenol
A. Aerobic gram-positive rod E. Quaternary ammonium compound
B. Aerobic gram-positive cocci
C. Anaerobic gram-positive rod
D. Flagellated protozoan parasite
E. Single-stranded RNA virus
221