MCQs:

1. A 3year old child develops acute glomerulonephritis following impetigo. The bacterium is a catalase-negative,
Gram-positive coccus that has M12surface protein. What is the most likely causative agent?
a. Streptococcus pyogenes b. Staphylococcus aureus c. Staphylococcus epidermidis
d. Streptococcus agalactiae e. Streptococcus pneumoniae
2. A child presents with impetigo with bullae. A Gram-positive, β-hemolytic, catalase-positive, coagulase-positive
coccus is isolated. Which of the following is the most likely organism?
a. Group A streptococcus b. Group B streptococcus
c. Staphylococcus aureus d. Staphylococcus epidermidis
3. A pregnant 28-year-old woman was screened at 38 weeks’ gestation for a bacterial pathogen that could be
passed to her newborn during vaginal birth. The screen identified the bacterium shown, which is catalase
negative and β -hemolytic. The pregnant woman was treated prophylactically with penicillin G. What is the
most likely etiology and syndrome?
a. Streptococcus pyogenes b. Staphylococcus aureus c. Staphylococcus epidermidis
d. Streptococcus agalactiae e. Streptococcus pneumoniae
4. A 5-day postoperative patient develops a high fever. An IV catheter is removed and culture of the tip reveals
Gram-positive cocci believed to be Staphylococcus aureus. Which of the following laboratory test results would
further support this belief?
a. α-Hemolysis on blood agar b. Bacitracin sensitivity
c. Coagulase positivity d. Urea hydrolysis
5. The most common cause of bacterial pharyngitis:
a. Streptococcus pyogenes b. Staphylococcus aureus c. Staphylococcus epidermidis
d. Streptococcus agalactiae e. Streptococcus pneumoniae
6. Which of the following is NOT a symptom of Strep. pyogenes - caused scarlet fever ?
a. Malaise b. Sandpaper rash c. Strawberry tongue
d. Circumoral pallor e. None of the above
7. Staphylococcus aureus differs from Staphylococcus epidermidis by -
a. Is coagulase positive b. Forms white colonies
c. A common cause of UTI d. Causes endocarditis in drug addicts
8. A patient has prosthetic valve replacement and he develops endocarditis 8 months later. The organism
responsible is -
a. Staph. aureus b. Strept. viridans
c. Staph. epidermidis d. Strept. pyogenes
9. Which one of the following gram positive organism is most common cause of UTI among sexually active
women-
a. Staphylococcus epidermidis b. Staphylococcus aureus
c. Staphylococcus saprophyticus d. Enterococcus
10. _______________ is the most common causal agent neonatal septicemia and meningitis.
a. Streptococcus pyogenes b. Staphylococcus aureus c. Staphylococcus epidermidis
d. Streptococcus agalactiae e. Streptococcus pneumoniae
11. A 4-year-old boy develops several honey-crusted lesions behind his ears and on his face. The simplest test for
the physician to determine the genus of bacteria responsible for this child’s illness is the:
a. catalase test b. coagulase test
c. hemolysis pattern on blood agar d. polymerase chain reaction
12. 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 103°F, 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-positive and coagulase-negative. Which of the
following organisms is the most likely cause?
a. Enterococcus faecalis b. Staphylococcus aureus
c. Staphylococcus epidermidis d. Staphylococcus saprophyticus
13. A 10-year-old child develops glomerulonephritis a week after he was treated for a sore throat. The causal agent
is identified by serotyping of the
a. capsule b. M proteins c. outer membrane proteins
d. pili e. teichoic acids
14. Which of the following virulence factor of Strep. pneumoniae that inhibits leukocyte respiratory burst and
inhibits classical complement fixation?
a. Polysaccharides capsule b. IgA protease
c. Teichoic acid d. Pneumolysin O
15. The most common cause of typical pneumonia is ________________.
a. Staph. aureus b. Strep. pneumoniae
c. Strep. agalactiae d. Strep. pyogenes
16. The most common cause of Otitis media is ________________.
a. Staph. aureus b. Strep. pneumoniae
c. Strep. agalactiae d. Strep. pyogenes

17. ______________ is the most common cause of adult meningitis.

a. Neisseria meningitis b. Staph. aureus
c. Strep. pneumoniae d. Strep. agalactiae
18. Latex particle agglutination is a test for capsular antigen of ____________ in CSF.
a. Neisseria meningitis b. Staph. aureus c. Strep. agalactiae
d. Strep. pneumoniae e. A and D
19. A 55-year-old woman had her rheumatic heart valve replaced with a 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?
a. Streptococcus viridans b. Pseudomonas aeruginosa c. Serratia marcescens
d. Staphylococcus aureus e. Streptococcus pneumoniae
20. Bacitracin is inhibitory for which of the following groups of streptococci:
a. A b. B
c. C d. D
21. __________ forms plaque on teeth and causes dental caries.

a. S. pyogenes b. Staph. aureus

c. Strep. mutans d. Strep. agalactiae
22. _____________ is associated with colon cancer.
a. S. mutans b. S. sanguinis
c. S. agalactiae d. S. gallolyticus
23. An infant presents with fever, convulsions, and nuchal rigidity during the first month of life. Which of the
following agents is the most likely cause?
a. Escherichia coli b. Haemophilus influenzae c. Listeria monocytogenes
d. Streptococcus agalactiae e. Streptococcus pneumoniae
24. 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?
a. Enterococcus faecalis b. Staphylococcus aureus c. Staphylococcus epidermidis
d. Streptococcus pyogenes e. Viridans streptococci
25. 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?
a. Gram-positive coccus, alpha hemolytic, catalase negative
b. Gram-positive coccus, beta hemolytic, catalase negative
c. Gram-positive coccus, alpha hemolytic, catalase positive
d. Gram-positive coccus, beta hemolytic, catalase positive
e. Gram-positive coccus, gamma hemolytic, catalase negative
26. 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?
a. Capsule b. Catalase c. Coagulase
d. M protein e. Teichoic acid
27. The best treatment for diphtheria is:
a. Penicillin b. Broad spectrum antibiotics
c. Toxoid d. antitoxin
28. Superantigen production by Staphylococcus aureus is involved in the pathogenesis of which one of the
following diseases?
a. Impetigo b. Osteomyelitis c. Scalded skin syndrome
d. Septicemia e. Toxic shock syndrome f.
29. 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 Staph epi [short for Staphylococcus epidermidis] bacteremia.” Which one of the
following sets of results did the tech find with the organism recovered from the blood culture?
a. Gram-positive cocci in chains, catalase-positive, coagulase-positive
b. Gram-positive cocci in chains, catalase-negative, coagulase-negative
c. Gram-positive cocci in clusters, catalase-positive, coagulase-negative
d. Gram-positive cocci in clusters, catalase-negative, coagulase-positive
e. Gram-positive diplococci, catalase-negative, coagulase-positive
30. Which of the following causes exudative pharyngitis in immunocompromised patients?
a. C. diphtheriae b. C. ulcerans
c. C. jeikeium d. None of the choices
31. Which one of following laboratory tests is the most appropriate to distinguish Streptococcus pyogenes from
other β-hemolytic streptococci?
a. Ability to grow in 6.5% NaCl b. Activation of C-reactive protein c. Hydrolysis of esculin in the
presence of bile
d. Inhibition by bacitracin e. Inhibition by optochin
32. Disease caused by which one of the following sets of bacteria can be prevented by a toxoid vaccine?
a. Bacillus anthracis and Clostridium botulinum
b. Bacillus anthracis and Clostridium perfringens
c. Bacillus cereus and Clostridium tetani
d. Corynebacterium diphtheriae and Clostridium tetani
e. Corynebacterium diphtheriae and Listeria monocytogenes
Matching Question : Match each toxin with its action.

(A) Diphtheria toxin 33. Causes paralysis by blocking release of acetylcholine

(B) Tetanus toxin 34. Inhibits protein synthesis by blocking elongation factor-2
(C) Botulinum toxin 35. Stimulates T cells to produce cytokines
(D) Toxic shock syndrome toxin 36. Stimulates the production of cyclic AMP by adding ADP-ribose to a G protein
(E) Cholera toxin 37. Inhibits the release of inhibitory neurotransmitters causing muscle spasms

38. Each of the statements about the classification of streptococci is correct EXCEPT:

a. Pneumococci (Streptococcus pneumoniae) are α-hemolytic and can be serotyped on the basis of their
polysaccharide capsules.
b. Enterococci are group D streptococci and can be classified by their ability to grow in 6.5% sodium chloride.
c. Although pneumococci and the viridans streptococci are α-hemolytic, they can be differentiated by the bile
solubility test and their susceptibility to optochin.
d. Viridans streptococci are identified by Lancefield grouping, which is based on the C carbohydrate in the cell wall.

39. Which of the following appears as gray-to-black colonies of club-shaped gram-positive rods arranged in V or
L shapes on Gram stain?

a. Bacillus anthracis b. Clostridium difficle

c. Corynebacterium diphtheria d. Actinomyces
40. A child with bull neck and membrane over tonsil. What is mechanism of the toxin responsible for this
condition?
a. Increased cAMP b. Inhibits GABA neurons
c. Inhibits Elongation Factor-2 d. increased secretion of cytokins
41. Metachromatic granules are seen in:
a. Corynebacterium b. E. coli
c. Yersinia d. Pseudomonas
42. Which of the following tests is used to differentiate between toxigenic or nontoxigenic C.diphtheriae ?
a. Dick test b. Schick’s test
c. Gram stain d. Elek test
43. Which of the following is used to detect the susceptibility to scarlet fever ?

a. Dick test b. Schick’s test

c. Gram stain d. Elek test
44. Which of the following is used for the detection of diphtheria toxin production in a sample?
a. ELISA for the toxin. b. Elek test. c. PCR for tox gene.
d. A & B. e. A&C. f. A,B &C.
45. Gram-positive short rods are seen in the CSF sample of a new borne child suffering from lethargy, fever and
seizure. Organism responsible is:
a. Group B Streptococcus b. Listeria
c. Clostridium tetani d. Bacillus anthracis
46. Tumbling motility is shown by:
a. Listeria monocytogenes b. Proteus vulgaris
c. Borrelia d. Clostridia
47. A 39-year-old female comes with high grade fever and signs suggesting meningitis. On CSF examination a
gram-positive bacilli was isolated. The organism involved is:
a. Streptococcus pneumoniae b. Listeria monocytogenes
c. H. influenzae d. Staph aureus
48. A 30-year-old woman with a bad obstetric history presents with fever. The blood culture from the patient
grows gram-positive small to medium coccobacilli that are pleomorphic, occurring in short chains. Direct wet
from the culture shows tumbling motility. The most likely organism is:
a. Listeria monocytogenes b. Corynebacterium sp.
c. Enterococcus spp d. Erysipelothrix rhusiopathiae
49. The coagulase test, in which the bacteria cause plasma to clot, is used to distinguish:
a. Streptococcus pyogenes from Enterococcus faecalis
b. Streptococcus pyogenes from Staphylococcus aureus
c. Staphylococcus aureus from Staphylococcus epidermidis
d. Staphylococcus epidermidis from Neisseria meningitidis
50. Which one of the following is a virulence factor for Staphylococcus aureus?
a. A heat-labile toxin that inhibits glycine release at the internuncial neuron
b. An oxygen-labile hemolysin
c. Resistance to novobiocin
d. Protein A that binds to the Fc portion of IgG
Match the following with Q 51-54:
a. Staphylococcus aureus
b. Streptococcus pyogenes
c. Enterococcus faecalis
d. Streptococcus pneumoniae
51. Grows in 6.5% sodium chloride
52. Is bile soluble
53. Produces enterotoxin
54. Is associated with rheumatic fever

Match the following with Q 55-58 :

a. Corynebacterium diphtheriae
b. Listeria monocytogenes
c. Bacillus anthracis
d. Clostridium botulinum
55. Causes both skin lesions and a severe pneumonia
56. Causes flaccid paralysis
57. Causes a pseudomembrane in the throat, which can cause respiratory tract obstruction
58. Causes meningitis in neonates and the immunosuppressed

59. A 25-year-old pregnant woman in the third trimester comes to the emergency room saying that about 12 hours
ago she began to feel feverish and weak. On examination, she has a temperature of 40°C but no other pertinent
findings. A blood culture grows small gram-positive rods that cause β-hemolysis on a blood agar plate
incubated in room air. Which one of the following bacteria is the MOST likely cause?
a. Clostridium perfringens b. Streptococcus pyogenes c. Bacillus cereus
d. Listeria monocytogenes e. Brucella abortus
60. A 6-year-old boy fell and sustained a deep wound from a rusty nail that penetrated his thigh. His mother
removed the nail and cleaned the wound with soap and water. The next morning, he had a temperature of
102°F, and his thigh was very painful and swollen. In the emergency room, crepitus (gas in the tissue) was
noted. A Gram stain of exudate from the wound area revealed large grampositive rods. Which one of the
following is the MOST likely cause?
a. Actinomyces israelii b. Clostridium c. Clostridium tetani
perfringens
d. Listeria e. Pseudomonas f. Nocardia asteroides
monocytogenes aeruginosa
61. Disease caused by which one of the following bacteria can be prevented by a toxoid vaccine?
a. Actinomyces israelii b. Neisseria meningitidis c. Borrelia burgdorferi
d. C. diphtheriae e. Haemophilus influenzae f. Listeria monocytogenes
62. A 30-year-old woman with a previous history of rheumatic fever now has a fever for the past 2 weeks. Physical
examination reveals a new heart murmur. You suspect endocarditis and do a blood culture, which grows a
viridans group streptococcus later identified as Streptococcus sanguinus. Of the following body sites, which one
is the MOST likely source of this organism?
a. Colon b. Mouth c. Skin
d. Stomach e. Vagina f.
63. 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. A Gram stain reveals many neutrophils and spirochetes, and culture on Thayer-Martin medium reveals no
colonies.
b. A Gram stain reveals many neutrophils and gram-variable rods, and culture on Thayer-Martin medium reveals β-
hemolytic colonies.
c. A Gram stain reveals many neutrophils and gram-negative diplococci, and culture on Thayer-Martin medium
reveals oxidase-positive colonies.
d. A Gram stain reveals many neutrophils but no gram-negative diplococci are seen, and culture on ThayerMartin
medium reveals coagulase-positive colonies.
64. Which one of the following sets of bacteria causes disease characterized by a pseudomembrane?
a. Bacillus anthracis and Listeria monocytogenes
b. Bacillus cereus and Clostridium perfringens
c. Bacillus cereus and Clostridium tetani
d. Corynebacterium diphtheriae and Clostridium difficile
e. Corynebacterium diphtheriae and Listeria monocytogenes
65. 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?
a. Bacillus anthracis b. Bacillus cereus c. Clostridium perfringens
d. Corynebacterium diphtheriae e. Listeria monocytogenes
66. Your 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?
a. Bacillus anthracis b. Bacillus cereus c. Clostridium perfringens
d. Corynebacterium diphtheriae e. Listeria monocytogenes
67. ___________ is the most common cause of Meningitis in renal transplant or cancer patients.
a. Strep. agalactiae b. N. meningitis
c. Strep. pneumoniae d. Listeria monocytogenes
68. Listeria monocytogens is:
a. A non-motile gram positive bacilli.
b. Easily isolated on ordinary medium
c. A strict human parasite.
d. A common cause of meningitis in renal transplant recipients
69. Which of the following is the common source of early onset neonatal infection with L. monocytogenes?
a. Haematogenously from mother
b. Hospital-acquired from early-onset case
c. Post-natal environment
d. maternally acquired during delivery
70. α-hemolytic, Gram positive rods , vancomycin resistant :
a. Erysipelothrix rhusiopathiae b. M. tuberculosis c. Strep. pneumoniae
d. Listeria monocytogenes e. C. diphtheriae
71. Growth of _____________ is improved by incubation in 5–10% carbon dioxide.
a. Erysipelothrix rhusiopathiae b. Enterococcus c. Strep. pneumoniae
d. Listeria monocytogenes e. C. diphtheriae
72. An 8-year-old girl presents to the urgent care facility with 1 day history of fever, sore throat, malaise, and
headache. Physical examination reveals a temperature of 39 °C, cervical lymphadenopathy, and a whitish
tonsillar exudate. A rapid diagnostic test is negative; however, culture of the exudate grew Gram-positive cocci
in chains that caused b-hemolysis on blood agar. What complication is prevented by appropriate antibiotic
therapy for this infection?
a. Bacteremia b. Carditis c. Encephalitis
d. Hepatitis e. Meningitis
73. What is the basis of serotyping of the pathogen in the above question?
a. Capsular antigens b. Cell wall antigens c. Flagellar antigens
d. O antigens e. M proteins
74. A 76-year-old hospitalized male being treated successfully with vancomycin for hospital-acquired methicillin-
resistant Staphylococcus aureus bacteremia develops a new onset of fever. A urinary tract infection is suspected
and a Gram stain of unspun urine reveals neutrophils and Gram-positive cocci. Antibiotic sensitivity results of
the organism cultured from the urine reveal resistance to cephalosporins, TMP–SMZ, aminoglycosides, and
vancomycin. Which bacteria is the most likely cause of his urinary tract infection?
a. Enterococcus faecalis b. Group B Streptococcus c. Peptostreptococcus
d. Staphylococcus saprophyticus e. Streptococcus pyogenes
75. A 6-year-old boy in Pakistan presents to a local hospital with involuntary limb movements. He also complains
of pain and swelling in several joints including the wrists, elbows, knees, and ankles as well as weakness and
shortness of breath. About 2 weeks earlier, he had been ill with fever and sore throat. A throat culture for
group A Streptococcus was negative. What other test result would indicate a recent infection with this
organism?
a. Elevated C-reactive protein b. Elevated erythrocyte c. Positive antistreptolysin O
sedimentation rate antibodies
d. Positive Lancefield agglutination e. Positive Rheumatoid factor test
test
76. With regard to the above question, what is the major virulence factor of this organism that plays a role in the
pathogenesis of the boy’s illness?
a. Capsule b. M protein c. Phage-associated toxin
d. Secretion of dextran e. Streptococcal superantigen
77. A 48-year-old man has been hospitalized in intensive care for 3 weeks following an automobile accident. He
develops a fever due to colonization of an intravenous line with Gram-positive cocci that are catalase-positive
and coagulase-negative. What is the most likely cause of this man’s fever?
a. Enterococcus faecalis b. Staphylococcus aureus c. Staphylococcus epidermidis
d. Streptococcus mutans e. Streptococcus pyogenes
78. What is the major virulence factor of the organism in the above case?
a. Biofilm production b. Panton–Valentine leukocidin c. Pyrogenic exotoxin
d. Streptokinase e. Vancomycin resistance f.
79. The main reason why methicillin-resistant Staphylococcus aureus (MRSA) strains are resistant to methicillin
and nafcillin is:
a. they produce β-lactamase that degrades the antibiotics.
b. they have altered penicillin-binding proteins that have reduced binding of the antibiotics.
c. they have mutant porin proteins that prevent the antibiotics from entering the bacteria.
d. they have plasmid-encoded export proteins that remove the drug from the bacteria.
80. 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:
a. coagulase. b. enterotoxin. c. exfoliatin.
d. P-V leukocidin. e. staphyloxanthin
81. 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?
a. Amoxicillin b. Ceftriaxone c. Ciprofloxacin
d. Gentamicin e. Vancomycin
82. 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?
a. Capsule b. Flagellar protein c. O antigen
d. Peptidoglycan e. Pilus protein
83. Which one of the following best describes the pathogenesis of rheumatic fever?
a. An exotoxin produced by Streptococcus pyogenes that acts as a superantigen damages cardiac muscle.
b. An exotoxin produced by Streptococcus pyogenes that ADPribosylates a G protein damages joint tissue.
c. Antibody to the capsular polysaccharide of Streptococcus pyogenes cross-reacts with joint tissue and damages it.
d. Antibody to the M protein of Streptococcus pyogenes crossreacts with cardiac muscle and damages it.
e. Endotoxin produced by Streptococcus pyogenes activates macrophages to release cytokines that damage cardiac
muscle.
84. Your 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. You do a Gram stain on pus from the ulcer and see 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 her lesion is most likely:
a. Enterococcus faecalis. b. Staphylococcus aureus. c. Streptococcus agalactiae.
d. Streptococcus pneumoniae. e. Streptococcus pyogenes.
85. Your patient is 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?
a. Staphylococcus aureus b. Streptococcus agalactiae c. Streptococcus mutans
d. Streptococcus pneumoniae e. Streptococcus pyogenes
86. A culture of skin lesions from a patient with pyoderma (impetigo) shows numerous colonies surrounded by a
zone of β-hemolysis on a blood agar plate. A Gram-stained smear shows gram-positive cocci. If you found the
catalase test to be negative, which one of the following organisms would you MOST probably have isolated?
a. Streptococcus pyogenes b. Staphylococcus aureus
c. Staphylococcus epidermidis d. Streptococcus pneumoniae
87. Your patient has subacute bacterial endocarditis caused by a member of the viridans group of streptococci.
Which one of the following sites is MOST likely to be the source of the organism?
a. Skin b. Colon
c. Oropharynx d. Urethra
88. Acute glomerulonephritis is a nonsuppurative complication that follows infection by which one of the following
organisms?
a. Enterococcus faecalis b. Streptococcus pyogenes
c. Streptococcus pneumoniae d. Streptococcus agalactiae
89. Which one of the following organisms is the MOST frequent bacterial cause of pharyngitis?
a. Staphylococcus aureus b. Streptococcus pneumoniae
c. Streptococcus pyogenes d. Neisseria meningitidis
90. Which one of the following is NOT a characteristic of the Staphylococcus associated with toxic shock
syndrome?
a. Release of a superantigen
b. Coagulase production
c. Appearance of the organism in grapelike clusters on Gram stained smear
d. Catalase-negative reaction
91. Each of the following statements concerning Corynebacterium diphtheriae is correct EXCEPT:
a. Corynebacterium diphtheriae is a gram-positive rod that does not form spores.
b. Toxin production is dependent on the organism’s being lysogenized by a bacteriophage.
c. Diphtheria toxoid should not be given to children younger than 3 years because the incidence of complications is
too high.
d. Antitoxin should be used to treat patients with diphtheria.
92. Which is not a mycobacteria tuberculosis complex organism?
a. M. africanum b. M. tuberculosis
c. M. bovis d. M. kansasii
93. _____________ is a growth medium specially used for culture of Mycobacterium tuberculosis.
a. Lowenstein-Jensen medium. b. Blood agar.
c. Middlebrook’s medium. d. Thayer-Martin medium.
94. Slow growth on Lowenstein-Jensen medium is produced by
a. M bovis b. Mycobacterium tuberculosis
c. Both (a) and (b) d. None of the above
95. The bacteria which cause(s) tuberculosis in man is/are
a. M bovis b. Mycobacterium tuberculosis
c. M africanum d. All of these
96. All are true about hyaluronidase EXCEPT:
a. Depolymerizes Hyaluronic acid
b. Spreading factor
c. Excreted by group A streptococci
d. Has some role in production of the disease
e. Promotes lysis of fibrin blood clots
97. Scalded Skin Syndrome (SSS) is caused by a toxin secreted by Staph. aureus which is called:
a. Leujocidin b. Alpha-toxin c. Beta-toxin
d. Exfoliatin e. Gamma-toxin
98. Acid fast genus other than T.B. is:
a. Actinomyces b. Nocardia c. Aspergillias
d. Corynebacteria e. Histoplasma
99. One is FALSE for Listeria Monocytogenes:
a. Gram positive b. Facultative anaerobe
c. Non-motile d. Small bacillus
100. Pathogenicity of staphylococci is determined by production of:
a. Haemolysin b. Pigment
c. Coagulase d. Catalase
101. Thayer-Martin medium is suitable for transporting:
a. Staphylococci. b. Pneumococci.
c. Meningococci. d. Haemophilus.
102. One is false about Staphylococcus epidermidis:
a. A common cause of food poisoning.
b. Coagulase negative.
c. Normal skin flora.
d. A common cause of prosthetic heart valve infection.
103. A toxigenic strain of Corynebacterium diphtheria is:
a. Gram negative bacillus. b. Lysogenic.
c. Pleomorphic. d. Always present in nasopharynx.
104. Of the organisms listed below, which one is the most frequent bacteria cause of acute osteomyelitis:
a. Streptococcus pyrogens. b. Streptococcus pneumonia. c. Pseudomonas aeruginosa.
d. Haemophilus influenzae. e. Staphylococcus aureus.
105. Differentiation of Streptococcus pneumoniae from other α-hemolytic streptococci is done by:
a. Bile solubility test. b. Optochin sensitivity test.
c. Inulin fermentation. d. All of the above.
106. Staphylococcus epidermidis is the etiological factor of:
a. Urinary tract infection among children & elderly males.
b. Enteritis.
c. Osteomylitis.
d. Pneumonia.
e. Acute bacterial endocarditis.
107. The CSF from a 2week old infant with meningitis shows rods with tumbling motility. These bacteria are
found to be Gram positive that do not form spores. What is the most likely agent?
a. Actinomyces b. Bacillus c. Clostridium
d. Corynebacterium e. Listeria
108. Pathogenic mechanisms involved in tuberculosis can be primarily attributed to which of the following?
a. Toxin production by the mycobacteria
b. Specific cell adhesion sites
c. Cell-mediated hypersensitivity
d. Humoral immunity
e. Clogging of alveoli by large numbers of acid-fast mycobacteria
109. L. monocytogenes causes a variety of diseases, including food poisoning. Listeria are small, Gram-positive,
motile rod-shaped bacteria. Which of the following best describes these microorganisms?
a. Listeria are facultative intracellular pathogens
b. Once infected, the immune system cannot destroy Listeria
c. Listeria cannot be cultivated on artificial media
d. Flagella are produced both at room temperature and at 37°C
e. There is no relationship between Listeria serovars and human infection
110. Your patient is 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?
a. Mycobacterium fortuitum-chelonae b. Mycobacterium leprae
c. Mycobacterium marinum d. Mycobacterium tuberculosis
111. Conversion from negative to positive tuberculin reaction is indication of:
a. Activation of an old tuberculous focus. b. Complete cure of tuberculosis.
c. Recent exposure to M. tuberculosis. d. Loss of sensitivity to tuberculin.
112. A positive tuberculin test means that the person has:
a. Delayed hypersensitivity to tubercle bacilli. b. No infection with tubercle bacilli at all.
c. Circulating antibodies. d. Increased susceptibility to infection.
113. Prophylaxis against tuberculosis is achieved by:
a. Killed mycobacterium bacilli b. B.C.G vaccine c. Purified protein derivative
d. Serum from tuberculous patients e. Penicillin
114. Mycobacterium tuberculosis has the following character:
a. Produce B-hemolysis on blood agar
b. It is a photochromogen
c. The cell wall has low concentration of lipid
d. Colonies require 3-6 weeks to appear
e. It is stained easily by gram-stain
115. A36-year-oldimmigrant who livedin a crowded resettlement campbefore comingto the United States now
has a cough that has been bothering him for several weeks. He has also lost 10pounds. Which of the following
factors is known to be most important in triggering the granulomatous reaction to wall off and contain the
infection?
a. Cord factor b. Mycolic acid c. Purified protein derivative (PPD)
d. Sulfatides e. Wax D
116. Which of the following organisms grows in 40%bile?
a. Enterococcus faecalis b. Streptococcus pneumoniae
c. Group B streptococci d. Viridans streptococci
117. A noncompliant HIV-positive patient with a CD4+cell count of 40/mm3 presents with a pulmonary
infection caused by an organism that requires 4weeksto grow on Lowenstein-Jensen medium. What is the best
descriptor of the most likely causative agent?
a. Acid-fast organism b. Dimorphic fungus c. Filamentous fungus
d. Gram-positive coccus e. Gram-negative coccus f. Gram-negative rod
118. What additional tissues are frequently involved with diphtheria besides the ‘‘bull neck’’ and the
pseudomembranous pharyngitis?
a. Skin(cutaneous diphtheria) b. Kidneys c. Heart and nerves
d. Liver and kidneys e. Ears and sinuses
119. Each of the following statements concerning Mycobacterium tuberculosis is correct EXCEPT:
a. After being stained with carbolfuchsin, M. tuberculosis resists decolorization with acid alcohol.
b. Mycobacterium tuberculosis has a large amount of mycolic acid in its cell wall.
c. Mycobacterium tuberculosis appears as a red rod in Gram stained specimens.
d. Mycobacterium tuberculosis appears as a red rod in acid-fast stained specimens.
120. Each of the following is associated with the Lancefield group B streptococci (S. agalactiae) EXCEPT:
a. Pyoderma (impetigo)
b. Vaginal carriage in 5% to 25% of normal women of childbearing age
c. Neonatal sepsis and meningitis
d. β-hemolysis
121. Each of the following statements concerning Mycobacterium tuberculosis is correct EXCEPT:
a. Some strains of M. tuberculosis isolated from patients exhibit multiple drug resistance.
b. Mycobacterium tuberculosis contains a small amount of lipid in its cell wall and therefore stains poorly with the
Gram stain.
c. Mycobacterium tuberculosis grows slowly, often requiring 3 to 6 weeks before colonies appear.
d. The antigen in the tuberculin skin test is a protein extracted from the organism.
122. 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?
a. Cord factor b. Calcium dipicolinate c. Peptidoglycan
d. Sulfatides e. Tuberculin
123. A box of ham sandwiches with mayonnaise prepared by a person with a boil on his neck was left out of the
refrigerator for the on-call interns. Three doctors became violently ill approximately 2 h after eating the
sandwiches. The most likely cause is
a. S. aureus enterotoxin b. Coagulase from S. aureus in the ham
c. S. aureus leukocidin d. C. perfringens toxin
124. 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?
a. Gram-positive coccus, alpha hemolytic, catalase negative
b. Gram-positive coccus, beta hemolytic, catalase negative
c. Gram-positive coccus, alpha hemolytic, catalase positive
d. Gram-positive coccus, beta hemolytic, catalase positive
e. Gram-positive coccus, gamma hemolytic, catalase negative
125. M. tuberculosis can be found in the sputum of patients with tuberculosis. After digestion of the sputum,
isolation is best accomplished using
a. Sheep blood agar
b. Löffler’s medium
c. Thayer-Martin agar
d. Thiosulfate citrate bile salts sucrose medium
e. Löwenstein-Jensen medium
126. Which of the following is the predominant organism on skin commonly seen as a blood culture
contaminant?
a. α-hemolytic streptococci b. Lactobacillus c. S. epidermidis
d. Escherichia coli e. B. fragilis
127. Erythema nodosum leprosum (ENL) occur in:
a. Borderline leprosy b. Lepromatous leprosy
c. Indeterminate type d. Tubercloid leprosy
128. A 7-day-old infant presents to the emergency department with a fever, poor feeding, and a bulging
fontanelle. During her physical examination, she begins to convulse. A Gram stain of the CSF reveals gram-
positive rods. Which of the following organisms is the most likely causal agent?
a. Escherichia coli b. Haemophilus influenzae c. Listeria monocytogenes
d. Neisseria meningitidis e. Streptococcus agalactiae
129. Actinomyces israelii has following feature
a. Exogenous infection b. Branching filaments
c. Aerobic d. Black granules
130. Actinomycetes, most common site is:
a. Cervicofacial b. Thoracic
c. Abdomen d. Brain
131. Nocardia and Actinomyces can be differentiated by which stain?
a. Gram b. PAS stain
c. Silver stain d. Acid fast stain
132. Which of the following is true about mycetoma ?
a. Fungating tumor-like masses caused by certain species of Klebsiella.
b. Fungating tumor-like masses caused by Nocardia asteroids.
c. Secondary brain abscesses occur in about one-third of patients with Nocardiosis.
d. None of the above.
133. A patient complained to his dentist about a draining lesion in his mouth. A Gram’s stain of the pus showed
a few Gram-positive cocci, leukocytes, and many branched Gram-positive rods. The most likely cause of the
disease is
a. Actinomyces israelii b. C. diphtheriae
c. Propionibacterium acnes d. S. aureus
134. The nephrogenic stains the lead to acute glomerulonephritis are frequently streptococci which cause:
a. Impetigo b. Scarlet fever c. Rheumatic fever
d. Post-partum infection e. Wound infection
135. Each of the following statements concerning Mycobacterium leprae is correct EXCEPT:
a. In lepromatous leprosy, large numbers of organisms are usually seen in acid-fast-stained smears.
b. The organism will grow on bacteriologic media in 3 to 6 weeks.
c. Prolonged therapy (9 months or longer) is required to prevent recurrence.
d. Loss of sensation due to nerve damage is often seen in leprosy.
136. Each of the following statements concerning Actinomyces and Nocardia is correct EXCEPT:
a. Actinomyces israelii is an anaerobic rod found as part of the normal flora in the mouth.
b. Both Actinomyces and Nocardia are branching, filamentous rods.
c. Nocardia asteroides causes infections primarily in immunocompromised patients.
d. Infections are usually diagnosed by detecting a significant rise in antibody titer.
137. Colonies resembling molar teeth are produced by
a. Nocardia brasiliensis b. N. asteroids
c. Actinomyces israelii d. Actinomadura madurae
138. A patient undergoing chemotherapy develops a cough. Acid-fast stain of his sputum shows rods and
slightly longer forms, with some branching, which vary in their acid-fast reaction from one area of the slide to
the next. The acid-fast stain was performed by an experienced medical technologist and, when redone, showed
the same variation. The growth was done aerobically. What is the most likely agent?
a. Actinomyces b. Chlamydia
c. Mycobacterium avian-intracellulare d. Nocardia
139. The finding of chains of aerobic Gram-positive rods, some of which have started to sporulate , from a
patient with respiratory symptoms and hemorrhagic lymphadenitis raises a major concern of which organism?
a. Actinomyces israelii b. Bacillus anthracis c. Campylobacter jejuni
d. Clostridium perfringens e. Haemophilus influenza
140. A farm worker presents in the emergency department with a black, necrotic wound on his forearm. He
does not recall any injury to the area, but the lesion is now swollen and nearly painless. Samples collected from
the lesion were plated on blood agar. Resulting colonies were rough edged and nonhemolytic. Gram stain of the
colony material revealed Gram-positive rods (boxcars) are shown with centrally located endospores. What is
the most likely etiology and infection?
a. Actinomyces israelii b. Bacillus anthracis c. Campylobacter jejuni
d. Clostridium perfringens e. Haemophilus influenza
141. A 34-year-old man comes to the emergency department due to 2 days of fever, malaise, and myalgia. He
has also had worsening shortness of breath and cough The patient works in the mail room at a large company,
does not smoke cigarettes, and drinks alcohol occasionally. Chest imaging shows lung infiltrates and prominent
widening of the mediastinum. Sputum and blood cultures yield large gram-positive rods that form colonies
resembling a "Medusa head." Which of the following is the most likely bacterial virulence factor contributing
to this patient's condition?
a. Antiphagocytic D-glutamate capsule
b. Antiphagocytic polysaccharide capsule
c. IgG binding outer membrane protein
d. intracellular polyphosphate granules
e. Pentrichous flagella
142. An outbreak of food poisoning occurs after a catered lunch attended by 112 people. Thirty percent of the
individuals who ate the lunch developed nausea and vomiting 3 h after consumption of the food. A health
department investigation linked the outbreak to contamination of chicken fried rice with a spore-forming
organism. What is the cause of this outbreak?
a. Bacillus cereus b. Clostridium perfringens
c. E.coli d. Staphylococcus aureus
143. Pathogenic mechanisms involved in tuberculosis can be primarily attributed to which of the following?
a. Toxin production by the mycobacteria
b. Specific cell adhesion sites
c. Cell-mediated hypersensitivity
d. Humoral immunity
e. Clogging of alveoli by large numbers of acid-fast mycobacteria
144. _________________ was, until the discovery of archaebacteria in hot springs, the most heat-resistant
organism known.
a. Bacillus subtilis b. Bacillus stearothermophilus
c. Bacillus polymyxa d. Bacillus pumilis
145. Which of the following is used for the diagnosis of tetanus?
a. PCR b. Isolation and culture
c. Clinical diagnosis d. Serologic tests
e. B & C f. A & C
g. C & D h. All of the above
146. A 45-year-old female executive goes to a 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 this toxin?
a. It blocks release of acetylcholine.
b. It inhibits glycine and GABA.
c. It is a lecithinase.
d. It is a superantigen.
e. It ribosylates eukaryotic elongation factor-2.
f. It ribosylates Gs.
147. A 34-year-old woman comes to the office due to skin changes. Blotches of skin on her arms appear to be of
a different color, and she also has a tingling sensation in her hands. These symptoms have developed over the
past several months. The patient has no other past medical history She is a political refugee from East Africa.
On examination, there are patchy areas of skin anesthesia and hypopigmentation on her upper extremities.
Nerve biopsy evaluated under light microscopy shows many organisms invading Schwann cells. HIV testing is
negative. Which of the following organisms is the most likely cause of this patient's condition?
a. Borrelia burgdorferi b. Campylobacter fetus c. Corynebacterium diphtheriae
d. Mycobacterium leprae e. Treponema pallidum
148. The toxin of which of the following is coded for by a prophage ( should be lysogenized bacteria)?
a. Clostridium botulinum b. C. diphtheria c. Group A streptococcus
d. A & B e. All of the above
149. Which of the following is the causative agent of floppy baby syndrome ?
a. C. tetani b. C. botulinum c. B. cereus
d. S. aureus e. C. sporogenes
150. Adults acquisition of botulism occurs by:
a. Spore ingestion b. Preformed toxin c. Traumatic implantation
d. B & C e. A & C f. All of the above
151. Nonmotile clostridia is:
a. Cl. perfringens b. Cl. novyi
c. Cl. botulinum d. Cl. difficile
152. Mechanism of action of tetanospasmin:
a. Inhibition of GABA release b. Inhibition of cAMP
c. Inactivation of Ach receptors d. Inhibition of cGMP
153. A patient is presented with trismus with opisthotonus position. The probable causative agent is:
a. Clostridium tetani
b. Clostridium perfringens
c. Clostridium difficile
154. Double zone of hemolysis on blood agar is seen in:
a. Group D streptococcus b. Listeria meningitides c. Staphylococcus aureus
d. Clostridium perfringens e. Actinomyces israelii
155. Antibiotic associated diarrhea and the more serious pseudomembranous enterocolitis can be caused by
a. Clostridium sordellii b. Clostridium perfringens c. Clostridium difficile
d. S. aureus e. B. cereus
156. 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?
a. Bacillus anthracis b. Bacillus cereus c. Clostridium perfringens
d. Corynebacterium diphtheriae e. Listeria monocytogenes
157. The following organism does not circulate in the blood:
a. Anthrax bacillus b. Pneumococcus
c. Yersinia Pestis d. Corynebacterium diphtheriae
158. Tetanus toxin produces the following characteristic symptom:
a. Dysentery. b. Constipation.
c. Vomiting. d. Lock jaw.
159. A high ASO titer indicated recent infection by streptococcus:
a. Viridance. b. Pyogenes.
c. Faecalis. d. Agalactae.
160. Urine culture is performed on:
a. Mid-stream specimen. b. The first few mls of urine.
c. Total 24 hours specimen. d. The last few mls of urine.
161. Burn infection is often associated with:
a. Pseudomonas aeruginosa. b. Mycoplasma pneumoniae. c. Corynebacterium diphtheriae.
d. Haemophilus influenzae. e. Salmonalla.
162. Nagler's reaction is used in rapid diagnosis of:
a. Gas gangrene b. Tetanus
c. Diphtheria d. Botulism
163. Your patient is 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?
a. Bacillus anthracis b. Clostridium botulinum c. Clostridium perfringens
d. Clostridium tetani e. Listeria monocytogenes
164. Your patient is 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?
a. Bacillus anthracis b. Clostridium botulinum c. Clostridium perfringens
d. Clostridium tetani e. Listeria monocytogenes
165. Symptoms of C. botulinum food poisoning include double vision, inability to speak, and respiratory
paralysis. These symptoms are consistent with
a. Invasion of the gut epithelium by C. botulinum
b. Secretion of an enterotoxin
c. Endotoxin shock
d. Ingestion of a neurotoxin
e. Activation of cyclic AMP
166. In patients with colon cancer, which of the following is the causative agent of septic shock?
a. Clostridium botulinum b. Clostridium perfringens
c. Clostridium difficile d. Clostridium septicum
167. Which of the following may causes gas gangrene in the absence of trauma?
a. Clostridium botulinum b. Clostridium perfringens c. Clostridium difficile
d. Clostridium septicum e. B & D f. All of the above
168. The following Clostridium is transmitted endogenously :
a. Botulinum b. Perfringens
c. Difficile d. Septicum
e. Tetani f. A & B
g. B & C h. C & D
169. The diagnostic tool of pseudomembranous colitis :
a. Culture b. Stool exam of toxin production
c. Nagler’s reaction d. PCR
170. 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 antibiotic regimens over the last year or two. He now has a temperature of 38.9°C (102°F).
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 laboratory as yielding a
gram-positive organism that is highly salt (NaCl) tolerant. What lab result is used to confirm the species of the
causal agent?
a. Bacitracin sensitivity b. Bile solubility c. Catalase production
d. Coagulase production e. Optochin sensitivity
171. What is the typical means of transmission of a toxin that blocks the release of inhibitory transmitters
GABA and glycine?
a. Eating home-canned foods
b. Fecal-oral, travel to foreign country
c. Infant given honey during the first year of life
d. Puncture wound
e. Respiratory, with incomplete vaccination history
172. An infant presents to the emergency department due to difficulty breathing, constipation, and anorexia.
Upon examination, the physician notes flaccid paralysis. A toxin screen of the stool identified the agent. What is
the mechanism of action of the toxin?
a. ADP ribosylation of eukaryotic elongation factor 2 (eEF-2)
b. ADP ribosylation of Gi
c. ADP ribosylation of GTP-binding protein
d. Blocks release of acetylcholine
e. Blocks release of inhibitory transmitters GABA and glycine
173. 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
organism most likely to be isolated from the leftover beans and lab findings which would be used in its
identification.
a. A gram-positive coccus which is catalase-positive and grows in a high salt environment
b. A gram-positive aerobic bacillus which sporulates
c. A gram-positive coccus which is catalase-negative and optochin-resistant
d. A gram-positive bacillus grown on a low oxidation-reduction medium
e. A gram-negative bacillus capable of reducing nitrates to nitrites
174. Several postal workers come down with symptoms of dyspnea, cyanosis, hemoptysis, and chest pain. Chest
x-ray reveals mediastinal widening. Sputum cultures are negative for all routine respiratory pathogens.
Serology correctly identifies the causal agent. Which of the following structures is possessed by the causal
agent?
a. Elementary body b. Endotoxin c. Periplasmic space
d. Reticulate body e. Spore
175. A 70-year-old man is hospitalized for an infection and treated with clindamycin. The patient improves and
returns to his nursing home. Two weeks later he is rushed to the emergency room with fever and loose, mucoid
green stools. The diarrhea is voluminous, and he is having severe abdominal pain. Sigmoidoscopy of his colon
reveals yellow-white plaques. What is the single most likely event/factor that contributed to this patient’s
current illness?
a. Administration of antibiotics
b. Advanced age
c. Drinking unpasteurized milk
d. Eating contaminated cold cuts
e. Living in nursing home
176. A male is presented with left mid-thigh crushed injury. Which is the most essential step to prevent gas
gangrene in this patient?
a. Wound debridement b. Anti-gas gangrene serum
c. Anti-tetanus d. Hyperbaric oxygen
177. A patient of Acute lymphocytic leukemia with fever and neutropenia develops diarrhea after
administration of amoxycillin therapy, which of the following organism is most likely to be the causative agent:
a. Salmonella Typhi b. Clostridium difficile
c. Clostridium perfringens d. Shigella flexneri
178. Vaccines are available against the following serogroups of Neisseria meningitidis EXCEPT:
a. Group A b. Group B
c. Group C d. Group W-135
179. Waterhouse-Friedrichsen syndrome is a complication seen in infection with:
a. Neisseria gonorrhoeae b. Neisseria meningitidis
c. Escherichia coli d. Mycobacterium tuberculosis
180. Which among the following differentiates Neisseria meningitidis from Neisseria gonorrhoeae?
a. It is oxidase positive b. It ferments glucose
c. It ferments maltose d. It reduces nitrates
181. Conjugate vaccines are available for the prevention of invasive disease caused by all of the following
except:
a. H influenzae b. Strep pneumoniae
c. N.meningitidis (group C) d. N.meningitidis (group B)
182. Neisseria meningitidis, group B, is characterized by
a. Repeating polysaccharide capsule of glucose and glucuronic acid
b. Outer-membrane proteins
c. γ-Glutamyl polypeptide
d. Sialic acid polymers
e. Hyaluronic acid
183. A 16-year-old male patient presents with headache, fever and neck stiffness for the past 24 hours. Similar
history was present one year back. CSF analysis shows WBC count–400/ml, with 90% neutrophils. Gram
staining shows gram negative diplococci. The immune system affected in this condition is:
a. B lymphocytes b. T lymphocytes
c. Immunoglobulins d. Complement system
184. Which serogroup is associated with atypical presentation of invasive meningococcal disease?
a. Group A b. Group B
c. Group C d. Group W
185. A previously healthy woman became nauseated and vomits 12 hours after eating home-pickled eggs.
Within 24 hours, she developed a diffuse fl accid paralysis and respiratory impairment, necessitating
hospitalization and mechanical ventilation. Other symptoms included diplopia and dysarthria. What is the
most likely diagnosis?
a. Botulism b. Brucellosis c. Gastrointestinal anthrax
d. Legionellosis e. Meningococcal disease
186. A 3-year-old female child presented with a febrile headache, vomiting, and a swollen right knee that was
exquisitely painful upon motion. Physical examination revealed a petechial rash on the skin. Gram stain of the
synovial fl uid revealed the presence of Gram-negative diplococci and culture suggested a strict aerobe that
fermented glucose and maltose. Capsule antigens were also detected by serology. Which one of the following is
most likely the causative agent of the disease?
a. Escherichia coli b. Neisseria meningitidis c. Neisseria gonorrhoeae
d. Staphylococcus aureus e. Haemophilus influenzae b
187. A 5-year-old child died from severe septic shock, disseminated intravascular coagulation, and cardiac
insufficiency following a sudden onset of fever, severe headache, and vomiting. The causative agent, a Gram-
negative diplococcus, was isolated from blood and cerebrospinal fluid (CSF) on Thayer–Martin agar and was
also identified in CSF by latex agglutination. What is the most important virulence factor involved in disease
production by the etiologic agent in this case?
a. Exotoxin production b. Flagella c. Lipooligosaccharide
d. Pili e. Polysaccharide capsule
188. A 37-year-old male is seen at a sexually transmitted disease clinic for treatment of gonorrhea. Prior
treatments for this disease have successfully eradicated the organism; however, the man has not changed his
behavior and has been repeatedly reinfected. What is the most important strategy the organism employs which
enables it to cause repeated infections?
a. Antigenic variation
b. Induction of immune suppression
c. Intracellular growth in alveolar macrophages
d. Polysaccharide capsule
e. Secretion of IgG protease
189. A 4-year-old child was hospitalized for suspected bacterial meningitis. Antigens of the infectious agent were
detected in the cerebral spinal fluid and an etiologic diagnosis was made. Which laboratory test allowed for the
detection of bacterial antigens?
a. Gram stain b. Indirect immunofluorescence c. India ink stain
d. Latex agglutination e. Polymerase chain reaction
190. Regarding the differences between N. meningitidis (meningococci) and N. gonorrhoeae (gonococci), which
one of the following is the most accurate statement?
a. Meningococci are oxidase-positive, whereas gonococci are not.
b. Meningococci have a thick polysaccharide capsule, whereas gonococci do not.
c. Meningococci have lipid A, whereas gonococci do not.
d. Meningococci produce penicillinase, whereas gonococci do not.
e. Meningococci synthesize IgA protease, whereas gonococci do not.
191. Your patient is 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?
a. Endotoxin b. IgA protease c. Oxidase
d. Pilus protein e. Superantigen
192. Clostridium perfringens type A food poisoning:
a. Is associated with consumption of contaminated milk
b. The toxin is produced only when the vegetative cells sporulate
c. The toxin is produced only when the spores germinate
d. Is accompanied by nervous symptoms and no diarrhea
e. Is produced by heat-stable enterotoxin
193. Neisseria Meningitidis is:
a. Transmitted by ingestion
b. A causative agent of neonatal meningitis
c. Carried in the nasopharynx by some healthy people
d. Isolated from urine of patients suffering from meningitis
e. All of the above
194. In people who have sickle cell anemia, osteomyelitis usually is associated with which of the following
organisms?
a. Micrococcus b. Escherichia c. Pseudomonas
d. Salmonella e. Streptococcus
195. Osteomyelitis in patients with sickle cell anemia is usually associated with infection by:
a. Escherichia coli. b. Salmonella enteritidis.
c. Streptococcus viridance. d. Pseudomonas aeruginosa.
196. Regarding the members of the family Enterobacteriaceae, which one of the following is the most accurate?
a. All members of the family are anaerobic, which means they must be cultured in the absence of oxygen.
b. All members of the family ferment lactose, which is an important diagnostic criterion in the clinical laboratory.
c. All members of the family have endotoxin, an important pathogenetic factor.
d. All members of the family produce an enterotoxin, which ADP-ribosylates a G protein in human enterocytes.
197. Each of the following agents is a recognized cause of diarrhea EXCEPT:
a. Clostridium perfringens b. Enterococcus faecalis
c. Escherichia coli d. Vibrio cholera
198. Which one of the following host defense mechanisms is the MOST important for preventing dysentery
caused by Salmonella?
a. Gastric acid b. Salivary enzymes
c. Normal flora of the mouth d. Alpha interferon
199. Five hours after eating reheated rice at a restaurant, a 24-yearold woman and her husband both developed
nausea, vomiting, and diarrhea. Which one of the following organisms is the MOST likely to be involved?
a. Clostridium perfringens b. Enterotoxigenic Escherichia coli
c. Bacillus cereus d. Salmonella typhi
200. The pathogenesis of which one of the following diseases does NOT involve an exotoxin?
a. Scarlet fever b. Typhoid fever
c. Toxic shock syndrome d. Botulism
201. Which one of the following illnesses is NOT a zoonosis?
a. Typhoid fever b. Q fever
c. Tularemia d. Rocky Mountain spotted fever
202. Each of the following statements concerning Clostridium perfringens is correct EXCEPT:
a. It causes gas gangrene.
b. It causes food poisoning.
c. It produces an exotoxin that degrades lecithin and causes necrosis and hemolysis.
d. It is a gram-negative rod that does not ferment lactose.
203. A 4-year-old girl has papular and pustular lesions on her face. The lesions are exuding a honey-colored
serous fluid. You make a clinical diagnosis of impetigo. A Gram stain of the exudate reveals gram-positive
cocci in chains, and a culture reveals β-hemolytic colonies on blood agar. For which one of the following
sequelae is she MOST at risk?
a. Bloody diarrhea
b. Blurred vision
c. Paralysis of the facial nerve (Bell’s palsy)
d. Red blood cells and albumin in her urine
e. Rusty-colored sputum
204. ___________ is responsible for the most serious forms of shigellosis.
a. Shigella sonnei b. Shigella flexneri
c. Shigella dysenteriae type 1 d. Shigella boydii
205. Which one of the following is always of clinical significance when present in sputum:
a. Escherichia coli. b. Salmonella typhi.
c. Bacillus anthracis. d. Shigella flexneri.
206. A 3-year-old child, who attends day care, is seen at the emergency department presenting with bloody
diarrhea (“currant jelly” stools), accompanied by painful abdominal cramping. Stool specimens were plated on
MacConkey and Hektoen agars. Gram stain of the resulting bacteria revealed Gram negative rods. Colorless
colonies grew on both MacConkey and Hektoen agars, and the organisms were nonmotile. What is the most
likely etiology and infection?
a. Escherichia coli. b. Salmonella typhi.
c. Bacillus anthracis. d. Shigella sonnei .
207. Infection with ________________ resembles that caused by Sh. dysenteriae type 1.
a. Entero-invasive E. coli b. Enteropathogenic E. coli
c. Enterotoxigenic E. coli d. Enteroaggregative E. coli
208. ______________ cause infantile enteritis.
a. Entero-invasive E. coli b. Enteropathogenic E. coli
c. Enterotoxigenic E. coli d. Enteroaggregative E. coli
209. _______________ causes a cholera-like illness.
a. Entero-invasive E. coli b. Enteropathogenic E. coli
c. Enterotoxigenic E. coli d. Enteroaggregative E. coli
210. _______________ cause chronic diarrhoeal illness.
a. Entero-invasive E. coli b. Enteropathogenic E. coli
c. Enterotoxigenic E. coli d. Enteroaggregative E. coli
211. The following results after infection other than streptococci:
a. Rheumatic fever. b. Acute glomerulonephritis.
c. Scarler fever. d. Erythema nodosum.
212. Blood culture should be sent to micro lab for investigation of:
a. Rheumatic fever. b. Diphtheria.
c. Tetanus. d. Acute epiglottitis.
213. Urinary tract infection may be caused by the following EXCEPT:
a. Shigella sonnei. b. Escherichia coli. c. Streptococcus faecalis.
d. Mycobacterium tuberculosis. e. Proteus mirabilis.
214. Urinary tract infection may be caused by the following EXCEPT:
a. Escherichia coli. b. Staphylococcus saprophyticus. c. Klebsiella spp.
d. Streptococcus viridans. e. Proteus mirabilis.
215. Which of the following toxins acts by inhibiting protein synthesis:
a. Cholera toxin b. Shiga toxin
c. Pertussis toxin d. LT of Enterotoxigenic E.coli
216. A 20-year-old man presented with hemorrhagic colitis. The stool sample grew Escherichia coli in pure
culture. The following serotype of E.coli is likely to be causative agent:
a. O157:H7 b. O159:H9
c. O107:H7 d. O55:H7
217. EHEC strain associated with HUS is:
a. O157 : H7 b. O7 : H157
c. O37 : H14 d. O157 : H9
218. Traveller’s diarrhea is caused by:
a. Entero-invasive E. coli b. Enteropathogenic E. coli
c. Enterotoxigenic E. coli d. Enteroaggregative E. coli
219. Which of the following is not true about HUS?
a. May present with hemorrhagic colitis b. Shiga like toxin has no role in HUS
c. Usually self-limited d. Fever is typically absent
220. A 2-year-old infant is brought to the emergency room with hemolytic uremic syndrome and
thrombocytopenia. Which one of the following bacteria would most likely be isolated from a stool specimen?
a. Shigella b. Salmonella
c. Enterobacter d. E. coli 0157/H7
221. Culture media used for diagnosis of EHEC O157: H7 is:
a. O7 culture b. Sorbitol MacConkey media
c. XLD agar d. Deoxycholate media
222. The non- sorbitol fermenter strain of E.coli is:
a. ETEC b. EPEC c. EIEC
d. EHEC e. EAEC f. None of the choices
223. Which bacteria cause night sweating ?
a. M. tuberculosis b. Strep. viridians
c. Staph. epidermis d. A & B
224. E. Coli cause the following diseases EXCEPT:
a. Neonatal meningitis b. Septicacemia c. Gastroenteritis
d. Urinary tract Infection e. Toxic shock syndrome
225. Urinary tract infection is not caused by:
a. Escherichia coli b. Klebsiella pneumonia c. Psudomonas aeruginosa
d. Proteus mirabilis e. Shigella dysentriae
226. The man is the only host for:
a. Shigella flexneri b. Salmonella entertidis c. Complyobacter faetus
d. Brucella abortus e. Yersinia pestis
227. The following diseases are due to toxemia EXCEPT:
a. Diphtheria b. Botulism c. Scalded Skin Syndrome
d. Tetanus e. Syphilis
228. The following disease is NOT a septicemia:
a. Subacute bacterial endocarditis b. Diphtheria c. Plague
d. Puerperal sepsis e. Enteric fever
229. The most common cause of acute postinfluenzal pneumonia is
a. Legionella b. Listeria c. Staphylococcus aureus
d. Klebsiella e. Escherichia coli
230. A bacterium was isolated from the central nervous system of a newborn that died of meningitis. The vagina
of the mother was colonized with the same isolate as determined by the capsular antigen. The microbe grew
well on standard blood and MacConkey agar at ambient atmospheric conditions. What is the most likely
etiologic agent?
a. Escherichia coli K1 b. Group B Streptococcus c. Haemophilus influenzae type b
d. Neisseria meningitidis serogroup e. Streptococcus pneumoniae
b
231. An adult tourist visiting a remote area of Guatemala developed fever, prostration, malaise, dysentery, and
dehydration. Based on current epidemiologic data of the region, a local physician reported that the causative
agent was probably a diarrheogenic strain of Escherichia coli and did not prescribe antibiotic therapy.
Presuming the Guatemalan doctor to be correct, which type of virulent E. coli is most consistent with this
clinical picture?
a. Enteroaggregative E. coli b. Enterohemorrhagic E. coli c. Enteroinvasive E. coli (EIEC)
(EAEC) (EHEC)
d. Enteropathogenic E. coli (EPEC) e. Enterotoxigenic E. coli (ETEC)
232. An 85-year-old male nursing home patient with a history of alcoholism suddenly developed a fl u-like
illness. He complained of chills and fever and had frequent coughing spells productive of thick, bloody sputum.
The attending physician diagnosed bronchopneumonia and prescribed antibiotics, but regrettably the patient
died within a week. What is the most likely cause of the patient’s pneumonia?
a. Haemophilus influenzae b. Klebsiella pneumoniae c. Legionella pneumophila
d. Mycoplasma pneumoniae e. Streptococcus pneumoniae
233. The round or oval macrophages that have small nuclei and are present in the nodules of rhinoscleroma is:
a. Kupffer cells b. Alveolar macrophages
c. Mikulicz cells d. langerhans cells
234. Heat-labile enterotoxin of Escherichia coli activates
a. guanylate cyclase b. adenylate cyclase
c. both (a) and (b) d. none of these
235. Heat-stable enterotoxin of Escherichia coli activates
a. guanylate cyclase b. adenylate cyclase
c. both (a) and (b) d. none of these
236. Prodigiosin (red pigment) is produced by members of genus
a. Hafnia b. Enterobacter
c. Serratia d. Cirobacter
237. Bipolar staining is characteristic of
a. Yersinia pestis b. Proteus mirabilis
c. Pseudomonas aeruginosa d. all of these
Match the following with Q 238-240
(A) Escherichia coli (B) Klebsiella pneumoniae (C) Salmonella enteritidis (D) Proteus mirabilis
238. Is frequently implicated in nosocomial infections, is an important cause of community-acquired pneumonia
in adults, and has a thick, mucoid capsule
239. Is the most common cause of urinary tract infections
240. Pathogenicity associated primarily with urinary tract infections; produces urease

241. An elderly patient with diabetes in the ICU has been on a ventilator for 4 days following open heart
surgery. Lung function has deteriorated, and lung specimens were collected and analyzed by culture, revealing
Gram-negative rods with colorless colonies on MacConkey agar indicate that the bacterium cannot ferment
lactose.. The organisms were resistant to many antimicrobial drugs. What is the most likely etiology and
infection?
a. Klebsiella pneumoniae b. Escherichia coli c. Legionella pneumophila
d. Pseudomonas aeruginosa e. Proteus mirabilis
242. An 18-year-old child with cystic fibrosis suffers from sudden, decreased lung function, which prompts a
trip to the emergency department. Sputum samples were collected and plated on MacConkey agar. The
resulting colorless colonies yielded Gram-negative, rod-shaped bacteria. What is the most likely cause of
infection?
a. Klebsiella pneumoniae b. Escherichia coli c. Legionella pneumophila
d. Pseudomonas aeruginosa e. M. tuberculosis
243. Most common Gram-negative organism causing pneumonia in cystic fibrosis:
a. Pseudomonas b. E. coli
c. Klebsiella d. Legionella
244. Ecthyma gangrenosum is caused by:
a. Pseudomonas b. Streptococcus
c. Staphylococcus d. B. anthracis
245. Your patient is 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?
a. Escherichia coli b. Proteus mirabilis
c. Pseudomonas aeruginosa d. Serratia marcescens
246. Your 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?
a. Campylobacter jejuni b. Escherichia coli c. Haemophilus influenzae
d. Pseudomonas aeruginosa e. Salmonella enterica
247. Your patient is a 75-year-old man with an indwelling urinary catheter following prostatectomy for prostate
cancer. He now has the sudden onset of fever to 40°C, blood pressure of 70/40, and a pulse of 140. You draw
several blood cultures, and the laboratory reports that all are positive for a gram-negative rod that forms red
pigmented colonies. Which one of the following bacteria is the most likely cause of this infection?
a. Escherichia coli b. Klebsiella pneumoniae c. Proteus mirabilis
d. Pseudomonas aeruginosa e. Serratia marcescens
248. All the following are characteristics of Pseudomonas aeruginosa EXCEPT:
a. An opportunistic pathogen
b. A causative agent of urinary tract infection
c. A causative agent of burn infection
d. A primary pathogen
e. A causative agent of eye infection
249. Proteus does NOT cause:
a. Fermentation of lactose. b. Swarming growth.
c. Urinary tract infection. d. Chronic otitis media.
250. The main differentiating characteristics of the Proteus group is:
a. A slow lactose fermenter. b. Hydrolysis of urea. c. Production of H2S.
d. Oxidase positive. e. Non motile.
251. Which of the following infection(s) can be caused by Pseudomonas aeruginosa?
a. Urinary tract infection b. Wound and burn infection
c. Respiratory tract infection d. All of these
252. The substance(s) which can be produced by strains of Pseudomonas aeruginosa is/are
a. Exotoxins A b. Elastase
c. Haemolysins d. All of these
253. Chloronychia(Green nails), the Fox-Goldman syndrome, is caused by infection of an often damaged nail
plate by:
a. Escherichia coli b. Klebsiella pneumoniae c. Proteus mirabilis
d. Pseudomonas aeruginosa e. Serratia marcescens f. Burkholderia cepacia
254. The mode of transmission of Burkholderia cepacia is mainly:
a. Fecal-oral rout b. Water aerosols c. respiratory droplets
d. sexual contact e. a & b f. B & C
255. Cause of recurrent pneumonia in individuals with cystic fibrosis:
a. Burkholderia cepacia b. Pseudomonas (no mucoid strain) c. Klebsiella
d. Streptococcus pneumoniae e. Pseudomonas ( mucoid strain) f. A & E
256. Cause of melioidosis is:
a. Burkholderia mallei b. Burkholderia pseudomallei
c. Burkholderia cepacia d. Pseudomonas aeruginosa
257. The causative agent of Whitmore's Disease :
a. Burkholderia mallei b. Burkholderia pseudomallei
c. Burkholderia cepacia d. Pseudomonas aeruginosa
258. Sixteen residents in a retirement home have fever, malaise, and anorexia. These residents have taken their
meals prepared by the same kitchen. Blood cultures from 11 of these residents grow Salmonella enterica subsp.
typhi. The primary reservoir of this organism is
a. hen’s egg b. dogs and cats c. turkeys
d. people e. water
259. A 6-year-old girl had crashed on a toboggan ride and complained of pain in the 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
a. requires an elevated oxidation reduction potential
b. is a gram-negative coccobacillus
c. is a marked lecithinase producer
d. is nonhemolytic on blood agar
e. is nonfermentative
260. 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 is revealed. Which organism is the most likely cause of
her condition?
a. EHEC b. ETEC
c. Salmonella enterica subsp. enteritidis d. Salmonella enterica subsp. typhi
e. Shigella dysenteriae
261. The clinical laboratory reports the presence of 0157:H7 strains of E. coli in the bloody stools of 6 children
ages 3–5 who attended a local petting zoo. These young children would be at an increased risk for developing
a. buboes b. hemolytic uremic syndrome
c. infant botulism d. renal stones
e. rice water stools
262. A 68-year-old woman on chemotherapy for leukemia has developed sepsis due to an infection with
Escherichia coli. The following day the patient develops septic shock and dies. The structure on the bacterium
most likely responsible for causing septic shock in this patient is
a. capsule b. lipopolysaccharide
c. pili d. spore
e. teichoic acid
263. A 45-year-old woman presents to the 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?
a. Capsule b. Catalase
c. Coagulase d. Exotoxin
e. Urease
264. 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 the following descriptions is most likely to fit the patient?
a. Alcoholic
b. Homeless
c. Hiker
d. IV drug user
e. Veterinarian
265. A 35-year-old man who is positive for 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?
a. Bacillus anthracis b. Clostridium perfringens
c. Enterococcus faecalis d. Pseudomonas aeruginosa
e. Staphylococcus aureus
266. Cell-mediated immunity is the main host defense against which one of the following organisms?
a. Escherichia coli b. Mycobacterium tuberculosis
c. Pseudomonas aeruginosa d. Staphylococcus aureus
e. Streptococcus pneumoniae
267. A 65-year-old man develops dysuria and hematuria. A Gram stain of a urine sample shows gram-negative
rods. Culture of the urine on EMB agar reveals lactose-negative colonies without evidence of swarming
motility. Which one of the following organisms is MOST likely to be the cause of his urinary tract infection?
a. Enterococcus faecalis b. Pseudomonas aeruginosa
c. Proteus vulgaris d. Escherichia coli
268. The pathogenesis of which one of the following diseases does NOT involve an exotoxin?
a. Scarlet fever b. Typhoid fever
c. Toxic shock syndrome d. Botulism
269. Tissue-degrading enzymes play an important role in the pathogenesis of several bacteria. Which one of the
following is NOT involved in tissue or cell damage?
a. Lecithinase of Clostridium perfringens b. Hyaluronidase of Streptococcus pyogenes
c. M protein of Streptococcus pneumoniae d. Leukocidin of Staphylococcus aureus
270. Which one of the following organisms causes diarrhea by producing an enterotoxin that increases
adenylate cyclase activity within enterocytes?
a. Escherichia coli b. Bacteroides fragilis
c. Staphylococcus aureus d. Enterococcus faecalis
271. A patient presents with a brain abscess. The dominant organism is an anaerobe normally found as part of
the oral flora. Which of the following best fits that description?
a. Nocardia b. Actinomyces
c. Mycobacterium d. Pseudomonas aeruginosa

Q3 Answer the following cases:

1- A 60-year-old male with depressed cell-mediated immunity presents with fever, chills, and weight loss. Acid-
fast staining of sputum samples was positive.

a- What is the most likely etiology and infection?

b- What are the fibrotic lesions seen on the chest x-ray (panel A) called?
2- What Gram-positive bacillus is capable of causing pulmonary (panel B) manifestations, as shown?

3- A farmer in Iowa presents at the emergency department with fever and confusion. Chest x-ray shows
mediastinitis and mediastinum widening, as shown (panel B). The physician collects a CSF sample for analysis,
and Gram stain of the CSF material is similar to that shown. The physician urgently treats the patient with IV
antibiotics and notifies the public health department. What is the most likely etiology and infection?

4- A 20-year-old man fell off his motorcycle and suffered a compound fracture of the femur. The fracture was
surgically reduced and the wound debrided. Forty-eight hours later, he spiked a fever (temperature, 40°C),
and the wound area became necrotic. Crepitus was felt, and a foul-smelling odor was perceived originating
from the wound. Marked anemia and a WBC count of 22,800 were found. Gram stain of the exudate showed
large gram-positive rods. Colonies grew on blood agar incubated anaerobically but not aerobically.

Diagnosis: Gas gangrene (myonecrosis) caused by Clostridium perfringens.

5- A 70-year-old man was admitted to the hospital after suffering extensive third-degree burns. Three days later,
he spiked a fever, and there was pus on the dressing that had a blue–green color. Gram stain of the pus
revealed gram-negative rods.
Diagnosis: Wound (burn) infection caused by Pseudomonas aeruginosa.

Good Luck 118