Morulae (intracellular inclusions in leukocytes) are characteristic of which of the following diseases?
(A) Malaria caused by Plasmodium falciparum infection but not Plasmodium malariae infection
Which of the following statements about epidemic typhus (Rickettsia prowazekii disease) is most correct?
(A) The disease occurs primarily in sub-Saharan Africa.
(B) It is transmitted by ticks.
(C) Mice are the reservoir.
(D) Historically, the disease occurs in times of prosperity.
(E) Recrudescence can occur many years after the initial infection.
The most useful drug to treat ehrlichiosis is
A disease characterized by malaise, headache, rigors, and fever developed in members of several families living in an unheated war-damaged house in an Eastern European country. Erythematous 2–6 mm macular red rashes appeared on the peoples’ trunks and later on their extremities. Some of the people had coughs. One elderly person, although sick, was much less sick than other adults. The people huddled together to keep warm; body lice were common. Which of the following statements is most correct?
(A) The disease that these people had is common in the Rocky Mountain states.
(B) The elderly person may have had acute epidemic typhus many years ago and recrudescent typhus now.
(C) Fleas from rodents in the house were spreading Rickettsia typhi.
(D) The primary host of the body louse infecting the people is the rat.
(E) Epidemic typhus can be prevented by a vaccine.
Which of the following statements about Ehrlichiae and ehrlichiosis is most correct?
(A) Dogs and mice are reservoirs.
(B) Mosquitoes are the vectors.
(C) Ampicillin is the treatment of choice.
(D) Culture is a good method to confirm the diagnosis.
(E) Ehrlichiae are typically found in lymphocytes.
A group of urban teenagers visited a sheep ranch in a large Western state for a 2-week experience. While they were there, many of the pregnant ewes delivered lambs to the delight of the closely observing teenagers. About 10 days later, three of the teenagers developed flulike illnesses characterized by malaise, cough, and fever. One had an infiltrate on chest radiography, indicating pneumonia. The three teenagers had different doctors, but the physicians each drew a blood specimen and submitted it to the city health department for serologic testing. All three specimens were positive for Q fever. Public health investigators determined that all of the teenagers had been to the sheep ranch. When the investigators contacted the ranch, they were told that there was no Q fever there and that no one who lived at the ranch had been sick. The most likely explanation for the teenagers’ illnesses and the lack of illness at the ranch is
(A) There was no Q fever at the ranch, and it was acquired elsewhere.
(B) The people at the ranch had been previously immunized against Q fever.
(C) The teenagers acquired Q fever at the ranch, and the people who lived there had all previously had Q fever and were now immune to it.
(D) The teenagers had other illnesses, and the positive Q fever serology result was unrelated.
(E) The public health laboratory had errors in the Q fever serologic tests.
A middle-aged sportsman, a resident of Oklahoma, took a hike through a rural wooded and brushy area near his home. The next morning, he noticed and removed a large (>1 cm) tick from his upper arm. About 1 week later, he experienced a gradual onset of fever and malaise. He now seeks medical attention because he is concerned about a possible infection transmitted by the tick. Which of the following diseases is most likely to be acquired from a tick?
(B) Rocky Mountain spotted fever
Which of the following drugs should not be used to treat Rocky Mountain spotted fever (Rickettsia rickettsii infection)?
Which of the following should be used to prevent Rocky Mountain spotted fever (Rickettsia rickettsii infection)?
(A) Attenuated Rickettsia rickettsii vaccine
(B) Prophylactic doxycycline
(C) Preventing tick bites by wearing protective clothing
(D) Delousing with insecticide
One week after deer hunting in a wooded area, a 33-year-old man developed fever to 39°C with headache and malaise. Over the subsequent 24 hours, he developed nausea, vomiting, abdominal pain, and diarrhea. On day 4, he developed a rash, initially around the wrists and ankles, which then progressively evolved, involving the arms, trunk, palms, and soles. Initially the rash was macular, but it quickly evolved into maculopapules, some with central petechiae. Rocky Mountain spotted fever caused by Rickettsia rickettsii was diagnosed. Which of the following statements about Rocky Mountain spotted fever is correct?
(A) The vectors of Rickettsia rickettsii are ticks of the genus Ixodes.
(B) A rash consistently appears by day 4 of illness.
(C) Rickettsia rickettsii forms inclusions in monocytes.
(D) The patient’s antibody response may not occur until after the second week of illness.
(E) The highest incidence of this disease is in the Rocky Mountain states.
The recommended treatment for Q-fever endocarditis is
(A) Emergent surgery; antibiotics are not effective
(B) Levofloxacin monotherapy for 6 weeks
(C) 18 months of combination therapy with doxycycline and hydroxychloroquine
(D) Penicillin and gentamicin combination therapy using IgG titers to determine duration
Coxiella burnetii can be transmitted by milk when animals such as goats and cows are infected. The presently recommended conditions of “high-temperature, short-time” pasteurization are adequate to destroy viable Coxiella organisms.
The histopathological hallmark of infection caused by Rickettsia rickettsiae is
(A) Morulae within granulocytes
(B) Morulae within monocytes
(C) Granulomatous inflammation
(D) Intracellular vacuoles
(E) Perivascular lymphocytes
All of the following statements regarding Rickettsialpox are correct except
(A) The cause of the disease is R akari.
(B) Ticks of the genus Amblyomma are responsible for transmission.
(D) Disease is more common in urban than rural areas.
Reasons why C burnetii could be a potential agent of bioterrorism include
(A) It is acquired by the inhalation.
(B) It is highly infectious.
(C) It can be difficult to treat depending on the phase of infection.
(D) Pneumonia may be severe.