USMLE style questions

Microbiology
Kim Moscatello, Ph.D.
A 66 year old white, homeless male presented to the ER with
a cough, fever, and chest pain. He vaguely remembered that
he began coughing a couple of weeks ago and his coughs had
become progressively worse since then. On Physical exam he
was found to have an elevated temperature of 40 C, a pulse
of 110/min, Respiratory rate of 34/min and BP of 104/70.
Sputum Gram stain revealed numerous Gram positive
diplococci and PMNs. How does the major virulence factor in
the above case function to avoid immune destruction?
A. antigenic variation
B. Antiphagocytic
C. inhibits phagolysosomal fusion
D. motile
E. binds to Fc portion of Antibody
A 75-year-old male has been hospitalized with a
broken hip. He fell getting out of his bed at the
local nursing home. A week after being
hospitalized, he develops pneumonia. He has a
productive cough with bright red sputum. A
sputum culture is positive for growth in 24 hours on
Blood Agar, Chocolate Agar, and MacConkeys Agar.
His PPD is positive. The most likely causative agent
is:
A. Streptococcus pneumoniae
B. Legionella pneumoniae
C. Staphylococcus aureus
D. Mycobacterium tuberculosis
E. Klebsiella pneumoniae
A 1 week old infant presents to the ER with fever,
irritability, bulging fontanelles and projectile
vomiting. The CSF is cultured and Gram stained and
Gram positive rods that are -hemolytic in blood
agar were identified. Which of the following is a
property of the most likely causative agent?
A. K1 capsule
B. facultative intracellular
C. Encapsulated yeast
D. CAMP positive
E. optochin sensitive
A 19 year old African American female with sickle cell disease presents
to the physician requesting an oral contraceptive. She is sexually active
with one partner. Her vital signs are within the normal limits.
Laboratory studies show the presence of Howell Jolly bodies in the
erythrocytes. This patient is at the greatest risk for mortality if she
develops an infection with which of the following organisms?
A. Aspergillus species
B. Candida albicans
C. Chlamydiophila pneumoniae
D. Neisseria gonorrhoeae
E. Streptococcus pneumoniae
 A 10 year old male presents to the pediatrician
with a fever, malaise and a dry hacking cough.
Physical exam reveals a fever of 102.5F, fine to
medium rales over the right lower lobe, and otitis
media. A chest x-ray revealed patchy infiltrates.
Ampicillin was prescribed and the patient didnt
have any relief of symptoms. A macrolide was
effective. Which of the following is a property of
the organism in the above case?
A. Are facultative intracellular
B. Contain cord factor
C. Form spores
D. Lack a cell wall
E. Lack a cytoplasmic membrane
A 35-year-old male presents in the ER with nausea,
vomiting and diarrhea. The diarrhea woke him in the
middle of the night and appears to be getting worse.
The abdominal pain is central in location and crampy.
Lactose non fermenting Gram negative rods were
isolated from the stool and did not produce H2S.
What is the mechanism of action of the toxin in this
case?
A. Blocking the release of acetylcholine
B. Increases cAMP
C. Inhibition of protein synthesis by ADP ribosylation of EF-2
D. Inhibition of inhibitory mediators GABA and glycine
E. Inhibition of protein synthesis via 60s ribosome
A 23 year old woman with a history of sickle
disease presents with fever and severe bone
pain localized to her left tibia. A x-ray film
reveals a lytic lesion and blood cultures reveal
infection. A bone culture grows Gram negative
rods. Which of the following best describes the
infecting organism?
A. It is comma shaped and sensitive to acidic pH
B. It is an obligate intracellular parasite
C. It is motile and does not ferment lactose
D. It is motile and oxidase positive
E. It is a non motile facultative anaerobe
 A graduate student studying virology has identified a
natural drug that seems to block the activity of
viral RNA dependent DNA polymerase. Against
which of the following viruses does this drug show
the most promise?
A. Adenovirus
B. Cytomegalovirus
C. Herpes simplex virus
D. HIV
E. Influenza
 An HIV virus has been isolated from a patient
that is NOT inhibited by soluble CD4. Which
of the following genes are likely mutated in
this viral strain?
A. Core proteins
B. Glycoprotein
C. Integrase
D. Protease
E. Reverse transcriptase
 A 6 month old baby is brought to the ER with a high fever.
Physical exam is remarkable for only fever of 104C. In the ER,
the child has a seizure and is admitted to the hospital.
Bacterial culture and Gram stain of the blood and CSF are
negative. Intranuclear inclusion bodies are found in the
lymphocytes. A few days later, as the fever resolves, multiple
small blanchable macules and papules are observed on the
infants back. The most likely pathogen is a member of which
of the following viral families.
A. Herpesviridae
B. Orthmyxoviridae
C. Paramyxoviridae
D. Parvoviridae
E. Poxviridae
 A 25 year old male is seen in the ER with fever, chest pain and
difficulty breathing. Physical examination is remarkable for fever,
tachycardia, pitting edema in both legs and decreased breath
sounds in the basal portions of the chest. A chest x-ray confirms
congestive cardiac failure. The causative agent is most likely a
member of which viral family?
A. Adenoviridae
B. Bunyaviridae
C. Herpesviridae
D. Orthmyxoviridae
E. Picornaviridae
 A 28 year old medical student has just returned from a medical
mission trip to Africa. She presents to her physician with a 2 week
history of fever and headaches that seem to occur every 48 hours.
Her vital signs are temperature 105.1F, P 140/min, R28/min and BP
82/40 mmHg. Physical examination shows diaphoresis and
splenomegaly. A peripheral blood smear demonstrates the
presence of Schuffner dots in infected erythrocytes. Treatment with
chloroquine is started and followed with a course of primaquine.
Which of the following is the best explanation for the inclusion of
primaquine in the patients medication regimen?
A. Drug resistance to chloroquine
B. High parasite load
C. Less toxicity than chloroquine
D. Prevents recurrence of malaria
E. Works synergistically with chloroquine
A 24-year-old male, with confirmed HIV infection and low CD4+ T
lymphocyte count, presents to the emergency department with
severe watery diarrhea that has been going on for a week. Stool
specimens are collected and sent to the laboratory for
bacteriology and parasitology examination. Bacterial cultures are
negative for intestinal pathogens. The laboratory report reveals
round acid-fast organisms that are 3-5 m in diameter. Which of
the following organisms is the causative agent?
A. Entamoeba histolyticum
B. Giardia lamblia
C. Mycobacterium kansasii
D. Cryptosporidium parvum
E. Isospora spp
A 29-year old man develops esophagitis, progressive
substernal pain and dysphagia over several weeks. He
also has difficulty swallowing. The oropharynx, buccal
mucosa, and tongue are covered with a white thick
membrane that scraps off easily. His CD4 count is 300
cells/microliter. Which of the following descriptions fits
the most likely causative agent?
A. Aseptate hyphae at 90 angles
B. Forms germ tubes at 37 C when incubated in
serum, form pseudohyphae when invades tissues
C. Septate hyphae at 45 angles
D. Short hyphae and round yeasts in spaghetti and
meatball pattern
E. Yeast at 37 C and mold and 25 C
A 30-year-old female presents to her
gynecologist with complaints of vaginal itching
and painful urination. She also complains of a
malodorous discharge. Examination is
significant for a frothy green malodorous
discharge. Which of the following findings is
diagnostic for the above infection?
A. Clue cells
B. Germ tubes in serum at 37 C
C. Koilocytes
D. Motile trophozoites on wet mount
E. Tzank positive cells
A 30-year-old female visits her physician complaining of
a series of nodules in a row on her arm. She says the
infection started shortly after working in her raspberry
bushes. The infection started around the cut, and
seems to be spreading up her arm. A skin biopsy would
likely reveal which of the following?
A. Broad based budding yeast
B. Cigar shaped yeast
C. Intracellular yeast
D. Spherule
E. Acid fast bacilli
A 37 year old male comes to the office with complaints of painful
blister like lesions on his penis. He says the vesicles just appeared 2
days ago. History is significant for a similar outbreak when he was on a
mission trip in Nepal several years ago. He never sought treatment
because they healed without issue. He is afebrile and does not appear
to be in distress. Heart, lung and abdomen are all normal via
examination. Examination of his genitals shows 8 vesicular lesions with
an erythematous base. There is no crusting, drainage or bleeding.
They are moderately tender. There is also mild, inguinal
lymphadenopathy. Which of the following images, if found, would
confirm the diagnosis?

A B C

D E F
A 50-year old male presents with fever, malaise and jaundice.
Liver biopsy reveals lymphocytic infiltrate. A hepatitis panel
was ordered with the following results: (major HBV panel is
pending). Which of the following is the most likely
interpretation of the serologic data?
HBcAb Anti- Anti- Anti-
IgM HCV HAV HAV-
IgM IgG
results + - - +

A. The patient currently has HBV and HAV

B. The patient currently has HBV and had HAV in the past
C. The patient currently has HAV and had HBV in the past
D. The patient is immune to HBV and HAV
E. The patient is immune to HAV, HBV and HCV