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General Microbiology Question Bank - 1990 Verified Questions

Page 1


General Microbiology Question

Bank

Course Introduction

General Microbiology is an introductory course that explores the fundamental concepts of microbiology, focusing on the biology of microorganisms such as bacteria, viruses, fungi, and protozoa. The course covers the structure, function, growth, and genetics of microbes, as well as their roles in health, disease, industry, and the environment. Students will gain an understanding of microbial diversity, metabolism, and the interactions between microorganisms and their hosts. Laboratory exercises complement the lectures by providing hands-on experience in culturing and identifying microbes and applying aseptic techniques.

Recommended Textbook

Microbiology An Evolving Science 4th Edition by John W. Foster

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28 Chapters

1990 Verified Questions

1990 Flashcards

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Page 2

Chapter 1: Microbial Life: Origin and Discovery

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Sample Questions

Q1) What feature of bacteria facilitated the DNA revolution in the 1970s?

A) They are very small.

B) They readily recombine DNA.

C) They have very large genomes.

D) All of their genes were known.

E) They do not cause disease.

Answer: B

Q2) In the three-domain model, the bacterial ancestor of mitochondria derives from ancient

A) fungi.

B) cyanobacteria.

C) respiring bacteria.

D) archaea.

E) protists.

Answer: C

Q3) What is the significance of the work of Ignaz Semmelweis and Joseph Lister?

Answer: They showed that use of antiseptics on doctors' hands and medical instruments drastically reduced the mortality rate of hospital patients. They made these observations before Robert Koch's germ theory of disease.

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Page 3

Chapter 2: Observing the Microbial Cell

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Sample Questions

Q1) Which type of microscopy is used to view the internal structures of a specimen?

A) light

B) atomic force

C) scanning electron

D) transmission electron

E) confocal fluorescence

Answer: D

Q2) A(n) ________ acts to vary the diameter of the light column in a light microscope.

A) condenser

B) objective

C) ocular

D) diaphragm

E) lens

Answer: D

Q3) List and describe three common shapes of bacteria.

Answer: Bacilli (bacillus in the singular) are rod-shaped bacteria. Cocci (singular, coccus) are spherical-shaped bacteria. Spirochetes are tightly coiled spirals or corkscrew-shaped bacteria.

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4

Chapter 3: Cell Structure and Function

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Sample Questions

Q1) Which is NOT a component of a Gram-negative bacterium's wall?

A) peptidoglycan

B) teichoic acid

C) N-acetylmuramic acid

D) diaminopimelic acid

E) MurNac

Answer: B

Q2) Polar aging of symmetrical bacteria such as E. coli plays a role in stress responses in which of the following ways?

A) Antibiotics only affect older poles of stressed cells.

B) Alternators and accelerators are better at responding to stress.

C) Proteins damaged by stresses accumulate at old poles, thereby allowing new poles to continue growing.

D) Newer poles are more resistant to acidity and heat.

E) Newer poles produce flagella and can swim away from stress.

Answer: C

Q3) Explain how bacteria can produce proteins more quickly than eukaryotes do.

Answer: Bacteria have no membrane around the nucleoid. This transcription and translation can be coupled with no need to transport the mRNA out of a nucleus.

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Page 5

Chapter 4: Bacterial Culture, Growth, and Development

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Sample Questions

Q1) Cyanobacterial heterocysts function to fix atmospheric A) hydrogen sulfide.

B) ammonia. C) oxygen.

D) carbon dioxide.

E) nitrogen.

Q2) Compare and contrast complex media, synthetic media, and enriched media.

Q3) The most common form of chemical energy is contained in the high-energy phosphate bonds of A) water.

B) glucose.

C) ATP.

D) CO .

E) NADH.

Q4) MacConkey medium contains bile salts, crystal violet, lactose, and the pH indicator neutral red. Some organisms can ferment lactose, producing acids as a by-product. Is this medium likely to be selective and/or differential? Explain.

Q5) Why would an organism go through the process of sporulation? How might endospores cause problems in the food industry?

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Chapter 5: Environmental Influences and Control of

Microbial Growth

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Sample Questions

Q1) What is biocontrol? Describe two examples.

Q2) All of the following are true about microbes and temperature EXCEPT

A) microbes have mechanisms to control their temperature.

B) temperature affects the average rate of molecular motion.

C) changes in temperature affect membrane fluidity.

D) changes in temperature affect transport.

E) every organism has an optimum temperature for growth.

Q3) A virus that infects bacteria is called a

A) bacteriophage.

B) viroid.

C) spore.

D) probiotic.

E) porin.

Q4) Which of the following is NOT true concerning irradiation of foods?

A) Food consumed by NASA astronauts is sterilized by irradiation.

B) Foods become radioactive when irradiated.

C) Viruses are resistant to doses approved for foods.

D) A higher dose of radiation is necessary to kill microbes in frozen foods.

E) It is effective in eliminating parasites and bacteria.

Q5) Describe three mechanisms organisms use to reduce osmotic stress.

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Chapter 6: Viruses

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Sample Questions

Q1) Tissue cultures are more feasible than whole animals for viral growth because they A) can develop vaccines.

B) can test a multitude of chemical and antibiotic agents.

C) are more time-consuming.

D) are less expensive.

E) are more expensive.

Q2) What determines the host range and tropism of a virus?

Q3) Which of the following is NOT true of the pararetroviruses?

A) They have an RNA genome.

B) They do not make a DNA intermediate.

C) Some have a viral reverse transcriptase.

D) Some use a host reverse transcriptase.

E) They consist of human and plant pathogens.

Q4) The genome of ________ ssRNA viruses can serve directly as mRNA.

A) positive-sense (+)

B) negative-sense (-)

C) all

D) double-stranded

E) prion

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Chapter 7: Genomes and Chromosomes

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Sample Questions

Q1) The thermal stability of the helix is predominantly due to the ________ of the hydrophobic base pairs.

A) attraction

B) binding

C) repulsion and van der Waals forces

D) stacking

E) redox potential

Q2) In early cloning techniques, E. coli was ________ with the DNA of interest contained in a plasmid or phage vector. This cloned DNA could then be transferred to another organism using a ________.

A) conjugated; contig

B) conjugated; vector

C) transformed; vector

D) transformed; contig

E) transformed; polymerase chain reaction

Q3) Describe how the name of bacterial genes and their gene product are denoted.

Q4) What is horizontal gene transfer and how does it differ from vertical gene transfer? Is horizontal gene transfer limited to bacteria and archaea?

Q5) What determines the timing of DNA replication in Escherichia coli?

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Chapter 8: Transcription, Translation, and Bioinformatics

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Sample Questions

Q1) Signal sequences are found where?

A) in the 30S ribosomal subunit

B) in the 50S ribosomal subunit

C) at the N-terminal end of a protein

D) at the C-terminal end of a mRNA

E) upstream of the promoter

Q2) The term "________" is used to describe movement of a protein from one compartment to another.

A) export

B) import

C) translocation

D) transport

E) secretion

Q3) Both codons and anticodons

A) are part of tRNA.

B) are sequences of DNA three nucleotides long.

C) are identical RNA sequences.

D) are complementary RNA sequences.

E) interact with tmRNA in order to function.

Q4) How are folded and unfolded proteins moved from the cytoplasm to the periplasm?

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Chapter 9: Gene Transfer, Mutations, and Genome

Evolution

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Sample Questions

Q1) Why does a genetic experiment using recombination generally involve screening hundreds of millions of cells to find a few recombinants that form visible colonies?

Q2) Describe four of the informational classes of mutations.

Q3) A difference between type II restriction enzyme and type I or type III restriction enzymes is that

A) type II enzymes require shorter recognition sequences.

B) type II enzymes cut at the recognition sequence rather than elsewhere.

C) type I and III cut palindromic sequences but type II does not.

D) type I and III require different proteins for methylation and cutting.

E) type II enzymes are found only in Gram-positive bacteria.

Q4) Many infectious bacteria have regions of DNA coding for virulence factors. These regions are called

A) transposases.

B) pathogenicity islands.

C) inverted repeats.

D) F plasmids.

E) genome reductions.

Q5) Describe two processes that may happen during the evolution toward pathogenicity.

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Chapter 10: Molecular Regulation

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Sample Questions

Q1) Which molecule is used for hybridization to DNA bound on a DNA microarray?

A) DNA

B) RNA

C) mRNA

D) cDNA

E) qDNA

Q2) Explain how a repressor protein works with respect to a biosynthetic operon.

Q3) When an inducer is added to a medium containing an organism with a metabolic pathway controlled by a repressor, the inducer then

A) combines with the repressor and activates the repressor.

B) combines with the repressor and inactivates the repressor.

C) combines with the substrate and blocks induction.

D) combines with the substrate and activates induction.

E) does not combine with, but functions as a chaperone molecule for, the enzyme-substrate complex.

Q4) Explain a way that organisms sense and respond to their environment.

Q5) How is sigma H degradation controlled by temperature, and why is this important to the cell?

Q6) What is diauxic growth and why does it occur?

Q7) Describe the function of prokaryotic activator proteins.

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Chapter 11: Viral Molecular Biology

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Sample Questions

Q1) Describe the replication process of the human immunodeficiency virus (HIV).

Q2) The capsid of the bacteriophage lambda is composed of two types of protein subunits, namely, D and E, arranged in a(n)________ shape.

A) icosahedral

B) rhomboidal

C) pyramidal

D) triclinic

E) cubic

Q3) What is an oncolytic virus? Give an example.

Q4) Which of the following is a mismatched pair?

A) herpes simplex virus 2-genital lesions

B) varicella-zoster virus-chickenpox, shingles

C) papillomavirus-genital warts

D) variola major virus-smallpox

E) None of the examples are mismatched.

Q5) Describe how priming for mRNA synthesis or template synthesis for viral progeny of influenza A virus differs from typical mRNA synthesis mechanisms.

Q6) How is lambda phage being used to fight the problem of antibiotic resistance in bacteria?

Page 13

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Chapter 12: Biotechniques and Synthetic Biology

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Sample Questions

Q1) Describe the whole-genome DNA-binding analysis using ChIP-on-chip technology.

Q2) How is bacterial DNA cross-linked to putative binding proteins for chromatin immunoprecipitation (ChIP)?

A) exposure to UV light

B) treatment with formaldehyde

C) treatment with heat

D) reduction with dithiothreitol

E) reduction with b-mercaptoethanol

Q3) A "buffer gate" in synthetic biology can best be described as

A) a single repressor molecule (R1) that prevents the production of an output molecule (Pr1).

B) alternate input molecules (I1 or I2) that drive the production of alternative proteins (Prn).

C) a single input inducer molecule (I1) that leads to the production of a single product (Pr1).

D) kill switches.

E) a potent DNA-damaging toxin.

Q4) Describe the use of a primary and secondary antibody in a western blot.

Q5) What is the conceptual basis of the primer extension technique?

Q6) Describe the difference between autoradiography and phosphor imaging.

Page 14

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Chapter 13: Energetics and Catabolism

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Sample Questions

Q1) Chemoorganotrophy is a term describing microorganisms that A) use preformed organic compounds as a source of electrons and obtain energy through fermentations or organic respiration.

B) obtain electrons and H+ via photolysis of H O or H S, producing O or S2, respectively. C) perform photolysis of small organic molecules.

D) use carbon dioxide as the carbon source.

E) pull electrons off minerals to donate to electron transport systems.

Q2) What is mixed-acid fermentation? Provide examples of industrial uses of its products.

Q3) Ethanolic fermentation is used in making beverages such as beer, wine, and pulque. It is carried out by yeast and A) lactobacillus.

B) leuconostoc.

C) propionibacterium.

D) zymomonas.

E) clostridium.

Q4) Describe the diagnostic use of sorbitol MacConkey agar to test for the presence of E. coli O157:H7.

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Page 15

Chapter 14: Electron Flow in Organotrophy, Lithotrophy, and Phototrophy

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Sample Questions

Q1) How does bacteriorhodopsin couple photoexcitation with proton pumping? How is ATP synthesized in bacteriorhodopsin-containing organisms?

Q2) Which of the following reactions is possible by reverse electron flow?

A) reduction of Fe3+ to Fe2+

B) NADP+ reduction to NADPH

C) protein biosynthesis

D) reduction of oxygen by Fe2+ to form H O and Fe3+

E) anammox

Q3) Extreme halophilic archaea exclusively utilize which kind of ion gradient?

A) H+

B) Na+

C) Ca2+

D) K+

E) Mg2+

Q4) What are methanotrophs? What is their role in the global carbon cycle?

Q5) Explain what kind of reaction bacteriorhodopsin performs and what it accomplishes for the cell. What is the name of the bacteriorhodopsin homologs, in what type of organisms were they identified, and what led to their discovery?

Q6) What is photoheterotrophy? Give examples of photoheterotrophic organisms.

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Chapter 15: Biosynthesis

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Sample Questions

Q1) The incorporation of NH into 2-oxoglutarate is the first step in nitrogen assimilation in bacterial cells. This reaction is catalyzed by the enzyme ________ and produces

A) glutamate dehydrogenase (GDH); glutamate

B) glutamine synthase (GS); glutamine

C) glutamate synthase (GOGAT); glutamate

D) 2-oxoglutarate aminase (2-OA); glutamine

E) 2-oxoglutarate dehydrogenase (2-ODH); glutamine

Q2) In the mechanism of nitrogen reduction, ________ directly takes the place of the H in the FeMo subunit of the enzyme nitrogenase.

A) NH3

B) N

C) HN=NH

D) H N-NH

E) NADPH

Q3) How do ammonium and oxygen regulate the expression of nitrogen fixation genes?

Q4) It is thought that the Calvin cycle appeared after the divergence of the three domains of life. What supports this hypothesis?

Q5) Briefly describe how NH is assimilated into biomass by bacteria.

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Chapter 16: Food and Industrial Microbiology

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Sample Questions

Q1) Recombinant Escherichia coli is used in the production of the following EXCEPT

A) interferon.

B) CC10 lung development protein.

C) human growth hormone.

D) insulin.

E) antibodies.

Q2) Tempeh, a staple food of Indonesia, is produced by an initial fermentation of soybeans with ________, followed by ________.

A) lactic acid bacteria; Aspergillus oryzae

B) lactic acid bacteria; Rhizopus oligosporus

C) Propionibacterium spp.; Aspergillus oryzae

D) Propionibacterium spp.; Leuconostoc mesenteroides

E) Propionibacterium spp.; Rhizopus oligosporus

Q3) Describe how the transportation of milk products by herders led to the formation of cheeses.

Q4) The strain Escherichia coli O157:H7 is pathogenic for humans. It was first identified in ground beef. What does an infection with it cause and do to humans? Why do you suppose infections are more prevalent in ground meat than on a steak?

Q5) Explain the difference between food spoilage and food poisoning.

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Chapter 17: Origins and Evolution

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Sample Questions

Q1) The loss of genes encoding for unselected traits is known as A) random mutation.

B) natural selection.

C) reductive evolution.

D) clade evolution.

E) random recombination.

Q2) Evidence in the study of adaptive evolution CANNOT be obtained from

A) comparisons of gene sequences within a genome.

B) comparisons of gene sequences between genomes.

C) the study of microorganisms growing in strongly selective environments.

D) sequencing a single genome several times (deep sequencing).

E) experimental evolution.

Q3) Discuss what horizontal gene transfer is. How does it occur and how might it obscure phylogenetic relationships among taxa?

Q4) Taxonomy can be defined as the

A) classifying of life forms into different categories with shared traits.

B) recognition of the class of a given microbe isolated in pure culture.

C) identification of a species in a sample or collection.

D) recognition of different classes of life.

E) testing of metabolic reactions to predict pathogenicity.

Page 19

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Chapter 18: Bacterial Diversity

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Sample Questions

Q1) Why is it that the deep-branching thermophiles may appear to have diverged from other bacteria earlier than they actually did?

Q2) A bacterial phylum is a group of organisms that share a common ancestor that diverged early from other bacteria, based on

A) small-subunit (16S) rRNA sequences.

B) the presence of certain plasmids.

C) their genomic size.

D) having 70S or 80S ribosomes.

E) the presence or absence of a cell wall.

Q3) The firmicutes ________ are the only known phototrophs that produce endospores.

A) actinomycetales

B) bacillales

C) clostridiales

D) heliobacteriaceae

E) cyanobacteria

Q4) The epsilonproteobacterium Helicobacter pylori is the cause of gastritis and stomach ulcers. What mechanism allows it to survive the acidic conditions of the mammalian stomach?

Q5) What is photoheterotrophy? Provide two examples.

Page 20

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Chapter 19: Archaeal Diversity

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Sample Questions

Q1) The Haloarchaea, extreme ________, are the only form of life to grow in concentrated brine.

A) thermophiles

B) psychrophiles

C) methanophiles

D) halophiles

E) acidophiles

Q2) Which archaea uses light energy to drive a retinal-based ion pup to establish a proton potential?

A) all archaea

B) hyperthermophilic Crenarchaeota

C) Methanobacteriales

D) Haloarchaea

E) Sulfolobales

Q3) Which organism has a periplasmic space containing membrane vesicles?

A) Desulfurococcus sp.

B) Ignicoccus sp.

C) Methanosarcina sp.

D) Methanothermus sp.

E) Pyrodictium sp.

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Chapter 20: Eukaryotic Diversity

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Sample Questions

Q1) All of the following are characteristics of eukaryotic organisms EXCEPT

A) their cells possess a nucleus.

B) all types of eukaryotic cells are surrounded by a cell wall.

C) they are highly compartmentalized and have an endomembrane system.

D) they include organisms with unicellular complex multicellular bodies or unicellular forms.

E) they display aerobic respiration, although some are capable of phototrophy.

Q2) What distinguishes the Opisthokonta from other eukaryotic clades?

A) an insertion coding for 11-17 amino acids in the elongation factor 1a gene

B) the sequence of ribosomal RNA genes

C) the sequence of RNA polymerase II

D) that some have a cell wall

E) that they are obligate heterotrophs

Q3) Describe how Trypanosoma brucei overwhelms the immune system of an infected animal host, and explain the possible current targets for drug therapy.

Q4) Why are phylogenetic data in the domain Eukarya overall harder to obtain than phylogenetic evidence in either the Bacteria or Archaea domains? How has this affected the systematics of Eukarya?

Q5) What are choanoflagellates and what is their importance in evolutionary studies?

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Chapter 21: Microbial Ecology

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Sample Questions

Q1) A rarefaction curve is the

A) number of sequences generated from a metagenome.

B) number of SSU rRNA sequences found in a metagenome.

C) number of OTUs found as a function of increasing sample size.

D) total number of OTUs from all combined genes in a metagenome.

E) number of organisms in an environment.

Q2) Which of the following plays an important role in keeping the water column clear enough for the penetration of light?

A) algae

B) bacteria

C) fish

D) invertebrates

E) viruses

Q3) In any environment, pathogens are always outnumbered by a vast community of neutral or helpful microbes. Describe some beneficial as well as devastating incidences of plant pathogens.

Q4) Compare and contrast the photic zones of freshwater lake and pelagic ecosystems.

Q5) Describe the initiation process for legume-rhizobium symbiosis.

Q6) The net biomass of a population does not indicate productivity within an ecosystem. Explain.

Page 23

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Chapter 22: Microbes in Global Elemental Cycles

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Sample Questions

Q1) Which is the most stable form of nitrogen?

A) NO

B) NO -

C) N

D) NH3

E) NH

Q2) How are wetlands similar to or different from commercial wastewater treatment plants?

Q3) Compare and contrast assimilatory and dissimilatory nitrate reduction.

Q4) Modifications of ________ structure and composition represents a common microbial adaptation to limiting phosphorous concentrations.

A) membrane

B) protein

C) DNA

D) polysaccharide

E) the cell wall

Q5) What types of evidence suggest the past existence of water on Mars?

Q6) Describe the difference between a source, sink, and reservoir of an element.

Q7) What are two mechanisms used by marine organisms to adapt to the scarcity of phosphorous?

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Chapter 23: Human Microbiota and Innate Immunity

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Sample Questions

Q1) How is it that Gram-positive cells are more resistant to complement than Gram-negative cells?

Q2) Which of the following organisms is NOT a cause of chronic inflammation?

A) a splinter

B) Mycobacterium tuberculosis

C) Mycobacterium marinum

D) Actinomyces bovis

E) biofilms on surgical implants

Q3) Much of the ________ is normally free from microbes in a healthy individual.

A) nose

B) mouth

C) skin

D) respiratory tract

E) genitourinary tract

Q4) Which condition is NOT related to obesity?

A) diabetes

B) cardiovascular disease

C) cancer

D) nonalcoholic fatty liver disease

E) alcoholism

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Chapter 24: The Adaptive Immune Response

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Sample Questions

Q1) Bacteremia is a condition in which live bacteria enter the bloodstream, but not the cells of the body. Which form of processing would occur to stimulate a cell-mediated immune response?

A) bacterial peptide transported from cytoplasm to rER for presentation on MHC I

B) endocytosis by APC followed by presentation on MHC II

C) neutrophil phagocytosis with presentation on Fc receptor

D) cytotoxic T-cell endocytosis for presentation on CD8 receptor

E) B-cell capping for presentation on the B-cell receptor

Q2) Anti-Streptococcus antibodies found in the serum of a patient during a primary antibody response differ from the antibodies produced during a secondary response to the same antigen because of

A) VDJ recombination.

B) affinity maturation.

C) class switching.

D) MHC processing.

E) antigen adaptation.

Q3) X-linked hyper IgM syndrome (XHIM) is an immunodeficiency disorder caused by mutations of the gene encoding CD154. Why is this disease characterized by recurrent infections (starting in childhood) and elevated serum levels of IgM?

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Chapter 25: Microbial Pathogenesis

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Sample Questions

Q1) Consider two isolates, A and B. Microbe A had an LD of 5 * 10 , while microbe B recorded an LD of 5 * 10 . Which isolate is more virulent?

A) unable to know based on information provided

B) microbe A

C) microbe B

D) They are equally virulent.

E) The values indicate that neither one is virulent.

Q2) Salmonella and Shigella both

A) produce shiga toxin.

B) are Gram-positive rods.

C) are resistant to gastric acid.

D) cause typhoid fever.

E) are facultative intracellular pathogens.

Q3) Petechiae, which result from large amounts of endotoxin, are distinguished by which symptom?

A) diarrhea

B) a pseudomembrane

C) elephantiasis

D) fever

E) a rash

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Chapter 26: Microbial Diseases

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Q1) What evidence suggests that Columbus did not bring syphilis back from the New World, but instead brought it from Europe to the New World?

Q2) Rubeola measles is caused by ________ virus.

A) hepatitis B

B) varicella

C) paramyxovirus

D) rhinovirus

E) adenovirus

Q3) Which of the following STDs is caused by a protozoan infection?

A) Treponema pallidum

B) Trichomonas vaginalis

C) Chlamydophila pneumoniae

D) HIV

E) Neisseria gonorrhoeae

Q4) Which of the following is NOT matched correctly?

A) erythema migrans-Neisseria gonorrhoeae

B) Borrelia burgdorferi-Lyme disease

C) salvanic cycle-wild rodent and flea cycling of plague

D) pelvic inflammatory disease-antigen phase variation

E) multidrug resistance-emerging Mycobacterium tuberculosis

Page 28

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Chapter 27: Antimicrobial Therapy

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72 Verified Questions

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Sample Questions

Q1) Minimal inhibitory concentration, or MIC, is ________ concentration of a drug that will prevent the growth of an organism.

A) the average

B) the lowest

C) the highest

D) the midline

E) any

Q2) In the 1930s, Gerhard Domagk injected his own daughter with a red dye in hopes of curing her invasive streptococcal infection, even though testing of this agent on agar plates growing Streptococcus sp. showed no antimicrobial effect. Analyze why he did this. What did this study show the importance of?

Q3) Most antiviral drugs approved for clinical use target viral proteins. Which of the following is NOT a targeted viral protein?

A) Cap-binding complex

B) proteases

C) polymerases

D) entry proteins

E) alpha-glucosidase

Q4) Why are drug-resistant bacteria less viable in comparison with wild type?

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Chapter 28: Clinical Microbiology and Epidemiology

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75 Verified Questions

75 Flashcards

Source URL: https://quizplus.com/quiz/27338

Sample Questions

Q1) How have changes within our human culture caused new diseases to emerge? Explain your answer using a specific example that supports your statements.

Q2) An antigen-capture ELISA could be looking for all of the following in a person who is presumed to have a severe acute lung infection EXCEPT

A) mycobacterium antigens.

B) SARS antigens.

C) Haemophilus sp. antigens.

D) pneumococcal antigens.

E) anti-influenza antibodies.

Q3) The clinical microbiology laboratory just received a sputum (deep-lung) sample that so far has been very slow-growing in nonselective agar, as well as not Gram stainable. What tests should be performed next, and why?

Q4) Tuberculosis has become a reemerging pathogen today in large part due to A) increased incidence of HIV infection.

B) airline travel reducing geographical distances.

C) surge in reservoir animal populations carrying the disease to humans.

D) strict compliance with drug regimens.

E) concurrent increases in hepatitis C infection.

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