URINE SECTION - QUESTIONS
1. What are the constituents of Cled agar and what is it used for?
What is the purpose of Andrade’s indicator?
2. Why is Isosensitest Agar used for sensitivity testing?
3. How would you deal with a urine sample, which had:
(i) No name on it?
(ii) Was leaking?
4. When would you not go ahead with processing a urine sample?
5. Which type of casts might you find in a urine microscopy and what is their significance?
6. Do you understand by the term ‘Dysmorphic Red Cells’ and how would you process a
urine
sample for these?
7. Name the antibiotics and disc strengths found in the Urine Disc Dispenser.
8. How should Augmentin discs be controlled (i.e. which organism and why?)? How would
you control other discs?
9. What extra test would you do on a presumptive Strep from a urine?
10. What extra test(s) would you perform on a Staph from a urine sample?
11. What is the characteristic sensitivity pattern for:
(i) Enterococcus Faecalis
(ii) Pseudomonas aeruginosa
(iii) Klebsiella species
(iv) Proteus species
12. What do you understand by COSHH regulations?
What is the COSHH Assessment for Boric Acid?
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URINE QUESTIONS
1. What is the correct procedure for collection of a urine sample for microbiological examination?
2. On microscopy, which cells and structures might indicate the presence of infection or renal
disease?
3. Which microbiological media are used for urine culture?
4. By what methods should urine samples ideally be plated in order to perform counts?
What is a significant count?
5. What is the main causative organism in ‘UTIs’?
6. What does the term ‘pyelonephritis’ mean and why is this type of infection more
significant?
7. Why is UTI significant in children?
8. Which organism might be considered as a cause of sterile pyuria?
9. What is meant by ‘covert’ bacteria?
10. What number of organisms is counted as “significant”?
What factors might affect this count and how can they be minimised?
11. What is the most common type of hospital acquired urinary tract infection?
12. What steps should be taken to avoid contamination of catheters and therefore samples
taken from them? Where should the specimen be taken from?
13. What type of infection may occur as a result of?
(i) Indwelling catheters
(ii) Instrumentation
(iii) Surgery
14. How would you identify the following organisms on urine agars?
(i) E. coli
(ii) Proteus mirabilis
(iii) Pseudomonas aeruginosa
(iv) Haemolytic streptococci
(v) Klebsiella species
(vi) Staph.saprophytiars
(vii) Salmonella species
(viii) Lactobacilli
(ix) Yeasts
15. What does the abbreviation MSSU stand for?
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16. What is the significance of Boric Acid containers and what is the final concentration of
Boric
Acid obtained?
17. What is the significance of seeing epithelial cell in urine?
18. Which of these is a lactose fermenter:
(i) E.coli
(ii) Enterococcus faecalis
(iii) Proteus species
(iv) Pseudomonas aeruginosa
19.Explain the method of counting bacteria in urine?
20.What do these terms stand for?
(i) Dysuria
(ii) Pyelonephritis
(iii) Cystitis
(iv) Enuresis
(v) Renal calculi
21.Explain the purpose of clavulanic acid in the amoxy-clavulanic acid combination?
22.Which of the following antibiotics are available in oral preparations:
(i) Ampicillin
(ii) Nalidixic Acid
(iii) Nitrofurantoin
(iv) Netlimicin
(v) Ciprofloxacin
23.Explain why Staphylococcus species may be acutely resistant to Ampicillin even although
a
zone is produced.
24.Which bacterial pathway does Trimethoprim and Sulphonamide act upon?
25. State 5 factors that may affect sensitivity tests.
26. Which organism is most frequently associated with renal calculi?
27.Explain why insufficient and non-boric acid urines are unacceptable.
BLOOD CULTURE QUESTIONS
1. What are the constituents of the media used in Bact Alert Blood Culture Bottles?
2. What is the principle behind the detection method for positive blood cultures?
3. What are the algorithms for detection of positive bottles on the system?
4. What is the procedure for dealing with bottles, which are already positive (yellow) on arrival
at lab?
5. How would you proceed if no organisms were seen in the Gram Film from a Blood
Culture?
6. Why is it important to look for the results of other specimens from the patient with a
positive blood culture to be assessed?
7. What type of organisms might you expect to isolate from an immunosuppressed patient?
8. What type of surgery might pre-dispose a patient to Gram negative septicaemia? What is
important about the cell wall of Gram negative bacteria in relation to “shock” in patients?
9. What should you do if you have a suspected Strep pneumoniae isolated from a blood
culture?
10. What would be the clinical picture in a patient with suspected meningococcal
septicaemia?
What would be the treatment of choice?
11. Which organism should you consider on seeing Gram negative bacilli in an anaerobic
bottle?
What tests should be put up?
12. Why is a chocolate plate included when subculturing blood cultures?
13. Which organisms should be considered as significant in a suspected case of sub-acute
bacterial endocarditis? How often should sets of blood cultures be taken?
14. When is the optimum time for sampling for blood cultures?
15. What would be the likely organism in blood cultures: a) Gram positive ‘bunches of grapes’ – aerobic
b) Gram positive bacilli in anaerobic bottle
c) Gram negative diplococci – aerobic
d) Gram negative bacilli, gassy - both bottles
e) Gram positive diplococci, capsules present – both bottles
16. What ‘Stokes Antbiotic Sensitivity pattern’ obtained first day from a blood culture might indicate a
possible ESBL?
17. Name some conditions that may cause persistent Septicaemia?
18. What volume of blood should be inoculated into:
I. Adult blood cultures
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II. Paediatric blood cultures
19. Which types of organisms may cause serious infections in neonates?
20. What antibiotic therapy should be started if infection with MRSA is suspected?
21. From what sources might a Staph aureus septicaemia occur?
22. Why is it important to process blood culture positives as soon as possible?
23. How should you subculture a positive bottle from a patient with a blood borne virus?
III. QUESTIONS - ANTIBIOTICS
MCQ
CHEMOTHERAPY – MULTIPLE CHOICE (and Anitbiotic resistance)
1. Which of the following affect the cell wall?
a) Penicillin
b) Polymyxin
c) Rifampicin
d) Clindamycin
e) Vancomycin
2. Which of the following are synergistic combinations?
a) Gentamicin and Carbenicillin
b) Penicillin and Streptomycin
c) Sulphonamide and Trimethoprim
d) Cefotaxime and Tobramycin
e) Penicillin and Tetracycline
3. Which of the following are aminoglycosides?
a) Netlimicin
b) Aureomycin
c) Spiramycin
d) Minocycline
e) Oleandomycin
4. Chloramphenicol is formed by: a) Streptomyces coelicolor
b) Streptomyces venezuelae
c) Streptomyces nodosus
d) Streptomycesgriseoflavis
e) Streptomyces flaveolus
5. Gentamicin is formed by: a) Micromonospora parvia
b) Streptomyces grideus
c) Streptomyces aureofaciens
d) Micromonospora purpurea
e) Bacillus polymyxa
6. Two components of CO-trimoxazole are: a) Polymyxin B
b) Sulphamethoxazole
c) Metronidazole
d) Nitrofurantoin
e) Trimethoprim
7. Which of the following are anti-fungal agents?
a) Nytratin
b) Amphotericin B
c) Flucytosine
d) Clotrimazole
e) Griseofulvin
8. Which of the following antibiotics can be incorporated into the media to aid the
isolation of Neiserria spp?
a) Cotrmoxazole
b) Lincomycin
c) Polymyxin
d) Tetracycline
e) Trimethoprim
9. Bacteroides fragilis is typically: a) Relatively sensitive to Penicillin
b) Relatively resistant to Penicillin
c) Sensitive to Aminoglycosides
d) Resistant to Aminoglycosides
e) Resistant to Vancomycin
10. A routine disc antibiotic sensitivity test produces results unexpected for the
species tested, which of the following factors should be investigated?
a) PH of the medium
b) Concentration of antibiotics in the discs
c) Molecular weight of the antibiotic
d) Size of the inoculum
e) Speed of diffusion of the antibiotic through the agar
11. On which media would Strep. pyogenes grow?
a) Neomycin blood agar
b) Gentamicin blood agar
c) Isosensitest agar
d) MacConkey agar
e) Nalidixic acid
12. Which of the following are plasmid mediated?
a) β-lactamase production in Staph aureus
b) Resistance of Pseudomonas spp to Chloramphenicol
c) F (fertility) factor in E. coli
d) Resistance of Mycoplasmas to penicillin
e) β-lactamase production in N.gonorrhoea
13. Which organisms are generally expected to be resistant to Penicillin?
a) Strep pyogenes
b) Strep faecalis
c) Pasteurella multocida
d) E. coli
e) N. gonorrhoea
14. Which antibiotics are likely to be effective in the treatment of gonorrhoea?
a) Penicillin
b) Trimethoprim
c) Spectinomycin
d) Vancomycin
e) Erythromycin
15. Which of the following are true of antibiotics in selective medium for N.gonorrhoea?
a) Vancomycin is added to inhibit Gram + bacteria
b) Lincomycin is added to inhibit Gram – bacteria
c) Trimethoprim lactate inhibits swarming Proteus
d) Colistin sulphate inhibits Gram – bacteria
e) Colistin sulphate inhibits Gram + bacteria
16. The normal pattern of a sensitive strain of Pseudomonas spp would be sensitive to: a) Chloramphenicol
b) Penicillin
c) Erythromycin
d) Gentamicin
e) Vancomycin
17. Which are described as drug tolerance?
a) β-lactamase production
b) Insusceptible metabolism
c) Failure of absorption of the drug
d) Failure of penetration of the drug
e) Drug destroying organisms
18. Penicillinases: a) Act in two main ways – amidases and β-lactamases
b) The amidase is the most important
c) Are only produces by Staph aureus
d) β-lactamase is responsible for opening the β-lactam ring
e) Are inactivated by Cephalosporins
19. To assay gentamicin in the presence of fucidin by plate diffusion would it be
advantageous to: a) Use an enterobacteriaceae as the control organism
b) Increase the PH of the medium to 8.0
c) Add β-lactamase to the sample
d) Use the Oxford Staph aureus as the control organism
e) Lower the PH of the medium to 6.0
20. The following factors affect results of antibiotic sensitivity tests by disc diffusion:a) Medium
b) Inoculum
c) Disc content
d) Prediffusion
e) Length of incubation
III ANTIBIOTICS
1. Explain the principles of Stokes sensitivity method. What factors can affect results.
2. Compare the advantages and disadvantages of Parental versus Oral therapy.
3. Give 2 examples of antibiotics affecting:
a) Cell wall
b) Metabolic synthesis
c) DNA synthesis
4. Give 2 examples of the following resistance mechanisms
a) Natural resistance
b) Acquired resistance
5. Define the following terms:
a) M.I.C.
b) M.B.C
6. Explain the principles of the Vitek
7. Explain how the Vitek detects ESBL antibiotic
8. Give one example causing the following:
a) Renal toxicity
b) Liver toxicity
c) Bone marrow toxicity
d) Skin reactions
9. Give 4 examples of gene transfer
10. Explain the principles of E test.
SEROLOGY QUESTIONS
1. Why is it important to monitor Gentamicin and Vancomycin levels?
2. Explain the theory behind the method used for Gentamicin and Vancomycin estimations.
3. What is the significance of a raised ASO titre?
4. What is the primary immune response?
5. What is the significance of date of onset and/or contact when investigating viral infections?
6. What disinfectants are suitable for virus inactivation?
7. Explain the following tests:
(i) T.P.H.A
(ii) T.P.I.
(iii) F.T.A.
8. What infections are antenatal bloods commonly screened for and why
VI. CAT 3 QUESTIONS
1. What is the reason for putting optochin (opt) and bacitracin (B) discs on sputum culture plates?
2. Why do we test for beta-lactamase production in H.influenzae isolates?
3. What are the commonest pathogens isolated from the sputa of cystic fibrosis patients?
4. Why should a Bronchoaleolar lavage be processed immediately upon arrival in the lab?
5. How can H.influenzae and H. parainfluenzae be distinguished from each other?
6. What are the most common causes of lower respiratory tract infections?
Not all are culturable in our lab, what alternative would be performed?
7. What is the significance of seeing epithelial cells in a sputum gram stain?
8. When should an albicans plate be added to a sputum culture?
A) How would you check that the cabinet in Cat 3 room was functioning properly?
c) What action would you take if the alarm sounded during use?
9. What is the COSHH assessment for auramine phenol stain?
10. What extra culture should be added if the patient has a history of bronciestasis and why?
11. How should a tissue sample be processed?
12. When might a coliform be significant when isolated from sputum?
13. How would you process a CSF sample for cryptococcus?
14. On which samples might you include a differential stain?
15. Which fungal agents may be implemented in respiratory infection and in which groups of
patients?
GENITAL QUESTIONS
1. What organisms would be regarded as normal flora in
I. Pre-pubertal girl
II. Post menopausal women
2. Which parasitic species (arthropods) can cause genital infections and how would you
identify these species?
3. Which viral species can cause sexually transmitted infections?
4. Which disease or syndromes may be associated with Chlamydial infection?
5. Which organism causes syphilis? How could you demonstrate presence of this organism
(or antibodies) in the lab? (name at least one specific and one non-specific test)
6. How would you go about identifying a suspected culture of N. gonorrhoea? Where in the
body might it cause infection?
7. Which types of organisms are implicated in Pelvic Inflammatory disease?
8. What is the causative agent (& toxin) in Toxic Shock Syndrome?
9. What is the significance of isolating a Group B Strep from an antenatal woman?
10. What are the selective agents used in culture media for the isolation of
I. N. gonorrhoea
II. Actinomyces spp
11. What is the principle behind acridine orange staining?
12. Which other diseases may be caused by Treponema species?
13. What neonatal infection can be caused by
I. N. gonorrhoea
II. Listeria monocytogens
III. Chlamydia trachomatis
14. Which mycoplasma species can cause infection in the genital tract – how could you
identify these species?
15. How could you proceed in identifying a suspected Actinomycete infection in an IUCD?
16. What are the pre-disposing factors for genital infections caused by yeasts?
17. How could you diagnose a suspected T.vaginalis case?
18. Which species are found in cases of Bacterial Vaginosis?
How would these organisms look in
I. Gram Stain
II. Acridine orange stain
What is the significance (if any) of culturing anaerobes from these samples and which
anaerobic species and commonly found?
19. When would
I. Anaerobes
II. Coliforms
Be significant in a HVS?
20. How would you identify a suspected Listeria monocytogenes culture and what would be a
likely clinical history?
21. When might
I. Haemophilus species
II. Pneumococci
Be significant in HVS?
22. Which organism commonly isolated from genital samples will fluoresce brick red under
UV light?
23. Which additional investigations would you consider on a sample of pus from a case of
Salpingitis?
24. What is the COSHH/Risk Assessment for
I. Acridine orange stain
II. Phadebact Monoclonal test
25. What would you do with an acridine slide showing moderate/numerous pus cells?
VIII. PARASITOLOGY – SHORT ANSWER QUESTIONS
1) Which categories of specimens should be examined for parasites in the lab?
2) What is the purpose of using concentration techniques?
3) What is the most common parasite seen?
4) Which parasites would you request a urine specimen for rather than a faeces sample?
5) Which objects commonly seen in wet preparations may be mistaken for parasites?
6) By which methods may Cryptosporidium cysts be strained?
7) In which areas of the world is Ascaris (roundworm) infection to be found and what is the
mode of transmission/
8) In which areas of the world is Schistosomiasis infection to be found? How many different of
Schistosome are there?
9) How useful is size of the parasite in identification and how should this be accurately measured?
10) What is the correct method for detection of threadworm infection?
PARASITOLOGY – MULTIPLE CHOICE
1. Which of the following is true of the threadworm?
a) Toxonomical name is Trichuris trichina.
b) Adult worms can be collected about the anus at night.
c) Examination of faeces for eggs is usually positive.
d) The male worm is about 6mm long.
e) The sellotape anal swab is useful for demonstration of eggs.
2. Which of the following are tapeworms?
a) Diphyllobothrium latum
b) Strongyloidea
c) Taenia saginate
d) Fasciola hepatica
e) Taenia solium
3. Which of the following are true of Giardiasis?
a) Giardia lamblia is also known Giardia intestinalis
b) The parasite is found in 2 forms - the trophozoite and the cyst
c) The parasite exists in the cyst form only.
d) Human infection occurs via the ingestion of trophozoites
e) The incubation period for infection is approximately 2 weeks.
4. Which of the following is true of Entamoeba histolytica?
a) Amoebae have 4 nuclei
b) Amoebae have eight or more nuclei
c) It may be found in aspirates from amoebic liver abscesses
d) The amoebae are often killed by addition of iodine to the wet film preparation
e) Exhibits motility by means of pseudopodia
5. Suitable specimens for the detection of parasites in the lab include:
a) Rectal swabs
b) Sellotape and swabs
c) Freshly taken ‘hot stools’
d) Urine specimens
e) Formed stools
6. Which of the following are true of tapeworms?
a) They are cestode worms
b) Belong to the genus Taenia
c) Are commonly associated with infections of chickens
d) Are commonly associated with infections of pork
e) T.solium and T. saginate may be differentiated on their scolices and proglottids
7. Which of the following are trematode worms?
a) Chinese liver flukes
b) Schistosomes
c) Fasciola hepatica
d) Enterobius vermicularis
e) Ascaris lumbricoides
8. Which of the following are true of the Schistosomes?
a) Are commonly seen in urine samples during infection
b) Are commonly seen in faecal samples during infection
c) Schistosoma mansoni has a characteristic thornlike lateral spine
d) Schistosoma haematobium has a characteristic thornlike lateral spine
e) Schistosoma haematobium has a characteristic small terminal spine
9. Which of the following is true of Cryptosporidium?
a) It is a flagellated parasite
b) One of the principle modes of transmission is by ingestion of contaminated water
c) Most disease in humans is caused by Cryptosporidium parium
d) Is only found to cause disease in developing countries
e) Is only found in patients who are HIV positive
10. State whether the following statements are true or false
a) The common name for Trichoris trichuna is the whip worm
b) Faecal – oral spread of cryptosporidium does not occur
c) The common name for Ascaris lumbricoides is the roundworm
d) Hydatid disease commonly causes liver abscesses
e) Urinary schistosomiaisis is known as Bilharzia
VIII. FAECES
1. What organisms predominate in the gastrointestinal tract?
2. What is the usual incubation period for Typhoid fever?
3. What is the site of infection in prolonged faecal carriage of S.typhi?
4. What cultures can be set up for Typhoid fever other than faecal cultures?
5. Name four endemic areas for Typhoid fever
6. What is the host for S.typhi?
7. What is the most likely antibiotic to be used for Typhoid fever and what problems may be
encountered?
8. What is the most important food source of infection for Salmonella gastroenteritis in man?
9. What is the incubation period for Staph aureus gastroenteritis?
10. What type of foods are usually incriminated in Cl. Perfringens gastroenteritis?
11. What is the main source of infection for Campylobacter gastroenteritis?
12. What is an infection called when animals pass it on to man?
13. What is the atmosphere required for cultivation of Campylobacter?
14. What antibiotic should be given for Campylobacter gastroenteritis if necessary?
15. What foods are incriminated in V. parahaemolyticus gastroenteritis?
16. What food is usually the source in Bacillus cereus enteritis, is this an infection or a toxaemia?
17. How does the exotoxin of Cl. Botulinum act?
18. How many types of Cl. Botulinum toxin are there?
19. What other infection does Y. enterocolitica cause other than gastroenteritis?
20. What incubation temperature may be may be helpful in isolation of Y.enterocolitica from blood?
21. What 3 different types of E.coli can be pathogenic on the gastrointestinal tract?
22. What are the two types of toxin produced by enterotoxigenic E.coli?
23. What is the most preventative measure for E.coli gastroenteritis?
24. What percentage of gastrointestinal illnesses are caused by Rotavirus in 6 months to 3
year olds?
25. What is the incubation period for Rotavirus?
26. What time of year is Rotavirus infection most common?
27. What are the four important Shigella species?
28. What is the incubation period for Shigella gastroenteritis?
29. What is the incubation period for amoebic dysentery?
30. Name four countries where amoebic dysentery predominates
31. What other organs (other than GI tract) may be infected with E. histolytica?
32. What therapy should be administered for E. histolytica infection?
33. What is the typical faecal specimen described as in V. cholerae infection?
34. What is the incubation period for Cholera?
35. Explain the mechanism of action of Cholera enterotoxin?
36. Where do trophpzoites of G. lamblia attach in the intestine?
37. What specimens other than faeces can be examined for G. lamblia?
38. What antibiotic therapy can be given for G.lamblia infection?
39. What organism is the cause of Pseudomembranous colitis?
40. What antibiotic therapy can be given for Pseudomembranous colitis?
41. Explain the use of alcohol shock technique for Cl difficile.
42. What test can distinguish Aeromonas sp from members of the enterobacteria?
43. What other test should be done to confirm an Aeromonas sp isolate’s pathogenicity?
44. What is the approximate size of a Gardia lamblia cyst?
45. What is the source of T. sagionata and T. solium tape worms?
46. What unusual method can be used to collect the eggs of enterobius vermicularis (threadworm)?
47. What is the approximate size of an ovum of Ascaris lumbricoides?
48. What parasite shows a large Glycogen vacuole when stained with iodine?
49. Up to what length can tapeworm grow to approximately?
50. What haematological finding may indicate infection with a parasite?
51. What medium would you use for the isolation of E.coli 0157?
52. What type of medium is this? (i.e. selective, enrichment, differential, etc).
53. What are the added ingredients that help identify/screen out the micro-organisms
54. What syndromes/illnesses can verocytotoxin-producing strains of this organism cause?
55. What further tests should be performed on suspected E.coli 0157 strains and where
should further work on suspected isolates be performed and why?
IX. MYCOLOGY - SHORT ANSWER QUESTIONS
1. What are the commonest types of dermatophyte infections?
2. Which non-dermatophyte species are also occasionally found to cause infection (particularly in
nails)?
3. How significant are yeasts when isolated from nail or skin specimens and when and how
should they be identified?
4. What are the identification methods used for dermatophytes and what are the significant
reactions of the commonest isolates?
5. Which species of dermatophyte produces Macrocondia only?
6. When would you use a slide culture for examination of fungi?
7. Which species is identified by microscopy only (i.e. cannot be cultured) and what might be
a common patient history in this case?
8. What is the significance of using two agars for culture i.e. Cydohexamide (Actidoine) and
Chloramphenacol?
9. If a specimen is received from e.g. a vet or farm worker what species would you look for
and how would this affect your culture protocol?
10. What species is ‘perforation of hair’ used to differentiate between?
11. What species is ‘growth on rice grains’ used to differentiate between?
12. Dermatophytes are associated with superficial infections. Can you give 2 examples of organisms
associated with:
(i) Subcutaneous mycoses
(ii) Systemic mycosis
13. Which dermatophyte commonly produces characteristic spiral hyphae?
14. Which dermatophyte commonly produces characteristic antler hyphae?
15. Aspergillus frequently causes invasive pulmonary disease, which species of Aspergillus
ismost commonly implicated and in what type of patient do these infections usually occur?
16. Organisms other than fungi/yeasts may be implicated in subcutaneous mycetomas e.g.
Madura foot. What groups do these other organisms belong to and how would you recognize
them?
17. Which yeast species may be found to cause meningitis (particularly in
immunocompromisedhosts) and how is it best identified.
18. Serological tests are now becoming available to help identify the major mycoses. Briefly
describe some examples of the test available. What are their major drawbacks?
(Chapter 10, Medical Mycology – A Practical Approach)
MULTPILE CHOICE
1. Mycrosporum Audouini: a) Produces abundant macorconidia
b) Grows on rice grains
c) Usually infects children
d) Is seldom pigmented
e) Is a primary cause of animal ringworm?
2. Which of these fungi are dermatophytes?
a) Trichphyton rubrum
b) Malassezia furfur
c) Aspergillus species
d) Epidermophyton foccosum
e) Microsporum canis
3. Candida albicans:
a) Is sensitive to Imidazoles
b) Produces germs tubes on corm meal agar
c) Produces arthrospores
d) Produces pseudomycelia
e) Causes ‘thrush’
4. Dermatophyte infections may be acquired from:a) Soil
b) Fellow man
c) Domestic animals
d) Wild animals
e) All of the above
5. In nature, Sporothrix schenkii grows:
a) In water
b) On domestic animals
c) On plants and in soil
d) On soil containing bird excreta
e) On insects
6. The major endemic area for blasotmycosis is:
a) Africa
b) A tropical area
c) South America
d) Eastern United States
e) Central America
7. Which of the following fungi are known to be secondary pathogens of nails?
a) Candida albicans
b) Aspergillus fumigatus
c) Scopularosis brevicaulis
d) Fusarium species
e) All of the above
8. The antifungal Griseofulvin:a) Must be given intravenously
b) Must be taken orally
c) Is fungicidal
d) Is effective treatment for superficial candinosis
9. What is the most probable portal of entry in Aspergillosis?
a) Puncture wound
b) Blood
c) Lungs
d) Gastrointestinal tract
e) Urinary tract
10. Which of the following may cause epidemic ringworm of the scalp?
a) Microsporum audouinii
b) Microsporum canis
c) Microsporum gypseum
d) Trichophyton rubrum
e) Trichophyton mentagrophytes
X GENERAL BENCH QUESTIONS
1. Explain the reasons for media used, discs used, periods of incubation and atmospheres for
each of the following specimens:
A. Wound
B. Eye
C. Knee aspirate
D. Ear
E. C.S.F
2. Explain the principles of the following: A. Staphaurex
B. Streptslide
C. Catalase
D. Gonocheck
E. Gram film
3. Link the following organisms with their expected activity: -
4. What organism would you expect to isolate form a gas gangrene infection and how would
you identify this organism?
5. Explain how you would separate a Staph aureus and a BH. Strept from a mixture of
coliforms
including Proteus sp.
6. Link the following types of patients with the bacterial infections most likely: -
7.Link the organisms and test results: -
8. Give 2 methods of detecting anaerobiosis in a gasjar.
9. Explain the procedure for carrying out a CSF examination.
PATHOGENICITY SHORT ANSWER
1. Write short notes on the following:
a) Pathogens
b) Saprophyte
c) Commensal
2. Describe what you understand by Koch’s postulates
3. Give an example of a bacterium possessing the following virulence factors:
a) Toxin
b) Capsule
c) Pili
4. Explain the following terms:
a) Horizontal spread
b) Vertical spread
c) Endogenous infection
d) Exogenous infection
5. Give and example of an infection transmitted by the following route:
a) Direct spread
b) Ingestion
c) Inoculation
d) Inhalation
SCREENS – QUESTIONS
1. What is the purpose of the screening swabs (2 answers).
2. What groups of patients require to be screened
3. What is the most preventative measure to stop cross infection?
4. What typing methods do you know?
5. Explain the term “autogenes”
6. Explain the term “nosocmial”
GENERAL QUESTIONS
Outline the important points in the completion of forms and labelling in the submission of
samples
for examination.
What are the most important issues when transporting samples to the laboratory?
What are the main points that have to be followed when sending samples through the post?
Explain how an External Quality Assurance Scheme works.
What are the functions of: The objectives
The oculars
Under what circumstances would you use a dark ground microscope?
How would you calculate the magnification of a microscope?
What is the phase contrast microscope used for?
Explain the use of micrometry.
Describe how you would do a Nagler test and state which organism is usually identified by it.
How would you identify an organism giving the colonial appearance of Staph aureus?
What is the principle of the urease test? Name and organism, which produces urease.
Outline the theory of Gram stain.
How can the following bacterial be distinguished form each other:
M. meningitides and N.gonorrhoeae?
Strept pneumoniae and viridians streptococci?
H. influenza and H parainfluenzae?
How would you group a beta haemolytic streptococcus?
How would you carry out a MRSA screen?
Name some of the common pathogens you would expect to isolate from a sample of sputum.
You mentioned ………………………………….. and ……………………………….
How would you identify them?
Name a method for determination of beta lactamase production.
What are the main causes of bacterial meningitis?
Name some of the methods for the disc and automated sensitivity testing.
What factors are likely to influence the size of the zone diameter in sensitivity testing?
What controls would you employ in discs sensitivity testing?
What controls would you employ in automated sensitivity testing and why?
How would you prepare a batch of blood agar and what are the important points that require
care to
ensure a good final product?
Explain the difference between an enrichment and a selective medium.
What are the selective agents used in Campylobacter medium?
Which specific pathogens are the following media used for isolation?
TCBS
Charcoal agar
New York City medium
Hoyles medium
What are the main constituents of CLED agar?
What is the principle of the autoclave?
What is the time and temperature normally used in an autoclave cycle?
Outline how you would use a hot air oven? What control would you employ?
What would you sterilise with a filter?
What are the main points that have to be applied in the use of disinfectant in the bacteriology
laboratory?
Why is aseptic technique important in bacteriology and how would you ensure this is
maintained?
Name a method that can be used for the short preservation of stock cultures.
Explain the use to freeze drying for preservation.
Outline the use of the computer system in use in your laboratory.
What advantage is there in using a database for surveillance and epidemiology?
MISCELLANEOUS QUESTIONS
1. Which of the following causes brick-red fluorescence under U.V. light?
a) Bacteroides fragilis
b) Fusobacterium necrophorum
c) Pseudomonas fluorescens
d) Prevotella melaninogenicus
e) None of these
2. Bacteroides ureolyticus was formerly classified as:
a) Bacteroides melaninogenicus
b) Lactobacillis audophilus
c) Bacteroides corrodens
d) Bacteroides bivius
e) Bacteroides oralis
3. Bacteroides fragilis is typically:
a) Relatively resistant to penicillin
b) Relatively sensitive to Penicillin
c) Sensitive to Aminoglycosides
d) Sensitive to Vancomycin
e) None of these
4. The family Bacteroidaceae includes which of the following genera?
a) Treponema
b) Fusobacterium
c) Leptospira
d) Leptotrichia
e) Peptostreptococcus
5. Which is true of Chlamydia Trachomatis?
a) Serotypes A,B and C cause genital infections
b) Quinoline antibiotics are of no benefit in treatment
c) Infections are less common than gonococcal infection
d) Carriage may be asymptomatic in both men and women
6. In the diagnosis of chlamydial infection, which of the following is true?
a) Urine samples are of use in the diagnosis of Chlamydial infection in women
b) Polymerase Chain Reaction may be used to detect Chlamydia trachomatis in specimens.
c) High vaginal swabs are suitable specimens for the detection of Chlamydia trachomatis
d) C. psittaci and C. pneumoniae.
e) Eye swabs are of no value in the diagnosis of congenital Chlamydial infection.
7. Which property can differentiate Chlamydiae from viruses?
a) Ability to elicit delayed hypersensitivity
b) Filterable nature of the infectious microorganism
c) Existence as obligate intracellular parasite
d) Formation on inclusion bodies in infected cells
e) Sensitivity to the Tetracyclines
8. Chlamydiae can have an unusual three-stage cycle of development. The correct sequence
of
these events is:
a) Penetration of the host cell
Synthesis of Elementary Body progeny
Development of an Initial Body
b) Penetration of the host cell
Development of an Initial Body
Synthesis of Elementary Body progeny
c) Development of an Initial Body
Synthesis of Elementary Body progeny
Penetration of the host cell
d) Synthesis of Elementary Body progeny
Development of an Initial Body
Penetration of the host cell
e) Synthesis of Elementary Body progeny
Penetration of the host cell
Development of an Initial Body
9. Which of the following genera are anaerobic cocci?
a) Peptostreptococci
b) Moraxella
c) Leptotrichia
d) Fusobacterium
e) Streptococci
10. Which of the following tests is of limited value in the identification of anaerobic
organisms?
a) Gas liquid Chromatography
b) Gene probe analysis
c) Fluorescence of pus in U.V. light
d) Gram stain
e) Immnofluorescent stain
11. Which of the following is true of Peptostreptococcus?
a) Gram variable
b) Strict anaerobes
c) Resistant to Penicillin
d) Catalase negative
e) Haemolytic on horse blood agar
12. Isolation of Gram negative anaerobic bacilli is NOT enhanced by:
a) Atmosphere anaerobic plus 105 CO2
b) Vitamin K supplement in growth medium
c) 2 - 3μg /ml of Metronidazole in growth medium
d) Haemin in growth mediun
e) An aminoglycoside as a selective agent in growth medium
13. Which of the following normally inhabits the female genital tract and may rarely cause
infection?
a) Mycoplasma hominis
b) Mycoplasma orale
c) Mycoplasma Pneumoniae
d) Mycoplasma salvarium
e) Ureaplasma ureolyticum
14. Which of the following is true of Mycoplasmas?
a) Have a rigid cell wall
b) Are sensitive to Penicillin
c) Stain well with Gram stain
d) Are resistant to Tetracyclines
e) Reproduce in artificial media
15. Which of the following is not a growth characteristic of the Mycoplasmas?
a) Form a “fried egg” colony on solid media
b) Grow readily in cell cultures
c) Require factors such as serum and yeast extract in growth medium.
d) All species require strictly aerobic conditions.
e) Are commonly grown in “sloppy agar”
16. Members of the Enterobacteriacae are always: a) Gram negative
b) Oxidase positive
c) Catalase positive
d) Motile
e) Ferment glucose
17. Which of the following are members of Enterobacteriacea: a) Cedecea
b) Citrobacter
c) Acinetobacter
d) Erwinia
e) Pasteurella
18. E.coli are: a) MR positive
b) Always motile
c) VP negative
d) Citrate negative
e) Usually indole positive
19. E.coli antigens
a) Kauffman scheme is based on O, H and K antigens
b) Most flagellar antigens are bi phasic
c) Over 160 different O antigens have been described
d) Numerous cross-reactions occur between E.coli O antigens and those of other genera
e) Over 100 different H antigens are known
20. Klebsiella are: a) Usually capsulated
b) MR positive
c) VP positive
d) Non- motile
e) Motile
21. Species of Klebsiella include
a) Klebsiella coli
b) Klebsiella pneumoniae subspecies rhinoscleromatis
c) Klebsiella oxytoca
d) Klebsiella ascrobata
e) Klebsiella morgani
23. Enterobacter are: a) Non-motile
b) Usually MR negative
c) Usually VP negative
d) Citrate positive
e) Generally ormithine decarboxylase positive
24. The normal habitats of Enterobacter are: a) Food
b) Soil
c) Water
d) Dust
25. Hafnia are: a) Usually motile
b) Indole positive
c) Urea negative
d) Urea positive
e) Gelatin positive
26 Hafnia are usually found in : a) Faeces
b) Sewage
c) Soil
d) Water
e) Dairy products
27. Serratia are: a) Motile
b) Usually MR negative
c) Usually VP negative
d) Gelatin negative
e) Indole positive
28. Serratia: a) 5 species
b) All produce a red pigment
c) Are found mainly in animal sources
d) Ser. liquefaciens was formerly Ent. liquefaciens
e) Pigmented varieties are usually more pathogenic
29. Citrobacter are: a) Non-motile
b) MR positive
c) Lysine decarboxylase positive
d) VP negative
e) Mannitol negative
30. Erwinia are: a) Usually motile
b) Urea positive
c) H2S positive
d) Mainly associated with plants
e) Pigmented
31. Edwardsiella: a) Motile
b) Have their main habitat G.I. tract of lower animals
c) 6 species included in genera
d) Oxidase positive
e) Penicillin sensitive
32. Kluyvera: a) Motile
b) Urea positive
c) Two species Kluy. ascorbata and Kluy. cryocrescens
d) Generally non-pathogenic for man
e) G + C content 55 - 57
33. Salmonella are: a) MP positive
b) H2S positive
c) Indole positive
d) VP positive
e) Urea positive
34. Which of the following Salmonella are non-motile
a) S. typhi
b) S. pullorum
c) S. typhimurium
d) S. gallinarum
e) S. vircha
35 S R variation in Salmonella is associated with: a) Loss of virutance
b) Loss of O antigen
c) Loss of flagellar antigen
d) Loss of viability
e) Uneven opacity in broth
36. Which of the following may process VI antigen
a) E.coli
b) Citrobacter spp
c) S. typhi
d) S. paratyphi C
e) S. dublin
37. Cedecea: a) Usually motile
b) Indole motile
c) Predominantly isolated from G I tract
d) No clear pathogenic role
e) Resistant to Ampicillin
38. Tatumella: a) Motile by polar, subpolar lateral flagella
b) Indole positive
c) Sensitive to Penicillin
d) No clear pathogenic role
e) Motile by peritrichous flagella
39. Proteusvulgaris: a) Produce acid and gas in maltose
b) Indole positive
c) Deaminate phenylalanine
d) Produce ureas
e) Do not utilise citrate
40. Providencia sp: a) Indole positive
b) Late lactose fermentors
c) Ureas positive
d) Deaminate phenylalanine
e) Indole negative
41. Shigella dysenterae type 1
a) Catalase negative
b) Indole negative
c) Mannitol negative
d) ONPG positive
e) An exotoxcin producer
42. Which of the following are true of Y. entertocolitica
a) 340 and 19H serotypes
b) Serotypes ‘O’ 3 ‘O’ 8 and ‘O’ 9 are the most frequent in human infections
c) Oxidase positive
d) Optimum recovery by cold enrichment
e) Catalase negative
43. Which of the following are urease producers
a) Yersinia pestis
b) Yersinia pseudotuberculers
c) Yersinia enterpcolitica
d) Salmonella sp
44. The genus Yersinia includes organisms formerly termed : a) Loefflorella mallei
b) Pseudomonas putida
c) Aanetobacter anitratus
d) Aanetobacter pestis
e) Pasteurella pseudotuberculosis
45. Y. pestis
a) Is the plague bacillus
b) Was discovered by Yersin in 1894
c) Was discovered by Kitasato in 1894
d) Is transmitted by rat bites
e) In 14th Century destroyed about ¼ of the population of Europe
46. The plague bacillus has a reservoir in small rodents but is transmitted to man by:a) Mosquitos
b) Mites
c) Ticks
d) Fleas
e) Lice
47. Suitable specimens for the diagnosis of Legionnaires disease include: a) Sputum
b) Lung biopsy
c) Clotted blood for serological testing
d) Nasopharyngeal secretions
e) Urine
48. Legionella pneumophila: a) Can be grown on blood agar
b) Is a Gram negative rod
c) Is easily seen in Gram films from sputa
d) Grows best at 22oC
e) Affects mainly children
49. Which of these antigens employed in the diagnosis of Syphilis are derived from
treponemes?
a) Cardiolipin
b) Kahn
c) Price precipitation antigen
d) Reiter protein
e) VDRL antigen
50. Diseases caused by Treponemia include: a) Syphilis
b) Bejel
c) Pinta
d) Relapsing fever
51. Organisms present in Vincent’s Angina
a) Borrelia (or Treponemia) vincenti
b) Treponema pallidum
c) Fusobacterium fusiform
d) Leprospira canicula
e) All of these
52. Which combinations are correct: a) TPHA/specific antitreponemal antibody
b) Reiter CFT/Group specific treponemal antibody
c) Wasserman/IgM antibody
d) TPI/Specific anti- treponemal antibody
e) VDRL/Specific anti-treponemal antibody
53. Which of the following tests detect reagin: a) TPHA (Treponaemai Pallidum Haemaglutination Assay)
b) VDRL (Veneral Disease Reference Lab)
c) Wasserman
d) FTA (Flurorescent Treponemal Antibody)
e) TPI (Treponemia Pallidum Immobilisation)
54. Which of the following are true of Syphilis: a) Reagin titres may be of value in monitoring therapy
b) Group specific antibody is not always produced during disease
c) All serological tests are also positive in yaws and related diseases
d) Diagnosis must be made definitively by microscopy of chancre exudate
e) TPI the confirmatory test is used by routine laboratories
55. Which of the following are characteristic of C. perfingens: a) Proteolysis
b) Fermenation of lactose
c) Peritrichous flagell
d) Lecithinase production
e) “Stormy clot” in litmus milk
56. The toxin of Clost. Perfingens is the enzyme: a) Hyalusonidase
b) Lecithinase
c) Deoxynbonuclease
d) Neuraminidase
e) Collagenase
57. The flora of gas gangrene infection may include: a) C. novyi
b) C. setpticum
c) C. histolyticum
d) C. perfringens
e) B. subtilis
58. Characteristic features of C. perfringens include: -
a) Ellners medium may induce sporulation
b) Proteolysis
c) “Stormy clot” reaction is specific for this organism
d) Guinea pigs or mice used in toxin – antitoxin neutralisation tests for typing
e) Food poisoning may be caused by strains producing relatively heat-sensitive spores
59. Listeria monocytogenes
a) Is motile by polar flagella
b) Always shows bipolar straining
c) Is ususally haemolytic in horse blood agar
d) Grows on MacConkey Agar
e) Ferments maltose
60. Listeria monocytogenes
a) Mainly affects persons under 3 weeks or over 40 years
b) May infect throat, CNS or pregnant uterus
c) Can form colonies at 4o C
d) Produces typical “Drumstick” spores
e) Optimal growth at 25o C
61. Erysipelottrix rhosopathiae
a) Is a strick anaerobe
b) Causes disease in swine
c) Is motile when grown at 20o C
d) Grows on MacConkey Agar
e) Rough forms grow in large chains
62. Differences between Listeria and Erysipelottrix: a) Motility
b) Indole production
c) Acid fastness
d) Catalase production
e) Growth at 4O C
63. Human Actinomycosis: a) Is caused by Actinomyces bovis
b) Is an endogenous infection
c) Forms “ sulphur granules” in pus
d) Pathogen may show true branching
64. Actinomyces israeli: a) Inhabits the human oral cavity
b) Non-sporing
c) Produces acid and gas from glucose
d) Catalase positive
e) Reduces nitrate to nitrite
65. Tissue biopsies taken from the following site may reveal the organism in Actinomycosis: a) Sinuses
b) Bone
c) Isolated lesions
d) Lymph nodes
e) All of these
66. Nocardia asteroides
a) Is always sensitive to Sulphonamides
b) Takes 4 week to grow
c) Contains hyaluronic acid
d) Produces “Star like” growth in broth
e) Grows on ordinary media
67. Differentiation between Nocardia asteroides and Actinomyces israelii; a) Growth aerobically
b) Generalised infection in rabbits
c) Motility of room temperature
d) Microaerophilic growth
e) Haemolysis on blood agar
68. The following organsims are microaerophilic anaerobes: a) Actinomyces israeli
b) Actinomyces bovis
c) Nocardia madurae
d) Actinomyces bavdeti
e) Nocardia asteroides
69. A suitable medium for the growing Legionella pneumophila is: a) Chocolate blood agar
b) Blood agar
c) Enriched blood containing ferric pyrophosphate and L-cysteine
d) Charcoal yeast agar
e) Bordet – Gengou agar
70. Which of the following normally inhabits the female genital tract and may rarely cause
infection: a) Mycoplasma hominus
b) Mycoplasma orale
c) Mycoplasma pneumoniae
d) Mycoplasma salivarium
e) Ureaplasma ureolyticum
71. Which of the following is true of Mycoplasma: a) Have a rigid cell wall
b) Are sensitive to Penicillin
c) Stain well with Gram stain
d) Are resistant to Tetracyclines
e) Reproduce an artificial media
EYES/EARS/THROAT
1. What unusual organism may be the cause of eye infection in neonates, what complication
may occur if infection is not treated?
2. What is the source of organism in the following eye infections: i. H. influenza
ii. Chlamydia
iii. Staph aureus
3. Write a short note on the following: i. Onchocerea
ii. Loa loa
iii. Acanthamoeba
4. List the differences between Inclusion conjunctivitis and Trachoma.
5. Explain the following: -
i. Otitis externa
ii. Otitis media
iii. Mastoid
6. What problems may occur when topical antibiotics are used for ear infections?
7. List the common causes of Otits media.
8. What does the term CSOM stand for?
9. What procedure is required when a diagnosis of ‘glue ear’ is made?
10. What complication may occur with a Strept pyogenes infection?
11. What detection methods can be used for C. diphtheria toxin?
12. What organisms are involved in the following: i. Acute epiglottitis
ii. Necrobacilliosis
iii. Vincent’s angina
13. What cultural method is used for the isolation of B. pertusis?
14 What is the significance of nasal carriage of Staph aureus?
Throat Infections
Mainly viral
Bacterial infections
Strept pyogenes – Erthogenic toxin, scarlet fever (affects heart and kidneys)
Strep groups C & G
More unusual
Corynebacterium diptheriae (toxin)
Arcanobacterium haemolytica
H. infuenzae (epiglottis)
F. necrophorum (necrobacilliosis)
N. gonorrhoea
N. meningitidis (Screening)
Vincent’s angina (oral hygiene)
B. pertussis (perinasal swab)
Oral infections
Candida - Dental caries, neonates
Coliforms - Post antibiotic
Nasal infections
Nasal carriage – Staph aureus N. meningitis
Sinusitis
All respiratory pathogens can cause sinusitis but can also be present in small numbers as
part of
normal flora.
(XII) GENERAL QUESTIONS
1. A) What procedures would you go through on receipt and booking in a specimen
to the laboratory?
B) What sources of error can occur at the following stages of specimen processing.
(I)Pre analytical (Specimen reception)
(II) Analytical (Laboratory process)
(III) Post analytical (Report production and dispatch)
2. A) What type of specimens should be examined in containment level 3 (not ITU
and Leukaemic samples).
B) What do you understand from the term COSHH.
3. A) In a case of bacterial meningitis, what results do you expect in: i. Appearance.
ii. WBC count.
iii. Gram film.
iv. Protein.
v. Glucose.
vi. Most likely organism.
vii. What further test could you do if there was no growth in culture with a
high cell count?
viii. What do you understand by the term aseptic meningitis?
B) What are the commonest causes of bacterial diarrhoea (name 2).
4. A) Explain the principle of the stokes comparative method for sensitivity testing,
what factors can affect the result.
B) Explain why it is important to monitor aminoglycoside levels.
C) How would you test Staphaureus for methicillin sensitivity if you did
not have a 30oC incubator?
5. A) Explain the principle of the Gram Stain.
B) Explain the principle of the Staphaurex test.
6. What methods of sterilisation do you know; briefly explain the principles of and
uses of each type.
7. What important security measures should be taken as regards use of the computer
system?
8. Explain the principles behind the Bact Alert blood culture system.
9. What tests can be used to differentiate the following organisms?
a) Staph aureus Staph epidermidis
b) N.gonorrhoea N. meningitis
c) H.influenza H. parainfluenzae
d) Strept pneumoniae Strept viridians
1. Explain the principles of our autoclave.
How are they monitored and why?
2. How would you package and send a specimen by post.
3. Describe how you would deal with a broken blood vial from a high-risk patient.
4. Why would we use Boric acid in our urine containers?
5. What are the main pathogens associated with Otitis media, what commensals may be
encountered at the site of infection?
6. What factors can affect zone size in disc diffusion tests?
7. What is the principle of the nitrocefin test for β lactamase detection, which organisms
must be tested and why?
8. What investigations should be added if a liquid faeces sample from a patient with a
recent antibiotic therapy is received?
9. How would you deal with a telephone call for a GP requesting a result and asking
about the suitability of a particular antibiotic?
10. Why should a BAL be processed immediately on arrival at the lab? How is it
processed?
11. What are the commonest pathogens isolated from the sputa of cystic fibrosis patients?
QUESTIONS – GENERAL – SHORT ANSWER.
1. Describe the process of CIE and give an example of its use.
2. Detail the procedure used for examination of CSF.
3. With regard to Protein, glucose and Cellular content, what results would you expect in the
following?
a) Viral meningitis
b) Meningococcal meningitis
c) TB meningitis
d) Subarrachnoid haemorrhage
4. What are the likely organisms causing meningitis in the following patients?
a) Neonate (3 examples).
b) 10 year old child (3 examples).
c) Elderly patient post fracture of skull (1 example).
d) HIV patient (1 example).
5. What is the most common pathogen form a specimen of knee fluid from a case of septic
arthritis?
Can you name any other possible causes?
6. What are the likely blood culture isolates from a patient with SBE (2 examples).
Describe this condition, what complications may arise after dental surgery?
7. Give 5 examples of organisms causing genital infection.
8. What type of specimen should be taken for culture for suspected whooping cough?
9. Give 3 examples of dermatophytes.
10. Detail how you would examine a faeces specimen from a patient returning from Egypt.
11. What unusual phenomenon is present in an actinomyces infected pus?
12. What organism would you expect to isolate from a patient with mesenteric adenitis?
13. Give examples of 3 respiratory pathogens.
14. Explain the term aspiration pneumonia, what type of organisms are the cause of this
infection
15. Explain the term zoonosis, give 3 examples.
16. Give 3 routes of transmitted infection.
17. Describe the procedure used for sensitivity testing for Mycobacterium tuberculosis.
18. What organism would you expect to isolate from products of conception?
(4 bacterial causes, 3 viral causes and 1parasite).
19. Describe the disease PMC. What organism should you isolate from faeces in this condition?
20. What organism would you isolate from faeces from a case of haemorrhagic colitis?
21. What species of fungi wold you expect to isolate from an ear swab?
22. List 5 possible causes of eye infection.
23. List 5 antibiotics, which could be monitored.
24. List 5 factors affecting sensitivity tests.
25. Briefly describe the mechanism of action of penicillin.
26. What is Blactamase?
27. List 3 possible causes of systemic mycosis.
28. How would you differentiate between Trichphyton rubrum and Trichophyton
mentagrophytes?
29. What is the most likely cause of scalp ringworm in a child?
30. Give 2 examples of bacteria, which cannot be grown of solid media.