Question 1

The diagnosis of Lyme disease in the United States is based on:&#10;A) characteristic clinical findings.&#10;B) history of exposure in endemic area.&#10;C) erythema migrans (EM)or an antibody response to Borrelia burgdorferi observable by the ELISA or Western blot test.&#10;D) all of the above.

Accepted Answer

In the United States,approximately 20% to 30% of patients with Lyme disease have positive responses,usually of the immunoglobulin M (IgM)isotype,during this period.However,by convalescence 2 to 4 weeks later,about 70% to 80% have seroreactivity,even after antibiotic treatment.After about 1 month,most patients with active infection have IgG antibody responses.After antibiotic treatment,antibody titers slowly fall,but IgG and even IgM responses may persist for many years after treatment.An IgM response cannot be interpreted as a manifestation of a recent infection or reinfection unless the appropriate clinical features are present.Antibodies formed include cryoglobulins,immune complexes,antibodies specific for B.burgdorferi,and anticardiolipin antibodies.Elevated titers of IgM are noted in early disease.

Question 2

Fill in the blanks with the correct pathogen.&#10;Examples of Vector-Borne Diseases&#10;   &#10;A)Bacteria&#10;B)Protozoan parasite&#10;C)Rickettsiae&#10;D)Virus&#10;

Accepted Answer

1,D;2,D;3,A;4,B;5,A&#10;

Question 3

Match the type of tick of the Ixodes ricinus complex with the geographic area of prevalence.

I.scapularis (formerly classified as I.dammini)

A)Europe
B)Western United States
C)Asia
D)Northeastern and Midwestern United States

Northeastern and Midwestern United States

Accepted Answer

Ixodes scapularis (formerly classified as Ixodes dammini) is prevalent in northeastern and midwestern United States, primarily in areas with high humidity and dense vegetation.

Question 4

One of the most widely available assays for antibody in Lyme disease is:&#10;A) EIA for total IgM or IgG antibodies.&#10;B) Southern blot test.&#10;C) indirect fluorescent antibody (IFA).&#10;D) RIA.

Accepted Answer

In the United States,the diagnosis is usually based on the recognition of the characteristic clinical findings,a history of exposure in an area in which the disease is endemic and,except in patients with EM,an antibody response to B.burgdorferi by enzyme-linked immunosorbent assay (ELISA)and Western blot.In more than 50% of cases,positive test results are inconsequential because physicians are comfortable making the diagnosis based on symptoms and patient history.Testing becomes important,however,when the telltale bull's eye rash or other symptoms characteristic of Lyme disease do not appear.

Question 5

Patients with Lyme arthritis should demonstrate positive findings for:&#10;A) serum antinuclear antibodies.&#10;B) rheumatoid factor.&#10;C) the VDRL test.&#10;D) antibodies to Borrelia burgdorferi.

Accepted Answer

Immunoblot analysis demonstrates that IgM antibodies form initially against the flagellar 41-kDa polypeptide but react later to additional cell wall antigens.An overlapping IgG response to these antigens develops in some individuals.These antigen-specific cellular and humoral responses are not known to eradicate B.burgdorferi infection in early disease or participate in disease pathogenesis.

Question 6

Match the type of tick of the Ixodes ricinus complex with the geographic area of prevalence.

I.scapularis (formerly classified as I.dammini)

A)Europe
B)Western United States
C)Asia
D)Northeastern and Midwestern United States

Accepted Answer

Ixodes persulcatus is commonly found in Asia.

Question 7

Serologic assays for Lyme disease are:&#10;A) highly specific in the early stages.&#10;B) highly sensitive in the early stages.&#10;C) insensitive during the first several weeks of infection.&#10;D) insensitive during the first months of infection.

Accepted Answer

Serodiagnostic tests are insensitive during the first several weeks of infection.

Question 8

Match the preferred host with the correct animal(s)or birds.&#10;Preferred host for larval and nymphal stages of I.scapularis.&#10;A)White-footed mouse&#10;B)White-tailed deer&#10;

Accepted Answer

The larval and nymphal stages of I.scapularis prefer to feed on the white-footed mouse, which is also a common host for the adult stage. While the white-tailed deer can also serve as a host for adult ticks, it is not the preferred host for the larval and nymphal stages.

Question 9

Match the type of tick of the Ixodes ricinus complex with the geographic area of prevalence.

I.scapularis (formerly classified as I.dammini)

A)Europe
B)Western United States
C)Asia
D)Northeastern and Midwestern United States

Accepted Answer

Ixodes ricinus is the most prevalent tick in Europe, especially in central and northern European countries.

Question 10

Lyme disease usually occurs during the summer,with most patients suffering from:&#10;A) flulike symptoms.&#10;B) erythema migrans (EM).&#10;C) arthritis.&#10;D) both a and b

Accepted Answer

In at least 60% to 80% of U.S.patients,Lyme disease begins with a slowly expanding skin lesion,EM,which occurs at the site of the tick bite.The skin lesion is frequently accompanied by flulike symptoms.

Question 11

Match the causative agent with the appropriate characteristic.

Borrelia burgdorferi strains

A)Associated with the chronic skin condition acrodermatitis chronica atrophicans (ACA)in Europe
B)United States
C)Associated with neurologic symptoms in Europe

Accepted Answer

The answer of Match the causative agent with the appropriate...

Question 12

Match the causative agent with the appropriate characteristic.

Borrelia burgdorferi strains

A)Associated with the chronic skin condition acrodermatitis chronica atrophicans (ACA)in Europe
B)United States
C)Associated with neurologic symptoms in Europe

Accepted Answer

The answer of Match the causative agent with the appropriate...

Question 13

Most U.S.cases of Lyme disease remain concentrated in ____________ regions.&#10;A) northeastern&#10;B) north-central&#10;C) Pacific coastal&#10;D) all of the above

Accepted Answer

The answer of Most U.S.cases of Lyme disease remain concentrated...

Question 14

Match the causative agent with the appropriate characteristic.

Borrelia burgdorferi strains

A)Associated with the chronic skin condition acrodermatitis chronica atrophicans (ACA)in Europe
B)United States
C)Associated with neurologic symptoms in Europe

Accepted Answer

The answer of Match the causative agent with the appropriate...

Question 15

Erythema chronicum migrans (ECM)is the _______________ caused by a tick bite.&#10;A) itchy rash&#10;B) red bull's-eye rash&#10;C) spirochete-infected skin lesion&#10;D) both b and c

Accepted Answer

The answer of Erythema chronicum migrans (ECM)is the _______________ caused...

Question 16

What is the causative agent of Lyme disease?&#10;A) Herpesvirus&#10;B) Borrelia burgdorferi&#10;C) Treponema pallidum&#10;D) Deer tick

Accepted Answer

The answer of What is the causative agent of Lyme...

Question 17

Match the type of tick of the Ixodes ricinus complex with the geographic area of prevalence.

I.scapularis (formerly classified as I.dammini)

A)Europe
B)Western United States
C)Asia
D)Northeastern and Midwestern United States

Accepted Answer

The answer of Match the type of tick of the...

Question 18

The CLIA-waived procedure for presumptive testing for Lyme disease is the:&#10;A) ELISA&#10;B) Western blot test.&#10;C) indirect fluorescent antibody (IFA).&#10;D) PreVue assay for Borrelia burgdorferi.

Accepted Answer

The answer of The CLIA-waived procedure for presumptive testing for...

Question 19

The clinical case definition of Lyme disease includes but is not limited to:&#10;A) the presence of erythema migrans.&#10;B) at least one objective,late-manifesting sign of musculoskeletal,neurologic,or cardiovascular disease for antibody to Borrelia burgdorferi.&#10;C) positive serologic evidence.&#10;D) all of the above.

Accepted Answer

The answer of The clinical case definition of Lyme disease...

Question 20

Match the preferred host with the correct animal(s)or birds.&#10;Preferred host for I.scapularis adult stage.&#10;A)White-footed mouse&#10;B)White-tailed deer

Accepted Answer

The answer of Match the preferred host with the correct...

Question 21

Match the organism with the appropriate characteristic:&#10;West Nile virus&#10;A)Infects red blood cells&#10;B)Member of the Japanese encephalitis group&#10;

Accepted Answer

The answer of Match the organism with the appropriate characteristic:&#10;West...

Question 22

Match the Ehrlichia species developmental stages with the appropriate description.

Final stage

A)Packed elementary bodies (initial bodies)visible
B)Enter a leukocyte by phagocytosis and multiply rapidly
C)Morular,or mulberry,forms

Accepted Answer

The answer of Match the Ehrlichia species developmental stages with...

Question 23

Match the organism with the appropriate characteristic:&#10;Babesiosis&#10;A)Infects red blood cells&#10;B)Member of the Japanese encephalitis group

Accepted Answer

The answer of Match the organism with the appropriate characteristic:&#10;Babesiosis&#10;A)Infects...

Question 24

Match the Ehrlichia species developmental stages with the appropriate description.

Final stage

A)Packed elementary bodies (initial bodies)visible
B)Enter a leukocyte by phagocytosis and multiply rapidly
C)Morular,or mulberry,forms

Accepted Answer

The answer of Match the Ehrlichia species developmental stages with...

Deck 19: Vector-Borne Diseases