NBME Microbiology Test

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A 45-year-old woman comes to the physician because of progressive facial swelling and pain during the past week. She has a 10-year history of poorly controlled type 1 diabetes mellitus. Physical examination shows ecchymoses over the left orbital and periorbital regions with proptosis. There is a necrotic lesion with a black eschar in the left naris. Findings on microscopic examination of material from the lesion include broad, irregularly shaped, nonseptate hyphae with branches at right angles. Which of the following is the most likely cause of the nasal lesion?

Correct! Wrong!

A 21-year-old woman who is a college student is brought to the emergency department 2 hours after the onset of fever, chills, severe headache, and confusion. Her temperature is 39°C (102.2°F), respirations are 16/min, and blood pressure is 100/60 mm Hg. Physical examination shows numerous petechial lesions over the upper and lower extremities. There is resistance to neck flexion. Analysis of cerebrospinal fluid shows numerous leukocytes and gram-negative diplococci. Administration of which of the following vaccines is most likely to have prevented this patient’s condition?

Correct! Wrong!

A sexually active 37-year-old woman comes to the physician because of a 2-day history of pain in the area of her genitals. Pelvic examination shows shallow, small, extremely tender ulcers with red bases in the vulvar and vaginal regions. A Tzanck smear shows the presence of multinucleated giant cells. Which of the following infectious agents is the most likely cause of these findings?

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During an experimental study, an investigator develops a new member of the class of non-nucleoside reverse transcriptase inhibitors. This new drug most likely inhibits HIV infection through which of the following mechanisms?

Correct! Wrong!

A 35-year-old woman delivers a newborn who develops meningitis. The mother has a streptococcus isolated from her vagina. The organism agglutinates with antiserum directed against type B surface carbohydrate. The virulence of this organism is related to a bacterial constituent that interferes with which of the following host phagocyte functions?

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A 33-year-old woman contracts malaria while on a 3-month business trip to a Central American country. She is treated with a full course of chloroquine and recovers uneventfully. Four months after returning to the USA, she has another febrile illness that resembles malaria. A peripheral blood smear shows ring forms in her erythrocytes. Which of the following species of Plasmodium is most likely to have caused the second febrile illness?

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Three weeks after traveling to California to study desert flowers, a 33-year-old man develops fever, chest pain, and muscle soreness. Two days later, red, tender nodules appear on the shins, and the right ankle is tender and painful. An x-ray of the chest shows a left pleural effusion. Which of the following is the most likely diagnosis?

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At a banquet, the menu includes fried chicken, home-fried potatoes, peas, chocolate eclairs, and coffee. Within 2 hours, most of the diners become violently ill, with nausea, vomiting, abdominal pain, and diarrhea. Analysis of the contaminated food is most likely to yield large numbers of which of the following organisms?

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A 35-year-old woman is admitted to the hospital because of fever and dry cough for 3 days. An x-ray of the chest shows abnormal findings. Laboratory tests show cold agglutinating antibodies in serum. Results of routine cultures of blood and sputum are negative. Which of the following is the most likely pathogen?

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A mutation that causes the loss of the 3´, 5´ exonuclease activity of DNA-dependent DNA polymerase is most likely to also cause Escherichia coli to have problems with which cellular process?

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During an experiment, an investigator gently abrades the skin from the flank of a mouse, creating a 1 × 2-cm skin window. A glass coverslip is then placed over the area so that cells attracted to the site attach to the coverslip for assessment. Two hours later, an extravasation of cells from the vasculature is noted on the coverslip. Which of the following complement components is the direct cause of the enhanced vascular permeability and chemoattraction in the abraded skin area in this experiment?

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A 35-year-old man comes to the physician for a follow-up examination. He has had persistent left upper quadrant abdominal pain for 3 weeks despite therapy with omeprazole. Upper esophagogastroduodenoscopy shows an active duodenal ulcer. Tests of gastric and duodenal biopsy specimens for urease are positive. Which of the following is the most likely causal organism?

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A 2-year-old boy is diagnosed with staphylococcal scalded skin syndrome. In vitro studies show the causal organism to be resistant to penicillin. Which of the following mechanisms of action is most likely involved in this resistance?

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A 3-year-old girl is brought to the emergency department by her father because of a persistent cough for 2 weeks. She sometimes vomits following a paroxysm of coughing. While she is not coughing, she appears well. She has not yet received any routine childhood vaccinations. Her temperature is 37°C (98.6°F). Physical examination shows petechiae over the sclera and face. Which of the following is the most likely diagnosis?

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An investigator injects an experimental animal with a newly discovered bacterial strain to evaluate T-lymphocyte activation. It is found that bacterial engulfment by macrophages results in the presentation of bacterial-derived peptide ligands to CD4+ T lymphocytes. Which of the following cell-surface molecules on the macrophage is most directly involved in the presentation of the processed peptides?

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An investigator conducts an experiment on Clostridium perfringens and then sterilizes the culture dishes by autoclaving. This method of sterilization is most appropriate because it ensures that which of the following bacterial structures are inactivated?

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A 52-year-old woman living in Maryland comes to the physician because of a 1-week history of low-grade fever, fatigue, and a red rash over the skin behind her left knee. She is an avid hiker. Her temperature is 38°C (100.4°F). Physical examination shows an 8-cm, warm, nontender, erythematous lesion with partial central clearing over the skin of the left popliteal area. Which of the following is the most likely causal organism?

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An 8-month-old girl is brought to the emergency department because of a 1-day history of rapid breathing. Her temperature is 38.4°C (101.1°F), pulse is 160/min, respirations are 60/min, and blood pressure is 100/68 mm Hg. Bilateral expiratory wheezing and crackles are heard on auscultation. A chest x-ray shows areas of atelectasis and hyperinflation. Which of the following is the most likely causal virus?

Correct! Wrong!

A 45-year-old man comes to the physician because of fever and night sweats for 8 days. He has Crohn disease treated with infliximab. His temperature is 39°C (102.2°F). Physical examination shows diffuse cervical lymphadenopathy. A biopsy specimen of the nodes shows caseating granulomas. No organisms are identified on Gram stain. Which of the following is the most likely causal organism?

Correct! Wrong!