Block 2 review

General bacteriology
Cell Wall
-Outermost component common to all bacteria (except Mycoplasma species) made up of
peptidoglycan
-The cross-linking via between NAM is catalyzed by transpeptidases and carboxypeptidases
(remove the terminal D-alanines) that are also called penicillin-binding proteins (PBP’s)
-Prokaryotes that have sterols in their membranes are Mycoplasma
-Ribosomes - 70S in size, with 50S & 30S subunits Eukaryotes 60S, 40S equal 80S
-Capsule - Composed of polysaccharide, except in the anthrax bacillus- polymerized d-glutamic
acid

ATP production for prokaryotes occur in outer membrane

Gram Pos
Thick Layer of Peptidoglycan with teichoic & teichuronic acids
The teichoic acids constitute major surface antigens of gram positive bacteria
Ability to induce septic shock when caused by certain gram positive bacteria
Gram stain purple

Gram Neg
Lipopolysaccharide: Consists of lipid A attached to a polysaccharide
-Constitutes the endotoxin of GNB
-Polysaccharide determines the major surface antigen- O Antigen
-Lipid A- associated with toxicity – pyrogenicity, lethal effect & tissue necrosis
Gram stain pink/red
Batalactimases in periplasmic spaces of gram neg

( These Rascals May Microscopically Lack Color )

Genetics - 3 processes that help in transfer of genes transformation, transduction and
conjugation

Transformation - naked dna uptake

-Requires free DNA
-Requires competent cells (capable of binding and importing free DNA from the environment)
-Captured DNA is incorporated by homologous recombination
Examples of transformation - Haemophilus influenzae, Streptococcus pneumoniae, Bacillus
species, and Neisseria species(SHiN-B)

Conjugation - Gene transfer from one bacterial cell to another involving direct cell-to-cell
contact
Because of fertility factor of sex pili, abx resistant genes are transfered among gram neg more
commonly

Transduction- by phage mediated transmission

Mnemonic for phage-mediated pathogenic factors = COBEDS
C: Cholera toxin, O: Presence of specific prophage in Salmonella can affect O antigens,
B: Phage CE or DE cause Clostridium botulinum to produce Botulinum toxin, E: Exotoxins A–C
(erythrogenic or pyogenic) of Streptococcus pyogenes, D: Prophage beta causes
Corynebacterium diphtheriae to make Diphtheria toxin, S: Shiga toxin
Abx
VRSA (50S ribosomes inhibition)- linzolides etc
Damage cell membrane by creating pores - Daptomycin and polymyxin
Mechanism of action of vancomycin - Vancomycin binds directly to the d -alanine- d -alanine
portion of the pentapeptide, which blocks the transpeptidase from binding, whereas the β-lactam
drugs bind to the transpeptidase itself. Resistance: Occurs in bacteria (eg, Enterococcus) via
amino acid modification of D-Ala- D-Ala to D-Ala-D -Lac.
Clindimycin - Treats anaerobic infections above the diaphragm vs metronidazole (anaerobic
infections below diaphragm.
Treatment for highly resistant bacteria
MRSA: vancomycin, daptomycin, linezolid, tigecycline, ceftaroline, doxycycline.
VRE: linezolid, tigecycline, and streptogramins (quinupristin, dalfopristin).
Multidrug-resistant P aeruginosa, multidrug-resistant Acinetobacter baumanii: polymyxins B and
colistin.

ABX resistance
-van a gene acquired by entercoccus species
Mrsa by mec a gene encodes for production of altered pbp which inhibits pcn binding protein
Most of gram neg treat by carbapenem, if resisent polymyxin and cholystin

Know the gram pos and neg flow charts and what tests are used
S. aureus
- most common cause of Osteomyelitis
-Gram post
-catalase +, -Coagulase +
-ferments mannitol
-causes Salmon colored sputum in pneumonia, also causes erythematous abscesses
- TSST cause scalded skin syndrome
-Protein A binds Fc region of Ig antibodies
S. Saprophyticus
- causes UTI in sexually active women
-Catalase +
-Coagulase -
-Novobiocin resistant

S. Epidermidis
- forms biofilm and causes endocarditis with prosthetic devices and catheters
-Catalase +
Coagulase -
-Novobiocin sensitive

Str. pyogenes (group A streptococcus)

- leading bacterial cause of pharyngitis & cellulitis
-Important cause of impetigo, necrotizing fasciitis & streptococcal toxic shock syndrome
-Inciting factor of 2 important immunologic diseases-rheumatic fever & acute glomerulonephritis
-B hemolytic
-hyaluronic acid capsule
-Bacitracin sensitive

Streptococcus agalactiae (group B streptococcus)

-leading cause of neonatal sepsis & meningitis
-bacitracin resistant
-test mom at 35 wks and treat with PCN before delivery

S. Pneumonia
-causes MOPS infections
-rust colored sputum
-optochin sensitive
-lancet shaped diplococci

Enterococcus
-PYR pos
-grows in 6.5 NaCl
-causes UTI, Biliary tree infections, endocarditis
-VRE, treat with Linezolid

Neisseria
- LOS very toxic
-meningitidis ferments maltose and glucose

Selective media
Pertussis - potato blood glycerol (Bordet - Gengou) and charcoal (Regan Lowe)
Neisseria - thayer martin media
H. Influenza - Growth requirement of factor x and factor v

Lactose Fermenting -Macconkey agar turns pink - e coli, klebsiella, serratia, enterobacter and
citrobacter

Pigment producing bacteria

Staph aureus mannitol salt agar- yellow color
Serratia - red color colonies on agar
Prevotella melaninogenica - black pigmented colonies
Pseudomona aeruginosa -blue green pigment

Non lactose fermenting - pale colony growth

Klebsiella -
Only non motile, lactose fermenting, gram neg organism

Salmonella,-
H2S pos

Proteus
-fishy odor, swarming, urease pos, non lactose forming

Pseudomonas aeruginosa
-Produces a grape like odor
-Curved rods

Shigella
-Non motile, non lactose fermenter(pale colorless colonies)
-It is H2S negative
-Transmitted via The five Fs—fingers, flies, food, fomites, and feces
-bloody diarrhea

H pylori
-present in stomach
-urea breath test for diagnosis, strong urease prod converts to ammonia and makes alkaline
which allows it to survive
-curved organism

Campylobacter jejuni
-grows well at 42°C
-most common cause of infectious diarrhea world wide

Ecoli -
EPEC - pediatric diarrhea
ETEC- travelers diarrhea, causes increase in cAMP and cGMP
EIEC - invasive, related to shigella
EHEC - shiga toxin producing, 0157:H7, HUS, caused by raw hamburger, less than 5y/o
predisposed, ABX CONTRAINDICATED, special media - colorless colonies, does not ferment
sorbitol on macconkey agar, inhibits 28S of 60s ribosome causing death of cell,

Eikenella corrodens
smell faintly of bleach (hypochlorite)
common in human bite infections, especially "reverse bite", "fight bite", or "clenched fist injuries“

Gram pos bacilli

Spore forming - Bacillus-aerobe, clostridium- anaerobe

Non spore forming

C. diphtheria -
Listeria- tumbling motility, grows in cold temps
Nocardia - Filamentous gram pos branching rods, aerobic,weak acid fast
Actinomyces- filamentous gram pos branching rods, anaerobic, non acid fast

Mycobacterium - aerobic, acid fast rod due to cell wall containing mycolic acids, causes
tuberculosis and leprosy

Spirochetes
Treponema Pallidum

Osteomyelitis
S Aureus -most common cause
S Typhi - most common cause in people with Sickle cell

Uti
E coli - most common cause
Proteus - associated with kidney stones (staghorn renal calculi)
Staph saprophyticus - if gram pos

STDs
Urethritis - most common cause gonorrhea- discharge purulent vs Chlamydia - watery
discharge
Gonorrhea - Diplococci with large amt of pustules, many antigenic variations so not able to
make vaccine
Treponema Pallidum (syphilis)- Ulcerative lesions on genitals, painless chancre, rubbery
painless enlarged lymph nodes,
Haemophilus Ducreyi - Soft painful ulcer with large painful lymph nodes
Chlamydia Lymphogranuloma Venereum (LGV) - differentiate by painless ulcer, genital
ulcerations with swollen lymph nodes in the groin, Painful swelling of inguinal and perirectal
lymph nodes
Klebsiella granulomatis - Causes granuloma inguinale characterized by genital
ulcers(painless). Small, painless nodules appear after about 10–40 days. Later, the
subcutaneous nodules burst, creating open, fleshy, oozing lesions. Diagnosed on biopsy-Bacilli
inside phagosomes of large macrophages-Donovan bodies

Pneumonia
Neonatal - group B streptococcus agalactiae , e coli, and listeria
Strep Pneumo -Most common cause of pneumonia overall
Mycoplasma Pneumonia-most common in If young adult living in close quarters, diagnose by
cold agglutination igm type of antibodies
Mycoplasma - no cell wall, uses sterol for synthesis, form Tiny "fried egg" colonies on media
Legionella pneumophila - atypical pneumonia, interstitial infiltrate -
at greatest risk age over 55 smoker alcoholic, water aerosols, hypo natremia, confusion,
growth requirement - fastidious requires cystein and iron (bcye agar)

Rusty sputum - streptococcus pneumonia, salmon sputum staph aureus, currant jelly sputum in
klebsiella
Klebsiella pneumonia - Alcoholic pts at greatest risk
Anaerobes - foul smelling sputum

N.Meningitis
Causes meningitis in close quarters

Gastroenteritis/enterocolitis
- watery diarrhea - cholera, ETEC, c diff and perfringens
-bloody diarrhea - Y enterocolitica, shigella, salmonella, EIEC, EHEC, Campylobacter
Most common bacterial cause - campylobacter
2nd most common - s Typhi (bloody stool)

Mechanism of action
C. Diphtheria - ADP-ribosylation of elongation factor 2(EF2), leads to inhibition of protein
synthesis & cell death, diagnose by pseudomembrane in throat, start antitoxin immediately then
abx treatment
Pertussis - It is A-B subunit toxin, causes ADP-ribosylation of Gi protein, which activate
adenylate cyclase, which increases cAMP, which results in local edema and over secretion of
fluid.
Clinical diagnosis of whooping cough, lab finding lymphocytosis,
txt erythromycin, if child hospitalization
C. perferingens - lecithinase disrupts cell membranes resulting in hemolysis
C. Botulinum - toxin inhibits release of Ach
C. Tetanus - blocks release of inhibitory mediators (glycine and GABA) at spinal synapses,
excitatory neurons are unopposed, extreme muscle spasm, diagnose clinically with lock jaw and
muscle spasm, treatment anti tetanus serum immediately, then tetanus toxoid vaccine
(administration of both active and passive vaccination)
C. difficile - Causes pseudomembranous colitis, Pathogenesis due to taking Antibiotics such as
clindamycin, cephalosporin, ampicillin/amoxicillin, Toxin A: Enterotoxin damages mucosa
leading to fluid increase, Toxin B: cytotoxin causes depolymerization of actin, destroying
cytoskeletal integrity of enterocyte
Cholera - ADP-ribosylation of Gs protein causes the persistent stimulation of adenylate cyclase,
increases cyclic AMP resulting in massive watery diarrhea
Bacillus Anthracis - Edema factor - increases the intracellular concentration of cAMP,
outpouring of fluid and local edema Lethal factor is a protease. Cleaves the phosphokinase that
activates MAP Kinase signal transduction pathway.This inhibits cell growth, leading to
apoptosis, cell death and the necrotic skin lesion(black eschar)
Pseudomonas - ADP ribosylation of eukaryotic elongation factor-2 (EEF-2)

Transmission
Cholera - shellfish
Botulinum - canned food for adults, honey for infants
S aureus - mayo containing foods, rapid onset of vomiting within 6 hrs
Bacillus cereus- reheated fried rice, rapid onset of vomiting within 6hrs
Campylobacter jejuni - poultry prod,
Salmonella typhi- poultry and egg products- bloody diarrhea
Listeria- Unpasteurized milk and milk products

Zoonotic diseases
Pasteurella multocida-Cat bite
Bartonella henselae - Cat scratch
Francisella tularensis-reservoir is Rabbits and transmission is by dermacenter ticks, ulcerative
lesions and lymphadenopathy
Bacillus Anthracis-”wool sorters disease” exposure to animal hides or wool, black eschar
clinically
Yersinia pestis - reservoir is rodents and is transmitted by flea bites, causes plague in
southwestern US (endemic) ,bipolar staining of bacilli, swollen tender lymph glands
Yersinia enterocolitica and pseudotuberculosis- causes pseudo appendicitis - transmitted by
eating raw pork
Brucella - transmitted via unpasteurized dairy products... goat milk-Brucella melitensis, cattle
-Brucella abortus, pigs-Brucella suis
Chlamydia psittaci- humans affected by inhaling birds feces e.g., parrots, pigeons, & poultry,
unable to gram stain chlamydia
Rickettsia - Small gram negative, nonmotile rods(coccobacilli), obligate intracellular parasites
Coxiella Burnetii - q fever, no insect vector
Rocky mountain spotted fever -rash begins on periphery and spreads upwards becomes
petechial, mortality is high and spreads via tick bites
Rickettsialpox- mites, at site of bite presence of black eschar, vesicular rash on body
Scrub typhus-caused by chiggers larvae, triad of symptoms in 50% of cases: an eschar at the
site of bite, regional lymphadenopathy & maculopapular rash
Microorganisms are important cause of human disease; they can have either prokaryotic or
eukaryotic type of cell. Which of the following sets of microbes have the eukaryotic type of cell
structure?
A. Helminths and viruses
B. Virus and bacteria
C. Bacteria and fungi
D. Fungi and Protozoa
E. Bacteria and helminths

Bacteria, fungi (yeasts and molds), viruses, and protozoa are important causes of human
disease. Which one of the following microbes has the prokaryotic type of cell structure?
Fungi
Protozoa
Virus
Bacteria
Helminths

A 76-year-old woman with a prosthetic (artificial) hip comes to you complaining of fever and pain
in that joint. You are concerned about an infection by S. epidermidis. Using your knowledge of
normal flora, what is the most likely source of this organism?
(A) Dental plaque
(B) Mouth
(C) Skin
(D) Stomach
(E) Vagina

A 30-year-old woman with a previous history of rheumatic fever who has had fever for the past 2
weeks. On examination, you find a new heart murmur. You suspect endocarditis and do a blood
culture, which grows a viridans group streptococcus later identified as S. sanguinis. Using your
knowledge of normal flora, what is the most likely source of this organism?
(A) Duodenum
(B) Skin
(C) Oral cavity
(D) Urethra
(E) Vagina

Which of the following cell components that is unique to bacterial cell and not found in
eukaryotic cell?
Ribosome
DNA
Cell wall peptidoglycan
RNA
Flagella

An outbreak of postsurgical wound infections caused by S. aureus has occurred in the hospital.
The infection control team was asked to determine whether the organism could be carried by
one of the operating room personnel. Using your knowledge of normal flora, which one of the
following body sites is the most likely location for this organism?
(A) Colon
(B) Gingival crevice
(C) Mouth
(D) Nose
(E) Throat

what’s the difference between viruses and bacteria?” Which one of the following would be the
most accurate statement to make?
(A) Viruses do not have mitochondria, whereas bacteria do.
(B) Viruses do not have a nucleolus, whereas bacteria do.
(C) Viruses do not have ribosomes, whereas bacteria do.
(D) Viruses replicate by binary fission, whereas bacteria replicate by mitosis.
(E) Viruses are prokaryotic, whereas bacteria are eukaryotic.

Bacteria, fungi (yeasts and molds), viruses, and protozoa are important causes of human
disease. Which one of the following microbes contains either DNA or RNA but not both?
(A) Bacteria
(B) Molds
(C) Protozoa
(D) Viruses
(E) Yeasts

Which one of the following contains DNA that is not surrounded by a nuclear membrane?
(A) Bacteria
(B) Molds
(C) Protozoa
(D) Yeasts

Mitochondria are missing in

Filamentous fungi,
Protozoan parasites,
Bacteria
Yeasts,
Helminths

A culture isolates from a patient with subacute endocarditis is reported to be gram positive and
possess a complex carbohydrate cell wall. What is the most likely taxonomic group of the causal
agents?
Fungus,
parasite,
prion,
prokaryote,
virus

If essential growth factors are provided bacteria follow a geometric fashion of cell growth, which
can be observed by plotting a growth curve having different phases, shown in given image here.
In which phase do the bacteria have exponential (logarithmic) growth?

Phase a
Phase c
Phase d
Phase b
Phase e

Cefazolin is often given prior to surgery to prevent postsurgical wound infections. Which of the
following best describes the mode of action of cefazolin?
It acts as an electron sink depriving the bacteria of reducing power
It binds to the 30S ribosome and inhibits bacterial protein synthesis
It inhibits transcription of bacterial mRNA
It inhibits transpeptidases needed to synthesize peptidoglycan
It inhibits folic acid synthesis needed to act as a methyl donor

Which of the following drugs inhibits bacterial nucleic acid synthesis by blocking the production
of tetrahydrofolic acid?
Ceftriaxone
Erythromycin
Metronidazole
Rifampin
Trimethoprim

Regarding both penicillins and aminoglycosides, which of the following is the most accurate?
Both act at the level of the cell wall
Both are bactericidal drugs
Both require an intact β-lactam ring for their activity
Both should not be given to children under the age of 8 years because damage to cartilage can
occur
They should not be given together because they are antagonistic

Listed below are drug combinations that are used to treat certain infections. Which of the
following is a combination in which both drugs act to inhibit the same metabolic pathway?
Ceftriaxone and azithromycin
Isoniazid and rifampin
Penicillin G and gentamicin
Sulfonamide and trimethoprim

Regarding antimicrobial drugs that act by inhibiting nucleic acid synthesis in bacteria, which of
the following is the most accurate?
Ciprofloxacin inhibits RNA polymerase by acting as a nucleic acid analogue
Rifampin inhibits the synthesis of messenger RNA
Sulfonamides inhibit DNA synthesis by chain termination of the elongating strand
Trimethoprim inhibits DNA polymerase by preventing the unwinding of double-stranded DNA

Rifampin- only drug that Inhibits mRNA synthesis by inhibiting RNA polymerase

Which antibiotic causes significant neurotoxicity and must be taken in conjunction with
pyridoxine (vitamin B6) to prevent these neurologic complications?
Amoxicillin
Ceftriaxone
Isoniazid
Rifampin
Vancomycin

Inhibits mycolic acid synthesis - basis of acid fast used in treatment of mycobacterium

Of the following antibiotics, which causes the most phototoxicity (rash when exposed to
sunlight)?
Nafcillin
Ciprofloxacin
Gentamicin
Metronidazole
Sulfamethoxazole - most common
Which of the following antibiotics causes “red man” syndrome?
Azithromycin
Doxycycline
Gentamicin
Sulfamethoxazole
Vancomycin - can also cause Dress syndrome

Your laboratory isolates an entirely new and unknown pathogen from one of your patients, which
has all the characteristics of an aerobic filamentous fungus expect that the ribosomes are
prokaryotic. Unfortunately, your patient with this pathogen is very ill. Which agent would most
likely be successful in treating your patient?
Third generation of cephalosporins
Isoniazid
Metronizadole
Careful limited usage of Shiga toxin
Tetracycline

Targets 30 S ribosomes, also aminoglycosides target the same

Which of the following agents if introduced into growing culture of bacteria, would halt growth
but, if then removed would allow growth to resume?
Antiseptic
Bacteriocide
Bacteriostat
Disinfectant
Sterilizing agent

A bacterial isolate from a patient with chronic sinusitis is shown to be sensitive to amoxicillin on
a Kirby-Baur agar disc diffusion test. A follow-up determination of the MIC(inhibits visible growth)
of the drug is reported back from the laboratory at 2 µg/ml with an MBC(kills bacteria) of 1µg/ml
what is the correct interpretation of this data?
The drug is bactericidal
The drug is bacteriostatic
The drug should be administered to the patient at 1 micro gram/ml
The drug should be administered to the patient at 2 micro gram/ml
There has been a laboratory error
Lower conc required to inhibit, higher conc required to kill

Regarding the specific mechanisms by which bacteria become resistant to antimicrobial drugs,
which one of the following is the most accurate?
Some bacteria contain an enzyme that cleaves the ring of aminoglycosides
Some bacteria contain clavulanic acid, which binds to penicillin G and inactivates it
Some bacteria contain a mutated gene encoding an altered transpeptidase, which makes them
resistant to doxycycline
Some bacteria contain a mutated gene that encodes an altered RNA polymerase, which makes
them resistant to rifampin
Some bacteria contain an altered ribosomal protein, which makes them resistant to isoniazid

Rifampin - Inhibits RNA polymerase, will not cleave rings

The susceptibility of bacteria to an antibiotic is often determined by using the minimal inhibitory
concentration (MIC) assay. Regarding the MIC assay, which one of the following is the most
accurate?
MIC is the lowest concentration of the bacteria isolated from the patient that inhibits the activity
of a standard dose of antibiotic
MIC is the lowest concentration of antibiotic that inhibits the growth of the bacteria isolated from
the patient
MIC is the lowest concentration of antibiotic that kills the bacteria isolated from the patient
MIC is the lowest concentration of antibiotic in the patient’s serum that inhibits the activity of a
standard dose of antibiotic

A burn patient develops a purulent infection at the site of skin graft. Culture of the pus is positive
for pseudomonas aeruginosa. The patient is started on anti-pseudomonal penicillin while a
kirby-Bauer agar disc diffusion test is requested for the isolate. The results are shown on the
plate

The patient is most sensitive to antibiotics i and ii

The patient is most sensitive to antibiotics i and iii
The patient is most sensitive to antibiotics ii and iii but the result can not be analyzed without a
key
The patient is most sensitive to antibiotics iii and iv
The patient is most sensitive to antibiotics iv

A 48-year-old woman with diabetes is brought to the emergency department in a confused state.
Earlier, she complained of fever, joint pains, vomiting, and profuse diarrhea. Her temperature is
41C blood pressure is 90/60mmHg, and pulse is 100/min and regular. A peeling, erythematous
rash resembling sunburn is present over palms or her hands and soles of her feet. The
conjunctiva are inflamed. The attending physician notes an old wound dressing on one finger
that covers a purple, inflamed cut. The toxin elaborated by the likely pathogen produces
pathology in which of the following?

It induces adenylate cyclase

It inhibits protein synthesis on 60S ribosomal subunit
It is a neurotoxin
It is a superantigen
It ribosylates EF-2

Signs suggest toxic shock syndrome, path is s aureus, know mechanism and signs and
symptoms

A 5 year old boy develops several honey crusted lesions on the face; gram staining of the
exudates showed gram positive cocci in chains. The simplest test of this illness to determine the
genus of bacteria is the
Coagulase test
Oxidase test
Bile solubility test
Urease test
Catalase test

Honey crusted lesions of impetigo can be caused by staphylococcus and streptococcus

- first test used - catalase - if pos it is staphylococcus if neg then streptococcus, 2nd test
used - coagulase test - if neg then it is streptococcus, 3rd test used -novobiocin - if
sensitive then s epidermidis, if resistant S saprophyticus

You’re in the clinical laboratory looking at a Gram stain when the laboratory technician comes up
to you and says, “I think your patient has Staphylococcus epidermidis bacteremia.” Which one
of the following sets of results did the tech find with the organism recovered from the blood
culture?
Gram-positive cocci in chains, catalase-positive, coagulase-positive
Gram-positive cocci in chains, catalase-negative, coagulase-negative
Gram-positive cocci in clusters, catalase-positive, coagulase-negative
Gram-positive cocci in clusters, catalase-negative, coagulase-positive
Gram-positive diplococci, catalase-negative, coagulase-positive

And novobiacin sensitive

Superantigen production by Staphylococcus aureus is involved in the pathogenesis of which

one of the following diseases?
Impetigo
Osteomyelitis
Scalded skin syndrome
Septicemia
Toxic shock syndrome

Which one of the following is the virulence factor produced by Staphylococcus aureus that
prevents the activation of complement and thereby reduces opsonization by C3b?
Catalase
Coagulase
Endotoxin
Protein A
Teichoic acid

The main reason why methicillin-resistant Staphylococcus aureus (MRSA) strains are resistant
to methicillin and nafcillin is:
They produce β-lactamase that degrades the antibiotics
They have altered penicillin-binding proteins that have reduced binding of the antibiotics
They have mutant porin proteins that prevent the antibiotics from entering the bacteria
They have plasmid-encoded export proteins that remove the drug from the bacteria

Gene responsible for this is Mec A gene, chromosomal mediated codes for alteration in
PBP

A pore-forming exotoxin produced by Staphylococcus aureus that kills cells and is important in
the severe, rapidly spreading necrotizing lesions caused by MRSA strains is:
Coagulase
Enterotoxin
Exfoliatin
P-v Leukocidin
Staphyloxanthin

Kills the leukocytes, killed by formation of the pores, most commone in CMRSA
(community aquired)

Of the following antibiotics, which one is the most appropriate to treat a severe necrotizing skin
infection caused by an MRSA strain of Staphylococcus aureus?
Amoxicillin
Ceftriaxone
Ciprofloxacin
Gentamicin
Vancomycin

VRSA drug of choice Linozelid, Tigecycline

A mother notices that her 6-year-old boy’s left knee is swollen, red, warm to the touch, and
movement is painful. She brings her son to see their pediatrician, who removes 15 ml of cloudy
fluid from the knee. A Gram stain and culture of the fluid shows gram-positive cocci arranged in
clusters. Which organism is most likely the cause of the boy’s symptoms?
Staphylococcus aureus
Bacillus cereus
Enterococcus faecalis
Neisseria gonorrhoeae
Streptococcus pyogenes

Clinical syndrome - septic arthritis

A 60-year-old woman with a prosthetic (artificial) hip comes to the clinic complaining of fever
and pain in that joint. Gram positive cocci in clusters, catalase positive, coagulase negative and
sensitive to novobiocin were grown in culture. It is probably a normal flora, what is the most
likely source of this organism?
Duodenum
Throat
Skin
Urethra
Vagina

staph epidermidis

Which one of the following best describes the pathogenesis of rheumatic fever?
An exotoxin produced by Streptococcus pyogenes that acts as a superantigen damages cardiac
muscle
An exotoxin produced by Streptococcus pyogenes that ADP-ribosylates a G protein damages
joint tissue
Antibody to the capsular polysaccharide of Streptococcus pyogenes cross-reacts with joint
tissue and damages it
Antibody to the M protein of Streptococcus pyogenes cross-reacts with cardiac muscle and
damages it
Endotoxin produced by Streptococcus pyogenes activates macrophages to release cytokines
that damage cardiac muscle

Which one of following laboratory tests is the most appropriate to distinguish Streptococcus
pyogenes from other β-hemolytic Streptococci?
Ability to grow in 6.5% NaCl
Activation of C-reactive protein
Hydrolysis of esculin in the presence of bile
Inhibition by bacitracin
Inhibition by optochin
Infections by which one of the following bacteria are typically treated with penicillins such as
amoxicillin, because they exhibit neither low-level resistance nor high-level resistance and
synergy with an aminoglycoside is not required in order for penicillins to be effective?
Enterococcus faecalis
Staphylococcus aureus
Staphylococcus epidermidis
Streptococcus pneumoniae
Streptococcus pyogenes

Combinations of aminoglycosides and PCN usually used for treatment of Enterococcus,

but till now s pyogenes not capable of getting resistant to PCN

A patient in the emergency room has a 5-cm ulcer on her leg that is surrounded by a red, warm,
and tender area of inflammation. Gram stain on pus from the ulcer revealed gram-positive cocci
in chains. Culture of the pus grows small β-hemolytic colonies that are catalase-negative and
are inhibited by bacitracin. These results indicate that the organism causing this lesion is most
likely:
Enterococcus faecalis
Staphylococcus aureus
Streptococcus agalactiae
Streptococcus pneumoniae
Streptococcus pyogenes

Not staph cause catalase neg, look for hemolysis, if bacitracin sensitive it is pyogenes, if
resistant it is agalactiae

The Jones family of four had a delicious picnic lunch last Sunday. It was a warm day, and the
food sat in the sun for several hours. Alas, 3 hours later, everyone came down with vomiting and
nonbloody diarrhea. In the emergency room, it was found that Mrs. Jones, who prepared the
food, had a paronychia on her thumb. Which one of the following is the most likely causative
organism?
Enterococcus faecalis
Staphylococcus aureus
Staphylococcus epidermidis
Streptococcus agalactiae
Streptococcus pyogenes
Can cause food poisoning within 2-6hrs of ingesting food. Usually will manifest with
vomiting due to enterotoxin and type of superantigen

A 20-year-old sexually active woman reports dysuria and other symptoms of a urinary tract
infection. Gram stain of the urine reveals gram-positive cocci. Which one of the following sets of
bacteria is most likely to cause this infection?
Staphylococcus aureus and Streptococcus pyogenes
Staphylococcus saprophyticus and Enterococcus faecalis
Streptococcus agalactiae and Staphylococcus epidermidis
Streptococcus pneumoniae and Enterococcus faecalis
Streptococcus pyogenes and Streptococcus pneumoniae

A-3-year old boy is brought to his primary care physician with vesicular lesions over face, some
or which have ruptured. He has no history of fever or other symptoms. Physical examination
reveals several vesicles. Beta-hemolytic colonies that are catalase-negative are grown on blood
agar from a culture exudate. Which of the following sequlae would most likely be associated
with the probable pathogen?
Guillian Barre syndrome
Toxic shock syndrome
Rheumatic fever - from tonsillitis (throat infections)
Glomerulonephritis - not rheumatic fever because he has lesions on face
Endocarditis

B-hemolytic colonies catalase neg so not staph grown on blood agar.

How do you classify streptococcus - do catalase test which should be neg, then look for
hemolysis on blood agar

A 26-year-old woman gives birth to a full –term infant after a difficult vaginal delivery. The child is
normal at the time of birth but thereafter becomes irritable, developing a fever of 40C and a
bulging fontanelle. Early nuchal rigidity is noted. Which of the following test performed on
isolates from the cerebrospinal fluid would most likely confirm the most likely diagnosis?
A bacitracin sensitivity
A CAMP test
Coagulase Test
Growth on bile esculin agar
Optochin sensitivity

Organism is s agalactiae most common cause of neonatal meningitis, most common

cause of meningitis in all age groups s pneumonia

A 2-week-old infant who was well until 2 days ago, when she stopped feeding and became
irritable. She now has a fever to 38°C, developed a petechial rash all over her body, and is very
difficult to arouse. In the emergency room, a blood culture and a spinal tap were done. Gram
stain of the spinal fluid showed gram-positive cocci in chains. Culture of the spinal fluid on blood
agar revealed β-hemolytic colonies that grew in the presence of bacitracin and hydrolyzed
hippurate. Which one of the following is the most likely causative organism?
Staphylococcus aureus
Streptococcus agalactiae
Streptococcus mutans
Streptococcus pneumoniae
Streptococcus pyogenes
Bacitracin resistant and hippurate pos

A-71-year-old man is admitted from his extended care facility (nursing home) because of recent
aggravation of an exfoliative skin condition that has plagued him for several years. He had been
receiving a variety of topical antibiotics regimens over the last year or two. He now has a
temperature of 38.9oC. The skin of upper chest, extremities, and neck shows erythema with
diffuse epidermal peeling and many pustular lesions. Cultures obtained from these lesions were
reported back from the lab as yielding a gram-positive organism that is highly salt tolerant. What
lab result is used to confirm the species of causal agent?
Bacitracin sensitivity
Bile solubility
Catalase production
Coagulase production
Optochin sensitivity

Staphylococcus infection, highly salt tolerant, look for coagulase prod

An outbreak of serious pneumococcal pneumonia and sepsis among inmates in an

overcrowded prison has occurred. Laboratory analysis determined that one serotype was
involved. The prison physician said that the pneumococcal vaccine might have limited the
outbreak. Which one of the following structures of the pneumococcus is responsible for
determining the serotype and is also the immunogen in the vaccine?
Capsule
Flagellar protein
O antigen
Peptidoglycan
Pilus protein

A 50-year-old woman who has a community-acquired pneumonia caused by Streptococcus

pneumoniae. Antibiotic susceptibility tests reveal an MIC of less than 0.1 mg/ml to penicillin G
(sensitive). Which one of the following is the best antibiotic to treat the infection?
Clindamycin
Gentamicin
Metronidazole or doxycycline
Penicillin G or levofloxacin
Vancomycin
A 4-year-old child has several bouts with pneumococcal pneumonia. His serum level of some
complement components are found low despite of normal values of all Ig. Which of the following
deficiency could explain this problem?
C1
C2
C3
C4
C5

A-55-year old alcoholic man was diagnosed a lobar pneumonia, his sputum shows numerous
GPC in short chains and pairs. His serum contains high titers of IgM antibodies specific for the
polysaccharide capsule of S.pneumoniae. The effector protective mechanism most likely act in
concert with this early IgM production to clear infection is
ADCC
Complement mediated opsonization
Cytotoxic T lymphocytes
LAK cells
NK cells

For all capsulated organisms

A 65-year-old man develops pneumonia. The organisms isolated from the sputum are gram-
positive cocci that are alpha hemolytic on blood agar and sensitive to optochin. Which structure
of the causal agent provides protection against phagocytosis?
Capsule
Catalase
Coagulase
M protein
Teichoic acid

A 10-year-old child develops glomerulonephritis a weak after he was treated for a impetigo (or
can be sore throat). The causal agent is identified by serotyping of the
Capsule
M protein
Lipopolysaccharide
Protein A
Teichoic acid

Step pyogenes

A-13-year-old girl presents to her pediatrician with fever, malaise, and a sore throat. Physical
examination reveals a fever of 103F, cervical lymphadenopathy, and pharyngeal erythema. A
swab is taken from some of the tonsillar exudate and cultured on blood agar. Culture reveals
beta hemolytic, gram-positive cocci, and rapid antigen test is positive. Which of the following
sequlae would likely be associated with this pathogen?
Guillian Barre syndrome
Toxic shock syndrome
Rheumatic fever
Meningitis
Endocarditis
A 55-year-old woman had her rheumatic heart valve replaced with prosthetic valve. Six blood
cultures became positive after 3 days of incubation. An optochin-resistant, catalase-negative
gram-positive coccus that was alpha-hemolytic was isolated. What was the most likely causal
agent?
Streptococcus viridans
Pseudomonas aeruginosa
Serratia marcescens
Staphylococcus aureus
Streptococcus pneumoniae

Alpha hemolytic - strep pneumonia and s viridans, differentiate by optochin sensitivity, if

resistant it is viridans

A 70-year-old woman is brought to the emergency department by her spouse with complaints of
shortness of breath and fever. Physical examination revealed a fever of 103oF, hypotension,
and a diastolic murmur. History revealed a cardiac valve replacement 5 years earlier. Three
consecutive blood cultures taken during febrile periods revealed gram-positive cocci that were
catalase-negative and bile-esculin test positive. Which of the following organisms is most likely
cause?
Enterococcus faecalis
Kingella kingae
Staphylococcus aureus
Staphylococcus epidermidis
Staphylococcus saprophyticus

A 60-year-old woman is hospitalized following a stroke and develops a high-grade fever with
chills. She is catheterized due to urinary incontinence and receives cephalosporin for treatment
of pneumonia. Blood cultures and Gram stain are performed by the laboratory. The organisms
isolated are gram-positive cocci that are catalase-negative and capable of growth in 6.5%
sodium chloride. Which of the following is the most likely causal agent?
Enterococcus faecalis
Staphylococcus aureus
Staphylococcus epidermidis
Streptococcus pyogenes
Viridans streptococci

A-15-year-old girl develops a sore throat, fever, and earache of approximately 1 week duration.
Upon examination by her physician, an erythematous rash is noted covering most of her body
and her tongue appears bright red. Which of the following is the description of the causal agent?
Gram-positive coccus, alpha hemolytic, catalase negative
Gram-positive coccus, beta hemolytic, catalase negative
Gram-positive coccus, alpha hemolytic, catalase positive
Gram-positive coccus, beta hemolytic, catalase positive
Gram-positive coccus, gamma hemolytic, catalase negative
Organism is strep pyogenes, disease is scarlett fever (strawberry tongue, sandpaper
rash, sore throat in your children) gram pos beta hemolytic and catalase neg

A 70-year-old man come down with endocarditis caused by Enterococcus faecalis. Which one of
the following is the best combination of antibiotics to treat the infection?
Azithromycin and trimethoprim-sulfamethoxazole
Chloramphenicol and rifampin
Doxycycline and levofloxacin
Metronidazole and clindamycin
Penicillin G and gentamicin

Always combo of pcn and gentamicin - best acting against enterococcus

A 21-year-old student was seen by his family physician with complaints of pharyngitis.
Examination of the pharynx revealed patchy erythema and exudates on the tonsillar pillars.
Throat smear showed gram-positive cocci in chains and gram-negative diplococci. He admitted
to having been sexually active. What is the significance of the Gram stain smear in this case?
It provides rapid means of diagnosing the infection
It indicates laboratory contamination
It is not useful as it is not possible to make a diagnosis this way
It strongly suggest gonococcal pharyngitis
It is evidence of infection with hemolytic Streptococci and Neisseriae

Gram neg could be moraxella common of resp tract and other streptococcus

Regarding the differences between N. meningitidis and N. gonorrhoeae , which one of the
following is the most accurate statement?
Meningococci are oxidase-positive, whereas gonococci are not
Meningococci have a thick polysaccharide capsule, whereas gonococci do not
Meningococci have lipid A, whereas gonococci do not
Meningococci produce penicillinase, whereas gonococci do not
Meningococci synthesize IgA protease, whereas gonococci do not

M will ferment maltose and glucose, G will only ferment glucose

A 14-year-old girl who was sent home from school because she had a fever of 102°C, a severe
headache, and was falling asleep in class. When her fever rose to 104°C, her mother took her
to the emergency room, where a blood pressure of 60/20 and several petechial hemorrhages
were found. Gram-negative diplococci were seen in a Gram stain of the spinal fluid. Which one
of the following is most likely to cause the fever, hypotension, and petechial hemorrhages?
Endotoxin
IgA protease
Oxidase
Pilus protein
Superantigen

Case of meningococcus - waterhouse frediricks syndrome, low bp and petechial hemmorrage,

and fever endotoxin lipoligosaccharides not lps

Regarding the patient in question above which one of the following is the best antibiotic to treat
the infection?
Azithromycin(macrolide) - 30s ribosome synthesis inhibition
Doxycycline - t for tetra, 30s ribosome synthesis inhibition
Penicillin G - cross linking inhibition of peptidoglycan
Rifampin - rna polymerase
Ceftriaxone - cross linking of peptioglycan synthesis inhibition

Regarding the differences between meningococci and gonococci, which one of the following is
the most accurate statement?
Humans are the reservoir for both organisms
Many clinical isolates of meningococci produce β-lactamase, but clinical isolates of gonococci
do not
Meningococci have multiple antigenic types, but gonococci have only one antigenic type
The conjugate vaccine against gonorrhea contains seven types of the pilus protein as the
immunogen
The main mode of transmission for both organisms is respiratory droplets

A 20-year-old man with a urethral exudate. You do a Gram stain of the pus and see gram-
negative diplococci with neutrophils. Which one of the following is the best antibiotic to treat the
infection?
Ceftriaxone or oral cefixime - crosslinking of peptidoglycans
Gentamicin
Penicillin G
Trimethoprim-sulfamethoxazole
Vancomycin

Case of gonnorheae -

A 19-year-old man was brought to the emergency department by his dorm mate with a petechial
rash, headache, nuchal rigidity and vomiting. Which of the following describes the most likely
causal agent?
Gram negative cocci, capsule, ferments maltose
Gram negative cocci ferments glucose only
Gram negative coccus bacillus capsular serotype b
Gram negative cocci, alpha hemolytic, optochin sensitive
Gram positive rods, growth at 4C
Meningitis due to N meningitidis, if older it would be strep pneumoniae which would be
gram pos alpha hemolytic and optochin sensitive

A 31-year-old man is treated for a fourth episode of disseminated Neisseria gonorrhea infection
in the last five years. He had no previous history of unusual or recurrent infections. If he has an
immunologic defect, which of the following is most likely?
Common variable immunodeficiency
C 8 deficiency
DiGeorge syndrome
Selective IgA deficiency
Severe combined immunodeficiency

A gram-negative coccobacillus was recovered on chocolate agar from the CSF of an

immunosuppressed patient. The organism was nonmotile and positive for indophenol oxidase
but failed to grow on MacConkey agar. The organism was highly susceptible to penicillin. The
most probable identification is
Acinetobacter spp
Pseudomonas aeruginosa
Pseudomonas stutzeri
Moraxella lacunata
Neisseria meningitidis

A Gram stain of a urethral discharge from a man showing extracellular and intracellular gram-
negative diplococci within segmented neutrophils is a presumptive identification for:
Neisseria gonorrhoeae
Neisseria meningitidis
Moraxella (Branhamella) catarrhalis
Neisseria lactamica
Chlamydia trachomatis

A 20-year-old woman presents with a history of vaginal discharge for the past 3 days. On pelvic
examination, you see a mucopurulent exudate at the cervical os, and there is tenderness on
palpation of the right fallopian tube. You do a Gram stain and culture on the cervical discharge.
The culture is done on Thayer-Martin medium, which is a chocolate agar that contains
antibiotics that inhibit the growth of normal flora. Of the following, which findings are the MOST
likely to be found?
A Gram stain reveals many neutrophils and spirochetes, and culture on Thayer-Martin medium
reveals no colonies
A Gram stain reveals many neutrophils and gram-variable rods, and culture on Thayer-Martin
medium reveals β-hemolytic colonies
A Gram stain reveals many neutrophils and gram-negative diplococci, and culture on Thayer-
Martin medium reveals oxidase-positive colonies - N Gonorrehae
A Gram stain reveals many neutrophils but no gram-negative diplococci are seen, and culture
on Thayer-Martin medium reveals coagulase-positive colonies
A Gram stain reveals many neutrophils but no gram-negative diplococci are seen, and culture
on Thayer-Martin medium reveals Chlamydia trachomatis

A 6-year-old boy got his ear hurts. His mother says this began yesterday and that he has a fever
of 103°F. On physical exam, you see a perforated ear drum that is exuding a small amount of
pus. Using a swab, you obtain a sample of the pus and do a Gram stain and culture. The Gram
stain reveals small cocco-bacillary rods. There is no growth on a blood agar plate, but a
chocolate agar plate supplemented with X and V factors grows small grey colonies. Which
one of the following bacteria is the most likely cause of his otitis media?
Bordetella pertussis
Haemophilus influenzae
Klebsiella pneumoniae
Legionella pneumophila
Pseudomonas aeruginosa

A 45-year-old man presents to the emergency department with shortness of breath and a
productive cough. His sputum was gelatinous and bloody. Gram stain of the sputum revealed
numerous PMNs and gram-negative rods. Which of following descriptions is most likely to fit the
patients?
Alcoholic - klebsiella pneumoniae
Homeless
Hiker
IV drug user
Veterinarian

A 75-year-old woman with a 110 pack-year history of cigarette smoking who now has a fever of
39°C and a cough productive of yellowish sputum. Gram stain of the sputum shows small gram-
negative rods. There is no growth on blood agar, but colonies do grow on chocolate agar
supplemented with hemin and NAD. Which one of the following bacteria is the most likely
cause of her pneumonia?
Bordetella pertussis
Haemophilus influenzae
Klebsiella pneumoniae
Legionella pneumophila
Pseudomonas aeruginosa

A 5-year-old boy with a high fever and signs of respiratory tract obstruction. Visualization of the
epiglottis shows inflammation characterized by marked swelling and “cherry-red” appearance.
Which one of the following is the best antibiotic to treat the infection?
Ampicillin
Ceftriaxone
Doxycycline
Gentamicin
Metronidazole
A 70-year-old, smoker, man with fever dry cough tachypnea and chest pain, a sputum sample
isolated organisms that grew on buffered charcoal yeast extract agar stained weakly gram
negative. Which of the following properties consistent with the organism?
Capsule
No cell wall
Optochin sensitive
Require iron and cysteine for growth
Serpentine growth in vitro

Legionella pneumophila - contains growth factors like iron and cysteine. Risk factors
alcoholic, older, chronic smoker. Transmitted through aerosols, not human to human
transmission

A 5-year-old child of an Eastern European immigrant is brought to pediatric clinic. The child is
weak exhausted from a week of paroxysmal coughing with inspiratory whoops, frequently
associated with vomiting. The parents profess religious objections to childhood vaccinations, but
permit withdrawal of blood sample, which reveals a lymphocytosis of 44000/mm3. Production of
lymphocytosis, insulin secretion, and histamine sensitization are all results of which attribute of
this organism?
Motility
Adenylate cyclase toxin
Beta-hemolysin
Anaerobic growth
Pertussis toxin
Filamentous hemagglutinin

An 8-year-old boy presents to emergency department with vomiting and severe cough in which
he can’t catch his breath. His vaccination history is incomplete. Physical exam reveals fever and
conjunctival injection. A nasopharyngeal aspirate grew gram-negative coccobacilli on Bordet-
Gengou media. What is the mechanism of action of toxin involved?
ADP ribolysation of eukaryotic elongation factor-2 (eEf-2)
ADP ribolysation of Gi protein - causes increase of cAMP and outpouring of fluids and other
secretions
ADP ribosylation of GTP-binding protein
Blocks release of acetylcholine
Blocks release of inhibitory transmitters GABA and glycine

Selective media potato blood agar and charcoal media -pertussis

A small gram-negative rod that causes an important respiratory tract disease, produces an
exotoxin that ADP-ribosylates a G1 protein. One remarkable feature of disease is a great
increase in lymphocytes. Doesn’t cause disease commonly in the United States now because of
the widespread use of the vaccine that induces antibodies against the exotoxin. The identity of
the mystery organism is mostly likely which of the following?
Bordetella pertussis
Haemophilus influenzae
Klebsiella pneumoniae
Legionella pneumophila
Pseudomonas aeruginosa

A 75-year-old man who has smoked cigarettes (two packs a day for more than 50 years) and
consumed alcoholic drinks (a six pack of beer each day) for most of his adult life. He now has
the signs and symptoms of pneumonia. Gram stain of the sputum reveals neutrophils but no
bacteria. Colonies appear on buffered charcoal yeast (BYCE) agar but not on blood agar. Which
one of the following bacteria is most likely to be the cause of his pneumonia?
Bordetella pertussis
Haemophilus influenzae
Klebsiella pneumoniae
Legionella pneumophila - associated with bloody diarrhea and pneumonia, hyponatremia leads
to CNS symptoms, confused, take urine sample serogroup 1 can be identified immediately
Pseudomonas aeruginosa

Regarding the patient in above question , which one of the following is the best antibiotic to treat
the infection?
Azithromycin - macrolide 50s ribosome inhibition can be given with Rifampin if
immunocompromised. Most URT infections use azithromycin
Ceftriaxone
Gentamicin
Metronidazole
Piperacillin/tazobactam

You are reading an article that says that otitis media is commonly caused by nonencapsulated
strains of Haemophilus influenzae. You are surprised that nonencapsulated strains can cause
this disease. Which one of the following BEST explains why your surprise is justified?
Nonencapsulated strains would not have endotoxin
Nonencapsulated strains cannot secrete exotoxin A
Nonencapsulated strains should be easily phagocytized
Nonencapsulated strains should be rapidly killed by ultraviolet light
Nonencapsulated strains should be susceptible to killing by cytotoxic T cells

A 50-year-old homeless alcoholic has a fever and is coughing up 1 cup of green, foul-smelling
sputum per day. You suspect that he may have a lung abscess. Which one of the following pairs
of organisms is MOST likely to be the cause?
Listeria monocytogenes and Legionella pneumophila
Nocardia asteroides and Mycoplasma pneumoniae
Fusobacterium nucleatum and Peptostreptococcus intermedius (anaerobes)
Clostridium perfringens and Chlamydia psittaci
A public health epidemiologist is called to investigate an outbreak of bloody diarrhea in 16
people. He found that it is associated with eating rare hamburgers in a particular fast-food
restaurant. A culture of the remaining uncooked hamburger grows a gram-negative rod that
produces a dark purple colony on EMB agar, which is evidence that it ferments lactose. Which
one of the following bacteria is the most likely cause of this outbreak?
Escherichia coli
Salmonella enterica
Salmonella typhi
Shigella dysenteriae
Vibrio cholerae

Species - EHEC 0157H7 child below 5 years at risk of developing hemolytic uremic
syndrome having history of diarrhea for 1 or 2 days admitted with renal complications
Mechanism of action of shiga like toxin inhibits synthesis of 28s subunit of 60s ribosome
Know everything about EHEC
ETEC - prod enterotoxins labile and stable
Labile toxin - increased cAMP outpouring of fluid and inhibition of reabsorption of
electrolytes, watery diarrhea
Stable - increase cGMP
Enteropathogenic - p for pediatric
Enteroinvasive - behaves like shigella, causes bloody diahhrea
Start abx except in EHEC in which it is contraindicated. HUS more common in children

A patient has third-degree burns over most of his body. He was doing well until 2 days ago,
when he spiked a fever, and his dressings revealed pus that had a blue-green color. Gram
stain of the pus revealed a gram-negative rod that formed colorless colonies on EMB agar.
Which one of the following bacteria is the most likely cause of this infection?
Campylobacter jejuni
Escherichia coli
Haemophilus influenzae
Pseudomonas aeruginosa
Salmonella enterica

Colorless on EMB is non lactose fermenting colonies

Direct Test for pseudomonas help to differentiate between other NLF colonies - use
oxidase test
Lactose fermenting colonies under enterobactracia - GMBs, catalase pos, oxidase neg,
nitrate pos, all fermenters
Lactose fermenting colonies on Mac agar - klebsiella, citrobacter, serasia (red colored),
most common cause of UTI Ecoli
Non motile LF prod bacteria, pink colony prominent capsule, gram neg bacteria -
klebsiella
Know Ecoli, Klebsiella, Serasia
Non lactose fermenting all pathogenic forming, non motile Shigella, yersinia pestis non
motile

Regarding the patient in above question , which one of the following is the best combination of
antibiotics to treat the infection?
Azithromycin plus gentamicin - (macrolide) 50s inhibition
Doxycycline plus gentamicin - 30s inhibition
Metronidazole plus gentamicin - prod of free radical damage
Piperacillin/tazobactam plus gentamicin peptidoglycan crosslinking inhibition member of B
lactum family,aminoglycoside inhibits 30s unit
Vancomycin plus gentamicin - peptidoglycan synthesis inhibition

Regarding the members of the family Enterobacteriaceae, which one of the following is the most
accurate?
All members of the family are anaerobic, which means they must be cultured in the absence of
oxygen
All members of the family ferment lactose, which is an important diagnostic criterion in the
clinical laboratory
All members of the family have endotoxin, an important pathogenetic factor
All members of the family produce an enterotoxin, which ADP-ribosylates a G protein in human
enterocytes

A 25-year-old woman with pain on urination and cloudy urine but no fever or flank pain. She has
not been hospitalized. You think she probably has cystitis, an infection of the urinary bladder. A
Gram stain of the urine reveals gram-negative rods. Culture of the urine on EMB agar shows
colorless colonies, and a urease test was positive. Swarming motility was noted on the blood
agar plate. Which one of the following bacteria is the most likely cause of this infection?
Escherichia coli
Helicobacter pylori
Proteus species
Pseudomonas aeruginosa
Serratia marcescens

Swarming specific to proteus, UTI associated with staghorn calculus

EMB colorless colony, non fermenting
Ecoli most common cause of UTI - should prod dark colored colonies and greenish
metallic hue on EMB, Urease never pos
Urease pos for pseudomonas UTI, super strong smell of ammonia

A 35-year-old woman with epilepsy who had a grand-mal seizure about 2 months ago. She
comes to see you now because she has been coughing up foul-smelling sputum for the past
week. Chest X-ray reveals a cavity with an air-fluid level. Gram stain of the sputum reveals
gram-negative rods, and culture reveals black colonies that grow on blood agar only in the
absence of air. Which one of the following bacteria is the most likely cause of this infection?
Bacteroides fragilis
Campylobacter jejuni
Klebsiella pneumoniae
Prevotella melaninogenica
Proteus mirabilis

Black color colonies in absence of air

15 residents in a retirement home have high fever, headache, malaise and anorexia. They have
taken their meal prepared by the same kitchen. Blood culture from about half of the residents
reported Salmonella enterica sub species typhi. The primary reservoir of this organism is?
Intestine/gall bladder of the carrier persons - strictly human pathogen
Dogs and cats
Hen’s eggs
Cattle
Water

A tourist who recently returned from a trip to Peru goes to her physician complaining of
persistent high fever, malaise and constipation that persisted over a week. She recalls that the
fever began slowly and climbed to 41 C. A physical exam reveals an enlarged spleen and tender
abdomen with rose-colored spots. Laboratory isolation of a bacterium that produces H2S and is
motile. Which organisms is the most likely cause of her condition?
EHEC
ETEC
Salmonella enterica subsp. enteritidis - gastroenteritis diarrhea
Salmonella enterica subsp. typhi
Shigella dysenteriae

ROse spots and hepatomegaly clues for typhi

The clinical reports the presence of o157:H7 strains of E.coli in the bloody stool of six children
ages 3-5 who attended a local petting zoo. These young children would be an increased risk for
developing
Buboes
Hemolytic uremic syndrome
Infant botulism
Renal stones
Rice water stools

A 68-year-old woman on chemotherapy for leukemia has developed sepsis due to an infection
with E.coli. The following day the patient develops septic shock and dies. The structure on
bacterium most likely responsible for causing septic shock in this patient is
Capsule
Lipopolysaccharide - lipid A
Pili
Spore
Teichoic acid

Septic shock is endotoxic shock

A 45-year-old woman presents to emergency department with intense pain in her lower back
and a burning sensation upon urination. A urine culture was taken and plated on MacConkey
agar. Gram-negative rods that did not ferment lactose were identified. Which virulence factor of
the causal agent is most important to pathogenesis?
Capsule
Catalase
Coagulase
Exotoxin
Urease

Organism is protease

A 70-year-old woman presents with rapid onset of fever to 39°C and a cough productive of
greenish sputum. She is not hospitalized and not immunocompromised. A chest X-ray reveals a
left lower lobe infiltrate. Of the following, which set of findings describes the MOST likely
causative organism found in the sputum culture?
Gram-positive diplococci that form an α-hemolytic colony
Gram-negative diplococci that form an oxidase-positive colony
Gram-positive rods that form a β-hemolytic colony
Gram-negative rods that form an oxidase-positive colony
Gram-negative cocci that grow only anaerobically

Pseudomonas is the organism

An 80-year-old man had a carcinoma of the colon removed 3 days ago. He was doing well until
this morning, when he spiked a fever to 39°C and complained of severe abdominal pain.
Examination revealed a “board-like” abdomen indicative of peritonitis. He was taken to the
operating room, where it was discovered that his anastomosis had broken down and bowel
contents had spilled into the peritoneal cavity. A foul-smelling exudate was observed. A Gram
stain of the peritoneal exudate revealed many gram-negative rods. Which one of the following
sets of bacteria is the MOST likely cause of this infection?
Escherichia coli and Brucella melitensis
Enterobacter cloacae and Salmonella enteritidis
Fusobacterium nucleatum and Bacteroides fragilis
Haemophilus influenzae and Actinomyces israelii
Shigella dysenteriae and Serratia marcescens

Foul smelling always anaerobe

A 25-year-old man gets into fist fight at the local bar and punches another patron in the mouth.
The following day his first becomes infected and he visits a local urgent care center. Exudate
from the wound is cultured on blood and chocolate agar and reveals gram-negative rods that
have a bleach-like odor. Which of the following agents is the most likely cause?
Actinobacillus actinomycetemcomitans
Cardiobacterium homonis
Eikenella corrodens
Pseudomonas aeruginosa
Kingella kingae

1. You’re on a summer program working in a clinic in a small village in South America.

There is an outbreak of cholera, and your patient has massive diarrhea and a blood pressure of
70/40. Which one of the following would be the most appropriate action to take?

1. Administer antimotility drugs to diminish the diarrhea

2. Administer intravenous saline to replenish volume
3. Administer tetracycline to kill the organism
4. Perform stool cultures and fecal leukocyte tests to make an accurate diagnosis

2. A 20-year-old woman suffers with diarrhea. She has just returned to the United States
from a 3-week trip to Peru, where she ate some raw shellfish at the farewell party. She now has
severe watery diarrhea, perhaps 20 bowel movements a day, and is feeling quite weak and
dizzy. Her stool is guaiac-negative, a test that determines whether there is blood in the stool. A
Gram stain of the stool reveals curved gram-negative rods. Culture of the stool on MacConkey’s
agar shows colorless colonies. Which one of the following bacteria is the most likely cause of
this infection?

1. Escherichia coli
2. Helicobacter pylori
3. Proteus mirabilis
4. Pseudomonas aeruginosa
5. Vibrio cholerae

3. A 50-year-old man has a “sour stomach” for several months. Antacids relieve the
symptoms. After taking a complete history and doing a physical examination, a urease breath
test, which was found positive. Which one of the following bacteria the most likely cause of the
patient’s disease?

1. Helicobacter pylori
2. Proteus mirabilis
3. Salmonella enterica
4. Serratia marcescens
5. Shigella dysenteriae
4. Eight of 10 family practice residents who had a potluck four days ago now have diarrhea
with abdominal cramps, general malaise and fever. They have blood tinged stool, laboratory
studies revealed the causal agent was a microaerophilic gram negative, curved rod with polar
flagella and give a “seagull” appearance. It grew on special media at 42C. The original
contamination probably was found in

1. Poultry Campylobacter??
2. Improperly canned food
3. Fried rice
4. Fish
5. Vegetable

5. A 38-year-old man who recently visited to South Asia on business, presents to the
emergency with profuse water diarrhea flaked with mucus, and severe dehydration. Which of
the following correctly describe the causal agent?

1. Gram negative curved rod: toxin that increase cAMP Cholera??

2. Gram-negative curved rod: toxin that inhibit protein synthesis
3. Gram-negative rod; toxin that inhibits protein synthesis
4. Gram negative rod; toxin that increases cAMP
5. Enterotoxin with a heat labile toxin that blocks the release of acetylcholine

6. A-30-year-old man presents to physician with complains of mid-epigastric pain. He

describes the pain as moderate, occasionally waking him at night, and improving following
meals. A urase breath test was positive. Which of the following correctly describes the causal
agent?

1. Gram-negative curved rod; microaerophilic H Pylori

2. Gram negative rod; aerobic
3. Gram-negative rod; facultative anaerobe
4. Gram positive rod; aerobic
5. Gram-positive rod; microaerophilic

7. A patient is admitted to the hospital because of a bleeding duodenal ulcer. Culture at

37C reveals urase-positive, gram-negative, curved rod. Which of the following is likely
complication due to infection with the causal agent

1. Diarrhea
2. Kidney stones
3. Pseudomembranous colitis
4. Stomach cancer
5. Vomiting
8. Your patient is a 30-year-old woman with non-bloody diarrhea for the past 14 hours.
Which one of the following organisms is LEAST likely to cause this illness?

1. Vibrio parahemolyticus
2. Enterococcus fecalis
3. Shigella dysenteriae
4. Salmonella enteritidis
5. Campylobacter jejuni

9. The pathogenesis of which one of the following organisms is MOST likely to involve
invasion of the intestinal mucosa?

1. Vibrio cholerae
2. Shigella sonnei
3. Enterotoxigenic Escherichia coli
4. Clostridium botulinum
5. Vibrio vulnificus

10. Which one of the following organisms that infects the gastrointestinal tract is the MOST
frequent cause of bacteremia?

1. Shigella flexneri
2. Campylobacter jejuni
3. Vibrio cholerae
4. Salmonella typhi
5. Salmonella enteritidis

11. Diarrhea caused by which one of the following agents is characterized by the presence of
fecal leukocytes?

1. Campylobacter jejuni
2. Salmonella enteritidis
3. Vibrio parahemolyticus
4. Enterotoxigenic Escherichia coli
5. Vibrio cholerae

12. Each of the following statements concerning enterotoxins is correct EXCEPT:

1. Enterotoxins typically cause bloody diarrhea with leukocytes in the stool.

2. Staphylococcus aureus produces an enterotoxin that causes vomiting and diarrhea
3. Vibrio cholerae causes cholera by producing an enterotoxin that increases adenylate
cyclase activity within the enterocyte.
4. Escherichia coli enterotoxin mediates ADP-ribosylation of a G protein
 5. Enterotoxin produced by Entero-aggregative E.coli(EAEC) : associated with persistent
non inflammatory diarrhea in adult and children

13. A patient has abdominal pain, and a mass is discovered in the left lower quadrant. Upon
laparotomy (surgical opening of the abdomen), an abscess is found. Culture of the pus revealed
Bacteroides fragilis. Regarding this organism, which one of the following is the most accurate?

1. A stage in the life cycle of Bacteroides fragilis involves forming spores in the soil
2. Bacteroides fragilis is an anaerobic gram-negative rod whose natural habitat is the
human colon
3. Bacteroides fragilis produces black colonies when grown on blood agar
4. Pathogenesis by Bacteroides fragilis involves an exotoxin that increases cyclic AMP by
ADP-ribosylation of a G protein
5. The toxoid vaccine should be administered to prevent disease caused by Bacteroides
fragilis

14. Regarding the patient in above question, which one of the following is the best antibiotic to
treat the infection?

1. Doxycycline
2. Gentamicin
3. Metronidazole
4. Penicillin G
5. Rifampin

1. A patient is a 10-year-old boy who has a high fever and swollen, painful axillary lymph
nodes on the left side. His mother says that he brought home a dead rat a few days ago. You
suspect he may have bubonic plague. Regarding the causative organism, which one of the
following is most accurate?

1. It has a very low LD50

2. It is transmitted from cat scratch
3. It is endemic primarily in the states along the East Coast of the United States
4. Its main virulence factor is an exotoxin that induces interleukin-2 (IL-2) production by
CD4-positive helper T cells
5. Infection should be treated with high doses of penicillin G intravenously

2. A 20-year-old man who was bitten on the hand when he tried to break up a fight between
two cats yesterday. He now has a red, hot, tender, swollen lesion at the bite site that has spread
rapidly across his hand. Which one of the following bacteria is the most likely cause of his
cellulitis?

1. Yersinia pestis
 2. Brucella melitensis
3. Francisella tularensis
4. Pasteurella multocida- cat bite
5. Bartonella henselae- cat scratch

3. A patient is a 30-year-old woman who reports that she has had intermittent fever of
102°F, sweating, and fatigue for the past month or so. She has lost her appetite and has lost
about 10 pounds in that period. She enjoys eating unpasteurized goat cheese. On examination,
hepatosplenomegaly is detected. A blood count reveals pancytopenia. Which one of the
following bacteria is the most likely cause of this infection?

1. Yersinia pestis
2. Brucella melitensis= Mexico, calirfonia, vets’ butchers etc
3. Francisella tularensis
4. Pasteurella multocida
5. Bartonella henselae

4. Regarding B. henselae, which one of the following is most accurate?

1. Bartonella henselae is an anaerobic, spore-forming, gram-positive rod

2. The natural habitat of B. henselae is the cat’s mouth= cat scratch disease
3. Bartonella henselae causes cellulitis in immunocompromised patients such as AIDS
patients
4. Diagnosis in the clinical laboratory depends on detecting antibodies in the patient’s
serum that will agglutinate cardiolipin= syphilis
5. The drug of choice for B. henselae infections is metronidazole

5. A 25-year-old man develops a high fever and swelling in the armpits and groin. Aspirates
from the lymph nodes reveal gram-negative rods with bipolar staining. The patient is most likely

1. Farmer
2. In the military
3. From the southwestern U.S Yersinia Pestis
4. Living in dormitory
5. Sexually promiscuous

6. Francisella tularensis

1. Causes zoonotic disease and is a potential warfare agent

2. Causes Anthroponotic disease and a potential warfare agent
3. Causes Waterborne disease and a potential warfare agent
4. Causes Zoonotic disease but not a potential warfare agent
5. Causes Anthroponotic disease and not a potential warfare agent
7. Identify the organism based on morphological features in a given image

1. Corynebacterium diphtheria
2. Yersinia pestis
3. Borrelia burgdorferi
4. Neisseria gonorrhoeae
5. Hemophilus ducreyi

8. A patient with non-healing skin lesion has that lesion biopsied to determine its cause.
The pathology lab reports back that the lesion has the characteristics of a stellate granuloma.
Which of the following is most likely to be true of the causal agent?

1. It has a lipopolysaccharide
2. It has a pili
3. It is an exotoxin producer
4. It is a super antigen
5. It is an intracellular Bartonella henselae (cat scratch)

9. A 35-year-old HIV positive man was scratched by his cat while playing 2 days ago. He
develops a raised, cherry-red vascular lesions on the skin of right hand with the subsequent
development of a necrosis. Which one of the following bacteria is the most likely cause of his
disease?

1. Yersinia pestis
2. Brucella melitensis
3. Francisella tularensis
4. Pasteurella multocida
5. Bartonella henselae= bacilary angiomanononas

Which one of the following is a club-shaped, gram-positive rod that causes disease by
producing an exotoxin that kills cells by inhibiting elongation factor-2, resulting in the inhibition of
protein synthesis?

Bacillus anthracis

Bacillus cereus

Clostridium perfringens

Corynebacterium diphtheriae

Listeria monocytogenes
Which one of the following is a large gram-positive rod that causes necrosis of tissue by
producing an exotoxin that degrades lecithin, resulting in the lysis of cell membranes?

Bacillus anthracis

Bacillus cereus

Clostridium perfringens

Corynebacterium diphtheriae

Listeria monocytogenes

Which one of the following sets of bacteria causes disease characterized by a

pseudomembrane?

Bacillus anthracis and Listeria monocytogenes

Bacillus cereus and Clostridium perfringens

Bacillus cereus and Clostridium tetani

Corynebacterium diphtheriae and Clostridium difficile

Corynebacterium diphtheriae and Listeria monocytogenes

Disease caused by which one of the following sets of bacteria can be prevented by a toxoid
vaccine?

Bacillus anthracis and Clostridium botulinum

Bacillus anthracis and Clostridium perfringens

Bacillus cereus and Clostridium tetani

Corynebacterium diphtheriae and Clostridium tetani

Corynebacterium diphtheriae and Listeria monocytogenes

A patient in the pediatric intensive care unit is a 2-week-old boy with a high fever and the signs
of meningitis. Gram stain of the spinal fluid reveals small gram-positive rods. Colonies on blood
agar show a narrow zone of β-hemolysis. Which one of the following is the most likely cause of
his neonatal meningitis?

Bacillus anthracis

Bacillus cereus

Clostridium perfringens

Corynebacterium diphtheriae

Listeria monocytogenes

Regarding the patient in above, which one of the following is the best antibiotic to treat the
infection?

Doxycycline

Gentamicin

Metronidazole

Ampicillin and Trimethoprim-sulfamethoxazole

Vancomycin

A 40-year-old woman with diplopia and other signs of cranial nerve weakness. History reveals
she grows her own vegetables and likes to preserve them in jars that she prepares at home.
She is fond of her preserved string beans, which is what she ate uncooked in a salad for dinner
last night. Which one of the following is the most likely cause of this clinical picture?

Bacillus anthracis

Clostridium botulinum

Clostridium perfringens

Clostridium tetani

Listeria monocytogenes

A 30-year-old man with a 2-cm lesion on his arm. It began as a painless papule that enlarged
and, within a few days, ulcerated and formed a black crust (eschar). He works in an abattoir
where his job is removing the hide from the cattle. A Gram stain of fluid from the lesion reveals
large gram-positive rods. Which one of the following bacteria is likely to be the cause?

Bacillus anthracis

Clostridium botulinum

Clostridium perfringens

Clostridium tetani

Listeria monocytogenes

A 30-year-old man who was brought to the emergency room following a motorcycle accident in
which he sustained a compound fracture of his leg. He now has a high fever and a rapidly
spreading cellulitis with crepitus in the area of the fracture. Large gram-positive rods are seen
on the exudate. Necrotic tissue was debrided. Which one of the following is the best antibiotic to
treat the infection?

Azithromycin

Ciprofloxacin

Gentamicin

Penicillin G C perfringens

Vancomycin

A 65-year-old woman who is several days post-op following removal of her carcinoma of the
colon. She now spikes a fever and has a cough, and chest X-ray shows pneumonia. While
being treated with the appropriate antibiotics, she develops severe diarrhea. You suspect she
may have pseudomembranous colitis. Which one of the following is the best antibiotic to treat
the infection?

Ceftriaxone

Doxycycline

Gentamicin

Metronidazole

Trimethoprim-sulfamethoxazole

What is the typical means of transmission of a toxin that blocks the release of inhibitory
transmission GABA and glycine
Eating home-canned foods

Fecal oral, travel to foreign country

Infant given honey during the first year of life

Puncture wound C tetanus

Respiratory, with incomplete vaccination history

An infant presents difficulty, breathing, constipation, anorexia. The physical notes flaccid
paralysis. What is the mechanism of the action of toxin ?

ADP ribolysation of the eukaryotic elongation factor 2(eEF-2) - Pseudomonas

ADP ribosylation of G1 protein

ADP ribosylation of GTP-binding (s)protein

Blocks release of acetylcholine -C botulinum

Block release of inhibitory transmitters GABA and glycine - C Tetanus

A 35-year old man who is positive HIV develops sepsis with the subsequent development of a
necrotic lesion on the buttock that has a black center and an erythematous margin. Which of the
following is the most likely causal agent?

Bacillus anthracis

Clostridium perfiringens

Enterococcus faecalis

Pseudomonas aeruginosa

Staphylococcus aureus

A 6-year-old girl had crashed on toboggan ride and complained of pain in perineal area. Exam
showed only bruising of the area. Two days later, she develops fever, prostration, discoloration
of the buttock, and blebs of the skin in the area. After admission to the hospital, she develops
progressive involvement of the leg, thigh, and buttock with extension to the lower abdomen. She
goes into shock and dies before surgery could be performed. At autopsy, a 1-inch piece of wood
is found in the perineum, which had perforated the anus. The most likely causal agent

Requires an elevated oxidation reduction potential

Is a gram-negative coccobacillus

Is a marked lecithinase producer C perfringens??

Is non hemolytic on blood agar

Is non fermentative

A 45-year old lady goes to cosmetic surgeon with the complaint of frown lines on her forehead
which she feels are negatively affecting her appearance. Rather than undergoing surgery, she
opts to try injection of BOTOX. What is the mechanism of action of toxin?

It blocks release of acetylcholine Botulinum

It inhibits glycine and GABA -tetanus

It is a lecithinease -perfringens

It is a superantigen

It ribosylates eukaryotic elongation factor-2 - pseudomonas

It ribosylates Gs - cholera

A previously healthy 5-month-old infant present upper body weakness including droopy eyes,
head lag, drooling, and inability to sit unassisted. The most likely infectious form is

Elementary body

Endospore botulinum probably from eating honey

Exotoxin

Reticulate body

Vegetative cell

Two days after eating a meal that included home-canned green beans, 3 people developed
various degrees of visual problems, including double vision and difficulties focusing. Describe
the Gram reaction of the organisms most likely to be isolated from the leftover beans and lab
findings which would be used in its identification.

A GPC which is catalase +ve and grow in high salt environment

A Gram +ve aerobic bacillus which sporulates

A GPC catalase negative and optochin resistant

A GPB grown on low oxidation-reduction medium Botulinum from canned foods

A gram-negative bacillus capable of reducing nitrates to nitrites

A 7-day-old infant presents to emergency department with fever, poor feeding, and bulging
fontanelle. During her physical examination, she begins to convulse. A Gram stain of CSF
reveals gram-positive roods. Which of the following organisms is the most likely causal agent?

Escherichia coli

Haemophilus influenzae

Listeria monocytogenes neonatal meningitis

Neisseria meningitidis

Streptococcus agalactiae

A 28-year-old woman presents to her gynecologist with complains of a malodorous vaginal

discharge. Upon examination the physician notes a thin, gray vaginal discharge with no vaginal
redness. A whiff test was positive for an amine odor. Which of the following is consistent with
this case?

Clue cells

Gram-negative diplococci in PMNs

Koilocytic cells

Owl-eye inclusions

Tzanck smear

A 25-year-old homeless man who complains of a cough for the past month The cough is now
productive of several tablespoons of blood-streaked sputum per day The sputum is not foul-
smelling He has lost 10 pounds but says that he doesn’t eat regularly On physical exam,
temperature is 38°C, and coarse rales were heard in the apex of the left lung An acid-fast stain
of the sputum reveals acid-fast rods Culture of the sputum shows no growth at 7 days, but buff-
colored colonies are visible at 21 days Of the following organisms, which one is most likely to be
the cause of this infection?

Mycobacterium fortuitum-chelonae

Mycobacterium leprae

Mycobacterium marinum
Mycobacterium tuberculosis

Actinomyces asteroides

Which of the following regimens is optimal initial treatment for the patient in above question ?

Isoniazid for 9 months

Isoniazid and gentamicin for 2 weeks

Isoniazid and rifampin for 4 months

Isoniazid, rifampin, pyrazinamide, ethambutol, for 2 months

Isoniazid, rifampin, pyrazinamide, fluroquinolones for 9 month

A 70-year-old man with progressive weakness in both legs that began about a week ago He
reports back pain and fever for the past month Magnetic resonance imaging (MRI) of the spine
reveals destruction of the seventh thoracic vertebra and a paravertebral mass Surgical
decompression and debridement was performed Histologic examination of the mass revealed
caseating granulomas, and Langhans’ giant cells were observed in the granulomas Gram stain
revealed no organisms, but an acid-fast stain showed red rods Culture shows no growth at 7
days, but growth is seen at 28 days Of the following, which one is the most likely cause?

Mycobacterium fortuitum-chelonae

Mycobacterium leprae

Mycobacterium marinum

Mycobacterium tuberculosis

M avium–intracellulare complex

A 30-year-old woman who is infected with HIV and has a low CD4 count She now has the
findings of pulmonary tuberculosis, but you are concerned that she may be infected with
Mycobacterium avium–intracellulare (MAI) Regarding MAI, which one of the following is most
accurate?

Disseminated disease caused by MAI is typically the result of decreased antibody production,
whereas disseminated disease caused by M tuberculosis is typically caused by reduced cell-
mediated immunity
Immigrants from Southeast Asia are more likely to be infected with MAI than with M tuberculosis
In the clinical laboratory, MAI forms colonies in 7 days, whereas M tuberculosis colonies
typically require at least 21 days of incubation for colonies to appear
MAI is typically susceptible to a drug regimen of isoniazid and rifampin, whereas M tuberculosis
is often resistant
The natural habitat of MAI is the environment, whereas the natural habitat of M tuberculosis is
humans

Regarding the patient in Question 4, if MAI was shown to be the cause of her symptoms, which
one of the following is the best choice of antibiotics to prescribe?

Amikacin and doxycycline

Clarithromycin, ethambutol, and rifabutin

Dapsone, rifampin, and clofazimine

Isoniazid and gentamicin

Isoniazid, rifampin, ethambutol, and pyrazinamide

A 20-year-old man with a single, slowly expanding, nonpainful scaly lesion on his chest for the
past 2 months The lesion is nonpruritic, and he has lost sensation at the site of the lesion He is
otherwise well He is a recent immigrant from Central America An acid-fast stain of a scraping of
the lesion is positive Which one of the following diseases is he most likely to have?

Cutaneous tuberculosis

Fish tank granuloma

Lepromatous leprosy

Scrofula

Tuberculoid leprosy

A 40-year-old homeless man presents to the emergency department with fever and night
sweats, coughing up blood Acid-fast bacilli are identified in his sputum Which of the following
virulence factors allows the causal agent to inhibit phagosome-lysosome fusion to survive
intracellularly?

Cord factor

Calcium dipicolinate

Peptidoglycan

Sulfatides mycobacterium tuberculosis??

Tuberculin
A 75-year-old woman with fever and a painful nodule on her forearm She also has a
nonproductive cough that she says is worse than her usual smoking-related cough She is taking
high-dose corticosteroids (prednisone) for an autoimmune disease Chest X-ray reveals a
nodular lesion in the right upper lobe A biopsy of the nodule on her arm was obtained Gram
stain of the specimen showed filaments of gram-positive rods The rods were also weakly acid-
fast Regarding the causative organism, which one of the following is most accurate?

Culture of the organism should be done under anaerobic conditions

The natural habitat of the organism is the soilNocardia??

It produces an exotoxin that inhibits protein synthesis by ADP-ribosylation

Sulfur granules are not seen in the draining lesion

The vaccine against this organism contains the capsular polysaccharide as the immunogen

A 20-year-old man who was in a fist fight in a bar about 3 weeks ago He took a punch that broke
his left second molar He now has a 3-cm inflamed area on the skin overlying the broken tooth
that is draining pus A Gram stain of the pus reveals gram-positive filamentous rods The rods
did not appear red in the acid-fast stain Regarding the causative organism, which one of the
following is most accurate?

Infections caused by this organism occur primarily in the Ohio and Mississippi River Valley area

The natural habitat of the organism is the soil

This organism is resistant to both penicillins and aminoglycosides

Sulfur granules are often seen in the pus located at the orifice of the sinus tract in the skin lesion
actinomyces

The vaccine against this organism contains a toxoid as the immunogen

A 65-year-old man with gradually increasing confusion and unsteadiness while walking A lumbar
puncture revealed clear spinal fluid, a normal glucose, and an elevated protein There were 96
cells/mm3, of which 86% were lymphocytes Gram stain of the cerebrospinal fluid (CSF) was
negative Magnetic resonance imaging (MRI) of the brain was normal A sample of CSF reacted
with beef heart cardiolipin at a titer of 1/1024 Regarding the causative organism of his infection,
which one of the following is most accurate?

It is transmitted by tick bite

Resistance to penicillin G is common, so ceftriaxone should be used
It has never been grown on bacteriologic media in the clinical laboratory
It is unlikely to be eradicated because beef cattle are a major reservoir for the organism
A confirmatory test for this organism utilizes an agglutination reaction with the capsular
polysaccharide of the organism

A 20-year-old man with an erythematous, macular, nonpainful rash on the right arm for the past
4 days The rash is approximately 10 cm in diameter He also has a fever to 100°F and a mild
headache He reports hiking on several weekends recently in New York State You suspect the
rash is erythema migrans and that he has Lyme disease Which one of the following is the best
approach to confirm your clinical diagnosis?

Detect IgM antibodies in an ELISA assay

Determine the titer in a VDRL test

Gram stain and culture on blood agar incubated aerobically
Gram stain and culture on blood agar incubated anaerobically
Grow on human cells in cell culture and identify with fluorescent antibody

Assume the above patient does have Lyme disease Which one of the following antibiotics is the
most appropriate to treat his infection?

Azithromycin or trimethoprim-sulfamethoxazole
Doxycycline or amoxicillin
Gentamicin or amikacin
Metronidazole or clindamycin
Penicillin G or levofloxacin

Regarding syphilis, which one of the following is most accurate?

The characteristic lesion of primary syphilis is a painful vesicle on the genitals

In secondary syphilis, the number of organisms is low, so the chance of transmitting the disease
to others is low
In secondary syphilis, both the rapid plasma reagin (RPR) and the fluorescent treponemal
antibody-absorbed (FTA-ABS) tests are usually positive
The antibody titer in the FTA-ABS test typically declines when the patient has been treated
adequately
In congenital syphilis, no antibody is formed against T pallidum because the fetus is tolerant to
the organism

Regarding B burgdorferi and Lyme disease, which one of the following is most accurate?

Borrelia burgdorferi infects a larger percentage of the rodent reservoir in western states, such as
California, than in northeastern states, such as New York
Pathogenesis of Lyme disease is based on the production of an exotoxin that induces
interleukin-2 production by T-helper cells
The vaccine against Lyme disease contains the capsular polysaccharide of all four serotypes as
the immunogen
Close family members of those infected with B burgdorferi should be given ciprofloxacin
Borrelia burgdorferi is transmitted to humans by the bite of ticks of the genus Ixodes

Benzathine penicillin G is used to treat primary and secondary syphilis rather than procaine
penicillin G Which one of the following is the best reason for this choice?

Patients allergic to procaine penicillin G are not allergic to benzathine penicillin G

Benzathine penicillin G has a higher minimal inhibitory concentration than procaine penicillin G
Benzathine penicillin G penetrates the central nervous system to a greater degree than procaine
penicillin G
Benzathine penicillin G is a depot preparation that provides a long-lasting, high level of drug that
kills the slow-growing T pallidum

A 15-day-old boy presents with conjunctivitis Iodine staining bodies are seen in conjunctival
scrapings The most likely infectious form is a(n)

Elementary body chlamydia infectious bodies

Reticulate body - non infectious bodies

Endospore

Exotoxin

A 33-year-old man presents to emergency department with a fever of 39.1C, facial palsy,
headache and malaise A circular maculopapular rash was identified on the patients left
shoulder; the patient was unaware of the rash The patient likely acquired the infection via which
of the following route

Consumption of contaminated food

Direct contact with fomite

Arthropod vector lyme disease

Respiratory route

Sexual contact

A 16-year-old patient has pneumonia with a dry hacking cough. The x-ray pattern shows a light,
diffuse infiltrative pattern. The most likely organism producing these symptoms is:

A non-Gram staining bacteria requiring sterols Mycoplasma pneumoniae

A bacillus showing granules when stained with methylene blue

A bacitracin-sensitive, catalase-negative gram positive coccus

A coagulase positive, gram-positive, catalase positive coccus clusters

A gram-positive bacillus grown on a low oxidation-reduction medium

Mycoplasma pneumoniae is an important cause of atypical pneumonia. Regarding this

organism which one of the following most accurate?

Amoxicillin and cephalosporins are the drug of choice

Antibody in patient’s serum will agglutinate human red cells at 4oC but not at 37oC

Gram stain of the sputum reveals small gram negative rods

It is an obligate intracellular parasite that can only grow within human cells in the clinical
laboratory

People with cystic fibrosis are predisposed to pneumonia caused by this organism

Which one of the following is the drug of choice for atypical pneumonia caused by
M.pneumoniae?

Amoxicillin

Azithromycin (Macrolides)

Ceftriaxone

Gentamicin

Vancomycin

A 40-year-old woman with the sudden onset of fever headache and petechial rash, blood
cultures are negative. She died the following day. An autopsy immunohistochemical test of brain
tissue revealed an infection of Rickettsia rickettsii. Of the following which one is most accurate?

It is likely she lives in Colorado and was bitten by a mosquito

It is likely she lives in Colorado and was bitten by a tick

It is likely she lives in Virginia and was bitten by a tick

It is likely she lives in Virginia was bitten by a flea

It is likely she lives in Connecticut and was bitten by a mosquito

Regarding Q fever which one of the following is most accurate?

The causative organisms is transmitted by tick bite

The natural habitat of the organism is white footed mouse

The diagnosis is made by gram stain and culture in chocolate agar

Veterinarian and abattoir workers are predisposed to infection no rash no vector

Patients with Q fever often have petechial rash

A 22-year-old woman complains of a persistent nonproductive cough and a fever of 101°F that
came on slowly over the last 4 days. Physical examination reveals some rales in the left lung
base. A patchy infiltrate is seen on chest X-ray. She works as a secretary in a law office and has
not traveled recently. She is not immunocompromised and has not been hospitalized recently. A
sample of her serum agglutinates red blood cells at 4°C but not at 37°C. Which one of the
following BEST describes the organism that is the MOST likely cause of her disease?

A very small bacterium that has no cell wall - mycoplasma pneumonia

A gram-negative diplococcus with a large capsule

An acid-fast rod that forms colonies within 7 days

A filamentous gram-positive rod that is weakly acid-fast

A spirochete that has never been grown on blood agar