Cindy Fairis is brought to your office by her mother because of a cough. She used to cough just in the morning, but in the last two weeks she has started to cough all day long and be very tired. Lately she has started coughing up greenish-grey sputum. When Cindy was 2 months old, she was diagnosed with cystic fibrosis. She is 11 now.
Question 1 - Single Best Answer
Is this scenario unusual for a child with cystic fibrosis?
A) yes
B) no
Question 2 - Single Best Answer
The cough is most likely the direct result of?
A) bacterial infection
B) viral infection
C) no infection, its just the nature of the thick mucous produced by individuals with cystic fibrosis
Question 3 - Single Best Answer
What bacteria are most likely to be infecting this child?
A) E. coli or Haemophilus influenzae
B) Haemophilus influenzae or Staphylococcus aureus
C) E. coli or Streptococcus pyogenes
D) Staphylococcus aureus or Pseudomonas aeruginosa
E) Pseudomonas aeruginosa or Moraxella catarrhalis
Question 4 - Single Best Answer
What type of a bacterium is Pseudomonas?
A) Gram positive coccus
B) Gram positive rod
C) Gram negative coccus
D) Gram negative rod
E) spirochete
Question 5 - Single Best Answer
Which of the following might have led to Cindy's diagnosis of cystic fibrosis (c.f.) at two months of age?
A) offensive, greasy stools and salty taste when kissed
B) sterility in a male or delayed puberty
C) colonization with Pseudomonas aeruginosa
D) meconium ileus
E) all of the above
Question 6 - Single Best Answer
What is the underlying defect in cystic fibrosis?
A) abnormal chloride channel
B) complement deficiency
C) IgA deficiency
D) pancreatic insufficiency
E) ciliostasis and immobile spermatozoa
Question 7 - Single Best Answer
How is pseudomonas infection/carriage determined?
A) anaerobic growth on blood agar
B) aerobic growth on blood or MacConkey agar
C) special Pseudomonagar
D) serum antibody to exotoxin A
E) growth in human macrophages
When Cindy's sputum was streaked on blood agar and incubated aerobically, large colonies with a green pigmentation and a grape-like odor were isolated.
Question 8 - Single Best Answer
The identity of the bacterium isolated is?
A) Staphylococcus aureus
B) Haemophilus influenzae
C) Pseudomonas aeruginosa
D) E. coli
E) none of the above
Question 9 - Single Best Answer
What confirmatory test could be done?
A) catalase
B) coagulase
C) oxidase
D) A disk
E) P disk
Question 10 - Single Best Answer
What is unusual about the metabolism of Pseudomonas?
A) it has no Krebs cycle enzymes
B) it cannot undergo fermentation
C) it has RNA as its genetic material
D) it has an elementary body and a reticulate body
E) it is an energy parasite so is obligately intracellular
You decide to treat Cindy with an aminoglycoside plus the newest of the cephalosporins.
Question 11 - Single Best Answer
The drugs should be administered?
A) in smaller than normal doses
B) in higher than normal doses
C) in normal doses
Question 12 - Single Best Answer
Will Cindy ever be free of the Pseudomonas that is causing her problem?
A) yes, the antibiotics will take care of the problem
B) no, she will be colonized for life
Question 13 - Single Best Answer
Besides cystic fibrosis patients, what other population is especially susceptible to Pseudomonas infections?
A) sickle cell anemics
B) veterinarians
C) hospitalized patients
D) gardeners
E) bridge players
Question 14 - Single Best Answer
What is one of the most common sites of infection by Pseudomonas aeruginosa in patients without cystic fibrosis?
A) burns
B) genitals
C) deep puncture wounds
D) mouth
E) heart
Question 15 - Single Best Answer
In hospitals, what is the usual reservoir of Pseudomonas?
A) sinks
B) flower pots
C) mops
D) respiratory therapy machines
E) all of the above