Which statement is correct ?

A. Staph aureus food poisoning is mediate by heat labile

toxin
B. Sthaphylococcal exofoliative toxin responsible for gas
gangrene
C. Staphylococcal scalded skin syndrome is a toxin
mediated infection seen primarily in
immunocompromised patients
D. Infection with coagulase negative staphylococci
characterized by an acute onset and rapidly fatal course
E. Staphylococci that are resistant to oxacillin are
resistant to all penicillins, cephalosporins &
carbapenems
Which statement is correct ?

A. Staph aureus food poisoning is mediate by heat labile

toxin
B. Sthaphylococcal exofoliative toxin responsible for gas
gangrene
C. Staphylococcal scalded skin syndrome is a toxin
mediated infection seen primarily in
immunocompromised patients
D. Infection with coagulase negative staphylococci
characterized by an acute onset and rapidly fatal course
E. Staphylococci that are resistant to oxacillin are
resistant to all penicillins, cephalosporins &
carbapenems
For which of the following toxin mediated
illnesses antibiotic therapy would NOT be
indicated ?

1) Group A streptococcal toxic shock-like

syndrome
2) Staph aureus food poisoning
3) Scalded skin syndrome
4) Staph aureus toxic shock syndrome
5) Diphtheria
For which of the following toxin mediated
illnesses antibiotic therapy would NOT be
indicated ?

1) Group A streptococcal toxic shock-like

syndrome
2) Staph aureus food poisoning
3) Scalded skin syndrome
4) Staph aureus toxic shock syndrome
5) Diphtheria
Considering acute rheumatic fever and AGN, which
statement is NOT true ?

1) Both are immune reactions

2) Ocurr at age of 5-15 years
3) Reactivation do not occur in either
4) AGN occurs commonly after skin infection
5) Acute rheumatic fever occurs commonly after
pharyngitis
Considering acute rheumatic fever and AGN, which
statement is NOT true ?

1) Both are immune reactions

2) Ocurr at age of 5-15 years
3) Reactivation do not occur in either
4) AGN occurs commonly after skin infection
5) Acute rheumatic fever occurs commonly after
pharyngitis
What is the mechanism of the DAMAGE in
kidneys in post-streptococcal glomerulonephritis ?

1) Infection of kidney tissue with the bacteria

2) Autoimmunity
3) Antigen-antibody complex
4) Locally produced but systemically active toxin
that kills kidney cells
5) Systemic inflammatory response syndrome
(SIRS) initiated by bacteria
What is the mechanism of the DAMAGE in
kidneys in post-streptococcal glomerulonephritis ?

1) Infection of kidney tissue with the bacteria

2) Autoimmunity
3) Antigen-antibody complex
4) Locally produced but systemically active toxin
that kills kidney cells
5) Systemic inflammatory response syndrome
(SIRS) initiated by bacteria
Bordetella pertussis produces a toxin that is
derived from peptidoglycan has the following
biological activity :

1) Kills heart cells

2) Causes lymphocytosis
3) Destroy ciliated epithelial cells
4) Stimulates autoimmunity
5) Causes neurological damage
Bordetella pertussis produces a toxin that is
derived from peptidoglycan has the following
biological activity :

1) Kills heart cells

2) Causes lymphocytosis
3) Destroy ciliated epithelial cells
4) Stimulates autoimmunity
5) Causes neurological damage
A man with tinea pedis (athlete’s foot)
developed secondary bacterial infection that
involved skin causing pain and redness and then
reached the knee.

1. what is causative agent ?

2. name this infection
3. mention two non-suppurative complications of
this infection
4. Mention a major feature that characterize this
bacterium
1. Streptococcus pyogenes
2. either cellulitis or erysipelas
3. acute glomerulonephritis (mainly) and acute
rheumatic fever
4. BACITRACIN sensetive
A child with fever, cough, pleurisy and
crepitations was diagnosed with pneumonia. The
causative organism was isolated in a routine
culture.

 What is the most likely causative agent ?

 mention predisposing factor for this child
condition ?
 Streptococcus pneumoniae.
 Splenectomy.
 Why splenectomy ?

Spleen is responsible for clearance of capsulated

bacteria because it produces antibodies from its
mature B lymphocytes (plasma cells) mediating
opsonization & phagocytosis.

remember :
S. pneumoniae sputum is rusty
• This is what is so called typical pneumonia
• It is called typical for 3 reasons :
 typical clinical picture (crepitation) on examination
 typical chest X-ray result (lobar consolidation) as it
involves only one lobe
 sputum is cultured on routine cultures (e.g, blood
culture)

Unlike atypical pneumonia that is:

diffuse through the whole lung (patchy infiltrates).
no crepitation because fluids are outside alveoli (in
the interstitium).
sputum is difficult to culture in ordinary media.
39 yrs old woman developed toxic shock
syndrome due S.aureus. Which sample is most
likely negative ?

1) Blood
2) Vaginal tampon
3) Nasal packing
4) Wound bandages
5) All of them are positive
39 yrs old woman developed toxic shock
syndrome due S.aureus. Which sample is most
likely negative ?

1) Blood
2) Vaginal tampon
3) Nasal packing
4) Wound bandages
5) All of them are positive
 To culture Staph for toxic shock, take specimen
other than blood, i.e: tampon, nasal packing,
wound swab. Because oraganism grows there
and release toxin into circulation.
 Unlike S.pyogenes toxic shock syndrome ,
where blood cultures are +ve for organism.
A man came to the outpatient clinic with copious
uretheral discharge. He gave a history of
numerous sexual contacts and 3 similar episodes
last year. The best explanation for the multiple
infection by this organism is :

1) Patient’s cellular immune response is

compromised.
2) Patient’s humoral immunity is compromised
3) The organism varies in its antigenic makeup
4) The pathogen suppresses immune responses
5) The pathogen produces pyrogenic exotoxin
A man came to the outpatient clinic with copious
uretheral discharge. He gave a history of
numerous sexual contacts and 3 similar episodes
last year. The best explanation for the multiple
infection by this organism is :

1) Patient’s cellular immune response is

compromised.
2) Patient’s humoral immunity is compromised
3) The organism varies in its antigenic makeup
4) The pathogen suppresses immune responses
5) The pathogen produces pyrogenic exotoxin
For the above patient ; the 1st and 2nd lines of
antibiotics therapy are respectively :

1) Ceftriaxone & Ampicillin

2) Ceftriaxone & Doxycycline
3) Ceftriaxone & Spectinomycin
4) Doxycycline & Ceftriaxone
5) Doxycycline & Amoxicillin
For the above patient ; the 1st and 2nd lines of
antibiotics therapy are respectively :

1) Ceftriaxone & Ampicillin

2) Ceftriaxone & Doxycycline
3) Ceftriaxone & Spectinomycin
4) Doxycycline & Ceftriaxone
5) Doxycycline & Amoxicillin
Regarding diphtheria, which of the following
statements is true ?

1) It spreads from cutaneous lesions

2) It is characterized by an inflammatory exudate
forming a greyish membrane on buccal mucosa
3) 3 doses of toxoid provides 75% protection
4) 1 & 2 are true
5) It produces a toxin that affect myocardium,
nervous and adrenal tissue
Regarding diphtheria, which of the following
statements is true ?

1) It spreads from cutaneous lesions

2) It is characterized by an inflammatory exudate
forming a greyish membrane on buccal mucosa
3) 3 doses of toxoid provides 75% protection
4) 1 & 2 are true
5) It produces a toxin that affect myocardium,
nervous and adrenal tissue
a 25 yrs old woman with a maculopapular rash
was diagnosed with syphilis, and was given
penicillin . Few hours later she developed Flu-
like symptoms. This symptoms are due to ?
………………………………….
Due to release of endotoxin-like substance and
other internal components from the dying
bacteria.

NOTE :
NOT due to allergy to penicillin
Called Jarisch-Herxheimer reaction
Managed with NSAIDs like aspirin
23 yrs old man with preexisting murmur
developed fever, shock , painless spots on palms
and painful nodules on the fingers 3 weeks after
doing dental surgery without antibiotics.

What is the most likely diagnosis ?

 causative agent ?
 how to avoid this condition (prophylaxis) ?
 important test for agent diagnosis ?
subacute bacterial endocarditis.
S. viridans (oral flora)
Give amoxicillin before dental surgery
OPTOCHIN resistant
NB:

In a normal person, Viridans can’t cause

endocarditis. When patient has a preexisting heart
damage ((rheumatic heart disease , Mitral valve
prolapse “MVP” Or septal defect ...etc)) the
organism can colonise heart valves causing
endocarditis, so prophylaxis is indicated here.
 Endocarditis
Infection of heart valves.
 clinical features :
fever , heart murmurs , painless spots on palm
(Janeway lesions) , painful nodes on soles (Osler’s
nodes) , bleeding under nail (Splinter hemorrhage)
& clubbing.
o Classification :
Acute & Subacute
• acute = S. Aureus
• subacute = S. viridans or S. epidermidis or S. bovis
NB: S. bovis endocarditis is related to bowel cancer.
S. aureus is so virulent .. Need no risk factors to
cause endocarditis, so it is acute.
Others are less virulent .. Need predisposing factors.
For example, viridans (most common cause of
subacute BE) attacks abnormal heart tissue (see
above), while S. epidermidis colonises prosthetic
(artificial) heart valves via its glycocalyx
The portal of entery for each one :
 S. aureus : not well documented
 S. viridans : dental surgery/oral trauma
 S. epidemidis : skin device/procedures (IV
cannula/catheters)
 Glycocalyx (slime layer)
 Composed of alginate polysaccharide derivatives
 Mediate adherence of bacteria to abnormal structures in human
body, including:
Intravenous Catheters , artificial (prosthetic) heart valves & hip
joint. where bacteria form a thick layer around these devices
called Biofilm , which also provide protection to bacteria
against immune system (Staphylococcus epidermidis)
Damaged heart structures :rheumatic heart disease or cardiac
septal defects; (Streptococcus viridians group members,
especially streptococcus mutans)
Abnormal lung secretions in cyctic fibrosis (Pseudomonas
auriginosa)
Based on target, which of these antibiotics is
different from others ?

1) Aminoglycoside
2) Chloramphenicol
3) Tetracycline
4) Streptogramin
5) daptomycin
Based on target, which of these antibiotics is
different from others ?

1) Aminoglycoside
2) Chloramphenicol
3) Tetracycline
4) Streptogramin
5) daptomycin
Which is NOT true about Borrelia burgdorferi ?

1) Transmitted through Ixodes ticks

2) No human to human transmission
3) Causes relapsing fever
4) Deers are the main reservoir
5) Forms rash called erythema migrans
Which is NOT true about Borrelia burgdorferi ?

1) Transmitted through Ixodes ticks

2) No human to human transmission
3) Causes relapsing fever
4) Deers are the main reservoir
5) Forms rash called erythema migrans
Remember :
Most - if not all – zoonotic diseases are treated with
doxycycline.

e.g:
Brucellosis, rickettsiae, lyme , anthrax, H. pylori, Q-
fever , leptospirosis , rabbit fever (tularemia),
parrot’s fever ,
Chlamydophilla pneumoniae .
Which immune response is important against
meningeococci ?

1) Humoral immunity
2) Cell mediated immunity
3) Complement system
4) Innate immunity
Which immune response is important against
meningeococci ?

1) Humoral immunity
2) Cell mediated immunity
3) Complement system
4) Innate immunity
 Especially the late acting complement
(C6,7,8,9) which are known as membrane attack
complex.
A deficiency in them is associated with
reccurent infections with N. meningitidis.
(also related to disseminated gonococcal
infection)
65 yrs old man , developed peritonitis after
abdominal surgery. The most likeley causative
agent is ……………………….
65 yrs old man , developed peritonitis after
abdominal surgery. The most likeley causative
agent is
Bacteroides fragilis
A 28 yrs old woman developed conjunctivitis,
uretheritis & artheritis after an STI.

I. What is the most likely diagnosis ?

II. Causative agent ?
III. Important immunological marker associated with
the disease ?
IV. Nature of vaccine ?
V. Mention other organisms can cause this disease.
I. Reiter’s syndrome
II. Chlamydia trachomatis , biovar :trachoma/ serovar :
D through K
III. MHC-I : HLA-B27
IV. No vaccine
V. Salmonella ,Shigella, Campylobacter,
Yersinia enterocolitica
A 14 yrs old male with acute otitis media received
amoxicillin with no obvious benefit. A Week later he
came with low grade fever, earache, general malaise &
cough. Chest radiograph showed infiltrates at the left
middle lung. Diagnosis was confirmed with cold
hemagglutinins. The following is a characteristic of the
most likely causative agent.

1) Contains no peptidoglycan
2) Form spores under adverse growth conditions
3) Gram +ve coccus
4) Acid fast
5) Secretes an AB toxin that has ADP-ribosylating activity
A 14 yrs old male with acute otitis media received
amoxicillin with no obvious benefit. A Week later he
came with low grade fever, earache, general malaise &
cough. Chest radiograph showed infiltrates at the left
middle lung. Diagnosis was confirmed with cold
hemagglutinins. The following is a characteristic of the
most likely causative agent.

1) Contains no peptidoglycan
2) Form spores under adverse growth conditions
3) Gram +ve coccus
4) Acid fast
5) Secretes an AB toxin that has ADP-ribosylating activity
The most common leptospira that causes
human disease is ?

1) Leptospira icterohemorrhagiae
2) Leptospira interrogans
3) Leptospira canicola
4) Leptospira weilii
5) Leptospira wolbachii
The most common leptospira that causes
human disease is ?

1) Leptospira icterohemorrhagiae
2) Leptospira interrogans
3) Leptospira canicola
4) Leptospira weilii
5) Leptospira wolbachii
Which meningeococcus serotype that is not
protected against by the poly saccharide vaccine ?

1) Serotype A
2) Serotype B
3) Serotype C
4) Serotype W135
5) Serotype Y
Which meningeococcus serotype that is not
protected against by the poly saccharide vaccine ?

1) Serotype A
2) Serotype B
3) Serotype C
4) Serotype W135
5) Serotype Y
A 25 yrs old woman came with vaginal discharge.
Regarding causative agent ; which of the following
is least likely to be caused by ?

1) Endometritis
2) Salpingitis
3) Pharyngitis
4) Epididymitis
5) Pyelonephritis
6) meningitis
A 25 yrs old woman came with vaginal discharge.
Regarding causative agent ; which of the following
is least likely to be caused by ?

1) Endometritis
2) Salpingitis
3) Pharyngitis
4) Epididymitis
5) Pyelonephritis
6) meningitis
Remember :

females have no epididymis nor prostate.

males have no salpinx nor endometrium.
A man receiving immunosuppresive drugs for
cancer developed sepsis after swimming in sea. It
is most likely caused by ?
………………….
A man receiving immunosuppresive drugs for
cancer developed sepsis after swimming in sea. It
is most likely caused by ?
vibrio vulnificus
Which of the following are shared properties
between tetanus & botulinum toxins ?

1) They are proteases

2) They act at neuromuscular junction
3) They act at spinal cord
4) They are actively secreted under anaerobic
growth conditions
5) They promote muscle contraction
Which of the following are shared properties
between tetanus & botulinum toxins ?

1) They are proteases

2) They act at neuromuscular junction
3) They act at spinal cord
4) They are actively secreted under anaerobic
growth conditions
5) They promote muscle contraction
A man was diagnosed with cancer took a dip into
swimming pool. Few hours later he developed
folliculitis in his armpit. The causative agent is ?
……………………..
A man was diagnosed with cancer took a dip into
swimming pool. Few hours later he developed
folliculitis in his armpit. The causative agent is ?
Pseudomonas auriginosa
Cystic fibrosis patients are highly susceptible to
infection by environmental bacterium which
undergoes phenotypic conversion from non-
mucoid to mucoid phenotype. This due to
microorganism :

1) Expressing altered LPS structure

2) Expressing elevated amount of cell surface
adhesin pili
3) Secrete high level of extracellular proteins
4) Overproducing alginate polysaccharide
5) Producing high level of antibiotic efflux pumps
Cystic fibrosis patients are highly susceptible to
infection by environmental bacterium which
undergoes phenotypic conversion from non-
mucoid to mucoid phenotype. This due to
microorganism :

1) Expressing altered LPS structure

2) Expressing elevated amount of cell surface
adhesin pili
3) Secrete high level of extracellular proteins
4) Overproducing alginate polysaccharide
5) Producing high level of antibiotic efflux pumps
A Young man with sickle cell anemia developed
osteomyelitis. Causative agent is ?
……………………..
A Young man with sickle cell anemia developed
osteomyelitis. Causative agent is ?
Salmonella typhi
The severity of endotoxin mediated diseases is
determined by ?
…………………….
The severity of endotoxin mediated diseases is
determined by ?
Lipid-A content in the LPS
A man with fever and gastrointestinal infection
has a low WBC count. It is most likely to be ?
….............................
A man with fever and gastrointestinal infection
has a low WBC count. It is most likely to be ?
Typhoid fever
Khalid is from khartoum developed shigellary
dysentery. The strain responsible for is ?
…………………….
Khalid is from khartoum developed shigellary
dysentery. The strain responsible for is ?
S. Flexneri
(the most common strain in sudan and 3 rd
world)
Which antibiotic is the best for a 7 yrs old child with
E.coli O157:H7 infection who developed hemolytic-
uremic syndrome ?
……………………..
Which antibiotic is the best for a 7 yrs old child with
E.coli O157:H7 infection who developed hemolytic-
uremic syndrome ?
No antibiotics
A lab personnel took 2 skin specimens from a
patient with closed skin abscess without
openening the abscess. Cultures grown coagulase
+ve and coagulase –ve organisms. Regarding
culture, which one is pathogenic ?
………………………………………………………..
A lab personnel took 2 skin specimens from a
patient with closed skin abscess without
openening the abscess. Cultures grown coagulase
+ve and coagulase –ve organisms. Regarding
culture, which statement is true ?
Both of them are contamination, no one is
pathogenic
A 35 yrs old male patient with pneumonia
coughed out sputum that contains gram +ve
and acid-fast bacteria which was not TB , the
most likely causative agent is ?
…………………………..
Nocardia Asteroides

NB.
It is partially acid-fast
Legionella’s most important virulence factor is ?
……………………………..
Legionella’s most important virulence factor is ?
Survival intracellularly
A patient with dental caries developed abscess in the
mouth. Microscopy of the abscess shown gram +ve rods
forming long branching filaments. It was anaerobic
bacterium. What is most likely causative agent?
……………………………
A patient with dental caries developed abscess in the
mouth. Microscopy of the abscess shown gram +ve rods
forming long branching filaments. It was anaerobic
bacterium. What is most likely causative agent?

Arachnia propionica
Anaerobic Gram positive filaments, which are
part of the normal flora of mucous membranes
& may be associated with traumatized or
surgically injured tissue include:

1) Nocardia asteroids
2) Bacillus subtilis
3) Mycobacterium smegmatis
4) Arachnia propionica
5) Streptomyces somaliensis
Anaerobic Gram positive filaments, which are
part of the normal flora of mucous membranes
& may be associated with traumatized or
surgically injured tissue include:

1) Nocardia asteroids
2) Bacillus subtilis
3) Mycobacterium smegmatis
4) Arachnia propionica
5) Streptomyces somaliensis
A 63-yrs old patient brought to the ER with 4 days of
fever, cough, confusion and mild diarrhea. His wif
said that he had just returned from a business trip
where he stayed in hotel. Lab investigations revealed
high WBC count and low sodium of 130 equivalent.
All of the following drugs would be useful
EXCEPT :

1) Azithromycin
2) Doxycycline
3) Levofloxacin
4) Moxifloxacin
5) Imepenem
A 63-yrs old patient brought to the ER with 4 days of
fever, cough, confusion and mild diarrhea. His wif
said that he had just returned from a business trip
where he stayed in hotel. Lab investigations revealed
high WBC count and low sodium of 130 equivalent.
All of the following drugs would be useful
EXCEPT :

1) Azithromycin
2) Doxycycline
3) Levofloxacin
4) Moxifloxacin
5) Imepenem
Legionella is best treated with macrolides
(-thromycin).
Alternatives like tetracycline, quinolones
and rifampin are also useful
It produces B-lactamases , so cell wall
drugs like penicillins & cephalosporins are
ineffective.
Aminoglycosides are ineffective also
An essential virulence factor of Bacteroides
fragilis in abdominal abscess formation is :

1) Collagenase
2) Heparinase
3) Superoxide dismutase
4) Capsular polysacchareide
5) lipopolysaccharide
An essential virulence factor of Bacteroides
fragilis in abdominal abscess formation is :

1) Collagenase
2) Heparinase
3) Superoxide dismutase
4) Capsular polysacchareide
5) lipopolysaccharide
All of the following is true about anaerobic
infections EXCEPT :

1) Often mixed
2) Present as abscess or gangrene
3) Occurs in the vicinity of mucous membranes
4) Erythromycin is the treatment of choice
5) Surgery is an essential accompanying therapy
All of the following is true about anaerobic
infections EXCEPT :

1) Often mixed
2) Present as abscess or gangrene
3) Occurs in the vicinity of mucous membranes
4) Erythromycin is the treatment of choice
5) Surgery is an essential accompanying therapy
Which of the following statements about
antibiotic susceptibility is NOT true ?

1) Its testing is based on inhibition zone around an

antibiotic-impregnated disc
2) E. coli is susceptible to ampicillin
3) MRSA is susceptible to meropenem
4) S. pyogenes is always susceptible to penicilin
5) Listeria monocytogenes is resistant to
cephalosporins
Which of the following statements about
antibiotic susceptibility is NOT true ?

1) Its testing is based on inhibition zone around an

antibiotic-impregnated disc
2) E. coli is susceptible to ampicillin
3) MRSA is susceptible to meropenem
4) S. pyogenes is always susceptible to penicilin
5) Listeria monocytogenes is resistant to
cephalosporins
21-year-old male without significant PMH was found
difficult to arouse by his roommate in his college
dormitory. Patient taken via fire rescue to ER. On exam,
he was lethargic, febrile to 1030F, tachycardic, tachypnec,
and hypotensve. His neck was stiff and he had a petechial
rash on the lower extremities. CSF revealed a neutrophilic
pleocytosis, low glucose, and elevated protein. Which of
the following antimicrobial regimens should be initiated?

1) Vancomycin administered intravenously and

intrathecally
2) Vancomycin + rifampin
3) Penicillin G
4) Trimethoprim-sulfamethoxazole
21-year-old male without significant PMH was found
difficult to arouse by his roommate in his college
dormitory. Patient taken via fire rescue to ER. On exam,
he was lethargic, febrile to 1030F, tachycardic, tachypnec,
and hypotensve. His neck was stiff and he had a petechial
rash on the lower extremities. CSF revealed a neutrophilic
pleocytosis, low glucose, and elevated protein. Which of
the following antimicrobial regimens should be initiated?

1) Vancomycin administered intravenously and

intrathecally
2) Vancomycin + rifampin
3) Penicillin G
4) Trimethoprim-sulfamethoxazole
TB patients need to be treated with a combination of
several antibiotics.which of the following is the most
important reason for such combinatory therapy ?

1) M. TB has many unique metabolic pathways

2) M. TB has a high mutational rate & present in high
numbers in infected tissues
3) M. TB encodes RNA polymerase that is different
from other microbes
4) M. TB is covered with thick waxy layer
5) TB patients are susceptible to secondary infections
TB patients need to be treated with a combination of
several antibiotics.which of the following is the most
important reason for such combinatory therapy ?

1) M. TB has many unique metabolic pathways

2) M. TB has a high mutational rate & present in high
numbers in infected tissues
3) M. TB encodes RNA polymerase that is different
from other microbes
4) M. TB is covered with thick waxy layer
5) TB patients are susceptible to secondary infections
One relationship between smooth LPS and
disease is that :

1) Only bacteria with smooth lps are vvirulent

2) O antigen is highly toxic and induces
inflammation
3) LPS protects wall-less bacteria from
environment and host defense
4) The O antigen is highly polymorphic among
different species of bacteria (antigenic variation)
5) Lipid A is a good example of molecular mimecry
(looks like host antigens)
One relationship between smooth LPS and
disease is that :

1) Only bacteria with smooth lps are vvirulent

2) O antigen is highly toxic and induces
inflammation
3) LPS protects wall-less bacteria from
environment and host defense
4) The O antigen is highly polymorphic among
different species of bacteria (antigenic variation)
5) Lipid A is a good example of molecular mimecry
(looks like host antigens)
A one year old immigrant girl who has not
received standard vaccinations experiences severe
cough that lasts for two weeks. The causative
organism identified on Bordet-Gengou agar. This
child has elevated lympocytes in her blood. The
lymphocytosis is due to ?

1) Bacterial infections always cause elevated

lymphocytes in blood
2) A toxin that stimulates adenylate cyclase
3) An exported adenylate cyclase from bacteria
4) Viral infection
A one year old immigrant girl who has not
received standard vaccinations experiences severe
cough that lasts for two weeks. The causative
organism identified on Bordet-Gengou agar. This
child has elevated lympocytes in her blood. The
lymphocytosis is due to ?

1) Bacterial infections always cause elevated

lymphocytes in blood
2) A toxin that stimulates adenylate cyclase
3) An exported adenylate cyclase from bacteria
4) Viral infection
The most basic characteristic of All plasmids :

1) Can conjugate from one cell to another

2) Carry antibiotic resistance
3) They are part of phage genome
4) Are formed only by gram –ve bacteria
5) None of the above is true
The most basic characteristic of All plasmids :

1) Can conjugate from one cell to another

2) Carry antibiotic resistance
3) They are part of phage genome
4) Are formed only by gram –ve bacteria
5) None of the above is true
Most of the damage from tuberculosis caused by :

1) Autoimmunity
2) Excess cytokine secretion causing eefects on
vascular endothelium
3) Antigen antibody complexes
4) Cell-mediated immunity
5) Non of the above
Most of the damage from tuberculosis caused by :

1) Autoimmunity
2) Excess cytokine secretion causing eefects on
vascular endothelium
3) Antigen antibody complexes
4) Cell-mediated immunity
5) Non of the above
All of the followings are part of gram negative
cells EXCEPT :

1) Periplasmic space
2) Teichoic acid
3) Thin layer of peptidoglycan
4) LPS
5) All of the above are parts of G –ve cells
All of the followings are part of gram negative
cells EXCEPT :

1) Periplasmic space
2) Teichoic acid
3) Thin layer of peptidoglycan
4) LPS
5) All of the above are parts of G –ve cells
Which of the following do legionella
pneumophila and pseudomonas auriginosa have
in common ?

1) Growth on McConkey agar

2) Water as their reservoir
3) Facultative intracellullar organisms
4) Optimally visualized using gram stain
5) Frequently causes disease in cyctic fibrosis
patients
Which of the following do legionella
pneumophila and pseudomonas auriginosa have
in common ?

1) Growth on McConkey agar

2) Water as their reservoir
3) Facultative intracellullar organisms
4) Optimally visualized using gram stain
5) Frequently causes disease in cyctic fibrosis
patients
Each of the following is a part of the definition of
Systemic inflammatory response syndrome
(SIRS) EXCEPT :

1) Documented infection
2) Increased heart rate
3) Elevated or decreased temprature
4) Increased respiratory rate
5) All of them are part of the definition of SIRS
Each of the following is a part of the definition of
Systemic inflammatory response syndrome
(SIRS) EXCEPT :

1) Documented infection
2) Increased heart rate
3) Elevated or decreased temprature
4) Increased respiratory rate
5) All of them are part of the definition of SIRS
NOTE :
 SIRS is defined clinically as : (complete disturbance of
vital signs and WBC count)
Vital signs are : heart rate, respiratory rate, body
temprature.
So SIRS is :

tachy-/bradycardia & hypo-/hyperthermia &

tachypnea & leukopenia/leukocytosis
When the cause of SIRS is an infection; it becomes
(sepsis or septicemia)
In a nutshell : SIRS + current infection = sepsis

The most FREQUENT complication of untreated
acute otitis media is :

1) Mastoiditis
2) Chronic otitis media
3) Otitis media with effusion
4) Meningitis
5) Non of the above- acute otitis media often self-
limiting infection
The most FREQUENT complication of untreated
acute otitis media is :

1) Mastoiditis
2) Chronic otitis media
3) Otitis media with effusion
4) Meningitis
5) Non of the above- acute otitis media often self-
limiting infection
The organism streaked on this blood agar plate
that has bacitracin disk on it was obtained from a
skin lesion of a young child. The organism failed
to form bubbles when mixed with peroxideif the
child is not infected anywhere else with this
organism; which of the following describes the
most likely sequale of this child’s current
infection ?

1) Toxic shock syndrome

2) Scarlet fever
3) Acute glomerulonephritis
The organism streaked on this blood agar plate
that has bacitracin disk on it was obtained from a
skin lesion of a young child. The organism failed
to form bubbles when mixed with peroxideif the
child is not infected anywhere else with this
organism; which of the following describes the
most likely sequale of this child’s current
infection ?

1) Toxic shock syndrome

2) Scarlet fever
3) Acute glomerulonephritis
Mycobacterium Tb and atypical mycobacteria
have in common all of the following EXCEPT :

1) Acid-fast staining
2) Reactivity on PPD skin test
3) Can cause respiratory infection in
immunocompromised
4) Are only found in humans
5) All of the above are common for both organisms
Mycobacterium Tb and atypical mycobacteria
have in common all of the following EXCEPT :

1) Acid-fast staining
2) Reactivity on PPD skin test
3) Can cause respiratory infection in
immunocompromised
4) Are only found in humans
5) All of the above are common for both organisms
Each of the following associations are correct
EXCEPT :

1) Gram negative – periplasm

2) Gram positive – teichoic acid
3) Wall-less – sterols
4) acid-fast -- waxes
5) All of these associations are correct
Each of the following associations are correct
EXCEPT :

1) Gram negative – periplasm

2) Gram positive – teichoic acid
3) Wall-less – sterols
4) acid-fast -- waxes
5) All of these associations are correct
Which of the following pairs of (organism-site
of infections) is LEAST correct ?

1) Shigella – colon
2) Salmonella typhimerium – small intestine
3) H. pylori – stomach
4) V. cholerae – small intestine
5) ETEC – large intestine
Which of the following pairs of (organism-site
of infections) is LEAST correct ?

1) Shigella – colon
2) Salmonella typhimerium – small intestine
3) H. pylori – stomach
4) V. cholerae – small intestine
5) ETEC – large intestine
The most frequent causes of UTI in community
and hospitals respectively are :

1) E. coli – klebsiella
2) Klebsiella – E. coli
3) E. coli – proteus
4) E. coli - E. coli
5) Klebsiella – pseudomonas
The most frequent causes of UTI in community
and hospitals respectively are :

1) E. coli – klebsiella
2) Klebsiella – E. coli
3) E. coli – proteus
4) E. coli - E. coli
5) Klebsiella – pseudomonas
Which of the following has the least similar
reservoir ?

1) Salmonella typhymerium & cambylobacter

jejuni
2) Salmonella typhi & shigella dysentry
3) E. coli O157: H7 & S. aureus
4) Bacillus cereus & clostridium botulinum
5) ETEC & EAEC
Which of the following has the least similar
reservoir ?

1) Salmonella typhymerium & cambylobacter

jejuni
2) Salmonella typhi & shigella dysentry
3) E. coli O157: H7 & S. aureus
4) Bacillus cereus & clostridium botulinum
5) ETEC & EAEC
A long scenario of [patient with recurrent otitis
media].. what is to be done for her ?

1) Self-limited condition, no therapy

2) Surgery
3) Trimethoprim-Sulfamethoxazole
4) Amoxicillin
A long scenario of [patient with recurrent otitis
media].. what is to be done for her ?

1) Self-limited condition, no therapy

2) Surgery
3) Trimethoprim-Sulfamethoxazole
4) Amoxicillin
Which of the following describes the paralysis
associated with tetanus ?

Neurotransmitter release is inhibited leading to

spastic paralysis
What do the screening tests for syphilis detects ?
………………………..
What do the screening tests for syphilis detects ?
LIPIDS
(cardiolipin & lethicin)
What best describes why chlamidya trachomatis
can cause such highly divergent disease such as
uretheritis , trachoma & LGV ?

There are different strains of C. trachomatis with

different set of virulence genes
A neonate presents with bacterial meningitis.
CSF gram stain would least likely show :

1) Gram –ve rods

2) Gram +ve cocci
3) Gram +ve rod
4) Gram –ve cocci
A neonate presents with bacterial meningitis.
CSF gram stain would least likely show :

1) Gram –ve rods

2) Gram +ve cocci
3) Gram +ve rod
4) Gram –ve cocci
A 6 months old child present with fever,
hoarseness, difficulty in breathing. Examination
showed red sowllen epiglottis. Immunity to this
infection is provided by antibodies against ?

1) Cytotoxic T cells
2) M protein
3) Polyribitol phosphate
4) Surface pili
5) Outer membrane proteins
A 6 months old child present with fever,
hoarseness, difficulty in breathing. Examination
showed red sowllen epiglottis. Immunity to this
infection is provided by antibodies against ?

1) Cytotoxic T cells
2) M protein
3) Polyribitol phosphate
4) Surface pili
5) Outer membrane proteins
An 18 yrs old student that developed diarrhea
with 8 to 10 stools aday. She was healthy 2 days
earlier and had no known immune deficits . The
stool contained neither blood nor pus cells. The
diarrhea is most likely due to :

1) A protein synthesis inhibitor toxin

2) An ADP-ribosylating toxin
An 18 yrs old student that developed diarrhea
with 8 to 10 stools aday. She was healthy 2 days
earlier and had no known immune deficits . The
stool contained neither blood nor pus cells. The
diarrhea is most likely due to :

1) A protein synthesis inhibitor toxin

2) An ADP-ribosylating toxin
The difference between regular (conventional) PCR and
TaqMan probe‐mediated real time PCR is that TaqMan
involves :

1) hybridization of product to cells in a histological section

2) an additional target‐specific probe besides the PCR
primer pair
3) detection of the product resolved in an agarose gel
4) hybridization of product to an array of DNA spots
5) amplification of random fragments of DNA
The difference between regular (conventional) PCR and
TaqMan probe‐mediated real time PCR is that TaqMan
involves :

1) hybridization of product to cells in a histological section

2) an additional target‐specific probe besides the PCR
primer pair
3) detection of the product resolved in an agarose gel
4) hybridization of product to an array of DNA spots
5) amplification of random fragments of DNA
A 12 years old boy presents with acute onset of
sore throat fever of 38.9 ‘ C and painful anterior
cervical lymphadenopathy. On exam the pharynx
is red and sowllen and tonsills are covered with
yellow white exudate. The child has also halitosis.
Which of the following non-suppurative
complications are of concern ?
A. Sinusitis
B. Acute rheumatic fever alone
C. Acute glomerulonephritis alone
D. Acute rheumatic fever and acute glomerulonephritis
E. Scarlet fever alone
A 12 years old boy presents with acute onset of
sore throat fever of 38.9 ‘ C and painful anterior
cervical lymphadenopathy. On exam the pharynx
is red and sowllen and tonsills are covered with
yellow white exudate. The child has also halitosis.
Which of the following non-suppurative
complications are of concern ?
A. Sinusitis
B. Acute rheumatic fever alone
C. Acute glomerulonephritis alone
D. Acute rheumatic fever and acute glomerulonephritis
E. Scarlet fever alone
The antibiotic combination Quinipristin and
Dalfopristin are

1) effective against resistant mycobacterium TB

2) indicated in subjects with chronic renal
impairment
3) particularly effective in the treatment of
pseudomonas infection in Cystic fibrosis
4) administered orally
5) Effective against multi-resistant Staph aureus
The antibiotic combination Quinipristin and
Dalfopristin are

1) effective against resistant mycobacterium TB

2) indicated in subjects with chronic renal
impairment
3) particularly effective in the treatment of
pseudomonas infection in Cystic fibrosis
4) administered orally
5) Effective against multi-resistant Staph aureus
A patient is referred to a neurologist because of ataxia.
Neurological examination reveals a loss of proprioception
and a wide-based, slapping gate. Magnetic resonance
imaging reveals degeneration of the dorsal columns and
dorsal roots of the spinal cord. Which of the following
organisms is most likely to have caused this pattern of
damage?

1) Haemophilus influenzae
2) Herpes simplex I
3) Neisseria gonorrhoeae
4) Neisseria meningitidis
5) Treponema pallidum
A patient is referred to a neurologist because of ataxia.
Neurological examination reveals a loss of proprioception
and a wide-based, slapping gate. Magnetic resonance
imaging reveals degeneration of the dorsal columns and
dorsal roots of the spinal cord. Which of the following
organisms is most likely to have caused this pattern of
damage?

1) Haemophilus influenzae
2) Herpes simplex I
3) Neisseria gonorrhoeae
4) Neisseria meningitidis
5) Treponema pallidum
A 37 yrs old patient treated with penicillin for syphilis 15
years ago. Her present serelogy revealed :
VDRL: negative
TPHA: positive
FTA-ABS: positive
the next step is ?

1) Penicillin for 2 weeks

2) No treatment
3) Benzathine penicillin single dose
4) Doxycycline for 10 days
5) Ciprofloxacin for 5 days
A 37 yrs old patient treated with penicillin for syphilis 15
years ago. Her present serelogy revealed :
VDRL: negative
TPHA: positive
FTA-ABS: positive
the next step is ?

1) Penicillin for 2 weeks

2) No treatment
3) Benzathine penicillin single dose
4) Doxycycline for 10 days
5) Ciprofloxacin for 5 days
A 16-year-old girl presents to her physician
complaining of redness and a yellowish
discharge from her left eye for the past 2 days.
She reports minimal crusting upon awakening
and denies eye pain or previous trauma. Upon
examination, there is diffuse conjunctival
hyperemia associated with a mucoid discharge.
The pupils dilate normally, although there is
mild photophobia in the affected eye. Gram's
stain of the exudate shows pleomorphic, gram-
negative bacilli. To culture this organism with
whole blood agar, which of the following must
be used?
1) Antibiotics to inhibit normal flora
2) Cold temperature
3) Egg yolk cholesterol
4) Reduced oxygen tension
5) Staphylococcus aureus
1) Antibiotics to inhibit normal flora
2) Cold temperature
3) Egg yolk cholesterol
4) Reduced oxygen tension
5) Staphylococcus aureus
Rgarding typhoid fever, which of the following is
true ?

A. Blood culture is sensetive investigation at least 5

days after commensement of antibiotics
B. The bacteria can be isolated from rose-spots
even after administration of antibiotics
C. Widal test is used to measure precipitating
antibodies
D. Urine culture are more sensetive than stool
cultures
E. Quinolones are not recommended for treatment
Rgarding typhoid fever, which of the following is
true ?

A. Blood culture is sensetive investigation at least 5

days after commensement of antibiotics
B. The bacteria can be isolated from rose-spots
even after administration of antibiotics
C. Widal test is used to measure precipitating
antibodies
D. Urine culture are more sensetive than stool
cultures
E. Quinolones are not recommended for treatment
Non-typable H. influenzae (NTHi) commonly
causes :

1) Meningitis
2) Bacteremia
3) Pneumonia
4) Otitis media
5) Otitis externa
Non-typable H. influenzae (NTHi) commonly
causes :

1) Meningitis
2) Bacteremia
3) Pneumonia
4) Otitis media
5) Otitis externa
A 54-year-old female is admitted with a severe
pneumonia. Bloods reveal both hyponatraemia and
deranged liver function tests. A chest x-ray shows patchy
alveolar infiltrates with consolidation in the right lower
lobe. Which one of the following investigations is most
likely to confirm the probable diagnosis?

1) Sputum cultureia
2) Urinary antigenia
3) Blood cultures
4) Bone marrow aspiration
5) Lumbar puncture
A 54-year-old female is admitted with a severe
pneumonia. Bloods reveal both hyponatraemia and
deranged liver function tests. A chest x-ray shows patchy
alveolar infiltrates with consolidation in the right lower
lobe. Which one of the following investigations is most
likely to confirm the probable diagnosis?

1) Sputum cultureia
2) Urinary antigenia
3) Blood cultures
4) Bone marrow aspiration
5) Lumbar puncture
A 40 yrs old patient present complaining of acute
pharyngitis, who is also suffering from a severe repetitive
cough followed each time by loud inspiration and
vomiting of mucous. Of the following which would you
suggest is most likely aetiological agent for causing these
symptoms ?

1) Bordetella pertussis
2) Neisseria gonorrhoeae
3) H. influenzae
4) Chlamydia pneumophila
5) Strepococcus pneumoniae
A 40 yrs old patient present complaining of acute
pharyngitis, who is also suffering from a severe repetitive
cough followed each time by loud inspiration and
vomiting of mucous. Of the following which would you
suggest is most likely aetiological agent for causing these
symptoms ?

1) Bordetella pertussis
2) Neisseria gonorrhoeae
3) H. influenzae
4) Chlamydia pneumophila
5) Strepococcus pneumoniae
In which disease would Donovan bodies be
present?

1) genital warts
2) lymphogranuloma venereum
3) Syphilis
4) granuloma inguinale
5) chancroid
In which disease would Donovan bodies be
present?

1) genital warts
2) lymphogranuloma venereum
3) Syphilis
4) granuloma inguinale
5) chancroid
 MCQ of (trachoma) .. Key word is [sandy sensation in the
eye]
All of the following is true EXCEPT ?

I. xxxxxxxxxxxxx
II. xxxxxxxxxxxxx
III. Treatment is only medical , no surgery needed
IV. xxxxxxxxxxxxx
V. Cephalosporins don’t affect the causative agent
 MCQ of (trachoma) .. Key word is [sandy sensation in the eye]
All of the following is true EXCEPT ?

I. xxxxxxxxxxxxx
II. xxxxxxxxxxxxx
III. Treatment is only medical , no surgery needed
IV. xxxxxxxxxxxxx
V. Cephalosporins don’t affect the causative agent

(laser surgery is a part of trachoma protocols .. So III is

the exception. Organism is intracellular , so cell wall
inhibitors are ineffective)
A previously normal full-term infant developed bilateral
conjunctivitis at 2 weeks of age was followed by severe
cough, but the infant remained afebrile. When the infant
was 4 weeks old, a chest X-ray showed bilateral
interstitial infilterates.
The most likely causative agent is ?

…………………………………………….
A previously normal full-term infant developed bilateral
conjunctivitis at 2 weeks of age was followed by severe
cough, but the infant remained afebrile. When the infant
was 4 weeks old, a chest X-ray showed bilateral
interstitial infilterates.
The most likely causative agent is ?

C. trachomatis , Biovar: trachoma/serovar: D-K

Ophthalmia neonatorum (neonatal conjunctivitis) is due to
either Gonococci OR Chlamydia trachomatis (biovar:
trachoma/serovar: A-C)
To differentiate :
1) Age of neonate : in the 1st week (5th day mostly) =
Gonococci
in the 2nd week ( 10th day mostly) =
Chlamydia

2) Presence of associated symptoms :

Cough or pneumonia (also known as stoccato cough) =
Chlamydia

3) If organism is possible to culture :

if repetitive culture of the agent are –ve , it is chlamydia
Case of STI .. Uretheritis or discharge , keyword
is : [ the organism fail to grow on ordinary
culture ]

Chlamydia trachomatis (biovar: trachoma/serovar:

D-K)
unlike gonorrhea ; chlamydia needs cell
culture.
A 70 years old man known to have diabetes was admitted
with pain and swelling in left ear and face. On
examination, the left ear was red, tender & sowllenthere
is a small amount of purulent discharge from the external
auditory canal and crust covering the skin. The left face
is tender & sowllen over the temporal bone. The primary
causative agent for this infection is ?
…………………………..
A 70 years old man known to have diabetes was admitted
with pain and swelling in left ear and face. On
examination, the left ear was red, tender & sowllenthere
is a small amount of purulent discharge from the external
auditory canal and crust covering the skin. The left face
is tender & sowllen over the temporal bone. The primary
causative agent for this infection is ?
Pseudomonas auriginosa
5 yrs boy, lethargy, oliguria , high blood urea and
creatinine. he had bloody diarrhea 6 days ago.

 diagnosis: ....................................................
 Causative agents (D.D) :
……………………………………………..
……………….…………………………….
 tests for condition diagnosis :
……………………………………………..
……………………………………………..
 Name a test to identify caustive agent :
………………………………………………
 Treatment : ……………………………………..
5 yrs boy, lethargy, oliguria , high blood urea and
creatinine. he had bloody diarrhea 6 days ago.

 diagnosis: hemolytic uremic syndrome (HUS)

 Causative agents (D.D) :
Vero-toxigenic E.coli O157:H7
Shigella dysentery serotype Shiga
(some times enteropathogenic E.coli & varicella virus)
 tests for condition diagnosis : 1) blood film : segmented RBCs
(schistocytes) 2) CBC : low platelet count
 Name a test to identify caustive agent : sorbitol McConkey
agar for E.coli (EHEC O157:H7 is a non sorbitol fermenter)
 Treatment : no antibiotic , only rehydration + renal dialysis
A 16 yrs old girl presented with a history of fever, severe
abdominal pain and bloody diarrhea. She used to eat a lot
of unpasteurized yogurt. She reported that diarrhea started
watery and foul-smelling 4 days ago before becoming
bloody.
Lab : Gram –ve curved rods in stool with PMNs
The following is true about this patient ?

1) Causative agent is ETEC

2) Causative agent is a retrovirus
3) Can present with neurological manifestations
A 16 yrs old girl presented with a history of fever, severe
abdominal pain and bloody diarrhea. She used to eat a lot
of unpasteurized yogurt. She reported that diarrhea started
watery and foul-smelling 4 days ago before becoming
bloody.
Lab : Gram –ve curved rods in stool with PMNs
The following is true about this patient ?

1) Causative agent is ETEC

2) Causative agent is a retrovirus
3) Can present with neurological manifestations
Case of (trachoma) .. Key word is [ sandy sensation in the
eyes ]

 What is the most likely diagnosis ?

………………………………
 Causative agent is ?
…………………………………………..
 Diagnostic tests :
……………………………………………………..
 Lines of treatment :
…………………………………………….
 Vaccine nature :
……………………………….
Case of (trachoma) .. Key word is [ sandy sensation in the
eyes ]

 What is the most likely diagnosis ?

Trachoma
 Causative agent is ?
Chlamydia trachomatis, Biovar: trachoma / serovar: A-C
 Diagnostic tests :
Indirect immunofluorescence / Gimesa or iodine stain /
McCoy cell line culture / Multiplex PCR / LCR
 Lines of treatment :
Doxycycline / Erythromycin
 Vaccine nature :
NO vaccine
Bloody diarrhea with mucous and pus cells

1) mention 4 D.D : ……....………………………….

2) Two differentiatng tests
…………………………………………………..
3) Name a neurological sequale for one of them
………………………..…………………………
4) Treatment for each : ………………………..
…………………………………………………………
…………………………….
Bloody diarrhea with mucous and pus cells

1) mention 4 D.D : cambylobacter , shigella , EHEC ,

clostridium difficle
2) Two differentiatng tests : Oxidase test / McConkey
3) Name a neurological sequale for one of them : Guillian-
Barre
4) Treatment for each : Cambylobacter : cipro /EHEC :
no / shigella : cipro / Clostridium : metronidazole or
vancomycin
TUBERCULOSIS
A patient with cough, hemoptysis, weight loss, upper right
lung lobe cavitation on X-ray .
 Diagnosis : post primary pulmonary tuberculosis
 Causative agent : mycobacterium Tb
 primary cell target of organism : macrophages
 immunological tests : In vitro: Quantiferon-TB , T-spot-TB
In vivo : mantauex test
 Drugs used : isoniazid, rifampicin, pyrazinamide, ethambutol
 you started treatment but no response ?
It is MDR, go to 2nd line :cipro,cycloserine, amikacin,
ethionamide
 how to monitor response to treatment in lab ? culture &
sensitivity , sputum ZN stain, PCR
 if the patient took drugs and becam worse ? IRIS which result
from immunity improvement with treatment.
TB vaccine :
Nature of vaccine : live attenuated
vaccine strain : M. bovis
The above patient developed sowellen painfull big
toe (gout) after starting TB treatment.
What drug caused this ?
………………………………
The above patient developed sowellen painfull big
toe (gout) after starting TB treatment.
What drug caused this ?
pyrazinamide (hyperurecimic drug)
An ICU 75 yrs old patient hospitalized for MI
care suddenly became febrile and toxic and
started to cough out sputum with blood. Chest X-
ray showed lung cavitations. The causative agent
is ?

…………………………………
An ICU 75 yrs old patient hospitalized for MI
care suddenly became febrile and toxic and
started to cough out sputum with blood. Chest X-
ray showed lung cavitations. The causative agent
is ?

MRSA
(the cavitation is due to panton-valentine
leucocidin which is a toxin lysogenized to MRSA
by a phage)
Most important virulence factor of borrelia ?
changing antigens of outer surface proteins (OSPs)

Bacterial vaginosis causative agent and

microscopic appearance ?
Gardnerella vaginalis / clue cells

7 yrs old child presents with diarrhea of few liters

per day with rice water consistency. The organism
is able to lyse sheep blood. What is the agent’s
specific type ?
vibrio Cholerae : El-Tor
 Notes about ..

E. Coli
 E. coli strains that causes UTI are known to have a unique
toxin. What is it ?
Hemolysin

 E.coli O157:H7 are grown on special culture. Describe it ?

Sorbitol McConkey agar : non sorbitol fermenter (unlike
other strains)

 E. coli that causes neonatal meningitis characterized by ?

K1 capsule

 Structural feature that make certain E. coli strains able to

cause UTI among other strains ?
Pili that bind Gal-Gal receptors in bladder
 Urinary Tract Infection
UTI is two types ..
A. Cystitis : urinary bladder infection.
(dysuria, urgency, frequency)

B. pyelonephritis: renal pelvis infection.

(fever, chills, flank pain )
if pyelonephritis is complicated by stone ; pain will
radiate to umbilicus.
 70 Years old man had dysuria, urgency and frequency
which had progressed 2 weeks later to with new
symptomps of fever, chills and flank pain radiating to
umbilicus. The most likely causative agent is ?
…………………………….
 70 Years old man had dysuria, urgency and frequency
which had progressed 2 weeks later to with new
symptomps of fever, chills and flank pain radiating to
umbilicus. The most likely causative agent is ?
Proteus

( it is the most vigorous motile bacteria, so rapidly ascend

from bladder to kidneys).

WHY stones ?
A 5 yrs old child brought to paediatric clinic complaining
of bloody diarrhea for 2 days.

 Possible bacterial causes ?

……………………………………………………….
 Stool specimen is collected, describe its possible
microscopic findings :
………………………………………………………..
 Name a selective 2 media for 2 organisms and describe
them :
…………………………………………………………
A 5 yrs old child brought to paediatric clinic complaining
of bloody diarrhea for 2 days.

 Possible bacterial causes ?

cambylobacter , shigella , EHEC , clostridium difficle
 Stool specimen is collected, describe its possible
microscopic findings :
G-ve curved rods/ G-ve rods / G+ve rods
 Name a selective 2 media for 2 organisms and describe
them :
XLD : salmonella is black / McConkey : shigella is
pale
 If The above patient developed renal failure a week
later ..
I. What would be the organism ? ...................................
II. What other findings expected in this case ?
……………………………………………………
III. Causative agent Selective media ?
……………………….
IV. Best antibiotic in this case ?
……………………………………………………….

 If the patient got an autoimmune disease.

I. Name it ? …………………………………..
II. Causative agent ? …………………………….
 If The above patient developed renal failure a week
later ..
I. What would be the organism ? EHEC (E.coli O157:H7)
II. What other findings expected in this case ?
Thrombocytopenia & schistocytes
III. Causative agent Selective media ? sorbitol McConkey
agar
IV. Best antibiotic in this case ? No antibiotic (kidneys are
shut off)

 If the patient got an autoimmune disease.

I. Name it ? Guillian-Barre syndrome
II. Causative agent ? Campylobacter jejuni
A man was jogging in a gym steped on a nail.
He took a tetanus booster. The second day he
presented with sowllen foot.

Diagnosis : ………………………….
Causative agent : ………………………..
Source of infection : …………………………..
two important cultures :
………………………………..
…..
……………………………
treatment : …………………………………..
A man was jogging in a gym steped on a nail.
He took a tetanus booster. The second day he
presented with sowllen foot.

Diagnosis : Osteochondritis
Causative agent : Pseudomonas auriginosa
Source of infection : sweat between nails
two important cultures : nutrient agar (green) &
McConkey (colourless)
treatment : pipracillin + tobramycin
A 30 years old hospitalized cystic fibrosis patient manifests with
low grade fever, non productive cough, dyspnea , pleuritic chest
pain. Lobar pneumonia is seen on X-ray examination.

 most likely causative agent :

……………………………..
 Mention 5 general risk factor predispose to infection by this
agent :

…………………………………………………………………
……………………………
 Mention 2 virulence factors :
………………………………………………..
 What is the most important therapeutic feature of this agent ?
………………………………………………..
A 30 years old hospitalized cystic fibrosis patient manifests
with low grade fever, non productive cough, dyspnea ,
pleuritic chest pain. Lobar pneumonia is seen on X-ray
examination.

 most likely causative agent :

Pseudomonas auriginosa
 Mention 5 general risk factor predispose to infection by this
agent :
1) chronic granulomatous disease 2) cystic fibrosis 3)
burn 4) hospitalization 5) diabetes
 Mention 2 virulence factors :
1) slime layer (glycocalyx)
2) exotoxin that inhibit protein synthesis by
inhibiting EF-2
For the patient above; mention one example for drugs
used to treat the condition for each family:

Penicillins : ………………………
Cephalosporins : ……………………..
Aminoglycosides : …………………………
For the patient above; mention one example for drugs
used to treat the condition for each family:

Penicillins : pipracillin
Cephalosporins : cefepime
Aminoglycosides : tobramycin
A 24-hour old infant develops ophthalmia neonotorum.
Which of the following statements about this infection is
false ?

1) The organism is acquired by the neonate during passage

through the birth canal
2) Pili are important in the adherence of this organism to
susceptible mammalian cells
3) The disease can be prevented by instilling antibiotic or
silver nitrate into the eyes of the newborn
4) Immunity in infants is associated with transplacental
transfer of protective antibodies from mother to infant
5) The organism can grow on Thayer-Martin medium
A 24-hour old infant develops ophthalmia neonotorum.
Which of the following statements about this infection is
false ?

1) The organism is acquired by the neonate during passage

through the birth canal
2) Pili are important in the adherence of this organism to
susceptible mammalian cells
3) The disease can be prevented by instilling antibiotic or
silver nitrate into the eyes of the newborn
4) Immunity in infants is associated with transplacental
transfer of protective antibodies from mother to infant
5) The organism can grow on Thayer-Martin medium
A newborn was delivered at home without a
qualified nurse. Umbilical cord was cut with
kitchen shears. He was initially well, then at the
3rd week to have involuntary muscle spasms
aggrevated by noise and light, know he has
general contraction and difficulty in breathing.
 Most likely diagnosis : …………………..
 Source of infection : ………………………….
 Mechanism of disease (pathogenesis) :
…………………………………………………
 Three characteristics of causative agent :
………………………………………………..
 Nature of vaccine : …………………
 antibiotics : ………………………
 Non medical (supportive) management :
……………………………………………………………
………………………………
 Most likely diagnosis : tetanus neonatorum
 Source of infection : unpasteurized knife
 Mechanism of disease (pathogenesis) :
tetanus toxin is a protease breaks down mediators of the release of
inhibitory neurotransmitters leading to overactive LMNs
 Three characteristics of causative agent :
1) G+ve rod 2) anaerobe 3) spore forming
 Nature of vaccine : Toxoid
 antibiotics : penicillin G & metronidazole
 Non medical (supportive) management :
1) respiratory support
2) wound debridement
3) isolate from noise and light
4) antitoxin (immunoglobulins)
5) sedation with diazepam
burn patient, developed swelling with green discharge with a
characteristic smell.
 Diagnosis : ………………………………………..
 charactistic features of causative agent :
………………………………………………
 How to confirm lab diagnosis ?
1. specimen : ………………….
2. Microscopy : ………………………….
3. culture :
………………………………………………………………
………………………………..
4. biochemical tests :
……………………………………………………………..
Treatment : ………………………………
burn patient, developed swelling with green discharge with a
characteristic smell.
 Diagnosis : psudomonas auriginosa wound infction
 charactistic features of causative agent :
strict aerobe (oxidase+) , catalase+ , motile.
 How to confirm lab diagnosis ?
1. specimen : swab
2. Microscopy : G-ve rods with flagella
3. culture : nutrient agar (green colour , grape like smell due to
aminoacetaphenol production) , McConky agar : pale
colonies because no lactose fermentation.
4. biochemical tests :
oxidase +ve & sugar fermentation is –ve (no fermentation)
& motility +ve
Treatment : pipracillin + tobramycin
SHORT NOTES
Difference between conventional & REAL time
PCR ?
no amplicon carry over in REAL because container is not
opened until the end of reaction avoiding contamination.
Unlike conventional PCR

Best specimen for legionella screening tests ?

Urine antigens

M protein and teichoic acid of S. pyogenes are

located on ?
Pili
Insect that transmits relapsing fever ?
body louse

Insect that transmits lyme ?

Ixodes (hard) ticks

Bacteria associated with ascending paralysis

(Guillian-Barre) ?
Campylobacter & Mycoplasma

What can increase staphylococcus aureus

virulence ?
Entero Toxigenic E. coli receptors in ?
Small intestine, but NOT the large intestine/colon.

Erythema multiforme (target shaped /bull’s eye

rash) causes ?
Mycoplasma & sulfonamides (Co-trimoxazole)
Cardiovascular complications of tertiary
syphilis :

I. Thoracic Aortic aneurysm

II. Aortic valve inssufficiency
III. Stenosis (or occlusion) of coronary orifices
IV. Obliterating endarteritis of vasa vasorum
Notes in ..

ANTIBIOTICS
Cephalosporins have no activity against the
following organisms (MALE) :

 M: for MRSA
 A: for Atypical bacteria (mycoplasma,
chlamydia, rickettsiae)
 L: for Listeria
 E: for Enterococci
A microbiology laboratory reports that there are two
Staphylococcus aureus strains in the Medical Intensive Care
Unit. Strain A has an MIC of 25 micrograms/mL for
methicillin while strain B has an MIC of 75micrograms/mL
for methicillin. Which strain will be easier to treat with
methicillin?

1) strain A
2) strain B
3) Neither, because methicillin does not have an MIC since it
is bactericidal
4) Neither, S. aureus is always naturally resistant to
methicillin
5) Neither, because the MIC has no bearing on treatment in
patients, it is strictly an in vitro effect
A microbiology laboratory reports that there are two
Staphylococcus aureus strains in the Medical Intensive Care
Unit. Strain A has an MIC of 25 micrograms/mL for
methicillin while strain B has an MIC of 75micrograms/mL
for methicillin. Which strain will be easier to treat with
methicillin?

1) strain A
2) strain B
3) Neither, because methicillin does not have an MIC since it
is bactericidal
4) Neither, S. aureus is always naturally resistant to
methicillin
5) Neither, because the MIC has no bearing on treatment in
patients, it is strictly an in vitro effect
If you added clavulanic acid to a growing culture
of bacteria, what would happen?

1) Protein synthesis would stop

2) DNA would become less supercoiled
3) The membrane would be disrupted
4) Folic acid would not be synthesized
5) None of the above
If you added clavulanic acid to a growing culture
of bacteria, what would happen?

1) Protein synthesis would stop

2) DNA would become less supercoiled
3) The membrane would be disrupted
4) Folic acid would not be synthesized
5) None of the above
What is the mode of resistanse to Vancomycin in
staph and enterococci ?
changing drug binding site from D-alanyl-D-alanyl to be
D-alanyl-D-lactate

Drug of choice for pseudomonas ?

pipracillin + tobramycin

 Ototoxic & nephrotoxic antibiotics ?

Aminoglycosides

2nd line drug for gonorrhea ?

Spectiomycin
Anti-pseudomonal drugs :
only 7 classes are effective aginst it ..

1. penicillins : pipracillin or ticarcillin

2. aminoglycosides : tobramycin or gentamicin
3. cephalosporin : 4th gen: cefepime (OR 3rd gen:
ceftazidime/cefoperazole)
4. floroquinolones : ciprofloxacin
5. carbapenem : meropenem
6. monobactam : aztreonam
7. polymixin E or B
 side effects of TB medication :

isoniazid : hepatotoxic, peripheral neuropathy,

lupus-like symptoms
Pyrazinamide : hepatotoxic, hyperurecimia (gout)
Rifampicin : hepatotoxic, red orange discoloration
of skin & secretions
Ethambutol : hepatotoxic, retrobulbar optic
neuritis, colour blindness(green-red colours)
Mechanism of action of
 Ceftriaxone :
cell wall synthesis inhibitor by inhibiting transpeptidase
preventing peptidoglycan cross- linking. ( should right it as
such to get full mark)

 Imipenem/cilastatin :
Imipenem : cell wall synthesis inhibitor by inhibiting
transpeptidase preventing peptidoglycan cross- linking.
cilastatin : protect imipenem from dehydropeptidase
enzyme in the kidney to stop its degradation.

 Amoxicillin/clavulanic acid :
Amoxicillin : cell wall synthesis inhibitor by
inhibiting transpeptidase preventing peptidoglycan cross-
 Co-Trimoxazole ( trimethoprim/sulphamethoxazole) :
Trimethoprim : inhibits dihidrofolate reductase thus
inhibits THF production thus inhibit purines & thymidine
synthesis
Sulphamethoxazole : inhibit folic acid synthesis

 Doxycycline : inhibit protein synthesis by binding 30s

subunit preventing aminoacyl tRNA from binding to
‘Acceptor’ site
Drugs for :
I. Neonatal meningitis : ……………………….
II. Tuberculoid leorosy : ……………………….
III. S. aureus food poisoning : ………………
IV. Pneumococcal pneumonia : ………………..
V. Lepromatous leprosy : ……………………………….
VI. Brucellosis : ………………………………..
VII. Syphilis : …………………………….
VIII. Acute rheumatic fever : ……………………
IX. Hemolytic-Uremic syndrome : ………………..
X. Acute post-streptococcal glomerulonephritis : …………..
XI. Pseudomembranous colitis : …………………………….
XII. Otitis media : ……………………….
Drugs for :
I. Neonatal meningitis : Ampicillin (common for the 3 bacteria)
II. Tuberculoid leorosy : dapsone + rifampicin
III. S. aureus food poisoning : no drug
IV. Pneumococcal pneumonia : penicillin G
V. Lepromatous leprosy : dapsone + rifampicin + clofazimine
VI. Brucellosis : doxycycline + rifampicin (6 weeks)
VII. Syphilis : benzathine penicillin
VIII. Acute rheumatic fever : benzathine penicillin
IX. Hemolytic-Uremic syndrome : no drug
X. Acute post-streptococcal glomerulonephritis : no drug
XI. Pseudomembranous colitis : oral vancomycin then
metronidazole
XII. Otitis media : amoxicillin
Fill in the gabs :
 Imipenem is an antibiotic that belongs to (cell wall) class of
(carbapenem) family. It is given in combination with
(cilastatin) to inhibit (renal dehydropeptidase enzyme) which
is responsible for (imipenem inactivation) but has no
antibacterial activity.

 Aztreonam belongs to (monobactam) family and is inactive

against (anaerobes) and (gram positive bacteria)

 The drugs (…) and (primaquine) causes hemolytic episode in

G6PD deficient patients.
(sulphamethoxazole or Co-trimoxazole or sulphonamide
are the same answers)
Aminoglycosides (especially streptomycine) have
a common side effect of being neurotoxic, because
they act (in high toxic doses) as botulinum toxin
inhibiting Ach release.. So the commonly
considered as iatrogenic cause of myasthenia
gravis.
 MICROBIAL GENETICS

A. Transformation :
Acquiring genes (DNA) from environment by a bacterium.
A bacterium able to acquire genes in that way is called
competent cell.

Competent cells are :

I. S. pneumoniae
II. N. gonorroheae
III. H. influenzae
IV. H. pylori
B. Transduction :
acquiring genes through bacteriophage (lysogenization).

Lysogenized genes are : (ABCDE + PV)

I. A : Shiga-like toxin A of E.coli (hemolytic-uremic
syndrome)
II. B : Botulinum toxin
III. C : Cholera toxin
IV. D : diphtheria toxin
V. E : Erythrogenic toxin of S. pyogenes (scarlet fever)
VI. PV : Panton-Valentine leukocidin toxin (MRSA, necrotizing
pneumonia in ICU pts.)
MYCOLOGY
Seven days after eye trauma, Ali came with pain,
conjunctivitis and visual blurring. Diagnosis was
endophthalmitis due to aspergillus fumigatus. Which of
the following is NOT correct about cuasative agent ?

1) Thermotolerant
2) Forms blue-green colonies
3) Has a propensity to invade blood vessels
4) Dimorphic fungus
5) Sensetiv to voriconazole
Seven days after eye trauma, Ali came with pain,
conjunctivitis and visual blurring. Diagnosis was
endophthalmitis due to aspergillus fumigatus. Which of
the following is NOT correct about cuasative agent ?

1) Thermotolerant
2) Forms blue-green colonies
3) Has a propensity to invade blood vessels
4) Dimorphic fungus
5) Sensetiv to voriconazole
Which of the following drugs cannot be used for
treatment of infections caused by Candida?

1) Amphotericin B
2) Itraconazole
3) Flucytosine
4) Griseofulvin
5) Mycostatin
Which of the following drugs cannot be used for
treatment of infections caused by Candida?

1) Amphotericin B
2) Itraconazole
3) Flucytosine
4) Griseofulvin
5) Mycostatin
A 3 yrs old child brought to paediatric clinic with history
of recurrent white thick plaques on buccal mucosa,
tongue and had difficulty in swallowing , skin lesions and
onychomycosis. Investigations showed
hypoparathyroidism. This child has :

1) Dermatophytosis
2) Oropharyngeal candidiasis
3) Chronic mucocutaneous candidiasis
4) Candida onychia
5) Candida eosophagitis
A 3 yrs old child brought to paediatric clinic with history
of recurrent white thick plaques on buccal mucosa,
tongue and had difficulty in swallowing , skin lesions and
onychomycosis. Investigations showed
hypoparathyroidism. This child has :

1) Dermatophytosis
2) Oropharyngeal candidiasis
3) Chronic mucocutaneous candidiasis
4) Candida onychia
5) Candida eosophagitis
Fatima is a diabetic patient who live in Gezira came
complaining of headache, right unilateral proptosis and
facial tenderness of 3 months duration. She was suspected
to have chronic sinusitis. Sinus puncture was done and
revealed thick dark clay-coloured discharge. The most
likely causative agent is :

1) Pseudomonas auriginosa
2) Mucor
3) Aspergillus
4) Prevotella melaninogenica
5) H. influenzae type B
Fatima is a diabetic patient who live in Gezira came
complaining of headache, right unilateral proptosis and
facial tenderness of 3 months duration. She was suspected
to have chronic sinusitis. Sinus puncture was done and
revealed thick dark clay-coloured discharge. The most
likely causative agent is :

1) Pseudomonas auriginosa
2) Mucor
3) Aspergillus
4) Prevotella melaninogenica
5) H. influenzae type B
The following disease is caused by dermatophytes

1) White piedra
2) Tinea nigra
3) Pityriasis versicolor
4) Kerion
5) Black piedra
The following disease is caused by dermatophytes

1) White piedra
2) Tinea nigra
3) Pityriasis versicolor
4) Kerion
5) Black piedra
Following use of intrauterine device (IUD) a
female experienced unusual vaginal discharge for
6 months. When removed, the IUD was covered
with yellowish discharge. Which of the following
is most likely to be cultured from the IUD?

1) Candida albicans
2) Chlamydia trachomatis
3) Actinomyces israeli
4) Neisseria gonorrhoea
5) Nocardia asteroids
Following use of intrauterine device (IUD) a
female experienced unusual vaginal discharge for
6 months. When removed, the IUD was covered
with yellowish discharge. Which of the following
is most likely to be cultured from the IUD?

1) Candida albicans
2) Chlamydia trachomatis
3) Actinomyces israeli
4) Neisseria gonorrhoea
5) Nocardia asteroids
Which of these fungal infection requires topical drugs
only ?

1) Tinea capitis
2) Recurrent tinea pedis
3) Tinea unguum
4) Tinea corporis
Which of these fungal infection requires topical drugs
only ?

1) Tinea capitis
2) Recurrent tinea pedis
3) Tinea unguum
4) Tinea corporis
Dry skin lesion wiyh hypopigmentation.
Organism is grown in medium rich in lipids, and
microscopy is described as [fungal hyphae and
cluster of spores].

I. Diagnosis : ……………………….
II. Causative agent : …………………….
III. Special growth requirement for agent :
……………
IV. Treatment : …………………………
Dry skin lesion wiyh hypopigmentation.
Organism is grown in medium rich in lipids, and
microscopy is described as [fungal hyphae and
cluster of spores].

I. Diagnosis : tinea versicolor ( pitryosis)

II. Causative agent : Malassezia furfur
III. Special growth requirement for agent : Lipids
IV. Treatment : selenium sulfide ointment
A patient who had undergone bone marrow
transplant and experienced neutropenia for 6
weeks is very likely to get:

1) Mucormycosis
2) Blastomyces pneumonia
3) Candida albicans thrush
4) Invasive Aspergillosis
5) Cryptococcus neoformans meningitis
A patient who had undergone bone marrow
transplant and experienced neutropenia for 6
weeks is very likely to get:

1) Mucormycosis
2) Blastomyces pneumonia
3) Candida albicans thrush
4) Invasive Aspergillosis
5) Cryptococcus neoformans meningitis
Which of the following statements about
macroconidia is false?

1) Large & multicellular

2) They are asexual spores
3) Are formed by deutromycetes
4) Are important in the identification of
dermatophytes
5) Can be seen directly in pathological specimens
Which of the following statements about
macroconidia is false?

1) Large & multicellular

2) They are asexual spores
3) Are formed by deutromycetes
4) Are important in the identification of
dermatophytes
5) Can be seen directly in pathological specimens
Treatment for Allergic Bronchopulmonary
Aspergillosis is

1) amphotericin B
2) Fluconozole
3) Penicillin
4) Corticosteroids
5) ivermectin
Treatment for Allergic Bronchopulmonary
Aspergillosis is

1) amphotericin B
2) Fluconozole
3) Penicillin
4) Corticosteroids
5) ivermectin
The anthropophilic group of dermatophytes 

1) cause inflammatory lesions that may heal

spontaneously
2) cause chronic, difficult to cure, infections
3) are a well-known cause of mycetoma
4) are associated with cats and dogs
5) include Microsporum gypseum
The anthropophilic group of dermatophytes 

1) cause inflammatory lesions that may heal

spontaneously
2) cause chronic, difficult to cure, infections
3) are a well-known cause of mycetoma
4) are associated with cats and dogs
5) include Microsporum gypseum
A patient with a fungal infection is treated with
an azole-class Peptide bond formation by
ribosomes.

1) One-carbon metabolism
2) Fatty acid synthesis
3) DNA replication
4) Ergosterol synthesis
5) None of the above
A patient with a fungal infection is treated with
an azole-class Peptide bond formation by
ribosomes.

1) One-carbon metabolism
2) Fatty acid synthesis
3) DNA replication
4) Ergosterol synthesis
5) None of the above
Which antifungal known to cause renal
impairment (nephrotoxic)?

Amphotericin B
Which paranasal sinus is more prone to get sinus
aspergillosis?

Maxillary sinus
Mechanism of Griseofulvin action :

bind keratin of the healthy tissue, thus

protect it from dermatophyte invasion.
GOOD LUCK