Chapter 021

Chapter 021 Infectious Diseases Affecting the Respiratory System Key
Multiple Choice Questions

1.
Which of the following is not part of the upper respiratory tract?

A. Mout
h
B. Nasal
cavity
C. Trache
a
D. Pharyn
x
E. Laryn
x
Learning Objective: 21.01 Draw or describe the important anatomical features of the respiratory tract.
2.
Which of the following is not part of the lower respiratory system?

A. Alveo
li
B. Bronc
hi
C. Bronchiol
es
D. Trache
a
E. Sinuse
s
3.
What features of the respiratory system protect is from infection?

A. Nasal
hairs
B. Cili
a
C. Mucu
s
D. Macrophag
es
E. All of the choices are
correct
Learning Objective: 21.02 List the natural defenses present in the respiratory system.
4.
Which antibody is concentrated in the respiratory tract?

A. Ig
A
B. Ig
E
C. Ig
G
D. Ig
M
correct
5.
Normal biota of the upper respiratory tract include

A. Corynebacteri
um
B. Candida
albicans
C. Haemophilus
influenzae
D. Staphlococcus
aureus
correct
Learning Objective: 21.03 List the types of normal biota presently known to occupy the respiratory tract.
6.
Normal biota of the upper respiratory tract include

A. Streptococcus
pyogenes
B. Streptococcus
pneumoniae
C. Neisseria
meningitides
D. Alpha-hemolytic
streptococci
correct
7.
Normal biota of the lower respiratory tract include

A. Corynebacteri
um
B. Candida
albicans
C. Haemophilus
influenzae
D. Staphlococcus
aureus
E. None of the choices are
correct
8.
What is the function of normal biota of the respiratory tract?

A. Competes with pathogens for resources and
space
B. Microbial
antagonism
C. Provide
antibodies
D. Both A and B are
correct
E. A, B and C are
correct
9.
The most common type of virus leading to rhinitis is

A. Coronavir
us
B. Adenovir
us
C. Rhinovir
us
D. Herpes simplex
virus
E. Retrovir
us
Learning Objective: 21.04 List the possible causative agents
Learning Objective: and diphtheria).
Learning Objective: diagnostic techniques and prevention/treatment for each of the diseases of the upper respiratory tract (rhinitis
Learning Objective: modes of transmission
Learning Objective: otitis media
Learning Objective: pharyngitis
Learning Objective: sinusitis
Learning Objective: virulence factors
10.
Cold viruses are transmitted by

A. Droplet contact and indirect
contact
B. Endogeno
us
C. Direct
contact
D. None of the choices are
correct
correct

11.
The most common mode of transmission for sinusitis is

A. Exotoxi
n
B. Direct
contact
C. Indirect
contact
D. Endogeno
us
E. Droplet
contact

Learning Objective: 21.05 Identify which disease is often caused by a mixture of microorganisms.
12.
Which of the following is true about sinusitis caused by allergy?

A. Greenish or yellowish mucous
discharge
B. Caused by Streptococcus
pneumoniae
C. Introduced by
trauma
D. Clear, watery
discharge
E. Preceded by viral
rhinitis

13.
The most common causative agent in fungal sinusitis is

A. Aspergillus
fumigatus
B. Haemophilus
influenzae
C. Candida
albicans
D. Corynebacteri
um
E. Streptococcus
pneumoniae

14.
Infection travels to the middle ear by way of the

A. Auditory
canal
B. Sinuse
s
C. Nasal
cavity
D. Eustachian (auditory)
tubes
E. Subarachnoid
space

15.
The most common causative agent of otitis media is

A. Aspergillus
fumigatus
B. Haemophilus
influenzae
C. Candida
albicans
D. Corynebacteri
um
E. Streptococcus
pneumoniae

16.
Streptococcal pharyngitis involves all the following except

A. A purulent exudate over the
tonsils
B. Can lead to scarlet fever if it is an erythrogenic toxinproducing strain
C. Can lead to serious
sequelae
D. Is usually caused by the viridans
streptococci
E. Causes redness, difficulty in swallowing
and fever

17.
The bright red rash and fever of scarlet fever is due to

A. Enterotoxi
ns
B. Hemolysi
ns
C. Toxic shock syndrome
toxin
D. Exfoliative
toxin
E. Erythrogenic
toxin

18.
Rheumatic fever is caused by

A. A primary streptococcal
infection
B. A primary viral
infection
C. A secondary streptococcal
infection
D. Both a primary streptococcal infection and a primary viral
infection
E. Both a primary viral infection and a secondary streptococcal
infection

19.
Superantigens
A. Include
streptolysin O
B. Include Erythrogenic
toxin
C. Induce production of tumor necrosis
factor
D. Include only streptolysin and
Erythrogenic toxin
correct
Learning Objective: 21.06 Identify two bacteria that can cause dangerous pharyngitis cases.
20.
Streptococcus pyogenes infection may affect

A. The tricuspid
valve
B. The aortic semilunar
valve
C. The biscupid
valve
D. Both the tricuspid valve and the aortic
semilunar valve
E. Both the aortic semilunar valve and
bicuspid valve
21.
Which of the following is/are the main causative agent/s of pharyngitis?

A. Streptococcus
pyogenes
B. Aspergillus
fumigatus
C. Viruse
s
D. Both B and C are
correct
E. Both A and C are
correct

22.
Untreated streptococcal pharyngitis can lead to all of the following except

A. Scarlet
fever
B. Otitis
media
C. Rheumatic
fever
D. Glomerulonephri
tis
E. Scarlatin
a

23.
Virulence factors of S. pyogenes include

A. Polysaccharides on the cell
wall
B. Lipoteichoic
acid
C. Spiky Mproteins
D. Hyaluronic acid
capsule
correct
24.
Which of the following is not true of S. pyogenes?

A. Group A
streptococcus
B. Grampositive
C. Forms
spores
D. Sensitive to
bacitracin
E. Betahemolytic
25.
Formation of a pseudomembrane in the back of the throat is seen in

A. Diphther
ia
B. Pharyngit
is
C. Tuberculosi
s
D. Pertussi
s
E. SARS

26.
Which of the following pertains to diphtheria?

A. Results in
meningitis
B. Symptoms include vomiting and
diarrhea
C. Can be transmitted from mother's birthcanal to
neonate
D. Prevented by the DTaP
immunization
correct

27.
The major virulence factor of Corynebacterium diphtheriae that causes serious

systemic effects is
A. Its
capsule
B. Metachromatic
granules
C. Exotoxi
n
D. Endospore
s
E. Endotoxi
n

28.
Diphtherotoxin targets cells in the

A. Pharynx and
lungs
B. Lungs and
heart
C. Heart and
brain
D. Heart and
nerves
E. Lungs and
nerves

29.
In addition to antimicrobials, patients with diphtheria are treated with

A. Antitoxi
n
B. Tracheosto
my
C. Heart
medication
D. Bronchosco
py
correct

30.
Pertussis has the following characteristics except

A. Pathogen has virulence factors to destroy the action of
respiratory cilia
B. Catarrhal stage has persistent, hacking coughs with
"whoops"
C. Early stage resembles a cold with nasal discharge and
sneezing
D. DTaP immunization will
prevent it
E. Transmission is by respiratory
droplets
Learning Objective: RSV disease
Learning Objective: and influenza).
Learning Objective: diagnostic techniques and prevention/treatment for each of the diseases infecting both the upper and lower
respiratory tract (pertussis
31.
The causative organism of Whooping cough is

A. Bordetella
pertussis
B. Streptococcus
pneumoniae
C. Haemophilus
influenzae
D. Streptococcus
pyogenes
E. Cornyebacterium
diphtheriae
32.
Which of the following is not a virulence factor of Bordetella pertussis?

A. Endotoxi
n
B. Tracheal
cytotoxin
C. Mprotein
D. Pertussis
toxin
E. Filamentous
hemagglutinin
33.
Which of the following is not true of whooping cough?

A. Secondary infections can occur during the
convalescent phase
B. Caused by a small aerobic gramnegative rod
C. Incubation period is 3 21
days
D. Coldlike symptoms are common for the
paroxysmal stage
E. An uncontrollable cough occurs during the
paroxysmal stage
34.
Respiratory syncytial virus

A. Causes serious disease in infants 6 months old or
younger
B. Uses the nasopharynx as its main
replication site
C. Can be treated with the antiviral aerosol
Ribavirin
D. Has symptoms of dyspnea and
rales
correct
35.
The enzyme associated with the influenza virus that hydrolyzes the protective
mucous coating of the respiratory tract is
A. Catalas
e
B. Reverse
transcriptase
C. Hyaluronida
se
D. Neuraminida
se
E. Kinas
e
Learning Objective: 21.08 Compare and contrast antigenic drift and antigenic shift in influenza viruses
36.
Symptoms of influenza include

A. Nasal discharge, mild fever, absence of
cough
B. Fever, diarrhea,
vomiting
C. Fever, myalgia, sore throat, cough, nasal
discharge
D. Fever, sore throat, rash,
cough
E. Fever and
pneumonia
37.
Influenza vaccines include all the following except

A. Inactivated intramuscular
vaccine
B. Usually incorporates three different
strains
C. Attenuated, nasal drops
vaccine
D. Provides lifelong
immunity
E. Has an overall effectiveness of 70% 90%
38.
Which of the following is not true of influenza?

A. Has glycoprotein spikes of hemagglutinin (H) and
neuraminidase (N)
B. Antigenic drift which changes the antigens to reduce immune
recognition
C. Antigenic shift causes changes in the RNA
strands
D. Influenza B viruses undergo both antigenic drift and
antigenic shift
E. H5N1 is the bird flu strain that may cause a
pandemic
39.
Which is not correct about Mycobacterium species?

A. All species are human
pathogens
B. Cell walls have waxy
lipids
C. Acid
fast
D. Usually have a slow growth
rate
E. Long, slender
rods
Learning Objective: 21.10 Discuss the problems associated with MDRTB and XDRTB.
40.
Mycobacterium tuberculosis
A. Produces several virulence factor enzymes and an
exotoxin
B. Has a cord factor that can prevent destruction by lysosomes and
macrophages
C. Can survive for 8 months in fine aerosol
particles
D. Has a
capsule
E. Lives in the
soil
41.
All of the following pertain to tuberculosis except

A. Live bacilli can remain dormant in the lungs and reactivate
later in life
B. Symptoms of active TB include low-grade fever, coughing, fatigue, weight loss
and night sweats
C. Lung infection can disseminate to many other organs in
extrapulmonary TB
D. The BCG vaccine is used in other
countries
E. Antimicrobials cannot treat and cure
tuberculosis
42.
Tuberculin skin testing

A. Injects PPD
intradermally
B. Uses a purified protein filtrate of Mycobacterium
tuberculosis
C. Will be positive if person has had previous
exposure
D. Will be positive in
active TB
correct
Learning Objective: 21.11 Demonstrate an in-depth understanding of the epidemiology of tuberculosis infection.
43.
A diagnosis of tuberculosis involves

A. Chest Xray
B. Acid fast stain of
sputum
C. Sputum
culture
D. Tuberculin skin
test
correct
44.
Which of the following causes a non-communicable pulmonary infection that

resembles tuberculosis?
A. Mycobacterium avium complex
(MAC)
B. Mycobacterium
kansasii
C. Mycobacterium
scrofulaceum
D. Mycobacterium fortuitum
complex
E. Mycobacterium
marinum
45.
The tubercles formed in primary tuberculosis are caused by an influx of

A. Neutrophi
ls
B. Basophil
s
C. Mononuclear
cells
D. Polymorphonuclear
leukocytes
E. Antibodi
es
46.
Extrapulmonary TB is more common in

A. Young children and immunosuppressed
patients
B. Elderl
y
C. Organ transplant
patients
D. AIDS
patients
correct
47.
When the centers of tubercles break down into _____ lesions, they gradually heal
by calcification that replaces normal lung tissue.
A. Primar
y
B. Secondar
y
C. Necrotic
caseous
D. Granulom
a
E. Tertiar
y
48.
Which is incorrect about Mycoplasma pneumoniae?

A. Has birds as a
reservoir
B. Common cause of primary atypical
pneumonia
C. Initially causes fever, malaise, sore throat,
headache
D. After 2 to 3 weeks develops into an unproductive cough and
earache
E. Is a bacterial cell without a
cell wall
Learning Objective: 21.13 List the distinguishing characteristics of nosocomial vs. community-acquired pneumonia.
49.
Streptococcus pneumoniae is
A. Alpha-hemolytic on blood
agar
B. Found in up to 50% of people as
normal flora
C. A gram positive diplococcus with a
capsule
D. A pathogen with
endotoxin
correct
50.
Disease/s caused by Streptococcus pneumoniae include

A. Otitis
media
B. Meningit
is
C. Lobar
pneumonia
D. Bronchial
pneumonia
correct
51.
People at greatest risk for pneumococcal infections include all the following
except
A. The
elderly
B. Those with underlying lung disease and viral
infections
C. Patients without a
spleen
D. Adolescents and young
adults
E. Young
infants
52.
Legionella pneumophila
A. Requires special lab growth
media
B. Often lives intracellularly in
amoebas
C. Causes fever, cough and
diarrhea
D. Always causes a severe
pneumonia
correct
53.
Which disease involves transmission by aerosolized water from whirlpool spas, air
conditioners, cooling towers and supermarket vegetable misters?
A. Legionellos
is
B. Pertussi
s
C. Brucellos
is
D. Plagu
e
E. Traveler's
diarrhea
54.
Which of the following is caused by Haemophilus influenzae in the respiratory

tract?
A. Bacterial
meningitis
B. Influenza
(flu)
C. Otitis
media
D. Bronchit
is
E. Epiglottit
is

55.
The vaccine for immunity to Haemophilus influenzae serotype b is

A. DTaP
B. Pneumova
x
C. MM
R
D. Hi
b
correct

56.
Characteristics of Histoplasma capsulatum include

A. Grows in moist soil, rich in nitrogen from bird and bat
droppings
B. Is a yeast with a
capsule
C. Is a
dermatophyte
D. Grows in dry, arid
soil
correct
57.
The highest incidence of histoplasmosis in the United States occurs in the

A. Southea
st
B. Southwe
st
C. East and
Midwest
D. Northea
st
E. Rocky
Mountains
58.
Which is incorrect about histoplasmosis?

A. Pathogen grows inside
macrophages
B. Transmitted by inhalation of
spores
C. Respiratory infections range from mild to
severe
D. Chronic cases have symptoms similar to
tuberculosis
E. Never spreads to sites outside the
respiratory tract
59.
Pneumocystis (carinii) jiroveci

A. Has protozoan and fungal
characteristics
B. Lacks ergosterol in its plasma
membrane
C. Is an obligate
parasite
D. Causes serious infection in elderly, premature infants and AIDS
patients
correct
Learning Objective: and nosocomial pneumonia).
Learning Objective: community-acquired pneumonia
Learning Objective: diagnostic techniques and prevention/treatment for each of the diseases infecting the lower respiratory tract
(tuberculosis
60.
Inhalation of respiratory secretions is involved in the transmission of the following

except
A. Influenz
a
B. Rhiniti
s
C. Legionell
a
D. Diphther
ia
E. SARS
(tuberculosis
61.
Hantavirus has all the following characteristics except

A. Reservoir is human
carriers
B. Is a
zoonosis
C. Symptoms are abrupt fever, lung edema, respiratory distress and
hypotension
D. Transmitted by aerosol transmission from rodent
excreta
E. The first U.S. outbreak occurred in 1993 in the
Southwest
Learning Objective: 21.12 Describe the importance of the recent phenomenon of cold viruses causing pneumonia.
62.
Sudden acute respiratory syndrome (SARS)

A. Causes high fever, pneumonia and respiratory
distress
B. Began with an initial outbreak in the United States and then spread to Canada
and China
C. Is caused by the respiratory syncytial
virus
D. Is a
zoonosis
correct
(tuberculosis
63.
This opportunist is the most frequent cause of life-threatening pneumonia in AIDS

patients
A. Cryptococcus
neoformans
B. Candida
albicans
C. Malassezia
furfur
D. Pneumocystis (carinii)
jiroveci
correct
(tuberculosis
64.
Drug resistant strains of Streptococcus pneumoniae are now treated with

A. Penicillin
v
B. Eryrthromy
cin
C. Tetracylin
e
D. Vancomyci
n
E. Kete
k
(tuberculosis
65.
Of the six Category A diseases listed by the U.S. Public Health Service, which effect
the respiratory tract?
A. botulis
m
B. pneumonic
plague
C. tularem
ia
D. small
pox
E. Both B and
C
66.
Influenza virus can exhibit constant mutation of viral glycoproteins, called ________,
or __________ , a more serious phenomenon caused by the exchange of a viral gene
with that of another influenza virus strain.
A. Antigenic drift, antigenic
drift
B. Antigenic shift, antigenic
drift
C. Antigenic drift, antigenic
shift
D. None of
these
True / False Questions

67.
The primary transmission route for acquiring agents of the common cold is by
contact with hands and fomites contaminated with the nasal discharges of an
infected person.
TRUE


68.
Secondary bacterial infections may occur with the common cold.

TRUE

69.
Antibiotic treatment for otitis media is standard procedure today.

FALSE

70.
Treatment for diphtheria requires only penicillin or erythromycin.

FALSE

71.
Pertussis outbreaks still occur in the United States.

TRUE
72.
Respiratory syncytial virus is a major cause of global respiratory infection

outbreaks in infants 6 months of age or younger.
TRUE
73.
Influenza is predominantly transmitted by the fecal-oral route.

FALSE
74.
People who have received the BCG immunization will generally have a negative
tuberculin skin test.
FALSE
(tuberculosis
75.
An induration of less than 5mm in the Mantoux test is negative for TB.
TRUE
Learning Objective: 21.11 Demonstrate and in-depth understanding of the epidemiology of tuberculosis.
(tuberculosis
76.
The major reservoir for the hantavirus is the deer mouse.

FALSE
77.
Legionellosis is a zoonosis.
FALSE
78.
The pathogen that causes Legionnaires pneumonia also causes a milder infection
called Pontiac fever.
TRUE
79.
A paroxysmal cough is associated with Legionnaires' disease.

FALSE
80.
Medical professionals actually observe MDRTB patients take their medicine

through a program called DOT.
TRUE
Chapter 021 Infectious Diseases Affecting the Respiratory System Summary

Category
# of Ques
tions
Learning Objective: 12.13 Describe the importance of the recent phenomenon of cold viruses causing pneu
monia.
4
23
12
Learning Objective: 21.11 Demonstrate an in-depth understanding of the epidemiology of tuberculosis infec
tion.
Learning Objective: 21.11 Demonstrate and in-depth understanding of the epidemiology of tuberculosis.
Learning Objective: 21.12 Describe the importance of the recent phenomenon of cold viruses causing pneu
monia.
Learning Objective: 21.13 List the distinguishing characteristics of nosocomial vs. community-acquired pneu
monia.
23
12

7
7
Learning Objective: diagnostic techniques and prevention/treatment for each of the diseases infecting both
the upper and lower respiratory tract (pertussis
12
Learning Objective: diagnostic techniques and prevention/treatment for each of the diseases infecting the lo
wer respiratory tract (tuberculosis
Learning Objective: diagnostic techniques and prevention/treatment for each of the diseases of the upper re
spiratory tract (rhinitis
23
42
23
23
12
23
42

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Chapter 021 Infectious Diseases Affecting the Respiratory System Key

Multiple Choice Questions

Which of the following is not part of the upper respiratory tract?

Which of the following is not part of the lower respiratory system?

What features of the respiratory system protect is from infection?

Which antibody is concentrated in the respiratory tract?

Normal biota of the upper respiratory tract include

Normal biota of the upper respiratory tract include

Normal biota of the lower respiratory tract include

What is the function of normal biota of the respiratory tract?

The most common type of virus leading to rhinitis is

Cold viruses are transmitted by

Learning Objective: 21.04 List the possible causative agents

The most common mode of transmission for sinusitis is

Learning Objective: 21.04 List the possible causative agents

Which of the following is true about sinusitis caused by allergy?

Learning Objective: 21.04 List the possible causative agents

The most common causative agent in fungal sinusitis is

Learning Objective: 21.04 List the possible causative agents

Infection travels to the middle ear by way of the

Learning Objective: 21.04 List the possible causative agents

The most common causative agent of otitis media is

Learning Objective: 21.04 List the possible causative agents

Streptococcal pharyngitis involves all the following except

Learning Objective: 21.04 List the possible causative agents

The bright red rash and fever of scarlet fever is due to

Learning Objective: 21.04 List the possible causative agents

Rheumatic fever is caused by

Learning Objective: 21.04 List the possible causative agents

Streptococcus pyogenes infection may affect

Which of the following is/are the main causative agent/s of pharyngitis?

Learning Objective: 21.04 List the possible causative agents

Untreated streptococcal pharyngitis can lead to all of the following except

Learning Objective: 21.04 List the possible causative agents

Virulence factors of S. pyogenes include

Which of the following is not true of S. pyogenes?

Formation of a pseudomembrane in the back of the throat is seen in

Learning Objective: 21.04 List the possible causative agents

Which of the following pertains to diphtheria?

Learning Objective: 21.04 List the possible causative agents

The major virulence factor of Corynebacterium diphtheriae that causes serious

Learning Objective: 21.04 List the possible causative agents

Diphtherotoxin targets cells in the

Learning Objective: 21.04 List the possible causative agents

In addition to antimicrobials, patients with diphtheria are treated with

Learning Objective: 21.04 List the possible causative agents

Pertussis has the following characteristics except

The causative organism of Whooping cough is

Which of the following is not a virulence factor of Bordetella pertussis?

Which of the following is not true of whooping cough?

Respiratory syncytial virus

Symptoms of influenza include

Influenza vaccines include all the following except

Which of the following is not true of influenza?

Which is not correct about Mycobacterium species?

All of the following pertain to tuberculosis except

Tuberculin skin testing

A diagnosis of tuberculosis involves

Which of the following causes a non-communicable pulmonary infection that

The tubercles formed in primary tuberculosis are caused by an influx of

Extrapulmonary TB is more common in

Which is incorrect about Mycoplasma pneumoniae?

Disease/s caused by Streptococcus pneumoniae include

Which of the following is caused by Haemophilus influenzae in the respiratory