Formative MCQs – week 4 – Microbiology and Immunology

1) Enveloped viruses are more easily inactivated by detergent than non-enveloped viruses.
Which one of the following viruses would be most susceptible to detergent?
a) Adenovirus 5
b) Human papillomavirus 16
c) Poliovirus
d) Coronavirus

2) A researched purified the genome of virus X and introduced it into cells by transfection. Two
days later, the culture supernatant contained a high titer of infectious virions. How would
virus X be classified?
a) Negative-sense RNA
b) Positive-sense RNA
c) Single-stranded DNA
d) Double-stranded DNA
e) Retrovirus

3) Which of the following descriptions is not accurate for the virus that causes chicken pox?
a) Double-stranded DNA genome
b) Enveloped virus
c) Has tegument
d) Thymidine kinase inhibition (acyclovir) can cure latent infections
e) Most transmission is through respiratory droplets.

4) Which of the following best describes the molecular target of oseltamivir (Tamiflu)?
a) Reverse transcriptase inhibitor
b) Inhibits the RNA-dependent RNA polymerase
c) Inhibits a protease required for the maturation of viral proteins
d) Inhibits neuraminidase

5) Which of the following influenza proteins are functionally equivalent to HIV GP120?
A) Neuraminidase/NA
B) Nucleocapsid/NP
C) Matrix protein/M2
D) Hemagglutinin/HA

6) Which stages of the Plasmodium falciparum life cycle might you expect to see on a thin blood
smear from a patient with severe malaria?
a) schizont stage
b) trophozoite stage
c) sporozoite stage
d) oocyst stage

7) Which of the following best describes antigenic variation by Plasmodium falciparum?

a) Sexual recombination of the parasites in the vector midgut generates new diversity of
antigens.
b) Low fidelity DNA polymerase in the parasite leads to random mutagenesis of genes
encoding relevant antigens.
c) Transcriptional switching from one antigen gene to another with only one expressed at
a time.
8) Which of the following explain why the reverse transcriptase inhibitor Lamivudine can inhibit
hepatitis B virus replication?
a) Hepatitis B virus is a retrovirus that needs to reverse transcribe its RNA genome.
b) Hepatitis B virus is a retrovirus that needs to reverse transcribe its RNA.
c) Hepatitis B virus is a picornavirus that requires and RNA-dependent RNA polymerase to
replicate its RNA genome.
d) Hepatitis B virus is a hepadnavirus that requires an RNA-dependent DNA polymerase to
replicated its DNA genome.

9) While completely unrelated pathogens, one shared feature of Toxoplasma gondii,

Mycobacterium tuberculosis, and Leishmania parasites is:
a) They all can latently infect hosts.
b) They are all pathogens of the GI tract.
c) Toxin secretion is key to their pathogenesis.
d) They are all Gram positive bacteria.

10) While completely unrelated pathogens, Legionella pneumophila, Mycobacterium

tuberculosis, and Leishmania parasites have several shared features including all of the
following EXCEPT:
a) All are intracellular parasites of macrophages.
b) Cell-mediated immunity is required for their control.
c) In order to survive in their host cells, they all need to avoid the lysosome.
d) M1 activated macrophages kill these organisms by generating reactive oxygen and
reactive nitrogen compounds.

11) Which of the following statements about the structure and replication of HIV is true?
A) Viral mRNA is the template for the synthesis of the genomic RNA.
B) During entry of HIV into the cell, the viral p24 protein interacts with the CD4 protein on
the cell surface.
C) HIV contains a protease that cleaves ribosomal proteins, resulting in the inhibition of
host cell protein synthesis.
D) HIV has an enzyme in the virion that synthesizes double-stranded DNA using the
single-stranded RNA as the template.

12) Which of the following statements about HIV disease progression is most accurate?
A) During the long asymptomatic period that can last for years, no HIV is synthesized.
B) People with a high level of viral RNA in their plasma are more likely to have
symptomatic AIDS than those with low levels.
C) During primary infection, Pneumocystis pneumonia commonly occurs.
D) Following infection and without treatment, the abundance of HIV p24 protein or Gag
RNA gradually increases for the duration of a patient’s life.

13) An 87-year-old man sees his doctor in March with high fever, aches and pains, and a
nonproductive cough. He says that he did not get the flu vaccine this year, because he has
gotten it for the past 10 years and thinks that he should be immune by now. What "immune
evasion" strategy does influenza use that requires the production and use of a new influenza
vaccine each year?
A. Inhibition of antigen processing
B. Antigenic drift
C. Production of immunosuppressive cytokines
D. Infection and destruction of immune cells
E. Production of cytokine receptor homologues

14. In 1988 a new childhood vaccine was developed to protect against epidemic
meningitis by mixing Haemophilus influenzae type B polysaccharide with whole, killed
Bordetella pertussis bacteria. The function of the whole, killed bacteria in this vaccine is as a(n)?
A. Carrier
B. Hapten
C. Mitogen
D. Adjuvant
E. Immunogen

15. Which of the following vaccines would be most likely to be effective after a single
dose?
A. Inactivated Virus
B. Live, attenuated virus
C. Toxoid (subunit) based vaccine
D. Conjugate vaccine
E. Virus-like Particle

16. A 39-year-old man has been HIV-positive for 10 years. Because he is homeless, he only
has irregular access to the antiretroviral drugs prescribed to him at the local AIDS clinic. When
he presents to the clinic for a checkup, his CD4 cell count is found to be 390/mm3. Which of the
following immunologic parameters is likely to be most profoundly depressed at this stage of his
infection?
A. Cell proliferation in response to pokeweed mitogen
B. Delayed-type hypersensitivity to Candida antigens
C. IgA production
D. Intracellular killing of bacteria
E. Rejection of allogenic skin grafts

17. (Vaccines) Both the inactivated polio vaccine (IPV) and the attenuated oral polio vaccine
(OPV) are effective in preventing poliovirus infection. Why is the IPV vaccine recommended for
use in children in North America?
A. IPV is effective after a single dose of vaccine
B. Immunity induced with IPV is longer-lasting than immunity induced with OPV
C. IPV induces stronger cytotoxic T lymphocyte responses
D. World-wide polio eradication is more attainable with universal IPV immunization
E. There is no risk of vaccine-associated paralytic polio when using IPV

18. (Vaccines) When the exotoxin polypeptides of bacteria are treated with formaldehyde, acid,
or heat, toxoids are produced. These toxoids are then used to vaccinate humans against
disease since they are antigenic and no longer toxic. Toxoids make effective vaccines because
they induce which of the following immune responses?
A. Toxin-neutralizing antibodies
B. Macrophage activation
C. Activation of complement
D. Toxin-specific Cytotoxic T Lymphocytes

19) Your patient has the following serological findings:

Hepatitis A IgM – Negative
Hepatitis B surface antigen – positive
Hepatitis B surface antibody – negative
Hepatitis B core total antibody – positive
Hepatitis B core antibody (IgM) – positive
Hepatitis C antibody – negative

Which of the following best describes the patient’s serology?

A) Acute infection with a DNA virus

B) Chronic infection with a DNA virus
C) Immunized against a DNA virus
D) Acute infection with a flavivirus

20) Which of the following best explains the high frequency of acute hepatitis in HIV patients
beginning antiretroviral therapy?

A) Liver toxicity of some antiretroviral drugs.

B) Antiretroviral drugs reactivate latent hepatitis B virus.
C) Reconstitution of the patient’s immune system leads to robust inflammatory responses to
chronic hepatitis B infection.

21) Which of the following molecules define the cell tropism of Epstein-Barr Virus?
A) ACE2
B) CXCR4
C) Sialic acid
D) CD21

22) Which of the following virus families is not associated with antigenic shift?
A) Reovirus
B) Orthomyxovirus
C) Coronavirus
D) Bunyavirus

ANSWERS

1) D, coronaviruses are enveloped.

2) B, positive sense RNA viruses can be translated using host machinery
3) D, acyclovir is modified by viral thymidine kinase and the resulting nucleoside gums up DNA
polymerase. However, acyclovir cannot cure latent infections.
4) D, neuraminidase activity is required for proper release of virions from infected cells.
5) D, Both gp120 and HA are trimeric proteins on the virion surface that are covalently bound to
imbedded fusion peptides. When triggered, the fusion peptide is deployed. It inserts into the
host cell membrane. Trimer rearrangements mediate the fusion between the host cell
membrane and the viral envelope. HIV gp120 is triggered by binding to the HIV receptor and co-
receptors at the plasma membrane. Influenza HA is triggered by low pH, and the virus fuses
with endosomal membranes.
6) B, schizont stages are retained in the vasculature and the other two states are essentially
only seen in mosquitos or are involved in transmission to people and not seen in blood stream.
7) C
8) D, Hepadnaviruses have an RNA intermediate in generating partially doubl-stranded DNA
genomes.
9) A; all three of these pathogens can cause life-long latent infections that can reactivate in
response to immunosuppression leading to severe disease.
10) C, all these pathogens parasitize macrophages and are subject to similar immune
mechanisms (cell mediated immunity involving Th1 cells, interferon gamma, IL-12, activated
macrophages, nitric oxide, etc). The immune system can only rarely (if ever) completely
eliminate infection. However, these pathogens reside in different intracellular niches.
Leishmania replicates in a fully acidified phagolysosome. Legionella and Mtb redirect the
phagosome away from fusion with lysosomes.

11) D. Gp120 (not p24) interacts with CD4. Poliovirus shuts off host gene expression by
cleavage of poly-A binding proteins.

12) B. During the acute phase of HIV infection, viral titers are high but the patients still have
sufficient CD4+ T cells to fight off otherwise unusual infections like Pneumocystis. After primary
infection, viral titers are kept low by the immune system even though HIV is constantly being
generated by infected cells.

13) B, random mutation in the HA and NA proteins allows the virus to escape antibody
responses to prior infection. The other concept that you should know for influenza is antigentic
shift, which involves the reassortment of viral genome segments and can lead to pandemics.

14) D, adjuvants are added into vaccine formulations to enhance immune stimulations.

15) B, live attenuated viruses can trigger robust immune responses given their ability to carry
out multiple steps of a ‘real’ infection. Live attenuated viruses can stimulate humoral and cellular
immunity.

16) B, HIV patients start experiencing immunological problems once T cell numbers decline
below 400-500 cells/mm3. Candida infections (cause oral thrush) are among the earlier of these
potential problems.

17) E. Currently, most of the polio infections worldwide are caused by vaccine-derived poliovirus
rather than wild polivirus.

18) A, toxoids are immunogenic and stimulate strong humoral immune responses against the
toxoids and proteins attached to it.

19) A, The patient has detectable hepatitis B virus antigens, demonstrating active replication of
the virus (a hepadnavirus). The patient has started to develop antibodies against the virus (IgM
recognizing the core) but does not have IgG nor does the patient have antibodies recognizing
the surface antigen which tend to develop months after infection. An immunized person would
have IgG recognizing the surface antigen but would not have antibodies that recognize any
other part of the virus.
20) C,
21) D
22) C, antigenic shift is associated with viruses that have their genome in multiple segments,
which allows reassortment to take place in cells infected with two different viruses at the same
time.