Microbiology

Q1. Enlist characteristics of family enterobacteriaceae.

Name the stages involved in the pathogenesis of this disease. ( not sure which diseases
pathogenesis is asked)
1. Gram negative rods
2. Facultative anaerobes
3. Ferment glucose
4. Oxidase negative
5. Reduce nitrates to nitrites
6. Anatomic Location

Q2. Enlist the 04 names of the pathogenic strains of escherichia coli.

Intestinal: cause diarrhea

❖ EPEC enteropathogenic E. coli (infantile diarrhea)

❖ EHEC – Hemolytic uremic syndrome (HUS) enterohemorrhagic E. coli
❖ EIEC enteroinvasive E. coli (dysentery)
❖ ETEC enterotoxigenic E. coli (travelers diarrhea)

Extraintestinal

- UPEC uropathogenic E. coli causing Urinary tract infection

- SEPEC sepsis associated E. coli (Gram negative rod sepsis)
- NMEC meningitis E.coli causing Neonatal meningitis

Q3. Describe the process of transduction in detail. Write the mechanism involved in
lysogenic conversion.
Transduction: the transfer of cell DNA by bacteriophage. During the growth of the virus in the
bacterial cell a part of bacterial DNA is incorporated into the viral particle which is then carried to
the recipient cell at the time of new infection and will get integrated into the host cell DNA and
thus acquire a new trait- lysogenic conversion.

Lysogeny: Type of life cycle that takes place when a bacteriophage infects certain types of
bacteria. In this process, the genome (the collection of genes in the nucleic acid core of a virus)
of the bacteriophage stably integrates into the chromosome of the host bacterium and replicates
in concert with it, new proteins (exotoxins) are made in this process.

Toxin produced by different bacteria after lysogenic conversion:

a. Botulinum toxin
b. Cholera toxin
 c. Diphtheria toxin
d. Erythrogenic toxin of streptococcus pyogenes
e. Shiga toxin of E. coli

1. Generalized transduction: when the virus carries a segment from any part of bacterial
chromosome
2. Specialized transduction: when the virus carries a restricted set of bacterial genes that
are transferred to another bacterium

Q4. Tabulate the five tests which differentiate between different species of staphylococci.

Q5. Describe the mode of action of toxins produced by staphylococcus aureus.

Enlist enzymes secreted by S. aureus:
Name toxins produced by S. aureus
Write the mechanism involved in toxic shock syndrome.
Name virulence factors of S. aureus
Enterotoxin causes food poisoning, characterized by prominent vomiting and watery, non
bloody diarrhea. Acts as a superantigen within the GIT to stimulate release of large amounts
of IL-1 and IL-2 from macrophages and helper T cells, enterotoxin is fairly heat resistance
(not activated by bad cooking) and is resistant to stomach acid and enzymes in stomach,
jejunum. There are 6types A-F.

Toxic shock syndrome toxin (TSST) causes toxic shock. Especially in tampons using
menstruating women or people with wound infections. TSST produced locally by S.aureus in
 vagina, nose or infected site, the toxin enters the bloodstream causing toxemia, TSST is a
superantigen and causes toxic shock by stimulating the release of IL-1, IL-2 and TNF

Exfoliatin causes scalded skin syndrome in young children. It is epidermolytic and acts as a
protease that cleaves desmoglein in desmosomes leading to separation of epidermis at the
granular cell layer.

Endotoxins:

- Alpha toxin; causes necrosis of skin and hemolysis and forms holes in cell membrane
and loss of low molecular weight substances from damaged cell
- PV leukocidin; causes severe skin/soft tissue infections, necrotizing pneumonia a 2
subunit toxin which assembles in cell membrane to form pores thus leaking cell contents,
kills WBCs

Enzymes produced:

- Coagulase
- Hyaluronidase
- Lipase
- Staphylokinase
- Clumping Factor

Q6. Enlist diseases produced by salmonella and write the pathogenesis of each disease.
1. Enterocolitis:

- Invasion of epithelial and subepithelial tissue of small and large intestines

Organisms penetrate both through and between mucosal cells into lamina propria resulting in
inflammation and diarrhea. Neutrophils limit the infection to the gut and adjacent lymph nodes

2. Typhoid:

Infection begins in the small intestine, organisms enter and multiply in mononuclear phagocytes
of peyer's patches and then spread to phagocytes of liver, gallbladder and spleen. This leads to
bacteremia, fever

Carrier state establishment, excretion of bacteria in feces

3. Septicemia:

Occurs in patients:

- With an underlying chronic disease e.g. sickle cell anemia or cancer - or

child with enterocolitis

Bacteria results in seeding of many organs with osteomyelitis, pneumonia and meningitis
infectious insult triggers a localized inflammatory reaction that then spills over to cause systemic
symptoms of fever or hypothermia, tachycardia

Q7. Enlist various methods of sterilization and disinfection.

Principle of autoclave.
What is pasteurization?
Enlist chemical methods of sterilization.
Define sterilization and disinfection. What are the ways by which heat can be applied for
Sterilization of surgical instruments
What is the mechanism by which heat can kill microorganisms?
Give two mechanisms by which chemical agents kill microorganisms and list two
examples from each category.
Sterilization
Is an ABSOLUTE state, and the killing of ALL forms of microbial life, including bacterial
spores, which are highly resistant e.g surgical instruments

Chemical Agents:

● Modification of proteins

GLUTARALDEHYDE; has 2 reactive aldehyde groups and is less toxic than

formaldehyde and is used to sterilize respiratory therapy equipment

ETHYLENE OXIDE GAS; used extensively in hospitals for sterilization of heat-sensitive

materials, killed by alkylating proteins and nucleic acids.

Physical Agents-

act by imparting energy in the form of heat or radiation or by removing organisms through
filtration

1. Heat
i. Autoclaving- used for non heat sensitive materials e.g. surgical gowns

Kills by denaturing proteins but membrane damage and enzymatic cleavage of DNA is
also involved, moist heat sterilizes at a lower temperature than dry heat because water
aids in disruption of non-covalent (H- bonds) which hold protein chains together in
secondary and tertiary structures

Autoclaving is the most frequent method of sterilization because bacterial spores are
resistant to boiling; they must be exposed to higher temperatures and this cannot be
achieved unless the pressure is increased.
AUTOCLAVE PRINCIPLE: an autoclave chamber is produced in which steam, at a pressure of
15 lb/in reaches temperature of 121 degree celsius and is held at that temperature for 15 to 20
minutes.

ii. Dry Heat used for glassware

Requires temperature in the range of 180 degrees for 2 hours

2. Radiation
i. UV light

The greatest antimicrobial activity of UV light occurs 250-260nm, this is the wavelength
of max absorption by purine and pyrimidine bases of DNA, lesion caused by UV
irradiation is formation of thymine dimers as a result DNA replication is inhibited and
organism cannot grow, used in hospitals to kill airborne organisms- OT, bacterial spores
are quite resistant and require a dose 10x more than vegetative bacteria ii. X Rays for
heat sensitive items sterilization e.g. sutures

Have a higher energy and penetrating power than UV radiation and kill mainly by
production of free radicals which break covalent bonds in DNA thus kill organism , spore
are resistant because of low water content

3. Filtration

The preferred method of sterilization of heat sensitive, solutions physically trap particles larger
than pore size and retain smaller particles via electrostatic alteration of particles to filters,
solutions filtered to be pyrogen free

Disinfection
is a RELATIVE state, and the killing of many but not all microorganisms, for adequate
disinfection, pathogens must be killed but some organisms and bacterial spores may survive,
endospores remain unaffected, e.g. bed linen

Chemical Agents:

1. Disruption of cell membranes

ALCOHOL; ethanol is used widely , 70% ethanol is often used as an antiseptic.

Ethanol will not kill bacterial spores so can only be used as a disinfectant.

DETERGENTS; surface active agents, quaternary ammonium compounds used for skin
antisepsis

PHENOLS; damage membranes and denature proteins, chlorhexidine is used as a hand

disinfectant prior to surgery

2. Modification of proteins
CHLORINE; disinfects water supply- powerful oxidizing agent that kills by cross linking
sulfhydryl groups in enzymes to form inactive disulfide

IODINE; like chlorine, inactivates sulfhydryl containing enzymes, bind specifically to tyrosine
residues in proteins

HEAVY METALS; act by binding to sulfhydryl groups and blocking enzymatic activity

HYDROGEN PEROXIDE; used as antiseptic to clean wounds, an oxidizing agent that attack
sulfhydryl groups, thereby inhibiting enzymatic activity

ACIDS AND ALKALIS; kill by denaturing proteins

3. Modification of Nucleic acids

CRYSTAL VIOLET; to treat fungal infections, binding of positively charged dye molecule to
negatively charged phosphate of nucleic acid, the dye inhibits the growth of unwanted
organisms in the sputum during 6 week incubation period

Physical Agents:

Heat- Pasteurization, heating of milk to 62 degrees for 30 mins, followed by rapid

cooling, sufficient to kill vegetatice cells of milk borne pathogens.

Q8. Enlist different types of diseases produced by streptococcus pyogenes.

Briefly write about the pathogenesis of Streptococcus pyogenes.

Type of Pathogenesis Disease

Pyogenic
- Local Impetigo
Cellulitis
Pharyngitis

- Disseminated Sepsis

Toxigenic Scarlet fever

Toxic shock

Immune mediated Rheumatic fever

Streptococcus pyogenes Acute glomerulonephritis

Pathogenesis:
Group A streptococci (S. pyogenes) cause disease by three mechanisms:
 1. Pyogenic inflammation: which is induced locally at the site of the organisms in tissue;
2. Exotoxin production: which can cause widespread systemic symptoms in areas of the
body where there are no organisms
3. Immunologic: which occurs when an antibody against a component of the organism
cross-reacts with normal tissue or forms immune complexes that damage normal tissue.
The immunologic reactions cause inflammation (e.g., the inflamed joints of rheumatic
fever), but there are no organisms in the lesions .
4. The M protein of S. pyogenes is its most important antiphagocytic factor, but its capsule,
composed of hyaluronic acid, is also antiphagocytic. Antibodies are not formed against
the capsule because hyaluronic acid is a normal component of the body and humans are
tolerant to it.

Inflammation related enzymes produced:

1. Hyaluronidase
2. Streptokinase
3. DNase

Toxins and Hemolysins Produced:

1. Erythrogenic toxins
2. Streptolysin O
3. Streptolysin S
4. Pyrogenic exotoxin A
5. Exotoxin B

Q9. Enlist diseases produced by salmonella typhi and discuss pathogenesis of typhoid
fever. Given above

Q10. A 6-years-girl developed a sore throat with high grade fever. On examination there
was a thick gray adherent membrane covering the tonsils. Gram stain of throat swab
revealed club shaped Gram positive rods arranged in V and L shaped arrangement
a. What is the most likely diagnosis?
Diphtheria

b. Name the causative organism?

Corynebacterium diphtheriae

c. Write the mode of transmission of the disease?

By means of air-borne droplets that can also infect the skin at the site of pre-existing
lesion.

d. Discuss the pathogenesis of the disease?

As given below.
 e. Describe the associated complications.
1. Extension of the membrane into the larynx and trachea, causing airway
obstruction.
2. Myocarditis accompanied by arrhythmias and circulatory collapse. Nerve
weakness or paralysis, especially of the cranial nerves.
3. Paralysis of the muscles of the soft palate and pharynx can lead to regurgitation
of fluids through the nose. Peripheral neuritis affecting muscles of the extremities
can also occur.
4. Cutaneous diphtheria may also cause ulcerating skin lesions.

OR

A 12 years old boy presented in the medical OPD with the complaints of fever and sore
throat. On examination thick gray membrane was seen covering the surface of tonsils
and throat which bled on touch. Gram stain revealed Gram positive rods.
a. Name the causative organism.
As given above

b. Briefly discuss its pathogenesis.

As given below

c. Enlist the complications of this disease.

As given above

d. Name vaccine for this disease.

Diphtheria toxoid (usually given as a combination of diphtheria toxoid, tetanus toxoid,
and acellular pertussis vaccine, often abbreviated as DTaP).

Q11. Write pathogenesis of diphtheria and associated complications.

Corynebacterium diphtheriae causes diphtheria.

The Diphtheria toxin inhibits protein synthesis by ADP ribosylation of elongation factor 2.
The toxin affects all eukaryotic cells but has no effect on analogous factors in prokaryotic cells.

The toxin is a single polypeptide with 2 functional domains;

- Binding B domain mediates bindings of toxin to glycoprotein receptors on cell membrane

- Active A domain possesses enzymatic activity that cleaves nicotinamide from NAD and
transfers the remaining ADP ribose to EF-2; thus inactivating it.

DNA that codes for Diphtheria toxin is part of DNA of temperate bacteriophage known as beta
phage, which during lysogenic phase of viral growth, the DNA of this virus integrates into
bacterial chromosome and toxin is synthesized- non lysogenized pathogen C.Diphtheria are
nonpathogenic and don't produce exotoxins.

Host response to C. diphtheria

1. Local inflammation in throat with a fibrinous exudate that forms gray pseudomembrane
2. Antibody that can neutralized exotoxin activity by blocking interaction of binding domain
with receptors, preventing entry into cell

Q12. Enlist diseases caused by salmonella species.

1. Enterocolitis
2. Septicemia
3. Typhoid

Q13. Tabulate 05 differences between exotoxin and endotoxin.

Q14. What is the pathogenesis of staphylococcal food poisoning?

It is caused by staphylococcus aureus.
Food poisoning (gastroenteritis) is caused by ingestion of enterotoxin, which is performed in
foods and hence has a short incubation period (1–8 hours). In staphylococcal food poisoning,
vomiting is typically more prominent than diarrhea.

Q15. Write the names of 04 bacteria that have been lysogenized.

MAYBE
1. Corynebacterium diphtheriae
2. Escreshia coli
 3. Pseudomonas
4. Bacillus
5. Enterobacteria

Q16. A 10-year-old girl is brought to the hospital with grayish discoloration of urine, and
swelling around the eyes for the past 02 days. On examination there was generalized
edema on the whole body, most pronounced in the periorbital and ankle regions. Past
history revealed that she had developed skin infection on the left cheek with fever almost
a month back which recovered in 10 to 12 days without any medication.
a. What is the most likely diagnosis?
Acute Glomerulonephritis/ post streptococcal glomerulonephritis

b. Name the causative organism?

Group A streptococcus i.e. Streptococcus pyogenes
c. Write the pathogenesis of the disease mentioned in the scenario?
As given below

d. Tabulate the 03 different types of diseases produced by this organism?

1. Strep throat, cellulitis
2. Scarlet fever, Streptococcal toxic shock syndrome
3. Impetigo, rheumatic fever
4. Necrotizing fasciitis
5. Post Streptococcal glomerulonephritis

Q17. Write down the pathogenesis of post streptococcal complications.

Write a short note on pathogenesis of Post streptococcal infections
Post streptococcal complications are disorders in which a local infection with group A
streptococci is followed weeks later by inflammation in an organ that was NOT infected
by the streptococci. The inflammation is caused by an
immunologic(antibody) response to streptococcal M proteins that cross-react with human
tissues.

ACUTE GLOMERULONEPHRITIS; typically occurs 2 to 3 weeks after a SKIN INFECTION by

certain group A streptococcal types in children. AGN is more frequent after skin infection
than after pharyngitis.

Characterized by;

- Hypertension
- Edema of face (esp periorbital region and ankles)
- Smoky urine (RBCs in urine)
The disease is initiated by antigen-antibody complexes on the glomerular basement membrane.
Complement is activated and C5a attracts neutrophils that secrete enzymes that damage
the endothelium of glomerular capillaries

ACUTE RHEUMATIC FEVER; approx 2 weeks after group A streptococcal infectionpharyngitis-

Characterized by;

- Fever
- Polyarthritis
- Carditis - damages mitral and aortic valves
- Uncontrollable spasmodic movements of limbs or face

Rheumatic fever is due to an immunologic cross reaction between antibodies formed against M
proteins of S. pyogenes and proteins on the surface of joint, heart and brain tissue. It is an
autoimmune disease exacerbated by recurrent streptococcal infections.

Q18. Enumerate the process of DNA transfer between bacterial cells.

TRANSFER WITHIN BACTERIAL CELLS

1. Transposons

Transfer of DNA from one site to another on the bacterial chromosome or to a plasmid, by
synthesizing a copy of their genome and inserting it at another site in the bacterial chromosome

Antibiotic resistance

2. Programmed rearrangements

Movement of a gene from a silent storage site to an active site thus bringing antigenic changes

Borrelia recurrentis/ Neisseria gonorrhoeae/ Trypanosomes

TRANSFER BETWEEN BACTERIAL CELLS

1. Conjugation

This refers to the physical contact between 2 bacterial cells causing DNA to transfer from the
‘donor’ to the ‘recipient’ THROUGH the conjugation tube. The process is controlled by fertility
plasmid- the F factor- which carries the genes for proteins required for conjugation e.g. pillin

2. Transduction

the transfer of cell DNA by bacteriophage. During the growth of the virus in the bacterial cell a
part of bacterial DNA is incorporated into the viral particle which is then carried to the
recipient cell at the time of new infection and will get integrated into the host cell DNA and
thus acquire a new trait- lysogenic conversion
Lysogeny: life cycle when bacteriophage infects bacteria genome of bacteriophage stably
integrated into chromosome of host bacterium and replaces with it transferred DNA
integrates into chromosomal DNA of recipient and new proteins (exotoxins) are made

Toxin produced by different bacteria after lysogenic conversion:

- Botulinum toxin
- Cholera toxin
- Diphtheria toxin

- Erythrogenic toxin of streptococcus pyogenes

- Shiga toxin of E. coli

Generalized transduction: when the virus carries a segment from any part of bacterial
chromosome

Specialized transduction: when the virus carries a restricted set of bacterial genes that are
transferred to another bacterium

3. Transformation: the transfer of DNA itself from

one cell to another.

Dead/dying bacteria release their DNA to be taken up by others- by cell receptors, synthesis for
uptake of DNA from the environment e.g. haemophilus, neisseria and streptococci OR the
extraction of DNA in the lab and the introduction of it into another bacterium

Q19. Write about the process of conjugation.

As given Above

Q20. A teenage student got his right femur fracture in a road traffic accident.
Debridement and surgical reduction was done. Few days later he developed high grade
fever and the wound became necrotic with a crepitus and foul smelling exudate. Gram
stain of the exudate revealed Gram positive rods which later grew on blood agar
anaerobically only.
a. What is the most likely diagnosis?
Gas Gangrene

b. Name the causative organism?

Clostridium perfringens

c. Name the exotoxins responsible for tissue necrosis and pathogenesis of the
disease.
C. perfringens grow in traumatized tissue (especially muscle) and produce a variety of
toxins. The most important is alpha toxin (lecithinase), which damages cell membranes,
 including those of erythrocytes, resulting in hemolysis. Degradative enzymes produce
gas in tissues.

d. How will you diagnose it in the laboratory?

1. Smears of tissue and exudate samples show large gram-positive rods.( spores
are not seen as they are formed under deficient conditions)
2. The organisms are cultured anaerobically and then identified by sugar
fermentation reactions and organic acid production.
3. C. perfringens colonies exhibit a double zone of hemolysis on blood agar.
4. Egg yolk agar is used to demonstrate the presence of the lecithinase

Q21. Enlist virulence factors produced by Group A Streptococci.

SEE Q8.

Q22.A 30-years-lady, in her second trimester of pregnancy presented to medical OPD

with complaints of weakness and persistent productive cough for the last 3 months. On
examination, pallor was found along with bilateral cervical lymphadenopathy. Incisional
biopsy of the lymph node was taken and sent for histopathological examination. Sections
revealed multinucleated giant cells along with collections of epithelioid cells.
a. Name the specific type of inflammation this patient is suffering from?
Chronic Granulomatous Inflammation

b. Enlist the causative agents for the above mentioned disease.

1. Tuberculosis
2. Syphilis
3. Crohn's disease
4. Leprosy
5. Mildly irritating forign body
6. Sarcoidosis

c. Briefly describe the pathogenesis of the disease.

Immune granulomas; caused by agents capable of inducing T cell mediated response,
macrophages activate T cells to produce cytokines (IL-2) which activates other T cells
perpetuating the response IFN-y activates macrophages

Foreign body granulomas; in response to inert foreing bodies, in the absence of the T
cell mediated immune response, epithelioid cells and giant cells are opposed to surface
of foreign body- foreign material can be identified as in the middle of granulomas

CGI morphologically specific pattern of chronic inflammation induced by T cell and

macrophage activation in response to agent that is resistant to eradication

Morphology Chronic granulomatous inflammation;

 - Activated granulomas have pink granular cytoplasm and epithelioid cells
- Giant cells (langerhans giant cells)
- Central zone of necrosis
- Granular cheesy appearance, caseous necrosis

Q23. On return from a trip to Pakistan a foreign journalist developed fever, loss of
appetite and constipation for the past one week. She recalled that the fever began slowly
and went up to 41°C. Physical exam revealed an enlarged spleen and tender abdomen
with rose color spots on her body.
a. Name the organism responsible for her condition?
Salmonella typhi

b. Write in detail the pathogenesis of her disease

c. How will you diagnose this case in the laboratory?

Q24. Classify antimicrobial drugs.
Name four mechanisms of action of antimicrobial drugs
1. Inhibition of cell wall synthesis:
a. Penicillin
b. Monobactam
c. Cycloserine and bacitracin
d. Cephalosporins
e. Carbapenems
f. Vancomycin
g. Fosfomycin
 2. Inhibition of protein synthesis:
a. Drugs That Act on 30S subunit:
- Aminoglycosides
- Tetracyclines
b. Drugs That Act on 50S subunit:
- Chloramphenicol
- Macrolides
- Clindamycin
- linezolid
- Telithromycin
- Streptogramins
- Retapamulin

3. Inhibition of nucleic acid synthesis:

a. Inhibition of precursor synthesis:
- Sulfonamides
- Trimethoprim
b. Inhibition of DNA Synthesis:
- Fluoroquinolones
c. Inhibition of mRNA synthesis:
- Rifampin
- Rifabutin
- Fidaxomicin
4. Alteration of cell membrane function:
a. Isoniazid
b. Metronidazole

Q25. Briefly discuss the mechanism of action of drugs acting on the bacterial cell wall.
Drugs that inhibit the bacterial cell wall are Beta lactam drugs with the exception of vancomycin.
They do so by either inhibiting cross-linking (transpeptidation) of peptidoglycan or they inhibit
other steps in peptidoglycan synthesis (cycloserine and bacitracin).

Q26. Enlist Streptococci and their diseases in a tabulated form.

1. Streptococcus pyogenes: pharyngitis and cellulitis
2. Streptococcus agalactiae: neonatal sepsis and meningitis
3. Enterococcus faecalis: hospital acquired urinary tract infections and endocarditis
4. Streptococcus Bovis: endocarditis
5. Streptococcus pneumoniae: pneumonia
6. Viridians group: endocarditis

Q27. Give an account of the pathogenesis of Yersinia pestis.

Q28. What do you understand about normal flora of the body? Name the members of the
normal flora of the oropharynx. (Viridians streptococcus and peptostreptococcus)
Q29. What is Colonization resistance and Carrier state?
Colonization Resistance:
The presence of anaerobes effectively interferes with colonization by potentially pathogenic
bacterial species through the depletion of oxygen and nutrients, the production of enzymes and
toxic end products, and the modulation of the host's intestinal innate immune response.
Carrier State:
The condition of harboring an infective organism without manifesting symptoms of infection. The
organism must be readily transmissible to another susceptible host and causing disease to
whom it’s transmitted.

Q30.Give the reasons for non-genetic bacterial drug resistance.

1. Inactive Drug (enzymatic degradation of drug)
2. Modify drug target in bacteria (modification of drugs target)
3. Reduce permeability of drug
4. Export of drug from bacteria

Q31. Compare the cell wall of Gram positive and Gram negative bacteria.
 Periplasmic space Small Large
Porins Cell Wall Outer Membrane
Color of gram stain Purple Pink
Example Staphylococcus Shigella

Q32. Discuss the process of Conjugation and high frequency Recombination.

Q33. A 52-year-old male post-cholecystectomy developed high grade fever and
severe pain at the site of the surgical wound. On examination the wound was infected
with copious pus discharge. Gram stain of the pus revealed Gram positive cocci
which were catalase positive.
a. Name the most likely causative agent?
Staphylococcus Aureus

b. What type of arrangement do you expect to see on Gram stain?

Spherical in clusters resembling a bunch of grapes.

c. Enlist the toxins and enzymes produced by this organism.

d. Describe the mode of action of 2 toxins produced by this organism
e. Tabulate 3 differences on the basis of which you can differentiate between the
f. various species of this organism.

OR

A 2-days-post appendectomy patient suddenly developed high grade fever and severe
pain at the site of the surgical wound. On examination the wound was found to be
infected with copious pus discharge. Gram stain of the pus revealed gram positive cocci
which were catalase positive.
 a. Name the causative agent responsible.
b. What type of arrangement would you see on Gram stain?
c. Enlist 3 enzymes produced by this organism
d. Enlist 3 toxins produced by this organism.

OR

A ten-years-old boy reported to the clinic with a painful arm as a result of injury while
playing baseball. The pain intensity had increased over two weeks' time and now he has
developed high grade fever.X-Ray of the humerus shows raised periosteum. Lesion
aspirate reveals Gram positive cocci in clusters which were catalase positive.
a. What is the diagnosis?
b. Name the causative organism responsible for this disease.
c. Enlist the enzymes produced by this organism
d. Enumerate the toxins produced by this organism

ANSWER FOR QUESTION 33 IS IN QUESTION 4 AND QUESTION 5

Q34. Enlist spore forming gram positive rods.

1. Bacillus (Aerobic):
a. B. anthracis
b. B. cereus
c. B. subtilis
2. Clostridium (Anaerobic):
a. C.tetani
b. C. botulinum
c. C. perfringens
d. C.difficile

Q35. Discuss pathogenesis of vibrio cholerae.

Q36. Enlist names of medically important species of clostridia and the diseases caused
by them.

Pathology
Q1. Define necrosis:
Form of cell death in which cellular membrane falls apart, cellular enzymes leak out and
ultimately digest the cell.

Q2. Enlist different types of necrosis with 02 examples for each type.
 1. Coagulative necrosis: Myocardial infarction, Acute tubular necrosis in kidney
2. Liquefactive necrosis: Lung Abscess, Brain Abscess.
3. Gangrenous necrosis: Diabetic foot, gangrene of bowel
4. Caseous necrosis: Tuberculous lesions or fungal infections (coccidiomycosis,
blastomycosis, histoplasmosis)
5. Fat necrosis: Acute pancreatitis, traumatic fat necrosis in breast.
6. Fibrinoid necrosis: Polyarteritis nodosa, Severe hypertension

Q3. Enlist difference between necrosis and apoptosis.

Q4. Tabulate differences between exudate and transudate.

Q5. Enlist factors that impair wound healing.
- Infection
- Diabetes
- Nutritional status
- Glucocorticoids
- Mechanical factors; increased local pressure
- Poor perfusion; from atherosclerosis, obstructed venous drainage
- Foreign bodies, steel glass
- Type and extent of tissue injury
- Location of injury

Q6. Enumerate and define different types of cellular adaptation with 1 example of each.
Hypertrophy :
Increase in size of cell resulting in increase in size of organ. In other words in hypertrophy there
are no new cells , just bigger cells with increased amounts of structural proteins and organelles.

It can be physiological or pathological:

 1. Physiological hypertrophy: enlargement of the uterus during pregnancy occurs as a
consequence of estrogen stimulated smooth muscle hypertrophy and smooth muscle
hyperplasia.
2. Pathological Hypertrophy: Cardiac enlargement due to hypertension or aortic valvular
disease.

Hyperplasia:
It occurs if the tissues contain cell populations capable of replication or contain abundant tissue
stem cells. It may occur concurrently with hypertrophy.

Hyperplasia can be physiological or pathological:

1. Physiological hyperplasia:
a. Hormonal hyperplasia: proliferation of glandular epithelium of the female breast
at puberty and during pregnancy,
b. Compensatory hyperplasia: residual tissue grows after resection or removal of
part of organ i.e. liver.
2. Pathological hyperplasia: A disturbed balance between estrogen and progesterone
causes endometrial hyperplasia, which leads to abnormal menstrual bleeding.
Atrophy:

Shrinkage in the size of the cell by the loss of cell substance is known as atrophy. Although
atrophic cells may have diminished function , they are not dead.

Causes of atrophy include:

a. Decreased workload
b. Loss of innervation
c. Diminished blood supply
d. Loss of endocrine stimulation and aging i.e. atrophy of the brain due to aging.
Metaplasia:

It is a reversible change in which one adult cell type is replaced by another adult cell type.In this
type of cellular adaptation , a cell type sensitive to a particular stress is replaced by another cell
type better able to withstand the adverse environment.

Example: Epithelial metaplasia is exemplified by the squamous change that occurs in the
respiratory epithelium of cigarette smokers

Q7. Write pathogenesis of coagulative necrosis.

Q8.A 35-year-old male patient presented to surgical OPD with complaints of fever with
productive cough for the last 03 months. The fever was low grade with evening rise and
was accompanied by progressive weight loss On examination, the patient was pale and
had enlarged bilateral cervical lymph nodes Blood Complete picture showed relative
lymphocytosis with raised ESR. Chest X-ray revealed bilateral diffuse opacities in both
lung fields. Excisional biopsy of the left level-Il cervical lymph node was carried out. The
biopsy showed collection of epithelioid cells
a. Name the likely type of inflammation in this patient.
Chronic granulomatous inflammation

b. List the etiologic factors (any 06) which will result in a similar histopathology.
c. Briefly describe all morphologic changes seen in such disease with the help of a
labeled diagram.
1. Activated granulomas have pink granular cytoplasm and epithelioid cells
2. Giant cells (langerhans giant cells)
3. Central zone of necrosis
4. Granular cheesy appearance, caseous necrosis
Q9. What are the two types of apoptosis? Give two examples for each type.
1. Physiological apoptosis: Thymus involution during aging and during embryogenesis
(separation of fingers and toes, formation of lumen in vessels etc)
2. Pathological apoptosis: DNA damage, Accumulation of misfolded proteins and in
infections (particularly viral)

Q10. What are cytokines? Tabulate different types of cytokines and their role in
inflammation.
Proteins secreted by many cell types (principally activated lymphocytes, macrophages, and
dendritic cells, but also endothelial, epithelial and connective tissue cells) that mediate and
regulate immune inflammatory reactions.
Q11. Define calcification and differentiate between its types.
It is defined as abnormal deposition of calcium salts, together with smaller amounts of iron,
magnesium, and other minerals.

Q12. Which type of injury is caused to the myocardium with thrombolytic therapy in the
management of MI? Briefly discuss the mechanism responsible for such injury.
What is ischemic reperfusion injury?
Q13. Tabulate differences between healing by primary intention and healing by
secondary intention.

Q14. A 21-year-old village girl presented to the Medical OPD with complaints of chronic
cough with fever and weight loss for the last 04 months. On examination, bilateral
cervical lymph nodes are enlarged. Chest X-ray revealed bilateral lung infiltrates. Left
cervical lymph node was excised and sent for histo-pathological examination.
a. Write down the morphological changes that are likely to be seen under the
microscope.
1. Activated granulomas have pink granular cytoplasm and epithelioid cells
2. Giant cells (langerhans giant cells)
3. Central zone of necrosis
4. Granular cheesy appearance, caseous necrosis
 b. Enlist any five (05) causes of the above mentioned pathology.
1. Tuberculosis
2. Syphilis
3. Crohn's disease
4. Leprosy
5. Mildly irritating forign body
6. Sarcoidosis

Q15. Write a short note on the role of Reactive oxygen species (ROS) in the process
of phagocytosis.
Phagocytes such as neutrophils and macrophages produce reactive oxygen species (ROS)
during phagocytosis and play important roles in the modulation of cell survival, cell death,
differentiation, cell signaling, and inflammation-related factor production
Q16. Define Acute inflammation. Write down the cellular events in acute inflammation.
The type of inflammation which is quick acting and short lived. It rapidly delivers leukocytes and
plasma proteins to the site of injury.
Q17. A 50 year old man, known diabetic and patient of ischemic heart disease presented
to a surgical emergency with complaints of severe pain in right iliac fossa. He was
diagnosed with acute appendicitis and an emergency appendectomy was performed. A
week after surgery, he presented to surgical OPD for follow up. Briefly explain the factors
impairing wound repair in such patients.
AS GIVEN ABOVE

Q18. Name the different causes of cell injury.

Q19. Differentiate between Hypertrophy and Atrophy (two differences) with two examples
each. (examples given above)
Q20. List important mediators involved in the process of inflammation along with their
sources and function.