Which BSL level is for lethal agents for which there are no vaccines or other countermeasures?

BSL 4

What is the optimal size for aerosol delivery of a bio agent?

1-5 microns

Which country deliberately did not follow the 1972 biological weapons convention even after signing?

USSR

Which is NOT a characteristic of Tier 1 agents? A) Easily Treatable B) Causes Mass Panic C) Dispersed in aerosol D) High mortality

A) easily treatable

Which transmission-based precautions are most appropriate to prevent a disease which is spread by close respiratory contact or secretions?

Droplet Precautions

Of the CDC and the USDA select agents discussed in this module, how many diseases are not zoonotic?

Two

What of the following in NOT a factor that makes a particular food more vulnerable to potential use as a vehicle for attack?

Long Shelf Life.

Which of the following agents has food-borne gastrointestinal infections as one of its forms?

Anthrax.

Naturally occurring outbreaks of food/waterborne disease and agricultural diseases have occurred from contamination with?

All of the above.

Which is the best definition for "epidemic".

The occurrence of an unexpected number of cases of disease for a given place and time period.

What is the best definition of "epidemiology"?

Describing and interpreting patterns of disease in populations.

"Concern should be heightened if the naturally occurring disease requires a vector for spread and the competent vector is missing." This is an example of which clue?

Uncommon disease.

Which of these biological agents could make an ideal bio terrorist weapon?

All of the above.

What can cause an epidemic in an unexpected area?

All answers.

Which hand washing aspect is most important?

Friction/ Rubbing

What is the most effective and cost efficient way to prevent the spread of germs/ infections?

Soap and water.

When should hand washing be performed?

All answers.

For decontamination of clothing and equipment, what is the correct bleach concentration?

5% Bleach

Which is the best definition of "epidemic"?

The occurrence of a large number of cases of disease for a given place and time period.

What precautions measures would you take if there was an outbreak and the causative agent is not yet determined?

Precautions based off signs and symptoms of patients.

True or False: MOP IV is equal to BSL-3?

True

What is the appropriate bleach to water solution when decontaminating equipment or Tyvek suit?

1:10

How often should airflow be checked in regards to the PAPR system?

Before each use.

What is the LRN?

National network of local, state, and federal public, hospital-based, food testing, vet and environmental testing labs that provide lab diagnostics in response of bio/chemical terrorism.

What are the main technologies that are utilized for agent ID?

All of the above.

Where does the testing occur?

OCONUS/CONUS (both location answer).

Which of the following is not a DoD biological ID level?

Repeat Testing

Current CDC recommendations for post-exposure prophylaxis (PEP) to aerosolized B. anthracis spores includes 60 days of oral antibiotics and a three dose series of anthrax vaccine adsorbed (AVA). True or False?

True

AVA is not currently licensed for PEP, and thus it would have to be given under an investigation New Drug (IND) protocol or an Emergency Use Authorization. True or False?

True

Clinical or sub-clinical meningitis in patients with IA is likely and should be suspected in all patients with inhalation or systemic anthrax. True or False?

True

For treatment of anthrax disease IV ciprofloxacin or other fluoroquinolones with a similar spectrum of activity and central nervous system penetration are recommended over doxycycyline as the primary: True or false?

True

Variable beta-lactam resistance has been identified among naturally occurring B. anthracis isolates, therefore penicillins should not be initially used for PEP of anthrax.

True

What type of biological agent is tularemia?

Bacteria

What characteristic of tularemia makes it particularly attractive as a bioweapon?

High infectivity.

On what continents is Francisella tularensis subsp. holarctica (type B) located?

North America, Europe, Asia

The common clinicical presentation of natural tularemia infection is:

Ucel

What is the incubation period of tularemia?

3-5 days.

Forms of disease observed with plague patients do NOT include:

Typhoidal

Important infection control measures to remember with plague patients do NOT include:

Incision and drainage of buboes.

Current measures for prevention and control of plague include which of the following:

Minimize contact with rodents and fleas.

Naturally occurring cases of plague are never seen in the United States and laboratory-confirmation of plague is proof of a bioterrorism event. True or False?

False

Yersinia pestis infection can occur in which of the following animals:

All of the above. (Rats, camels, chipmunks, prairie dogs).

There are seven classical species of Brucella. Which is considered the most virulent Brucella spp. for humans?

B. melitensis

Although clinical features in humans are non-specific, the most common clinical finding in acute brucellosis is:

Fever

What is the most likely natural method of human exposure to and acquisition of Brucella spp. infections?

Consumption of unpasteurized milk products (raw milk).

What is the most common clinical finding in livestock (sheep, goats, cattle, etc) on farms and/or in areas where Brucella spp. is highly suspected and/or endemic?

Abortions in livestock.

Brucella spp. is a facultative intracellular coccobacillus (i.e. bacteria). Intracellular survival in what cell type is important in the pathogenesis of brucellosis and lesion development in different organs?

Monocytes/ Macrophages

Regarding Q fever infection all of the following are true except:

High mortality in humans.

What is the most likely natural method of human exposure to and acquisition of Q fever infection?

Aerosol contact with C. burnetii-infected animals or animal remains.

If C. Burnetii suspected and/or confirmed samples or cultures are being handled at a laboratory, what is the biosafety level rating?

BSL-3

What is the most common clinical finding in livestock in areas where C. burnetii is highly suspected or endemic?

Spontaneous abortions in livestock.

C. burnetii is a faculative intracellular coccobacillus (bacteria). Once inhaled and trapped in the lungs, intracellular survival in what cell type is important in the pathogenesis of Q fever and lesion?

Monocytes/ Macrophages

The natural reservoir of Burkholderia mallei (glanders) is the:

Horse (plus mules/ donkeys).

Proper safety for handling Burkholderia mallei samples/ cultures in a lab is what Biosafety Level?

BSL-3

All of the following are true regarding the treatment of Burkholderia mallei (glanders) infections regardless of clinical severity except:

Oral maintenance therapy for no more than 30 days following IV therapy.

All of the following are diagnostic tests used in diagnosis of Burkholderia in humans except:

Mallein Test

The primary method a horse can become infected by glanders is through:

All of the above (inhalation, breaks in skin, ingestion).

All of the following are suitable environments for Burkholderia pseudomallei survival except:

Dry, Desert Conditions

What is the most likely route of natural infection for Burkholderia pseudomallei (melioidosis)?

Inoculation/ Direct Penetration

What is the proper Biosafety Level when handling Burkholderia Pseudomallei samples/ cultures?

BSL-3

All of the following are true regarding the treatment of Burkholderia Pseudomallei infections regardless of severity except:

Oral maintenance for no more than 30 days following IV therapy.

What is the most common reported acute clinical manifestation of Burkholderia Pseudomallei in children?

Purulent Parotitis

The shape of Brucella bacteria is:

Coccobacilli

An eschar is a coal-black scab associated with:

Anthrax

Bipolar safety pin staining is associated with Yersinia pestis samples. True or False?

True

Bacillus anthracis is the bacteria which causes anthrax, true or false?

True.

The key features of ulceroglandular tularemia are a skin lesion that can start as a papule and then ulcerate, plus regional lymph node involvement. True or false?

True

In a warfare scenario, a rapidly progressive pneumonia with sputum gram stain findings of gram negative coccobacilli with safety pin appearance is:

Raises a differential diagnosis of plague, tularemia, and meliodosis.

What is the proper PPE for droplets?

Surgical Mask

What lab test would be most valuable at this point?

Rapid ID of the gram-negative coccobacillus by PCR (e.g. JBAIDS).

Empiric antibiotic therapy should include:

An aminoglycoside

If a person is suspected to have plague, who is contacted?

Public Health, Hospital Occupational Health, and Clinical Laboratory

Staphyloccocal enterotoxin B (SEB) exerts its toxin on:

The immune system

Staphylococcus aureus is a relatively rare bacteria and is normally not associated with human microbactium:

False (found in 30-50% of population)

Clinical symptoms of oral SEB intoxication does not include which of the following; diarrhea, violent vomiting, fever, paralysis.

Paralysis

There are no FDA licensed vaccines or therapeutics against SEB. True or false?

True

Natural SEB aerosol exposure is common:

True

Rice intoxication is readily transmissible between human hosts, True or False?

False

In animal studies, ricin was found to have the highest potency when introduced:

By injection/ inhalation

Ricin's toxicity is caused by its ability to:

Interrupt protein synthesis

What is the typical percentage of ricin toxin found in a single castor bean?

Less than 5%

True or False, the castor bean plant, Ricin Communis is considered to be a controlled species and difficult to obtain?

False

T/F: Patient with intoxications and incubating infections (with exceptions like the flu) are not contagious.

True

Pulmonary edema due to ricin intoxication is expected to occur later in pulmonary edema due to SEB intoxication:

True

T/F The key feature of botulism is descending flaccid paralysis, usually without fever.

True

When sending samples to the lab, use for DD Form 1911 (Material Courier Receipt).

True

An important quality of viruses within the genus Orthopoxvirus is:

They impart significant cross-protective immunity in humans and animal models.

The first phase of smallpox disease consist of:

Acute flu-like illness with high fever and no rash.

The distribution of the rash of smallpox is described as:

Centrifugal (peripheral)

Which would probably not be helpful in treating a case of smallpox?

Antiviral drug: Ribavirin

What drug class is most important when treating filoviral infections?

Supportive Care

The earliest presumed infected cells for filovirus (ebola/ marbug viruses) are:

Lymphocytes

Which of the following diseases are caused by a virus in one of the families associated with viral hemorrhagic fevers (Filoviridae, Arenaviridae, Bunyaviridae or Falviridae)?

Dengue

Which viral hemorrhagic fever has the highest fatality rate?

Ebola

In 2015, how many infections of ebola have been caused through casual contact?

zero

Which characteristics make alphavirus optimal for use as potential weapons?

All answers

What is the pattern of transmission in a biowarfare attack with alphavirus?

Humans and Equines> Mosquitoes> Equines> Mosquitoes> Humans

In the transmission cycle of VEEV, epizootics precede epidemics by:

1-2 weeks

What does ecchymosis mean?

discoloration of the skin resulting from bleeding underneath

T/F: Variola major ordinary type presents in >90% of cases among unvaccinated persons.

True

Guarnieri bodies are associated with:

Variola virus

T/F: Variola major hemorrhagic type is known as "The Black Death".

False

Chicken pox is most confused with what other disease:

Smallpox

The number of psychological casualties following a chem/bio attack are likely to be:

Greater ratio than 1:1 when comparing physically wounded victims.

Outbreaks of Multiple Unexplained Symptoms is:

Symptoms seen during OMUS include fatigue, shortness of breath, headache, dizziness, and memory trouble.

Is childcare/ elderly care/ petcare a barrier for willingness to report to an emergency situation?

No

Psychological first aid is:

A focus on emotional processing and detailed trauma narratives.

The normal response to a disaster is:

Stunned, bewildered and panic