Deck 20: Infectious Diseases Affecting the Cardiovascular and Lymphatic Systems

Question 1

Your patient was admitted for a gunshot wound about a week ago. As a precautionary activity, the doctor placed her on antibiotics for a few days while recuperating. Blood specimens are drawn on the patient a several times daily and sent to the microbiology lab for analysis of bacteria. Nothing
Has grown in culture. On her 4th day in the hospital, she has had no fever and no other signs of infection, but one set of blood specimens has been reported positive for a bacterium. The culture was identi?ed by the lab as Staphylococcus epidermidis, a common organism on the skin. Predict the likely situation leading to this.

A) Staphylococcus epidermidis is a very slow growing bacterium and was probably in the blood right after the gunshot wound, but failed to grow until now.
B) The patient is immunodepressed and very susceptible to bacterial infection.
C) Staphylococcus epidermidis is a skin contaminant that ended up in the blood specimen as a consequence of poor aseptic technique during the venipuncture.
D) Staphylococcus epidermidis has converted to a pathogen because of the antibiotics prescribed for the patient.

Answer 1

Staphylococcus epidermidis is a skin contaminant that ended up in the blood specimen as a consequence of poor aseptic technique during the venipuncture.

Question 2

The ?brous sac that encloses the heart is the ______.

A) myocardium
B) epicardium
C) ectocardium
D) endocardium
E) pericardium

Answer 2

pericardium

Question 3

Which of the following statements regarding the structure of blood vessels is incorrect?

A) Blood vessels are often found in parallel with lymphatic vessels.
B) Capillaries have only a single layer of endothelium, rendering them fragile and leaky during an infection with a hemorrhagic fever virus.
C) Connective tissue and muscle ?bers are found in the layers of tissue surrounding both arteries and veins.
D) In contrast to veins, arteries have higher blood pressure, more tissue layers, and are thinner vessels.

Answer 3

In contrast to veins, arteries have higher blood pressure, more tissue layers, and are thinner vessels.

Question 4

Hemorrhagic and nonhemorrhagic fever diseases have a common feature of a high fever. These categories of diseases are distinguished by _______.

A) the pattern of the fever, whether it is constant or varies with time
B) viral causes in hemorrhagic fevers and bacterial or protozoan causes in nonhemorrhagic fevers
C) the viral load in the blood, speci?cally the viral titer
D) the integrity of the capillary endothelium and its ability to contain the blood
E) the overall mortality rate, as hemorrhagic fevers have a much higher mortality rate

Question 5

Despite the aggressive defense of the cardiovascular system by the immune system, some microbes can invade and establish an infection in the blood. From the following list of microbes and their virulence factors, identify the mismatch.

A) Borrelia burgdorferi changes its surface antigens to avoid immune recognition.
B) Bacillus anthracis produces antioxidants to combat lysosomes.
C) Coxiella burnetii produces an endospore-like structure.
D) Trypanosoma cruzi cloaks itself in host proteins to avoid immune recognition.

Question 6

After a Drug Enforcement Agency raid on a location that housed intravenous drug users, several were brought to the hospital with rapid breathing, fever, and an altered mental state. Which of the following statements is correct?

A) Many drug users are HIV-positive, so the patients should all be monitored for levels of CD4 T-cells before any other action is taken.
B) A broad-spectrum antibiotic is needed promptly, as they are likely to be in septic shock from intravenous introduction of microbes into the blood.
C) Unsanitary conditions in the house probably resulted in infestations with insects, so it's prudent to examine them for insect bites that may provide a clue.
D) Stained blood smears should be performed promptly to look for abnormalities in the blood cells.

Question 7

Several infections of the cardiovascular system can be identi?ed by inspecting a stained blood smear in the microscope. For the following infections, identify the microscope observation that does not ?t the disease.

A) Chagas disease; protozoan visible among blood cells
B) Epstein-Barr virus; virus visible inside red blood cells
C) Babesiosis; protozoan visible inside red blood cells
D) Malaria; ring trophozoites visible inside red blood cells

Question 8

The presence of viruses in the blood is called ______.

A) viremia
B) hemovirus
C) fungemia
D) septicemia

Question 9

The most important defense of the cardiovascular system against infection is ______.

A) the blood-brain barrier
B) lymph nodes
C) lymphocytes in the blood
D) fever

Question 10

Under normal healthy circumstances, the lymphatic system filters any microorganisms present.

Question 11

The cardiovascular and lymphatic systems have no normal biota.

Question 12

Which of the following statements is incorrect regarding subacute endocarditis?

A) Bacteria colonize previously damaged heart tissue resulting in bio?lm growth.
B) It is caused by autoantibodies that inappropriately target heart and valve tissue.
C) It can be caused by oral bacteria that are introduced to the blood by dental procedures.
D) It occurs exclusively in patients that have prior heart damage.

Question 13

Most cases of sepsis are caused by ______.

A) viruses
B) bacteria
C) prions
D) protozoans
E) fungi

Question 14

Epidemiologists classify diseases by their mortality rate (the percent of infected individuals who die from the disease) and by their communicability (how easy it is to transmit the disease). Which of the following diseases of the cardiovascular system is mismatched with a description of its properties?

A) Plague; somewhat high mortality rate and low communicability
B) AIDS; high mortality rate and low communicability
C) Ebola; high mortality rate and high communicability
D) Malaria; low mortality rate and high communicability

Question 15

The heart wall has three layers. In order from the outer layer to the inner layer, they are ______.

A) endocardium, myocardium, and epicardium
B) myocardium, endocardium, and epicardium
C) endocardium, epicardium, and myocardium
D) epicardium, myocardium, and endocardium

Question 16

Anthrax is ______.

A) a zoonosis
B) transmitted by contact, inhalation, or ingestion
C) a disease that, in humans, can cause a rapidly fatal toxemia and septicemia
D) only seen sporadically in the United States
E) All of the choices are correct.

Question 17

When bacteria ?ourish and grow in the blood stream, the condition is termed ______.

A) fungemia
B) bactocarditis
C) sepsis
D) viremia

Question 18

Endocarditis is often a consequence of bacteria attached to the heart valves. These microbes are not eliminated by circulating lymphocytes because _______.

A) Gram-positive microbes don't have an exotoxin surface molecule to trigger an immune response
B) lymphocytes do not circulate through the heart valves to detect the presence of microbes
C) lymphocytes cannot engulf microbes attached to tissue
D) these microbes become covered in platelets and ?brin which is not recognized as foreign by the immune system

Question 19

Which of the following infectious agents and means of disposal are mismatched?

A) Drums made with animal hides should be treated with sterilizing gas to eliminate endospores.
B) Coagulation factors puri?ed from blood must be heat-treated to destroy HIV.
C) Carcasses of animals that died of anthrax must be incinerated to avoid endospores entering the soil.
D) Mosquito bed nets must be washed in bleach weekly to eliminate any residual Plasmodium.

Question 20

The cardiovascular system is highly protected from microbial infection because _______.

A) failure to do so will result in a systemic infection
B) it is the only body system that has no normal microbiota
C) it is the only body system that is liquid-based, i.e., with blood
D) it is so close to the skin that even minor injuries could lead to major infection

Question 21

Rabbits and rodents are the chief reservoirs of the causative agent of ______.

A) Lyme disease
B) plague
C) brucellosis
D) mononucleosis
E) tularemia

Question 22

Lyme disease is transmitted by ______.

A) ?ies
B) ?eas
C) droplets
D) lice
E) ticks

Question 23

Yersinia pestis _______.

A) was virulent historically but currently circulating strains are not virulent
B) is usually transmitted by a ?ea vector
C) has deer as an endemic reservoir
D) does not respond to antimicrobial drugs

Question 24

Erythema migrans, a bull's-eye rash, at the site of a tick bite is associated with ______.

A) Lyme disease
B) Rocky Mountain spotted fever
C) Q fever
D) plague
E) ehrlichiosis

Question 25

The causative organism of malaria is a ______.

A) bacterium
B) prion
C) virus
D) protozoan
E) fungus

Question 26

Which of the following is not true of tularemia?

A) Its symptoms include fever, swollen lymph nodes, ulcerative lesions, conjunctivitis, and pneumonia.
B) The causative agent is a gram-positive bacterium.
C) It is transmitted by arthropod vectors.
D) It is sometimes called rabbit fever.
E) It is a zoonosis.

Question 27

Plague exhibits a _______.

A) septic form historically called the Black Death
B) bubonic form in which swollen lesions termed buboes develop
C) pneumonic form that manifests as a respiratory disease
D) All of the choices are correct.

Question 28

Acute endocarditis is most commonly contracted through ______.

A) parenteral entry
B) droplets
C) fomites
D) casual contact
E) ingestion

Question 29

The preferred treatment for anthrax is ______.

A) quinine
B) penicillin
C) decided after consultation with the CDC
D) the Bio-Thrax vaccine
E) cipro?oxacin

Question 30

The white-footed mouse, deer, and deer ticks are important to maintaining the zoonotic transmission cycle associated with ______.

A) plague
B) Rocky Mountain spotted fever
C) babesiosis
D) Lyme disease
E) Q fever

Question 31

Which of the following statements regarding Bacillus anthracis is incorrect?

A) It is a gram-positive bacillus.
B) A capsule and exotoxins are virulence factors.
C) Its reservoir includes grazing animals and soil.
D) It grows primarily under anaerobic conditions.
E) It is capable of forming endospores.

Question 32

The causative agent of Lyme disease is ______.

A) Borrelia burgdorferi
B) Borrelia hermsii
C) Ixodes paci?cus
D) Ixodes scapularis
E) Leptospira interrogans

Question 33

Control of rodent populations is important for preventing ______.

A) brucellosis
B) plague
C) Q fever
D) malaria

Question 34

Which of the following statements regarding the Epstein-Barr virus is incorrect?

A) An infection typically requires hospitalization for about a week.
B) An infection results in sudden leukocytosis.
C) The virus is transmitted by direct oral contact and saliva.
D) The virus has a 30-50 day incubation period.
E) Transmission has been documented through contaminated blood transfusions and organ transplants.

Question 35

Which of the following is not true of bubonic plague?

A) A patient exhibits fever, headache, nausea, and weakness.
B) It is transmitted by the fecal-oral route.
C) An infection can progress to septicemia.
D) It is caused by Yersinia pestis.
E) A patient often has enlarged inguinal lymph nodes.

Question 36

The most common causative agent of acute endocarditis is ______.

A) Staphylococcus aureus
B) Streptococcus pneumoniae
C) Neisseria gonorrhoeae
D) Epstein-Barr virus
E) Streptococcus pyogenes

Question 37

Which of the following is incorrect regarding Yersinia pestis?

A) It is a gram-negative rod.
B) It has a capsule as a virulence factor.
C) It produces coagulase as a virulence factor.
D) It produces an enterotoxin.
E) It exhibits bipolar staining and appears to resemble a safety pin.

Question 38

A common cardiovascular/lymphatic system disease in AIDS patients is ______.

A) Burkitt's lymphoma
B) cytomegalovirus
C) acute endocarditis
D) brucellosis
E) ehrlichiosis

Question 39

Symptoms of infectious mononucleosis include _______.

A) fever and pocks on skin
B) fever, severe diarrhea, pneumonitis, hepatitis, and retinitis
C) vesicular lesions in oral mucosa
D) sore throat, fever, cervical lymphadenopathy, and splenomegaly

Question 40

Bubonic plague is transmitted by ______.

A) fomites
B) rats
C) sexual contact
D) mosquitoes
E) ?eas

Question 41

Plague is a quarantinable disease.

Question 42

The causative agent in a case of sepsis can be isolated by _______.

A) inoculating blood agar with a sample of the patient's blood
B) sending a blood sample to the CDC laboratories in Atlanta
C) performing a Kirby-Bauer assay on a sample of the patient's blood
D) centrifugation of the blood to separate cells and plasma

Question 43

Anthrax is not routinely diagnosed in the United States because _______.

A) healthcare workers haven't been trained to detect it
B) infections are usually asymptomatic
C) infection is generally only seen in late-stage AIDS patients
D) it is a rare infection

Question 44

Which of the following are features that make Bacillus anthracis a potential bioterrorism weapon?

A) It is naturally occurring worldwide in soil, and intentional release may not be suspected.
B) It forms endospores that can be stored in powder form inde?nitely.
C) Pulmonary anthrax is rapidly fatal.
D) Vaccination is not widespread in the United States.
E) All of these choices are correct.

Question 45

Which type of hemorrhagic fever is also known as "breakbone fever" because of the severe pain in muscles and joints?

A) Ebola
B) Lassa fever
C) Dengue fever
D) Marburg
E) Chikungunya

Question 46

Which of these diseases would most likely be identi?ed by viewing a stained blood smear in a light microscope?

A) HIV
B) Chagas disease
C) Dengue fever
D) Ebola hemorrhagic fever

Question 47

You just returned from a hiking/camping trip and are experiencing symptoms of an infection: high fever, swollen lymph nodes, and black-and-blue marks or hemorrhages under the skin. Your doctor asks if you have been in the four corners area of the United States (where the states of Arizona, colorado, New Mexico, and Utah all meet). What does the doctor suspect?

A) You might have picked up the plague bacterium from ?eas that normally feed on rodents in that area.
B) Those four states have high rates of Chikungunya, which is what the doctor suspects that you have.
C) Hemorrhagic fever is often associated with bats in that region of the United States.
D) Since there are many mosquitoes in that area, you might have been infected with Plasmodium.

Question 48

Which of the following statements regarding sepsis is incorrect?

A) The presence of microbes in the blood results in increased viscosity, and a rise in blood pressure is a hallmark of sepsis.
B) Both gram-negative and gram-positive bacteria in the blood can induce sepsis.
C) A sample of blood plated on a variety of bacterial media is a good method to identify the causative organism in sepsis.
D) The Gram-negative cell envelope stimulates an in?ammatory response that leads to endotoxic shock.

Question 49

Which of the following is not true of Ebola and Marburg?

A) They transmitted by direct contact with body ?uids from affected individuals.
B) Blood clotting is disrupted in an infection with these viruses.
C) The viruses are transmitted by mosquitoes.
D) They are ?loviruses.
E) There is currently no effective treatment for infected individuals.

Question 50

Humans should be routinely vaccinated against Lyme disease.

Question 51

Lyme disease is only seen in people living in Lyme, Connecticut.

Question 52

Which of the following is a hemorrhagic fever?

A) Rocky Mountain spotted fever
B) Q fever
C) Cat-scratch fever
D) Chikungunya
E) Trench fever

Question 53

Brucellosis is _______.

A) treated with a 3-6 week course of antibiotics
B) seen in patients as a ?uctuating fever, with headache, muscle pain, and weakness
C) diagnosed with serological testing of the patient's blood
D) an occupational illness of people who work with animals
E) All of the choices are correct.

Question 54

The reservoir for the Lassa fever virus is the ______.

A) Anopheles mosquito
B) multimammate rat
C) fruit bat
D) Aedes mosquito
E) deer tick

Question 55

Aedes mosquitoes are the vectors involved in Chikungunya and dengue fever.

Question 56

Pasteurization of milk helps to prevent _______.

A) endocarditis
B) mononucleosis
C) tularemia
D) plague
E) brucellosis

Question 57

Which type of hemorrhagic fever has been shown to respond to ribavirin?

A) Lassa fever
B) Rocky Mountain spotted fever
C) Ebola
D) Marburg

Question 58

Which of the following is not associated with sepsis?

A) Respiratory acidosis
B) Fever and shaking chills
C) Parenteral or endogenous transfer
D) Endotoxic shock
E) Drop in blood pressure

Question 59

Your 49-year-old mother has just been diagnosed with subacute endocarditis with the following symptoms: fever, a rash, and early congestive heart failure. You wonder how this infection occurred, particularly since she appeared to be healthy before this. Which of the following questions for her physician is most pertinent to understanding the cause of this infection?

A) Does she have an abnormal heart valve or a murmur?
B) Could she have AIDS?
C) Could she have contracted this from a mosquito bite, since she does so much gardening?
D) Is this infection related to menopause?

Question 60

Ehrlichiosis, Rocky Mountain Spotted Fever, dengue fever, and tularemia are all infectious diseases of the cardiovascular system. What feature do they have in common?

A) The causative agent of each of these diseases is a bacterium.
B) They are all endemic in the mountain states in the western United States.
C) People with immune de?ciencies are especially susceptible to these diseases.
D) They are all transmitted by arthropod vectors.

Question 61

The cyclic bouts of fever and chills in malaria are caused by _______.

A) white blood cell lysis
B) neurological involvement
C) red blood cell lysis
D) the timing of the viral life cycle

Question 62

A frequent cancer that is seen in AIDS patients is ______.

A) leukemia
B) melanoma
C) Kaposi's sarcoma
D) Hodgkin's lymphoma
E) myeloma

Question 63

Rifampin is the drug of choice for malaria.

Question 64

At the blood donation facility, you are completing an information form. The form asks about your health history and includes a question about whether you have ever had malaria or visited a country where malaria is endemic. Why is this information relevant?

A) This is just one of many pathogens that blood is screened for. The information given by the donor saves the staff time in testing the blood.
B) Recipients differ in their susceptibility to malaria; if you have had malaria, the staff will earmark your blood to speci?c kinds of recipients.
C) Malarial parasites can persist in the liver, and, as a result, could be contaminating your blood and transferred to a recipient.
D) If you are infected with malaria, you are probably also infected with HIV, and that would disqualify your donation.

Question 65

For the following list of anti-HIV drugs and their mechanism of action. Identify the mismatch.

A) Protease inhibitor - blocks the active site of the protease required for assembling new viral particles
B) Integrase inhibitor - blocks the active site of the enzyme required to splice HIV DNA into the human genome
C) Reverse transcriptase inhibitor - blocks the active site of the enzyme required to convert viral RNA to DNA
D) AZT (azidothymidine) - as an analog of thymidine, it is incorporated into viral RNA in place of thymidine

Question 66

In severe cases of Rocky Mountain spotted fever, the enlarged lesions of the rash can become necrotic and predispose the patient to gangrene of toes and ?ngertips.

Question 67

Select the statement that is correct regarding Chagas disease.

A) An effective vaccine is available for prevention in endemic areas.
B) It is caused by a fungal pathogen.
C) It is transmitted by respiratory droplets.
D) Late-stage disease is characterized by autoimmune reactions in the host.

Question 68

The symptoms that occur in cyclic 48- to 72-hour episodes in a malaria patient are _______.

A) chills, fever, and sweating
B) sore throat, low grade fever, and swollen lymph nodes
C) bloody, mucus-?lled stools, fever, diarrhea, and weight loss
D) urinary frequency and pain, and vaginal discharge
E) fever, swollen lymph nodes, and joint pain

Question 69

Which of the following statements concerning Rocky Mountain spotted fever is correct?

A) The causative bacterium is transmitted by Ixodes ticks.
B) Infections are seen in highest numbers in the Rocky Mountains.
C) An infection rarely has complications beyond mild discomfort.
D) Disease symptoms include fever, headache, and rash.

Question 70

Which of the following is mismatched?

A) Coxiella burnetii - Q fever
B) Yersinia pestis - plague
C) Bartonella henselae - cat-scratch disease
D) Rickettsia typhi - Rocky Mountain spotted fever
E) Bartonella quintana - trench fever

Question 71

Cat scratch disease can be prevented by ______,

A) promptly cleaning any scratch wound
B) animal control
C) avoiding environments with ticks
D) avoiding unpasteurized milk
E) vaccination

Question 72

The gram-negative bacillus associated with abscesses from cat bites or scratches is _______.

A) Salmonella typhimurium
B) Francisella tularensis
C) Bartonella henselae
D) Brucella suis
E) Yersinia pestis

Question 73

Which of the following statements regarding Q fever is incorrect?

A) The causative agent, Coxiella burnetii, is transmitted by lice.
B) The disease is mild, and most cases go undetected.
C) The causative agent, Coxiella burnetii, produces resistant endospore-like structures.
D) Symptoms include fever, muscle aches, rash, and occasionally pneumonia.
E) Humans can be infected from the airborne spread of particles from infected animals.

Question 74

Retroviruses have all of the following characteristics except _______.

A) a DNA genome
B) integration into the host genome
C) reverse transcriptase
D) glycoprotein spikes
E) an envelope

Question 75

Which of the following statements regarding the development of AIDS following infection with HIV is incorrect?

A) Viral antigens can be detected at high levels in the blood within days following infection, then their numbers fall dramatically during a latent period and rise again when AIDS
Symptoms occur.
B) Antibodies to HIV antigens formed in response to HIV infection appear within a few weeks of infection and remain high through latency and AIDS.
C) An HIV-positive individual in the latency phase can be distinguished from an uninfected individual by the presence of antibodies to HIV antigens in their blood.
D) CD4 T cells are present in low numbers in an uninfected individual, but become elevated upon HIV infection, and ultimately fall to very low numbers (<200 cells/ml) as the infection

Question 76

Malaria may be prevented by ________.

A) using bed nets sprayed with insecticide
B) eliminating standing water
C) taking prophylactic drugs
D) using genetically engineered mosquitoes
E) All of the choices are correct.

Question 77

Which of the following statements is incorrect regarding patients with AIDS?

A) AIDS patients can get unusual cancers and neurological disorders.
B) AIDS patients have an immunode?ciency.
C) The highest number of AIDS cases worldwide is in the United States.
D) AIDS patients have a CD4 T-cell titer below 200 cells/mm3 of blood.
E) AIDS patients get repeated, life-threatening, opportunistic infections.

Question 78

Which of the following statements is incorrect regarding malaria?

A) The mosquito inoculates human blood with sporozoites.
B) Trophozoites develop in red blood cells.
C) Gametocytes enter the mosquito as she draws a blood meal from a human.
D) Merozoites enter and multiply in liver cells.

Question 79

Which of the following statements regarding erhlichiosis is incorrect?

A) Symptoms include fever, headache, and muscle pains.
B) The disease vector is transmitted by Ixodes ticks.
C) Treatment requires an extensive course of antibiotics, usually 3-6 weeks.
D) The disease is diagnosed by PCR or indirect ?uorescent antibody tests.
E) It often coinfects with Borrelia burgdorferi.

Question 80

Which of the following statements regarding HIV is incorrect?

A) PCR is the primary technique for detecting HIV in blood.
B) The virus can enter into nervous tissues and cause abnormalities.
C) The virus becomes latent in host cells.
D) The viral DNA integrates into the host DNA.
E) The virus attaches to host cells with CD4 receptors.