Annie Brown is a 15-year-old female who is brought to your office by her mother. Annie ran away from home when she was 13 because of a sexually abusive and violent father and mother who was unwilling or unable to stop the abuse. Her father has recently been convicted of assault and jailed. Annie's mother is trying to put her life back together and is also trying to make a home for Annie, who she found through the Salvation Army, and who has been home, now, for only two weeks.
Annie survived on the streets by prostitution and petty theft. She has come to you because of a vaginal discharge and some itching and burning on urination. Her mother is also worried that she might have some other health problems associated with her life-style of the last two years.
Question 1 - Single Best Answer
Annie is obviously in need of psychological counseling which you understand that both she and her mother are getting. The MOST worrisome physical problem(s) she could be suffering from is/are
A) malnutrition
B) cancers of the female genitalia
C) infectious diseases, including AIDS
D) pregnancy
E) both C and D
Question 2 - Single Best Answer
What are three of the four major groups of pathogens that can cause infectious diseases?
A) E. coli, Salmonella, and AIDS
B) prokaryotes, metakaryotes, and eukaryotes
C) viruses, bacteria, and fungi
D) protozoa, worms, and bacteria
E) symbionts, commensals, and parasites
Question 3 - Single Best Answer
Pathogens can be either prokaryotes or eukaryotes. Which are viruses?
A) prokaryotes
B) eukaryotes
C) neither
Question 4 - Single Best Answer
Which of the following are prokaryotes?
A) plasmodia
B) herpes
C) people
D) Neisseria
E) more than one of the above
Question 5 - Best 2 Answers
Why is it important to know which microbes are prokaryotes and which are eukaryotes?
A) most antibiotics are directed against the prokaryotes
B) eukaryotes cause much more serious disease
C) there are no vaccines for diseases caused by prokaryotes
D) viruses that are human pathogens only replicate in eukaryotic cells
E) it is not important to know
Question 6 - Single Best Answer
What is the major difference between prokaryotes and eukaryotes?
A) only eukaryotes have peptidoglycan
B) viruses only replicate in prokaryotes
C) only prokaryotes have mitochondria
D) only eukaryotes have a cell membrane
E) only eukaryotes have a nuclear membrane
Getting back to Annie, you note that she looks much older than her age, is somewhat tired and drawn, but looks in reasonably good health. A pelvic exam reveals erythema of the vulvar area and a discharge with the consistency of cottage cheese. She tells you it is also somewhat uncomfortable to urinate. When you ask her about her menstrual periods, she says she has not had a period in about three months.
Question 7 - Single Best Answer
Which of the four major groups of pathogens could be causing Annie's presenting problem (vaginal discharge with itching and pain when urinating)?
A) bacteria
B) virus
C) parasite
D) fungus
E) any or all of the above
Question 8 - Single Best Answer
Which of the following specific agents is the most likely to produce the very thick discharge you have seen?
A) Trichomonas vaginalis
B) Gardnerella vaginalis
C) Candida albicans
D) Neisseria gonorrhoea
E) Chlamydia trachomatis
Question 9 - Single Best Answer
What implements would you need to diagnose her problem?
A) microscope
B) x-ray machine
C) CAT scanner
D) agar plates and an incubator
E) none -- you can tell just by looking
Treatment of a sample of the discharge with KOH (potassium hydroxide) reveals no unusual odor. Microscopic exam of the KOH treated preparation reveals yeast and pseudomycelia (also known as pseudohyphae). A wet mount does not reveal any motile organisms. A Gram stain shows PMN's but no intracellular Gram negative diplococci.
Question 10 - Single Best Answer
What in the world are Gram negative diplococci?
A) a part of the endoplasmic reticulum
B) a kind of bacterium with a double layered cell wall
C) what mitochondria in PMN's are sometimes called
D) a rod-shaped bacterium
E) a protozoan parasite that stays in mating pairs, microbial love-bugs
Question 11 - Single Best Answer
The exam of Annie's discharge with the microscope confirms a diagnosis of____
A) Trichomonas vaginalis
B) Gardnerella vaginalis
C) Candida albicans
D) Neisseria gonorrhoea
E) Chlamydia trachomatis
Question 12 - Single Best Answer
What are some things that can increase the likelihood of a disease-producing Candida infection?
A) AIDS
B) antibiotic treatment
C) sex with a partner who is infected
D) two of the above
E) all of the above
Question 13 - Single Best Answer
Her Candida is an endogenous infection. But pathogens can be passed from person to person (horizontal transmission) in a variety of ways. Besides the most popular way (sexual) what are some other routes of horizontal transmission?
A) transplacental transmission
B) respiratory
C) ingestion
D) through a break in the skin
E) more than one of the above
Question 14 - Single Best Answer
What are some other tests that you would order for Annie?
A) VDRL
B) HIV
C) fluorescent antibody assay for chlamydia
D) A and C above
E) all of the above
Question 15 - Single Best Answer
You think that an HIV test is very important because vaginal candidiasis is one of the signs of AIDS unique to women. What is another?
A) increased outbreaks of Herpes lesions
B) invasive cervical cancer
C) tuberculosis
D) cryptosporidiosis
E) gonorrhea
Question 16 - Single Best Answer
Would you recommend a pregnancy test?
A) definitely
B) only if her mother says its o.k.
C) only if Annie wants one
Annie took the pregnancy test. It was positive. She refused the HIV test.
Question 17 - Single Best Answer
How does one screen for the presence of HIV?
A) count CD4 cells
B) look for antibody to the virus with the Elisa test
C) look for the lesions of Kaposi's sarcoma
D) look for antibody with a Western blot
E) all of the above
Question 18 - Single Best Answer
Does the fact that Annie is pregnant change your concern that she have an HIV test?
A) yes
B) no
Question 19 - Single Best Answer
If the HIV test is positive and she wanted to have the baby, how would you treat her?
A) acyclovir
B) AZT
C) thymidine kinase
D) methotrexate
E) rifampicin
Question 20 - Single Best Answer
What is the causative agent of AIDS?
A) a double-stranded DNA virus
B) a virus that contains two strands of RNA
C) a virus with circular RNA
D) a helical virus
E) it is not caused by a microbe, its just a response to a life style
When you explained to Annie that you could help her baby if she was infected with HIV, she allowed you to do a test. Unfortunately it was positive. However she was treated with AZT and the baby, Danny Brown, was born HIV negative. Danny grew up and went to medical school. Annie was later treated with the new protease inhibitors and survived to see Danny graduate and go on to become a famous psychiatrist who developed and became famous for a successful intervention program for abusive fathers.