BLUE COLOR: SAMPLEX
- Ophthalmia neonatorum usually occurs 1-4 days
GREEN COLOR: EJG
I. GONOCOCCUS: NEISSERIA GONORRHOEAE
Uncomplicated Gonorrhea
→ GENITAL GONORRHEA
Primary infection:
● Males: urethra
● Pre-pubertal females: vulva and vagina
● Post-pubertal females: cervix
Incubation period:
● Males: 2-5 days
● Females: 5-10 days
Males: Urethritis
● Purulent discharge, dysuria without urgency or
frequency
● Untreated urethritis in males resolves
spontaneously in several weeks or may be
complicated by epididymitis, penile edema,
lymphangitis, prostatitis, or seminal vesiculitis.
● (+) Gram negative intracellular diplococci in
discharge
Prepubertal females: Vulvovaginitis
● Purulent vaginal discharge with a swollen,
erythematous, tender, and excoriated vulva.
● Dysuria may occur.
Postpubertal females: Cervicitis, Urethritis
● Purulent discharge, suprapubic pain, dysuria,
intermenstrual bleeding, dyspareunia.
● The cervix may be inflamed and tender.
● In urogenital gonorrhea limited to the lower genital
tract:
● Pain is not enhanced by moving the cervix, and the
adnexa are not tender to palpation.
● Purulent material may be expressed from the
urethra or ducts of the Bartholin gland.
Rectal gonorrhea
● Often asymptomatic
● May cause proctitis with symptoms of anal
discharge, pruritus, bleeding, pain, tenesmus,
constipation.
● May not be from anal intercourse but may
represent colonization from vaginal infection.
Uncomplicated Gonorrhea
→ Gonococcal Ophthalmitis
● May be unilateral or bilateral
● Occurs at any age group after inoculation of the
eye with infected secretions
after birth
- Ocular infection in older patients result from
inoculation or autoinoculation from a genital site
● Begins with mild inflammation and a
serosanguineous discharge.
● Within 24 hr, the discharge becomes thick and
purulent, and tense edema of the eyelids with
marked chemosis occurs.
● Without treatment → corneal ulceration, rupture,
blindness
Disseminated Gonococcal Infections
• Hematogenous dissemination occurs in 1-3% of all
gonococcal infections more frequently after asymptomatic
primary infections than symptomatic infections.
• Women account for the majority of cases
- With symptoms beginning 7-30 days after infection
and within 7 days of menstruation.
• Most common manifestations:
- Asymmetric arthralgia
- Petechial or pustular acral skin lesions
- Tenosynovitis
- Suppurative arthritis
- Rarely: Carditis, Meningitis, Osteomyelitis
• Most common initial symptom:
- Acute polyarthralgia with fever
- Polyarticular septic arthritis in neonate
- Only 25% of patients complain of skin lesions.
- Most deny genitourinary symptoms; however,
primary mucosal infection is documented by
genitourinary cultures.
• Positive cultures:
- Cervical cultures: 80-90%
- Urethral cultures (males): 50-60%
- Pharyngeal cultures: 10-20%
- Rectal culture: 15%
• DGI is classified into two clinical syndromes that have
some overlapping features:
- Tenosynovitis-dermatitis syndrome
- Suppurative arthritis syndrome
Tenosynovitis-Dermatitis Syndrome
– more common
• Fever, chills, skin lesions, and polyarthralgia
predominantly involving the wrists, hands, fingers
• Skin lesions: painful, discrete, 1-20 mm pink or red
macules → maculopapular, vesicular, bullous, pustular, or
petechial lesions.
1 | BACTERIOLOGY B BY ENOKI (MRG)
• The typical necrotic pustule on an erythematous base is
distributed unevenly over the extremities, including the
palmar and plantar surfaces, usually sparing the face and
scalp.
• Blood culture: positive in 30-40% of cases
• Synovial fluid culture: almost uniformly negative
TREATMENT
Gonorrhea: Treatment
- Ceftriaxone: drug of choice
- Due to ↑ prevalence of penicillin-resistant N.
gonorrhoeae
Treatment for Adolescent and Adult Infections (≥45 kg)
- Ceftriaxone 250 mg/kg in single dose IM/IV
- Alternative: Cefixime 400 mg PO single dose
- Rectal and uncomplicated urogenital infection
- Pharyngeal: Cefixime not used
- Gonococcal conjunctivitis: Ceftriaxone 1 g IM
single dose
EJG MUST KNOW
Treatment:
● Cefixime + doxycycline: dysuria, urethral d/c, gonococcal
urethritis
● Ceftriaxone + erythromycin: sexually abused cases
● Erythromycin + tetracycline: gonococcal ophthalmia
● Ceftriaxone: purulent eye discharge
Disseminated gonococcal infection:
● painful necrotic pustule on an erythematous base on
palms and soles
● do NOT present with: genitourinary symptoms
● necrotic pustules on an erythematous base, distributed
unevenly on the extremities including palms and soles in a
sexually active adolescent girl with fever, chills and
polyarthralgia
Conjunctivitis: most common manifestation
● Asymptomatic EXCEPT: urogenital infections in children
●Fitz-hugh-curtis syndrome: lower abdominal pain,
jaundiced with RUQ pain, with cervical and adnexal
tenderness
● Acute PID: leukocytosis, elevated ESR, suprapubic pain,
cervical tenderness, adnexal tenderness
● Asymptomatic primary infection in women:
Hematogenous dissemination occurs in 1-3% of all
gonococcal infections more frequently after
II. TREPONEMA PALLIDUM (SYPHILIS)
CONGENITAL SYPHILIS
Congenital SY: Early Signs – noted in the 1st 2 years of life
• Transplacental spirochetemia, analogous to 2° stage of
acquired SY
• Hepatosplenomegaly
• Jaundice and elevated liver enzymes
• Diffuse lymphadenopathy
• Coomb’s negative hemolytic anemia
• Thrombocytopenia with platelet trapping in an enlarged
spleen
• Erythematous maculopapular and vesiculobullous lesions
with desquamation on hands and feet
Mucous membrane involvement:
- Mucous patches, rhinitis (snuffles)
- Condylomatous lesions: contain abundant
spirochetes.
- Blood and moist open lesions in congenital SY and
children with acquired 1° or 2° SY are infectious
until 24 hrs of appropriate treatment
Bone involvement: common
- Wimberger’s lines: metaphyseal demineralization
of medial aspect of proximal tibia
- Osteochondritis: involving the wrists, elbow,
ankles, knees; Tertiary painful, multiple, causing
irritability and refusal to move involved extremity
(pseudoparalysis of Parrot)
Other Manifestations:
CNS abnormalities (neurosyphilis, often asymptomatic),
failure to thrive, chorioretinitis, nephritis and nephrotic
syndrome
Congenital SY: Late Signs - appear at >2 years old
2 | BACTERIOLOGY A BY ENOKI (MRG)

Acquired Syphilis – Three Stages
I. PRIMARY SYPHILIS
• Painless indurated ulcers (chancres) at site of entry
(genitalia) + regional non-tender lymphadenitis
• Heal spontaneously w/n 4-6 weeks leaving a thin scar
II. SECONDARY
• Occurs 2-10 weeks after the chancre heals
• Related to spirochetemia
• Rash: maculopapular, generalized, non-pruritic
particularly on palm and soles; may be pustular
• Condyloma lata (gray-white / erythematous wart-like
plaques around anus or vagina)
• Mucous patches in mucous membranes
• Flu-like illness
- Low grade fever, headache, malaise, anorexia,
weight loss, sore throat, myalgia, arthralgia,
generalized lymphadenopathy
• Renal, hepatic and ophthalmologic manifestations
• Meningitis in 30% of cases
- May be asymptomatic, but with pleocytosis and ↑
protein
III. LATENT
● 1-2 months after onset of rash
- Period after infection when seroreactive but
asymptomatic (VDRL + TREPONEMA PALLIDUM
IMMUNOASSAY REACTIVE)
- Early latent SY: relapses with secondary
manifestations
- Late latent SY: asymptomatic
IV. TERTIARY
• Late latent but symptomatic with neurologic,
cardiovascular, and gummatous lesions (non-suppurative
granuloma of skin and musculoskeletal system due to host’s
hypersensitivity reaction)
• Neurosyphilis
- Infection of the CNS
- Occur at any stage especially in HIV patients
DIAGNOSIS
• Dark field microscopy
• Serology: principal means for diagnosis
• Non-treponemal tests:
- Venereal Disease Research Laboratory
- Rapid Plasma Reagin: Detect antibodies against a
phospholipid antigen on the treponeme surface
that cross react w/ mammalian cardiolipin-
lecithin-cholesterol complex
- not specific for SY
- Correlate with disease activity: for screening
- Titers increase w/ active disease, including
treatment failures or reinfection; decline with
adequate treatment
- Nonreactive w/in 1 year of tx for primary SY, 2
years for secondary SY, few months in congenital
SY
- False (+) in autoimmune disease
Specific Treponemal Tests
- Confirmatory
• Remain positive for life; do not correlate with disease
activity. Measure specific T. pallidum antibodies (IgG, IgM,
IgA) which appear earlier than non-treponemal antibodies
- T. pallidum hemagglutination assay
(TPHA)
- Fluorescent treponemal Ab absorption
test (FTA-ABS)
- T. pallidum particle agglutination test
(TPPA)
- Enzyme-linked immunosorbent assays
(ELISA) to detect treponemal IgG and IgM
Syphilis: Treatment
Primary, secondary or early latent (<1 year):
● Pen G Benzathine 50,000u/k IM one dose or
● Doxycycline 100 BID x2 weeks
● Erythromycin 500 qid x 2 weeks
Late latent (>1 year) or latent of unknown duration or
tertiary (gumma or CV Syphilis) Neurosyphilis
● Aq Pen G 200,000-300,000 u/day q 4-6 hrs x 10-14
days Congenital Syphilis
● Aq Pen G 50,000 u/kg q12 (≤D7), q8 (>D7) x 10-14
days
EJG MUST KNOW
● Memorize tables for stages and tests before anything
● Does not need to be evaluated nor treated with
penicillin: mother was treated with penicillin before
pregnancy with stable low VDRL titer
3 | BACTERIOLOGY A BY ENOKI (MRG)
● Early sign of congenital syphilis:
erythematous maculopapular and vesiculobullous lesions
with desquamation on hands and feet
● Primary syphilis: painless indurated ulcer of the skin or
mucous membrane at the site of inoculation
● Latent syphilis: seroreactive but asymptomatic
●Manifestations: Jaundice, enlarged liver and spleen, nasal
discharge (rhinitis), skeletal abnormality, painful limbs
(bone involvement - winberger lines and osteochondritis
periostitis of long bones - painful) maculopapular
vesiculobullous rashes particularly on palms and soles /
erythematous maculopapular or bullous lesions followed by
desquamation of hands and feet, anemia (coomb’s negative
HA)
III. CHLAMYDIA TRACHOMATIS (CHLAMYDIA)
Neonatal Chlamydial (Inclusion) Conjunctivitis
→ Ocular congestion, edema
• Develops in 30-50% of babies born to mothers with active,
untreated chlamydia infection
• Eye discharge develops 5-14 days to several weeks after
birth and lasts for 1-2 weeks
• Severity ranges from mild injection with scant mucoid
discharge to severe with copious purulent discharge,
chemosis, and pseudomembrane; conjunctivae may be
friable; bleeds when swabbed.
• Not sight-threatening
• About 50% have nasopharyngeal infection
Pneumonia
→ Afebrile illness of insidious onset at 2-19 weeks after
birth
→ Staccato cough, tachypnea, rales, wheezing
(uncommon), nasal stuffiness and otitis media
• Develops in 10-20% of babies born to mothers with active,
untreated chlamydia
• Only 25% with nasopharyngeal infection develop
pneumonia
• Onset: 1-3 months old
• Insidious, with persistent cough, tachypnea, absence of
fever
• Auscultation reveals rales; wheezing is uncommon
• Absence of fever and wheezing helps to distinguish C.
trachomatis pneumonia from RSV pneumonia
• Chest X-ray:
- Hyperinflation with minimal interstitial or alveolar
infiltrates
• (+) Peripheral eosinophilia (>400 cells/mm3)
Chlamydia: Treatment
Chlamydia conjunctivitis and Chlamydial pneumonia
→ Oral erythromycin for 14 days since ≥50% with
nasopharyngeal infection or disease at other sites
Genital Tract Infection
Adolescents and adults
- Oral Doxycycline (200 mg/day in 2 doses) x 7 days
- Azithromycin 20 mg/kg, max 1 g oral
Alternatives:
- Oral erythromycin (2 g/day in 4 doses) x 7 days
- Ofloxacin (600 mg/day in 2 doses)
- Levofloxacin (500 mg OD) for 7 days
Children ≥45 kg, <8 years old
- Azithromycin 1 g, SD
Children ≥45 kg, >8 years old
- Azithromycin 1 g, SD
- Doxycycline 100 mg BID x 7 days
EJG MUST KNOW
“Eye discharge of 7 days without colds, cough nor fever,
bilateral mild to moderate conjunctival injection and
minimal mucopurulent eye discharge, GS: few polymorph
leucocytes without microorganisms”
C. trachomatis conjunctivitis: oral erythromycin 50
mg/kg/day 4x/day x 14 days
● Memorize LGV stages
- 1st stage: primary lesion: painless, transient,
papule on genitals
- 2nd stage: unilateral femoral or inguinal
lymphadenitis, with enlarging painful buboes →
breakdown and drain especially in men
- 3rd stage: genito-anorectal syndrome with
rectovaginal fistulas, rectal strictures, urethral
destruction
●CHLAMYDIA TRACHOMATIS CASES:
→ RR of 70/min and minimal intercostal retractions and
crackles
→ Pertinent physical findings were as follows: temp 37C, CR
130/min, RR 65/min with minimal retractions, occasional
crackles, no wheezes
→ Chest x-ray show hyperinflation with minimal interstitial
or
alveolar infiltrates and peripheral eosinophilia
→ Eosinophilia
● Conjunctivitis: presence of this manifestation, concurrent
or in the recent past, in a 2-week old infant with prolonged
cough
● Important feature of neonatal chlamydia conjunctivitis:
around half of babies have nasopharyngeal infection that
can develop into pneumonia
4 | BACTERIOLOGY A BY ENOKI (MRG)
● Genital infections caused by C. trachomatis vs. N.
gonorrhea are more: mucoid than purulent
● Infection is highly communicable among: sexually active
adolescents and young adults
● Transmitted from the genital tract of infected mothers to
their infants during delivery
● Asymptomatic infection of the nasopharynx, conjunctivae,
vagina and rectum can be acquired at birth
● Genital tract infection in adolescents and adults is
transmitted sexually.
IV. CHLAMYDOPHILA PNEUMONIAE
Chlamydophila: Clinical Manifestations
→ Infected persons may be asymptomatic or
mild-moderately ill
• Usual clinical manifestations:
- Pneumonia, acute bronchitis, prolonged cough,
pharyngitis, laryngitis, otitis media, sinusitis
• Classic atypical (non-bacterial) pneumonia, not easily
differentiated from other pathogens especially M.
pneumoniae
• With mild-moderate constitutional symptoms like fever,
malaise, headache, cough, often pharyngitis
• Severe pneumonia with pleural effusion and empyema has
been described
• Mild illness can be pertussis-like
• Can serve as infectious trigger for:
- Asthma, pulmonary exacerbations in cystic
fibrosis, acute chest syndrome in sickle cell
anemia
• Isolated cases of otitis media, mostly as co-infection
• Asymptomatic respiratory infection in 2-5% of adults
for 1 year or longer
Chlamydophila: Diagnosis
• Clinical findings not differentiated from other causes
pneumoniae
• Presents with rales and wheezing
• Chest X-ray:
- Appears worse than patient’s clinical status; can
diffuse involvement or lobar infiltrates with small
effusions of atypical show mild, pleural
• Complete Blood Count:
- May be elevated with a left shift, but usually
unremarkable
• Tissue culture (Cycloheximide-treated Hep2 and HL cells):
- Posterior nasopharyngeal swab (optimum
specimen), sputum, throat cultures, pleural fluid,
BAL
• Serologic testing: primary means of diagnosis
- Micro Immunofluorescent antibody test
- Most sensitive and specific for acute infection
- positive infection: 4x ↑ in IgG titer or IgM titer ≥16
- IgM appears 2-3 weeks after illness; IgG peaks at
6-8 weeks
- In reinfection: IgM may not appear; IgG ↑ within
1-2 weeks
- Early antimicrobial therapy may suppress antibody
response
- Diagnosis require a paired serum, hence
retrospective
EJG MUST KNOW
Chlamydophila pneumoniae:
● Memorize clin manifs
● Insidious onset, persistent cough
● Occurs between 1-3 months old as persistent cough in the
absence of: fever (kasama yung: tachypnea and wheezing)
● NOT TRUE: constitutional symptoms like fever, malaise,
headache, cough and pharyngitis are often severe
● can serve as an infectious trigger of asthma
● (mild illness) can manifest as a pertussis like disease
● cannot be readily differentiated clinically from an infection
caused by mycoplasma pneumonia
● CXR findings are more significant than the clinical status
MYCOPLASMA PNEUMONIAE
Asymptomatic carriage may occur weeks-months
→ most cases: no need for hospitalization
Mycoplasma: Clinical Manifestations
• Most commonly recognized clinical syndromes:
Tracheobronchitis, Bronchopneumonia
→ Gradual onset of headache, malaise, fever, sore throat,
followed by lower respiratory symptoms like hoarseness
and cough
• Coryza or GI complaints unusual, more suggestive of viral
etiology
• Variable course if untreated
• Coughing
- Usually worsens during the 1st week, with all
symptoms resolving within 2 weeks; may last up to
4 weeks with wheezing
- Initially, nonproductive; older children with frothy
white sputum
• Symptoms more severe than physical signs, appearing
later
• (+) Fine crackles, with progression → fever intensifies,
cough more distressing, dyspnea
5 | BACTERIOLOGY A BY ENOKI (MRG)
• Clinical findings less severe than CXR: “walking
pneumonia”
• Generally recover without complications
Chest X-ray:
- Nonspecific: interstitial or bronchopneumonia
- Involvement is most common in lower lobes with
unilateral, centrally dense infiltrate in 75% of cases
- Hilar adenopathy in 1/3 of cases
- Significant effusion is unusual; large pleural
effusions if severe
- Normal WBC count, elevated ESR
• Additional respiratory illnesses (infrequent):
- URI, pharyngitis, sinusitis, croup, bronchiolitis,
• Common trigger of wheezing in asthmatic children; can
cause chronic colonization resulting in lung dysfunction in
adolescents and adult asthma patients
Dermatologic Diseases / Skin Complications
→ 10% of children with pneumonia has maculopapular
rashes
• May present as maculopapular rash, urticaria, and
mycoplasma associated rash and mucositis (erythema
multiforme or Steven- Johnson syndrome), Gianottti-Crosti
syndrome and erythema nodosum
• Mycoplasma-associated rash and mucositis occur 3-21
days after initial respiratory symptoms, last <14 days, rarely
severe
• Mucositis alone without rash
EJG MUST KNOW
Treatment:
● Clarithromycin: appropriate for mycoplasma
community-acquired pneumonia
● Typically sensitive to erythromycin, clarithromycin or
azithromycin
● Pneumonia in school-aged children and young adults
especially if cough is prominent
● Most commonly presents as tracheobronchitis and
pneumonia
● May present with target or iris lesions on the skin
● Erythematous macules that develop central necrosis to
form vesicles, bullae and areas of denudation on the face,
trunk and extremities, plus environment of two or more
mucosal surfaces usually the eyes and mouth
● Skin manifestations like maculopapular rashes, erythema
multiforme & SJS with or without a respiratory illness
● Around 10% of children with pneumonia can have rashes
● Coryza is NOT common
● Symptoms > signs: symptoms are usually more severe
than the physical signs which appear later
● CXR > CFs: clinical findings are often less severe than
chest radiograph
● Most extrapulmonary site for mycoplasma pneumonia
infection: CNS
● Onset: gradual onset of headache, malaise, fever and
sore throat progressing later to hoarseness and cough
SALMONELLA
Salmonella: Etiology
>2500 Salmonella serotypes
- Most human diseases caused by groups A-E
- Serotype Typhi is classified in serogroup D
Incubation period
- Gastroenteritis: 6-48 hrs
- Enteric fever: usually 7-14 days (3-60 days)
Nontyphoidal salmonella
→ Poultry and eggs:
- Traditionally regarded as a common source
- Other sources: fruits and vegetables, peanut
butter, cereals, infant formula, bakery products
contaminated by contact with infected animal
product or human
→ Animals: Principal source of human nontyphoidal
Salmonella disease (cats, dogs, reptiles, pet rodents,
amphibians)
→ Get infected through consumption of contaminated raw
meat or poultry-derived products
→ Animal feeds containing fishmeal or bone meal
contaminated with Salmonella are important sources to
animals
→ Subtherapeutic concentrations of antibiotics added to
feeds to promote growth → promotes drug-resistant
bacteria including Salmonella in gut flora of animals with
contamination of their meat → consumed by humans
→ Acute Gastroenteritis
• Most common presentation
• Incubation period: 6-72 hours (mean 24 hours)
• Abrupt onset of nausea, vomiting, abdominal cramps
followed by watery or bloody, mucoid diarrhea
Extraintestinal Focal Infections
• Following bacteremia, with propensity to seed and cause
focal suppurative infections commonly involving the
skeletal system, meninges, IV sites, and sites of preexisting
abnormalities
• Most common in:
- Infants ≤3 months
- Sickle disease
- Prior GI surgery
- Osteomyelitis in sickle cell disease
- Reactive arthritis in adolescent with HLA-B27
6 | BACTERIOLOGY A BY ENOKI (MRG)
 -Meningitis in infants EJG MUST KNOW

Typhoid (Enteric) Fever Treatment:

→Chloramphenicol: In the Philippines, the empiric drug of
Caused by S. typhi choice of uncomplicated typhoid fever
• Similar but less severe disease by S. paratyphi A
• Rarely S. paratyphi B or C

• Diarrhea in 30% of cases after several days of fever

(YOUNGER CHILDREN)
- Stools are pea soup with RBCs and fecal leukocytes
- Small volume not grossly bloody
• Constipation in 50% of cases (OLDER CHILDREN)

Temperature increases, becoming unremitting

- 40-40.5°C by end of 1st week
- On 2nd week, high fever, fatigue, anorexia and
abdominal symptoms increase
- Relative bradycardia, hepatosplenomegaly,
abdominal distention and tenderness
• Rose spots (2.5%) on lower chest and abdomen
•Uncomplicated: symptoms / PE function resolve in 2-4
weeks
• Malaise and lethargy for 1-2 months

Complications may occur during the 2nd to 3rd week of

illness:
● Intestinal hemorrhage (<1-10%)
- Most common; Results from erosion of necrotic
Peyer’s patch through the wall of an enteric vessel
● Intestinal perforation (0.5-1%)
- May be preceded by a marked increase in
abdominal pain, tenderness, vomiting and
features of peritonitis
- Rising WBC count
- Left shift and free air on abdominal x-ray

Salmonella: Treatment

● Antibiotics not recommended for uncomplicated

gastroenteritis caused by Nontyphoidal species
→ suppress normal flora, prolong both excretion
of Salmonella + remote risk of chronic carrier state
● Antimicrobial Treatment indicated in patients
with increased risk of invasive disease:
- infants <3 months, IBD, achlorhydria,
antacid use, malignancy,
hemoglobinopathies, AIDS, malnutrition,
severe colitis

● DOC: 3rd generation cephalosporins

- Ceftriaxone 75 mg/kg/day OD x 7 days
- Cefotaxime 100-200 mg/kg/day q6 x 5-14 days
- Ampicillin 100 mg/kg/day x 7 days
- Cefixime 15 mg/kg/day x 7-10 days

7 | BACTERIOLOGY A BY ENOKI (MRG)

 - Leukocytosis with left shift (more bands than
neutrophils)
SHIGELLA • Enzyme immunoassay for Shiga toxin
- for detection of S. dysenteriae type 1 in stool
Shigella: Clinical Manifestations • Blood culture
• Characteristic features: - In severely ill, immunocompromised,
- Severe, abdominal pain, high fever, emesis, malnourished patient
anorexia, generalized toxicity, urgency, painful • Other tests
defecation - Fluorescent antibody test
• Diarrhea: - PCR assay
- May be watery, in large volume evolving into - Enzyme-linked DNA probes
small-volume bloody, mucoid stools.
- Most never progress to bloody diarrhea Shigella: Differential Diagnosis
- bloody stools from the outset • Infections by Campylobacter jejuni, Salmonella spp.,
- Untreated diarrhea can last 1-2 weeks; 10% EIEC, STEC (E. coli O157:H7) Yersinia enterocolitica,
persisting >10 Clostridium difficile, Entamoeba histolytica, IBD
days in malnourished, AIDS, occasionally normal children - Toxic megacolon and rectal prolapse is a
• Physical Exam: complication of both Shigella and Clostridium
- Abdominal distention, tenderness, hyperactive difficile
bowel sounds, tender rectum on digital exam.
• Neurologic findings:
- The most common extraintestinal manifestations EJG MUST KNOW
in 40% of hospitalized children: convulsions,
headache, lethargy, confusion, neck rigidity
before or after onset of diarrhea
- Cause of neurologic findings is unclear; not due to
shiga-toxin, nor febrile seizures; often suggest
CNS infection (pleocytosis with minimally
elevated protein levels), but meningitis is rare

Shigella: Complications

• Dehydration (most common): SUNKEN EYEBALL

● Hemolytic Uremic Syndrome: S. dysenteriae type

1
● Toxic encephalopathy (Ekiri syndrome)
- Seizures, extreme fever, brain edema, rapidly fatal
without sepsis or significant dehydration
- Rare; cause not well understood
● Other Complications:
- Rectal prolapse, toxic megacolon or
pseudomembranous colitis (usually associated
with S. dysenteriae), cholestatic hepatitis,
conjunctivitis, iritis, corneal ulcers, pneumonia,
arthritis (usually 2-5 weeks after enteritis),
reactive arthritis, cystitis, myocarditis, vaginitis
(blood-tinged discharge associated with S.
flexneri)

Shigella: Diagnosis
• Stool exam, Stool culture
(+) Fecal leukocytes >50 on methylene-blue staining is
sensitive but not specific; or 100 PMN/hpf, confirming
colitis; (+) Fecal blood
• Complete Blood Count

8 | BACTERIOLOGY A BY ENOKI (MRG)

 CHOLERA days 9 Dose:
- <6 months: 10 mg
Cholera: Clinical Manifestations - 6 months - 12 years: 20 mg

Majority of cases are mild or inapparent (asymptomatic) Antimicrobial therapy

• Among symptomatic cases, 20% develop severe - Only for cases with moderate-severe dehydration
dehydration that - Shortens duration of illness, reduces period of
can rapidly lead to death excretion, decreases volume of diarrhea,
• Following the incubation period, acute watery diarrhea decreases fluid requirements
and vomiting ensues. The onset may be sudden, with - Duration of treatment: 3 days
profuse watery diarrhea, but some have a prodrome of
anorexia and abdominal discomfort and stool may initially
be brown
• Diarrhea → painless purging of rice water stools
(suspended flecks of mucus) with a fishy smell (hallmark
of the disease)
• Vomiting with clear water fluid usually present at onset
of disease

Cholera gravis
- Most severe form
- Results when purging rates of 500-1000 mL/hr
occur
- Purging leads to dehydration manifested as:
- Decreased urine output
- Sunken fontanel (in infants)
- Sunken eyes
- Absence of tears
- Dry oral mucosa
- Shriveled hands and feet
(washerwoman’s hands)
- Poor skin turgor
- Thready pulse
- Tachycardia
- Hypotension
- Vascular collapse within <24 hrs after
onset

Stools contain high concentrations of Na, K, Cl, HCO3 →

hypokalemia, metabolic acidosis (typical Kussmaul
breathing), hypoglycemia, seizures and coma can occur

Deaths within hours if fluid losses not rapidly corrected

Cholera: Treatment
● Rehydration therapy
- Most important treatment modality
- ORS for mild-moderate dehydration
- IV lactated ringer’s (D5LR / D5 0.9 NaCl) for shock
cases
● Zinc supplementation
- Zinc should be given as soon as vomiting stops
- Shorten duration of diarrhea and reduces
subsequent diarrhea episodes if given daily x 14
ESCHERICHIA COLI
1. Enterotoxigenic E. coli (ETEC)
→ Produce secretory enterotoxins
• Major cause of dehydrating infantile diarrhea in
developing countries (10-30%) and traveler’s diarrhea
(20-60%), and 3-39% of overall diarrheas in developing
countries
• Explosive, watery, non-mucoid, non-bloody diarrhea,
abdominal pain, nausea, vomiting and little or no fever
• Usually, it is self-limited and resolves in 3-5 days.

9 | BACTERIOLOGY A BY ENOKI (MRG)

Heat-labile toxin (LT) stimulates adenylate cyclase,
resulting in increased cyclic adenosine monophosphate
(CAMP)
Heat-stable toxin (ST) is a small molecule not related to
cholera toxin. ST stimulates guanylate cyclase, resulting in
increased cyclic guanosine monophosphate (CGMP).
Diffusely Adherent E. coli (DAEC)
- Although the status of DAEC as true pathogens in
doubt, studies in developed and developing
countries have associated these organisms with
diarrhea, particularly after the 1st or 2nd year of
life.

Enteroinvasive E. coli (EIEC)/ E. HISTOLYTICA • Can also cause traveler’s diarrhea in adults
• Produces acute watery diarrhea, not dysenteric, often
Usually presents either with: prolonged.
- Watery diarrhea similar to ETEC or
- Dysentery syndrome with bloody, mucoid stools, EJG MUST KNOW
fever, fecal leukocytes, systemic toxicity,
abdominal cramps, tenesmus
• Resembles bacillary dysentery because EIEC share
virulence genes with Shigella spp

Shiga Toxin-producing E. coli (STEC)

• Formerly enterohemorrhagic E. coli (EHEC)

• May be asymptomatic
• Mild diarrhea or severe hemorrhagic colitis
•Abdominal pain and initially, watery diarrhea →
blood-streaked to bloody stools
• Fever is uncommon unlike in shigellosis
• Majority recover
• 5-10% develop systemic complications:

● Hemolytic Uremic Syndrome

- Renal failure, hemolytic anemia,
thrombocytopenia § More severe in children 6
months - 10 years old
● Thrombotic Thrombocytopenic Purpura in adult
- Microangiopathic hemolytic anemia,
thrombocytopenic purpura, fever, renal disease,
neurologic abnormalities CAMPYLOBACTER
• Shiga Toxin E. coli O157:H7 – prototype and most
virulent member of the E. coli pathotype Acute Gastroenteritis
• Transmission: → Most common presentation
- person-to-person, also by food and water, small • Incubation period: 3 days (1-7 days)
inoculate can cause disease with some strains • Prodrome: fever, headache, myalgia, and within1-3 days
• Poorly cooked hamburgers – common cause of develop crampy abdominal pain and loose, watery stools
food-borne outbreaks or less commonly, bloody, mucus-containing stools
• Other foods: apple cider, lettuce, spinach, mayonnaise, • If severe (15%), bloody stools 2-4 days from onset
salami, unpasteurized milk • Older children (6-15 years) may not develop diarrhea at
all
Enteroaggregative E. coli (EAggEC / EAEC) • Fever may be the only manifestation initially.
- Febrile seizures may occur.
Associated with: • 60-90% of older children with crampy periumbilical
- Acute and persistent diarrhea (>14 days) in pain even after LBM; can mimic appendicitis, colitis, or
developing countries especially in <2 years old intussusception
and malnourished • Relapse can occur in 5-10% of patients
- Acute / persistent diarrhea in HIV-infected adults • Persistent or recurrent Campylobacter gastroenteritis
and children reported in immunocompetent patients, in
- Acute traveler’s diarrhea: second to ETEC hypogammaglobulinemia

10 | BACTERIOLOGY A BY ENOKI (MRG)

 (both congenital and acquired), AIDS
• Mild disease lasts x 1-2 days like viral diarrhea
• Recovery:
- Majority recover in <1 week 9 20-30% ill x 2
weeks
- 5-10% ill x >2 weeks
• Persistent infection can mimic chronic inflammatory
bowel disease; considered when evaluating for
inflammatory bowel disease

Reactive Arthritis

• Occurs in 3-13% of adolescents / adults especially if

HLA-B27 (+)
• Appears in 1-2 weeks (5-40 days) after diarrhea; involves
large joints, resolves without sequelae, migratory, without
fever
• Synovial fluid lacks bacteria
• Less common is reactive arthritis with conjunctivitis,
urethritis (Reiter syndrome) and rash

EJG MUST KNOW

TUBERCULOSIS

11 | BACTERIOLOGY A BY ENOKI (MRG)

SAMPLEX # 1: PARBS
1. An infection with this pathogen primarily manifests
as secretory diarrhea by attaching to the surface of
the intestinal epithelium and stimulate secretion of
water and electrolytes by activating guanylate cyclase
and raising intracellular cGMP.
A. V. cholera C. Heat stable toxin ETEC
B. Heat labile toxin ETEC D. Shigella dysentery
2. What is the most common cause of bacillary
dysentery?
A. Shigella C. Campylobacter
B. Yersinia D. Salmonella non-typhoidal
3. Toxic megacolon and rectal prolapse are
complications seen in enteric infection/is caused by:
ANSWER: Shigella and C. difficile
4. Which of the following pathogens produces a
secretory watery diarrhea among infants and young
children and is the major causative agent of travelers'
diarrhea?
ANSWER: ETEC
5. Vertical transmission of these pathogens can
produce perinatal infection resulting in a spectrum of
illnesses ranging from isolated diarrhea or
hematochezia to fulminant neonatal sepsis.
A. Shigella
B. Non-typhoidal salmonella
C. Campylobacter
D. All of the above
6. A 5-day-old baby boy born at the lying-in was
brought for check-up because of mucopurulent eye
discharge and reddish bulbar and palpebral
conjunctivae of 2 days duration. He was afebrile
without cough nor colds. He had good suck and
activity. Gram stain of eye discharge showed many
pus cells and gram-negative intracellular diplococci.
What is the appropriate treatment
ANSWER: Single dose Ceftriaxone IM
7, Tess, a 17 y/o girl, consults regarding the results of
her VDRL and treponema pallidum immunoassay,
which were both reactive. She is asymptomatic but
works as a guest relations officer (GRO) in a bar. What
is your working impression?
ANSWER: Latent syphilis
8. A two-year-old girl had on and off fever, abdominal
pain and watery diarrhea 1 1/2 days earlier. A few
minutes prior to administration he had generalized
seizures hence rushed to the hospital. On admission,
vital signs were stable PE including neurologic exam
were essentially normal except for irritability and
slightly sunken eyeballs and dry lips. Electrolytes were
normal. Stool exam showed >50 pus cells. What is the
most likely etiologic agent?
ANSWER: SHIGELLA
9. A 10-year-old boy was admitted because of on and
off fever of 12 days with abdominal pain, decreased
appetite followed by watery diarrhea of 5 days
duration. On PE, he was febrile, awake, weak- looking
with stable signs. Pertinent PE centered on the
abdomen that was soft with slight tenderness over
the right upper quadrant, liver span=8cm and
palpable splenic edge ~2cm. CBC showed
Hgb: 10.2, Hct :32, WBC: 6,000, seg: 0.68, lymph:
0.31, mono:0.01, Platelets 180,000. Blood culture was
also ordered. Which of these antibiotics is not
appropriate for empiric use?
ANSWER: CEFUROXIME → Typhoid: anemia,
leukopenia or neutropenia, thrombocytopenia;
Cefuroxime is not a preferred treatment. (amoxicillin,
chloramphenicol, TMP-SMX may be given)
10. Which statement about gonococcal infections is
FALSE?
A. Most genital tract infections do not produce
symptoms in children.
B. Most cases of rectal and pharyngeal gonococcal
infections are asymptomatic.
C. Infected newborns most commonly present with
purulent eye discharge.
D. Disseminated infection commonly presents with
joint pains and rashes.
11. This is NOT TRUE of Mycoplasma pneumonia
infection:
A. It can trigger asthma.
B. Clinical presentation is similar to infections caused
by Chlamydophila pneumonia.
C. Most cases are severe warranting hospitalization
D. The onset of illness is gradual consisting of fever,
malaise, headache, cough, and sore throat followed by
cough and hoarseness
12. Jim, a 2-year old boy, was seen at the clinic
because of fever and cough of 12 days duration
despite 4 days of amoxicillin. The boy has had colds
12 | BACTERIOLOGY A BY ENOKI (MRG)
and coughs almost monthly for the last 3 months. His
mother disclosed that an aunt who regularly visits
them was recently diagnosed to have PTB. CBC, CXR
and tuberculin test were ordered. CBC was normal.
The chest x-ray showed interstitial pneumonia with
prominent hilar nodes. His tuberculin test showed 10
mm induration. What is your assessment?
18. A 17-year-old girl who was allegedly molested
several times by her stepfather was seen at the Child
Protection Unit. PE showed wart-like plaques around
the vagina. The VDRL test was reactive and confirmed
by TPPA. What is the recommended treatment?
ANSWER: Benzathine Penicillin IM SD

ANSWER: CLINICALLY DIAGNOSED TB SAMPLEX # 2: SEPTEMBER 21, 2022

13. No treatment is necessary or a single dose of 1. The nontreponemal tests like VDRL or RPR
Benzathine Penicillin (if follow-up is uncertain) is are not used for:
recommended for an asymptomatic neonate born to a Select one:
mother with serologic test positive for Syphilis if: a. rapid and easy screening
b. establishing the diagnosis of syphilis
A. The quantitative VDRL/RPR of the baby is less than c. monitoring response to treatment
four times that of maternal titer and mother was d. determining disease activity
adequately treated before pregnancy with low, stable
titer during pregnancy 2. Abdominal distention, tenderness,
hyperactive bowel sounds and tender
14. Which statement about Cholera is TRUE? rectum on digital exam in a child with watery
A. Most cases present as cholera gravis capable of or bloody diarrhea are characteristic findings
purging 500- 1000 ml of rice-water-like stools/hour. in:
B. Vomiting is prominent at the onset without Select one:
abdominal cramps nor fever. a. Shigellosis
C. Convulsions, headache and/or lethargy may be b. Campylobacter gastroenteritis
present before or after the onset of diarrhea. c. Salmonellosis
D. Abdominal distention and tenderness, hyperactive d. Enteric fever
bowel sounds and tender rectum on digital exam are
commonly noted 3. Which of these describes C. trachomatis
pneumonia of infancy?
15. Which is true about the interferon gamma-release a. presents with rales and wheezing.
assay (IGRA)? b. high fever
A. It can distinguish infection from disease as c. with persistent cough with tachypnea
compared to the d. abrupt onset
tuberculin skin test (TST).
B. TB is ruled out if IGRA is negative. 4. Which of these statements about
C. It is as sensitive as the TST, but more specific as it Chlamydophila pneumonia infection is NOT
does not cross- react with BCG vaccination. TRUE?
D. It is more sensitive and specific than the tuberculin a. Can trigger hyperactivity among asthmatics
skin test. b. CXR findings are more significant than the clinical
status
16. How will a 2-year-old boy with TB-exposure who c. Mild illness can be pertussis-like
was initially tuberculin test negative be classified if he d. It is associated with extrapulmonary disease
remains to be asymptomatic with a negative CXR and
repeat tuberculin test after 3 months of INH show no 5. The incubation period from the time the TB
induration? bacilli enters the body until cutaneous
sensitivity develops has been found to be:
ANSWER: WELL CHILD Select one:
a. 2 weeks-12 weeks
17. In a 5-year-old girl, the following is the b. 3 weeks-6 weeks → TST
recommended treatment regimen of gram-stain of c. 1 week-3 weeks
purulent vaginal discharge showing many pus cells d. 6 weeks -20 weeks
and gram (-) intracellular diplococci
ANSWER: SD of Ceftriaxone IV/IM + Oral 6. Following bacteremia, this bacteria has the
Erythromycin x 14 days propensity to seed and cause focal

13 | BACTERIOLOGY A BY ENOKI (MRG)

 suppurative infections like meningitis
particularly among infants.
Select one:
a. Campylobacter jejuni b. Shigella
c. Nontyphoidal Salmonella d. Enteroinvasive E.coli
7. A day prior to admission a child was
documented to have episodes of fever.
Mother reported to you that based on her
monitoring , the child’s temperature ranged
from 37 deg. C - 38.5 deg. C. The pattern of
fever is considered as:
Select one:
a. Intermittent b. Remittent
c. Sustained d. Relapsing
8. This is NOT TRUE about primary syphilis:
a. Presents as a painless ulcer usually at the genitalia
b. Adjacent lymph nodes are enlarged and tender
c. Extragenital painless ulcers may occur
d. Ulcer may heal spontaneously
9. This is true about Shiga-toxin producing E.coli
infection except:
a. diarrhea maybe watery or bloody
b. fever is common
c. can cause a syndrome of acute kidney failure,
thrombocytopenia and hemolytic anemia
d. most infections recover without complications
10. In cholera with moderate to severe
dehydration, the antimicrobial will:
Select one:
a. Reduce period of excretion
b. Shorten duration of illness
c. Decrease volume of diarrhea
d. All the items are correct
11. Abdominal pain, usually periumbilical ,is
noted in a majority of children with this
diarrheal disease that may persist even after
LBM resolves. It can mimic appendicitis,
colitis or intussusception.
Select one:
a. Salmonellosis
b. Shigellosis
c. STEC diarrhea
d. Campylobacter jejuni enteritis
12. The following statements about Inclusion
Conjunctivitis in infants are True EXCEPT?
Select one:
a. It can be mild with scanty eye discharge to severe
with copious purulent discharge.
b. Routine eye prophylaxis with ophthalmic
erythromycin at birth is effective against chlamydia
and gonorrhea.
c. Eye discharge develops 5 -14 days to several days
after birth.
d. It is not sight-threatening
13. A 6-month old healthy baby boy was brought
for a check –up. He was asymptomatic, not
sickly with good appetite and adequate
weight and length. His mother disclosed that
she was recently diagnosed to have PTB,
MTb gene Xpert positive without Rifampicin
resistance and started on HRZE. There was
no tuberculin test available, but the baby had
normal CXR. What is the recommended
management for the baby?
a. no treatment needed
b. 2HRZE +4HR
c. 6H → RADIOLOGIC FX AND OR SIGNS SUGGESTIVE
OF TB → “NO” → TB INFECTION: continue 3H (“6H”)
d. 2HRZ + 4HR
14. A 5 year old girl was seen because of vaginal
discharge. She is allegedly being sexually
molested by her stepfather. Urinalysis was
normal. Gram stain of the vaginal discharge
showed gram negative intracellular
diplococci. What empirical treatment will you
consider?
a. seven days of ceftriaxone + 7 days of oral
doxycycline
b. single dose of ceftriaxone + single dose of
ciprofloxacin
c. seven days of ceftriaxone + single dose of
azithromycin
d. single dose of ceftriaxone + 14 days of oral
erythromycin
15. Which statement is NOT TRUE in
Mycoplasma pneumonia infection?
a. Clinical findings are less severe than the chest x-ray
findings.
b. Around 10% of children with pneumonia can have
rashes.
c. Coryza is common.
d. It is characterized by gradual onset of headache,
malaise, fever and sore throat progressing later to
hoarseness and cough.
SAMPLEX # 3: MARCH 16, 2022
1. The following statements are TRUE about
typhoid fever EXCEPT:
Select one:
a. Intestinal hemorrhage and /or perforation
commonly occur within the first week of fever.
14 | BACTERIOLOGY A BY ENOKI (MRG)
b. Hepatomegaly, splenomegaly and/or distended
abdomen with sustained fever are common on the
2nd week of illness
c. Diarrhea may occur several days after the onset of
fever in younger children while constipation occurs
more often in older children.
d. The symptoms and PE findings may gradually
resolve within 2-4 weeks if uncomplicated.
2. Which organism is associated with a diarrheal
disease where some patients go on to
develop acute kidney failure,
thrombocytopenia, and microangiopathic
hemolytic anemia?
Select one:
a. Enteroinvasive E.coli
b. Shiga toxin-producing E.coli
c. Enterotoxigenic E.coli
d. Enteroaggregative E.coli
3. One of the following statements about
Chlamydia trachomatis pneumonia in infancy
is Not True:
Select one:
a. occurs in infants 1-3 months old
b. onset is insidious with prominent coughing,
tachypnea but without fever
c. wheezing is common
d. chest x-ray shows hyperinflation with minimal
interstitial infiltrates
4. A 3 y/o boy has been noted to be less playful
with poor appetite, no apparent weight gain
and almost monthly bouts of cough and colds
for the last 8 months. His 41-year-old yaya
has recently been diagnosed to have DM and
PTB. The boy was worked up. Tuberculin test
showed 10 mm induration. Chest x-ray
showed right hilar adenopathy. What is the
recommended management for the child?
Select one:
a. 2HRZ+4HR
b. 2HRZE +4 HR
c. 6H
d. 6HR
5. A 15 y/o had fever and cough, headache,
sore throat for 12 days. His mother
self-medicated with amoxicillin 500mg 3x/day
starting on day 7 of illness but without relief.
He was not in distress, but with occasional
crackles and wheezes. CBC was normal.
Tuberculin test: non-reactive. CXR showed
interstitial pneumonia. What is an
appropriate antibiotic to give?
Select one:
a. cephalexin
b. cefuroxime
c. amoxicillin with clavulanate
d. Azithromycin
6. A 17 y/o male consulted due to a single,
indurated, painless penile ulcer on the left
side of the urethra associated with
non-fluctuant left inguinal adenopathy. A
VDRL test was reactive at 1: 256. What is the
appropriate drug to give?
Select one:
a. Benzathine Penicillin IM every week x 3 doses
b. PenG Na q6hrs. IV x 10 days
c. Benzathine Penicillin single dose IM
d. Ceftriaxone IV/IM single dose + single dose of oral
azithromycin
7. A 7 y/o had 3 episodes of non-projectile
vomiting followed by several bouts of
profuse, watery diarrhea without abdominal
pain starting 18 hours earlier. Stools were
watery with flecks of mucus and fishy smell.
PE: BP: 80/65, PR:130/min, RR:40/min, T:36
C. CRT 3=sec; weak-looking, deep sunken
eyeballs, dry lips, poor skin turgor. Which is
the most likely etiologic cause of his illness?
Select one:
a. Shigella
b. Salmonella
c. V. Cholera
d. Campylobacter
8. Children infected with this organism can
present as watery or bloody diarrhea with
crampy periumbilical pain that may persist
even after the diarrhea resolves. The
abdominal pain can mimic appendicitis,
colitis or intussusception.
Select one:
a. Enterotoxigenic E. coli
b. Enteropathogenic E. coli
c. Salmonella
d. Campylobacter
9. A 17 y/o male consulted due to a single,
indurated, painless penile ulcer on the left
side of the urethra associated with
non-fluctuant left inguinal adenopathy. A
VDRL test was reactive at 1: 256. What is the
appropriate drug to give?
Select one:
a. Benzathine Penicillin IM every week x 3 doses
b. PenG Na q 6 hrs. IV x 10 days
c. Benzathine Penicillin single dose IM
d. Ceftriaxone IV/IM single dose + single dose of oral
azithromycin
15 | BACTERIOLOGY A BY ENOKI (MRG)
 10. Some high school students bought and ate
egg sandwich from a vendor outside the
school for breakfast. At dismissal, all of them
who ate the sandwich had fever, nausea,
abdominal cramps followed by several
episodes of vomiting and watery,
non-bloody diarrhea. Which is the most likely
cause of the diarrhea?
Select one:
a. Enterotoxigenic E.coli
b. Shigella
c. Vibrio cholera
d. Non-typhoidal salmonella
11. The nontreponemal tests like VDRL or RPR
are not used for
Select one:
a. detecting re-infection
b. establishing the diagnosis of syphilis
c. monitoring response to treatment
d. rapid and easy screening
12. A 4y/o girl had on and off fever and diarrhea
x 2 days. Stools were initially yellowish,
watery-lined, then became mucoid, and
blood-streaked, with urgency and painful
defecation. PE: awake, stable vital signs, some
signs of dehydration. Stool exam showed 30
pus cells, 15-20 RBC without ova/parasites.
What is the most common cause of his
illness?
Select one:
a. Enteroinvasive E. coli
b. Campylobacter
c. Shigella
d. Entamoeba histolytica
13. A 7 y/o girl had a cough and colds for 7 days.
Past medical history was unremarkable.
Mother denied any exposure to TB but they
live in a crowded neighborhood. PE was
normal. CXR showed interstitial pneumonitis
with prominent hilar nodes. What is your
assessment?
Select one:
a. Clinically diagnosed Pulmonary TB
b. Bacteriologically confirmed PTB
c. Presumptive TB
d. Latent TB
14. Most cases of congenital syphilis are
asymptomatic and identified only by prenatal
screening. But, this can be an early clinical
sign:
Select one:
a. saber shin
b. olympian brow
c. osteochondritis
d. Rhagades
15. A 5-year-old girl was seen because of vaginal
discharge. She is allegedly being sexually
molested by her stepfather. Urinalysis was
normal. Gram stain of the vaginal discharge
showed gram negative intracellular
diplococci. What empirical treatment will you
consider?
Select one:
a. single dose of ceftriaxone
b. seven days of ceftriaxone + 7 days of azithromycin
c. single dose of ceftriaxone + 7 days of oral
erythromycin
d. single dose of ceftriaxone + 7 days of oral
doxycycline
SAMPLEX # 4: SEPTEMBER 21, 2021
1. A 17-year-old victim of sexual abuse was
admitted to a shelter. PE: painless indurated
ulcer, vaginal opening; (+) palpable inguinal,
non-tender lymphadenopathy. VDRL test
reactive at 1: 256 and confirmed by
Treponema pallidum immunoassay. What is
the recommended regimen?
a.Penicillin G Na every 6 hours IV x 10 days
b.Ceftriaxone IV single dose
c.Benzathine Penicillin IM every week x 3 doses
d.Benzathine Penicillin single dose IM
2. A 7-year-old with 12 hours of profuse watery
diarrhea and several bouts of vomiting, but
no abdominal pain and tenderness was seen.
Stools: fishy, watery with flecks of mucus. PE:
weak-looking, deep sunken eyeballs, dry lips,
and poor skin turgor. BP: 80/65, PR:130,
RR:40, Temp 36 C. CRT 3 sec. What is the drug
of choice?
a.Chloramphenicol
b.Doxycycline
c.Ciprofloxacin
d.Azithromycin
3. Enteroaggregative E.coli is associated with:
a.Acute traveler’s diarrhea
b.Acute and persistent diarrhea in HIV-infected adults
and children
c.Acute and persistent diarrhea(more than14 days) in
less than 2-years-old and malnourished children
d.All the choices are correct
4. Tenesmus often associated with abdominal
pain and mucoid stools is usually noted in
disorders caused by:
a.ETEC b.Salmonella
c. E. histolytica d.G. lamblia
16 | BACTERIOLOGY A BY ENOKI (MRG)

5. An 11-month-old, on her third bout of cough
since birth, was admitted for fever, cough,
and difficulty of breathing. Chest X-ray:
interstitial pneumonitis with hilar
adenopathies. Tuberculin test: 11 mm
induration. This is most likely:
a.Bacteriologically confirmed TB
b.Clinically diagnosed TB
c.Latent TB
d.TB exposure
6. Compared to Gonorrhea, which of the
following is true of Chlamydia
urethritis/cervicitis?
a.Has a more acute onset and presents with a purulent
discharge
b.Is less commonly asymptomatic in both men and
women
c.Has a less acute onset and presents with more
mucoid discharge
d.Does not cause inclusion conjunctivitis by
autoinoculation
7. Which is NOT true about reactive arthritis
following Campylobacter jejuni enteritis?
a.Campylobacter is usually isolated from the synovial
fluid
b.Large joints are often involved, and joint pains are
typically migratory.
c.The joint pains respond well to nonsteroidal anti-
inflammatory agents.
d.It occurs most commonly 1-2 weeks after the
diarrhea.
8. A 10-year-old boy with 9 days fever,
abdominal pain, decreased appetite and
watery diarrhea, was admitted. PE: stable
vital signs, slight RUQ tenderness, liver edge 3
cm below RSCM. CBC: Hb=10, Hct-32,
WBC=6, seg=0.59, lymph=0.33, mono=0.06,
eos=0.02, platelets=180. Stool exam:
watery-lined, yellowish, mucoid, wbc=5-6,
rbc=4-5. Which is the most likely diagnosis?
a.Typhoid fever b.Hepatitis
c.Systemic viral infection d.Infectious Diarrhea
9. Which organism is associated with a rash and
mucositis following initial respiratory
manifestations?
a.Mycoplasma pneumoniae
b.Chlamydophila pneumoniae
c.Chlamydia trachomatis
d.Streptococcus pneumoniae
10. A 4-year-old girl was admitted because of
vomiting, watery diarrhea and abdominal
pain and 2 hours of high fever, followed by
15 second generalized seizures. PE was
normal. Stool: watery, mucoid, yellow, acidic
with rbc:0-2, pus cells: 40-60 and bacteria
plenty. Serum electrolytes were normal.
Which is the most likely etiologic agent?
a.Shigella b.Campylobacter jejuni
c.Non-typhoidal Salmonella d.Vibrio cholerae
11. A 4-year-old afebrile boy with bloody mucoid
stools, abdominal pain, emesis, anorexia, and
tenesmus, was admitted. Which of the
following organisms is/are the most likely
etiology?
a.Shiga Toxin-producing E.coli
b.All choices are correct
c.Enteroinvasive E.coli
d.Shigella
12. Pets like birds, amphibians and reptiles can
be the sources of diarrhea secondary to:
a.Shiga-toxin EC
b.Yersinia
c.Non-typhoidal salmonella
d.Campylobacter
13. Neonates infected with this organism can
present as a purulent conjunctivitis and/or
polyarticular septic arthritis:
a.Treponema pallidum
b.Neisseria gonorrhoeae
c.Chlamydia trachomatis
d.E.coli with K1 polysaccharide Ag
14. Ted, a 14 year old boy, had a fever and cough
for 8 days. He did not show signs of
respiratory distress, but had occasional
crackles . Of note were maculopapular
rashes. CXR showed interstitial pneumonia.
Which is the most likely etiologic agent?
a.Chlamydophila pneumoniae
b.Mycoplasma pneumoniae
c.Streptococcus pneumoniae
d.Chlamydia trachomatis
15. A 17 yo male was seen at a clinic for a single,
indurated, painless penile ulcer associated
with a nonfluctuant left inguinal
adenopathy. This is most likely:
a.Gonorrhea
b.Herpes genitalia
c.Primary Syphilis
d.Chlamydia urethritis
17 | BACTERIOLOGY A BY ENOKI (MRG)
 16. An 8 year old boy was brought to the clinic
because of several bouts of vomiting and
watery diarrhea of around 18 hours duration
from the onset . His family has been staying
temporarily in an evacuation camp . He was
weak-looking with BP: 80/60, PR: 140, RR:
30/min, Temp: 37 C. PPE showed sunken
fontanels/eyeballs, absence of tears, dry oral
mucosa, shriveled hands and feet , poor skin
turgor, cold extremities. Which is the most
likely etiologic agent?
a.Non-typhoidal salmonella
b.Enteroinvasive E.coli
c.Vibrio cholera
d.Shigella
17. A 6-month old baby was seen at the
service-opd for a check-up. She was noted by
her mother to have decreased milk intake
from the usual 8oz/feeding, now just 4
oz/feeding for the last 3 weeks. Her mother
was recently diagnosed to have
bacteriologically confirmed PTB at the local
health center and started on HRZE. The
tuberculin test of the baby showed 10 mm
induration. Chest X-ray showed hilar
adenopathies. What is the recommended
treatment regimen?
a.2HRZE + 10HR
b.6 H
c.2HRZ + 4HR
d.2HRZE +4HR
18. Antibiotics are not routinely recommended
for uncomplicated gastroenteritis caused by
this organism as it may suppress normal
flora, prolong both excretion & increase
remote risk of chronic carrier state:
a.Vibrio cholera
b.Nontyphoidal salmonella
c.Campylobacter jejuni
d.EIEC
19. Persistent infection with this organism can
mimic chronic inflammatory bowel disease
and should be ruled out when working up for
this disease:
a.Non-typhoidal Salmonella
b.Campylobacter jejuni
c.Salmonella typhi
d.Enteropathogenic E.coli
20. Treponemal tests like T. pallidum
hemagglutination assay (TPHA), the
fluorescent treponemal antibody absorption
(FTA-ABS) test, and the T. pallidum particle
agglutination (TPPA) are used to:
a.determine response to treatment
b.determine disease activity
c.confirm diagnosis of Syphilis
d.screen for syphilis
21. Which is said to be the cause of an afebrile
pneumonia among infants 1-3 months old
that would characteristically present with
eosinophilia (more than 400 cells/mm3)?
a.Mycoplasma pneumoniae
b.Chlamydia trachomatis
c. Bordetella pertussis
d.Streptococcus pneumonia
22. This/These organisms is/are associated with
hemolytic uremic syndrome following a bout
of diarrhea:
a.Shiga toxin-producing E.coli
b.None of the choices
c.Shigella dysenteriae serotype 1 and Shiga
toxin-producing E.coli
d.Shigella dysenteriae serotype 1
24. An infant who presents with jaundice,
hepatosplenomegaly, nasal discharge, with
maculopapular or vesiculobullous rashes particularly
on palms and soles within the first few weeks of life
together with thrombocytopenia is most likely a case
of?
a.staphylococcal scalded skin syndrome
b.chlamydia trachomatis infection
c.congenital syphilis
d.disseminated gonococcal infection
18 | BACTERIOLOGY A BY ENOKI (MRG)
SAMPLEX # 1: PARBS
1. An infection with this pathogen primarily manifests
as secretory diarrhea by attaching to the surface of
the intestinal epithelium and stimulate secretion of
water and electrolytes by activating guanylate cyclase
and raising intracellular cGMP.
A. V. cholera C. Heat stable toxin ETEC
B. Heat labile toxin ETEC D. Shigella dysentery
2. What is the most common cause of bacillary
dysentery?
A. Shigella C. Campylobacter
B. Yersinia D. Salmonella non-typhoidal
3. Toxic megacolon and rectal prolapse are
complications seen in enteric infection/is caused by:
ANSWER: Shigella and C. difficile
4. Which of the following pathogens produces a
secretory watery diarrhea among infants and young
children and is the major causative agent of travelers'
diarrhea?
ANSWER: ETEC
5. Vertical transmission of these pathogens can
produce perinatal infection resulting in a spectrum of
illnesses ranging from isolated diarrhea or
hematochezia to fulminant neonatal sepsis.
A. Shigella
B. Non-typhoidal salmonella
C. Campylobacter
D. All of the above
6. A 5-day-old baby boy born at the lying-in was
brought for check-up because of mucopurulent eye
discharge and reddish bulbar and palpebral
conjunctivae of 2 days duration. He was afebrile
without cough nor colds. He had good suck and
activity. Gram stain of eye discharge showed many
pus cells and gram-negative intracellular diplococci.
What is the appropriate treatment
ANSWER: Single dose Ceftriaxone IM
7, Tess, a 17 y/o girl, consults regarding the results of
her VDRL and treponema pallidum immunoassay,
which were both reactive. She is asymptomatic but
works as a guest relations officer (GRO) in a bar. What
is your working impression?
ANSWER: Latent syphilis
8. A two-year-old girl had on and off fever, abdominal
pain and watery diarrhea 1 1/2 days earlier. A few
minutes prior to administration he had generalized
seizures hence rushed to the hospital. On admission,
vital signs were stable PE including neurologic exam
were essentially normal except for irritability and
slightly sunken eyeballs and dry lips. Electrolytes were
normal. Stool exam showed >50 pus cells. What is the
most likely etiologic agent?
ANSWER: SHIGELLA
9. A 10-year-old boy was admitted because of on and
off fever of 12 days with abdominal pain, decreased
appetite followed by watery diarrhea of 5 days
duration. On PE, he was febrile, awake, weak- looking
with stable signs. Pertinent PE centered on the
abdomen that was soft with slight tenderness over
the right upper quadrant, liver span=8cm and
palpable splenic edge ~2cm. CBC showed
Hgb: 10.2, Hct :32, WBC: 6,000, seg: 0.68, lymph:
0.31, mono:0.01, Platelets 180,000. Blood culture was
also ordered. Which of these antibiotics is not
appropriate for empiric use?
ANSWER: CEFUROXIME → Typhoid: anemia,
leukopenia or neutropenia, thrombocytopenia;
Cefuroxime is not a preferred treatment. (amoxicillin,
chloramphenicol, TMP-SMX may be given)
10. Which statement about gonococcal infections is
FALSE?
A. Most genital tract infections do not produce
symptoms in children.
B. Most cases of rectal and pharyngeal gonococcal
infections are asymptomatic.
C. Infected newborns most commonly present with
purulent eye discharge.
D. Disseminated infection commonly presents with
joint pains and rashes.
11. This is NOT TRUE of Mycoplasma pneumonia
infection:
A. It can trigger asthma.
B. Clinical presentation is similar to infections caused
by Chlamydophila pneumonia.
C. Most cases are severe warranting hospitalization
D. The onset of illness is gradual consisting of fever,
malaise, headache, cough, and sore throat followed by
cough and hoarseness
12. Jim, a 2-year old boy, was seen at the clinic
because of fever and cough of 12 days duration
despite 4 days of amoxicillin. The boy has had colds
12 | BACTERIOLOGY A BY ENOKI (MRG)
and coughs almost monthly for the last 3 months. His
mother disclosed that an aunt who regularly visits
them was recently diagnosed to have PTB. CBC, CXR
and tuberculin test were ordered. CBC was normal.
The chest x-ray showed interstitial pneumonia with
prominent hilar nodes. His tuberculin test showed 10
mm induration. What is your assessment?
18. A 17-year-old girl who was allegedly molested
several times by her stepfather was seen at the Child
Protection Unit. PE showed wart-like plaques around
the vagina. The VDRL test was reactive and confirmed
by TPPA. What is the recommended treatment?
ANSWER: Benzathine Penicillin IM SD

ANSWER: CLINICALLY DIAGNOSED TB SAMPLEX # 2: SEPTEMBER 21, 2022

13. No treatment is necessary or a single dose of 1. The nontreponemal tests like VDRL or RPR
Benzathine Penicillin (if follow-up is uncertain) is are not used for:
recommended for an asymptomatic neonate born to a Select one:
mother with serologic test positive for Syphilis if: a. rapid and easy screening
b. establishing the diagnosis of syphilis
A. The quantitative VDRL/RPR of the baby is less than c. monitoring response to treatment
four times that of maternal titer and mother was d. determining disease activity
adequately treated before pregnancy with low, stable
titer during pregnancy 2. Abdominal distention, tenderness,
hyperactive bowel sounds and tender
14. Which statement about Cholera is TRUE? rectum on digital exam in a child with watery
A. Most cases present as cholera gravis capable of or bloody diarrhea are characteristic findings
purging 500- 1000 ml of rice-water-like stools/hour. in:
B. Vomiting is prominent at the onset without Select one:
abdominal cramps nor fever. a. Shigellosis
C. Convulsions, headache and/or lethargy may be b. Campylobacter gastroenteritis
present before or after the onset of diarrhea. c. Salmonellosis
D. Abdominal distention and tenderness, hyperactive d. Enteric fever
bowel sounds and tender rectum on digital exam are
commonly noted 3. Which of these describes C. trachomatis
pneumonia of infancy?
15. Which is true about the interferon gamma-release a. presents with rales and wheezing.
assay (IGRA)? b. high fever
A. It can distinguish infection from disease as c. with persistent cough with tachypnea
compared to the d. abrupt onset
tuberculin skin test (TST).
B. TB is ruled out if IGRA is negative. 4. Which of these statements about
C. It is as sensitive as the TST, but more specific as it Chlamydophila pneumonia infection is NOT
does not cross- react with BCG vaccination. TRUE?
D. It is more sensitive and specific than the tuberculin a. Can trigger hyperactivity among asthmatics
skin test. b. CXR findings are more significant than the clinical
status
16. How will a 2-year-old boy with TB-exposure who c. Mild illness can be pertussis-like
was initially tuberculin test negative be classified if he d. It is associated with extrapulmonary disease
remains to be asymptomatic with a negative CXR and
repeat tuberculin test after 3 months of INH show no 5. The incubation period from the time the TB
induration? bacilli enters the body until cutaneous
sensitivity develops has been found to be:
ANSWER: WELL CHILD Select one:
a. 2 weeks-12 weeks
17. In a 5-year-old girl, the following is the b. 3 weeks-6 weeks → TST
recommended treatment regimen of gram-stain of c. 1 week-3 weeks
purulent vaginal discharge showing many pus cells d. 6 weeks -20 weeks
and gram (-) intracellular diplococci
ANSWER: SD of Ceftriaxone IV/IM + Oral 6. Following bacteremia, this bacteria has the
Erythromycin x 14 days propensity to seed and cause focal

13 | BACTERIOLOGY A BY ENOKI (MRG)

 suppurative infections like meningitis
particularly among infants.
Select one:
a. Campylobacter jejuni b. Shigella
c. Nontyphoidal Salmonella d. Enteroinvasive E.coli
7. A day prior to admission a child was
documented to have episodes of fever.
Mother reported to you that based on her
monitoring , the child’s temperature ranged
from 37 deg. C - 38.5 deg. C. The pattern of
fever is considered as:
Select one:
a. Intermittent b. Remittent
c. Sustained d. Relapsing
8. This is NOT TRUE about primary syphilis:
a. Presents as a painless ulcer usually at the genitalia
b. Adjacent lymph nodes are enlarged and tender
c. Extragenital painless ulcers may occur
d. Ulcer may heal spontaneously
9. This is true about Shiga-toxin producing E.coli
infection except:
a. diarrhea maybe watery or bloody
b. fever is common
c. can cause a syndrome of acute kidney failure,
thrombocytopenia and hemolytic anemia
d. most infections recover without complications
10. In cholera with moderate to severe
dehydration, the antimicrobial will:
Select one:
a. Reduce period of excretion
b. Shorten duration of illness
c. Decrease volume of diarrhea
d. All the items are correct
11. Abdominal pain, usually periumbilical ,is
noted in a majority of children with this
diarrheal disease that may persist even after
LBM resolves. It can mimic appendicitis,
colitis or intussusception.
Select one:
a. Salmonellosis
b. Shigellosis
c. STEC diarrhea
d. Campylobacter jejuni enteritis
12. The following statements about Inclusion
Conjunctivitis in infants are True EXCEPT?
Select one:
a. It can be mild with scanty eye discharge to severe
with copious purulent discharge.
b. Routine eye prophylaxis with ophthalmic
erythromycin at birth is effective against chlamydia
and gonorrhea.
c. Eye discharge develops 5 -14 days to several days
after birth.
d. It is not sight-threatening
13. A 6-month old healthy baby boy was brought
for a check –up. He was asymptomatic, not
sickly with good appetite and adequate
weight and length. His mother disclosed that
she was recently diagnosed to have PTB,
MTb gene Xpert positive without Rifampicin
resistance and started on HRZE. There was
no tuberculin test available, but the baby had
normal CXR. What is the recommended
management for the baby?
a. no treatment needed
b. 2HRZE +4HR
c. 6H → RADIOLOGIC FX AND OR SIGNS SUGGESTIVE
OF TB → “NO” → TB INFECTION: continue 3H (“6H”)
d. 2HRZ + 4HR
14. A 5 year old girl was seen because of vaginal
discharge. She is allegedly being sexually
molested by her stepfather. Urinalysis was
normal. Gram stain of the vaginal discharge
showed gram negative intracellular
diplococci. What empirical treatment will you
consider?
a. seven days of ceftriaxone + 7 days of oral
doxycycline
b. single dose of ceftriaxone + single dose of
ciprofloxacin
c. seven days of ceftriaxone + single dose of
azithromycin
d. single dose of ceftriaxone + 14 days of oral
erythromycin
15. Which statement is NOT TRUE in
Mycoplasma pneumonia infection?
a. Clinical findings are less severe than the chest x-ray
findings.
b. Around 10% of children with pneumonia can have
rashes.
c. Coryza is common.
d. It is characterized by gradual onset of headache,
malaise, fever and sore throat progressing later to
hoarseness and cough.
SAMPLEX # 3: MARCH 16, 2022
1. The following statements are TRUE about
typhoid fever EXCEPT:
Select one:
a. Intestinal hemorrhage and /or perforation
commonly occur within the first week of fever.
14 | BACTERIOLOGY A BY ENOKI (MRG)
b. Hepatomegaly, splenomegaly and/or distended
abdomen with sustained fever are common on the
2nd week of illness
c. Diarrhea may occur several days after the onset of
fever in younger children while constipation occurs
more often in older children.
d. The symptoms and PE findings may gradually
resolve within 2-4 weeks if uncomplicated.
2. Which organism is associated with a diarrheal
disease where some patients go on to
develop acute kidney failure,
thrombocytopenia, and microangiopathic
hemolytic anemia?
Select one:
a. Enteroinvasive E.coli
b. Shiga toxin-producing E.coli
c. Enterotoxigenic E.coli
d. Enteroaggregative E.coli
3. One of the following statements about
Chlamydia trachomatis pneumonia in infancy
is Not True:
Select one:
a. occurs in infants 1-3 months old
b. onset is insidious with prominent coughing,
tachypnea but without fever
c. wheezing is common
d. chest x-ray shows hyperinflation with minimal
interstitial infiltrates
4. A 3 y/o boy has been noted to be less playful
with poor appetite, no apparent weight gain
and almost monthly bouts of cough and colds
for the last 8 months. His 41-year-old yaya
has recently been diagnosed to have DM and
PTB. The boy was worked up. Tuberculin test
showed 10 mm induration. Chest x-ray
showed right hilar adenopathy. What is the
recommended management for the child?
Select one:
a. 2HRZ+4HR
b. 2HRZE +4 HR
c. 6H
d. 6HR
5. A 15 y/o had fever and cough, headache,
sore throat for 12 days. His mother
self-medicated with amoxicillin 500mg 3x/day
starting on day 7 of illness but without relief.
He was not in distress, but with occasional
crackles and wheezes. CBC was normal.
Tuberculin test: non-reactive. CXR showed
interstitial pneumonia. What is an
appropriate antibiotic to give?
Select one:
a. cephalexin
b. cefuroxime
c. amoxicillin with clavulanate
d. Azithromycin
6. A 17 y/o male consulted due to a single,
indurated, painless penile ulcer on the left
side of the urethra associated with
non-fluctuant left inguinal adenopathy. A
VDRL test was reactive at 1: 256. What is the
appropriate drug to give?
Select one:
a. Benzathine Penicillin IM every week x 3 doses
b. PenG Na q6hrs. IV x 10 days
c. Benzathine Penicillin single dose IM
d. Ceftriaxone IV/IM single dose + single dose of oral
azithromycin
7. A 7 y/o had 3 episodes of non-projectile
vomiting followed by several bouts of
profuse, watery diarrhea without abdominal
pain starting 18 hours earlier. Stools were
watery with flecks of mucus and fishy smell.
PE: BP: 80/65, PR:130/min, RR:40/min, T:36
C. CRT 3=sec; weak-looking, deep sunken
eyeballs, dry lips, poor skin turgor. Which is
the most likely etiologic cause of his illness?
Select one:
a. Shigella
b. Salmonella
c. V. Cholera
d. Campylobacter
8. Children infected with this organism can
present as watery or bloody diarrhea with
crampy periumbilical pain that may persist
even after the diarrhea resolves. The
abdominal pain can mimic appendicitis,
colitis or intussusception.
Select one:
a. Enterotoxigenic E. coli
b. Enteropathogenic E. coli
c. Salmonella
d. Campylobacter
9. A 17 y/o male consulted due to a single,
indurated, painless penile ulcer on the left
side of the urethra associated with
non-fluctuant left inguinal adenopathy. A
VDRL test was reactive at 1: 256. What is the
appropriate drug to give?
Select one:
a. Benzathine Penicillin IM every week x 3 doses
b. PenG Na q 6 hrs. IV x 10 days
c. Benzathine Penicillin single dose IM
d. Ceftriaxone IV/IM single dose + single dose of oral
azithromycin
15 | BACTERIOLOGY A BY ENOKI (MRG)
 10. Some high school students bought and ate
egg sandwich from a vendor outside the
school for breakfast. At dismissal, all of them
who ate the sandwich had fever, nausea,
abdominal cramps followed by several
episodes of vomiting and watery,
non-bloody diarrhea. Which is the most likely
cause of the diarrhea?
Select one:
a. Enterotoxigenic E.coli
b. Shigella
c. Vibrio cholera
d. Non-typhoidal salmonella
11. The nontreponemal tests like VDRL or RPR
are not used for
Select one:
a. detecting re-infection
b. establishing the diagnosis of syphilis
c. monitoring response to treatment
d. rapid and easy screening
12. A 4y/o girl had on and off fever and diarrhea
x 2 days. Stools were initially yellowish,
watery-lined, then became mucoid, and
blood-streaked, with urgency and painful
defecation. PE: awake, stable vital signs, some
signs of dehydration. Stool exam showed 30
pus cells, 15-20 RBC without ova/parasites.
What is the most common cause of his
illness?
Select one:
a. Enteroinvasive E. coli
b. Campylobacter
c. Shigella
d. Entamoeba histolytica
13. A 7 y/o girl had a cough and colds for 7 days.
Past medical history was unremarkable.
Mother denied any exposure to TB but they
live in a crowded neighborhood. PE was
normal. CXR showed interstitial pneumonitis
with prominent hilar nodes. What is your
assessment?
Select one:
a. Clinically diagnosed Pulmonary TB
b. Bacteriologically confirmed PTB
c. Presumptive TB
d. Latent TB
14. Most cases of congenital syphilis are
asymptomatic and identified only by prenatal
screening. But, this can be an early clinical
sign:
Select one:
a. saber shin
b. olympian brow
c. osteochondritis
d. Rhagades
15. A 5-year-old girl was seen because of vaginal
discharge. She is allegedly being sexually
molested by her stepfather. Urinalysis was
normal. Gram stain of the vaginal discharge
showed gram negative intracellular
diplococci. What empirical treatment will you
consider?
Select one:
a. single dose of ceftriaxone
b. seven days of ceftriaxone + 7 days of azithromycin
c. single dose of ceftriaxone + 7 days of oral
erythromycin
d. single dose of ceftriaxone + 7 days of oral
doxycycline
SAMPLEX # 4: SEPTEMBER 21, 2021
1. A 17-year-old victim of sexual abuse was
admitted to a shelter. PE: painless indurated
ulcer, vaginal opening; (+) palpable inguinal,
non-tender lymphadenopathy. VDRL test
reactive at 1: 256 and confirmed by
Treponema pallidum immunoassay. What is
the recommended regimen?
a.Penicillin G Na every 6 hours IV x 10 days
b.Ceftriaxone IV single dose
c.Benzathine Penicillin IM every week x 3 doses
d.Benzathine Penicillin single dose IM
2. A 7-year-old with 12 hours of profuse watery
diarrhea and several bouts of vomiting, but
no abdominal pain and tenderness was seen.
Stools: fishy, watery with flecks of mucus. PE:
weak-looking, deep sunken eyeballs, dry lips,
and poor skin turgor. BP: 80/65, PR:130,
RR:40, Temp 36 C. CRT 3 sec. What is the drug
of choice?
a.Chloramphenicol
b.Doxycycline
c.Ciprofloxacin
d.Azithromycin
3. Enteroaggregative E.coli is associated with:
a.Acute traveler’s diarrhea
b.Acute and persistent diarrhea in HIV-infected adults
and children
c.Acute and persistent diarrhea(more than14 days) in
less than 2-years-old and malnourished children
d.All the choices are correct
4. Tenesmus often associated with abdominal
pain and mucoid stools is usually noted in
disorders caused by:
a.ETEC b.Salmonella
c. E. histolytica d.G. lamblia
16 | BACTERIOLOGY A BY ENOKI (MRG)

5. An 11-month-old, on her third bout of cough
since birth, was admitted for fever, cough,
and difficulty of breathing. Chest X-ray:
interstitial pneumonitis with hilar
adenopathies. Tuberculin test: 11 mm
induration. This is most likely:
a.Bacteriologically confirmed TB
b.Clinically diagnosed TB
c.Latent TB
d.TB exposure
6. Compared to Gonorrhea, which of the
following is true of Chlamydia
urethritis/cervicitis?
a.Has a more acute onset and presents with a purulent
discharge
b.Is less commonly asymptomatic in both men and
women
c.Has a less acute onset and presents with more
mucoid discharge
d.Does not cause inclusion conjunctivitis by
autoinoculation
7. Which is NOT true about reactive arthritis
following Campylobacter jejuni enteritis?
a.Campylobacter is usually isolated from the synovial
fluid
b.Large joints are often involved, and joint pains are
typically migratory.
c.The joint pains respond well to nonsteroidal anti-
inflammatory agents.
d.It occurs most commonly 1-2 weeks after the
diarrhea.
8. A 10-year-old boy with 9 days fever,
abdominal pain, decreased appetite and
watery diarrhea, was admitted. PE: stable
vital signs, slight RUQ tenderness, liver edge 3
cm below RSCM. CBC: Hb=10, Hct-32,
WBC=6, seg=0.59, lymph=0.33, mono=0.06,
eos=0.02, platelets=180. Stool exam:
watery-lined, yellowish, mucoid, wbc=5-6,
rbc=4-5. Which is the most likely diagnosis?
a.Typhoid fever b.Hepatitis
c.Systemic viral infection d.Infectious Diarrhea
9. Which organism is associated with a rash and
mucositis following initial respiratory
manifestations?
a.Mycoplasma pneumoniae
b.Chlamydophila pneumoniae
c.Chlamydia trachomatis
d.Streptococcus pneumoniae
10. A 4-year-old girl was admitted because of
vomiting, watery diarrhea and abdominal
pain and 2 hours of high fever, followed by
15 second generalized seizures. PE was
normal. Stool: watery, mucoid, yellow, acidic
with rbc:0-2, pus cells: 40-60 and bacteria
plenty. Serum electrolytes were normal.
Which is the most likely etiologic agent?
a.Shigella b.Campylobacter jejuni
c.Non-typhoidal Salmonella d.Vibrio cholerae
11. A 4-year-old afebrile boy with bloody mucoid
stools, abdominal pain, emesis, anorexia, and
tenesmus, was admitted. Which of the
following organisms is/are the most likely
etiology?
a.Shiga Toxin-producing E.coli
b.All choices are correct
c.Enteroinvasive E.coli
d.Shigella
12. Pets like birds, amphibians and reptiles can
be the sources of diarrhea secondary to:
a.Shiga-toxin EC
b.Yersinia
c.Non-typhoidal salmonella
d.Campylobacter
13. Neonates infected with this organism can
present as a purulent conjunctivitis and/or
polyarticular septic arthritis:
a.Treponema pallidum
b.Neisseria gonorrhoeae
c.Chlamydia trachomatis
d.E.coli with K1 polysaccharide Ag
14. Ted, a 14 year old boy, had a fever and cough
for 8 days. He did not show signs of
respiratory distress, but had occasional
crackles . Of note were maculopapular
rashes. CXR showed interstitial pneumonia.
Which is the most likely etiologic agent?
a.Chlamydophila pneumoniae
b.Mycoplasma pneumoniae
c.Streptococcus pneumoniae
d.Chlamydia trachomatis
15. A 17 yo male was seen at a clinic for a single,
indurated, painless penile ulcer associated
with a nonfluctuant left inguinal
adenopathy. This is most likely:
a.Gonorrhea
b.Herpes genitalia
c.Primary Syphilis
d.Chlamydia urethritis
17 | BACTERIOLOGY A BY ENOKI (MRG)
 16. An 8 year old boy was brought to the clinic
because of several bouts of vomiting and
watery diarrhea of around 18 hours duration
from the onset . His family has been staying
temporarily in an evacuation camp . He was
weak-looking with BP: 80/60, PR: 140, RR:
30/min, Temp: 37 C. PPE showed sunken
fontanels/eyeballs, absence of tears, dry oral
mucosa, shriveled hands and feet , poor skin
turgor, cold extremities. Which is the most
likely etiologic agent?
a.Non-typhoidal salmonella
b.Enteroinvasive E.coli
c.Vibrio cholera
d.Shigella
17. A 6-month old baby was seen at the
service-opd for a check-up. She was noted by
her mother to have decreased milk intake
from the usual 8oz/feeding, now just 4
oz/feeding for the last 3 weeks. Her mother
was recently diagnosed to have
bacteriologically confirmed PTB at the local
health center and started on HRZE. The
tuberculin test of the baby showed 10 mm
induration. Chest X-ray showed hilar
adenopathies. What is the recommended
treatment regimen?
a.2HRZE + 10HR
b.6 H
c.2HRZ + 4HR
d.2HRZE +4HR
18. Antibiotics are not routinely recommended
for uncomplicated gastroenteritis caused by
this organism as it may suppress normal
flora, prolong both excretion & increase
remote risk of chronic carrier state:
a.Vibrio cholera
b.Nontyphoidal salmonella
c.Campylobacter jejuni
d.EIEC
19. Persistent infection with this organism can
mimic chronic inflammatory bowel disease
and should be ruled out when working up for
this disease:
a.Non-typhoidal Salmonella
b.Campylobacter jejuni
c.Salmonella typhi
d.Enteropathogenic E.coli
20. Treponemal tests like T. pallidum
hemagglutination assay (TPHA), the
fluorescent treponemal antibody absorption
(FTA-ABS) test, and the T. pallidum particle
agglutination (TPPA) are used to:
a.determine response to treatment
b.determine disease activity
c.confirm diagnosis of Syphilis
d.screen for syphilis
21. Which is said to be the cause of an afebrile
pneumonia among infants 1-3 months old
that would characteristically present with
eosinophilia (more than 400 cells/mm3)?
a.Mycoplasma pneumoniae
b.Chlamydia trachomatis
c. Bordetella pertussis
d.Streptococcus pneumonia
22. This/These organisms is/are associated with
hemolytic uremic syndrome following a bout
of diarrhea:
a.Shiga toxin-producing E.coli
b.None of the choices
c.Shigella dysenteriae serotype 1 and Shiga
toxin-producing E.coli
d.Shigella dysenteriae serotype 1
24. An infant who presents with jaundice,
hepatosplenomegaly, nasal discharge, with
maculopapular or vesiculobullous rashes particularly
on palms and soles within the first few weeks of life
together with thrombocytopenia is most likely a case
of?
a.staphylococcal scalded skin syndrome
b.chlamydia trachomatis infection
c.congenital syphilis
d.disseminated gonococcal infection
18 | BACTERIOLOGY A BY ENOKI (MRG)