TentamenTests bij Mechanisms of Disease 1 - Geneeskunde UL

Bevat oefenmateriaal bij het blok uit voorgaande collegejaren.

Voor soortgelijke vragen en casussen, zie ook

• Oefenmateriaal bij Gezonde en Zieke Cellen 1 (GZC)
• Oefentoetsen bij Gezonde & Zieke Cellen 2 (GZC)
• Gezonde & Zieke Cellen 2 (GZC 2) - B2 - Geneeskunde - UU - Oefenbundel

MOD 1 - Oefententamen 1

1. What structural component contains a Gram-positive bacteria?

1. Lipopolysaccharide

2. Lipoteichoic acid

3. Outer membrane

4. Periplasmic space

2. Which organism can form cysts?

1. Staphylococcus aureus (S. Aureus)

2. Entamoeba histolytica

3. Aspergillus fumigatus

4. Cytomegalovirus

3. Bacteria can transfer resistance in different ways against antimicrobial agents. In which transfer is a bacteriophage (virus) involved?

1. Conjugation

2. Transduction

3. Transformation

4. Transfection

4. A 38-year-old man from Somalia has cervical lymph node TBC. If you take a lymph node biopsy, which histological pattern will most likely be seen?

1. Acute pyogenic inflammation

2. Chronic inflammation and fibrosis

3. Granulomas

4. Necrosis without inflammation

5. A woman of 52-year-old who had a renal transplantation one month ago has dyspnea, fever (39.2), and non-productive cough. On the X-ray of the chest is an interstitial pneumonia visible and a broncho-alveolar lavage shows that cytomegalovirus is present in the lavage fluid. Indicate which disorder of host defence has likely played a major role in the pathogenesis. (1 anwer)

1. Presence of corpus alienum

2. Break in skin integrity

3. Break in mucous membrane integrity

4. Chronic granulomatous disease

5. Common variable immunodeficiency

6. Complement deficiency

7. Granulocyte function disorder

8. Granulocytopenia

9. Leukocyte adhesion deficiency

10. Spleen dysfunction/asplenia

11. Incomplete emptying of urinary bladder

12. Severe combined immunodeficiency (SCID)

13. Lack of gastric acid

14. Impaired coughing

15. Impaired cell-mediated immunity

16. Impaired intestinal peristalsis

17. Impaired colonization resistance

18. Impaired ciliary function

19. X-linked agammaglobulinaemia

6. How can a cytomegalovirus be recognized in histology?

7. A pregnant woman has not been vaccinated against rubella. She does not know whether she had rubella in the past. Serology shows that IgG antibodies against rubella are negative and IgM antibodies against rubella are positive. How should this test be interpreted?

1. She had rubella earlier and the foetus is protected by maternal antibodies

2. She is recently infected with rubella implicating a risk for the foetus

3. This has no consequences if she is completetely asymptomatic

8. A 26-year-old male visits the general practitioner because of painful and frequent micturition. The general practitioner does not think it is a urinary tract infection, because of the medical history (10% chance). The dipstick test has a sensitivity of 56% and a specificity of 97%. Suppose the test is positive, what is the probability that this male has a urinary tract infection?

9. A woman of 24 years old has fever and a painful swelling in the left breast. She gave birth to a healthy baby 3 weeks ago. There is fluctuation and a very painful swelling when the doctor investigates the breast. The surgeon decides to make an incision from which drainage of pus is seen. A Gram stain is made and the coagulase test is positive. Which organism is the cause of the described symptoms? (1 answer)

1. Ancylostoma duodenale

2. Ascaris lumbricoides

3. Aspergillus fumigatus

4. Candida albicans

5. Clostridium perfringens

6. Echinococcus granulosus

7. Entamoeba histolytica

8. Escherichia coli

9. Giardia lamblia

10. Mycobacterium tuberculosis

11. Neisseria gonorrhoeae

12. Neisseria meningitides

13. Plasmodium falciparum

14. Plasmodium vivax

15. Salmomenella species

16. Staphylococcus aureus

17. Staphylococcus epidermidis

18. Streptococcus pneumoniae

19. Streptococcus pyogenes

20. Schistosoma species

21. Strongyloides stercolaris

22. Toxoplasma gondii

23. Treponema pallidum

24. Trichuris trichiura

10. How would you treat the patient and what questions would you ask before you are going to treat the patient?

11. A man of 34 years old had several unsafe sexual contacts with the exception of the past 6 months. He feels perfectly well. The man is going to start a new relationship, but he wants to know whether he would be infected with HIV. What diagnostic test should be done? (1 answer)

1. Antigen assay, bacterial

2. Antigen assay, protozoa

3. Antigen assay, viral

4. DNA/RNA (PCR) detection

5. Electron microscopy

6. Culture, bacterial

7. Culture, fungal

8. Culture, viral

9. Culture, worms

10. Microscopy, auramine stain

11. Microscopy, thick and thin blood smear

12. Microscopy, dark field

13. Microscopy, cysts, eggs and larvae

14. Microscopy, Gram stain

15. Microscopy, KOH

16. Microscopy, Ziehl-Neelsen stain

17. Serology

18. Toxin assay

12. What transmission routes of HIV are there possible in general?

13. If the patient would be HIV positive, what should you do with a needlestick accident?

14. An obese woman of 43 years old has cellulitis (soft tissue infection) of her right foot and low-grade fever. The foot is red, swollen and painful during palpation. A skin defect is detected between the first and the second toe which is caused by fungal infection. She also has diabetes mellitus. What 2 microorganisms cause cellulitis? (2 answers)

1. Aspergillus fumigatus

2. Candida albicans

3. Cytomegalovirus

4. Echinococcus granulosus

5. Entamoeba histolytica

6. Epstein-Barr-virus

7. Escherichia coli

8. Giardia lamblia

9. Herpes simplex virus

10. HIV

11. Influenzavirus

12. Mycobacterium tuberculosis

13. Neisseria meningitidis

14. Plasmodium falciparum

15. Plasmodium vivax

16. Schistosoma species

17. Staphylococcus aureus (S. Aureus)

18. Staphylococcus epidermidis

19. Streptococcus pneumoniae

20. Streptococcus pyogenes

21. Strongyloides stercoralis

22. Toxoplasma gondii

23. Treponema pallidum

24. Varicocella-zoster virus

15. What microorganisms cause diarrhea? Base on clinical presentation, how can you differentiate between the different microorganisms? What microorganisms are associated with an immune defense disorder?

16. Which antibiotics can inhibit nucleic acid synthesis?

1. Cephalosporines (e.g. cefuroxim)

2. Chinolones (e.g. ciprofloxacin)

3. Macrolides (e.g. clarithromycin)

4. Tetracyclines (e.g. doxycycline)

17. Resistance of methicillin-resistant Staphylococcus Aureus (MRSA) to flucloxacillin is caused by:

1. Active secretion from the bacterial cell

2. Altered penicillin-binding proteins

3. Beta-lactamase production

4. Decreased cell wall permeability

18. A woman of 55 years old has painful micturition with diabetes. She has no fever and looks not very ill. Escheria coli is seen in the urine culture, which is sensitive for nitrofurantoin cefuroxime, gentamicin, ciprofloxacin, resistant to amoxicillin. What antibiotic should the patient get?

19. Via which route is Hepatitis B transmitted?

1. The air

2. Droplets

3. By a vector

4. Sexually

5. Nutrition

20. The reproductive rate of influenza is 3-4. What percentage of a population must be vaccinated in order to prevent an epidemic when a vaccine would be completely protective?

21. A Zambian woman of 44 years old immigrated to the Netherlands 2 years ago. She has fever and abdominal pain, diagnose as appendicitis. There is a worm in the lumen of the appendix of 15cm. What is the way of transmission? (2 answers)

1. Animal bite

2. Blood transfusion

3. Breast feeding

4. Consumption of drinking water

5. Consumption of improperly washed vegetables

6. Consumption of insufficiently heated meat

7. Contact with soil

8. Contact with animal excreta

9. Contact with droplets of airway secretion

10. Contact with hands of healthcare workers

11. Contact with secretion in the birth canal

12. Contact with seawater

13. Contact with fresh water

14. Direct skin-to-skin contact with a patient

15. Human faeco-oral contact

16. Inhalation of droplet nuclei

17. Inhalation of droplets of airway secretion

18. Inhalation of small droplets from the environment

19. Inhalation of spores in the air

20. Mosquito bite

21. Prick with a used injection needle

22. Sexual contact

23. Tick bite

24. Vertical transmission (during pregnancy)

22. In a nursing home, there are 10 patients with muscle pain, high fever, cough and feelings of general illness in a short period of time. There is influenza diagnosed. What is the way of transmission? (2 answers)

1. Animal bite

2. Blood transfusion

3. Breast feeding

4. Consumption of drinking water

5. Consumption of improperly washed vegetables

6. Consumption of insufficiently heated meat

7. Contact with soil

8. Contact with animal excreta

9. Contact with droplets of airway secretion

10. Contact with hands of healthcare workers

11. Contact with secretion in the birth canal

12. Contact with seawater

13. Contact with fresh water

14. Direct skin-to-skin contact with a patient

15. Human faeco-oral contact

16. Inhalation of droplet nuclei

17. Inhalation of droplets of airway secretion

18. Inhalation of small droplets from the environment

19. Inhalation of spores in the air

20. Mosquito bite

21. Prick with a used injection needle

22. Sexual contact

23. Tick bite

24. Vertical transmission (during pregnancy)

23. How can Schistosoma be prevented when you travel through Africa?

    1. Avoid close contact with Schistosoma patients

    2. Avoid fresh vegetables, uncooked food and water

    3. Avoid walking or swimming in surface waters

    4. Timely vaccination with Schistosoma antigens

24. A patient with pneumonia caused by Legionella is admitted to the hospital. Should this patient be isolated?

1. No, isolation is not necessary

2. Only if there are patients with impaired immunity on the ward

3. Yes, isolation is always indicated

25. A man of 28 years old has been bitten by a dog in Indonesia. The dog ran away. The patient was vaccinated for tetanus in his youth and after a trauma at work three years ago. Give 2 measures that should be taken (2 answers).

1. Adequate heating of food

2. Antimicrobial prophylaxis

3. Asepsis

4. Use of protective grown

5. Protection against mosquito bites

6. Disinfection of skin

7. Disinfection of instruments, surfaces, devices

8. Control of animal reservoir

9. Hand hygiene

10. Use of gloves, non-sterile

11. Use of gloves, sterile

12. Cold storage of food

13. Wearing a face mask, surgical

14. Wearing a face mask (FFP1, FFP2)

15. Passive immunization

16. Sewage treatment

17. Cleaning with water and soap

18. Screening of blood products

19. Sterilization

20. Vaccination

21. Vector control

22. Nursing in an isolation room

23. Water purification

24. No intervention or control measure necessary

26. A man of 28 years old has been bitten by a dog in Indonesia. The dog bit the man without procovaction. The patient was vaccinated for tetanus in his youth and after a trauma at work three years ago. Give 2 measures besides the 2 above mentioned measures that should be taken (2 answers).

1. Adequate heating of food

2. Antimicrobial prophylaxis

3. Asepsis

4. Use of protective grown

5. Protection against mosquito bites

6. Disinfection of skin

7. Disinfection of instruments, surfaces, devices

8. Control of animal reservoir

9. Hand hygiene

10. Use of gloves, non-sterile

11. Use of gloves, sterile

12. Cold storage of food

13. Wearing a face mask, surgical

14. Wearing a face mask (FFP1, FFP2)

15. Passive immunization

16. Sewage treatment

17. Cleaning with water and soap

18. Screening of blood products

19. Sterilization

20. Vaccination

21. Vector control

22. Nursing in an isolation room

23. Water purification

24. No intervention or control measure necessary

27. Which patients are at highest risk of Aspergillus pneumonia?

28. Which patients are at highest risk of VZV reactivations?’

29. Which patients are at highest risk of CMV disease?

30. Which patients are at highest risk of PTLD?

31. Which patients are at highest risk of Sepsis which is caused by Staphylococcus epidermidis?

32. Which patients are at highest risk of infections with Haemophilus and Streptococcus pneumoniae?

33. Which patients are at highest risk of sepsis which is caused by pneumococci?

MOD 1 - Oefententamen 2

1. Which virulence factor causes the acute inflammation of the meninges after Neisseria meningitides infection?

1. Capsule

2. Endotoxin (LPS)

3. Flagellae

4. Teichoic acid

2. Ebola virus is transmitted only by contact with the patient or body fluid. What type of virus is Ebola therefore?

1. DNA virus

2. Enveloped virus

3. Naked capsid virus

4. RNA virus

3. A man of 63 years old has had a knee surgery and develops fever 4 days after the surgery. In the blood it has been seen that Staphylococcus Aureus is present. On which test results was this determination based?

1. Catalase negative, coagulase negative

2. Catalase negative, coagulase positive

3. Catalase positive, coagulase negative

4. Catalase positive, coagulase positive

4. A man of 44 years old has had several infections and a complement deficiency (factor C2) has been found. Which microorganisms are most likely to cause infection in the patient?

1. Viruses

2. Extracellular bacteria

3. Intracellular bacteria

4. Fungi, yeasts

5. Why does H. influenza cause invasive diseases (e.g. meningitis) when it has a capsule and not when it does not have a capsule?

1. It is impossible for the bacterium to enter the CSF unencapsulated

2. The capsule causes tissue damage, which triggers the inflammatory reaction

3. The capsule protects against bactericidal proteins in the cerebrospinal fluid

4. The capsule protects against phagocytosis by granulocytes

6. A man of 73 years old is in IC after heart surgery. He has an intravenous cathether and artificial respiration. He has fever and suspected sepsis. Therefore, intravenous antibiotic therapy is started. Which component of the patient’s host defense is impaired?

1. Barrier function

2. Cellular immunity

3. Complement function

4. Granulocyte function

5. Humoral immunity

7. A patient has pneumococcal pneumonia. What microscopic finding is characteristic for a sputum grain stain?

1. 10-15 squamous epithelial cells; 0-2 leukocytes; 0-2 Gram-positive cocci in groups

2. 10-20 polymorphonuclear leukocytes; 20-30 Gram-positive diplococci

3. 10-20 polymorphonuclear leukocytes; 20-30 Gram-negative diplococci

4. 0-2 squamous epithelial cells; 5-10 leukocytes, > 100 fine Gram-negative rods

8. A woman of 40 years old has pneumonia caused by Streptococcus pneumoniae three times during the last four years. Now, she has signs of sinusitis. She has irregular stools, flatulence, cramps during the last half year. She lost 10kg. In the feces, Giardia cysts are found. Which disorder of host defence has likely played a major role in the pathogenesis? (1 answer)

1. Presence of corpus alienum

2. Break in skin integrity

3. Break in mucous membrane integrity

4. Chronic granulomatous disease

5. Common variable immunodeficiency

6. Complement deficiency

7. Granulocyte function disorder

8. Granulocytopenia

9. Leukocyte adhesion deficiency

10. Spleen dysfunction or asplenia

11. Incomplete emptying of urinary bladder

12. Severe combined immunodefiency

13. Lack of gastric acid

14. Impaired coughing

15. Impaired cell-mediated immunity

16. Impaired intestinal peristalsis

17. Impaired colonization resistance

18. Impaired ciliary function

19. X-linked agammaglobulinaemia

9. A man of 54 years old is admitted for coughing and fever without sputum. 3 months ago he had a stem cell transplantation and he received low dose cyclosporine to prevent graft-vs-host disease. The count of the cells are low-normal. The chest radiograph is also normal. The culture of the broncho-alveolar lavage becomes positive. Which organism is the cause? (1 answer)

1. Ancylostoma duodenale

2. Ascaris lumbricoides

3. Aspergillus fumigatus

4. Candida albicans

5. Clostridium perfringens

6. Echinococcus granulosus

7. Entamoeba histolytica

8. Escheria coli

9. Giardia lamblia

10. Mycobacterium tuberculosis

11. Neisseria gonorrhoeae

12. Neisseria meningitides

13. Plasmodium falciparum

14. Plasmodium vivax

15. Salmonella species

16. Staphylococcus Aureus (S. Aureus)

17. Staphylococcus epidermidis

18. Streptococcus pneumoniae

19. Streptococcus pyogenes

20. Schistosoma species

21. Strongyloides stercoralis

22. Toxoplasma gondii

23. Treponema pallidum

24. Trichuris trichiura

10. A woman of 43 years old presents with a painless large red spot on the left side of her left breast. The skin is intact, the lesion 15cm and faintly pink to red, without pus or vesicles. There is a crust in the center. 2 weeks ago she went hiking in the woods and had tick bites. What diagnostic test is necessary? (1 answer)

1. Antigen assay, bacterial

2. Antigen assay, protozoa

3. Antigen assay, viral

4. DNA/RNA (PCR)

5. Electron microscopy

6. Culture, bacterial

7. Culture, fungal

8. Culture, viral

9. Culture, worms

10. Microscopy, auramine stain

11. Microscopy, thick and thin blood smear

12. Microscopy, dark field

13. Microscopy, cysts, eggs and larvae

14. Microscopy, Gram stain

15. Microscopy, KOH

16. Microscopy, Ziehl-Neelsen stain

17. Serology

18. Toxin assay

19. No test, diagnostics not necessary

11. A man of 18 years old has tonsillitis. The tonsils are swollen and produce pus in the crypts. The enlarged lymph nodes in his neck can be palpated. Which microorganisms causes this disease? (1 answer)

1. Aspergillus fumigatus

2. Candida albicans

3. Cytomegalovirus

4. Echinococcus granulosus

5. Entamoeba histolytica

6. Epstein-Barr-virus

7. Escheria coli

8. Giardia lamblia

9. Herpes simplex virus

10. Human immunodeficiency virus

11. Influenzavirus

12. Mycobacterium tuberculosis

13. Neisseria meningitides

14. Plasmodium falciparum

15. Plasmodium vivax

16. Schistosoma species

17. Staphylococcus aureus

18. Staphylococcus epidermidis

19. Streptococcus pneumoniae

20. Streptococcus pyogenes

21. Strongyloides stercoralis

22. Toxoplasma gondii

23. Treponema pallidum

24. Varicella-zoster virus

Antwoordsleutels

Oefententamen 1

1. B

2. B

3. B

4. C

5. 0

6. Cytomegalovirus can be recognized by Cytomegalovirus can be recognized in histology by typical “owl’s eyes appearance”. http://virology-online.com/viruses/CMV.htm

7. B

8. (56/83)*100=67%

9. P

10. Treatment: the woman should try to continue to give breast feeding from both breasts.

11. Q

12. Transmission routes of HIV: blood, semen, pre-seminal fluid, rectal fluids, vaginal fluids, breast milk. Mostly by anal or vaginal sex with infected persons, and using needles from infected persons. Less common is from mother to child during pregnancy, and for healthcare professionals by being stuck with a contaminated needle. https://www.aids.gov/hiv-aids-basics/hiv-aids-101/how-you-get-hiv-aids/index.html#how

13. The first step is to clean the spot, and then directly start with PEP. RIVM: richtlijn prikaccidenten

14. Q, T

15. Diarrhea can be caused by viruses (noro, rota, adenovirus), bacteria (Campylobacter, Salmonella, Shigella, Yersina, E. coli, and parasites (Giardia lamblia, Cryptosporidium). If it takes shorter than 1 week, it is caused by viruses and bacteria, if it takes longer than 1 week, it is caused by parasites. Infections with parasites are associated with an immune defensive disorder. https://www.nhg.org/standaarden/volledig/nhg-standaard-acute-diarree#idm9134224

16. B

17. B

18. Nitrofurantoin

19. D

20. 66-75%

21. E, G

22. I, Q

23. C

24. A

25. B, F

26. O, T

27. Immune compromised patients

28. Immune compromised patients, elderly. https://www.ncbi.nlm.nih.gov/books/NBK47371/

29. Immune compromised patients, patients who had organ transplantation

30. Patients who had solid organ transplantation (SOT), or allogeneic hematopoietic stem cell transplantation (HSCT). http://emedicine.medscape.com/article/431364-overview

31. Different answers at the internet…

32. Patients with HIV. https://books.google.nl/books?id=Ats3BQAAQBAJ&pg=PA121&lpg=PA121&dq=highest+risk+Haemophilus+and+Streptococcus+pneumoniae&source=bl&ots=79Z0TMELKe&sig=kPfbGQ0TJxZFx0Z1hJHptD6hPkU&hl=nl&sa=X&ved=0ahUKEwiB6aDJrLzPAhWE8RQKHQyWAacQ6AEITjAF#v=onepage&q=highest%20risk%20Haemophilus%20and%20Streptococcus%20pneumoniae&f=false

33. Infants and children till 5 years without vaccination. http://www.medicalnewstoday.com/info/pneumococcal-disease

Oefententamen 2

1. B

2. B

3. D

4. B

5. D

6. A

7. B

8. E

9. C

10. S

11. F