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Test Bank For Textbook Of Diagnostic Microbiology

7th Edition By Connie R. Mahon
Chapters 1 - 41

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Mahon: Textbook of Diagnostic Microbiology, 7th Edition Test Bank

Table of contents
Part 1: Introduction to Clinical Microbiology
Chapter 1. Bacterial Cell Structure, Physiology, Metabolism, andw Genetics
Chapter 2. Host-Parasite Interaction
Chapter 3. The Laboratory Role in Infection Control
Chapter 4. Control of Microorganisms: Disinfection, Sterilization, and Microbiology Safety
Chapter 5. Performance Improvement in the Microbiology Laboratory
Chapter 6. Specimen Collection and Processing
Chapter 7. Microscopic Examination of Materials from Infected Sites
Chapter 8. Use of Colony Morphology for the Presumptive Identification of Microorganisms
Chapter 9. Biochemical Identification of Gram-Negative Bacteria
Chapter 10. Immunodiagnosis of Infectious Diseases
Chapter 11. Applications of Molecularw Diagnostics
Chapter 12. Antibacterial Mechanisms of Action and Bacterial Resistance Mechanisms
Chapter 13. Antimicrobial Susceptibility Testing
Part 2: Laboratory Identification of Significant Isolates
Chapter 14. Staphylococci
Chapter 15. Streptococcus, Enterococcus, and OtherwCatalase-Negative, Gram-Positive Cocci
Chapter 16. Aerobic Gram-Positive Bacilli
Chapter 17. Neisseria Species and Moraxella catarrhalis
Chapter 18. Haemophilus, HACEK, Legionella and Other Fastidious Gram-Negative Bacilli
Chapter 19. Enterobacteriaceae
Chapter 20. Vibrio, Aeromonas, and Campylobacter Species
Chapter 21. Nonfermenting and Miscellaneous Gram-Negative Bacilli
Chapter 22. Anaerobes of Clinical Importance
Chapter 23. The Spirochetes
Chapter 24. Chlamydia, Rickettsia, and Similar Organisms
Chapter 25. Mycoplasma and Ureaplasma
Chapter 26. Mycobacterium tuberculosis and Nontuberculous Mycobacteria
Chapter 27. Medically Significant Fungi
Chapter 28. Diagnostic Parasitology
Chapter 29. Clinical Virology
Chapter 30. Agents of Bioterrorwand Forensic Microbiology
Chapter 31. Biofilms: Architects of Disease
Part 3: Laboratory Diagnosis of Infectious Diseases: and Organ System Approach to DiagnosticMicrobio
l
ogy
Chapter 32. Upper and Lower Respiratory Tract Infections
Chapter 33. Skin and Soft Tissue Infections
Chapter 34. Gastrointestinal Infections and Food Poisoning
Chapter 35. Infections of the Central Nervous System
Chapter 36. Bacteremia and Sepsis
Chapter 37. Urinary Tract Infections
Chapter 38. Genital Infections and Sexually Transmitted Infections
Chapter 39. Infections in Special Populations
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Chapter 40. Zoonotic Diseases

Chapter 41. Ocular Infections
-

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Chapter 01: Bacterial Cell Structure, Physiology, Metabolism, and Genetic sMaho
n: Textbook of Diagnostic Microbiology, 7th Edition Test Bank

MULTIPLE CHOICE

1. To survive, microbial inhabitants have learned to adapt by varying all of the following, except
a. growth rate.
b. growth in all atmospheric conditions.
c. growth at particular temperatures.
d. bacterial shape.
ANSWER: D
The chapter begins by discussing the way microbial inhabitants have had to evolve to survi
vein many different niches and habitats. It discusses slow growers, rapid growers, and repli
cation with scarce or abundant nutrients, underwdifferent atmospheric conditions, temperatur
e requirements, and cell structure. Bacterial shape as a form of evolution is not discussed.

OBJ: Level 2: Interpretation

2. Who was considered the father of protozoology and bacteriology?

a. Anton van Leeuwenhoek
b. Louis Pasteur
c. Carl Landsteiner
d. Michael Douglas
ANSWER: A
The book discusses Anton van Leeuwenhoek as the inventor of the microscope and the fir
s t person to see the “beasties.” So they dubbed him the father of protozoology and bacterio
lo gy.The otherwthree individuals were not discussed.

OBJ: Level 1: Recall

3. Prokaryotic cells have which of the following structures in theirwcytoplasm?

a. Golgi apparatus
b. Ribosomes
c. Mitochondria
d. Endoplasmic reticulum
ANSWER: B
All the structures listed are found in eukaryotic cells, but ribosomes are the only ones th
atapply to prokaryotic cells.

OBJ: Level 1: Recall

4. This form of DNA is commonly found in eukaryotic cells.

a. Linear
b. Circular
c. Plasmid
d. Colloid

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ANSWER: A
Circular and plasmid DNA are usually found only in bacteria, not eukaryotic cells. Colloid
isa property of protein molecules and is not associated with nucleotides.

OBJ: Level 1: Recall

5. The nuclear membrane in prokaryotes is

a. missing.
b. impenetrable.
c. a classic membrane.
d. a lipid bilayer membrane.

ANSWER: A
Prokaryotic cells do not have any membrane-
bound structures in the cytoplasm including astructured nucleus.

OBJ: Level 1: Recall

6. A microorganism that is a unicellular organism and lacks a nuclear membrane and tr

uenucleus belongs to which classification?
a. Fungi
b. Bacteria
c. Algae
d. Parasite
ANSWER: B
Fungi, algae, and parasites are unicellular eukaryotic organisms that contain a true nucleu
s.Bacteria are prokaryotic and do not contain a true nucleus or nuclearwmembrane.
OBJ: Level 1: Recall

7. In the laboratory, the clinical microbiologist is responsible for all the following, except
a. isolating microorganisms.
b. selecting treatment for patients.
c. identifying microorganisms.
d. analyzing bacteria that cause disease.
ANSWER: B
Clinical microbiologists do not select the treatment for patients. They provide the doctor wi
ththe name of the organism and the antibiotics that can kill the bacteria, but not in the final
selection of treatment protocols.

OBJ: Level 2: Recall

8. What enables the microbiologist to select the correct media for primary culture and optimi
zethe chance of isolating a pathogenic organism?
a. Determining staining characteristics
b. Understanding the cell structure and biochemical pathways of an organism
c. Understanding the growth requirements of potential pathogens at specific body site
d. Knowing the differences in cell walls of particular bacteria
ANSWER: C

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By understanding growth requirements, a microbiologist can maximize the chance of t

heorganism being isolated from a culture. The otherwthree choices are used to identif
y a bacterium once it has grown on media.

OBJ: Level 2: Interpretation

9. A clinical laboratory scientist is working on the bench, reading plates, and notices that a
culture has both a unicellular form and a filamentous form. What type of organism exhibi
tsthese forms?
a. Virus
b. Fungi
c. Bacteria
d. Parasite
ANSWER: B
Viruses typically only have one form and would not grow on plate media. Bacteria have tw
o forms: a vegetative cell and spore form. Parasites may have trophozoite, cysts, egg, etc.
F ungiare the organism classification that may have both unicellular yeast forms and filame
nt ous hyphal forms in the same culture plate.

OBJ: Level 2: Interpretation

10. All of the following statements are true about viruses, except:
a. Viruses consist of DNA or RNA but not both.
b. Viruses are acellular but are surrounded by a protein coat.
c. Viruses can infect bacteria, plants, and animals.
d. Viruses do not need host cells to survive and grow.

ANSWER: D
Viruses need to have a host cell because they do not have the ability to reproduce or nouri
shthemselves without the host’s cellular mechanisms.

OBJ: Level 2: Interpretation

11. Diagnostic microbiologists apply placement and naming of bacterial organisms into all t
hefollowing categories, except
a. order.
b. family.
c. genus.
d. species.

ANSWER: A
Clinical microbiologists use the family, genus, and species taxonomic categories to identif
yspecies that are important for diagnostic diseases.

OBJ: Level 1: Recall

12. Bacterial species that exhibit phenotypic differences are considered

a. biovarieties.
b. serovarieties.
c. phagevarieties.
d. subspecies.

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ANSWER: D
Biovarieties vary based on biochemical test results, serovarieties vary based on serologic t
e stresults, and phagevarieties is a fictitious word.

OBJ: Level 2: Interpretation

13. What structure is described as a phospholipid bilayer embedded with proteins and sterols th
atregulates the type and amount of chemicals that pass in and out of a cell?
a. Cell wall
b. Mitochondria
c. Endoplasmic reticulum
d. Plasma membrane
ANSWER: D
The cell wall is the outerwcovering made up of lipids. The mitochondria is a cellular organe
ll e that is considered the powerhouse of the cell (electron transport and oxidative phosphor
ylat ionoccur here). The endoplasmic reticulum is a cellularworganelle where protein synthes
is oc curs.

OBJ: Level 1: Recall

14. What makes the interior of the plasma membrane potentially impermeable to water-
solublemolecules?
a. The hydrophobic tails of the phospholipid molecules are found there.
b. The hydrophilic tails of the phospholipid molecules are found there.
c. The ion channels are found there.
d. The cholesterol molecules in the plasma membrane are found solely in the interi
orof the membrane.
ANSWER: A
The plasma membrane is designed so that the hydrophilic heads of the phospholipid mol
e cules are positioned to make contact with the intracellular and extracellular fluids. The
hy drophobic tails of the phospholipid molecules face away from the fluids and form the
int erior of the plasma membrane. The tails of the phospholipid molecules are hydropho
bic,n ot hydrophilic. The ion channels extend through the cellular membrane. The choles
terol molecules also extend through the plasma membrane.

OBJ: Level 2: Interpretation

15. The function of a cell wall is to

a. regulate the transport of macromolecules in and out of the cell.
b. provide rigidity and strength to the exteriorwof the cell.
c. provide reserve energy to the eukaryotic cell.
d. protect the eukaryote from predators.
ANSWER: B
The plasma membrane regulates the transport of macromolecules in and out of the cell, n
ot the cell wall. The mitochondria provide energy to the eukaryotic cell. Cell walls are not
ableto protect a eukaryotic cell from predators.

OBJ: Level 1: Recall

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16. Name the numerous short (3 to 10 μm) projections that extend from the cell surface and a
reused for cellular locomotion.
a. Flagella
b. Mitochondria
c. Cilia
d. Phospholipid
ANSWER: C
By definition, cilia are short projections extending from the cell surface and are used forw
locomotion, whereas flagella are longer projections used for locomotion. Mitochondria a
recellular organelles responsible for electron transport and oxidative phosphorylation.
Phospholipids are polarwmolecules that form the plasma membrane.

OBJ: Level 1: Recall

17. A microbiology technologist performs a traditional bacterial stain on a colony from a wou
ndculture that is suspected to contain bacteria from the genus Clostridium. The unstained
areasin the bacterial cell observed by the technologist are called
a. cilia.
b. ribosomes.
c. endospores.
d. mitochondria.
ANSWER: C
Ribosomes are small circular areas used for protein synthesis that are not visible on a tra d
itional stain. Cilia are short projections on the outside of the plasma membrane used forl o
comotion. Mitochondria are cellularworganelles used for energy production.

OBJ: Level 2: Interpretation

18. This constituent of a gram-

positive cell wall absorbs crystal violet but is not dissolved byalcohol, thus giving the
gram-positive cell its characteristic purple color.
a. Mycolic acid
b. Cholesterol
c. Carbolfuchsin
d. Peptidoglycan

ANSWER: D
Mycolic acid is part of the cell wall of the Mycobacterium and Nocardia spp., but does n
o t play a part in the Gram stain. Cholesterol is also part of the cell membrane, not the cell
wall,so it does not play a part in the Gram stain. Carbolfuchsin is a stain used in bacteriol
ogy.

OBJ: Level 2: Interpretation

19. Mycobacteria have a gram-

positive cell wall structure with a waxy layer containing these twocompounds.
a. Glycolipids and mycolic acid
b. Glycolipids and phospholipids
c. Mycolic acid and lipopolysaccharides
d. Lipopolysaccharides and phospholipids
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ANSWER: A

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Glycolipids are a part of the waxy layer, but phospholipids are part of the plasma membra
n e.Mycolic acid is a part of the waxy layer, but lipopolysaccharides are part of a gram-
negative cell wall. Lipopolysaccharides are part of a gram-
negative wall, and phospholipids are part ofa plasma membrane.

OBJ: Level 1: Recall

20. When performing a Gram stain on a gram-

negative organism, the crystal violet is absorbedinto this outer cell wall layer, and then w
ashed away with the acetone alcohol. What is the main component of the outerwlayer of t
he cell wall?
a. Peptidoglycan
b. Mycolic acid
c. N-acetyl-D-muramic acid
d. Lipopolysaccharide
ANSWER: D
Peptidoglycan is a thinner layer under the lipopolysaccharide in a gram-
negative organism,whereas mycolic acid is the waxy layer present in a mycobacterium’s o
uterwcell wall, and N-acetyl-D-muramic acid is part of the peptidoglycan.

OBJ: Level 1: Recall

21. The three regions of the lipopolysaccharide include all the following, except
a. antigenic O-specific polysaccharide.
b. mycolic acid.
c. core polysaccharide.
d. endotoxin (inner lipid A).

ANSWER: B
Antigenic O-
specific polysaccharide, core polysaccharide, and endotoxin are all part of thelipopolysac c
haride layer.

OBJ: Level 1: Recall

22. The outerwcell wall of the gram-

negative bacteria serves three important functions, whichincludes all the following, exc e
pt:
a. It provides an attachment site for the flagella, which will act in locomotion.
b. It acts as a barrier to hydrophobic compounds and harmful substances.
c. It acts as a sieve.
d. It provides attachment sites that enhance adhesion to host cells.
ANSWER: A
The outer cell wall of gram-
negative bacteria acts as a barrier to hydrophobic compounds andharmful substances, acts
a s a sieve, and provides attachment sites that enhance adhesion to host cells. Flagella atta
ch to the cell membrane, not to the cell wall.

OBJ: Level 1: Recall

23. Mycoplasma and Ureaplasma spp. must have media supplemented with serum orwsugar
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asnutrients and because
a. their cell walls contain only peptidoglycan.
b. they lack cell walls.

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.
.

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c. the sterols in their cell walls are soluble in normal bacterial media.
d. their cell walls contain detoxifying enzymes.

ANSWER: B
These two genera have no cell walls, so the other choices are not appropriate. Serum a nds
ugar are needed nutrients and assist with osmotic balance of the media.

OBJ: Level 1: Recall

24. What is the purpose of a capsule?

a. Prevent osmotic rupture of the cell membrane
b. Make up the periplasmic space
c. Act as a virulence factor in helping the pathogen evade phagocytosis
d. Provide an attachment site for somatic antigens
ANSWER: C
The capsule acts as a virulence factor in helping the pathogen evade phagocytosis because
antibodies have difficulty attaching to the capsule of bacteria and therefore are unable to p
repare the organism forwingestion. The cell membrane is not prone to osmotic rupture wh e
ninside a host; the periplasmic space is found between the peptidoglycan and the lipopol y
saccharide layers of the cell wall in gram-
negative organisms; and somatic antigensare found below the capsule.

OBJ: Level 1: Recall

25. The three basic shapes of bacteria include all the following, except
a. spirochetes.
b. cell wall deficient.
c. cocci.
d. bacilli.
ANSWER: B
Cell wall deficient is not one of the basic shapes of bacteria. It refers to the cell
w allcomposition, not the bacterial shape.

OBJ: Level 1: Recall

26. The Gram stain is a routine stain used in bacteriology to determine gram-
positive andgram-negative bacteria based on the
a. phenotypic characteristics of the organism.
b. composition of the bacterial cell wall.
c. composition of the bacterial cell membrane.
d. composition of the bacterial pili.
ANSWER: B
The composition of the bacterial cell wall is routinely used in bacteriology. The peptidoglyc
ancell walls of the gram-
positive bacteria retain the crystal violet (purple) stain, whereas crystal violet stain is washe
d away because of the lipopolysaccharide (outer membrane) present in thecell walls of the
g ram-negative cells. The outer membrane retains the Safranin (pink) with thecounter stain.

OBJ: Level 1: Recall

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27. In what staining procedure does carbolfuchsin penetrate the bacterial cell wall through heat
ordetergent treatment?
a. Gram stain
b. Acridine orange stain
c. Endospore stain
d. Acid-fast stain
ANSWER: D
Of all the stains listed, the acid-
fast stain is the only one that requires heatingwor detergent treatment so that the carbolfuc
hsin stain can penetrate the waxy wall of acid-
fast bacteria. Gram staining uses crystal violet stain; acridine orange is used in acridine o r
ange stain; andthe endospore stain uses malachite green.

OBJ: Level 1: Recall

28. What stain is used for medically important fungi?

a. Methylene blue
b. Acridine orange
c. Acid-fast
d. Lactophenol cotton blue

ANSWER: D
Lactophenol cotton blue is the only fungi stain listed. Methylene blue is used to stain Co
rynebacterium spp.; acridine orange is used to stain all types of bacteria, living or dead;a
nd acid-fast is used to stain Mycobacterium spp.

OBJ: Level 1: Recall

29. All the following are types of media, except

a. selective.
b. differential.
c. fastidious.
d. transport.
ANSWER: C
Fastidious refers to the nutrient requirements of bacteria, not a type of media. Selective med
iahave ingredients added to grow only selected bacteria. Differential media have chemicals
added to allow visualization of metabolic differences of bacteria. Transport media are used t
okeep bacteria alive during transport to the laboratory.

OBJ: Level 1: Recall

30. Which of the following environmental factors influence the growth of bacteria in t
helaboratory?
a. pH
b. Temperature
c. Gaseous composition of the atmosphere
d. All of the above
ANSWER: D

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Most bacteria grow best at a pH between 7.0 and 7.5, at 35 C, with a requirement for t
hegaseous composition of the atmosphere. Some bacteria require higher than atmosphe
r ic moisture (humidity) levels for optimal growth (Neisseria sp.).

OBJ: Level 1: Recall

31. Some bacteria grow at 25 C or 42 C, but diagnostic laboratories routinely grow pathogen
icbacteria at what temperature?
a. 30 C
b. 60 C
c. 35 C
d. 10 C
ANSWER: C
Most pathogenic bacteria grow well at 35 C because it is close to body temperature; 30 C
isthe temperature at which most medically important fungi grow well; 60 C is too hot for
pathogenic bacteria to grow, and 10 C is too cold for pathogenic bacteria to grow.

OBJ: Level 1: Recall

32. Which of these bacteria cannot grow in the presence of oxygen?

a. Obligate aerobes
b. Capnophilic organisms
c. Facultative anaerobes
d. Obligate anaerobe

ANSWER: D
An obligate anaerobe is a bacterium that is killed when exposed to normal atmospheric con
ditions of oxygen and requires strict absence of oxygen. An obligate aerobe is a bacteriumt
hat grows only in the presence of oxygen, and a capnophilic bacterium grows only in the pr
esence of 5% to 10% carbon dioxide.

OBJ: Level 1: Recall

33. What class of organisms, such as the Streptococcus sp., can survive in the presence of oxyg
enbut do not use oxygen in its metabolic processes?
a. Microaerophilic
b. Aerotolerant anaerobe
c. Obligate anaerobe
d. Facultative anaerobe
ANSWER: B
An aerotolerant anaerobe is one that can live in the presence of oxygen but does not use o
xygen in its metabolic processes. A microaerophilic bacterium requires a reduced level ofo
xygen to grow. An obligate anaerobe cannot survive in the presence of oxygen, and a facu
ltative anaerobe can grow eitherwwith or without oxygen.

OBJ: Level 1: Recall

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34. The laboratory receives a specimen in which the doctorwsuspects that the infecting organism
isHaemophilus influenzae. This organism grows best in an atmosphere that contains 5% to
10%carbon dioxide. It is therefore classified as what type of bacteria?
a. Obligate aerobe
b. Capnophilic
c. Facultative anaerobe
d. Obligate anaerobe

ANSWER: B
Capnophilic bacteria need increased carbon dioxide in the atmosphere to grow; obligate
aerobes can grow only in the presence of oxygen; facultative anaerobes can grow in
th e presence or absence of air; and obligate anaerobes need an atmosphere without oxy
ge n togrow.

OBJ: Level 1: Recall

35. The following describes the log phase of bacterial growth:

a. Preparing to divide
b. Limited nutrients with bacteria count remaining constant
c. Number of nonviable bacterial cells exceeds the numberwof viable cells
d. Bacteria doubling with each generation time
ANSWER: D
As a bacterium is immersed in an environment with favorable conditions for growth, the b a
cterium starts dividing; soon their numbers increase logarithmically. The growth tapers off a
s the nutrients become limited; then the bacteria will begin to die as the nutrients are exh au
sted.

OBJ: Level 1: Recall

36. Diagnostic schemes in the microbiology laboratory typically analyze each unknow
nbacterium’s metabolic processes for all the following, except
a. utilization of a variety of substrates as carbon sources.
b. energy utilization for metabolic processes.
c. production of specific end products from specific substrates.
d. production of an acid or alkaline pH in the test medium.
ANSWER: B
The microbiologist examines production of specific end products, production of an acid or a
lkaline pH in the test medium, and utilization of various carbon sources forwenergy to identif
ybacteria. Identification schemes are based on the percentages of bacterial species that exhi
b it particularwmetabolic processes in vitro.

OBJ: Level 1: Recall

37. Which is a biochemical process carried out by both obligate and facultative anaerobes?
a. Fermentation
b. Respiration
c. Oxidation
d. Reduction
ANSWER: A

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Fermentation takes place without oxygen. Respiration and oxidation need oxygen to occu r
.Reduction is a chemical reaction that can occur independent of bacteria.

OBJ: Level 1: Recall

38. What type of fermentation produces lactic, acetic, succinic, and formic acids as the e
ndproducts?
a. Butanediol
b. Propionic
c. Mixed acid
d. Homolactic
ANSWER: C
Most of the fermentative processes produce only a single acid as a metabolic by-
product. Mixed acid fermentation produces several different acids: lactic, acetic, succinic,
a nd formic.

OBJ: Level 1: Recall

39. If bacteria utilize various carbohydrates for growth, they are usually detected by
a. alkaline production and change of color from the pH indicator.
b. production of carbon dioxide.
c. production of keto acids.
d. acid production and change of color from the pH indicator.
ANSWER: D
Most bacterial identification systems examine the ability of bacteria to utilize several differe
ntcarbohydrates. The medium contains the specific carbohydrate being examined and a pH
i ndicator that can produce a color change: blue to yellow or red to yellow
OBJ: Level 1: Recall

40. In the medical microbiology laboratory, the ability of a gram-

negative bacterium to fermentthis sugar is the first step in its identification.
a. Sucrose
b. Mannitol
c. Trehalose
d. Lactose
ANSWER: D
Media used for gram-
negative bacillus that contain this sugar allow for the differentiation intolactose fermenters a
nd nonlactose fermenters. With this characteristic, organisms can be placed into these two l
arge groupings. This aids in the identification of gram-negative organisms.

OBJ: Level 1: Recall

41. A
is a single, closed, circular piece of DNA that is supercoiled to fit inside a bacterialcell.
a. phenotype
b. chromosome
c. frame-shift mutation
d. transposon
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ANSWER: B
Chromosomes contain the genome of a bacterial cell. The DNA in the genome must
becompacted and wrapped around protein molecules to fit inside the cell nucleus.
Th is compacting, wrapping, and supercoiling makes up the chromosome.

OBJ: Level 1: Recall

42. Genes that code for antibiotic resistance are often found on small, circular pieces of DNA.
These DNA pieces are called
a. plasmids.
b. phenotypes.
c. chromosomes.
d. genomes.
ANSWER: A
Plasmids found in bacteria are small, extrachromosomal DNA. Plasmids are found in t
hecytoplasm and can be replicated and passed on to daughter cells. Plasmids contain
t he antibiotic resistance genes for some antibiotics.

OBJ: Level 1: Recall

43. What process involves transferring or exchanging genes between similar regions on tw
oseparate DNA molecules?
a. IS element
b. Replication
c. Recombination
d. Transcription
ANSWER: C
Recombination is the process described. Transcription occurs when a DNA molecule makes
an RNA molecule. Replication occurs when DNA is used to make another DNA molecule.
AnIS element is a type of mutation that occurs when a small piece of DNA jumps from one
area in a chromosome to another.

OBJ: Level 1: Recall

44. A microbiologist is working with two separate cultures of the same organism. The bacteria
inone culture are resistant to penicillin, whereas the bacteria in the otherwculture are suscept
ible to penicillin. The bacteria from both cultures are mixed together, and all the resulting b
acteriaare resistant to penicillin. What caused this phenomenon?
a. The plasmid carrying the resistance gene was transferred to the susceptib
l epopulation of bacteria.
b. The plasmid carrying the susceptibility gene was transferred to the resist
a ntpopulation of bacteria.
c. An IS element was inserted into the genome of the susceptible bacteri
alpopulation.
d. A frame-
shift mutation occurred that allowed the susceptible population of bacteriato deve
lop resistance to penicillin.
ANSWER: A

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Antibiotic resistance is carried by plasmids, which can easily be transferred from one bacteri
um to another. The receiving bacterium then displays the characteristics contained in the pla
smid. IS elements and frame-
shift mutations occur on the chromosomes and take longerto manifest than do plasmid transf
ers.

OBJ: Level 2: Interpretation

45. Diphtheria is a disease produced by Corynebacterium diphtheriae. However, not all C.

diphtheriae bacteria produce the toxin that causes this disease. To produce the toxin, t
hebacteria must first become infected with a bacteriophage. The process by which bac
t erialgenes are transferred to new bacteria by the bacteriophage is called
a. conjugation.
b. transduction.
c. replication.
d. transformation.
ANSWER: B
Conjugation occurs when genetic material is passed from one bacterium to another through
the use of a sex pilus or similar appendages. Replication is when DNA makes a copywof itse
lf.Transformation occurs when naked DNA or plasmids are taken up and incorporated int
o a bacteria’s genome.

OBJ: Level 1: Recall

46. Lysogeny occurs when

a. genes present in the IS element are expressed in the bacterial cell.
b. genetic material is transferred from one bacterium to another through a sex pilus.
c. competent bacteria cells take up naked DNA
d. genes present in the bacteriophage DNA are incorporated into the bacteria
’sgenome.
ANSWER: D
IS elements are small pieces of bacterial DNA that jumped from one area in a chromosome
t o another area in the same chromosome. When using a sex pilus to transfer DNA, the pro
ce ss is called conjugation. Competent cells taking up DNA into their genomes represent tr
ansd uction.

OBJ: Level 1: Recall

47. These are enzymes that cut the bacterial DNA at specific locations.
a. Bacteriophage enzymes
b. Restriction enzymes
c. Temperate lysogeny enzymes
d. Conjugation enzymes

ANSWER: B
Restriction enzymes allow bacteria to cut a place in its genome and insert specific sequenc
esof foreign DNA. Researchers also use the resulting fragments to identify identical geno
mes. Bacteriophage enzymes do not cut the host bacteria DNA. Temperate lyosgeny enzy
mes areassociated with bacteriophage activation and conjugation enzymes assist in transfer
of DNAfrom one bacterial cell to another.
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OBJ: Level 1: Recall

.
.

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Chapter 02: Host–Parasite Interaction

Mahon: Textbook of Diagnostic Microbiology, 7th Edition

MULTIPLE CHOICE

1. Organisms that participate in a biological relationship where both benefit from one anotherwa
recalled
a. parasites.
b. symbionts.
c. hosts.
d. flora.
ANSWER:w B
Symbiosis is a relationship where two organisms live together and their association benefi
t s both organisms. Organisms that live in symbiosis are said to be symbionts. Parasites a
re organisms that live off a host and harm the host. The host is the organism that provides
the nutrients to the otherworganisms. Flora are described as microorganisms that inhabit t
he bo dysites of healthy individuals.

OBJ: Level 1: Recall

2. Parasitism is
a. a biological relationship between two or more organisms in which both benef
itfrom one another.
b. a biological relationship between only two organisms in which there are
nobeneficial or harmful effects to the host
c. a biological relationship in which one species gains benefits at the expense of the
host.
d. a synonym for mutualism.
ANSWER:w C
When both organisms live together and one organism benefits at the expense of the host, t
hisis parasitism. When both organisms live togetherwand both benefit, this is symbiosis. W
hen both organisms live together and neither benefits, this is commensalism. Mutualism an
d symbiosis are synonyms.

OBJ: Level 1: Recall

3. This bacterial state occurs when a host harbors a disease-

causing organism, but does not showsigns of disease.
a. Carrier
b. Transient
c. Resident
d. Indigenous
ANSWER: A
Transient, resident, and indigenous referwto particular types of flora associated with the hum
anbody, whereas carrier refers to the state in which pathogenic organisms establish themsel
ves in a host without causing disease, but the host can still transmit the infection.

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OBJ: Level 1: Recall

4. Healthy people are colonized by many different bacteria in many different sites. The
sebacteria are referred to as
a. transient flora.
b. carrier flora.
c. maintenance flora.
d. indigenous flora.
ANSWER: D
Indigenous flora are usual orwnormal flora, whereas transient flora are microbial flora that a
represent at a site temporarily. Carrier and maintenance flora are not types of microbial flo
ra found on the human body.

OBJ: Level 1: Recall

5. Diabetics may sometimes be infected with their own resident flora. This type of infection
iscalled
a. an opportunistic infection.
b. a carrier state.
c. symbiosis.
d. a parasitic infection.
ANSWER: A
Opportunistic infections occur when the host has changes in body chemistry associated wit
h age, disease states, and drug or antibiotic effects. Carrier states are those in which a hos
t doesnot show symptoms of a disease, but it can infect otherwhosts with pathogenic organi
s ms.
Symbiosis is a biological relationship that benefits the host and the organism. A parasiticin
fection is one in which the parasite receives benefits, but at the expense of the host.

OBJ: Level 1: Recall

6. Mechanisms used by the skin to prevent infection and protect the underlying tissue fro
minvasion by potential pathogens include all the following, except
a. desquamation of the epithelium.
b. excretion of lysozyme by sweat glands.
c. antibiotics that inhibit many microorganisms.
d. mechanical separation of microorganisms from the tissues.
ANSWER: C
The skin produces fatty acids that inhibit microorganisms, not antibiotics. The remaining thr eemechanis
ms are described in the text on page 25.

OBJ: Level 1: Recall

7. A laboratory professional is testing a new antimicrobial soap. The tech washes her forear
mthen does a culture of the skin. Which organisms should she most likely expect to find
growing in the culture?
a. Diphtheroids and Bacillus spp.
b. Staphylococcus epidermidis and Propionibacterium
c. S. aureus and Propionibacterium

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d. Diphtheroids and Propionibacterium
e. None of these organisms should be found.

ANSWER: B
Superficial antisepsis of the skin does not kill the Propionibacterium and S. epidermidis th
atlive in the hair follicles and sebaceous glands. Diphtheroids are found in moist areas suc
h asthe axillae and toes. S. aureus is typically a pathogen but can be found on healthy s
kin
.
Handwashing does not remove all bacteria from the skin.

OBJ: Level 1: Interpretation

8. What mechanism allows strict anaerobes to grow in the cervices and areas between the tee
thwhen plaque is present?
a. A low oxidation-reduction potential occurs at the tooth surface underwthe plaque.
b. The bacteria secrete sugar to nourish the strict anaerobes.
c. The normal flora secrete antibiotics to kill all the other bacteria and allow the stri
ctanaerobes to thrive.
d. The plaque-
causing bacteria secrete an alkaline fluid and change the pH around thetooth.
ANSWER: A
The growth of the plaque-
causing bacteria on the tooth’s surface contain as many as 1011 streptococci per gram, and
t his amount of bacteria lowers the oxidation-
reduction potential atthe tooth surface. Strict anaerobes cannot grow in the presence of ox
y gen, and lowering the oxidation-
reduction potential lowers the amount of oxygen at the tooth surface. Normal oral flora or
g anisms do not secrete sugar, antibiotics, or alkaline fluid.

OBJ: Level 1: Recall

9. The stomach can be considered a first line of defense against microbial infections because
a. most microorganisms are susceptible to the antibiotics and alkaline pH present i
nthe stomach.
b. most microorganisms are killed by the liver enzymes that are emptied into t
hestomach during a meal.
c. the stomach produces proteases, which attack the lipopolysaccharide cell wall
ofthe organisms.
d. most microorganisms are susceptible to the acid pH of the stomach.
ANSWER: D
The stomach cells secrete enough acid to create an environment with a pH of approximately
1.Bacteria that are enmeshed in food, spore-
forming bacterial species in their spore phase, and the cysts of parasites can survive the extr
eme pH present in the stomach. The stomach does not produce antibiotics, and liver enzyme
s do not empty into the stomach during digestion.

OBJ: Level 1: Recall

10. This type of bacteria is able to live in the colon with little to no oxygen and is the predomin
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antorganism.
a. Anaerobes
b. Facultative anaerobes
c. Facultative gram-negative rods

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d. Gram-positive cocci
ANSWER: A
Anaerobes make up over 90% of the microbial flora of the large intestine. The facultative a
naerobes, facultative gram-negative rods, and gram-
positive cocci are present in the colon inmuch smaller numbers than the anaerobes.

OBJ: Level 1: Recall

11. After perforation of the colon, surgeons must guard against infection in the
because ofleakage of the contents of the colon.
a. peritoneal cavity
b. urinary bladder
c. vaginal flora
d. renal vein

ANSWER: A
The peritoneal cavity is the space between the internal organs and the abdominal wall—
a normally sterile space. The colon contains lots of bacteria that can cause an infection in t
his normally sterile space because there are no normal flora or immune system cells here to
fightoff an infection. The organisms would have no natural defenses to overcome before c
ausing an infection.

OBJ: Level 1: Recall

12. The human body is constantly challenged by pathogens in the environment. It is not infect
edby every pathogen it encounters because the microbial flora
a. engulf the pathogenic bacteria
b. produce conditions at the microenvironmental level that block colonization.
c. prime ourwimmune system.
d. activate and support the action of antigen-
presenting cells, cytokines, andcell-mediated immunity.
ANSWER: B
Several mechanisms are used bywmicrobial flora to ensure that colonization of pathogen
i c organisms is blocked, such as lowering the reduction-
oxidation potential, lowering the pH,producing antimicrobials, and depleting the nutrien
t s present in a particular environment.

OBJ: Level 2: Interpretation

13. The abilitywof an organism to produce disease in an individual is called

a. pathogenicity.
b. iatrogenic infection.
c. parasitic infection.
d. opportunistic infection.

ANSWER: A
An iatrogenic infection occurs as the result of medical treatment or procedure. A parasiti
cinfection occurs when an organism invades a host and only the organism benefits from
thebiological relationship. An opportunistic infection occurs when the condition of the h
ost changes and the resident flora cause an infection.

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OBJ: Level 1: Recall

14. A patient with an indwelling catheter develops a fever and lethargy. In addition, the urine
inthe catheter bag has turned a brownish colorwand smells foul, which suggests an infectio
n ispresent. What type of infection does this describe?
a. Opportunistic
b. Iatrogenic
c. Pathogenic
d. Parasitic
ANSWER: B
An iatrogenic infection occurs as the result of medical treatment orwprocedures. In this cas
e,the use of an indwelling catheterwto treat a medical condition has resulted in an infection.
Anopportunistic infection occurs when a host’s condition changes and resident flora are a
ble tocause disease. Pathogenic describes the types of organisms that cause disease, but no
t a typeof infection. A parasitic infection occurs when an organism invades a host and
onl y the organism benefits from the biological relationship.

OBJ: Level 2: Recall

15. The smaller the number of microorganisms necessary to cause infection in a competent ho
st,the more the microorganism.
a. opportunistic
b. parasitic
c. invasive
d. virulent
ANSWER: D
Virulence refers to the relative ability of a microorganism to cause disease; more virulent o
rganisms need fewer organisms to cause disease in a host. Opportunistic refers to a type of
resident flora that causes infection when the conditions in a host change. A parasitic infecti
onoccurs when an organism invades a host and onlywthe organism benefits from the biolog
i cal relationship. Invasive refers to entering tissue, not the degree of ease with which an or
g anismcan cause disease.

OBJ: Level 1: Recall

16. Factors that determine the pathogenicity and increase the virulence of organisms include a
llthe following, except
a. an organism’s ability to avoid phagocytosis.
b. an organism’s ability to produce exotoxins and extracellular enzymes.
c. an organism’s ability to produce infection when host conditions change.
d. an organism’s ability to survive intracellularly when phagocytized.
ANSWER: C
An organism’s ability to produce infection when the host conditions change is referred to
a s an opportunistic pathogen. The other three statements refer to ways that a microorgan
ism cansurvive the attack of a host’s immune system and produce disease.

OBJ: Level 2: Interpretation

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.
.

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17. The most common bacterial characteristic that allows forwevasion of phagocytosis by the ho
stis called
a. exotoxin production.
b. extracellular enzyme production.
c. pili.
d. polysaccharide capsule.
ANSWER: D
Organisms possessing a polysaccharide capsule are considered highly virulent because the
ycan evade phagocytosis. Exotoxin and extracellular enzyme production and pili are facto
rs that can increase an organism’s virulence. The exotoxins and extracellular enzymes
ma y be used to survive phagocytosis, but these do not help an organism evade phagocyto
sis. Pili areused to transferwplasmids that may contain the genes for antimicrobial resistanc
e an d, therefore, help an organism survive in the host.

OBJ: Level 1: Recall

18. This is a leukocidin that is lethal to leukocytes and produced by staphylococci.

a. Panton-Valentine
b. Lancefield
c. Hemolysin
d. Adhesins
ANSWER: A
The Panton-
Valentine leukocidin is lethal to leukocytes and contributes to the invasiveness ofstaphyloc
occi. Lancefield deals with classifying -
hemolytic streptococci on the basis of antigens found on theirwouterwcovering. Hemolysins
a re produced by streptococci, and these lyse red blood cells. Adhesins are cell-
surface structures that mediate attachment to other cells.

OBJ: Level 1: Recall

19. Changes in these host structures can result in lower virulence of a microorganism.
a. Pili
b. Adhesin receptors
c. Surface polysaccharides
d. Phagocytes
ANSWER: B
Adhesin receptors are structures found on the host cell that are necessary for attachment of
bacterial adhesins and the beginnings of an infection. Pili and surface polysaccharides are t
hemain bacterial structures of attachments called adhesins. Phagocytes are white blood cel
l s (WBCs) that engulf invadingwmicroorganisms.

OBJ: Level 1: Recall

20. After attachment to host cells, a pathogen may use the following mechanisms to establi
shitself and cause disease, except:
a. Uses lactoferrin for iron
b. Produces an IgA protease that degrades the IgA at mucosal surfaces
c. Produces lysozyme to kill the host cell

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d. Circumvents host antibodies by shifting key cell-surface antigens
ANSWER: C
After engulfing bacteria, the host cell releases lysosomal contents that kill the organism. T
hebacteria do not produce lysozyme.

OBJ: Level 1: Recall

21. Dissemination of a pathogen is

a. when a pathogen penetrates and grows in tissues.
b. when a pathogen multiplies intracellularly.
c. when a pathogen circumvents host antibodies by shifting key cell-surface antigens.
d. when infection with a pathogen spreads from the initial infection site to dista
ntsites such as organs and tissues.
ANSWER: D
Invasion of a pathogen allows the microbe to take advantage of the host’s transport system
(the blood) and seek out other areas that can be infected. This occurs only if the pathogen c
anelude the host’s immune system during this journey. Invasion is when a pathogen penetr
ates and grows in tissues. Intracellular multiplication of a pathogen occurs when an organi
s m cansurvive phagocytosis. When a pathogen shifts key cell-
surface antigens, it is evading a host’simmune system.

OBJ: Level 1: Recall

22. A physician notices that several patients are infected with Clostridium difficile, but only a fe
wof the patients are symptomatic for disease. The reason for this discrepancy is
a. only those strains of the organisms carrying the extrachromosomal DNA coding
for the toxin gene will produce toxin and cause the individuals to be symptomat
ic.
b. only those strains of the organism carrying DNA coding for the toxin within i
tsmain DNA molecule will produce toxin and cause the individuals to be sy
mptomatic.
c. the exotoxin produced contains only the nontoxic portion.
d. the exotoxin must be produced in conjunction with extracellular enzymes to cau
seproblems.
ANSWER: A
The exotoxin gene is commonly encoded for by phages, plasmids, or transposons and does
n otnormally reside within an organism’s main DNA molecule. Exotoxins are highly charac
terwized molecules that are composed of a nontoxic subunit that binds the toxin to the host c
ells, allowing attachment of the toxin. Exotoxins exhibit their effects without the aid of extr
acell ularwenzymes. Extracellular enzymes are another factor that contributes to the virulenc
e and invasiveness of organisms.

OBJ: Level 2: Interpretation

23. The effects of endotoxins consist of dramatic changes in all the following, except
a. blood pressure.
b. fluid imbalance.
c. clotting.
d. body temperature.

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ANSWER: B
Unlike shock caused by fluid loss, such as that seen in severe bleeding, septic shock is u n
affected by fluid administration. An increase in body temperature occurs within an hour af
terwexposure. Severe hypotension occurs within 30 minutes after exposure. The endotoxi n
also initiates coagulation, which can result in intravascular coagulation.

OBJ: Level 2: Interpretation

24. A patient is brought to the emergency room with the following symptoms: body temperatu
reof 102° F, low blood pressure, elevated WBC, and disseminated intravascular coagulati
o
n. This person has gram-
negative rods growing in the blood. What is responsible for these symptoms?
a. Exotoxin
b. Extracellular enzymes
c. Endotoxin
d. Exfoliating toxin
ANSWER: C
Effects of the lipid A portion of the lipopolysaccharide present in the cell walls of gr a
m-
negative bacteria include increased body temperature, hypotension, intravascular clottin
g, neutropenia, metabolic changes, changes in humoral and cellular immunity, an dcha
nges resistance to infection.

OBJ: Level 3: Synthesis

25. Healthy skin secretes these substances to help prevent colonization by transient and possib
lypathogenic organisms.
a. Long-chain fatty acids
b. Sebaceous glands
c. Carbohydrates
d. Antibodies
ANSWER: A
Long-
chain fatty acids produced by the sebaceous glands allow the skin environment to be acidi
c, leading to a low pH environment. Many pathogens prefer the near-
neutral environmentin the body to produce disease. Bacteriocidal substances are produced b
y the microbial flora that colonize the skin, and antibodies are produced by lymphocytes.

OBJ: Level 1: Recall

26. Lysozyme is
a. an antibody produced by the skin.
b. a low-molecular-
weight enzyme that hydrolyzes the peptidoglycan layer ofbacterial cell w
alls.
c. an exotoxin that digests the lipopolysaccharide layer of the bacterial cell wall.
d. a radical similar to hydrogen peroxide.
ANSWER: B
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Antibodies are produced only by the lymphocytes. Exotoxins are produced by bacteria and
a retoxic to the host. Lysozyme is a low-molecular-
weight enzyme that hydrolyzes the peptidoglycan layer of bacterial cell walls.

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OBJ: Level 1: Recall

27. Interferon is a substance produced by the body that inhibits viral replication. Interfe
r onaccomplishes this task by
a. digesting the virus that is attempting to attach to the host cell.
b. destroying the host cell before the virus can attach and replicate.
c. binding to surface receptors that stimulate the cell to synthesize enzymes th
atinhibit viral replication over several days.
d. stimulating platelets to produce -lysins.
ANSWER: C
Interferon is produced by eukaryotic cells in response to a viral infection, and it stimulates
t hecell to synthesize enzymes that inhibit viral replication overwseveral days. Interferons
are not enzymes and cannot digest viruses. Destroying the host cell before the virus can att
ach wouldbe counterproductive, because the purpose is to keep the host cells viable and fr
ee of infection. The -
lysin’s cationic proteins are produced by platelets during coagulation and areactive against g
ram-positive bacteria, not viruses.

OBJ: Level 2: Interpretation

28. All the following activities must occur forwphagocytosis to take place and be effective in h
ostdefense, except
a. attachment of the particle to the phagocyte.
b. ingestion.
c. killing.
d. migration of lymphocytes to the area of infection (chemotaxis).

ANSWER: D
Phagocytes are neutrophils orwmacrophages. Lymphocytes are not phagocytic and cann ote
ngulf bacteria.

OBJ: Level 1: Recall

29. This process results in enhanced phagocytosis by neutrophils.

a. Opsonization
b. Chemotaxis
c. Digestion
d. Glycolysis
ANSWER: A
Chemotaxis is the process of phagocytes migrating toward the site of the infection. Digesti
onis when the contents of the lysozyme are mixed with the phagocytized bacteria. Glycol
y sis isa metabolic process where glucose is broken down and energy is generated.

OBJ: Level 1: Recall

30. One of the most effective defenses bacteria have against phagocytosis is
a. enzymes.
b. the capsule.
c. plasmids.

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d. lipopolysaccharide layer.
ANSWER: B
Enzymes facilitate host cell destruction but do not have any effect on phagocytosis. Plasmi
dscarrywsmall pieces of DNA that can code for toxins, enzymes, and antibiotic resistance.
The lipopolysaccharide layer acts as an endotoxin that causes septic shock.

OBJ: Level 1: Recall

31. Innate immunity consists of which of the following components?

a. Physical and chemical barriers such as the skin and mucous membranes
b. Blood proteins that act as mediators of infection
c. Cells capable of phagocytosis
d. All of the above are part of the innate immune system
ANSWER: D
Innate immunity includes (1) physical and chemical barriers, such as the skin and mucous m
embranes; (2) blood proteins that act as mediators of infection; and (3) a cellular mechanis
m capable of phagocytosis, such as neutrophils and macrophages, and other leukocytes such
as natural killerwcells.

OBJ: Level 2: Interpretation

32. The major constituents of the adaptive or specific immune response are
a. neutrophils.
b. macrophages.
c. monocytes.
d. lymphocytes.
ANSWER: D
Lymphocytes produce antibodies in response to specific antigens present in the blood.
Neutrophils, macrophages, and monocytes are all phagocytic cells that function in inna
teimmunity, not the specific immune response.

OBJ: Level 1: Recall

33. This class of antibodies is usually found as a pentamer.

a. IgM
b. IgG
c. IgA
d. IgE
ANSWER: A
IgM is made up of five basic immunoglobulin subunits and is considered a pentamer. IgG is
amonomer, IgA is a dimer, and IgE is a monomer.

OBJ: Level 1: Recall

34. A subsequent exposure to the same antigen elicits a(n)

, characterized by a rapid increase in IgG antibody associated with higher levels, a prol on
ged elevation, and a moregradual decline in antibody levels.
a. primary immune response

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b. anamnestic immune response
c. opsonin immune response
d. innate immune response
ANSWER: B
The primary immune response consists of production of IgM antibodies. The innate immu
neresponse does not consist of antibody production but rather physical and chemical barrie
rs toinfection and phagocytosis.

OBJ: Level 1: Recall

35. These are low-molecular-weight proteins secreted by T cells.

a. Antibodies
b. Opsonins
c. Lymphokines
d. Lysozyme
ANSWER: C
Antibodies are produced by B cells. Opsonins are antibodies or pieces of complement that h
elp make a pathogen ready to be phagocytized. Lysozyme is the enzyme present in host cell
vacuoles that assist in killing a phagocytized microorganism. Lymphokines are produced by
Tcells as a result of antigen binding, activation, cell division, and differentiation.

OBJ: Level 1: Recall

36. Immunity to intracellular bacterial pathogens, such as Mycobacterium tuberculosis,

isprimarily cell mediated, through the activities of
a. interferons and macrophages
b. antibodies and lymphokines.
c. lysozyme, T lymphocytes, and antibodies.
d. T lymphocytes, lymphokines, and macrophages.
ANSWER: D
T lymphocytes, lymphokines, and macrophages are used by the immune system to battle
intracellular pathogens most effectively. Interferons are useful against viruses, not bacte
ri a.Macrophages are effective against intracellular pathogens because they are phagocyt
es. Antibodies are not useful against intracellularwpathogens because they cannot reach th
e p athogen that lives inside the cell. Lysozyme is an enzyme that is used to kill bacteria
onc ethey are phagocytized.

OBJ: Level 2: Interpretation

37. Pathogens can be transmitted through all the following routes, except
a. ingestion.
b. handwashing.
c. sexual contact.
d. air.
ANSWER: B
Handwashing is a major method to prevent spread of infections. Pathogens can be transmitt
edby ingestion, sexual contact, and air.

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OBJ: Level 1: Recall

38. Because infections can be encountered via the air,

can cause transmission of somepathogens.
a. cuts
b. eyes
c. coughing
d. eating
ANSWER: C
Airborne infections are the most commonly encountered infections. They are transmitted b
y droplets in the air that can be generated by coughing orwsneezing. Cuts, eyes, and childr
e n arenot usual pathways for airborne transmission of a pathogen.

OBJ: Level 1: Recall

39. The resulting disease from this route of transmission is a disease of animals that is transmitt
edto humans.
a. Sexual contact
b. Zoonotic
c. Airborne
d. Ingestion
ANSWER:D B
Sexual contact, airborne, and ingestion are all routes of transmission forwdiseases of huma
nsthat are passed from person to person. Zoonotic describes diseases of animals that infec
t humans.

OBJ: Level 1: Recall

.
.

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Chapter 03: The Laboratory Role in Infection Control M

ahon: Textbook of Diagnostic Microbiology, 7th Edition

MULTIPLE CHOICE

1. In acute care hospitals, transmission of pathogens as a result of treatment occurs as all t

hefollowing “classifications” of infections, except
a. hand hygiene-acquired infections.
b. surgical site infections.
c. catheter-related bloodstream infections.
d. ventilator-associated pneumonias.
ANSWER: A
Although infections can be transmitted through improper hand hygiene, it is not a classificati
on of infection acquired in a hospital. Good handwashing technique is essential for preventi
n g the spread of pathogens in a health care setting, but infections are not classified as hand
h ygiene-acquired infections. Surgical site infections, catheter-
related bloodstream infections, and ventilator-
associated pneumonias are acquired from a treatment rendered to thepatient. For example, ca
theter-
related bloodstream infections usually occur when patients havesterile catheter devices impla
nted into their bloodstream. Because of the invasive nature of thecatheter, bacteria can colo
n ize on the catheter and cause sepsis. The patient did not enter the hospital with this infect
ion
, but acquired the infection as a result of medical treatment.

OBJ: Level 1: Recall

2. An iatrogenic infection is one that
a. is caused by gram-negative bacteria.
b. occurs as a result of medical treatment.
c. is found in urinary tract infections.
d. is not subject to outbreak investigation.
ANSWER:w B
The definition of an iatrogenic infection is one that is acquired in a health care setting. Iatro
genic infections can be caused by gram-
negative bacteria, but other types of bacteria mayalso cause these types of infections (i.e., m
ethicillin-
resistant Staphylococcus aureus, MRSA).Urinary tract infections can be a type of iatrogenic
infection, but other types of infections are also iatrogenic. Because an iatrogenic infection
i s acquired in a health care setting, outbreak investigations are routinely conducted to deter
m ine the source of the infection so that the bacteria can be killed and the spread of infectio
n s topped.

OBJ: Level 1: Recall

3. This ongoing process helps public health and health care officials recognize outbreak
s,upward trends of infections, and positive effects of interventions.
a. Handwashing techniques
b. Intervention
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c. Surveillance
d. Antimicrobial resistance

ANSWER:w C

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Handwashing techniques help to prevent the spread of pathogens, and antimicrobial resistan
ceidentifies organisms that are resistant to particularwantibiotics, but these do not identify o
u tbreaks, upward trends of infections, or positive effects of interventions. Intervention is an
a ction taken to kill pathogenic bacteria-
causing disease. Surveillance, collection, and analysisof data about infections help public he
alth officials recognize outbreaks, upward trends of infections, and positive effects of interv
entions.

OBJ: Level 1: Recall

4. Iatrogenic infections are commonly associated with

a. breaks in aseptic technique.
b. preexisting infections.
c. food-borne illness.
d. respiratory aerosol transmission.

ANSWER: A
Health care-
associated (nosocomial) infections occur after the patient arrives (generally not within the fi
rst 48 hours) and were not incubating in the community before the patient arrived.They occ
urwbecause of instrumentation, increased use of antimicrobial agents, breaks in aseptic tech
n iques, and lack of hand hygiene.

OBJ: Level 1: Recall

5. When reviewing surgical site infections, the infection control practitioner must determine
ifthe patient’s infection is health care–
associated by considering all the following, except
a. whetherwan endotracheal tube was present during surgery.
b. the length of surgery.
c. the degree of contamination of the surgical site (gunshot wound to the abdom
enversus a hernia repair).
d. whetherwany breaks in surgical technique occurred.
ANSWER: A
During surgery, there is a chance that bacteria present in the environment (including instru
m ents) can be transferred to the surgical site and cause an infection. When put under gener
al anesthesia, patients usually have a tube inserted to keep theirwairway open. This is not un
iqu e to any particular surgery and therefore will probably not contribute to a nosocomial i
nfecti on. The length of surgery could contribute to an infection—
the longerwa person’s innerwtissue is exposed to the air, the more chance there is for bacteria
or fungi to get into that wound. The degree of contamination of the surgical site may contr
i bute to a surgical site infection because the gut contains lots of bacteria. When it is opene
d up, bacteria can leak intothe sterile abdominal cavity. If there were breaks in surgical tec
hni que and a contaminated object was introduced into the sterile area, bacteria may have tr
ansf erred to the wound, and aninfection would follow.

OBJ: Level 1: Recall

6. To keep abreast of all infections that occur in the hospital, infection control practitioners s
et up surveillance programs. These surveillance programs look at this parameter to deter
mi ne ifthere are more or fewerwinfections in a given period.
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a. Antimicrobial susceptibility reports
b. Infection rates

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c. Handwashing rates
d. Glove usage

ANSWER: B
Antimicrobial susceptibility reports inform practitioners about the organisms that are resista
ntto particular drugs. They do not address the number of infections in a health care facility.
Handwashing is an important part of preventing the spread of pathogens, but there is no o
n e who goes around and counts the number of times someone washes his or herwhands. So
th is isnot a parameter. Glove usage is assumed to be 100%, and it does not tell the practiti
on er howmany infections were in the health care setting.

OBJ: Level 2: Interpretation

7. This program involves a close watch of only specific, high-risk, high-

volume procedures fornosocomial infections.
a. Baseline data
b. Total surveillance program
c. Targeted surveillance program
d. Data mining
ANSWER: C
Targeted surveillance programs look at particular programs for increases or decreases in inf
ection rates. Baseline data are used in a surveillance program and offer a marker forwcompa
rison of subsequent data. Total surveillance programs look at all procedures for increases
o r decreases in infection rates. Data mining uses sophisticated tools to analyze data.

OBJ: Level 1: Recall

8. The counties surrounding yours are seeing an increase in the number of whooping cou
ghcases. This is important for the microbiology laboratory because
a. physicians may start sending these cases to you.
b. you will need to advise physicians to suspect such cases and to send them to t
hehospitals in the surroundingwcounties.
c. you need to make sure that the infection control practitioners in those counti
eshave baseline data.
d. you need to educate health care providers on specimen collection and transportati
on, and have the specialized media ready so you can detect any cases inyour cou
nty.
ANSWER: D
The laboratory can be proactive in educating health care providers on specimen collection a
ndtransportation if those are unique to a specific public health concern. Awareness of infec
ti on control activities within the public health setting allows the laboratory to acquire the n
ece ssarymedia or reagents to meet emerging needs.

OBJ: Level 2: Interpretation

9. Information that the microbiologywlaboratory can provide to infection control practition

e rsincludes
a. the prevalence of a particular pathogen.
b. data on the effectiveness of handwashing techniques.

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c. information about the outbreak of meningitis cases in the surrounding counties.
d. the antibiotic ordering patterns of particular physicians.

ANSWER: A
The prevalence of a particular pathogen is another piece of information that the microbiolog
ylaboratory can provide to the infection control practitioner. Prevalence is the number of ca
sesof disease that occurs in a given moment in time or specific time period in a given popu
l ation.Therefore, knowing what pathogens are isolated from a given body site and being fa
m iliar with what pathogens are frequently isolated from a given location within a health car
e facilityare important to the infection control practitioner.

OBJ: Level 1: Recall

10. A microbiology technologist is workingwat the bench and notices that a patient from t
hecardiac intensive care unit (CICU) grows a Klebsiella pneumoniae bacterium that
i s anextended-spectrum -lactamase-
producing isolate. This technologist would advise the physician to
a. order any antimicrobial that is effective against gram-negative rods in general.
b. limit the use of antimicrobial agents that tend to induce the formatio
n ofextended-spectrum -lactamases.
c. draw more blood cultures, because the ones that grew that organism a
recontaminated.
d. be on the lookout for diarrhea.
ANSWER: B
Being able to recognize what pathogens are isolated from patients in a cardiac CICU may p
rofovide the opportunity for the infection control practitioner to inform health care providers
TESTBANKSELLER . C O M
theweffects of antibiotic pressure. As an example, i f e x t e n d ed - spectrumw-lactamase-producing
Klebsiella pneumoniae isolates were seen in that MICU, the physicians may be advised
t o limit the use of antimicrobial agents that tend to induce the formation of extended-
spectrum
-lactamases.

OBJ: Level 2: Recall

11. Organisms that represent public health concerns can be recovered from patients in an acute
care hospital. All of the following isolates are considered significant or major public he
alt h concerns that are reportable to public health jurisdictions to follow up as a potential o
utbr eak,except
a. Neisseria meningitis.
b. West Nile virus.
c. MRSA.
d. encephalitis viruses.

ANSWER: C
Although MRSA can be an infection control issue within a health care facility, it is not yet
considered a significant public health concern. Methicillin-
resistant S. aureus is usually bornand bred in a health care setting, but more cases of com
munity-
acquired MRSA are being seen. The other organisms are spread by mosquitoes and close c
ontact.
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OBJ: Level 1: Recall

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12. Organisms that are frequently encountered as causes of health care-

associated infections inacute care settings include all the following organisms, except
a. MRSA.
b. enterococci.
c. Clostridium difficile.
d. Neisseria meningitis.
ANSWER: D
N. meningitis is usually not implicated inwhealth care-
associated infections. These infectionsare usually outbreaks that occur in the community, e
specially in schools.

OBJ: Level 1: Recall

13. Patients in both extended care facilities and home care settings are frequently immunosupp
ressed by disease or therapy and often need intravascular orwotherwdevice-
relatedcare. The microbes identified in these patients are often opportunistic pathogens and
include all the following, except
a. Pseudomonas aeruginosa.
b. Neisseria meningitis.
c. Candida.
d. Acinetobacter.

ANSWER: B
Infectious etiologic agents of infection control significance identified in these patients include
P. aeruginosa, Candida, Staphylococcus aureus, Acinetobacter, Clostridium difficile,
methicillin-resistant Staphylococcus, and vancomycin-resistant enterococci.
OBJ: Level 2: Interpretation

14. Prisoners or people housed in behavioral health facilities are more likely to contract infectio
nswith pathogens from their intimate contact with blood and body fluids. A likely pathogen
maybe
a. Pseudomonas aeruginosa.
b. Hepatitis C.
c. Methicillin-resistant Staphylococcus aureus (MRSA).
d. Clostridium difficile.
ANSWER: B
People who are housed together in some form of communal living, such as prisons or beha
vioral health facilities, have infection control-
related infections similar to the other settings previously described. The infectious disease
s are more likely related to the activitiesof the persons within the facility. As an example,
MRSA is recovered from prisoners who practice illicit tattooing with nonsterile, shared eq
uipment, whereas lice and hepatitis C are more frequently seen in behavioral health settin
g s because of the community source of the clients and theirwintimate contact with blood
and body fluids.

OBJ: Level 1: Recall

15. An outbreak occurs when

a. numbers of isolates or infection rates increase significantly above the baseline.

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b. numbers of isolates or infection rates decrease significantly below the baseline.

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c. many people in a community are infected with a particularworganism.
d. the mortality rate from a particular organism increases above 2%.

ANSWER: A
When numbers of isolates or infection rates increase above the baseline or when an isolate
ofa rare or potential bioterrorism agent is recovered, an “outbreak” may have occurred. Th
e microbiology laboratory may be the first to recognize that event and will likely particip
at e inthe investigation of that outbreak.

OBJ: Level 1: Recall

16. An index case is

a. an epidemiologic curve for a particular pathogen.
b. the last case described in an outbreak.
c. the first case described in an outbreak.
d. the case where the numberwof infections with a particular organism rises above t
hebaseline.
ANSWER: C
The first case described is the index case, and the other infections that followed were to
bedetermined if they were related to that first case.

OBJ: Level 1: Recall

17. When an outbreak is suspected, all the following steps are taken in investigating that event,
except
a. establishing a case definition.
b. confirming that an outbreak exists.
c. immediately treating all persons involved with appropriate antibiotic.
d. establishing an epidemiologic curve.
ANSWER: C
First establish a case definition, and then confirm that an outbreak exists. One must be certa
inthat all the suspected cases match the definition and that there are more than an expected
numberwof cases. Additional cases may be added to the initial number of cases. Next, pull t
ogether as much information about the cases as possible, related to person, place, or time, t
hen draw an epidemiologic curve. Then form a hypothesis about the likely reservoir, sourc
e
,and means of transmission. At any point along the timeline, establish interventions to stop t
heoutbreak.

OBJ: Level 1: Recall

18. In an outbreak investigation and in the collection of routine surveillance data, what sorts
ofactivities are critical?
a. Microbiologists’ awareness of the processes that occur in a routine investigation
b. Alerting the public health department about potential outbreaks
c. Analyzing data on antimicrobial susceptibilitywfrom pathogens in the hospital s
othe health care providers understand the type of antimicrobials that must be
u sed
d. Collecting, processing, reporting, and reviewing pertinent cultures
ANSWER: D
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In an outbreak investigation and in the collection of routine surveillance data, the collection
, processing, reporting, and reviewing of pertinent cultures become critical. The availability
ofculture reviews that may result in the initiation or termination of an outbreak investigati
on cannot be overlooked in importance. These data form the basis for the decisions made
at eachstep of the investigation of an outbreak.

OBJ: Level 1: Recall

19. If a large statewide or worldwide epidemic occurs, one of the major difficulties is
a. collecting and transporting specimens from people who live out of state or arou
ndthe world.
b. determining what organism is causing the outbreak.
c. arranging to get all the people with the infections to come back to the main area
ofthe outbreak for an extended period.
d. making sure enough media and technologists are available to process the lar
geamount of cultures associated with the outbreak investigation.
ANSWER: A
One of the major difficulties in a large outbreak is the ability to collect and transport speci
mens from patients who live out of the area. Some of the individuals may have had theirc
ul tures processed in their home state or country so that results from those cultures are diff
icu lt to retrieve.

OBJ: Level 1: Recall

20. What is pulsed-field gel electrophoresis?

a. The process of performing various environmental cultures to aid inwinfectio
ncontrol investigations
b. A strain-
typing technique that can be an important adjunct to epidemiologicinvesti gat
ions
c. A culture technique that compares the two antibiograms of an isolate with t
heindex case
d. A technique that checks forwwater quality
ANSWER: B
Pulsed-
field gel electrophoresis enables a microbiology technologist to determine the strain ofan or
ganism. Knowing the strain is important because, in an outbreak, the same strain of organis
m is causing the problem. If the strain can be identified, the index case can be found, and t
he outbreak can be stopped. This strain typingwtechnique is more sensitive than comparingw
a ntibiograms.

OBJ: Level 1: Recall

21. Although environmental cultures are not usually performed because the environment is rarel
yimplicated in disease transmission, they occasionally are useful. Samples will be taken fro
m all of the following, except
a. air.
b. water.
c. hands.
d. surfaces.
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ANSWER: C
Recommendations surrounding environmental infection control have been extensively discu
ssed in a Centers for Disease Control and Prevention (CDC) document. The environmentis r
arely implicated in disease transmission, except with immunosuppressed patients. The air,
w ater, and surfaces are cultured when appropriate. Hands may transmit pathogens, but they
ar e not considered part of the environment.

OBJ: Level 1: Recall

22. Waterborne illnesses that may be associated with contaminated drinking water or recreatio
nwater include all the following, except
a. legionellosis.
b. hepatitis A.
c. Pseudomonas skin infection.
d. hepatitis B.
ANSWER: D
Hepatitis B is a blood-
borne pathogen and cannot be contracted from contaminated water. Waterborne diseases inc
lude respiratory illnesses (such as legionellosis), hepatitis (hepatitis Aor hepatitis E), skin i
n fections (from Pseudomonas or mycobacteria), and central nervous system infections (Nae
g leria).

OBJ: Level 1: Recall

23. In the United States, 46 outbreaks annually owing to waterborne pathogens cause this illne
ssand affect several thousand people.
a. Diarrhea
b. Hepatitis C
c. Naegleria
d. Legionnaires’ disease
ANSWER: A
These outbreaks can be due to Giardia lamblia, Escherichia coli, the Norwalk virus, Norwa
lk-like viruses, and other viruses associated with diarrhea. Hepatitis C is a blood-
bornepathogen. Infection with Naegleria affects the brain and is relatively rare. Legionnair
e s’ disease is a respiratory illness.

OBJ: Level 1: Recall

24. The role of the microbiology laboratory is to perform cultures and provide culture results
tohealth care providers. The microbiology laboratory also has the responsibility to
a. report the identification orwsuspicion of certain infectious diseases to local, stat
e,and federal public health entities.
b. report any bioterrorism findings to the news media.
c. report odd infectious diseases to the CDC.
d. report any bioterrorism finding to the police.
ANSWER: A

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Because of the escalation of terrorism in the United States and the distinct possibility of a w
idespread bioterrorism attack, it is imperative that the laboratory technologist knows what in
fectious diseases are reportable, to what agency they are to be reported, and in what time fr
a me they are to be reported. The identification or suspicion of certain infectious diseases wi
ll need to be reported to particular government agencies to begin an investigation. If these re
p orts are not made, no one will know of the possibility of an outbreak or a bioterrorism at
tac
k. Laboratory technologists need to follow the policies of their laboratory for notification.

OBJ: Level 1: Recall

25. The hospital infection control committee will expect reports from the laboratory that deal wi
thall the following, except
a. antibiograms.
b. waterwcontamination rates.
c. blood culture contamination rates.
d. pathogens recovered in certain hospital units.
ANSWER: B
Committees review the results and note any trends that may be occurring. This is important
sothat outbreaks may be caught early while they are still manageable. Water contamination
rwatesare never included in these periodic reports because routine environmental cultures ar
e n ot performed in the hospital. Antibiograms, blood culture contamination rates, and path
ogen s recovered in certain hospital units are extremely important when looking for outbre
aks.

OBJ: Level 1: Recall

26. Laboratory technologists must not only keep themselves educated in their contribution to t
heinfection control team,they must keep
a. housekeeping alerted as to the nature of the microbiology laboratory’s
biohazardous waste.
b. laboratory management aware of equipment needs.
c. the infection control personnel educated regarding the laboratory’s contribution t
othe team.
d. the Centers for CDC informed of the continuing education needs of t
hemicrobiology laboratory’s staff.
ANSWER: C
The infection control team needs to know the types of contributions the microbiology labora
tory can make. When new procedures or new equipment are added to the laboratory, person
nel need to know what new type of information is now available to the infection controltea
m. New information may make discovering outbreaks easier and quicker. Housekeeping kn
o ws that the microbiology laboratory’s waste is biohazardous and treats it as such. The hou
se keeping team has no need to know exactly what is in the bags. Laboratory management
mon itors workload and new equipment, so the supervisory team would keep track of the eq
uipm ent needs of the department. The CDC does not need to be notified of the microbiolog
y lab oratory staff’s continuing education needs.

OBJ: Level 1: Recall

27. This is practiced throughout the hospital and mandates safety for all personnel when handli
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ngblood and body fluids.

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a. Biosafety level 2
b. Handwashing
c. Wearing of respirators
d. Standard Precautions
ANSWER: D
Standard Precautions are used by all hospital personnel to prevent infection with blood-
bornepathogens. This is mandated by the Occupational Safety and Health Administration
( OSHA).Handwashing is also practiced throughout the hospital when hands become soile
d, but this is used for everything, not just when handling blood and body fluids. Biosafety
lev el 2 precautions are practiced only in the laboratory, not throughout the hospital. Wea
ring o f respirators is used in biosafety level 3 and level 4 precautions. Respirators are us
ually onl y worn in the laboratory and not throughout the hospital.

OBJ: Level 1: Recall

28. What types of activities have led to the emergence of the microbiology laboratory as t
heforefront in keeping Americans safe?
a. Terrorist
b. Research
c. Military
d. Educational
ANSWER: A
With the advent of terrorist activities in the world, the microbiology laboratory has become
a nintegral part of that area of the infection control program. Whether dealing with emergin
g diseases, such as severe acute respiratory syndrome (SARS), orwreemerging disease, such
as anthrax, the laboratory must stay closely aligned with the infection control activities in th
e s etting that the laboratory serves. Hospital laboratories will be the first point of contact fo
r cu ltures of infected people.

OBJ: Level 1: Recall

29. An example of an emerging disease is

a. influenza.
b. West Nile virus.
c. malaria.
d. chicken pox.
ANSWER: B
West Nile virus is a zoonotic virus that is slowly beginning to infect humans. This disease h
asbeen diagnosed in humans since the late 1990s. Influenza has been around for many year
s—
one of the worse outbreaks was in 1916. Malaria has been around in the tropics since the
Europeans began invading South America and Africa. Chicken pox is a common virus, so
c ommon that a vaccine was developed to ward off infection in the 1960s.

OBJ: Level 1: Recal

l
.
.

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Chapter 04: Control of Microorganisms

Mahon: Textbook of Diagnostic Microbiology, 7th Edition

MULTIPLE CHOICE

1. The chemical or physical method that destroys all forms of life is called
a. sterilization.
b. disinfection.
c. bacteriostatic.
d. bactericidal.

ANSWER: A
Sterilization is the destruction of all forms of life, including bacterial spores. Disinfection is
aprocess that eliminates a defined scope of microorganisms, including in some cases spore
s.
Bacteriostatic inhibits the growth of microorganisms. Bactericidal kills bacteria.

OBJ: Level 1: Recall

2. Organisms that are the most resistant to heat, chemicals, and radiation are
a. parasites.
b. prions.
c. bacteria.
d. viruses.
ANSWER:w B
Prions are naked pieces of protein, so they are harderwto kill than any otherworganism. Virus
e s usually contain a nucleic acid and all the mentioned formsof killing can effectively disrup
t their nucleic acid. Bacteria and parasites are complete organisms that are killed by disinfect
io nand sterilization, even in the spore and cyst stages.

OBJ: Level 1: Recall

3. After using the phone, the laboratory tech sprayed the receiverwwith a chemical spray. Th
isprocess will kill a defined scope of microorganisms. What is this process called?
a. Sterilization
b. Bacteriostatic
c. Disinfection
d. Bactericidal
ANSWER:w C
Disinfection kills a defined scope of microorganisms. Sterilization kills all organisms and sp
ores at a site. Bacteriostatic and bactericidal are adjectives that describe the particular actio
n of chemical agents: to inhibit bacterial growth or kill bacteria.

OBJ: Level 2: Interpretation

4. Before performing a phlebotomy, the phlebotomist will clean the area on a patient’s arm wi
tha substance before inserting the needle. This substance is called a(n)
a. disinfectant.
b. sterilizer.

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c. antiseptic.
d. bactericidal.

ANSWER: C
An antiseptic is a substance applied to the skin for the purpose of eliminating or reducingwt
henumber of bacteria present. A disinfectant is a chemical agent used to kill microorganis
ms onan inanimate object. To sterilize is to kill all life; skin will still have organisms gro
wi ng afterwiping. Bactericidal is the process of killing bacteria.

OBJ: Level 2: Interpretation

5. All the following factors play a significant role in the selection and implementation of t
heappropriate method of disinfection, except
a. temperature.
b. contact time.
c. biofilms.
d. humidity.
ANSWER: D
Humidity is not important when attempting to disinfect or kill organisms. Temperature, c
ontact time, and biofilms all play a role in selection and implementation of the appropria
t emethod of disinfection.

OBJ: Level 1: Recall

6. When eliminating organisms from inanimate objects, higher numbers of organisms requir
elonger exposure times because
a. all disinfecting agentsare not alike and some require shorterwtimes.
b. the chemical composition of the disinfecting agent varies.
c. disinfecting agents containingwcarbon tetrachloride require longer times to act.
d. it takes longerwto eliminate 99% of microorganisms.
ANSWER: D
When there are higher numbers of microorganisms, it takes longer to kill 99% of the micr
oorganisms present. Although disinfectants are different, it still takes longer to kill moreor
ganisms. The chemical composition of a disinfecting agent may affect the time required t
o kill microorganisms, but microbial load is a determining factor.

OBJ: Level 1: Recall

7. If this is present on a surface to be disinfected, it can shield microorganisms from t

hedisinfectant or inactivate the disinfectant. What is this substance?
a. Bleach (sodium hypochlorite)
b. Organic material
c. Hydrochloric acid
d. Water
ANSWER: B
Organic matter (e.g., blood, pus) can keep the disinfectant from reaching and killing the mi
croorganism. Bleach, hydrochloric acid, and water can counteract another disinfectant, butt
hey cannot shield microorganisms from a disinfectant.

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OBJ: Level 1: Recall

8. Disinfectants are usually used at this temperature.

a. 50° C to 100° C
b. 0° C to 10° C
c. 25° C to 50° C
d. 20° C to 22° C

ANSWER: D
Disinfectants are usually used at room temperature (20° C to 22° C). Too high orwtoo lo
w atemperature can actually inactivate a disinfectant.

OBJ: Level 1: Recall

9. Pasteurization achieves _ .
a. disinfection
b. sterilization
c. asepsis
d. filtration
ANSWER: A
Pasteurization kills food-
borne pathogens, but not microbial spores present in a liquid. Because sterilization is killin
g of all microorganisms plus spores and cysts, pasteurization only disinfects. Asepsis desc
r ibes no bacteria present. Filtration describes another method ofdisinfection where microor
g anisms are removed from a liquid by a physical device—a filter.

OBJ: Level 1: Recall

10. Chemosterilizers exert their killingweffect through all the following mechanisms, except
a. denaturation of cellularwproteins.
b. damage of RNA and DNA.
c. inactivating enzyme substrates.
d. reactions with components of the cytoplasmic membrane.
ANSWER: C
Inactivating an enzyme substrate may or may not have an effect on cellular function. If a c
hemical can denature proteins that are used by the cell, damage RNA or DNA, or react with
components of the cell membrane, they can damage the cell.

OBJ: Level 1: Recall

11. Alcohols use this mechanism to inactivate microorganisms.

a. Denature proteins
b. Destroy DNA
c. Denature RNA
d. Inhibit cell wall synthesis

ANSWER: A
Alcohols disrupt the tertiary and quaternary structure of the cell wall proteins to destroy m
icroorganisms. They do not have the capability to destroy DNA, denature RNA, or inhi bit
cell wall synthesis.

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OBJ: Level 1: Recall

12. The tech needs to sterilize a piece of equipment that cannot be autoclaved orwgas sterilized
because the equipment contains lenses, metal, and rubber components. What solution sho
uldbe used to sterilize this piece of equipment?
a. 10% bleach
b. 37% formalin
c. Glutaraldehyde
d. 90% alcohol
ANSWER: C
Glutaraldehyde is the sterilant of choice, because it is not inactivated by organic material,
a ndit can kill both microbes and spores, depending on contact time. Ten percent bleach ca
nn ot beused because it is a corrosive and can corrode metal; 37% formalin cannot be used
be cause itis a carcinogen, and the Occupational Safety and Health Administration (OSH
A) do es not recommend it for routine sterilizing or disinfecting; 90% alcohol can be corro
sive, b ut it is also inactivated with any organic material that may be present on the instru
ment.

OBJ: Level 1: Recall

13. Forwthe most effective microbial killing, all iodophors must be properly diluted because
a. they stain the skin if too concentrated.
b. this decreases contact time forwadequate killing.
c. there must be enough free iodine to kill the microorganisms.
d. this increases contact time for adequate killing.
ANSWER: C
The reason forwdiluting iodophors properly is that the dilution ratio is important to ensure the
reis enough free iodine to kill microorganisms. When iodophors are used as skin preparatio
n s, contact time is essential forwkilling microorganisms. Contact time does not depend on di
lut ion.Iodophors are considered nonstaining.

OBJ: Level 1: Recall

14. Even though hypochlorites are inexpensive and have a broad range of microbes that they ki
ll,they are not used as sterilants because of
a. the corrosive nature of the compound.
b. the activation required by organic matter.
c. short exposure time forwsporicidal action.
d. long exposure time forwsporicidal action.
ANSWER: D
Hypochlorites require a long exposure time to kill spores, and they are inactivated by organ
icmaterial present on an object. They are not used as a disinfectant because they are corros
i ve.

OBJ: Level 1: Recall

15. Many materials in hospitals that must be sterilized cannot withstand steam sterilization. G
assterilization is used instead, using this gas.
a. Nitrous oxide
b. Oxygen
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c. Ethylene oxide
d. Carbon dioxide

ANSWER: C
Ethylene oxide is usually mixed with nitrogen or carbon dioxide before use because it is
explosive in its pure form. It is used in hospitals and in the manufacturing industry for st
erilizing thermoplastic products. Nitrous oxide, oxygen, and carbon dioxide are all gases
, but they do not kill microbes or their spores.

OBJ: Level 1: Recall

16. Why should health care workers wash their hands after coming into contact with a patient?
a. To reduce the amount of red blood cells transmitted from one patient to the next
b. To reduce the occurrence of hemolytic transfusion reactions
c. To reduce the need for antiseptics and disinfectants
d. To reduce the spread of pathogenic bacteria from one individual to another
ANSWER:D D
Any pathogenic bacteria present on the hands of one individual will be passed on to the ne
x t individual unless the hands are washed to remove the pathogens. Hands visibly contamin
at ed with red blood cells are always washed after becoming soiled. Hemolytic transfusion r
eac tionsare caused by the intravenous administration of red blood cells. Antiseptics and disi
nfe ctants will always be needed to cleanse skin and inanimate objects to free them of patho
geni c bacteria.

OBJ: Level 1: Recall

17. High-level disinfectants are active against all the following, except
a. parasites.
b. spores.
c. fungi.
d. tubercle bacilli.

ANSWER: A
High-
level disinfectants are active against vegetative cells, tubercle bacilli, spores, fungi, andvir
u ses. These disinfectants may have no activity against parasite cysts orwegg forms.

OBJ: Level 1: Recall

18. This agency regulates the use, sale, and distribution of antimicrobial pesticide products f
orcertain inanimate, hard, nonporous surfaces, or incorporates into substances under the
pesticide law.
a. Antimicrobial Division of Environmental Protection Agency (EPA)
b. Centers for Disease Control and Prevention (CDC)
c. U.S. Army Medical Research Institute forw Infectious Diseases (USAMRIID)
d. U.S. Food and Drug Administration (FDA)
ANSWER: A

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The Antimicrobial Division of the EPA regulates the use of antimicrobials on inanimate, n
onporous surfaces. The CDC acts as a clearinghouse for information of medically importa
n tbacteria and houses one of two biosafety level 4 (BSL-
4) laboratories. The other (BSL-
4) laboratory is found at the Army infectious disease research facility, USAMRIID. The F
DA regulates substances that are put into the body.

OBJ: Level 1: Recall

19. These two alcohols are effective in killing enveloped viruses such as hepatitis B virus (HBV).
a. 50% isopropyl and 50% butanol
b. 95% propanol and 70% ethanol
c. 70% isopropyl and 95% ethanol
d. 70% pentanol and 70% isopropyl
ANSWER:D C
The only two alcohols used in U.S. hospitals that kill HBV are 70% isopropyl and 95
%ethanol.

OBJ: Level 1: Recall

20. This chemical is a saturated 5-carbon dialdehyde that has broad-

spectrum activity, rapidkilling action, and remains active in the presence of organic m att
er.
a. Formalin
b. Formaldehyde
c. Haloaldehyde
d. Glutaraldehyde
ANSWER: D
Glutaraldehyde is a good killing agent because it has broad-
spectrum activity and rapid killingaction, remains active in the presence of organic matter, a
nd can be usedwon sensitive equipment. Formalin is designated as a carcinogen by the OSH
A, and worker exposure limits have been set. These adverse effects limit its usefulness. Fo
r maldehyde is a gas that is usuallyknown as formalin. Haloaldehyde is not used as a disinfe
ct ant.

OBJ: Level 2: Interpretation

21. These disinfectants are cationic, surface-

activated agents that work by reducingwthe surfacetension of molecules in a liquid, resulti
ng in the disruption of the cellular membrane of microbes.
a. Quaternary ammonium compounds
b. Heavy metals
c. Chlorines
d. Iodophors

ANSWER: A
Quaternary ammonium compounds are disinfectants that are cationic, surface-
activated agentsthat disrupt the cellular membrane of microbes. Heavy metals are bacteriosta
tic. The mechanism, by which chlorines kill microorganisms, is the oxidative effects of hyp
o chlorous acid. Iodophors kill through the action of periodic acid.
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OBJ: Level 1: Recall

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22. This organization regulates chemical skin antiseptics.

a. EPA
b. FDA
c. CDC
d. National Institutes of Health (NIH)
ANSWER: B
The FDA regulates chemical skin antiseptics. The Antimicrobial Division of the EPA r
egulates disinfectants. The CDC is the nation’s clearinghouse on infectious diseases. Th
eNIH is a conglomerate of special federal agencies that award research grants to furthe
r knowledge in a particular area.

OBJ: Level 1: Recall

23. The main goal of handwashing is to

a. sterilize a person’s hand.
b. increase the risk of passing on pathogens.
c. eliminate transient flora.
d. disinfect a person’s hands.
ANSWER: C
A person’s hands are never sterile; therefore, the best handwashing scenario would be to cl
eanse the hands of transient flora. Sterilizing someone’s hands would also strip the hands o
f essential oils that would contribute to drying and cracking of the skin. Washing would eli
m inate most pathogens, thereby decreasing, not increasing, a person’s ability to transmit pa
th ogens. Disinfection occurs when microorganisms are killed on inanimate objects.

OBJ: Level 1: Recall

24. Routine handwashing in health care settings mandates washing at all the following times,
except
a. in high-risk areas such as ICU and burn units.
b. on entering protective isolation units.
c. before and afterwroutine patient contact.
d. when gloves become soiled during a procedure or dressing change on the sa
mepatient.
ANSWER: D
Soiled gloves are changed duringwa procedure or dressingwchange on a single patient, but t
hehands are not washed until contact with that patient terminates.

OBJ: Level 1: Recall

25. The purpose of surgical hand scrubs and waterless hand rubs is to
a. eliminate the transient flora and most of the resident flora on the skin.
b. remove all physical dirt and some residential flora.
c. remove all resident flora.
d. remove all transient flora.
ANSWER: A
.
.

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Surgical scrubs try to eliminate as much bacteria from the surgeon’s hand as possible. In ca
sethe surgeon’s glove is torn orwpunctured, very little bacteria will enter the surgical wound.
Transient and resident flora must be removed by the surgical hand scrubs and waterless ha
ndrubs.

OBJ: Level 1: Recall

26. The most common iodophor used in the United States forwpreoperative skin preparation is
a. calcium iodophor.
b. 95% ethanol and iodine.
c. tincture of iodine.
d. povidone-iodine.
ANSWER: D
Povidone-
iodine contains a low amount of free molecular iodine, reducing toxic effects, staining,
and irritation. It also provides slow and continuous release of iodine. Tincture ofiodin
e is not used frequently. Ca iodophor and 95% ethanol and iodine are not used for preo
p erative surgical skin preparation.

OBJ: Level 1: Recall

27. This topical antiseptic disrupts the microbial cell membrane and precipitates the cellul
arcontents.
a. Chlorhexidine gluconate
b. Povidone-iodine
c. 95% ethanol
d. 60% isopropyl alcohol

ANSWER: A
The bactericidal mechanism forwchlorhexidine gluconate is to disrupt the microbial cell me
m brane and precipitate the cellular contents. Povidone-
iodine uses hypoiodonic acid and free iodine to disrupt the cell and eventually kill it. The b
a ctericidal mechanism for alcohols isdenaturing proteins.

OBJ: Level 1: Recall

28. This compound is a diphenyl etherwand it exerts its bactericidal effects by disrupting the ce
ll wall. It has good activity against gram-
positive cocci, but poor activity against fungi. What isits name?
a. 95% ethanol
b. Triclosan
c. Chlorhexidine gluconate
d. Povidone-iodine
ANSWER: B
Triclosan is a diphenyl ether, and it exerts its bactericidal effects by disrupting the cell wa
ll.Ninety-
five percent ethanol denatures the cellular proteins. Chlorhexidine gluconate disruptsthe ce
llular membrane and spills the cell’s contents. Povidone-
iodine kills the bacteria with free iodine and hypoiodonic acid.

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OBJ: Level 2: Interpretation

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29. Laboratory safety includes all the following areas, except

a. radioactivity.
b. chemical.
c. isolation.
d. fire.
ANSWER: C
Isolation safety and precautions are usually practiced in conjunction with the patient on the
floor or outpatient setting. In the laboratory, there are few patients, so safety focuses on ar
easlike radioactivity, chemical safety, and fire safety.

OBJ: Level 1: Recall

30. Why is laboratory-

acquired infection an obvious hazard forwpersonnel working in amicrobiology lab
oratory?
a. Microbiology personnel do not always adhere to safety practices.
b. Safety practices are not applicable for the microbiology laboratory.
c. In-service education is not provided for microbiology staff.
d. Personnel deal with a variety of infectious agents: viral, fungal, parasitic, an
dbacterial.
ANSWER: D
All specimens handled by laboratory techs are considered to be potentially infectious. Ther
efore, if a person is careless, a laboratory-
acquired infection can occur. Microbiology personnel should follow safety procedures for t
heirwown safety. Safety procedures do apply tothe microbiology laboratory, and training is p
rovided to each employee.

OBJ: Level 1: Recall

31. The comprehensive safety program for the microbiology laboratory needs to fulfill all t
hefollowing provision, except:
a. It is specific to the hospital and does not need to conform to state, local, a
ndfederal regulations.
b. It must address biological hazards.
c. It must teach correct techniques for lifting and moving heavy objects and patien
ts(where applicable).
d. It must describe the safe handling, storage, and disposal of chemicals.
ANSWER: A
The safetywprogram must comply with federal and state regulations, hospital procedures, an
d good laboratory practice. It needs to address all safety hazards (fire, chemical, radiologic
, andbiological) and be uniformly applied. Procedures need to be written, and employees ne
e d to take responsibility for keeping their workplace safe.

OBJ: Level 1: Recall

32. Processing of patient specimens and handling of actively growing cultures of microorganis
msput an employee at risk of potential contact with the infectious agent through all the follo
wingroutes, except
a. mucous membranes.

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b. blood splashed onto intact skin.

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c. inhalation of aerosols.
d. accidental ingestion.

ANSWER: B
When working with specimens and culture plates, there is little chance of contracting an in
fection if blood is splashed onto intact skin. Infection—
through the mucous membranes byrubbing eyes with contaminated hands, from inhaling a
erosolized microorganisms, orwby accidental ingestion—
is possible when handling specimens and actively growing culture plates.

OBJ: Level 1: Recall

33. All of the following organisms can typically cause infection from aerosolization of specimens,
except
a. Mycobacterium tuberculosis.
b. Brucella spp.
c. Staphylococcus aureus.
d. Francisella tularensis.
ANSWER: C
Cases of S. aureus infection of laboratory workers occur often, but not usually through aeros
olinhalation. Many reported cases of laboratory workers being infected with M. tuberculosis
after being exposed to aerosols when processing sputum specimens fill the literature. Brucew
llaand F. tularensis are very infectious organisms and several cases a year are reported of la
boratory workers who contract the disease after processing culture specimens.

OBJ: Level 1: Recall

34. What protective measures can a laboratory workerwtake when working with actively growi
ngcultures to ensure that they do not become infected?
a. Ensure that fungal cultures are sealed and worked in a biosafety cabinet.
b. Wash their hands at the end of their shift.
c. Handle specimens routinely, using extra care forw HIV and HBV cultures.
d. Take off bandages on fingers when reading plates.
ANSWER: A
Fungal cultures produce many infectious spores that can disseminate rapidly via the ventil
ation system if a plate is opened on the bench in a laboratory. These cultures should alw
ay s be handled in a biosafety cabinet. Bench technicians should wash their hands freque
ntly to ensure the number of pathogenic microorganisms on their hands is always low.Al
l speci mens should be handled as though they are HBV and HIV positive—
with extreme care. Cuts on the hand should always be covered by finger cots orwgloves.

OBJ: Level 1: Recall

35. The laboratory exposure control plan should contain all the following, except
a. engineer and work practice controls.
b. review of control plan every 5 years.
c. methods of compliance for Standard Precautions.
d. guidelines for handlingwand disposal of regulated waste.
ANSWER: B

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The exposure control plan is mandated by the OSHA to protect workers against blood-
borne pathogens. This plan must be reviewed and updated annually. It must contain a det
er minationof tasks and procedures that may result in an occupational hazard, a plan to inv
esti gate all exposure incidents, and a plan to prevent these from reoccurring, methods of c
ompl iance for Standard Precautions, engineering and work practice controls, personal prot
ective equipment (PPE), guidelines for ensuring that the work site is maintained in a clean
and san itary manner,guidelines for handling and disposal of regulated waste, and a trainin
g progra m for all employees (OSHA Bloodborne Standards).

OBJ: Level 1: Recall

36. Universal/Standard Precautions require that

a. only some body fluids be considered infectious and capable of transmittin
gdisease.
b. body fluids with visible blood be treated as noninfectious.
c. blood and body fluids from all patients be considered infectious and capable
oftransmitting disease.
d. urine and feces be considered noninfectious.
ANSWER: C
Anything that comes from a patient is capable of transmitting disease. Blood and all body
fluids, including secretions and excretions, except sweat, regardless of whether visible blo
o dis present, are considered infectious.

OBJ: Level 1: Recall

37. Engineering controls and work practice controls to ensure Standard Precautions are followe
dinclude all the following, except
a. eyewash stations.
b. the use of safety needles.
c. plastic shield barriers.
d. fire blankets.
ANSWER: D
The OSHA defines engineering controls as controls that isolate or remove the hazard from t
heworkplace. Some examples of engineering controls are the use of closed tube sampling b
y laboratory equipment, the use of safety needles and single-
use holders, eyewash stations, emergencywshowers, and plastic shield barriers. Ideally labora
tories should have negative air pressure, access to the laboratory should be limited, and ther
e should be a plan to prevent insect infestation.

OBJ: Level 1: Recall

38. Standard Precautions do not address which of the following?

a. Handwashing
b. Gloves
c. Laboratory coats
d. Respirators
ANSWER: D

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Respirators are not included in the items addressed by Standard Precautions because they
a reused in a biosafety level 3 (BSL-
3) laboratory. To ensure the guidelines required in StandardPrecautions are followed withi
n the laboratory, engineering controls and work practice controls are instituted, and empl
oy ers must provide PPE.

OBJ: Level 1: Recall

39. Safety program and work practice controls consist of all of the following, except
a. ensuring written procedures are in place forwa task.
b. altering the manner in which a task is performed to reduce exposure to infectio
usagents.
c. allowing workers to eat at the bench if it gets busy and they do not have time
totake a lunch break.
d. reviewing the procedure manual annually.
ANSWER: C
Safety programs and work practice controls consist of altering the mannerw in which a task
i s performed to reduce the likelihood of exposure to infectious agents. This is accomplishe
d by no mouth pipetting; no eating, drinking, or applying cosmetics in the laboratory; disinf
ec ting workstations at the end of each shift and after any spill of infectious material; no rec
ap ping orbreaking of contaminated needles; disposal of needles in an appropriate puncture-
resistant container; performing procedures in a manner to minimize splashing and the gener
ation of airdroplets; placing specimens forwtransport in well-
constructed containers with secure lids to prevent leakage of infectious materials; and freq
u ent handwashing.

OBJ: Level 1: Recall

40. All of the following are examples of PPE, except
a. gloves.
b. laboratory coats.
c. safety glasses.
d. prescription glasses.
ANSWER: D
PPE must be protective and appropriate. Blood and body fluids must not be able to penetr
a tethe PPE material. Prescription glasses are not considered PPE because splashes of blo
od andbody fluids can get to the eye by coming in around the sides, top, and bottom of th
e gl asses. Safety glasses form a barrierwwhere body fluids cannot come in around the sid
es, to p, or bottom.

OBJ: Level 1: Recall

41. Technicians are doingwthe morning chemistry run. Once they load the specimens onto the i
nstrument, they remove theirwgloves to do paperwork in a clean area of the laboratory. Wh
atshould the technicians do afterwremoving their gloves?
a. Reposition the tubes in the racks.
b. Take a break and eat a snack.
c. Call any critical values.
d. Wash their hands.
ANSWER: D
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As soon as the gloves come off, the technicians must wash theirwhands to ensure that all p
otential pathogens are removed before the technicians touch inanimate objects in the cle a
narea of the laboratory.

OBJ: Level 3: Synthesis

42. The biosafety levels were categorized using all the following criteria, except
a. the bacterial load necessarywto cause infection.
b. the organism’s ability to cause serious illness.
c. the organism’s mode of transmission.
d. whetherwthere is treatment available for an infection.
ANSWER: A
Bacterial load was not a criterion. The fourwbiosafety levels were derived from categories
ofetiologic agents. These categories include the organism’s ability to cause serious illness
, theorganism’s mode of transmission, whether there is treatment available for infection, a
nd whether there are any preventive measures such as vaccines.

OBJ: Level 1: Recall

43. A biosafety level 1 (BSL-1) level of containment is used for organisms that
a. cause 90% mortality of infected people.
b. are well classified and not known to cause disease in healthy people.
c. cause 90% morbidity of infected people.
d. can be transmitted through aerosols.
ANSWER: B
This is the lowest level of biosafety. These organisms pose a minimal threat to laboratorype
rsonnel and the environment. Laboratory work can be conducted on open bench tops. Emp
l oyees should be trained in laboratory procedures and supervised by a scientist with trainin
g in microbiology.

OBJ: Level 1: Recall

44. A biosafety level 2 (BSL-2) level of containment is used for organisms that
a. can cause a catastrophe if released.
b. usually cause 90% mortality in the population.
c. create a moderate potential hazard for employees and the environment.
d. do not cause significant harm to employees and the environment.
ANSWER: C
These organisms pose a moderate hazard. Guidelines for laboratories that handle these agen
tsinclude having a biosafety cabinet, limiting access to the laboratory when cultures are o
ut
, having employees receive immunizations for contact with possible pathogens, having an
up-to-
date biosafety manual, wearing PPE, and restricting use of sharp items to times when noalte
rnative equipment can be used.

OBJ: Level 1: Recall

45. Because biosafety level 3 (BSL-

3) organisms have the potential for aerosol transmission, anddiseases with these agents ma
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y have serious lethal consequences, all of the following guidelines apply to BSL-
3 laboratories, except:

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a. BSL-
3 laboratories should be separated from other parts of the building by anant e
room.
b. BSL-
3 laboratories should have restricted access with documentation of personnelente r
ing and exiting the laboratory.
c. BSL-
3 laboratories should have solid ceiling and floor seams, and any seams mustbe se
aled.
d. BSL-3 laboratories should have positive air pressure.
ANSWER: D
BSL-3 laboratories must follow BSL-
2 safety guidelines and must also have a class II orw III biological safety cabinet; must ens
ur e that employees wearwappropriate PPE; shouldwbe separated from the other parts of the b
uil ding by an anteroom; should have negative air pressure and the air from inside the labora
tor y should be directed outside without recirculation; should have ceilings and floors that a
re s olid and any seams sealed; and must beconstructed so that all parts of the laboratory ca
n be easily cleaned and disinfected. BSL-4 laboratories should have restricted access.

OBJ: Level 1: Recall

46. Biosafety level 4 (BSL-

4) organisms are dangerous, exotic, and pose an increased risk ofaerosol-
transmitted infections and life-
threatening disease. Two examples of BSL- 4 organisms are
a. Marburg and Congo-Crimean hemorrhagic fever.
b. St. Louis encephalitis virus and Coccidioides immitis.
c. Mycobacterium tuberculosis and Ebola virus.
d. Francisella tularensis and Ebola virus.
ANSWER: A
The only two BSL-4 organisms listed are Marburg and Congo-
Crimean hemorrhagic fever. St.Louis encephalitis virus, M. tuberculosis, and F. tularensis a
re all BSL-3 organisms.

OBJ: Level 1: Recall

47. OSHA requires laboratories to have this document to ensure that laboratory personnel have
athorough working knowledge of the hazards of the chemicals with which they work.
a. Chemical control plan
b. Standard operating procedures
c. Chemical hygiene plan
d. OSHA compliance plan
ANSWER: C
OSHA regulations require that employees compile a chemical hygiene plan that details th
ehazards of the chemicals used in the workplace. This plan must also contain a provision
forhazardous communication training.

OBJ: Level 1: Recall

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48. A Material Safety Data Sheet (MSDS) contains all the following information, except
a. The nature of a chemical (flammable, toxic, carcinogenic)
b. General characteristics
c. Precautions when using a chemical

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d. Classification of a chemical (acid, base, protein)
ANSWER: D
MSDSs document the nature of a chemical (flammable, toxic, carcinogenic), general chara
cteristics, precautions to take in using a chemical, emergency information, spill cleanuppr
o cedure, and disposal recommendations.

OBJ: Level 1: Recall

49. If a laboratory uses hazardous chemicals, it must

a. keep a chemical inventory and MSDSs on hand.
b. keep chemicals in a special corrosive cabinet.
c. keep chemicals in a special locking cabinet.
d. post chemical names and locations on the door of the laboratory.
ANSWER: A
A laboratory must maintain a current inventory of hazardous chemicals, and the MSDSs f
orthose particular chemicals according to 29 CFR Part 1910, Subpart 2, Toxic and Hazar d
ousSubstances (OSHA).

OBJ: Level 1: Recall

50. Laboratory safety for hazardous chemicals includes

a. restricting use of these chemicals to specific individuals.
b. using fume hoods to prevent inhalation of fumes.
c. locking chemicals in one specific “corrosives” cabinet.
d. providing biohazard training to affected individuals.
ANSWER: B
Laboratory safety for hazardous chemicals includes using fume hoods to prevent inhalatio
n offumes, personal protective devices (fume masks, gloves, aprons, and eyewear), acid an
d f lammable spill kits, and warning signs in appropriate places announcing the hazardous
che mical.

OBJ: Level 1: Recall

51. Most institutions use the RACE acronym to respond to a fire emergency. RACE stands for
a. race, alert, cite, evacuate.
b. run, avoid, call, emergency.
c. rescue, alarm, contain, extinguish.
d. retrieve, announce, close, exit.
ANSWER: C
RACE stands for rescue (remove anyone who is in danger), alarm (know where the nearest f
ire pull box orwalarm station is located and know the numberwto call to report the fire), cont a
in(close doors to contain fire and smoke), and extinguish (use the properly rated fire exting
uisher on small fires).

OBJ: Level 1: Recall

52. The best way to care for your back is to prevent back injuries. All of the followingware so
meways to prevent back injuries, except

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a. carefully lifting heavy objects overhead.
b. using good posture.
c. using the legs to lift, not the back.
d. asking for assistance when a load is too heavy.
ANSWER: A
Carrying heavy trays of culture plates, lifting heavy loads in and out of autoclaves, and sitti
ngor standing improperly can all contribute to back stress injuries. Using good posture, usin
g thelegs to lift (not the back), asking for assistance when a load is too heavy, and staying
p hysically fit all help prevent back injuries.

OBJ: Level 1: Recall

53. Three levels of laboratories outlined in the Laboratory Response Network (LRN) include a
llthe following, except
a. sentinel.
b. reference.
c. first responder.
d. national responder.
ANSWER: C
The CDC developed the LRN in 1999 so that laboratories could respond quickly and effecti
vely to a bioterrorism event. The three levels of laboratories contained in this documentincl
ude sentinel, reference, and national responder.

OBJ: Level 1: Recall

54. In the LRN program, hospital based microbiology laboratories are classified as this type
oflaboratory.
a. Reference
b. National
c. Primary
d. Sentinel
ANSWER: D
There are only 100 reference laboratories in the United States and two national laboratori
es(CDC and the SAMRIID). The remaining hospital laboratories are designated as senti
n el laboratories.

OBJ: Level 1: Recall

55. Category A bioterrorism agents

a. pose the highest threat because they are easily transmitted and highly infectious.
b. have moderate morbidity and low mortality and are not easily transmitted.
c. are emerging pathogens.
d. are enteric pathogens.
ANSWER: A
Category B bioterrorism agents have moderate morbidity and low mortality and are not easi
lytransmitted. Category C bioterrorism agents are emerging pathogens. Enteric pathogens a
re usually considered gram-negative rods.

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OBJ: Level 1: Recall

56. Once bioterrorism is suspected, a sentinel laboratory should perform all culture manipulatio
nusing these safety guidelines.
a. BSL-2
b. BSL-3
c. BSL-4
d. BSL-1
ANSWER: B
All manipulations should be handled using BSL-
3 guidelines, and all work should be done ina class II or III biological safety cabinet. As s
oon as possible after a sample has been identified as a potential bioterrorism agent, it shou
l d be referred to the appropriate LRN Reference laboratory.

OBJ: Level 1: Recall

.
.

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Chapter 05: Performance Improvement in the Microbiology Laborator yMa

hon: Textbook of Diagnostic Microbiology, 7th Edition

MULTIPLE CHOICE

1. Quality control is designed to

a. ensure the medical reliability of laboratory data.
b. check media
c. check reagents
d. monitor incubator and refrigerator temperatures

ANSWER: A
Checking media, checking reagents, and monitoring incubator and refrigerator temperature
sare all included in quality control. Each of these choices represents only a part of quality
control, whereas the first choice encompasses all the activities one would do in a quality c
ontrol program.

OBJ: Level 1: Recall

2. Actual laboratory testing is called a(n)

a. preanalytic activity.
b. analytic activity.
c. postanalytic activity.
d. research activity.
ANSWER: B
The analytic activity is the actual running of the laboratory test. Preanalytic activity is what
happens before a laboratory test is run. Postanalytic activity is what happens after a laborato
r ytest is run. Research is a term that applies to a series of focused experiments conducted t
o t esta hypothesis.

OBJ: Level 1: Recall

3. All of the following activities will directly affect the quality of a laboratory test, except
a. preanalytic.
b. analytic.
c. accreditation.
d. postanalytic.
ANSWER: C
Accreditation is a peerwreview of the policies and procedures of a laboratory that may indir
ectly affect the quality of a laboratory test. Laboratory professionals have found that thepre
analytic, analytic, and postanalytic activities directly affect the quality of a laboratory test.

OBJ: Level 1: Recall

4. In January 2004, The Joint Commission (TJC) implemented performance measurements f

ororganizational systems that are critical to patient safety, quality of care, treatment, and
services. This new initiative is called
a. performance improvement.

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b. quality control.
c. quality assurance.
d. shared visions new pathway.
ANSWER: D
The new TJC initiative, shared visionsnew pathway, focuses on performance measureme
ntof organizational systems that are critical to patient safety, quality of care, treatment, a
n d services. Quality control consists of processes pertaining to the quality of analytic test
in g.
Performance improvement is a process that consists of setting performance standards, meas
uring the standards against some criteria, then improving processes that fall short of the sta
ndards. Quality assurance is a comprehensive system that takes the preanalytic, analytic, a
n d postanalytic processes into consideration when determining the quality of laboratory d
ata.

OBJ: Level 1: Recall

5. All of the following activities are included in a laboratory quality control program, except
a. airwquality.
b. temperatures.
c. media.
d. antimicrobial susceptibility testing.
ANSWER: A
The airwquality in a laboratory is not routinely tested. A quality control program focuses o
n procedures, equipment, and policies that affect how well laboratory tests are performe
d, thequality of submitted specimens, and test results.

OBJ: Level 1: Recall

6. The morning technician arrives at the microbiology laboratory and goes around checkin
gdaily temperatures. This person will check temperatures daily on all of the following
equipment, except
a. centrifuges.
b. incubators.
c. heating blocks.
d. refrigerators.
ANSWER: A
A centrifuge is not typically a temperature-dependent piece of equipment.

OBJ: Level 2: Interpretation

7. Thermometers used in the laboratory must be calibrated before they are put into use. This
isaccomplished by
a. sending to the National Institute of Standards and Technology (NIST) to determi
neits accuracy.
b. checking against an NIST thermometer.
c. measuring the grades to make sure they are the standard size and accurate.
d. using a colored dye.
ANSWER: B
A thermometer calibration is conducted by comparing the NIST thermometer reading to t
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helaboratory thermometer’s reading. Any variation is noted on the certificate of calibrati
o n.

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OBJ: Level 1: Recall

8. Preventive maintenance on an instrument includes all the following, except

a. disinfecting the surface of the instrument.
b. oiling and cleaning the instrument.
c. replacing filters.
d. recalibrating instruments.

ANSWER: A
Disinfecting the surface of an instrument is usually done as a daily activity and is generally
not considered preventive maintenance. All the other choices are preventive maintenance a
ctivities that will keep an instrument in top shape and functioning at the proper level so as
t oincrease its lifetime and keep it producing quality results.

OBJ: Level 1: Recall

9. Commercial media must have quality control testing performed by the manufacturer. Becau
seof high failure rates, all of the following media must be retested by the hospital laborator
y, except
a. Campylobacter media.
b. selective media for pathogenic Neisseria.
c. trypticase soy agar with 5% sheep blood.
d. chocolate.
ANSWER: C
Trypticase soy agar with 5% sheep blood does not have a high failure rate, so the hospi
tallaboratory need not retest it.
OBJ: Level 1: Recall

10. Media that do not need to be retested by the hospital laboratory must still undergo observati
onforwall of the following, except
a. moisture.
b. sterility.
c. breakage.
d. organism colony characteristics.
ANSWER: D
When a laboratory is not required to retest prepared media, it still must observe media forw
moisture, sterility, breakage, and appearance. Results of media observation must be record
e dand must include lot numbers.

OBJ: Level 1: Recall

11. When a medium needs to be quality controlled because it was prepared in house or because
itis complex, all the following rules must be followed, except:
a. Only media not specified in Clinical and Laboratory Standards Institute (CLS
I)guidelines should be tested.
b. The medium should be tested for sterility and pH.
c. The organism selected for quality control testingwshould represent most fastidio
usorganisms for which the medium is designed.

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d. Testing techniques should be different for primary plating media than f
orbiochemical or subculturing media.
ANSWER: A
All in-
house media must be tested for pH, sterility, and positive and negative reacting organisms
—
that is, if a medium should inhibit a specific organism or group of organisms, it should be
tested with those organisms to ensure it “works.” CLSI guidelines give specific guidance a
s to what type of quality control testing should be performed on media prepared inhouse.

OBJ: Level 1: Recall

12. Reagents that should undergo quality control in the microbiology laboratory include all t
hefollowing, except
a. Optochin.
b. immersion oil.
c. -lactamase.
d. nitrate.
ANSWER: B
Immersion oil does not need quality control testing. All stains performed in a microbiology
l aboratory alongwwith Optochin, -
lactamase, nitrate, bacitracin, catalase, coagulation, gelatin,germ tube, hippurate, Kovac’s, o
xidase, PYR, typing sera, Voges-
Proskauer, and X & V stripsshould undergo quality control testing in a microbiology labora
t ory.

OBJ: Level 1: Recall

13. In any susceptibility system, variables that can affect the results include the following:
1. Antibiotic potency
2. Inoculum concentration
3. Bactericidal level
4. pH
5. Anion content
a. 1, 2, and 3 are correct
b. 1, 3, 4, and 5 are correct
c. 1, 2, 3, 4, and 5 are correct
d. 1, 2, and 4 are correct
ANSWER: D
The factors affecting results include antibiotic potency, inoculum, concentration, and pH. T
hebactericidal level of antibiotic and anion content does not affect susceptibility results. Ot
her factors affecting results include agar depth, evaporation, cation content, thymidine conte
nt, instrument failure, temperature, moisture, and difficulty in determining endpoints.

OBJ: Level 2: Interpretation

14. Susceptibility testing of control organisms is usually conducted daily until precision can be
demonstrated with or
days of susceptibility testing using CLSI guidelines.
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a. 20; 30; consecutive
b. 15; 20; consecutive
c. 30; 40; nonconsecutive

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d. 5; 10; consistent
ANSWER: A
Once the 20- or 30-
day evaluation has been accomplished, quality control organisms maywbetested weekly inst
ead of daily. All results should be kept as long as the antimicrobial agent isused or at lea
st 2 years afterwdiscontinuing the agent.

OBJ: Level 1: Recall

15. How can personnel competency be determined?

a. Asking an employee to explain how to do a test
b. Proficiency testing
c. Asking another employee to comment on someone’s competency
d. Assuming competency from one’s credentials
ANSWER: B
Proficiency testing consists of carefully designing samples and giving them to technicians as
unknowns for the purpose of identifying them. This will show how competent a technicia
n is at performing job tasks. Asking an employee how to do a test is not the same as having
s omeone perform the test. Performing a test involves motorwskills and coordination that can
no tbe measured by asking a person how a test is performed.

OBJ: Level 1: Recall

16. The following are provisions of CLIA 88, except:

a. Verify employee competency upon employment.
b. Determine an employee’s competency.
c. Reverify the employee’s competency monthly
d. Reverify the employee’s competency annually.
ANSWER: C
To maintain quality in the laboratory, CLIA 88 mandated that an employee’s competency m
ust be verified upon employment, an employer must determine an employee’s competency,
and the employee’s competency must be reverified annually. It did not mandate reverifying
anemployee’s competency monthly because this would be an impossible task—
the time frame istoo short.

OBJ: Level 1: Recall

17. Quality control stock cultures are available from all of the following, except
a. American Type Culture Collection (ATCC).
b. commercial sources.
c. proficiency testing isolates.
d. Centers for Disease Control and Prevention (CDC).

ANSWER: D
CDC is a clearinghouse for knowledge concerning infectious diseases, but CDC does n ot
provide stock cultures to hospital laboratories.

OBJ: Level 1: Recall

18. Popular media choices for maintaining stock cultures include

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a. Tryptic soy agar deeps.
b. cornmeal.
c. Sabouraud dextrose.
d. Cystine tryptic agar with glucose.
ANSWER: A
TSA deeps is the only choice that is sugar-
free. Forwbest results, a stock culture should be grown in a large volume of broth, then divid
ed among enough small freezerwvials to last a year. Media selection for freezing is at the di
s cretion of the individual laboratory, but it shouldnot contain sugars. If organisms use sugar
s while being maintained, acid by-
products could kill the organism overwtime. CTA, Sabouraud dextrose, and cornmeal all hav
e sugar.

OBJ: Level 1: Recall

19. Which of the following is an example of a mission statement for an institution?

a. “The AFMS Flagship—Comprehensive Healthcare…On Time…On Target”
b. “Working Together for a Healthy America”
c. “Your Total eLearning Solution”
d. “Will AnswerwQuestions Correctly 95% of the Time”
ANSWER: B
An organization’s vision and mission statements must be clearly emphasized so that all em
ployees become involved and understand that each one of them has a role in the mission, a
nd that they must strive to make performance improvement part of their everyday life to ac
hieve the organization’s mission. The first and third choices are vision statements, whereast
he last choice is an objective.

OBJ: Level 2: Interpretation

20. All the following are components of TJC recommendations for establishing performan
cemonitors, except
a. plan.
b. design.
c. do.
d. assess.
ANSWER: C
The components of the recommendations are plan, design, measure, and assess.

OBJ: Level 1: Recall

21. Customers of a laboratory include all the following, except

a. patients.
b. insurers.
c. doctors.
d. accrediting organizations.
ANSWER: D
Anyone who looks to the laboratory forwservice is a customer. Accrediting organizations a
renot expecting services from a laboratory, so they cannot be considered a customer. Doc
t ors,nurses, insurers, and patients are all customers.
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OBJ: Level 1: Recall

22. Multiple unlabeled specimen have been sent to the laboratory from multiple in-
patient locations. The laboratory manager decides corrective action needs to occur. What s
hould beconstructed to evaluate and correct the problem?
a. Find fault with the nurse causing the problem.
b. Provide training for the nurse responsible for the problem.
c. Empower a facilitator.
d. Make a cross-functional team.
ANSWER: D
When patient outcome is less than desirable, the process must be evaluated and corrected. T
hefocus is on the process, not the individual. The primary rule to follow is to refrain from fi
ngerpointingwor fault finding. Preanalytic and postanalytic activities usually take place outsi
de the laboratory and require a cross-functional team to evaluate and correct the problem.

OBJ: Level 3: Synthesis

23. When is a broken process fixed?

a. When the problem is prevented from happening again.
b. When everyone is happy with the process.
c. When the process becomes seamless.
d. When the hospital administrator determines that the cross-
functional team is nolonger needed.
ANSWER: A
A process is fixed only when the problem is prevented from happening again. It is not fixed
just because the reason something went wrong is explained

OBJ: Level 1: Recall

24. What is benchmarking?

a. Identifying a problem to be fixed
b. Seeking an industry’s or profession’s best practices to imitate and improve
c. Explaining why a problem occurred
d. Asking the CEO’s opinion and going with his orwher idea
ANSWER: B
Benchmarking is seeking an industry’s or profession’s best practice to imitate and improve
. Benchmarking was initially practiced in business and industry, but it has now become an
i mportant part of the hospital quality management program.

OBJ: Level 1: Recall

25. When performing tests in the microbiology laboratory, the detection limit of a test refers
tothe of that test.
a. analytic specificity
b. analytic sensitivity
c. clinical sensitivity
d. clinical specificity .
.
ANSWER: B
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The analytic sensitivity of a test refers to its ability to detect a particularwanalyte or a small
c hange in its concentration. Analytic sensitivity is usually defined as the 0.95 confidence le
ve l(±2 SD) and may be referred to as the detection limit. Analytic specificity is a test’s abil
ity notto react with substances other than the one of interest. Clinical sensitivity is the propo
rtio n of specimens that test positive from people who are known to have the disease. Clini
cal sp ecificity is the population of specimens that test negative from those known to be dis
ease fre e.

OBJ: Level 1: Recall

26. A technician is performing a chemistry test on a control sample. The technician gets the
following values for the control: 4.3, 4.3, 4.3, 4.2, 4.4, 4.3, 4.2, and 4.4. The actual value
is
4.3. These results are said to be
a. systematically inaccurate.
b. sensitive.
c. accurate.
d. bias.
ANSWER: C
The degree of conformity of a measurement to a standard or true value is accuracy. Bias is t
hemean difference of test results from an accepted reference method caused by systematic
e rrors.

OBJ: Level 3: Synthesis

27. A test is performed on a group of 10 patients. Six patients have a disease, and four are free of
the disease. If six patients (all known to have the disease) of this group test positive for t h
edisease, we say that the clinical sensitivity of this test is
a. 60%.
b. 40%.
c. 50%.
d. 100%.

ANSWER: D
Clinical sensitivity is the proportion of positive test results obtained when a test is applied
t o patients known to have the disease. Thus, it is the frequency of positive test results in pa
ti entswith the disease. If six patients in our group are known to have the disease and all six
t est positive, then the clinical sensitivity of the test is 100%.

OBJ: Level 3: Synthesis

28. A group of 10 patients are to be tested: six are known to have a disease and four are disea
sefree. If the four disease-
free patients tested negative for this disease, what would the clinicalspecificity of this test
be?
a. 100%
b. 60%
c. 40%
d. 50%
ANSWER:D A

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Clinical specificity is the proportion of negative results obtained when a test is applied to
patients known to be free of disease. Thus it is the frequency of negative test results in p
atients without the disease. So if there are four patients in this group and they all test neg
ative with this test, then the clinical specificity is 100%—
all negative individuals testednegative with this test.

OBJ: Level 3: Synthesis

29. Incidence is
a. the frequency of a disease at a designated single point in time in the populati
onbeing tested.
b. the number of new cases of disease over a period of time.
c. proportion of negative test results in a population known to be free of disease.
d. positive results in patients with the disease.
ANSWER: B
Incidence is defined as the number of new cases of disease over a period of time. Prevalen
c e is the frequency of a disease at a designated single point in time in the population being
te sted.Clinical specificity is the proportion of negative test results in a population known t
o b e free of the disease. Clinical sensitivity is the positive results in patients with the disea
se.

OBJ: Level 1: Recall

30. A test can have both a positive and a negative predictive value (NPV). All the followi
ngelements are needed to compute the positive and NPV of a test, except
a. sensitivity of a test.
b. specificity of a test.
c. type of disease being tested.
d. prevalence of the disease being tested.
ANSWER: C
The predictive value of a test is the probability that a positive result (positive predictive valu
e,PPV) accurately indicates the presence of an analyte or a specific disease. The formula is

where PPV = positive predictive valu

eP = prevalence of disease being test
edSe = sensitivitywof test
Sp = specificity of test

OBJ: Level 1: Recall

31. Assume that a certain test forwgroup A Streptococcus has reported sensitivity and specificity
of90% and 98%, respectively, and the estimated prevalence forwgroup A Streptococcus infec
tionin acute pharyngitis is 5%. What is the PPV of this test?
a. 99.5%
b. 30%
c. 90%
d. 70.3%
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ANSWER: D

PPV = positive predictive value

P = prevalence of disease being teste d
Se = sensitivity of test
Sp = specificity of test

OBJ: Level 3: Synthesis

32. Usually, negative test results are more reliable in predicting

a. the absence of disease.
b. the presence of disease.
c. the sensitivitywof a test.
d. the specificity of a test.
ANSWER: A
Usually, with tests, the NPV is higher than the PPV. This shows that tests can more accurate
lypredict the absence of disease. The sensitivity and specificity of a test do not predict the p
resence orwabsence of a disease.

OBJ: Level 1: Recall

33. The efficiency of a test indicates

a. the percentage of patients who test positive forwthe disease.
b. the percentage of patients who are correctly identified as having or not havi
ngthe disease.
c. the percentage of patients who test negative for the disease.
d. the number of patients tested for a disease.
ANSWER: B
Test efficiency =
TP = number of patients with true-
positive TN = number of patients with true
-
negativeFP = number of patients with false
-
positive FN = number of patients with false
-negative

OBJ: Level 1: Recall

34. Screening is
a. used for only particular test analytes.
b. not practical in a hospital laboratory.
c. used for testing large populations of patients.
d. when a high incidence of a disease is found in a population.
ANSWER: C
Screening is used for testingwlarge populations of patients. Generally, screening tests ha
vehigh clinical sensitivity and NPV. Positive results with such tests generally require c
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onfirmation with a more specific test.

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OBJ: Level 1: Recall

35. Confirmation is used after

a. careful consideration by the doctor to do the test.
b. a test that has a low predictive value.
c. a test that has a low specificity.
d. obtaining a positive screening result.
ANSWER: D
Confirmation is the process of repeating a screening test using a test that is more sensitive a
ndspecific to ensure accuracy forwthe initial screening result. Confirmatory tests help seek o
ut false-positive screening tests.

OBJ: Level 1: Recall

36. When choosing a test to perform in your laboratory, an in-

house verification is alwaysperformed. Verification of a tes
t
a. serves to establish that the performance parameters of the test are satisfactory.
b. lets technicians actually perform the test.
c. lets physicians perform the test.
d. allows laboratory management to view positive results.
ANSWER: A
A test must be verified by a laboratory to ensure that it will work as described on the packa
ge.A test must perform up to specifications in a laboratory or it is not worth using. Althou
g h having technicians perform the test in-
house shortens the turnaround time for results, the test is evaluated for its performance. Phy
sicians are not allowed to perform tests in a clinical laboratory. Laboratory management do
es not need to see positive test results. Laboratory management will evaluate the test on its
in-house performance.

OBJ: Level 1: Recall

37. Test validation is the ongoing process of providing information that a test is performi
ngcorrectly. The components of validation include all the following, except
a. quality control.
b. specimen requirements.
c. proficiency testing.
d. instrument calibration.
ANSWER: B
Specimen requirements do not assess the functioning of a test. Quality control, proficien c
ytesting, and instrument calibration evaluate test functioning on a continual basis.

OBJ: Level 1: Recall

38. All of the following provide guidelines to ensure the continual correct performance of tests,
except
a. accrediting agencies.
b. regulatory agencies.
c. CDC.
d. manufacturers.
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ANSWER: C
CDC does not publish recommendations in regard to continual test validation. CDC is acle
aringhouse for infectious disease knowledge.

OBJ: Level 1: Recall

.
.

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Chapter 06: Specimen Collection and Processing

Mahon: Textbook of Diagnostic Microbiology, 7th Edition

MULTIPLE CHOICE

1. Data generated by the laboratory is directly influenced by

a. the quality of the specimen and its condition when received.
b. the physician’s decision to do the test.
c. quality control performed on a monthly basis.
d. the air quality in the laboratory.

ANSWER: A
The old adage of garbagewin–garbage out applies here. High-
quality specimens result in high-
quality laboratory results. Even though the laboratory professional does not usually perfor
m the preanalytic process of collecting microbiology specimens, it directly affects theout
c ome.

OBJ: Level 1: Recall

2. To assist hospital personnel in collecting the highest quality specimen, the laboratory should
a. post the microbiology laboratory’s phone numbers in each section so personnel ca
ncall with questions and problems.
b. develop a well-written handbook and make it available at every patient care unit.
c. allow personnel to go to the floor and collect all specimens.
d. severely reprimand staff for not collecting specimens properly.
ANSWER: B
The laboratory should establish policies for specimen management, and these must be distr
ibuted to all users and clients of microbiologywlaboratory services. A well-
written handbook should be available at every patient care unit specifying the policies for
specimen collection and transport, and test ordering. Training and education, such as in-
services by themicrobiology technologist, should be provided to the individuals collecting
t he specimens.

OBJ: Level 1: Recall

3. The goal of the specimen collectorwwhen collecting specimens for culture should be to
a. make sure the specimen gets to the laboratory.
b. avoid hurting the patient when collecting the specimen.
c. maintain the viability of the living organisms at the site with minim
alcontamination.
d. get the specimen quickly to get the doctor off the collector’s back.
ANSWER: C
The specimens to be analyzed in the microbiology laboratory are likely to contain living org
anisms and the goal of the specimen collector must be to maintain the viability of these org
a nisms with minimal contamination. That means the specimen needs to be delivered to thel
a boratory quicklywso that the organisms do not die, taking yourwtime when collecting the sp
ec imen to make sure you get a good one, and collectingwthe best specimen you can—
even ifit means inconveniencing the patient for just a little bit.
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OBJ: Level 1: Recall

4. All the following principles of specimen collection are fundamental to ensuring appropria
tespecimen management, except:
a. Collect the appropriate quantity of specimen.
b. Label the specimen accurately with the specific anatomic site and the patie
ntinformation.
c. Select the correct anatomic site to collect the specimen.
d. It is acceptable to delay transport of the specimen to the laboratory if it is
intransport media.
ANSWER: D
The following principles of specimen collection are fundamental to ensuring appropriate sp
ecimen management: if possible, collect the specimen in the acute phase of the infection an
d before antibiotics are administered; select the correct anatomic site to collect the specim
e n; collect the specimen using the proper technique and supplies with minimal contamina
tio n from normal flora; collect the appropriate quantity of specimen; package the specime
n in a container designed to maintain the viability of the organisms and avoid hazardsdue to
lea kage; label the specimen accurately with the specific anatomic site and the patient infor
mati on; and transport the specimen to the laboratory promptly or make provisions to store t
he s pecimen in an environment that will not degrade the suspected organism(s).

OBJ: Level 1: Recall

5. Why is it acceptable for a fecal sample to bewcollected in a nonsterile container?

a. Fecal samples can be runny and if the specimen leaks, this can present a biohazard.
b. Many types of bacteria call the intestinal tract home: the specimen cannot become
c. cLoenatkapmroi noaft ec od .n tainers are alwayswsterile, so the containerwwill bewleakproof,was w
ewll as sterile.
d. Because DNA probes can determine resident flora from pathogenic bacteria.
ANSWER: B
There are many types of bacteria in a normal, healthy colon. With so many bacteria as nor
malflora, the risk of contamination is slight with a stool specimen. Stool specimens are ev
al uatedfor specific pathogens rather than identifying all bacteria present.

OBJ: Level 2: Interpretation

6. Swabs are appropriate for specimens collected from all the following sites, except
a. upper respiratory tract.
b. external ear.
c. urine.
d. genital tract.
ANSWER: C

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In general, swabs are not recommended for urine collection because they do not provide suf
ficient quantity, are easily contaminated, and can become dried out, leading to a loss of org
anisms. Swabs are appropriate for specimens from the upper respiratory tract, external ear,e
ye, and genital tract. Swab collection systems are available that provide transport media and
protect the specimen from drying. Urine cultures are always spread on a plate using a calib r
ated loop so that the technician can estimate the number of organisms present in the urine s
pecimen.

OBJ: Level 1: Recall

7. How should specimen collection instructions be given to the patient to ensure collection of
agood specimen for culture?
a. Written only in English
b. Verbally, in many different languages
c. Verbally, only in English
d. Both verbal and written instruction in simple language
ANSWER: D
It is best to give the patient as much information as possible to collect the specimen. It is a
lways good to read the procedure to the patient and show pictures to ensure they understa
n dthe procedure. This needs to be done in more than one language, because sometimes th
e patient does not speak English well and may not understand the procedure.

OBJ: Level 1: Recall

8. Why is clean-catch midstream urine used forwa urine culture as opposed to a clean-
catchurine?
a. The first portion of the urine flow washes contaminants from the urethra and t
henext portion of urine is more representative of the bladder.
b. The name was changed, but the procedure remains the same and the entire amou
ntof urine from the bladder is cultured.
c. No urine is free from contamination, so just wipe the external genitalia and vo
idinto the cup.
d. Catheterized specimens are also called clean-catch midstream urine specimen.
ANSWER: A
Instructions for urine collection must include an explanation of the clean-
catch midstream urine specimen. A first morning specimen is preferred because it provid
e s a more concentrated sample. The patient collects this specimen following cleansing of
e xternal genitalia to reduce the presence of indigenous flora. Patients are asked to void wi
th out collecting the first portion of the urine and instead to collect the middle portion. The
fi rst portion of the urine flow washes contaminants from the urethra and the midstream p
orti on ismore representative of the bladder. Personnel collecting catheterized specimens s
houl d also use this technique to eliminate organisms carried up the urethra during cathete
rizati on.

OBJ: Level 1: Recall

9. Sputum specimens are often collected for the diagnosis of

a. acute pharyngitis.
b. bacterial pneumonia.
c. meningitis.
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d. diverticulitis.
ANSWER: B
Many types of bacterial pneumonia produce purulent material that is coughed up as sputum
. This specimen may contain the pathologic agents producing the disease. Unfortunately, lo
werrespiratory tract specimens are among the most difficult specimens to collect adequately
because they are contaminated with oropharyngeal flora.

OBJ: Level 1: Recall

10. The best way to minimize the amount of upper respiratory flora in a sputum specimen is
tofollow which of these procedures?
a. Cough up the specimen and when the specimen gets to the laboratory, digest
itwith enzymes that will kill the normal flora.
b. When plating the specimen, ensure that the swab goes deep into the sample to g
etonly bacteria present in the lowerwlung.
c. Have the patient rinse the mouth with water and expectorate with the aid of a real
lydeep cough directly into a sterile container.
d. Have a respiratory technician decontaminate a patient’s mouth and throat befo
rethe specimen is collected.
ANSWER: C
Rinsing the mouth will clean out most of the normal flora. A deep cough should gather as
m uch purulent material as possible from the lower lung area. Using enzymes to digest the s
pe cimen will kill all bacteria in it, not just the normal flora. Sometimes the sputum is so thi
ckt hat it is not possible to probe into the middle of the specimen to avoid any outerwcontam
inati ngwflora. It is not practical to have a respiratory technician disinfect a patient’s mouth a
nd th roat before collecting a sputum specimen

OBJ: Level 1: Recall

11. The specimen of choice for detecting gastrointestinal pathogens is

a. a urine specimen.
b. vomit.
c. a swab of the anal area with no feces on it.
d. a stool specimen.
ANSWER: D
A stool specimen contains samples of the gastrointestinal tract, and any pathogens that may
bethere can be passed out by the body. Urine specimens are good for diagnosing urinary tra
ct infections. Vomit is not a good specimen because most gastrointestinal infections occur i
n theintestines and vomit comes from the stomach. A swab of the anal area with no feces
on it will not reveal gastrointestinal pathogens. The most likelywisolates from a swab of thi
s typ e is skin flora.

OBJ: Level 1: Recall

12. Proper identification of each specimen includes a label firmly attached to the container wi
thall the following information, except
a. diagnosis.
b. name.

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c. identification number.
d. date.

ANSWER: A
Proper identification of each specimen includes a label firmly attached to the container with
the following information: name, identification number, room number, physician, culture si
te,date of collection, and time of collection.

OBJ: Level 1: Recall

13. To perform a quality laboratory analysis, the laboratory needs specific information regardi
n gthe patient and the specimen. What can be a critical weak link in the specimen manage
m ent process?
a. Poor specimen collection techniques
b. Incomplete information on the requisition
c. Poor-quality hospital information system
d. Poor-quality laboratory information system
ANSWER: B
To perform a quality laboratory analysis, the laboratory needs specific information regarding
the patient and the specimen. All that the laboratory knows about the patient is learned f
ro m the requisition form. The less information that is provided, the more difficult it is for th
e l aboratory to provide good patient care. Incomplete information on the requisition is often
a weak link in the specimen management process. Complete and thorough requisitions can
oft enlead the microbiology technologist to suspect certain pathogens based on the diagnosis
orwpatient history. This will allow them to use specific media orwmake certain adjustments t
o th e incubation to maximize recovery of the pathogen.

OBJ: Level 1: Recall

14. The requisition form should provide all the following information, except
a. patient name or identification number.
b. patient age and gender.
c. patient home address.
d. specific anatomic site.
ANSWER: C
Patient address is not needed on the requisition. The requisition form should contain the foll
owing information: patient name and identification number, patient age and gender, patientr
o om number or location, physician name and address, specific anatomic site, date and hour
of specimen collection, clinical diagnosis orwrelevant patient history, antimicrobial agents (if
the patient is receiving), and name of individual transcribing orders.

OBJ: Level 1: Recall

15. If a test is not considered appropriate for the specimen, the following should happen:
a. Discipline the ward clerk for ordering the wrong test.
b. Discipline the nurse for ordering the wrong test.
c. Hold a training session to teach hospital staff about correctly ordering tests.
d. The laboratory needs to communicate with the physician to determine exactly wh
atneeds to be done.

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ANSWER: D
The laboratory needs to communicate with the physician to find out what needs to be done.
Disciplining the ward clerk and the nurse is not a solution to this problem. They do not kn
owwhat are and what are not appropriate tests for each specimen. Because each situation is
different, there is no need for a staff training session.

OBJ: Level 1: Recall

16. All specimens must be transported

a. in leakproof secondary containers.
b. in syringes with needles attached.
c. in a tube of broth.
d. in a latex glove.

ANSWER: A
It is imperative that specimens collected forwmicrobiology do not pose a safety hazard to tho
sewho handle them. Leaking containers and specimens with needles attached present the gre
atest hazards. All specimens must be transported in leakproof secondary containers. A tube
o f broth and a latex glove are not leakproof secondary containers.

OBJ: Level 1: Recall

17. A safe method of transporting aspirated wound material would be in

a. a leakproof bag.
b. a tube of broth.
c. an anaerobic transport system.
d. a plastic container.
ANSWER: C
Transporting personnel should refuse to transport specimens without the protection of a sec
ondary container. Refusing to accept syringes with needles attached is also appropriate. Th
e aspirated material could also be transferred to another sterile container with a tight lid o
rt o an anaerobic transport container.

OBJ: Level 2: Interpretation

18. What is the primary goal in the transportation of specimens to the laboratory?
a. To get the specimen to the laboratory by the end of the day
b. To maintain the specimen as near its original state as possible with minim
aldeterioration
c. To place the specimen in formalin and then transport it to the laboratory
d. To allow the specimen to sit, as long as it is delivered to the laboratory within 2
to3 days after collection
ANSWER: B
The primary goal in the transportation of specimens to the laboratory is to maintain the spec
imen as near its original state as possible with minimal deterioration and to prevent risk tot
h e specimen handler. Pathogens deteriorate rapidly if there is no food or the right environm
e ntal conditions. Formalin will kill most pathogens, so you do not want to place the speci
me n in formalin. Specimens should be transported to the laboratory ideally within 30 minut
es o f collection and preferably within 2 hours.

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OBJ: Level 1: Recall

19. If transport of the specimen is delayed, the specimen can be maintained by all of t
hefollowing, except
a. preservatives.
b. transport or holding medium.
c. saltwater.
d. anticoagulants.
ANSWER: C
Pathogens should be stored according to the best conditions to keep them viable. These in
clude use of preservatives, anticoagulants, transport or holding medium, and even culture
media. Organisms that are not cold sensitive can also be placed in the refrigerator to preve
ntdegradation of the specimen.

OBJ: Level 1: Recall

20. A night technician is working in microbiology when a cerebrospinal fluid (CSF) specime
n comes in. Almost simultaneously, the technician is called to the emergency departmen
t to draw blood on seriously injured car crash victims. How would the technician store
th e CSFuntil time permits to work on the CSF specimen?
a. Put the specimen in the refrigerator where it is good for 4 hours at 4° C.
b. Leave the specimen on the shelf where it is good forw6 hours at room temperature.
c. Pourwthe specimen into a tube of broth.
d. Place the specimen in a 35° C incubator where it is good for up to 6 hours.
ANSWER: D
Because CSF specimens are usually home to fastidious pathogens, creating an environment
closest to that in the body will preserve the organisms the longest. So placing the specime
n ina 35° C incubator for 6 hours will allow for maximum organism recovery. Leaving the
tu be ina refrigerator orwat room temperature will cause the fragile organisms to die. CSF is
al ways cultured according to protocol, and the entire specimen is never poured into a tube
of broth topreserve it.

OBJ: Level 1: Recall

21. Two types of specimens can use preservatives to maintain them until they can be delivered
tothe laboratory. They are
a. urine, stool.
b. urine, vaginal secretions.
c. stool, throat cultures.
d. pus from a wound, vaginal secretions.
ANSWER: A
The preservatives are designed to maintain the bacterial population in the urine at room te
mperature for 24 hours and thus are useful for collection of urine specimens at distant loc
ations. Stool specimens for bacterial culture and ova and parasites can be added to a vialc
ontaining preservatives to maintain the organisms until they can be transported to the labo
ratory. Vaginal secretions, throat cultures, and pus from a wound can be placed in a vialc
o ntainingwtransport media to maintain the viability of the organisms.

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OBJ: Level 1: Recall

22. Specimens such as blood, bone marrow, and synovium are mixed with anticoagulants rig
htafterwcollection. Why should this occur?
a. Anticoagulants often dissolve part of the bacteria’s cell wall and congeal ma
nybacteria into groups.
b. Organisms become bound up in the clotted material and are difficult to isolate.
c. It ensures the specimen will work when using an automated spreader device.
d. It kills off the normal flora and only leaves the pathogens in the specimen.
ANSWER: B
When a specimen clots, many of the pathogens are trapped inside the clotted blood. This m
akes it more difficult to determine the cause of the infection. Anticoagulants do not dissolve
bacterial cell walls, but they do have a certain degree of antimicrobial properties. Very sm
al l amounts must always be used to ensure that this compound does not kill any bacteria pr
es ent in the specimen.

OBJ: Level 1: Recall

23. The purpose of transport media is to

a. make sure the microorganisms can multiply and live as though they were still
inthe host.
b. keep the swab moist so that the microorganisms do not dry out.
c. ensure the preservation of microorganisms in the specimen.
d. take the place of plating a routine culture with the specimen.

ANSWER: C
The purpose of transport media is to maintain the viability of the bacteria in the specimen.
These materials do not want to promote multiplication because the metabolic by-
products (i.e., acids) may build up and kill the bacteria. These media do keep the swab moi
s t, but this isnot theirw purpose. Also, the use of transport media is to do just that—
ensure viable organisms during transport. They will neverwtake the place of a routine culture
.

OBJ: Level 1: Recall

24. In certain instances, it is desirable for specimens to be inoculated directly onto culture medi
a.Specimens for this pathogen can be placed onto a commercial transport system called a J
a mes
E. Martin Biological Environmental Chamber (JEMBEC) system. What pathogen is this?
a. Bordetella pertussis
b. Clostridium difficile
c. Francisella tularensis
d. Neisseria gonorrhoeae
ANSWER: D

.
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.

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The JEMBEC system was developed specifically for transporting culture media inoculated
with specimens for N. gonorrhoeae (GC) cultures. This method of transport increases the yi
eld of organisms recovered from cultures. This system consists of a media selective for Nei
s seria spp., a Ziploc plastic bag, and a tablet. The tablet is added to the proper spot, a coup
le of drops of waterw are added to the table, and then the cover is placed on the media. Th
eenti re plate is inserted into the plastic bag and sealed so that an atmosphere high in carbon
diox ide can be generated.

OBJ: Level 1: Recall

25. The shipment of clinical specimens and cultures of microorganisms is governed by a compl
exset of national and international guidelines issued by
a. The Department of Transportation (DOT) and the U.S. Postal Service.
b. The Department of Agriculture and the United Parcel Service.
c. The Department of Energy and Federal Express.
d. The Department of Defense and Homeland Security.
ANSWER: A
The DOT prescribes regulations for the safe transportation of hazardous material in commer
ceto ensure public safety and minimize risks in transportation. The regulations specify the w
ay potentially infectious substances must be packaged to prevent leaks orw spills, and how
th e packages must be labeled to caution handlers and otherwparties about theirwhazardous co
nte nt. The U.S. Postal Service reinforces these transportation regulations.

OBJ: Level 1: Recall

26. How does the DOT define an infectious substance?
27. 27.
a. Any substance capable of transmitting disease
b. A material known to contain or is suspected of containing a pathogen that caus
esdisease in humans or animals
c. Any substance that can cause disease in animals
d. A bacterium, virus, prion, orwvirion
ANSWER: B
The DOT defines an infectious substance as material known to contain or is suspected of c
ontainingwa pathogen that causes disease in humans or animals. An infectious substance is
assigned to a risk group with a number from 1 (low risk) to 4 (high risk). The substance
m ustbe capable of transmitting disease to human orwanimals. It can be bacterial spores tha
t ar e notconsidered a bacterium, virus, prion, or virion.

OBJ: Level 1: Recall

28. A technician receives a package from a supplier of quality control microorganisms. T

hepackage has a small watertight vial in a largerwwatertight tube. The largerwtube has
somebubble wrap around it, but the larger tube is just placed in the fiberboard box. A
ll of thefollowing was right with this packaging, except:
a. The microorganisms are placed in a small watertight vial.
b. The small vial is placed in a larger watertight tube.
c. The primary receptacle was placed into the secondary container with no absorbe
ntmaterial.
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d. The outer container is made of fiberboard.

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ANSWER: C
Patient specimens or culture isolates must be triple packaged before being shipped. The
material is placed into a primary receptacle that must be watertight. Absorbent material
i s placed around the primary receptacle and it is then placed into a secondary container
th at isalso watertight. The secondary package is sealed and placed into a sturdy outer co
nta inerwconstructed of fiberboard.

OBJ: Level 1: Recall

29. All of the four levels represent a possible scheme forwprioritizing the handling of specimens,
except
a. Level 1: critical.
b. Level 2: unprotected.
c. Level 3: quantitation required.
d. Level 4: anticoagulated.
ANSWER: D
Level 4: specimens that are arriving in transport media. Level 1: critical because the specim
ens represent a potential life-
threatening illness and are from an invasive source. Level2: unprotected; may quicklywdegra
de or have overgrowth of contaminating flora. Level 3: requires quantitation, and a delay i
n processing may adversely affect the accuracy of quantitation.

OBJ: Level 1: Recall

30. Types of specimens that can be batch processed, including all the following, except
a. specimens for fastidious organisms
b. specimens for acid-fast bacillus (AFB) cultures.
c. stool specimens for ova and parasite tests that are collected in preservatives.
d. specimens for viral culture collected in viral transport media.
ANSWER: A
Specimens for GC cultures involve a very fastidious and fragile organism—
Neisseria gonorrhoeae—
and these cultures must be processed immediately so as to preserve the bacteria prese
n t in the specimen. All other specimens mentioned can be batch processed.

OBJ: Level 1: Recall

31. All of the following are examples of suboptimal specimens that must be rejected, except:
a. The information on the requisition does not match the information on the specim
enlabel.
b. The specimen is for a Neisseria gonorrhoeae (GC) culture and submitted in
aJEMBEC system.
c. The specimen container is leaking when received in the laboratory.
d. The specimen is received in a fixative solution such as formalin.
ANSWER: B
The specimen forwa GC culture that is submitted in a JEMBEC system is the correct way
tosubmit that specimen for culture. The rest options are grounds for rejecting the specim
en.

OBJ: Level 2: Interpretation

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