Respiratory System

(1)An 8-year-old child was brought to the ENT OPD with history of fever
and pain in throat for 2 days. He had 102ºF fever and throat examination
revealed pustules over the tonsils. Swabs collected from the tonsillar
pillars was sent for culture and AST. Culture on blood agar grew small
pinpoint colonies of 0.5–1 mm size with wide zone of β-hemolysis.
Gram stain of the culture showed Gram positive spherical cocci (0.5 -1
μm) arranged in short chains. (2x5=10)

Gram stain β-haemolytic colonies on BA and the organism is

Bacitracin sensitive.

1. Identify the causative agent based on the microbiological

investigations performed. Streptococcus pyogenes (Group A
Streptococci)
2. Enumerate four conditions caused by this organism. Erythema
,necrotizing fascilitis,Streptococcal Toxic Shock Syndrome,Streptococcal
myositis
 3. What further biochemical test will you perform for identification of
this organism? Catalase – Negative ; CAMP(Christe Atkins and Munich -
Peterson test)-Negative
4. Which test is done for serogrouping of the organism? Lancefield
Grouping
5. Name two common antibiotics used against the organism.
Penicillin ; Macrolide such as erythromycin in case of penicillin allergic

(2)A 2-year-old baby presented with pain in throat. On examination a

white patch was seen over the posterior pharynx and it bled on touch. His
family members said that his immunization was not as per schedule.
Swab collected from the throat was subjected to staining and culture.
(2x5=10)

B B C C
Gram positive bacilli Metachromatic granules
with cuneiform arrangement

B
Potassium tellurite agar shows black colonies

1. What is the clinical diagnosis and its causative organism?Faucial

Diphtheria ; Corynebacterium diphtheriae
2. Name the stain for demonstration of metachromatic granules.Loeffler’s
methylene blue. Better stained with Albert’s(Most Common), Neisser’s
and Ponder’s stain
3. Name the other common media used for isolation of the organism.
Enriched media – Blood agar, Chocolate agar , Loeffler’s serum slope
Selective media-Potassium tellurite agar and Tinsdale medium produce
black colonies.
4. Which test is carried out in vitro to identify toxin producing organisms.
Elek’s gel precipitation test
5. Mention the vaccination schedule for the prevention of this disease.
DPT Vaccine (Glaxo/Kasauli)
(3)A 4-year-old girl was brought to the emergency room by her parents
for acute onset of fever, productive cough and dyspnea for last 2 days.
Physical examination revealed dull note on percussion. Chest X ray
showed consolidation over left lower lobe. Sputum sample was sent to
microbiology laboratory for Gram stain and culture. (2x5=10)

Gram positive diplococci Blood agar showing α-hemolysis with

sensitivity to optochin

1. What is the clinical diagnosis and its causative organism? Pneumonia

Streptococcus pneumoniae (pneumococcus)
2. List two clinical conditions caused by this organism. Pneumonia,
Meningitis
3. Name two biochemical tests used for confirmation. Bile solubility,
optochin sensitivity
4. Name two drugs used for the treatment. Amoxicillin , Ceftriaxone ,
levofloxacin.
5. Name the types of vaccines available for prevention of the disease.
23-valent pneumococcal polysaccharide vaccine (PPSV23)
Pneumococcal conjugate vaccine (PCV13)
(4)A 29-year-old lady was admitted with complaints of cough with
expectoration, chest pain, evening rise of temperature and loss of weight
for more than 1 month. Auscultation revealed crepitation and rales over
left upper lobe of lungs. Chest X ray showed cavity measuring 18mm x
11mm. Her sputum was collected and subjected to microscopy.
(2x5=10)

ZN staining of sputum smear showing long,

slender and beaded, red colored acid fast
bacilli

1.What is the clinical diagnosis and its causative organism? Tuberculosis ;

Mycobacterium tuberculosis
2.Name four media for culture of this organism.LJ medium, kirchner
medium,Middlebrook 7H9,BACTEK(MGIT)
3.Name two methods of drug susceptibility tests.CBNAAT;Line probe
assay
4.Name the skin test and its interpretation available for diagnosis.
Tuberculin Skin Test; Reading taken after 48-72 hours
≥10 mm – Positive (tuberculin reaction)
6-9 mm: Equivocal (doubtful reaction)
<5 mm: Negative Reaction
5.Name the first line drugs used for its treatment
Isoniazide,Rifapicin,Pyrazinamide,Ethambutol
(5)During the COVID 19 pandemic, in September 2020, an elderly
patient presented to the OPD, with complaints of sore throat and fever for
the last 7 days. His throat swab was sent for RT PCR and he was kept
under isolation. The result of the real time RT - PCR is shown below.
(2x5=10)

Real time RT-PCR showing the result

1. Interpret the test result and give your diagnosis.RiboNucleoprotein

Gene , Envelope Gene ,RNA Dependent RNA Polymerase Gene

The patient has COVID-19
2. Name two other methods available for diagnosis. Antigen detection

;CBNAAT
3. What is Omicron? It is the B.1.1.529 variant of SARS-CoV-2.It was first
reported to WHO from South Africa on 24 November 2021
4. Name the three protocols for prevention of the transmission.Hand

Hygiene,use of mask/PPE, Social Distancing

5. Name two types of vaccines available in India for prevention of the

disease. Covaxin,Covishield
(6)A 40-year-old female with uncontrolled diabetes mellitus was referred
to a teaching hospital with severe eye pain and facial rash for 4 days.
Facial rash progressed to extensive ulceration of the mid-face and
bilateral loss of vision. She had nasal bridge collapse, with black eschars
on the nasal mucosa and markedly elevated fasting blood sugar with
severe ketoacidosis. She had surgical debridement and tissue was sent for
histopathological examination and fungal culture.
(2x5=10)

B C D
HP showing broad aseptate hyphae.LPCB showing sporangium with rhizoid.

1. What is the clinical diagnosis and the likely etiological

agent?Rhinocerebral Mucormycosis ; Rhizopus mucor

2. Name two other species of this group.Rhizopus arrhizus &

Rhizopus microsporus
3. Name two other clinical manifestations caused by this

organism?Pulmonary mucormycosis & Cutaneous Mucormycosis

4. Which medium is commonly used for the isolation of the

pathogen?Sabouraud Destrox agar (SDA)

5. Name two anti-fungal agents used for the treatment.

Amphotericin B , Posconazole , isavuconazole

(7)A 46-year-old lady complains of hemoptysis for 2-3 episodes in 2 days
and cough for 1month. She gave past history of pulmonary tuberculosis
10 years back. On chest examination, bilateral breath sounds were
reduced. Chest X-ray revealed fungal ball in previous cavitary lesion in
right upper lobe of lung. Sputum and lung biopsy were sent for fungal
culture and identification. (2x5=10)

H & E stained lung section: LPCB mount of the colonies

septate narrow hyphae with
acute angle branching.

1. What is the clinical diagnosis and the likely etiological

agent?Pulmonary Aspergillosis ; Aspergillus fumigatus

2. Enumerate two other clinical manifestations caused by this

organism. Invasive Sinusitis ; Cardiac aspergillosis

3. Name two predisposing conditions.Profound neutropenia , long –
term corticosteroid therapy.
4. Which antigen is used for detection of the organism?

Β-d-glucan ,Galactomannan
5. Name two species of the organism. Aspergillus Niger ; Aspergillus

Flavus
(8)A 72-year-old patient (without wearing any mask) presented to the
casualty with complaints of fever, dry cough, malaise and throat pain.
The security guard (without mask) guided him to go to the casualty. The
resident doctor (without mask) took history, examined the patient. His
throat swab was sent for COVID 19 testing which came positive.
Subsequently the security guard and the resident doctor also tested
positive for COVID -19. (2x5=10)

1.Identify the infection control breaches. Patient and Security guard not
wearing mask ; Resident Doctor not wearing PPE while examination
2.What are the personal protective equipment (PPE) need to be worn
while giving care to this patient?N95 mask , Gloves, Gown , Face Shield
3.What is the correct sequence of donning and doffing of PPE?
Donning
Hand wash CapShoe CoverHand Rub Inner
GloveCover all/GownMask
(Surgical/N95)GogglesHoodOuter Gloves
Doffing
Outer Pair of Gloves Face ShieldGownShoe
CoverRespiratory MaskCapInner Pair of GlovesHand
Wash
4.What do you mean by standard precautions? Standard precautions are a
set of infection control practices used to prevent transmission of diseases
that can be acquired by contact with blood, body fluids, non-intact skin
(including rashes), and mucous membranes.
5.In which colored bin will you discard your gloves and mask.
GlovesRed
MaskYellow
CarDioVascular System
(1)A 50-year-old male on central line for 72 hours in ICU
presented with fever of 103°F, altered mental status, heart rate
102/ minute and respiratory rate 24/ minute. Blood was
collected both from central line and venipuncture separately in
BacT/Alert bottles and sent for culture. Both central line and
venipuncture bottles flagged positive for Staphylococcus aureus
after 4 hours and 7 hours of incubation, respectively.
(2x5=10)

a) What is the diagnosis?Central line associated blood

stream infection
b) Name two other clinical conditions produced by the
organism.Abscess, Toxic Shock Syndrome
c) What is MRSA?Methicillin resistant Staphylococcus
aureus
d) What antibiotics will you choose for MRSA
infection?Vancomycin,linezolid,teicoplanin
e) Name two preventive practices.MRSA screening ,
treatment of carrier , stoppage of antibiotic misuse and
hand hygiene.
(2)A 60-year-old man from a village presented with vesicular
rashes, lymphadenopathy and eschar on upper limb. There was a
history of high grade fever, myalgia and respiratory distress for
the past two days. A serological test using Proteus mirabilis OX
K was performed and titer was 1:640.

(2x5=10)

a) What is the clinical diagnosis? Scrub Typhus

b) What is the causative agent and mode of
transmission?Orientia tsutsugamushi ;bite of infected
trombiculid mites (Leptotrombidium)
c) Name the serological test and its type.Weil-Felix test –
Heterophile Agglutination test
d) How will you confirm the diagnosis? Indirect
Immunofluorescence(gold standard)
e) What common antibiotic is used to treat this
condition?Doxycycline is the drug of choice
;alternatively Chloramphenicol or azithromycin
(3)A 50-year-old male from Odisha presented with fever chills
and rigor for five days with anemia. The patient developed
seizures prior to admission. He was started on ceftriaxone but
did not improve. On physical examination, there was
splenomegaly. The peripheral blood smear examination shows
the following findings:
(2x5=10)

Peripheral blood smear

a) Mention the clinical diagnosis and the etiological agent based on the test
performed? Malaria ; Plasmodium falciparum
b) What is the infective form and the definitive host? Sporozoites ; Female
Anopheles Mosquito
c) What are the various complications seen?Cerebral Malaria ; Black water
Fever
d) Name the various diagnostic modalities.Peripheral blood smear [Gold
standard(thick and thin smear)],Quantitatve Buffy Coat Examination ,
Kawamoto technique (Fluorescence Microscopy ), Antigen detection by
rapid diagnostic test ,PCR
e) Name two drugs used to treat this clinical condition.
-Artesunate + Sulfasalazine + Pyrimethamine + Primaquine
-Artemether+Lumefantrine +Primaquine
(4)A patient was waiting for appendicectomy surgery. The
surgeon wanted to rule out HIV status pre-operatively. A
serological test was performed as shown in the figure:
(2x5=10)

a) Interpret the result and give your diagnosis.HIV -

1,2Combined Infection ; HIV Infection
b) What is the principle of the test? Immunochromatography
c) To which family does the causative agent belong?
Retroviridae
d) What is the confirmatory test for HIV?HIV RNA detection
by RTPCR(Best Confirmatory),Branched DNA Assay, Real
time RTPCR, Nucleic acid sequence-based amplification
(NASBA)
e) Which test is carried out to monitor the treatment? Real time
RTPCR
(5)A 46-year-old male from a village came to the hospital with
history of fever on and off for the past one year and recent
unilateral swelling of the left lower limb. His blood sample was
collected and sent for peripheral blood smear examination.
(2x5=10)

a) Identify the parasite. Wuchereria bancrofti

b) What is the infective stage of the parasite for man?
Filariform larvae
c) How does man acquire this infection and what is the
vector involved? Bite of Culex quinquefasciatus ; Culex
d) What are the different modalities of diagnosis for this
clinical condition? Microfilaria detection , Antigen
Detection , Antibody detection , USG , PCR.
e) What is the drug used to treat this condition?
Diethylcarbamazine (DEC)
(6)A 40-year-old man from Bihar presented with splenomegaly,
anemia and fever. The bone marrow aspirate collected was sent
for Giemsa staining.
(2x5=10)

a) Identify the etiological agent and the clinical diagnosis

based on smear. Leishmania donovani ; Kala Azar
(Visceral Leishmaniasis )
b) What is the vector and the infective form? Female sandfly
(Phlebotamus argentipes) ; Promastigote
c) Name the culture media used. NNN(Novy – MacNeal-
Nicolle) medium , Schneider’s liquid medium
d) Name the antigen used in the serological test. Rk39 or
rKE16antigen.
e) Name two drugs used for treatment. Pentavalent
antimonials , Liposomal Amphotericin B, Miltefosine,
Paromomycin
(7)A 30-year-old HIV infected female presents to the clinic with
history of high grade fever and altered mental status. On
examination, her blood pressure was found to be 90/60 mm of
Hg and respiratory rate was increased to 28/minute. Blood
cultures were collected in BacT/ALERT bottles which flagged
positive after 22 hours of incubation. Gram stain of blood
culture broth is as shown in the figure:
(2x5=10)

a) What is the clinical diagnosis and the likely etiological agent? Sepsis ;
Candida albicans , Candida glabrata .
b) Name two risk factors predisposing this clinical condition. Extreme age ,
pregnancy , Immunocompromised individuals , Broad Spectrum Antibiotics.
c) Name two other clinical manifestations caused by this organism? Urinary
Tract Infection , Pulmonary Candidiasis
d) Name the culture media used for isolation of the organism.
Sabouraud’s Destroxe agar (SDA)
e) Name the common test used to identify the species.
Germ tube test , Dalmau plate culture
URINARY TRACT INFECTIONS
1.A female patient developed high grade fever with chills and pain
abdomen on the 6th post-operative day of spinal surgery. CBC showed a
high neutrophil count. Urine sample from indwelling catheter was sent to
the laboratory for routine microscopy, culture and antimicrobial
susceptibility test. (2x5 =10)

A B C

a. What is the clinical diagnosis? Catheter associated UTI

b. Identify the causative agent based on the laboratory
investigations. Enterococcus
c. Name two other clinical conditions produced by this
bacterium.UTI, Bacteremia , Infective Endocarditis
d. Name two other bacteria commonly associated with
CAUTI.E.Coli , Pseudomonas , Klebsiella
 e. What type of antibiotic sensitivity testing has been depicted
in the above diagram (Fig. D)?Kirby – Bauer Disk Diffusion
Test

2.A 32-year-old female was admitted with dysuria (burning micturition)

and increased frequency of micturition for the past 2 days. Culture of the
urine specimens revealed lactose fermenting colonies on MacConkey
agar which was Gram negative motile bacilli.
(2x5 =10)

a. What is your clinical diagnosis and name the probable etiological

agent? Urinary Tract Infection ; Escerichia coli
b. What are the risk factors associated? Short Urethra , Close
proximity of urethra and anus
c. What is significant bacteriuria? A count of ≥ 105 Colony Forming
Units (CFU)/mL is considered as Significant Bacteriuria
d. Name two other common bacteria causing this infection.
Klebsiella pneumonia , Proteus
e. What is the most suitable culture media used for urine
sample?MacConey Agar
3.A 28-year-old female was admitted with hematuria, flank pain, evening
rise of temperature and weight loss. Three consecutive early morning
urine specimens were sent. Microscopic examination of urine revealed
presence of pus cells, RBCs but no bacteria on Gram stain. Routine
culture of urine revealed no organism.
(2x5 =10)

1. What is your clinical diagnosis and the etiological agent?

Renal tuberculosis ; Mycobacterium tuberculosis.
2. Name the stain used to detect the organism. Ziehl–Neelsen
stain
3. What is the common culture medium used for the causative
agent? LJ medium
4. Name two other tests for identifying the organism.
CBNAAT;Culture
5. Name the drugs used for initial treatment.
Isoniazid,Rifampicin,Ethambutol,Pyrazinamide
Hepatobiliary, UTI, STD,
Miscellaneous
(1)A 43-year-old woman presented with pain abdomen, loss of
appetite, malaise and persistent fatigue for past 2 months. She
had received multiple blood transfusions in last 5 months. On
examination there is icterus and tenderness in right
hypochondrium. Laboratory investigations show
hyperbilirubinemia and elevated liver enzymes with HbsAg
positive.
(2x5 =10)

a.What is the provisional diagnosis?Viral Hepatitis (Hepatitis B)

b.What are the modes of transmission?Sexual transmission , needle stick
injury , blood transfusion , vertical transmission from mother to foetus
c.Name the serological markers used for diagnosis of acute
hepatitis.Antigen – HBsAg,HBeAg,HbcAg
Antibody-Anti-HBc Ab, Anti-HBs Ab,Anti-HBe Ab
Molecular marker – HBV DNA
d.What is the vaccine available for this condition?Hepatitis B
recombinant subunit Vaccine
e.What is the schedule of the above vaccine?
National Immunization schedule – 6,10,14 weeks(along with DPT
vaccine)
Adult Vaccination schedule – 0,1 and 6 months
(2)A child aged 2 years developed icterus, pain in the abdomen
and mild fever with loss of appetite, nausea and vomiting.
Investigations showed elevated serum bilirubin and
transaminase. In the neighbourhood similar cases were also seen
among the children.
(2x5 =10)

a. What is the most probable diagnosis?Viral Hepatitis

(Hepatitis A)
b. What serological investigations you will do for
confirmation?Anti-HAV antibody detection , HAV
antigen detection
c. What is the mode of transmission of the disease?Fecal-
oral
d. What is the vaccine available and mention it’s dose
schedule?
Formaldehyde inactivated vaccine-1st dose –
I.M(deltoid) to children after 12 months of age ,
followed by a booster dose after 6-12 months gap.
Live attenuated vaccine –Single dose subcutaneously
e. Name the other hepatitis virus transmitted through
similar route.Hepatitis E
(3)A 35-year-old female patient with history of dysentery for 2 months
suddenly developed high grade fever with acute pain in right
hypochondrium and was brought to the emergency department. USG
abdomen revealed enlarged liver with abscess and features of acute
peritonitis. She succumbs to death before any intervention. Postmortem
sample of liver shown in the figure.
(2.5x4 =10)

Image of postmortem specimen of liver.Aspirated Anchovy sauce pus from liver specimen

a. What is the postmortem diagnosis and name the causative agent?

Amoebic Liver Abscess ;Entamoeba histolytica
b. Name the laboratory tests that can be done to confirm the diagnosis
anti-mortem. Antigen Antibody detection , PCR , USG
c. What is the infective form and mode of transmission?
Quadrinucleated cyst ; Fecal – oral
d. Name two drugs used to treat the disease .Metronidazole ,
tinidazole
(4)A 56-year-old man presented with complaints of pain in right
hypochondrium. Ultrasonography revealed a space-occupying lesion in
the right lobe of liver. Pericystectomy was done carefully preventing
spillage of cyst fluid and the specimen was subjected to histopathology.
The cyst fluid microscopy showed presence of scolex and hooklets.
(2x5 =10)

Gross specimen of cyst

B C
Histopathology of the cyst wall Endocyst with attached brood capsule.
.
a. What is the clinical diagnosis?Hydatid disease(Echinococcosis)
b. Name the causative agent of this condition.Echinococcus granulosus
c. Name the definitive and intermediate hosts.Dog ;
Sheep(man accidental)
d. What is the infective form and mode of transmission of the
disease?Eggs ; ingestion of food contaminated with dog faeces
e. What are the diagnostic modalities? Hydatid Fluid microscopy,
Histological Examination, Antibody Detection, Imaging methods,
Molecular Methods, Skin Test(Casoni Test)
(5)A 39-year-old male with multiple sexual partners presented
to the skin OPD with a painless, indurated ulcer on the penis.
The inguinal lymph nodes on examination were enlarged, non-
tender and firm. Serum sample collected from the patient was
subjected to a serological test.

(2x5 =10)

a.What is the clinical diagnosis and causative organism?Syphilis; Treponema

pallidum
b.Identify the laboratory test from the above picture and name the antigen used.
Venereal Disease Research Laboratory Test ; Cardiolipin
c.What type of Ag-Ab reaction is the above serological test? Precipitation(slide
flocculation)
d.Name two specific tests used for diagnosis. TPI(Trepnema pallidum Immobilization
test) ;
FTA-ABS (Fluorescent treponemal antibody absorption test)
e.Which test is used to monitor the treatment?VDRL
(6)A 42-year-old HIV positive female presented to the STD clinic with
complaints of intense vulvar itching and scanty, white, thick, cheesy
discharge. The discharge was collected and sent for gram staining and
culture.
(2 x5 =10)

Gram Stain

Growth on SDA

a. What is the clinical diagnosis?Vaginal Candidiasis

b. Describe the Gram stain finding.Gram-positive budding yeast cells(blastoconidia) with
pseudohyphae
c. Comment on the colony morphology on SDA.Creamy white and pasty colonies
d. Which further tests are needed for accurate species identification?Germ tube test,Dalmau
plate culture, CHROMagar, Growth at 45°C
e. Mention two other clinical conditions caused by it.Septicemia , Pulmonary Candidiasis
(7)A 27-year-man had developed mucopurulent discharge, followed by
development of dysuria and urethral irritation. He had a history of
multiple sexual partners. Microscopy of the urethral swab revealed sterile
pyuria and presence of compact inclusion bodies which are later stained
by Lugol’s iodine.
(2 x5 =10)

a. What is the most probable etiological diagnosis? Chlamydia trachomatis

b. What is the serotype of the causative agent?
D-K(D ,Da, E, F, G, H, I, Ia, J, Ja ,K).
c. Name two other clinical conditions produced by the causative agent?
Trachoma,Infant Pneumonia.
d. How is this infection diagnosed in the laboratory?Casteneda
stain,Machiavello stain,Gimenez stain,Lugol’s iodine, Direct IF,Antigen
Detection(LPS antigens) by enzyme immunoassay, Nucleic acid
amplification test(NAAT),Antibody detection.
e. Name the common antibiotic used for treatment.Azithromycin (DOC)/
Doxycycline , tetracycline , erythromycin
 Skin,Soft Tissue and
Musculoskeletal System Infection
(1)A 15 year old boy presented to surgery OPD with tender, bright red,
subcutaneous swelling on malar area of the face with indurated peau
d’orange texture of involved skin along with fever and chills. A clinical
diagnosis of cellulitis was made. The aspirated pus specimen was sent to
microbiology laboratory for culture and antimicrobial susceptibility
testing. The bacteria is Bacitracin resistant.
(2.5x4=10)

B C A. Beta-hemolytic colonies on BA
D B. CAMP TestEpositive

1. Identify the causative agent based on the microbiological

investigations performed.Streptococcus agalactiae
2. Enumerate two infections caused by this
organism.Meningitis,Neonatal sepsis
3. What antibiotic you would like to prescribe?Penicillin / Ampicillin +
Gentamicin
4. Name another bacteria producing beta hemolysis on blood
agar.Staphylococcus aureus
(2)A 37 year old village lady presented with complaints of numerous
hypo-pigmented skin lesions on her arms, cheeks, abdomen, back and
legs for last 5 years. Her eyebrows had started thinning and she had
numbness in her forearm. Specimen collected from the skin lesion was
subjected to microscopy.

Microscopy of Slit Skin Smear.

1. What is the clinical diagnosis and it’s the causative organism?
Leprosy; Mycobacterium Leprae
2. What type of staining is used for this bacteria?Modified Z-N
Staining (5% H2SO4 as decolouriser)
3. Enumerate the clinical types of this disease.Paucibacillary(PB)
Leprosy,Multibacillary(MB) Leprosy.
4. How these bacteria are propagated?Nasal droplet infection &
Contact Transmission.
5. Name the intradermal skin test associated with this
disease.Lepromin test
(3)A 42 year old male who is a worker in a wool factory, was admitted
into hospital with prolonged fever, chills, night sweats and chest
discomfort with blood stained sputum. Sputum specimen was collected
and was subjected to Gram staining.(2x5=10)

A. Gram-positive, large rectangular bacilli and pus cells; B. Culture smear-shows Gram-positive bacilli
with non-bulging spores (bamboo stick appearance).

1. What is the clinical diagnosis and it’s causative

organism?Pulmonary Anthrax; Bacillus Anthracis
2. List two virulence factors.Anthrax Toxin , Anthrax Capsule
3. Enumerate different clinical types of infections caused by this
bacteria in human?Cutaneous Anthrax (Malignant
Pustule),Intestinal Anthrax
4. Name the staining reaction depicted in picture below.

A B C
McFadyean’s reaction
5. Which vaccine is used for it’s prevention?Live Attenuated ,
Non-Capsulated Spore Vaccine (Stern Vaccine)
Adsorbed (Alum Precipitated)Toxoid Vaccine
(4)A 6 year old boy had developed multiple painful vescicles over the
lips, tongue and buccal mucosa. His parents revealed that two of his
school batch mates had a similar presentation few days back. Scrapings
obtained from the base of the lesion is subjected to staining (Tzanck
preparation).(2x5=10)

A CB
A. Vesicular lesions on lips and tongue ; B. Periocular vesicular lesions.
C. Tzanck cells in Tzanck preparation.

1. What is the most probable diagnosis and etiological

agent?Herpes Virus Infection ; Herpes Simplex Virus-1
2. What are the various cutaneous and mucosal infections
produced?
Herpes whitlow , Febrile blister , Herpes gladiatorum,
Erythema multiforme , Pharyngitis
3. Name two other members of organisms belonging to the
same family.Herpes Simplex Virus -2 , Varicella-Zoster
virus , Epstein – barr Virus , Cytomegalovirus ,HHV-
6,HHV-7, Kaposi’s Sarcoma
4. What type of inclusion body is formed in this disease?
Cowdry type A inclusion bodies (Lipschultz body)
5. Name a drug commonly used to treat this
condition.Acyclovir
(5)A 42 year old man with 30% burn injury developed burn wound
infection after 5 days of hospitalisation. Exudate specimen was sent for
culture and AST. Gram stain of the isolate showed Gram negative bacilli
which is motile and oxidase positive. (2x5=10)

A. Growth on Nutrient Agar B. Beta haemolytic colony on BA & NLF on MacConkey

agar.

1. What is the causative organism?Pseudomonas aeruginosa

2. List two clinical conditions caused by this organism.Catheter-
assosicated Urinary Tract Infection ,Surgical Site Infection
3. Name two pigments produced by this bacteria?Pyocyanin ,
Pyomelanin
4. Name two HAIs associated with this bacteria Ventilator Associated
Pneumonia , Central Line Associated Bloodstream Infection.
5. Enumerate two important preventive interventions adopted in
hospitals to check the spread of this organism? Hand Hygiene ,
Sterilization of Instruments .
(6)A 3 year old child developed fever, cough, coryza and conjunctivitis
followed by the appearance of a maculopapular rash over face and trunk,
soon progressed all over the body. On examination, small bluish white
spot surrounded by erythema was found in the buccal mucosa and on
inquiry mother gave history of incomplete vaccination. (2x5=10)

A B C
A. Koplik spot in buccal mucosa
B. Skin Rashes
C. Multinucleated giant cell in infected cell lines.

1. What is the most probable clinical diagnosis? Measles

2. What is the etiological agent and to which group it
belongs?Measles Virus ; Paramyxoviridae
3. Mention two complications of the disease.Subacute Sclerosing
Panencephalitis(SSPE), Giant – cell Pneumonitis(Hecht’s
Pneumonia)
4. Mention one serological test used to diagnose the disease.Antibody
detection by ELISA.
5. Name the type of vaccine used and its schedule.MMR (live
attenuated)
9-12 months – MR – 1st dose
16-24 months – MR – 2nd dose
(7)A 7 year old girl presented to the dermatology clinic with itchy, scaly
patches on her skin and scalp.The lesions were ring shaped with
spreading margins. Scrapings from the lesions were sent for microscopy
and fungal culture. KOH mount revealed thin septate hyphae with
arthrospores. Culture finding shows: (2x5=10)

B C
A. Cottony growth on SDA B. Thick walled, spiny, spindle shaped, pointed ends
macroconidia

1. What is the clinical diagnosis and its probable causative

organisms?Dermatophytoses ; Microsporum
2. Which parts of the body are affected?Skin and hair
3. What are the clinical features seen in this disease?Itchy scaly
pathes on skin with central clearing and raised edges,brittle hair
with alopecia
4. What are the various modalities of laboratory diagnosis?Wood
Lamp Examination , Direct examination , Culture,Hair
perforation test , urease test , Dermatophyte test medium and
Dermatophyte Identification Medium , PCR
5. Mention two other members causing similar clinical
conditions.Tricophyton , Epidermophyton
 (8)+A 35 year old farmer, with history of thorn prick injury 20 days back
presented to the hospital with swelling of the right foot, multiple sinuses,
discharging black granules for 1 week. Granules were collected in a
sterile gauze and sent to the laboratory for diagnosis. Histopathological
examination of the granules is given in figure. (2x5=10)

A B
HP finding: Sun ray appearance of the organism.

1. What is the clinical diagnosis?Mycetoma (Eumycetoma)

2. List the probable causative organisms.Madurella mycetomatis,
Madurella grisea, Exophiala jeanselmei ,Curvularia Species
3. What are the various modalities available to confirm the
diagnosis?Macroscopic examination of granules , KOH mount
4. What are the different types of the disease?Actinomycetoma
Eumycetoma , Botromycosis
5. Mention about the treatment for the above clinical
condition.Itraconazole/Amphotericin B
Gastrointestinal Infections
(1)A 30-year old man presented with a 2 day history of severe
diarrhoea and vomiting. His symptoms started abruptly, with
rice watery diarrhoea followed by vomiting. He had no
abdominal pain and fever. On examination, his pulse was 115
per minute and blood pressure was 80/50 mm Hg. His mucous
membranes were dry and his eyes appeared sunken.
(2X5=10)

a) What is the provisional clinical diagnosis? Cholera

b) What is the sample and how will you transport it to the
laboratory?Stool ; Cary – Blair medium , Venkatraman –
Ramakrishnan(VR) medium.
c) Name two selective media for isolation of the organism.
Bile salt Agar & TCBS agar
d) Name the bio-types of the pathogen.Classical and El Tor
e) What are the serotypes?Ogawa,Inaba,Hikojima
(2)A 20 year old man developed acute onset of nausea, vomiting
followed by diarrhoea shortly after returning from a party. His
symptoms started approximately 4 hours after consumption of
food. It was informed that three other guests who had attended
the party also became ill with similar symptoms.
(2X5=10)

a. What is your clinical diagnosis and what is the most

probable causative agent? Food Poisoning ; Staphylococcus
aureus
b. What is the possible mechanism of this clinical condition?
Toxin mediated ; Staphylococcus enterotoxin
c. What laboratory test will you perform to identify the
causative agent? Catalase test ; Coagulase test (both positive)
d. Name two other organisms causing similar manifestations.
Bacillus cereus & Clostridium perfringens
e. Name two other diseases caused by the causative agent.
Toxic Shock Syndrome & Abscess
(3)A 12 year old boy developed lower abdominal cramp,
tenesmus and frequency of stool. The stool contained blood,
mucus with minimal fecal matter.
(2X5=10)

a. What is the clinical diagnosis and the most likely etiologic

agent of this condition? Dysentery ; Shigella dysenteriae
b. What is the most common mode of infection? Fecal – oral
route
c. Culture shows NLF colonies which was non-motile Gram
negative bacilli. Name one selective medium and one
enrichment medium for the organism.
Selective – Selenite F Broth, Tetrathionate Broth
Enrichment- DCA, XLD Agar
d. Name the species of this organism.S.flexneri ,S.boydii, S.
sonnei
e. Name two other pathogens causing similar clinical
condition. Entamoeba histolytica, Enterohemorrhagic E.coli
(4)A four-year-old child was admitted to the paediatrics ward
with abdominal distress, diarrhoea, mild dehydration, fever and
vomiting for 2 days. Stool sample was positive for rotavirus
antigen detected by ELISA.
(2X5=10)

a. What is your clinical diagnosis?Viral Diarrhea

b. What are the other viral agents that may cause similar
illness? Astrovirus, calicivirus and enteric adenovirus
c. Name the mode of transmission of this infection.
Contaminated Food and water (Fecal – oral)
d. What are the different modalities of laboratory diagnosis?
RT-PCR , Antigen Detection
e. How will you prevent such diseases in future? Vaccination,
Hygiene and Sanitation, Community Strict Hand Hygiene.