(Micro Biology)

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WELCOME
We presenting our first
note book containing-
“The solution of last
five- year question of
all subject”
University of Dhaka
KAZI JAHID ALAM (STANC; batch-4)

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1st B.Sc. in Nursing Final Examination of December 2020, held in September -2021
Subject : Fundamental of Nursing-1
Paper-II :Microbiology
Full Mark:70 Time :2hours 40 minutes
Use separate answer scripts for each group
Group-A
Short answer question(SAQ):Answer any of three of the following. (3×5=)15
1.a)What are the essential structure of bacteria. 2
b)Give difference between Gram positive and gram negative bacteria cell. 3
2.a)Define Sterilization, disinfection and antisepsis with examples.
2
B)State the principle of autoclave. 3
3 A).Define virus. Draw and level an envelope virus.
2
b).Mention the difference between bacteria and virus 3
4.a).Name some opportunistic fungus. 2
b).Mention the predisposing factors of candidiasis 3
Essay question (EQ) Answer any two of the following. (2×10)=20
1.Define bacterial spore. Mention the Medical importance of spore with example. Write Down the
pathogenesis and management of tetanus. 10
2.Define and classify Immunity. Mention the difference innate and acquired immunity
10
3.Name five mosquito borne diseases. Write down the agent, vector, complication and prevention of
dengue fever.
Group-B
1.What do you mean by normal flora.
b)Write down the harmful and beneficial effects of normal flora.
2.a)Write down the procedure of collection of urine for culture.
b)Name some common bacteria causing urinary tract infection (UTI)
3. a)Define nosocomial infection with examples.
b)Write short note on : SARS-CoV-2.
4. Write short note on : a)EPI b)Hypersensitivity
1.What are the indication of blood culture. Give the laboratory diagnosis of Kala -Azar. Write shortly
about PKDL.
2.Describe the pre and post exposure prophylaxis of Hepatitis B virus.
3.Classify plasmodium species. Which species of plasmodium are found in Bangladesh? Which one is
more dangerous and why? Write complication of Falciparum malaria.

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University of Dhaka
1st B.Sc. in Nursing Final Examination January 2020,
Group-A
Short answer question(SAQ):Answer any of three of the following. (3×5=15)
1.a) Draw and label a capsulated bacterium

b) Define normal flora. Enumerate the medical importance of normal FLORA WITH EXAMPLE.
2.A)Name the species of malarial parasite. Which more dangerous and why?
b)Give complications and diagnosis of Kala-azar.
3.a)Define vaccine. Name four live attenuated vaccine.
b)Define Antigen. Mention the criteria of a good antigen.
4. Write short note on : a)EPI b)Nosocomial infection.
1./Define sterilization, disinfection and antisepsis. Classify methods of sterilization. State the principle of
autoclave.
2.Define and classify immunity. Mention the component of innate immunity. Differences between
innate and acquired immunity.
3.Write the name of spore forming bacteria. Give the pathogenesis and management of tetanus.
Group-B
1.a) Write down the common viral diseases in Bangladesh.
b)Name the hepatitis viruses. Mention the mode of transmition of Hepatitis B Viruses.
2.a)What are the indication of blood culture?
b)Mention the common opportunistic infection of AIDS.
3.a)Classify Fungus according to morphology with example.
b)Mention the predisposing factors of vaginal candidiasis.
4.a) Write short note on : a)Dengue fever b)The management of bite of rabies dog.
1.Write down the general principles of microbiological sample collection procedure.

2.Define parasite and host .Write down the complication of round worm and hock worm.
3.Define and classify hypersensitivity? Describe the mechanism of type 1 hypersensitivity.

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University of Dhaka
st
1 B.Sc. in Nursing Final Examination January 2019,
Group-A
1.a)define sterilization, disinfection and antisepsis.

b)Write down the principles of autoclave.
2.a)Define nosocomial infection with example.
b)How can prevent nosocomial infections?
3.a)Draw and label a typical bacterium. B)Classify bacteria according to their O2 requirement.
4.Write short note on: a)Bacterial Spore b) pasteurization.
1.a)Mention the differences between bacterium and human cell. Write down the essential components
of bacteria with function.
2.a)Classify immunity with examples. Mention difference between active and passive immunity.
3.Mention the different methods of blood culture. Which one is the best among them an why?Write
down the principle of collection of blood for culture.
Group-B
1.a)Name the agent and vactor of Kala-azar.

b)Among malaria which is more dangerous and explain why?
2.a)Classify Fungus according to morphology with example.
b)Mention the predisposing factors of vaginal candidiasis.
3.a)mention the route of transmission of HIV.
B)What do you mean by HIV and AIDS?
4. a)Name the common nematods found in Bangladesh.
b)Mention different medical and surgical complications of round warm infection.
1.Name some common protozoal diseases in Bangladesh. What is EPI ? Mention the different
advantages of live vaccine.
2.Name the hepatitis viruses with their route of transmission. Write down the management of a bite by
a rabid dog.
3)Classify fungus according to their site of disease production with examples. Mention the difference
between fungus and bacteria in tabulated form.

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University of Dhaka
st
1 B.Sc. in Nursing Final Examination January 2018,
Group-A
1a)What is bacterial spore? Name the 2 spore forming bacteria and diseases they produce. Write down
the importance of bacterial spore.
2.Wrie down the procedure for collection of blood and urine for microbiological culture.
3.Define and classify hyper sensitivity reaction. Mention five causes of immune suppretion .
4. Write short note on : Nosocomial infection.

1 .Define normal flora. Name the most common flora of skin ,colon and vagina. Write down the merits
and demerits of normal flora.
2.Define and classify immunity. Mention difference between active and passive immunity.
3. a)Define sterilization, disinfection and antisepsis. Classify methods of sterilization. Write down the
principles of autoclave.
Group-B
1.Name the agent of Kala-Azar. Mention the complication of kala-azar.

2.Name four intestinal worms against which vaccination done in EPI. Mention 3 conditions where both
pre exposure and post exposure prophylaxis needed.
4.Write short note on: Viral hepatitis.
1.Write down the differences between virus and bacteria. Mention the common opportunistic infections
in HIV-AIDS patients.
2.Define fungus and classify it according to morphology. Mention the common sites of Candida
infection. What are predisposing factors for Candida infection?
3.Name some parasites that infect blood cells. Which species of Plasmodium is found in Bangladesh and
which one is the most dangerous one? Mention the complication of Falciparum malaria.

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University of Dhaka
1st B.Sc. in Nursing Final Examination January- 2017,
Group-A
1.Define nosocomial infection with example. Mention the steps to prevent it.
2.Describe bacterial growth curve with diagram.
3.Define sterilization, disinfection and antisepsis. Write down the principles of autoclaving.
4.Write short note on : Bacterial spore.
1.Draw and label a bacterium. Write down essential components on bacteria with their functions.
2.Write down the general principles of sample collection for collection for microbial laboratory
examination.
3. Define and classify Immunity. Mention the differences between innate and acquired immunity
Group-B
1.Classify Plasmodium. Which is common in Bangladesh? Which one is dangerous and Why?
2 Mention 3 major differences between autoclaving and hot air oven. Mention the sterilization methods
for glass ware ,powder, gown and scissors.
3.Define virus. Mention the importance of viral envelope. Name 5 common viral diseases in Bangladesh.
4.Write short note on: Universal precaution.
1.Describe the pre- exposure and post exposure prophylaxis of tetanus, rabies and hepatitis B.
2.Draw and label an enveloped virus. Mention the route of transmission of common virus infection.
3.Menyiondifferences between bacteria and fungus. Mention the route of transmission of HIV .Name
the common opportunistic infection in AIDS patient.

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Question December 2020,(2021)

Group-A
SAQ
Answer to the question no. 1
2021-GROUP-A-SAQ- 1.a)What are the essential structure of bacteria.
b)Give difference between Gram positive and gram negative bacteria cell.
(a) Essential components of bacteria are:
• Cell wall.
• Plasma membrane.
• Ribosome.
• Nucleoid.
• Mesosome.
. Periplasm
(b) The defference between Gram positive and gram negative bacteria cell are:
Traits Gram-Positive bacteria Gram-Negative bacteria

Gram Staining These bacteria retain the These bacteria do not retain
crystal violet colour even the stain colour even after
after they are washed with they are washed with
acetone or alcohol and acetone or alcohol and
appear as purple-coloured appear as pink-coloured
when examined under the when examined under the
microscope after gram microscope after gram
staining. staining.
Cell Wall A single-layered, smooth A double-layered, wavy cell-
cell wall wall
Cell Wall thickness The thickness of the cell The thickness of the cell
wall is 20 to 80 nanometres wall is 8 to 10 nanometres
Peptidoglycan Layer It is a thick layer/ also can It is a thin layer/ often
be multilayered single-layered.
Teichoic acids Presence of teichoic acids Absence of teichoic acids
Outer membrane The outer membrane is The outer membrane is
absent present (mostly)
Porins Absent Occurs in Outer Membrane
Mesosome It is more prominent. It is less prominent.
Morphology Cocci or spore-forming rods Non-spore forming rods.
Flagella Structure Two rings in basal body Four rings in basal body
Lipid content Very low 20 to 30%
Lipopolysaccharide Absent Present
Toxin Produced Exotoxins Endotoxins or Exotoxins
Resistance to Antibiotic More susceptible More resistant

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Examples Staphylococcus, Escherichia, Salmonella,

Streptococcus, etc. etc.
2021-GROUP-A-SAQ 2.a)Define Sterilization, disinfection and antisepsis with examples.

B)State the principle of autoclave.
(a) Definitions
• Sterilization: Sterilization is an absolute process of freeing of an article from all
types of organisms including spores. Ex- Autoclave, Hot air oven.
• Disinfection: It is a process of reducing the number of pathogenic organisms
from an inanimate objects to such a level which can not cause disease.
• Antisepsis: It is the process of reducing the number of pathogenic organisms
from an animate object such as skin and mucus membrane to such a level that
can not cause disease.
(b) Principles of Autoclave:
• At atmospheric pressure, water boils at100oC.
• With the rise of pressure, boiling point of water also rises provided no air
is present.
• Steam under pressure unmixed with air has more temperature than mixed
with air.
• Steam under pressure has more penetrating power. This is because steam
condenses to water on the surface of object and release huge amount of
latent heat which efficiently penetrate the object.
Temperature Above the atmospheric pressure Sterilization hold time
(⁰C) (lb/inch2) (min)
121-124 1.1 15
134-138 2.2 3
2021-GROUP-A-SAQ -3 A).Define virus. Draw and level an envelope virus.

b).Mention the difference between bacteria and virus
(a) Virus: An infective agent that typically consists of a nucleic acid molecule in a protein coat, is
too small to be seen by light microscopy, and is able to multiply only within the living cells of
a host ."the hepatitis B virus"

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Draw and level an envelope virus:
Figure: envelope virus
(b). The difference between bacteria and virus:

Characteristics Bacteria Viruses
Size Larger (1000 nm) Smaller (20-400 nm) 10
Peptidoglycan or
Cell Wall No cell wall. Protein coat present instead.
Lipopolysaccharide
Ribosomes Present Absent
Number of cells One cell (Unicellular) No cells
Living/Non-
Living organisms Between living and non-living things.
Living
DNA and RNA floating freely

DNA and RNA DNA or RNA enclosed inside a coat of protein.
in cytoplasm.
Infection Localized Systemic
Reproduce Able to reproduce by itself Need a living cell to reproduce
Invades a host cell and takes over the cell causing

Fission- a form of asexual
Reproduction it to make copies of the viral DNA/RNA. Destroys
reproduction
the host cell releasing new viruses.
Duration of A bacterial illness commonly

Most viral illnesses last 2 to 10 days.
illness will last longer than 10 days.
A bacterial illness notoriously

Fever A viral infection may or may not cause a fever.
causes a fever.
Cellular
Possesses a cellular machinery Lack cellular machinery
Machinery
Under Visible under Light

Visible only under Electron Microscope.
Microscope Microscope.
Viruses are not beneficial. However, a particular

Some bacteria are beneficial
Benefits virus may be able to destroy brain tumors. Viruses
(Normal Flora)
can be useful in genetic engineering.
Treatment Antibiotics Virus does not respond to antibiotics.

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Staphylococcus aureus, Vibrio

Examples HIV, Hepatitis A virus, Rhino Virus, etc
cholerae, etc
2021-GROUP-A-SAQ 4.a).Name some opportunistic fungus.

b).Mention the predisposing factors of candidiasis
(a). Opportunistic fungi refers to those fungi that normally would not cause infections in
otherwise healthy people but are able to cause infection under certain circumstances such as
immunodefficiency, cancer, organ transplant, neutropenic patients, diabetes, debilitated patients
and patients on long term antibiotics.
Some opportunistic fungus are:

Opportunistic fungal agent Diseases
Candida albicans Different form of candidiasis
Cryptococcus neoformans Cryptococcosis
Asperpillus Funigatus Aspergillosis
Mucor Mucor mycosis/phycomycosis
Pneumocystis carinii Pneumonia in immunocompromised patients
b). The predisposing factors of candidiasis :

1. Immunodeficiency diseases: AIDS, Malignancy.
2. Drug: Broad spectrum -antibiotics ,Steroid, Anticancer drug etc.
3. Endocrine: Diabetes mellitus.
4. Physiological: Pregnancy, Extreme age,(old and infancy).
5. Traumatic burn, Maceration.
6. Others: Indwelling catheters.
Essay question (EQ) Answer.

2021-GROUP-A-EQ 1.Define bacterial spore. Mention the Medical importance of spore with example.
Write Down the pathogenesis and management of tetanus.

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Spore ; Spore are highly resistant dormant stage of bacteria formed in

unfavorable environmental condition and have the capacity to re-establish the
vegetative form under appropriate environment. Example: Bacillus, Clostridium
etc.
Importance:
• Highly resistant structure, so difficult to kill them by antibiotics,
chemicals or heat.
• Spores are infective form of many bacteria.
• Spores are used as indicator of sterilization.
• Preserve the bacterial population from extreme environmental influences .
• Spore can be destroyed by autoclaving and specially designed sporicidal solution.
• Can survive for many years, especially in soil.
Pathogenesis of tetanus:
Deep crush injury like RTA causes inoculation of spores of C. tetani
Tissue necrosis lower the local oxygen and causes germination of the spores
Bacteria germinates, multiplies and produces toxin which is carried by retrograde axonal
movement into the CNS
Toxin binds to the ganglioside receptors, blocks release of inhibitory mediators ( e.g.
glycine and GABA) at spinal cord
Wide spread spasm of skeletal muscles.

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Management of tetanus :
Medications
• Antitoxin Tetanus antitoxin is given as prophylaxis to the persons at risk with infected
wounds, wounds contaminated with soil or mud, deep or punctured wounds and wounds
with devitalising tissue damages. A dose of 1,500 IU should be given subcutaneously or
intramuscularly as early as possible after the wound is received.:
• Sedatives Benzodiazepines and other sedatives
• Vaccination
▪ Tetanus anti-toxin(TIG)-250 unit in intravenous route..

▪ TT (Tetanus toxoid)-Intramuscular.
• Antibiotics Antibiotics are administered to patients with tetanus on the presumption
that it prevents local proliferation of C. tetani at the wound site. The antibiotics that can
be used include penicillin G, metronidazole and doxycycline.
• Other drugs Other medications might be used to regulate involuntary muscle
activity, such as your heartbeat and breathing. Morphine might be used for this
purpose as well as for sedation.
Wound care
Care for your wound requires cleaning to remove dirt, debris or foreign objects that may
be harboring bacteria. Your care team will also clear the wound of any dead tissue that
could provide an environment in which bacteria can grow.
• Control bleeding. Apply direct pressure to stop bleeding.
• Clean the wound. After the bleeding stops, rinse the wound with a saline
solution, bottled water or clear running water.
• Use antibiotics. Apply a thin layer of an antibiotic cream or ointment to

discourage bacterial growth and infection.
• Cover the wound. Bandages can keep the wound clean and keep harmful
bacteria out. Keep the wound covered until a scab forms. If you cannot
clean the wound thoroughly, do not cover it and instead seek medical care.

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• Change the dressing. Rinse the wound, apply antibiotic ointment, and
replace the bandage at least once a day or whenever the dressing becomes
wet or dirty.
• Manage adverse reactions. If the antibiotic causes a rash, stop using it. If
you're allergic to the adhesive used in most bandages, switch to adhesive-
free dressings or sterile gauze and paper tape.
2021-GROUP-A-EQ 2.Define and classify Immunity. Mention the difference between innate and and
acquired immunity
Immunity: The ability of an organism to resist a particular infection or toxin by the action of specific
antibodies or sensitized white blood cells.
Classification Immunity
A. Innate (Non -specific)immunity:
1)Genetic/constitutional
2)Mechanical:
• Keratin layer of skin
• Intact mucus membrane
• Mucocilliary movement.
• Reflex e.g. Coughing reflex ,sneezing reflex etc.
3)humoral:
• Normal bacterial flora
• Acid in gastric juice
• Complement system
• Interferons etc.
4)Cellular:
• Macrophage
• Eosinophile
• NK cells etc.
B. Acquired (specific) immunity:
1)Active:(Where antigens are exposed to the body)
i) Natural:
• After clinical and sub clinical infections e.g. Hepatitis A virus infection.
Ii)Artificial:
• Different form of vaccines e.g., bacterial vaccines ,viral vaccine , toxoid vaccines ,etc.
2) Passive :
i) Natural:
• Transfer of maternal antibody to fetus through placenta.
• Transfer antibody from mother to infants by breast milk.

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Ii)Artificial:
➢ Antisera & antitoxins e.g. TIG (tetanus immunoglobins),ATS(anti tetanus
immunoglobins)ADS(anti diphtheria serum) etc.
The difference between innate and acquired immunity
Traits Innate immunity Acquired immunity

1. Time of Present from birth Acquired after birth upon contact with
development antigens
2. Specificity Non-specific Specific
3. Response to Initial and subsequent response are Primary and secondary responses
subsequent same differ qualitively & quantitively
exposure of
antigen
4. Immunological No immunological memory There is always immunological
memory memory
5. Present in Both vertebrates and invertebrates Only in vertebrates
6. Mechanical Present(e.g.-Skin, mucus membrane) Absent
barrier
7. Cells involved Macrophages, leukocytes, NK-cells Pre dominantly T&B -lymphocytes
2021-GROUP-A-EQ 3.Name five mosquito borne diseases .Write down the agent, vector, complication
and prevention of dengue fever.
Mosquito-borne diseases are those spread by the bite of an infected mosquito.

Diseases that are spread to people by mosquitoes include-
• Dengue, virus,
• Malaria.
• Chikungunya virus,
• Zika
• West Nile virus
The agent, vector, complication and prevention of dengue fever.
The agent of Dengue fever
▪ Dengue virus
Vector is responsible for dengue-
Aedes aegypti (mosquito)
Complications of dengue fever

▪ Hemorrhagic complications

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▪ Fluid overload
-Ascites, Plural effusion, Pulmonary aedema
▪ Metabolic acidosis and electrolyte imbalance

▪ Severe shock
▪ Acute Respiratory Distress Syndrome
▪ Hyperglycaemia
▪ Nosocomial infections
▪ Myocarditis
▪ Hepatitis
Prevention
• Prevention of mosquito breeding:

o Preventing mosquitoes from accessing egg-laying habitats by
environmental management and modification;
o Disposing of solid waste properly and removing artificial man-made
habitats that can hold water;
o Covering, emptying and cleaning of domestic water storage containers on
a weekly basis;
o Applying appropriate insecticides to water storage outdoor containers;
• Personal protection from mosquito bites:

o Using of personal household protection measures, such as window
screens, repellents, coils and vaporizers. These measures must be
observed during the day both inside and outside of the home (e.g.: at
work/school) because the primary mosquito vectors bites throughout the
day;
o Wearing clothing that minimizes skin exposure to mosquitoes is advised;
• Community engagement:
o Educating the community on the risks of mosquito-borne diseases;
o Engaging with the community to improve participation and mobilization for
sustained vector control;
• Active mosquito and virus surveillance:

o Active monitoring and surveillance of vector abundance and species
composition should be carried out to determine effectiveness of control
interventions;

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o Prospectively monitor prevalence of virus in the mosquito population, with

active screening of sentinel mosquito collections;
o Vector surveillance can be combined with clinical and environment
surveillance
Group-B
Short answer question(SAQ):Answer any of three of the following.
2021-GROUP-B-SAQ- 1.What do you mean by normal flora

b)Write down the harmful and beneficial effects of normal flora.
(a)Normal flora: Normal flora is the term used to describe the various bacteria and fungi that
are permanent residents of certain body sites, especially the skin, oropharynx, colon, and vagina
who does not cause disease in immunocompetent individual but can cause disease in
immunosuppressed person.
The skin and mucous membranes always harbor a variety of microorganisms that can be arranged
into two groups:
• The resident flora
• The transient flora
(b) Harmful effects of normal flora
• Bacterial synergism.
• Competition for nutrients.
• Induction of a low grade toxemia.
• The normal flora may be agents of disease.
• Transfer to susceptible hosts
Beneficial effects of normal flora.

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• The members of the normal flora play a role both in the maintenance of health and in the
causation of disease in three significant ways:
• They can cause disease, especially in immunocompromised and debilitated individuals.
Although these organisms are nonpathogens in their usual anatomic location, they can be
pathogens in other parts of the body.
• They constitute a protective host defense mechanism. The nonpathogenic resident
bacteria occupy attachment sites on the skin and mucosa that can interfere with
colonization by pathogenic bacteria. The ability of members of the normal flora to limit
the growth of pathogens is called colonization resistance. If the normal flora is
suppressed, pathogens may grow and cause disease. For example, antibiotics
can reduce the normal colonic flora that allows Clostridium difficile, which is resistant to
the antibiotics, to overgrow and cause pseudomembranous colitis.
• They may serve a nutritional function. The intestinal bacteria produce several B vitamins
and vitamin K. Poorly nourished people who are treated with oral antibiotics can have
vitamin deficiencies as a result of the reduction in the normal flora. However, since germ-
free animals are well-nourished, the normal flora is not essential for proper nutrition.
2021-GROUP-B-SAQ -2.a)Write down the procedure of collection of urine for culture.

b)Name some common bacteria causing urinary tract infection (UTI)
(a) The procedure of collection of urine for culture:
1. Collect supplies.
2. Introduce yourself, check patient's identification band or tag.
3. Wash hands, put on gloves.
4. Explain procedure to patient. Provide privacy or assist to toilet.
5. Wipe genitals with a towelette or clean with a washcloth.
6. Allow urine for flow for two seconds, then place sterile container to collect sample.
7. Patient can finish urinating.
8. Replace lid on specimen container and label according to policy. Place in a
specimen bag.
9. Remove gloves, wash hands.
10. Assist patient to clean up and return to comfortable position.
11. Transport specimen to designated spot for lab pick-up.
(b) some common bacteria causing urinary tract infection (UTI):
Urinary tract infections (UTIs) are a severe public health problem and are caused by a
range of pathogens, but most commonly by
• Escherichia coli,
• Klebsiella pneumoniae,
• Proteus mirabilis,

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• Enterococcus faecalis and

• Staphylococcus saprophyticus.
2021-GROUP-B-SAQ -3. a)Define nosocomial infection with examples.
Nosocomial infection: Nosocomial infections defined an infection occurs after 48hours of

admission or within 72 hours of discharge from the hospital . Some of the common
nosocomial infections are-
• urinary tract infections,
• respiratory pneumonia,
• surgical site wound infections,
• bacteremia,
• gastrointestinal and skin infections.
Steps to nosocomial infection :
❖ Maintenance of proper sterilization and disinfection procedures.
❖ Fully disinfecting skin and equipment.
❖ Washing hands regularly.
❖ Wearing protective equipment like face masks and gloves.
❖ Adoption of effective antiseptic techniques.
❖ Rational use of antibiotics.
❖ Proper hospital waste disposal.
❖ Regularly changing urinary catheters, and removing them as soon as possible.
❖ Removing hair near a surgical area.
❖ Ensuring an effective administrative set up
❖ Correct hospital designing for proper spacing of patients.
❖ Detection of the carriers and proper treatment.
b)Write short note on : SARS-CoV-2.
Severe acute respiratory syndrome coronavirus 2" (SARS-CoV-2)

SARS-CoV-2 is a member of a large family of viruses called coronaviruses (covid 19).
These viruses can infect people and some animals. SARS-CoV-2 was first known to
infect people in 2019. The virus is thought to spread from person to person through
droplets released when an infected person coughs, sneezes, or talks.
The natural reservoir for SARS-CoV-2 :
The most likely ecological reservoirs for SARS-CoV-2 are bats, but it is believed that the
virus jumped the species barrier to humans from another intermediate animal host. This

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intermediate animal host could be a domestic food animal, a wild animal, or a

domesticated wild animal which has not yet been identified.
sars-cov-2 complications
• Acute Respiratory Failure.
• Pneumonia.
• Acute Respiratory Distress Syndrome (ARDS)
• Acute Liver Injury.
• Acute Cardiac Injury.
• Secondary Infection.
• Acute Kidney Injury.
• Septic Shock.
To prevent the spread of COVID-19:
• Maintain a safe distance from others (at least 1 meter), even if they don’t appear to be
sick.
• Wear a mask in public, especially indoors or when physical distancing is not possible.
• Choose open, well-ventilated spaces over closed ones. Open a window if indoors.
• Clean your hands often. Use soap and water, or an alcohol-based hand rub.
• Get vaccinated when it’s your turn. Follow local guidance about vaccination.
• Cover your nose and mouth with your bent elbow or a tissue when you cough or sneeze.

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• Stay home if you feel unwell.

Vaccination :Nine vaccines have been approved for emergency or full use by at least one
stringent regulatory authority recognized by the World Health Organization (WHO):
2021-GROUP-B-SAQ -4. Write short note on : a)EPI b)Hypersensitivity

(a)EPI
The Expanded Programme on Immunization (EPI) was established in 1974 to develop and
expand immunization programs throughout the world. In 1977, the goal was set to make
immunization against diphtheria, pertussis, tetanus, poliomyelitis, measles and tuberculosis
available to every child in the world by 1990.
the importance of EPI

EPI covers vaccination services implemented in order to ensure the immunization of
all vulnerable age groups by preventively reaching out to them before they
contract and develop infectious diseases: pertussis, diphtheria, tetanus, measles,
rubella, mumps, tuberculosis, polio, chickenpox, hepatitis A, hepatitis B

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(b)Hypersensitivity:

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Definition: Hypersensitivity is defined as an inappropriate, altered and exaggerated

immune response causing cellular damage or dysfunction.
Types of hypersensitivity:
• Type-1 hypersensitivity (Anaphylactic reaction),
Example: Asthma and drug reactions (Penicillin)
• Type-2 hypersensitivity (Cytotoxic hypersensitivity),
Example:
➢ Incompatible blood transfusion,
➢ Hemolytic disease of newborn,
➢ Autoimmune hemolytic anemia,
➢ Autoimmune thrombocytopenia.
• Type-3 hypersensitivity (Immune complex mediated hypersensitivity),

Example:
✓ drug-induced serum sickness,
✓ farmer's lung and
✓ systemic lupus erythematosus.
• Type-4 hypersensitivity (Cell Mediated or delayed type hypersensitivity)
, Example: Tuberculine test
• Type-5 hypersensitivity (Stimulatory type hypersensitivity.
Example: Graves disease.
Essay question (EQ) Answer any two of the following.
2021-GROUP-B-EQ -1.What are the indication of blood culture. Give the laboratory diagnosis of Kala -
azar. Write shortly about PKDL.
The indication of blood culture:

1. Eenteric fever
2. Seoticemia
3. Bacteremia
4. Meningitis
5. Pyrexia of unknown origin
6. Bacterial infective Endocarditis
7. Osteomilitis
8. Brucellosis
9. Urinary Tract infection (If there is fever ,rigor, or evidevce of septic shock)
The laboratory diagnosis of Kala -azar:

WHO standard criteria for diagnosis of Kala-azar in Bangladesh
• Fever more than 2 weeks.
• Coming from endemic zone.
• Splenomegaly.
Lab diagnosis

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Sample collection:
• Aspirates from spleen, liver, bone marrow and lymph node or biopsy
material from these tissues.
• Blood
• Urine
Test
Sample
Blood Blood count, antibody detection and PCR
Splenic aspirate Microscopy, culture, PCR
Bone marrow aspirate Microscopy, culture, PCR

Urine Antigen detection
• Haematological findings:
• Anaemia
• High ESR
• Leukopenia with relative lymphocytosis (70% -80% )
• Thrombocytopenia.
• Direct evidence:
• 1. Microscopic examination of PBF, splenic aspirate, bone marrow biopsy,
lymph node biopsy to see LD body inside macrophage.
PKDL(Post-kala-azar dermal leishmaniasis ):

Post-kala-azar dermal leishmaniasis (PKDL) is a complication of visceral leishmaniasis (VL); it is
characterised by a macular, maculopapular, and nodular rash in a patient who has recovered from
VL and who is otherwise well. The rash usually starts around the mouth from where it spreads to
other parts of the body depending on severity.
Post-kala-azar dermal leishmaniasis (also known as "Post-kala-azar dermatosis") found mainly on
the face, arms, and upper part of the trunk. It occurs years (in the Indian variation) or a few
months(in the African strain) after the successful treatment of visceral leishmaniasis.
It is mainly seen in Sudan and India where it follows treated VL in 50% and 5-10% of cases,
respectively. Thus, it is largely restricted to areas where Leishmania donovani is the
causative parasite. The interval at which PKDL follows VL is 0–6 months in Sudan and 2–3 years in
India. PKDL probably has an important role in interepidemic periods of VL, acting as a reservoir for
parasites.
PKDL was first identified by Sir Upendranath Brahmachari, who initially called it dermal leishmanoid.
He published his observations in the Indian Medical Gazette in 1922.[1]

25
Mechanism
The cause of PKDL is uncertain. Possibilities may include use of antimonial drugs, sunburn,
reinfection with kala-azar, memory T cell responses failing in certain organs; and genetic
susceptibility.
There is increasing evidence that the pathogenesis is largely immunologically mediated; high
concentrations of interleukin 10 in the peripheral blood of VL patients predict the development of
PKDL. During VL, interferon gamma is not produced by peripheral blood mononuclear cells (PBMC).
After treatment of VL, PBMCs start producing interferon gamma, which coincides with the
appearance of PKDL lesions due to interferon-gamma-producing cells causing skin inflammation as
a reaction to persisting parasites in the skin.
Diagnosis
PKDL is difficult to diagnose.
Diagnosis is mainly clinical, but parasites can be seen by microscopy in smears with
limited sensitivity. PCR and monoclonal antibodies may detect parasites in more than 80% of
cases. Serological tests and the leishmanin skin test are of limited value.
Treatment
Treatment is always needed in Indian PKDL; in Sudan, most cases are self-limited but severe and
chronic cases are treated. Sodium stibogluconate is given at 20 mg/kg for 2 months in Sudan and for
4 months in India. Liposomal amphotericine B seems effective. Although research has brought many
new insights in pathogenesis and management of PKDL, several issues in particular in relation to
control remain unsolved and deserve urgent attention.
Miltefosine is the only available oral medication available for VL and PKDL While the drug works for
short-term treatment of VL, PKDL would require a longer treatment of more than 28 days with this
drug. Miltefosine is not recommended for use as a monotherapy to treat PKDL.
Society and culture

People with PKDL are a reservoir of leishmaniasis. To eliminate leishmaniasis from a population,
people with PKDL must get treatment.
The government of India has an kala-azar elimination program ongoing which entered a
consolidation phase in 2017.

26
2021-GROUP-B-EQ 2.Describe the pre and post exposure prophylaxis of Hepatitis B virus.
Pre-exposuure prophylaxis of hepatitis B :

• Primary course of vaccination consists of 3 doses.
• In each dose, 0.5ml of vaccine is given intramuscular (I/m) at 0, 1 and 6 months.
• After an interval of 1-4 months a blood test taken for anti- HBsAb level.
Post-exposure prophylaxis of hepatitis B :

Passive immunization : By Hepatitis B immunoglobulin(HBIG).Immediate administration of HBIG is
recommended as the initial step in preventing infection by individuals –
• Accidently exposed to HBV – contaminated blood by needlestick or other means.
• Those exposed to infection by sexual contact with an HBV – positive partner.
• Infants born to mothers who are HBV infected.
2021-GROUP-B-EQ 3.Classify plasmodium species. Which species of plasmodium are found in

Bangladesh? Which one is more dangerous and why? Write complication of Falciparum malaria.
Classification plasmodium species:
Type of Malaria
Name of species
P.vivax Benign tertian malaria
P. falciparum Malignant tertian malaria

P. ovale Tertian malaria
P. malariae Quartan malaria
Species of plasmodium found in Bangladesh is:
P. Hilly areas like Chittagong, Sylhet, Malignant tertian

falciparum Mymensingh, Jamalpur Sherpur etc. malaria
Complications of Falciparum malaria :

27
The neurological complications of falciparum malaria are often associated with

dysfunction of other organs and systems, with effects such as -
• severe anemia,
• hypoglycemia,
• acute renal failure,
• hepatic impairment, and
• coagulation disorders.
January - 2020
Group-A
Short answer question(SAQ):Answer any of three of the following
2020-GROUP-A-SAQ- 1.a) Draw and label a capsulated bacterium

b) Define normal flora. Enumerate the medical importance of normal FLORA WITH EXAMPLE.
a)

28
Figure :a capsulated bacterium
(b).Normal flora is the term used to describe the various bacteria and fungi that are permanent
residents of certain body sites, especially the skin, oropharynx, colon, and vagina who does not
cause disease in immunocompetent individual but can cause disease in immunosuppressed
person.
The medical importance of normal FLORA WITH EXAMPLE:
• The members of the normal flora play a role both in the maintenance of health and in the
causation of disease in three significant ways:
• They can cause disease, especially in immunocompromised and debilitated individuals.
Although these organisms are nonpathogens in their usual anatomic location, they can be
pathogens in other parts of the body.
• They constitute a protective host defense mechanism. The nonpathogenic resident
bacteria occupy attachment sites on the skin and mucosa that can interfere with
colonization by pathogenic bacteria. The ability of members of the normal flora to limit

29
the growth of pathogens is called colonization resistance. If the normal flora is

suppressed, pathogens may grow and cause disease. For example, antibiotics
can reduce the normal colonic flora that allows Clostridium difficile, which is resistant to
the antibiotics, to overgrow and cause pseudomembranous colitis.
• They may serve a nutritional function. The intestinal bacteria produce several B vitamins
and vitamin K. Poorly nourished people who are treated with oral antibiotics can have
vitamin deficiencies as a result of the reduction in the normal flora. However, since germ-
free animals are well-nourished, the normal flora is not essential for proper nutrition.
2020-GROUP-A-SAQ- 2.A)Name the species of malarial parasite. Which more dangerous and why?
(a) Classification plasmodium species:
Type of Malaria
Name of species

Plasmodium falciparum is the most deadly of the human malaria parasites. The particular
virulence of this species derives from its ability to subvert the physiology of its host during the
blood stages of its development.
Complications of kala azar

• Amoebic or bacillary dysentery or gastro-enteritis
• Pneumonia
• TB
• Bleeding manifestation.
Diagnosis of Kala-azar.
WHO standard criteria for diagnosis of Kala-azar in Bangladesh
• Fever more than 2 weeks.
• Coming from endemic zone.
• Splenomegaly.

30
Lab diagnosis
• Sample collection:
• Aspirates from spleen, liver, bone marrow and lymph node or biopsy
material from these tissues.
• Blood
• Urine
Sample Test
Blood Blood count, antibody detection and PCR
Splenic aspirate Microscopy, culture, PCR
Bone marrow aspirate Microscopy, culture, PCR
Urine Antigen detection
• Haematological findings:
• Anaemia
• High ESR
• Leukopenia with relative lymphocytosis (70% -80% )
• Thrombocytopenia.
• For detection of antibody-
ICT()
• Direct evidence:
• 1. Microscopic examination of PBF, splenic aspirate, bone marrow biopsy,
lymph node biopsy to see LD body inside macrophage.
2020-GROUP-A-SAQ- 3.a)Define vaccine. Name four live attenuated vaccine.

b)Define Antigen. Mention the criteria of a good antigen.
(a) Vaccine: Vaccine is a biological preparation that provides active acquired immunity
against a particular disease.
• Live attenuated viral vaccines:-
• Oral polio vaccine. Yellow fever virus, Mumps, virus, Mumps virus,
Rubella virus.
• Live attenuated bacterial vaccines:-Salmonella,
Mycobacterium tuberculosis, Yersinia pestis.

31
(b) Antigen : A toxin or other foreign substance which causes the body to make an immune
response in the body, especially the production of antibodies against that substance .
A good antigen shows the following features:
• Intramolecular areas of stable structure and complex chemical bonding

• Large stretches which are not composed of long repeating units
• A molecular weight of at least 8 000 to 10 000 Da (however, it must be noted that
haptens of only 200 Da molecular weight have been conjugated with a carrier
protein)
• Can undergo processing by the immune system
• Has regions that can be presented to the antibody-forming process to stimulate
the immune system
• Has structural dissimilarity with the host
• Peptide antigens should contain immunogenic regions with at least 30% of amino
acids such as lysine, glutamine, arginine, glutamic acid, aspargine and aspartic
acid, called immunogenic amino acids, as well as sufficiently high numbers of
hydrophilic or charged functional groups
2020-GROUP-A-SAQ- 4. Write short note on : a)EPI b)Nosocomial infection.

a)EPI :SEE 2021-GROUP-B-SAQ-4-a
b)Nosocomial infection
Nosocomial infection: Nosocomial infections defined an infection occurs after 48hours of
admission or within 72 hours of discharge from the hospital . Some of the common
nosocomial infections are-
• urinary tract infections,
• respiratory pneumonia,

32
• surgical site wound infections,

• bacteremia,
• gastrointestinal and skin infections.
Steps to nosocomial infection :
❖ Maintenance of proper sterilization and disinfection procedures.
❖ Fully disinfecting skin and equipment.
❖ Washing hands regularly.
❖ Wearing protective equipment like face masks and gloves.
❖ Adoption of effective antiseptic techniques.
❖ Rational use of antibiotics.
❖ Proper hospital waste disposal.
❖ Regularly changing urinary catheters, and removing them as soon as possible.
❖ Removing hair near a surgical area.
❖ Ensuring an effective administrative set up
❖ Correct hospital designing for proper spacing of patients.
❖ Detection of the carriers and proper treatment.
2020-GROUP-A-EQ- 1./Define sterilization, disinfection and antisepsis. Classify methods of sterilization .

State the principle of autoclave.
Definitions
Methods of sterilization
• There are two main methods of sterilization:
o Physical method,
o Chemical method.
• Physical methods of sterilization:

33
Moist heat Radiat Filtratio Ultrasonic

Dry ion n ation
heat
Below At Above X –ray Berkefeld Ultrasonogr
100oC 100oC type am
100oC
Hot Air Pasteuriza Boiling Autocla γ – ray Chamber
Oven tion ve land type
Red Vaccine Steaming β – ray Seitz type
Heat bath
Flaming Water Tyndaliza UV Membran
bath tion radiatio e filter
n
Incinera Inspissato
tion r
• Chemical methods (Disinfectants):

):
Agents that damage cell Agents that modify functional groups of protein and
membrane nucleic acid
Surface Phenolic Alcohol Heavy metals Silver Oxidizing

active compounds compounds agents
agents
Triton Phenol Ethanol Mercuric 1% solution Iodine
K-12 50 – 70% chloride of AgNO3
(HgCl2)
Triton Cresol Isopropyl Metaphen Hydrogen

W-30 alcohol peroxide
Hypochlorite
Chemical methods (Disinfectants):

34
Dyes Alkylating agents Agents that denature proteins
Aniline dyes 37% Formaldehyde Acids Alkalis
Brilliant green 2% Glutaraldehyde HCl 2% NaOH
Malachite green Ethylene oxide H2SO4
Principles of Autoclave:
is present.
with air.
121-124 1.1 15
134-138 2.2 3
2020-GROUP-A-EQ- 2.Define and classify immunity. Mention the component of innate immunity.
Differences between innate and acquired immunity.
Answer{2021-group-a-eq-2}
.Components of innate immunity :
a)Mechanical/physical:
1.Anatomical barriers:
• Keratin layer of intact skin.

• Intact mucus membrane.
• Bony encasements.
2.Mechanical removal:
• Mucus and cilia

• Coughing and sneezing reflexes -expel trapped foreign substances

35
• Vomiting and diarrhoea

• The physical flushing action of body fluids
b)Chemical Factors:
1.Pattern--recognition receptors
2.Antigene non-specific antimicrobial chemicals:
• Low pH of stomach and vagina inhibits growth of many microbes

• Fatty acid of skin inhibits growth of micro organisms.
• Acid pH of sweat and sebaceous secretions inhibits to microorganism.
• Lysozyme in tears ,nasal secretions and saliva degrades peptidoglycan of bacterial cell wall.
• Spermine and zinc in the semen are bactericidal.
• Lactoperoxidase in milk ha bactericidal action
3.Antigen non-specific antimicrobial cytokines.
c)Biological Factors(celluar and soluble factors);
1.The complement system ;
• The lactin complement pathway.

• The alternate complement pathway.
2.Cells involved in body defense:
• Defense cells in the blood (leucocytes)

• Defense cell in the tissue(macrophage, must cells, dendritic cells etc.)
• Normal flora can compete with pathogenic bacteria for nutrients and also produce
antimicrobial substances.
• Phagocytosis
• Inflammation
• Nutritional Immunity
• Fever
• The acute phase response.
2020-GROUP-A-EQ- 3.Write the name of spore forming bacteria . Give the pathogenesis and
management of tetanus.
The name of spore forming bacteria :

➢ Bacillus cereus,
➢ Bacillus anthracis,
➢ Bacillus thuringiensis,
➢ Clostridium botulinum,
➢ Clostridium tetani.

36
➢ Bacillus coagulans,
➢ Clostridium butyricum, and
➢ Clostridium pasteurianum
• Pathogenesis:
Deep crush injury like RTA causes inoculation of spores of C. tetani
Tissue necrosis lower the local oxygen and causes germination of the spores
Bacteria germinates, multiplies and produces toxin which is carried by retrograde axonal
movement into the CNS
Toxin binds to the ganglioside receptors, blocks release of inhibitory mediators ( e.g.
glycine and GABA) at spinal cord
Wide spread spasm of skeletal muscles
management of tetanus.{ 2021-GROUP-A-EQ- 1 }
Group-B
2020-GROUP-B-SAQ- 1.a) Write down the common viral diseases in Bangladesh.
b)Name the hepatitis viruses. Mention the mode of transmition of Hepatitis B Viruses.
(_a)Common viral diseases in Bangladesh include

➢ hepatitis,
➢ poliomyelitis,
➢ rabies,
➢ measles,
➢ mumps,
➢ rotavirus diarrhoea, and
➢ 'chicken pox'
(b)
Hepatitis viruses consists of at least five human pathogens:
• Hepatitis A virus (HAV),
• Hepatitis B virus (HBV),
• Hepatitis C virus (HCV),
• Hepatitis D virus (HDV),
• Hepatitis E virus (HEV).
Many other virus can cause hepatitis such as
• Epstein-Barr virus,
• Cytomegalovirus,
• Yellow fever virus,

37
• Herpes simplex virus,

• Rubella virus.
Mode of transmition
Blood, improperly sterilized syringes, needles and by tattooing or ear piercing.
• During sexual intercourse,
• Perinatally from infected mother to new born, during birth or breast
feeding.
2020-GROUP-B-SAQ- 2.a)What are the indication of blood culture?

b)Mention the common opportunistic infection of AIDS.
(a) The indication of blood culture:
▪ Enteric fever
▪ Septicemia
▪ Bacteremia
▪ Meningitis
▪ Pyrexia of unknown origin
▪ Bacterial infective endocarditis
▪ Osteomyelitis
▪ Brucellosis
▪ Urinary tract infection(If there is fever, rigors or evidence of septic shock)
(b)The common opportunistic infection in AIDS patient.
• Bacterial Pneumonia
• Herpes simplex virus 1 (HSV-1) infection
• Pneumocystis pneumonia
• Salmonella infection,
• toxoplasmosis,
• Cryptococcal meningitis
• candidiasis (thrush) and
• tuberculosis.
• cryptosporidiosis
• Lower respiratory tract infections (LRTIs) are the most common respiratory
diseases and are frequently the first clinical manifestations of HIV infections.
2020-GROUP-B-SAQ- 3.a)Classify Fungus according to morphology with example.

- b)Mention the predisposing factors of vaginal candidiasis.
the predisposing factors of vaginal candidiasis.

• Loss of acid pH of vagina

38
• Pregnancy
• Diabetes mellitus
• Prolonged use of oral contraceptic pill
(a) Morphological classification:

• Yeast: Crypptococcus neoformans
• Yeast like: Candida albicans
• Molds: Dermatohytes
• Dimorphic: Histoplasma capsulatum
2020-GROUP-B-SAQ- 4. Write short note on : a)Dengue fever

b)The management of bite of rabies dog.
a)Dengue fever
The agent, vector, complication and prevention of dengue fever.
The agent of Dengue fever
▪ Dengue is caused by a virus member of the genus Flavivirus and family Flaviviridae.
▪ Virus is 50 nm.in size and contains a single strained RNA.
▪ There are 4 sero types of this virus
-DEN1
-DEN2
-DEN3
-DEN4
Vector is responsible for dengue-
Aedes aegypti (mosquito)
Complications of dengue fever

▪ Haemorrhagic complecations
▪ Fluid overload
-Ascites, Plural effusion, Pulmonary aedema
▪ Metabolic acidosis and electrolyte imbalance

▪ Severe shock
▪ Acute Respiratory Distress Syndrome
▪ Hyperglycaemia

39
▪ Nosocomial infections
▪ Mycocarditis
▪ Hepatitis
Prevention
• Prevention of mosquito breeding:

o Preventing mosquitoes from accessing egg-laying habitats by
environmental management and modification;
o Disposing of solid waste properly and removing artificial man-made
habitats that can hold water;
o Covering, emptying and cleaning of domestic water storage containers on
a weekly basis;
o Applying appropriate insecticides to water storage outdoor containers;
• Personal protection from mosquito bites:

o Using of personal household protection measures, such as window
screens, repellents, coils and vaporizers. These measures must be
observed during the day both inside and outside of the home (e.g.: at
work/school) because the primary mosquito vectors bites throughout the
day;
o Wearing clothing that minimises skin exposure to mosquitoes is advised;
• Community engagement:
o Educating the community on the risks of mosquito-borne diseases;
o Engaging with the community to improve participation and mobilization for
sustained vector control;
• Active mosquito and virus surveillance:

o Active monitoring and surveillance of vector abundance and species
composition should be carried out to determine effectiveness of control
interventions;
o Prospectively monitor prevalence of virus in the mosquito population, with
active screening of sentinel mosquito collections;
o Vector surveillance can be combined with clinical and environment
surveillance

40
b)The management of bite of rabies dog.
Category I Required treatment

• No bite mark. • Vigorous washing with
• No scratch mark. soap and water
• Only history of touching or licks on • No vaccine.
intact skin. • No RIG.
Category II
• Minor scratch mark or abrasion, no soap and water
bleeding or oozing. OR • Post exposure prophylactic
• Just oozing but no active bleeding. vaccine.
• No RIG.
Category III
• Single or multiple bite mark. OR • Vigorous washing with
• Deep, multiple scratch marks. OR soap and water
• Contact of mucous membrane with • Post exposure prophylactic
saliva (licks) vaccine.
• RIG (20 IU/kg body
weight).
Eassy question (EQ) Answer any two of the following. (2×10)=20
2020-GROUP-B-EQ- 1.Write down the general principles of microbiological sample collection procedure.
The general principles of microbiological sample collection procedure:

• The specimen must be collected from the right person
• The patient should be intimated will in advance regarding the procedure and sample of
specimen .
• The specimen container should be properly steriled
• Every specimen should be separately labed clearly with patients name, Bed no., reg. ,number,
ward number etc and nature of specimen very care full with date and time of collection,
• Specimens must be collected in adequate amount by the nature of test.
• Use special container for some specimen such as fasting blood sugar, random blood sugar, blood
for electrolytes etc.
• All specimens duly labed should be kept in separate tray for dispatching to lab.

41
• Morning specimen should collected by the night nurse on duty .Other samples should be
collected by day duty nurse.
• Any instruction for special test should be noted by nurse in nursing lab not book and instructions
are followed accordingly.
2020-GROUP-B-EQ- 2.Define parasite and host .Write down the complication of round worm and hock
worm.
Parasite: Parasite is the living organism which takes shelter & nourishment from
the host but host got nothing in return rather suffers from some injury.
Host: Host is that animal which harbor the parasite.
Complications of round warm infection :

▪ Ascaris pneumonia(Loeffler’s Syndrome)
▪ Lesion in various organ like brain , heart, kidney due to larvae in systemic circulation
▪ Protein energy malnutrition
▪ Night blindness
▪ Typhoid like fever due to absorption of toxic body fluid of ascaris lumbricoides
▪ Allergic manifestations
▪ Inflammatory changes in the liver and biliary canaliculi due to involvement of the ova
▪ Abdominal pain is common in children.
▪ Results in malnutrition, anaemia and Vit-A deficiency.
▪ May block the appendicular lumen or the common bile duct and even perforate the
intestinal wall.
Health Hazard of hook worm :
▪ Dermatitis or ground itch of the site of entry
▪ Creeping eruption along the tract of movement of larva beneath the skin.
▪ Bronchitis and brocho-pneumonia may occur
▪ Pathogenic effects caused by adult worm.
▪ Chronic blood loss: Each Ancylostoma duodenale is capable of drawing 0.2 ml blood
and each Necator americanus Is capable of drawing 0.03 ml blood per day.This results
in microcytic microcytic hypochromic anaemia
2020-GROUP-B-EQ- 3.Define and classify hypersensitivity? Describe the mechanism of type 1

hypersensitivity.

42
Definition:
Hypersensitivity is defined as an inappropriate, altered and exaggerated immune
response causing cellular damage or dysfunction.
• Type-4 hypersensitivity (Cell Mediated or delayed type hypersensitivity),
• Type-5 hypersensitivity (Stimulatory type hypersensitivity
Mechanism of Type-1 hypersensitivity
1st exposure or Sensitization:
Entrance of an antigen or allergen into the body for the 1 st time
Antigen or allergen is taken up by macrophage, processed and presented to T H2 cells
TH2 cells stimulate B cells which then transforms into plasma cells
Plasma cells produce IgE instead of IgM
Fc portion of the IgE binds with its receptor on mast cells and basophils (Sensitization)
2nd exposure:
Re-exposure of the same antigen in the pre-sensitized person
Antigen binds to and cross links IgE on the surface of mast cell and basophils
Release of primary and secondary inflammatory mediator
University of Dhaka
1st B.Sc. in Nursing Final Examination January 2019,
Group-A
2019-GROUP-A-SAQ- 1.a)define sterilization, disinfection and antisepsis.

b)Write down the principles of autoclave.

43
Answer: Definitions
• Principles of Autoclave:
is present.
with air.
121-124 1.1 15
134-138 2.2 3
2019-GROUP-A-SAQ- - 2.a)Define nosocomial infection with example.

b)How can prevent nosocomial infections?
Answer{2020-GROUP-A-SAQ- 4}

44
2019-GROUP-A-SAQ- - 3.a)Draw and label a typical bacterium. B)Classify bacteria according to their O2
requirement.
(a)
Jahid
(b)
Classification of bacteria on the basis of oxygen requirement:
• Obligate aerobes: Can not live with out oxygen such as Pseudomonas
aeruginosa and Mycobacterium tuberculosis.
• Obligate anaerobes: Can not live in presence of oxygen such as
Clostridium tetani.

45
• Facultative anaerobes: Live in presence of oxygen but do not die in

absence of oxygen such as Streptococcus pyogenes.
• Microaerophilic: Can live in presence of small amount of oxygen (5-10%)
such as Campylobacter jejuni and Helicobactor pylori.
• Aerotolerant: Grow to some extent in oxygen but multiply much more
rapidly in anaerobic condition such as Clostridium histolyticum.
2019-GROUP-A-SAQ- - 4.Write short note on: a)Bacterial Spore b) pasteurization
(a) Spore: Spore are highly resistant dormant stage of bacteria formed in
vegetative form under appropriate environment. Example: Bacillus, Clostridium
etc.
• Structure of spore
• Spore core
• Spore wall
• Spore cortex
• Spore coat
Figure :spore
Importance of bacterial spore:

chemicals or heat.

46

b) pasteurization:
Pasteurization (or pasteurization) is a process of heat processing a liquid or a food to kill

pathogenic bacteria to make the food safe to eat. It involves heating the food to kill most
harmful microorganisms. Producers pasteurize dairy and other foods to make them safe
to eat. The process is named after Louis Pasteur.
Methods of Milk Pasteurization
• High Temperature Short Time. In the United States, the most common method of
pasteurization is High Temperature Short Time (HTST). ...
• Higher Heat Shorter Time. ...
• Ultra High Temperature. ...
• Ultra Pasteurized
The purpose of pasteurization in microbiology

pasteurization, heat-treatment process that destroys pathogenic microorganisms
in certain foods and beverages.
BENEFITS OF PASTURIZATION
• . Prolonged shelf life

• Preventing disease
• Quick and safe sanitation
• Consistent product quality
• Potential improvements in flavor and scent
• Regulatory compliance
2019-GROUP-A-EQ- - 1.a)Mention the differences between bacterium and human cell. Write down the
essential components of bacteria with function.
The differences between bacterium and human cell:

47
Structure Bacterium Human cell
Nucleus Nuclear membrane Absent Present
Nucleolus Absent Present
Chromosome One, More than one, linear

circular
Location Free in Enclosed in a

cytoplasm membrane bound
structure
Replication Binary Mitotic division

fission
Extrachromosomal DNA Plasmid Mitochondria
Cytoplasm Cytoplasmic organelles such as absent Present

mitochondria, Golgi body, endoplasmic
reticulum etc.
Lysosomes Absent Present
Ribosome 70s 80s (40s+60s)

(30s+50s)
The essential components of bacteria with function :
Components Function
1.Cell wall I. Give rigid support
II. Protect against osmotic pressure
III. It is the site of action of penicillin’s,
Cephalosporins and is degrade by
lysozyme.
IV. In gram negative bacteria,
Lippopolysaccharide of outer membrane
acts as endotoxin
2.Cytoplasmic membrane/Plasma membrane i. It is the site of oxidative and transport enzymes

48
3.Ribosome I. Protein synthesis

ii. Site of action aminoglycosides, erythromycin,
tetracycline & chloramphenicol.
4.Nucleoid Contain genetic materials.
5.Mesosome Participates in cell division & secration
6.Periplasm(in gram negative bacteria) Contains many hydrolytic enzymes, including β -
lactamases
2019-GROUP-A-EQ- 2.a)Classify immunity with examples. Mention difference between active and
passive immunity.
A. Innate (Non -specific)immunity:
2)Mechanical:
• Reflex e.g. Coughing reflex ,sneezing reflex etc.
3)humoral:
• Interferons etc.
4)Cellular:
• Macrophage
• Eosinophile
• NK cells etc.
1) Natural:
2) Passive :
➢ Antisera & antitoxins e.g. TIG (tetanus immunoglobins),ATS(anti tetanus
The difference between innate and acquired immunity{2021-GROUP-A-EQ 2.}
2019-GROUP-A-EQ- 3.Mention the different methods of blood culture. Which one is the best among
them an why? Write down the principle of collection of blood for culture.

49
There are three methods of blood culture –

1. Traditional method – using liquid media or biphasic media
2. Lytic method -After processing in lytic solution in solid media.
3. Automated method – (within 6 hours)
Among these methods Automated method is the best method or more advantageous :
Because-
• Chances of contamination is minimum.
• Reduce huge number of manual workload
• No need to separate incubator.
• Some machine can detect the organisms.
Procedure of collection of blood :

• 10ml of blood is needed for each blood culture bottle.
• First locate a vein in the flexor aspect of elbow region.
• The area of skin where the blood will be drawn must be disinfected by wiping the area with
alcohol in a circular fashion.
• The same pattern of wining is repeated using an iodine or iodophor solution.
• The top of the bottle is disinfected using alcohol.
• Draw the blood and about 10 ml of blood is injected into each blood culture bottle.
• The type of bottle used will vary based on whether the physician is looking for bacteria(aerobes
or anaerobes), yeast or mold.
Group-B
2019-GROUP-B-SAQ- 1.a)Name the agent and vactor of Kala-azar.

b)Among malaria which is more dangerous and explain why? a
(a)
➢ Agent: Leishmania donovani
➢ Infective form: Promastigote
➢ Host: Human

50
➢ Vector: Sandfly Phlebotomus argentipes
b)Among malaria which is more dangerous and explain why?
Classification of Plasmodium:
Name of species Type of Malaria



Plasmodium falciparum is the most deadly. In Americas 77% of the infections are due to
Plasmodium vivax. Falciparum can cause severe malaria because it multiples rapidly in the
blood, and can thus cause severe blood loss (anemia). In addition, the infected parasites
can clog small blood vessels. When this occurs in the brain, cerebral malaria results, a
complication that can be fatal. P.
2019-GROUP-B-SAQ- 2.a)Classify Fungus according to morphology with example.
(a)Morphological classification Fungus:

b)Mention the predisposing factors of vaginal candidiasis.{ 2020-GROUP-B-SAQ- 3.}
2019-GROUP-B-SAQ- 3.a)mention the route of transmission of HIV.

51
(a) Transmission of HIV

• Unprotected Sex:
• Most common route of transmission.
• Accounts for nearly 80% - 90% of the world's HIV infections.
• Mother-to-child transmission:
• Occurs either across placenta or at birth or via breast milk.
• More than 50% of neonatal infections occur during vaginal delivery.
• Transmission via donated blood or blood products:
• Transmission of HIV via blood transfusion has been greatly reduced by screening
of donated blood.
• However, there is a "window" period early in infection when the blood of an
infected person contain HIV but antibodies are not detectable. Blood banks now
test for the presence of p24 antigen in an effort to detect blood that contains HIV.
• Accidental needle injury:
•It rarely produces HIV even after prolonged exposure, supporting the view that the
infectious dose of HIV is high. Risk of being infected after percutaneous exposure to
HIV-infected blood is estimated to be about 0.3%.
• Injectable Drug Users:
• IDUs represent 8% of new HIV infections.
• Transgender People:
• A 2008 review of HIV studies among transgender revealed 28% new HIV infection
cases.
B)What do you mean by HIV and AIDS.
Human Immunodeficiency Virus (HIV):

Introduction to HIV
• HIV is a retrovirus responsible for progressive failure of the immune system resulting in
life threatening opportunistic infections & cancers.
• It is an icosahedral, enveloped RNA virus.
• It is called retrovirus as because it contains reverse transcriptase enzyme which produces
DNA from viral RNA.
• Mainly infects and kills helper T cells resulting in the loss of cell-mediated immunity.
Acquired immunodeficiency syndrome (AIDS) is a chronic, potentially life-

threatening condition caused by the human immunodeficiency virus (HIV)
2019-GROUP-B-SAQ- 4.a)Name the common nematods found in Bangladesh.
The common nematodes found in Bangladesh are :

➢ Ascaris lumbricoides,
➢ Trichuris trichiura,
➢ Ancylostoma duodenale
➢ Enterobius vermicularisetc.
b)Mention different medical and surgical complications of round warm infection.

52
Complications of round warm infection

▪ Lesion in various organ like brain , heart, kidney due to larvae in systemic circulation
▪ Night blindness
▪ Results in malnutrition, anaemia and Vit-A deficiency.
intestinal wall.
2019-GROUP-B-EQ- 1.Name some common protozoal diseases in Bangladesh .What is EPI ? Mention the
different advantages of live vaccine.
Some common protozoal diseases in Bangladesh
• Malaria
• Leishmaniasis
• trypanosomiasis
• Toxoplasmosis
• Chagas disease.
• Toxoplasmosis
• Cryptosporidiosis
EPI
The Expanded Programme on Immunization (EPI) was established in 1974 to develop and expand
immunization programs throughout the world. In 1977, the goal was set to make immunization against
diphtheria, pertussis, tetanus, poliomyelitis, measles and tuberculosis available to every child in the
world by 1990.
The importance of EPI :EPI covers vaccination services implemented in order to ensure the immunization
of all vulnerable age groups by preventively reaching out to them before they contract and develop
infectious diseases: pertussis, diphtheria, tetanus, measles, rubella, mumps, tuberculosis, polio,
chickenpox, hepatitis A, hepatitis B
EPI schedule in BD :

53
The different advantages and Disadvantages of live vaccine.

54
Advantages
• Accurately imitate natural infections
• Are effective at evoking both strong antibody and cell-mediated immune reactions
• Can elicit long-lasting or life-long immunity.
• Often only one or two doses are required
• Quick immunity onset
• Cost-effective (compared to some other health interventions
• Can have strong beneficial non-specific effects.[37]
Disadvantage
• In rare cases, particularly when there is inadequate vaccination of the population,
natural mutations during viral replication, or interference by related viruses, can cause an
attenuated virus to revert to its wild-type form or mutate to a new strain, potentially
resulting in the new virus being infectious or pathogenic.
• Often not recommended for severely immunocompromised patients due to the risk of
potential complications
• Live strains typically require advanced maintenance, such as refrigeration and fresh
media, making transport to remote areas difficult and costly.
2019-GROUP-B-EQ- 2.Name the hepatitis viruses with their route of transmission. Write down the
management of a bite by a rabid dog.
• Hepatitis viruses consists of at least five human pathogens:
• Hepatitis A virus (HAV),
• Hepatitis B virus (HBV),
• Hepatitis C virus (HCV),
• Hepatitis D virus (HDV),
• Hepatitis E virus (HEV).
Transmission Hepatitis A virus (HAV),
• HAV is transmitted by fecal-oral route

• Stool specimen remain infectious from 2 weeks before to 2 weeks after the
onset of jaundice.

55
• Outbreaks are common in:

• Families, institutions and day care centers,
• Neonatal intensive care units,
• Among military troops.
• Sudden explosive epidemics of type A hepatitis usually result from fecal
contamination of a single source, e g. milk, drinking water, or food.
Transmission Hepatitis B virus (HBV)
• Blood, improperly sterilized syringes, needles and by tattooing or ear

piercing.
• During sexual intercourse,
• Perinatally from infected mother to new born, during birth or breast
feeding.
Transmission Hepatitis C virus (HCV)
• Human are the only reservoir for HCV.

• It is transmitted primarily via blood.
• Injectable drug users.
• Rarely by blood transfusion and needle-stick injury.
• Sexual transmission & transmission from mother to child also occur.
Transmission Hepatitis D virus (HDV)
➢ Through broken skin (via injection, tattooing etc.)

➢ Through contact with infected blood or blood products
➢ As like as HBV
Transmission Hepatitis E virus (HEV)
➢ Contaminated water in areas of poor sanitation.
➢ From infected household member
The management of a bite by a rabid dog:
Required treatment
Category I

56

• No scratch mark. soap and water
• Only history of touching or licks on • No vaccine.
intact skin. • No RIG.
Category II
• Minor scratch mark or abrasion, no soap and water
bleeding or oozing. OR • Post exposure prophylactic
• Just oozing but no active bleeding. vaccine.
• No RIG.
Category III
• Single or multiple bite mark. OR • Vigorous washing with
• Deep, multiple scratch marks. OR soap and water
• Contact of mucous membrane with • Post exposure prophylactic
saliva (licks) vaccine.
• RIG (20 IU/kg body
weight).
2019-GROUP-B-EQ- 3)Classify fungus according to their site of disease production with examples.
Mention the difference between fungus and bacteria in tabulated form.
(Classification according to the site of infection):

• Superficial fungus (present in dead layer (Keratin layer) of skin):
• Pityriasis versicolor: Malassezia furfur.
• Tinea nigra: Hortaea werneckii
• Cutaneous fungus (present in epidermis, hair and nail):

• Dermatophytosis:
• Microsporum spp,
• Trichophyton spp,
• Epidermophyton spp.
• Candida albicans.
• Subcutaneous fungus:

57
• Sporotrichosis: Sporothrix spp.

• Chromoblastomycosis:
• Phialophora verrucosa,
• Mycetoma:
• Madurella mycetomatis,
• Pseudallescheria boydii
• Systemic fungus:
1)Primary:
• Coccidioidomycosis:
• Coccidioides immitis,
• Coccidioides posadasii
• Histoplasmosis: Histoplasma capsulatum.
• Blastomycosis: Blastomyces dermatitidis
• Paracoccidioidomycosis: Paracoccidioides brasiliensis.
2) Opportunistic:
• Candida albicans.
• Cryptococcosis:
• Cryptococcus neoformans,
• Cryptococcus gattii
• Aspergillosis: Aspergillus fumigatus.
• Mucormycosis:
• Rhizopus,
• Absidia,
• Cunninghamella
The difference between fungus and bacteria

.
PARAMETER BACTERIA FUNGI
They are Prokaryotes,
Characteristics They are Eukaryotes, Multi-celled with

Single-celled without Organelles.
organelles.
Nucleus They lack the nucleus. Nucleus present.

58
PARAMETER BACTERIA FUNGI
Cell wall The cell wall is consisting of

The cell wall is consisting of chitin.
Composition peptidoglycan.
Cell The cell membrane exists

Cell membrane exists.
Membrane below the cell wall.
Mode of
Asexual. Can be either sexually or asexually.
reproduction
Motility Move through flagellum. They are non-motile.
Mode of Can be autotrophs, but Heterotrophs, usually feed on the

nutrition usually heterotrophs. dead and decayed matter.
Host They need a host to grow. They grow on their own.
They obtain energy from the used and

Source of They obtain energy from
pre-existing sources present in an
energy. sugars, proteins, and fats.
environment.
University of Dhaka
1st B.Sc in Nursing Final Examination January 2018,
Use separate answer scripts for eatch group
Group-A

59
2018-GROUP-A-SAQ- 1What is bacterial spore? Name the 2 spore forming bacteria and diseases they
produce. Write down
the importance of bacterial spore.
Spore: Spore are highly resistant dormant stage of bacteria formed in

vegetative form under appropriate environment. Example: Bacillus,
Clostridium etc.
The 2 spore forming bacteria and diseases they produce
Bacteria Disease they produce

Clostridium botulinum Botulism(food poisoning)
Bacillus anthracis Anthrax (disease of domestic animal)

chemicals or heat.
2018-GROUP-A-SAQ-2.Wrie down the procedure for collection of blood and urine for microbiological
culture.
Procedure of collection of blood :
• 10ml of blood is needed for each blood culture bottle.
• First locate a vein in the flexor aspect of elbow region.
• The area of skin where the blood will be drawn must be disinfected by wiping the area with
alcohol in a circular fashion.
• The same pattern of wining is repeated using an iodine or iodophor solution.
• The top of the bottle is disinfected using alcohol.
• Draw the blood and about 10 ml of blood is injected into each blood culture bottle.
• The type of bottle used will vary based on whether the physician is looking for bacteria(aerobes
or anaerobes), yeast or mold.
Procedure of collection of :
• Check the physicians order and nursing care plan
• Identify the patient .
• Explain the procedure to the patient with specific instructions about washing the genital area
(skin around the urethra mkeatus) with soap and water: give the labeled container. Instruct
patient to not wet the label on the outside.
• Ask the patient to direct the first and last part of urine stream into a urinal or toilet and to
collect the middle part of the stream into the special container
• Have the patient place the specimen container in proper/designated place.

60
• With gloved hand place the specimen container in polythene bag.

• Send specimen to the laboratory with completed, signed laboratory form.
• Remove gloves and wash hand.
• Record the procedure in the nurses notes and other appropriate forms.
2018-GROUP-A-SAQ-3.Define and classify hyper sensitivity reaction. Mention five causes of immune
suppression .
Definition:
Hypersensitivity is defined as an inappropriate, altered and exaggerated immune
response causing cellular damage or dysfunction.
• Type-4 hypersensitivity (Cell Mediated or delayed type hypersensitivity),
• Type-5 hypersensitivity (Stimulatory type hypersensitivity)
Mention five causes of immune suppression :
• Age. Our immune systems become less effective when we become elderly.
• Persisting (chronic) disease. Immune systems tend to become less effective as

certain long-term illnesses progress. Examples include severe chronic kidney
disease, chronic liver disease and diabetes mellitus.
• Malnutrition.
• Medicines for illness caused by the immune system attacking itself

(autoimmune conditions). Examples include rheumatoid arthritis and Crohn's
disease.
• Medicines in the form of oral steroids for conditions which result in
inflammation where treatment is needed to reduce inflammation.
• Medicines taken to prevent rejection in people who have had organ or bone
marrow transplants.
• Chemotherapy or radiotherapy treatment for cancer
2018-GROUP-A-SAQ-4. Write short note on : Nosocomial infection.
Answer {2020-GROUP-A-SAQ- 4 b}
2018-GROUP-A-EQ-1 .Define normal flora. Name the most common flora of skin ,colon and vagina.
Write down the merits and demerits of normal flora.

61
• Normal flora is the term used to describe the various bacteria and fungi that
are permanent residents of certain body sites, especially the skin, oropharynx,
colon, and vagina who does not cause disease in immunocompetent
individual but can cause disease in immunosuppressed person.
Location Important organism Less important organism

Skin • Staphylococcus • Staphylococcus aureus.
epidermidis • Diphtheroids.
• Various streptococci.
• Pseudomonas aeruginosa.
• Anaerobes.
• Candida albicans
Colon • Bacteroides fragilis. • Bifidobacterium.
• Escherichia coli • Fusobacterium,
• Lactobacillus.
• Various aerobic gram-negative
rods.
• Enterococcus faecalis.
• Clostridium.
Location • Important organism • Less important organism
Vagina • Lactobacillus. • Various streptococci.
• E. coli. • Various gram-negative rods.
• Group B streptococci • B. fragilis,
• Diphtheroids.
• C. albicans.
Tne merits of normal flora.
• The members of the normal flora play a role both in the maintenance of
health and in the causation of disease in three significant ways:
• They can cause disease, especially in immunocompromised and
debilitated individuals. Although these organisms are nonpathogens in
their usual anatomic location, they can be pathogens in other parts of the
body.
• They constitute a protective host defense mechanism. The nonpathogenic
resident bacteria occupy attachment sites on the skin and mucosa that can
interfere with colonization by pathogenic bacteria. The ability of members of

62
the normal flora to limit the growth of pathogens is called colonization

resistance. If the normal flora is suppressed, pathogens may grow and cause
disease. For example, antibiotics
can reduce the normal colonic flora that allows Clostridium difficile, which
is resistant to the antibiotics, to overgrow and cause pseudomembranous
colitis.
• They may serve a nutritional function. The intestinal bacteria produce
several B vitamins and vitamin K. Poorly nourished people who are treated
with oral antibiotics can have vitamin deficiencies as a result of the
reduction in the normal flora. However, since germ-free animals are well-
nourished, the normal flora is not essential for proper nutrition.
Tne merits of normal flora.
• Bacterial synergism.
• Competition for nutrients.
• Induction of a low grade toxemia.
• The normal flora may be agents of disease.
• Transfer to susceptible hosts
2018-GROUP-A-EQ-2.Define and classify immunity. Mention difference between active and passive
immunity.
A.Innate (Non -specific)immunity:
2)Mechanical:
• Reflex eg. Couging reflex ,sneezing reflex etc
3)humoral:
• Interferons etc
4)Cellular:
• Macrophage
• Eosinophile
• NK cells etc.

63

1) Natural:
2) Passive :
➢ Antisera & antitoxins e.g. TIG(tetanus immunoglobins),ATS(anti tetanus
The difference between innate and unacquired immunity
Traits Innate immunity Acquired immunity

Time of Present from birth Acquired after birth upon contact with
development antigens
Specificity Non-specific Specific
Response to Initial and subsequent response are Primary and secondary responses
subsequent same differ qualitively & quantitively
exposure of
antigen
Immunological No immunological memory There is always immunological
memory memory
Present in Both vertebrates and invertebrates Only in vertebrates
Mechanical Present(e.g.-Skin, mucus membrane) Absent
barrier
Cells involved Macrophages, leukocytes, NK-cells Pre dominantly T&B - lumphocytes
2018-GROUP-A-EQ-3. a) Define sterilization, disinfection and antisepsis. Classify methods of

sterilization. Write down the principles of autoclave.
Sterilization: Sterilization is an absolute process of freeing of an article from all types

of organisms including spores. Ex- Autoclave, Hot air oven.
Disinfection: It is a process of reducing the number of pathogenic organisms from
an inanimate objects to such a level which can not cause disease
Antisepsis: It is the process of reducing the number of pathogenic organisms from
an animate object such as skin and mucus membrane to such a level that can not
cause disease
Methods of sterilization
• There are two main methods of sterilization:
o Physical method,
o Chemical method.

64
• Physical methods of sterilization:

Moist heat Radiat Filtratio Ultrasonic
Dry ion n ation
heat
Below At Above X –ray Berkefeld Ultrasonogr
100 C
o
100 C
o
type am
100oC
Hot Air Pasteuriza Boiling Autocla γ – ray Chamber
Oven tion ve land type
Red Vaccine Steaming β – ray Seitz type
Heat bath
Flaming Water Tyndaliza UV Membran
bath tion radiatio e filter
n
Incinera Inspissato
tion r

Agents that damage cell membrane Agents that modify functional groups of
protein and nucleic acid
65
Surface Phenolic Alcohol Heavy metals Silver Oxidizing
active compounds compounds agents
agents
Triton Phenol Ethanol Mercuric 1% solution Iodine
K-12 50 – 70% chloride of AgNO3
(HgCl2)
Triton Cresol Isopropyl Metaphen Hydrogen

W-30 alcohol peroxide
Hypochlorite
Dyes Alkylating agents Agents that denature proteins
Aniline dyes 37% Formaldehyde Acids Alkalis
Brilliant green 2% Glutaraldehyde HCl 2% NaOH
Malachite green Ethylene oxide H2SO4
is present.
with air.
121-124 1.1 15
134-138 2.2 3

66
Group-B
2018-GROUP-B-SAQ-1.Name the agent of Kala-azar. Mention the complication of kala-azar.
• Agent: Leishmania donovani

• Infective form: Promastigote
• Host: Human
• Vector: Sandfly Phlebotomus argentipes
The complecation of kala-azar

• fever,
• weight loss,
• spleen and liver enlargement,
• and, if not treated, death
2018-GROUP-B-SAQ-2.Name four intestinal worms .Mention the health hazard of round worm
infection.
There are four species of intestinal helminthic parasites, also known as geohelminths and soil-
transmitted helminths:
➢ Ascaris lumbricoides (roundworm),
➢ Trichiuris trichiuria (whipworm),
➢ Ancylostoma duodenale, and
➢ Necator americanicus (hookworms).
Hazard of round worm:

▪ Lesion in various organ like brain ,heart,kidney due to larvae in systemic circulation
▪ Night blindness
▪ Results in malnutrition,anaemia and Vit-A deficiency.
intestinal wall.
2018-GROUP-B-SAQ-3.Name diesease against which vaccination done in EPI.Mention 3 conditions

where both pre exposure and post exposure prophylaxis needed.

67
The six diseases were:

• diphtheria,
• pertussis,
• tetanus,
• poliomyelitis,
• measles and
• tuberculosis.
2018-GROUP-B-SAQ-4.Write short note on: Viral hepatitis.

Viral hepatitis:
Viral hepatitis is an infection that causes liver inflammation and damage. Several
different viruses cause hepatitis, including hepatitis A, B, C, D, and E. The hepatitis A
and E viruses typically cause acute infections. The hepatitis B, C, and D viruses can
cause acute and chronic infections. Hepatitis means inflammation of the liver. The liver
is a vital organ that processes nutrients, filters the blood, and fights infections. When the
liver is inflamed or damaged, its function can be affected.
Causes viral hepatitis.
• Heavy alcohol use

• toxins,
• some medications, and
• certain medical conditions
• several health conditionscan cause hepatitis.
Symptoms of hepatitis can include:
• fever,
• fatigue,
• loss of appetite,
• nausea,
• vomiting,
• abdominal pain,
• dark urine,
• light-colored stools,
• joint pain, and
• jaundice.
Prevention
Vaccination for Hepatitis A and Hepatitis B. Vaccines for hepatitis A and hepatitis B are the
most effective preventive measures against those viruses.
Treatment
• There is no cure for hepatitis B, which resolves on its own in 95% of cases. Supportive
care can help manage symptoms. In cases of chronic illness, a doctor may prescribe an
antiviral medication, and they will monitor the liver regularly to check for damage over
time.

68
• Currently, the most effective therapy for hepatitis C is a drug combination consisting
of pegylated interferon and ribavirin. Pegylated interferon is taken weekly as an
injection and ribavirin is a twice daily tablet. The treatment is a form of chemotherapy
and the ability to tolerate it varies widely for each person
2018-GROUP-B-EQ-1.Write down the differences between virus and bacteria . Mention the common
opportunistic infections in HIV-AIDS patients.
The differences between virus and bacteria:

Size Larger (1000 nm) Smaller (20-400 nm) 69
Peptidoglycan or No cell wall. Protein coat present

Cell Wall
Lipopolysaccharide instead.
Ribosomes Present Absent
Number of cells One cell (Unicellular) No cells
Between living and non-living

Living/Non-Living Living organisms
things.
DNA and RNA floating DNA or RNA enclosed inside a

DNA and RNA
freely in cytoplasm. coat of protein.
Infection Localized Systemic
Reproduce Able to reproduce by itself Need a living cell to reproduce
Invades a host cell and takes over

the cell causing it to make copies
Fission- a form of asexual
Reproduction of the viral DNA/RNA. Destroys
reproduction
the host cell releasing new
viruses.
A bacterial illness
Most viral illnesses last 2 to 10
Duration of illness commonly will last longer
days.
than 10 days.
A bacterial illness A viral infection may or may not

Fever
notoriously causes a fever. cause a fever.
Possesses a cellular
Cellular Machinery Lack cellular machinery
machinery
Visible under Light Visible only under Electron

Under Microscope
Microscope. Microscope.

70
Viruses are not beneficial.

However, a particular virus may
Some bacteria are
Benefits be able to destroy brain tumors.
beneficial (Normal Flora)
Viruses can be useful in genetic
engineering.
Virus does not respond to

Treatment Antibiotics
antibiotics.
Staphylococcus aureus, HIV, Hepatitis A virus, Rhino

Examples
Vibrio cholerae, etc Virus, etc
Food poisoning, gastritis

AIDS, common cold, influenza,
Diseases/Infections and ulcers, meningitis,
chickenpox, etc
pneumonia, etc
The common opportunistic infection in AIDS patient.
• toxoplasmosis,
• tuberculosis.
2018-GROUP-B-EQ-2.Define fungus and classify it according to morphology.Mention the common sites

of Candida infection. What are predisposing factors for Candida infection?
Fungus: A fungus (plural: fungi or funguses) is any member of the group of eukaryotic organisms
that includes microorganisms such as yeasts and molds, as well as the more familiar mushrooms.

71
Morphological classification:
the common sites of Candida infection. What are predisposing factors for Candida infection?
Candida normally lives on skin and inside the body, such as the
• mouth,
• throat,
• gut, and
• vagina,
The predisposing factors for Candida infection:
• recent antibiotic use,

• pregnancy,
• diabetes mellitus,
• oral-contraceptives and
• inadequate therapy
2018-GROUP-B-EQ-3.Name some parasites that infect blood cells.Which species of Plasmodium is found
in Bangladesh and which one is the most dangerous one?Mention the complecation of Falciparum
malaria.
EQ-3) The most commonly encountered blood parasites include
• Haemoproteus spp.,
• Leucocytozoon spp.,
• Trypanosoma spp.,
• Plasmodium spp. (malaria)


• microfilaria.

72

• Plasmodium falciparum is the most deadly. In Americas 77% of the infections are due
to Plasmodium vivax
Complications of Malaria
• Pernicious malaria.
• Black water fever.
• Renal failure.
• Tropical spleenomegaly syndrome (TSS).
University of Dhaka
st
1 B.Sc in Nursing Final Examination January- 2017,
Use separate answer scripts for eatch group
Group-A
2017-GROUP-A-SAQ-1.Define nosocomial infection with example.Mention the steps to prevent it.

Answer{2020-GROUP-A-SAQ- 4.b}
2017-GROUP-A-SAQ-2.Describe bacterial growth curve with diagram.
The bacterial growth curve represents the number of live cells in a bacterial population
over a period of time. There are four distinct phases of the growth curve:
• Lag phase
• Exponential (log) phase ,
• Stationary phase , and

73
• Death phase/decline phase
Description of each phase:
1.Lag phase: This is the time or period required for bacteria for adjustment in human body.
Criteria:
• No appreciable multiplication of bacteria occurs in this phase.

• Metabolic activity incrases
• Cell size mayincresae.
• Time requires 1-4 hours.
Importance:Membrane acting antibiotic such as polymyxin,amphotericin-B can be used in this

phase.Detergents ,soaps and other surface acting agents act better in this phase.
2.Log phase :
Criteria:
• Rapid ceel multiplication & cell number increases in geometrical process.

• Active synthesis of cell wall occurs
• Metabolic activities increases at a very high rate.
• Time requires 1-4 hours
Importance :

74
• Antibiotic act better at this phase as cell membrane growth is very active during this phase.
• At this phase disease-producing capability of bacteria is highest ,and if not treated the disease
properly at this stage,dreadful condition like septicaemia can result.
3.Stationary phase:
Criteria:
• At this stage, multiplication rate and death rate of bacteria is equal,so net growth is zero.
• Cell dies because of exhaustion of neutrient in the bacteria and accumulation of toxic products
in the medium.
• Exotoxin production starts at this stage.
• Time requires few hours to days.
Importance:
• Release of exotoxin starts.

• Spore forming bacteria starts forming spore.
• Cell wall acting antibiotic may be used.
• Gram positive bacteria may be transformed into gram negative bacteria by erosion of
peptidoglycan layer.
4. Death phase/ Decline phase:
Criteria:
• The death rate is greater than multiplication rate.

• Accumulation of toxic product occurs.
• Time requires for few hours to days.
Importance:
• Exotoxin of C. diptheria is produced in this phase.

• Bacteria may develop L-forms ,which are resistant to antibiotics.
• Sporulation starts in some bacteria
2017-GROUP-A-SAQ-3.Define sterilization,disinfection and antisepsis.Write down the principles of

autoclaving.
• Sterilization: Sterilization is an absolute process of freeing of an article from all types of

organisms including spores. Ex- Autoclave, Hot air oven.
• Disinfection: It is a process of reducing the number of pathogenic organisms from
an inanimate objects to such a level which can not cause disease.
• Antisepsis: It is the process of reducing the number of pathogenic organisms from an animate
object such as skin and mucus membrane to such a level that can not cause disease

75
is present.
with air.
121-124 1.1 15
134-138 2.2 3
2017-GROUP-A-SAQ- 4.Write short note on : Bacterial spore.
Spore: Spore are highly resistant dormant stage of bacteria formed in unfavorable
environmental condition and have the capacity to re-establish the vegetative
form under appropriate environment. Example: Bacillus, Clostridium etc.
• Structure of spore
• Spore core
• Spore wall
• Spore cortex
• Spore coat

76
Figure :spore

chemicals or heat.
2017-GROUP-A-EQ-1.Draw and label a bacterium.Write down essential components on bacteria with

their functions.

77
Essential components on bacteria with their functions. {2019-GROUP-A-EQ- - 1.}
2017-GROUP-A-EQ-2.Write down the general princeples of sample collection for collection for microbial
laboratory examination.
ANSWE [SEE 2020-GROUP-B-EQ-1}
2017-GROUP-A-EQ-3. Define and classify Immunity.Mention the differences between innate and
acuired immunity .
Answer{2021-GROUP-A-EQ- 2.}

78
Group-B
2017-GROUP-B-SAQ-1.Classify Plasmodium.Which is common in Bangladesh ?Which one is dangerous

and Why?
Classification of Plasmodium:



• Plasmodium falciparum is the most deadly. In Americas 77% of the infections are due
to Plasmodium vivax. Falciparum can cause severe malaria because it multiples
rapidly in the blood, and can thus cause severe blood loss (anemia). In addition,
the infected parasites can clog small blood vessels. When this occurs in the brain,
cerebral malaria results, a complication that can be fatal. P.
2017-GROUP-B-SAQ-2 .Mention 3 major differences between autoclaving and hot nair oven.Mention
the sterilization methods for glasss ware ,powder,gown and scissors.
Differences between autoclaving and hot nair oven:

Autoclave Hot air oven
Less time consuming More time consuming
Moist heat has more penetrating power Dry heat has less penetrating power
Latent heat of evaporation is release Latent heat of evaporation is not release
The sterilization methods for glasss ware ,powder,gown and scissors

Materials Sterilizatio methods

79
Glass ware Hot air oven

Powder Hot air oven
Gown(aprons) Autoclave
Scissors(Sharp instruments) 5% cresol
2017-GROUP-B-SAQ-3.Define virus.Mention the importance of viral envelope.Name 5 common viral

diseases in Bangladesh.
• Virus : An infective agent that typically consists of a nucleic acid molecule in a protein coat, is
too small to be seen by light microscopy, and is able to multiply only within the living cells of
a host.
• The importance of viral envelope:
A viral envelope is the outermost layer of many types of viruses. It protects the genetic material
in their life cycle when traveling between host cells. The viral envelope serves several
functions, including :
-protecting the RNA or DNA molecule(s),
- evading recognition by the immune system, and
- facilitating virus entry
• Common viral diseases in Bangladesh include :
- hepatitis,
- poliomyelitis,
- rabies,
- measles,
- mumps,
-rotavirus diarrhoea, and
- 'chicken pox'.
2017-GROUP-B-SAQ-4.Write short note on: Universal precaution.
Universal precautions : Universal precautions refers to the practice of avoiding contact

with patients’ body fluids, by means of the wearing of nonporous articles such
as medical gloves, googles and face shields.
Steps of Universal Precautions

• Education.
• Hand washing.
• Use of protective barriers (Personal Protective Equipment (PPE)

80
▪ Gloves. Wear when touching blood, body fluids, secretions, excretions,

mucous membranes, nonintact skin. ...
▪ Facial protection (eyes, nose, and mouth)
▪ Gown.
• Cleaning of contaminated surfaces.
• Safe handling/disposal of contaminated material.
• Prevention of needle stick and injuries from other.
• Respiratory hygiene and cough etiquette.
2017-GROUP-B-EQ-1.Describe the pre-expure and post exposure prophylaxis of tetanus, rabies and
hepatitis B.
➢ Pre-expure prophylaxis of tetanus:
❖ Primary -1 : at 6 weekss of age

❖ Primary -2after 4-6 years
❖ Primary -3 : after 4-6 weeks
❖ Boster : 4-6 years of age
❖ Additional : every 10 years after last dose.
➢ Post exposure prophylaxis of tetanus :

❖ Debridement of wound.
❖ Tetanus anti-toxoid(TIG)-250 unit in intra venous route.
❖ TT(Tetanus toxoid)-Intrmuscular.
Pre-expure prophylaxis of rabies :

By active immunization.
Types of vaccine:
➢ Human diploid cell vaccine
➢ Nerve tissue vaccine
➢ Rabies virus absorbed
➢ Purified chik embryo cell vaccine
➢ Duck ebbryo vaccine
➢ Monkey lung vaccine
Post-expure prophylaxis of rabies :

Active:

81
i) Human diploid cell vaccine:

• Dose – 1ml (0,3,7,14 and 28th day ;a boster is recommended by WHO at 90 th day)
ii) Inactivated sheep brain vaccine:

▪ Slight – 2 ml X 7days
▪ Moderate – 5 ml X 14 days
▪ Great risk – 10 ml X 14 days
Passive: Human rabies immunoglobulin.

Types of rabies antibody:
• Rabies immunoglobulin human.
• Antirabies serum equine
Pre-expure prophylaxis of hepatitis B :

• Primary course of vaccination consists of 3 doses.
• In each dose, 0.5ml of vaccine is given intramuscular (I/m) at 0, 1 and 6 months.
• After an interval of 1-4 months a blood test taken for anti- HBsAb level.
Post-expure prophylaxis of hepatitis B :

Passive immunization : By Hepatitis B immunoglobulin(HBIG).Immediate administration of HBIG is
recommended as the initial step in preventing infection by individuals –
• Accidently exposed to HBV – comtaminated blood by needlestick or other means.
• Those exposed to infection by sexual contact with an HBV – positive partner.
• Infants born to mothers who are HBV infected.
Active immunization : By vaccine prepared from HBsAg
2017-GROUP-B-EQ-2.Draw and label an enveloped virus. Mention the route of transmission of common
virus infection.

82
2017-GROUP-B-EQ-3.Mention differences between bacteria and fungus . Mention the route of

transmission of HIV .Name the common opportunistic infection in AIDS patient.
The difference between Bacteria and Fungi.{ 2019-GROUP-B-EQ- 3}
Transmission of HIV
• Unprotected Sex:
• Most common route of transmission.
• Accounts for nearly 80% - 90% of the world's HIV infections.
• Mother-to-child transmission:
• Occurs either across placenta or at birth or via breast milk.
• More than 50% of neonatal infections occur during vaginal delivery.
• Transmission via donated blood or blood products:
• Transmission of HIV via blood transfusion has been greatly reduced
by screening of donated blood.
• However, there is a "window" period early in infection when the
blood of an infected person contain HIV but antibodies are not
detectable. Blood banks now test for the presence of p24 antigen in an
effort to detect blood that contains HIV.
• Accidental needle injury:
•It rarely produces HIV even after prolonged exposure, supporting the view
that the infectious dose of HIV is high. Risk of being infected after

83
percutaneous exposure to HIV-infected blood is estimated to be about

0.3%.
• Injectable Drug Users:
• IDUs represent 8% of new HIV infections.
• Transgender People:
• A 2008 review of HIV studies among transgender revealed 28% new
HIV infection cases.
The common opportunistic infection in AIDS patient.
• toxoplasmosis,
• tuberculosis.

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1

KAZI JAHID ALAM (STANC; batch-4)

Essay question (EQ) Answer any two of the following. (2×10)=20

KAZI JAHID ALAM (STANC; batch-4)

1.a) Draw and label a capsulated bacterium

Essay question (EQ) Answer any two of the following. (2×10)=20

Essay question (EQ) Answer any two of the following. (2×10)=20

1.Write down the general principles of microbiological sample collection procedure.

KAZI JAHID ALAM (STANC; batch-4)

1.a)define sterilization, disinfection and antisepsis.

Essay question (EQ) Answer any two of the following. (2×10)=20

1.a)Name the agent and vactor of Kala-azar.

Essay question (EQ) Answer any two of the following. (2×10)=20

KAZI JAHID ALAM (STANC; batch-4)

Essay question (EQ) Answer any two of the following. (2×10)=20

1.Name the agent of Kala-Azar. Mention the complication of kala-azar.

Essay question (EQ) Answer any two of the following. (2×10)=20

KAZI JAHID ALAM (STANC; batch-4)

Essay question (EQ) Answer any two of the following. (2×10)=20

Essay question (EQ) Answer any two of the following. (2×10)=20

KAZI JAHID ALAM (STANC; batch-4)

Question December 2020,(2021)

Traits Gram-Positive bacteria Gram-Negative bacteria

KAZI JAHID ALAM (STANC; batch-4)

Examples Staphylococcus, Escherichia, Salmonella,

2021-GROUP-A-SAQ 2.a)Define Sterilization, disinfection and antisepsis with examples.

2021-GROUP-A-SAQ -3 A).Define virus. Draw and level an envelope virus.

KAZI JAHID ALAM (STANC; batch-4)

Draw and level an envelope virus:

Figure: envelope virus

(b). The difference between bacteria and virus:

KAZI JAHID ALAM (STANC; batch-4)

Size Larger (1000 nm) Smaller (20-400 nm) 10

Ribosomes Present Absent

Number of cells One cell (Unicellular) No cells

DNA and RNA floating freely

Infection Localized Systemic

Reproduce Able to reproduce by itself Need a living cell to reproduce

Invades a host cell and takes over the cell causing

Duration of A bacterial illness commonly

A bacterial illness notoriously

Under Visible under Light

Viruses are not beneficial. However, a particular

Treatment Antibiotics Virus does not respond to antibiotics.

KAZI JAHID ALAM (STANC; batch-4)

Characteristics Bacteria Viruses

Staphylococcus aureus, Vibrio

2021-GROUP-A-SAQ 4.a).Name some opportunistic fungus.

Some opportunistic fungus are:

b). The predisposing factors of candidiasis :

Essay question (EQ) Answer.

KAZI JAHID ALAM (STANC; batch-4)

Spore ; Spore are highly resistant dormant stage of bacteria formed in

Deep crush injury like RTA causes inoculation of spores of C. tetani

Wide spread spasm of skeletal muscles.

KAZI JAHID ALAM (STANC; batch-4)

• Sedatives Benzodiazepines and other sedatives