Question 1

What document prohibits the use of biological agents during war?
A) Geneva Protocol
B) Treaty of Versailles
C) Antiproliferation Pact
D) Law of Armed Conflict

Accepted Answer

Despite a Geneva Protocol prohibiting the use of biological agents during war signed by many nations,a number of countries began biological warfare research programs in the 1920s.

Question 2

What type of anthrax is most deadly and most likely to be seen in a bioterrorism attack?
A) Gastrointestinal
B) Inhalation
C) Cutaneous
D) Spinal

Accepted Answer

Inhalation anthrax occurs when a patient inhales Bacillus anthracis; it usually takes at least 8000 spores to initiate this form of the disease.Inhalation anthrax is the form of anthrax most likely to be seen in a bioterrorism event.Data from the accidental spore release in Sverdlosk,Russia,in 1976 suggested a mortality rate of almost 100%.However,the mortality rate of patients with inhalation anthrax in the United States in 2001 was only 45% (5 out of 11).

Question 3

All the following organizations established the Laboratory Response Network EXCEPT:
A) United States Army Medical Research Institute for Infectious Diseases (USAMRIID)
B) Centers for Disease Control and Prevention (CDC)
C) Central Intelligence Agency (CIA)
D) Federal Bureau of Investigation (FBI)

Accepted Answer

In an effort to increase responsiveness and to create a nationwide ability to rapidly detect the covert or overt deployment of biological weapons in the United States and its territories,the CDC,the Association of Public Health Laboratories (APHL),the FBI,and USAMRIID established the Laboratory Response Network (LRN)in 1999; later that year,most states and territories were implementing training for the detection of biological attacks using standardized LRN protocols.

Question 4

How can biological weapons enter the host?
A) Through the respiratory tract
B) Through the gastrointestinal (GI) tract
C) Through the mucous membranes
D) All of the above

Accepted Answer

Biological weapons can enter the host via the respiratory tract,GI tract,and through the skin and mucous membranes.Dispensing bioterror agents in food or water may not be efficient due to the dilution of the agents.

Question 5

A microbiologist is looking at a sheep blood agar (SBA)plate from a patient who might have been exposed to a biological agent.The colonies that are growing on the plate are nonhemolytic,large,have a ground-glass appearance,and look like a Medusa's head.On Gram stain,the colonies are large gram-positive rods that seem to have central spores.What is the most probable organism?
A) Bacillus anthracis
B) Brucella mallei
C) Burkholderia cepacia
D) Yersinia pestis

Accepted Answer

In aerobic culture,B.anthracis will yield large (2- to 5-mm),nonhemolytic colonies on 5% SBA.Colony growth can be rapid,as little as 8 hours.Mature colonies have a ground-glass appearance; cells are characteristically large gram-positive bacilli,possibly showing endospore formation.The spores are central or subterminal and do not cause the bacterial cell to swell.The colony margins often have feathery projections coming from the margin,referred to as "Medusa-head" colonies.

Question 6

What federal regulation establishes the rules of possession,use,and transfer of select agents and toxins?
A) Public Health Security and Bioterrorism Preparedness and Response Act of 2002
B) 42 CFR 73
C) Animal Health and Inspection Act
D) Infectious Agent Act

Accepted Answer

In the 1990s,an individual was arrested in Ohio and in Nevada while carrying Yersinia pestis and anthrax spores in his car.Ironically,ordering and possessing these potential weapons did not necessarily constitute a crime.These cases identified gaps in the law and helped define the need for stricter laws such as the Public Health Security and Bioterrorism Preparedness and Response Act of 2002 and the recently enacted 42 CFR 73,Possession,Use and Transfer of Select Agents and Toxins; Final Rule (March 2005).

Question 7

What category of bioterrorism agents would have the greatest impact?
A) Category A
B) Category B
C) Category C
D) Category D

Accepted Answer

Category A agents (or Biothreat Level A)would have the greatest impact,whereas Categories B and C would have less impact.Although Bacillus anthracis is considered a biosafety level 2 (BSL-2)in clinical laboratories,it is a Category A agent in regard to a bioterror threat.

Question 8

Which of these are designated as sentinel hospitals in the Laboratory Response Network (LRN)?
A) Centers for Disease Control and Prevention (CDC)
B) Reference laboratories
C) State public health laboratories
D) Community hospitals with microbiology laboratories

Accepted Answer

As defined by the LRN,community hospitals with microbiology capabilities are designated as sentinel (formerly level A)LRN laboratories.Sentinel laboratories must have a biosafety level 2 (BSL-2)facility and the laboratory protocols published on the CDC and American Society for Microbiology (ASM)Web sites to rule out the presence of biological agents.

Question 9

What type of plague is the most common and results from the bite of a flea?
A) Bubonic plague
B) Septicemic plague
C) Pneumonic plague
D) Osmotic plague

Accepted Answer

Bubonic plague,the most common form of disease,results from the bite of a flea,and is characterized by fever,chills,headache,and malaise.The plague bacteria are transported to the local lymph nodes,most commonly the femoral,inguinal,or cervical.As the bacteria multiply,the lymph node becomes inflamed and painful,forming the characteristic bubo with evident erythema.

Question 10

What classification system was developed in 1999 by academic infectious disease experts,government officials,military intelligence experts,and law enforcement officials?
A) Biosafety levels
B) High, moderate, and low categories
C) A, B, C categories
D) Normal, increased, and high categories

Accepted Answer

In 1999,academic infectious disease experts,national public health experts,Department of Health and Human Services agency representatives,civilian and military intelligence experts,and law enforcement officials met to comment on the threat potential of infectious agents to civilian populations.As a result,agents were placed into one of three categories-A,B,or C-for initial public health preparedness efforts.

Question 11

A microbiology technician is looking at a set of plates from a seriously ill patient.The sheep blood agar (SBA)plate shows small,nonhemolytic colonies that have a fried egg appearance.On MacConkey,these organisms grow as a small,nonlactose fermenter.On Gram stain,this organism is a bipolar staining,plump gram-negative rod.What is the most probable organism?
A) Brucella mallei
B) Brucella anthracis
C) Yersinia pestis
D) Burkholderia cepacia

Accepted Answer

Laboratory Response Network (LRN)protocols define a suspicious Yersinia pestis isolate as a bipolar staining gram-negative node that forms very small colonies after 24 hours incubation at 37° C,although colonies grown at room temperature may be larger.Colonies of Y.pestis on SBA may grow slowly,and cultures may have to be held for up to 48 hours for good colony growth.Colonies are nonhemolytic and can have a fried egg appearance.On media selective for gram-negative bacilli,such as MacConkey agar,the organism will grow as small,nonlactose fermenting colonies.

Question 12

What is the specimen of choice for gastrointestinal and inhalation anthrax?
A) Sputum
B) Vesicular fluid from lesions
C) Spinal fluid
D) Blood

Accepted Answer

The specimen of choice for patients with gastrointestinal anthrax is blood,particularly a few days after exposure.The specimen of choice for patients with inhalation anthrax is also blood.

Question 13

What is the specimen of choice for cutaneous anthrax?
A) Blood
B) Spinal fluid
C) Vesicular fluid from lesions
D) Sputum

Accepted Answer

The specimen of choice for cutaneous anthrax is vesicular fluid from fresh vesicles.Also,swabs can be used to collect material from under the edge of the crust of the eschar.

Question 14

Who will be most likely to suspect a covert bioterrorism attack?
A) Firefighters and the police
B) Microbiologists and physicians
C) The public health department
D) Centers for Disease Control and Prevention (CDC) and Homeland Security

Accepted Answer

A covert event poses more of a challenge to public health interests.Clinical microbiologists and physicians will most likely be the first to suspect the attack.

Question 15

Yersinia pestis causes all the following EXCEPT:
A) Bubonic plague
B) Septicemic plague
C) Pneumonic plague
D) Meningococcal plague

Accepted Answer

Y.pestis causes bubonic plague,septicemic plague,and pneumonic plague.The infections can occur as a result of being bitten by an infested flea,handling contaminated materials,or inhaling aerosolized plague bacteria.

Question 16

What is bioterrorism?
A) The use of bacteria, viruses, fungi, or toxins to injure people, animals, or crops to cause civil unrest
B) The use of synthetic biological substances to kill innocent people
C) The use of biological substances to kill, maim, or injure as many people as possible
D) The use of biohazardous substances to cause chaos

Accepted Answer

Bioterrorism is the use of bacteria,viruses,fungi,or toxins to injure people,animals,or crops to cause civil unrest.

Question 17

Organisms that have the following characteristics-aerobic growth,nonhemolytic colonies 2 to 5 mm in diameter,catalase positive,nonmotile,large gram-positive bacilli recovered from lesions,blood,cerebrospinal fluid (CSF)or lymph nodes-can be presumptively identified as:
A) Brucella mallei
B) Brucella anthracis
C) Yersinia pestis
D) Burkholderia cepacia

Accepted Answer

According to Centers for Disease Control and Prevention (CDC)protocols,a presumptive identification of B.anthracis can be made if an isolate has the following characteristics: aerobic growth,nonhemolytic colonies 2 to 5 mm in diameter,catalase positive,nonmotile,large gram-positive bacilli recovered from lesions,blood,CSF,or lymph nodes.

Question 18

One of the first recorded terror attacks occurred in 1984 in a restaurant in The Dalles,Oregon.What organism was used in this attack?
A) Salmonella
B) Escherichia coli
C) Clostridium
D) Staphylococcus

Accepted Answer

In 1984,the followers of Bhagwan Shree Rajneesh used Salmonella as a weapon to help influence election results in The Dalles,Oregon.By spraying liquid-based Salmonella culture into salad bars in restaurants,these followers caused 750 people to develop culture-positive salmonellosis.

Question 19

What organism caused the disease known as the Black Death?
A) Brucella mallei
B) Brucella anthracis
C) Yersinia pestis
D) Burkholderia cepacia

Accepted Answer

Throughout history,plague pandemics have demonstrated the efficacy of this organism as a weapon against humankind.The infection,commonly referred to as the Black Death,was decimating the Muslims,and in an effort to spread the disease to the Genoese in Kaffa,Tartar soldiers who had died of the Black Death were catapulted into the walled city.

Question 20

What is the role of the sentinel laboratory?
A) To rule out or refer suspicious isolates
B) To identify suspicious isolates
C) To act as a reference laboratory for physician office laboratories
D) None of the above

Accepted Answer

The role of a sentinel laboratory is to rule out or refer suspicious isolates,not to identify.Because sentinel laboratories will refer isolates to a regional reference laboratory,clinical laboratory scientists must be aware of the strict requirements for shipping and transporting infectious agents.

Quiz 30: Agents of Bioterror

What document prohibits the use of biological agents during war?

What type of anthrax is most deadly and most likely to be seen in a bioterrorism attack?

All the following organizations established the Laboratory Response Network EXCEPT:

How can biological weapons enter the host?

What federal regulation establishes the rules of possession,use,and transfer of select agents and toxins?

What category of bioterrorism agents would have the greatest impact?

Which of these are designated as sentinel hospitals in the Laboratory Response Network (LRN) ?

What type of plague is the most common and results from the bite of a flea?

What classification system was developed in 1999 by academic infectious disease experts,government officials,military intelligence experts,and law enforcement officials?

What is the specimen of choice for gastrointestinal and inhalation anthrax?

What is the specimen of choice for cutaneous anthrax?

Who will be most likely to suspect a covert bioterrorism attack?

Yersinia pestis causes all the following EXCEPT:

What is bioterrorism?

Organisms that have the following characteristics-aerobic growth,nonhemolytic colonies 2 to 5 mm in diameter,catalase positive,nonmotile,large gram-positive bacilli recovered from lesions,blood,cerebrospinal fluid (CSF) or lymph nodes-can be presumptively identified as:

One of the first recorded terror attacks occurred in 1984 in a restaurant in The Dalles,Oregon.What organism was used in this attack?

What organism caused the disease known as the Black Death?

What is the role of the sentinel laboratory?