Bacte Sample Question

You answered the question incorrectly.
A flagellar strain would show peritrichous flagellae for each of the following
organisms except:
The correct answer is highlighted below
Bordetella bronchiseptica
Alcaligenes faecalis
Pseudomonas aeruginosa
Escherichia coli
Feedback3
Pseudomonas aeruginosa, and other Pseudomonas species, are motile via a single
polar flagellum. All of the other motile strains listed in this exercise possess
peritrichous flagellae.
The slide coagulase test is a rapid method for identifying which of the following
organisms.
Staphylococcus hominis
Staphylococcus pneumoniae
Staphylococcus aureus
Neisseria gonorrhoeae
Feedback3
Since not all isolates of S. aureus are detected by the slide coagulase test, suspicious
organisms negative by the slide test must be confirmed by the tube coagulase test.
Chryseobacterium is the new genus name for the bacterium formerly called
Flavobacterium meningosepticum, an important agent of neonatal mentingitis. The
biochemical characteristic that is unique for the Family Flavobacteriaceae among the
nonfermenters is:

Indole production
Esculin hydrolysis
Glucose oxidation
Resistance to penicillin
Feedback1
Among the nonfermenters, the production of indole points to one of the

Flavobacteriaceae, including Chryseomonas meningosepticum. Indole production is
weak; therefore, extraction with xylene and reaction with Ehrlich's rather than
Kovac's reagent is required for its detection in the standard laboratory procedure.
Esculin hydrolysis, oxidation of glucose and susceptibility profiles to penicillin are
variable among the Flavobacteriaceae and do not represent characteristics unique to
this group.
A patient who was seen in the ED has symptoms consistent with cellulitis. A Gram
stain from the patient's blood culture revealed Gram-positive cocci in pairs and short
chains. Blood cultures grew an organism that was susceptible to a 0.04 unit disk of
bacitracin. Other characteristics one would expect to see are:
Beta hemolysis, negative CAMP, negative catalase, growth in 6.5% salt

Negative catalase, positive CAMP, beta hemolysis, no grow in 6.5% salt
Beta hemolysis, negative catalase, negative CAMP, no growth in 6.5% salt
No growth in 6.5% salt, positive CAMP, catalase positive, beta hemolysis
Feedback3
C is the correct answer. The major cause of cellulitis is Group A strep (Streptococcus
pyogenes). Because it is susceptible to bacitracin, it should also be beta-hemolytic and
negative in catalase, CAMP, and 6.5% NaCl broth.

Match the names of each of the bacterial species with its most likely appearance on
blood agar, as illustrated in the photographs.
Your answers are on the left. The correct answers are on the right and highlighted.
Staphylococcus aureus A
Streptococcus milleri (anginosus) B
Viridans streptococcus C
Beta hemolytic streptococcus, group C D
Feedback
Streptococcus milleri (anginosus) grows on blood agar as tiny colonies, as illustrated

in Image B. Hemolysis is usually beta, but may be alpha or absent. One additional
clue to the identification of S. milleri is the detection of a distinct butterscotch odor.
Group C beta hemolytic streptococci produce semi-transparent colonies on blood
agar, surrounded by a relatively large zone of beta hemolysis (Image D). This is in
contrast to the larger, more opaque white or yellow colonies of Staphylococcus aureus
in which the diameter of the colony is greater compared to the zone of beta hemolysis
(Image A). Viridans streptococci produce small, semi-transparent colonies that are
surrounded by distinct zones of green, alpha hemolysis, as seen in Image C.
You answered the question correctly.

Look, oh look at the little red dot,
Tell me, O tell me, who I am not.
Haemophilus parainfluenzae
Haemophilus influenzae
Haemophilus parahaemolyticus
Haemophilus aphrophilus
Feedback2
The development of the red pigment after inoculation with the test organism, as seen
with ultraviolet illumination, on the delta aminolevulinic acid paper disk indicates the
production of protoporphyrin intermediates. Each of the Haemophilus species listed in
this exercise except Haemophilus influenzae, has the capability of synthesizing hemin
from the aminoluvulinic acid substrate and therefore is not X factor dependent.
Haemophilus influenzae is both V and X-factor dependent; therefore, would not have
the capability of producing the fluorescing protoporphyrin intermediates as seen with
this disk test.
The OF dextrose activity is a key initial assessment in the presumptive identification

of the nonfermentative gram negative bacilli. Place each of the bacterial species into
Bucket A if it utilizes dextrose oxidatively (yellow reaction in the open tube) or into
Bucket B if it is non-oxidative (produces no acid in either the open or the closed
tube).
Bucket B Comamonas testosteroni

Bucket A Burkholderia pickettii
Bucket B Alcaligenes faecalis (odorans)
Bucket B Moraxella osloensis
Feedback
Several species of nonfermenters do not utilize glucose fermentatively or oxidatively,

deriving energy by mechanisms other than through carbohydrate metabolism
(chemolithotrophs). All of the species belonging to the newly formed genus
Pseudomonas are oxidizers; similarly all members of the genus Burkholderia
(formerly in the genus Pseudomonas) are oxidizers. Therefore, in the list of organisms
included in this exercise, only B. pickettii is an oxidizer and should be placed into
Bucket A. Comamonas testosteroni formerly was classified as one of the
asaccharolytic pseudomonads. All members of the genus Alcaligenes (except A.
xyloseoxidans) and the genus Moraxella do not derive energy from glucose.
Therefore, these three species will produce no color change in either the open or the
closed OF dextrose tubes.
An organism isolated from the spinal fluid of a newborn produced small, grayish,
slightly translucent beta-hemolytic colonies on sheep blood agar. A Gram stain of the
colony showed small gram-positive rods that look like diphtheroids. The organism is
MOST likely:
Corynebacterium diphtheriae
Erysipelothrix insidiosa
Listeria monocytogenes
Campylobacter fetus
Bacillus cereus
Feedback3
Listeria monocytogenes can appear as hazy gray colonies with small zone of beta-
hemolysis on sheep blood agar. Gram stain demonstrates small gram positive rods and
coccobacilli, which both tend to have rounded ends; occasionally in pairs and chains.
This morphology is known as "diphtheroid-like". Listeria monocytogenes is a
significant cause of neonatal meningitis.

The formula for oxidative/fermentative (OF) culture media, for the determination of
glucose oxidizers, differs from carbohydrate fermentation media by each of the
following properties except:
Relative decrease in the protein concentration

Relative increase in the carbohydrate concentration
Relative decrease in the agar concentration
Relative increase in the salt concentration
Feedback4
The concentration of protein is reduced in OF medium, and the relative amount of

carbohydrate is increased. This is done to maximize the production of acid from the
increased amounts of carbohydrate and to reduce the amount of alkaline amines
produced from the oxidation of the amino acids. The agar concentration is decreased
so that any acid produced from the carbohydrate will have free access to the color
indicator. The concentration of sodium chloride is equal both in fermentative and OF
media.
The bacterial species belonging to the HACEK group can be linked to specific clinical
conditions. Match the names of the bacterial species with the name of its most likely
associated infection.
Actinobacillus actinomycetemcomitans Localized juvenile periodontitis

Cardiobacterium hominis Culture negative endocarditis
Eikenella corrodens Clenched fist infection
Kingella kingae Juvenile osteomyelitis
Feedback
Eikenella corrodens is a normal inhabitant of the oropharynx and is involved in

human bite infections, including inflammation of the knuckles following fist fights
(clenched fist syndrome). Kingella kingae has a particular predilection for causing
infections of the bones and joints, particularly of young children. Actinobacillus
actinomycetemcomitans produces leukocidins, neutrophil chemotaxis-inhibiting
factor, a bone resorption inducing factor, and several other enzymes that prevent
phagocytosis at the site of infection and a slowly progressive alveolar bone
destruction. Although each member of the HACEK group can cause endocarditis,
Cardiobacterium hominis is very slow growing and often is not recovered because
blood culture bottles are terminated too quickly; thus leading to false negative results
and one of the causes of what has been called culture negative endocarditis.
Question Difficulty: Level 8
Match the names of each of the bacterial species listed with its most likely Gram stain
morphology as illustrated in the photographs.
Corynebacterium species A
Lactobacillus species B
Nocardia species C
Bacillus species D
Feedback
The bacterial cells of Nocardia species are described as gram-positive filamentous

bacilli that branch, as illustrated in Image C. Corynebacterium species produces short
gram-positive bacilli that tend to arrange irregularly in Oriental letter patterns (Image
A). Bacillus species may produce either short or long gram positive bacilli; however,
the presence of spores is a key identifying feature of the genus (Image D).
Lactobacilli are rectangular-shaped, gram positive bacilli that often form short chains,
as seen in Image B.
The upper photomicrograph illustrates a gram stain of sputum obtained from a 55 year
old man with symptoms of bacterial pneumonia. The lower photograph represents the
growth of an inoculum from the specimen on 5% sheep blood agar, on which had
been placed an optochin ("P") and a 1 ug oxacilin disk. After 18 hours incubation at
37C in 5% CO2, the zone around the optochin disk is 18mm and around the OX disk
is 8mm. The interpretation is that the organism is most likely:
Normal flora and not the cause of pneumonia

A viridans streptococcus, penicillin sensitive
A pneumococcus, penicillin resistant
A pneumococcus, penicillin sensitive
Feedback
The gram stain shown in the upper frame illustrates many background segmented
neutrophils and many gram positive diplococci typical of Streptococcus pneumoniae.
The high concentration of bacteria in pure culture virtually assures that it is the cause
of the pneumonia. The >14mm zone around the "P" disk confirms the identification as
Streptococcus pneumoniae, and the 8mm zone around the "OX" disk indicates that
this strain is resistant to oxacillin (a zone diameter of less than 19 is considered
resistant), and by extension resistant to penicillin as well. Therefore, "pneumococcus,
penicillin resistant" is the correct response.
Match each organism listed below with the culture medium from the drop down box
that is used for organism differentiation and/or optimum organism recovery.
Enriched thioglycolate medium Anaerobes

Hektoen enteric agar Salmonella/Shigella
Sabourand dextrose agar Fungi
Feedback
Hektoen enteric agar is used for recovery of Salmonella/Shigella
Enriched thioglycolate medium is used for differentiation of anaerobes
Sabourand dextrose agar is used for the cultivation of fungi
Bacitracin susceptibility is useful for which two of the following:
The correct answers are highlighted below
Distinguishing Staphylococci from micrococci

Presumptive identification of Group A streptococci
Identification of Haemophilus
Identification of Neisseria
Feedback
Staphylococci are resistant to bacitracin while micrococcus are sensitive. Group A
beta-hemolytic Streptococci are sensitive to bacitracin, while most other Groups are
resistant.
A sputum brick red with flame,

The bacterium that bears his name.
Yersinia
Pasteurella
Salmonella
Klebsiella
Feedback
Klebsiella pneumoniae is the bacterial species that causes a necrotizing pneumonia

characterized by the production of a brick red sputum. The organism is named after
Edwin Klebs, whose picture is shown in the photograph. Klebs was a German
microbiologist who, as early as 1875, had observed several bacterial species in
clinical specimens, but did not have pure culture techniques to make any disease
associations. K. pneumoniae was first characterized by Joseph Schroeter in Germany,
but was also studied by Carl Friedlander in the United States, and became known for
some period of time as the Friedlander bacillus in the American literature. Alexandre
Yersin was an assistant to Pasteur in Paris, and was sent on assignment to Hong King
in 1894 to determine the cause of an outbreak of bubonic plague. The plague bacillus
was first named after Pasteur (Pasteurella pestis), but later changed to Yersinia, in
honor of this man who had actually discovered the organism, not his world renowned
mentor. Daniel Salmon was the Chief of the Bureau of Animal Husbandry in
Washington in the late 1800's, and made his mark by discovering the bacterial cause
of hog cholera, which was later called Salmonella cholerasuis. This bacterium was
not the cause of hog cholera after all, but nevertheless paved the way for a large and
confusing group of bacteria to carry his name.
Match the names or the organisms listed with the bucket indicating whether each is
cryophlic (can grow as low as 4C) or is themophilic (grows at temperatures of 42C
or higher).
Thermophylic Pseudomonas aeruginosa

Cryophilic Listeria monocytogenes
Cryophilic Yersinia enterocolitica
Thermophylic Campylobacter jejuni
Feedback
Of the bacterial species listed in this exercise, Listeria monocytogenes and Yersinia
enterocolitica are cryophilic and can grow at refrigerator temperatures. This is one
important implication in that these two organisms are possible infective agents in
cases of transfusion related septicemia as the organisms can survive and replicate at
the storage temperature of blood products. Pseudomonas aeruginosa and
Campylobacter jejuni have the property that they can grow at 42C, the latter
optimally at the higher temperature requiring a separate incubator if recovery from
clinical specimens is to be maximized.

A 49 year old farmer developed a swelling of the neck beneath the left jaw with
enlargement of the left posterior cervical lymph nodes. The photomicrograph is
representative of a direct gram stain prepared from purulent material aspirated from
one of the enlarged lymph nodes. The organism was not acid fast. The most likely
identification is:
Actinobacillus actinomycetemcomitans
Mycobacterium scrofulaceum
Actinomyces israelii
Bifidobacterium dentium
Feedback
The case description is classic for "lumpy jaw", the most common cause of which is
Actinomyces israelii. The branching, gram positive filaments against a background
sea of neutrophils as seen in the photomicrograph is characteristic of the cell
morphology of this bacterium. Although, as the name indicates, Actinobacillus
actinomycetemcomitans (comatans means "to accompany") is often found in
conjunction with A. israelii, the bacterial cells are gram negative rather than gram
positive, of which there is no evidence here. Mycobacterium scrofulaceum causes
"scrofula", also an infection of the posterior neck area leading to enlargement of
posterior cervical lymph nodes. However, the inflammatory response is more
granulomatous than purulent and the bacterial cells do not branch and are acid fast.
The bacterial cells of Bifidobacterium dentium are gram positive rods that can branch;
however, they are much larger than the filaments of A. israelii and are club-shaped on
the ends, resembling "dog bones". Bifidobacterium species have only rarely been
incriminated in human infections and do not cause "lumpy jaw".

A patient with atypical (reactive) lymphocytes in his peripheral blood smear should be
tested for:
Herpes simplex virus infection

Epstein-Barr virus infection
Bacterial meningitis
Acute leukemia
Feedback
Epstein-Barr virus causes infectious mononucleosis, which is associated with atypical

(reactive) lymphocytosis.
Public health guidelines recommend that laboratory specimens for influenza testing be
manipulated using which of the following safety precautions?
Safety goggles
Safety cabinet
Utility gloves
Feedback
Public health guidelines recommend that manipulation of samples for influenza

testing be done inside a safety cabinet. Safety goggles could be worn if the specimen
or procedure may be prone to splashes or sprays of infectious material. Utility gloves
are not necessary.
A stool from a two-year-old girl grew clear colonies on MacConkey agar, red colonies
on XLD, and green colonies on HE without black centers. It was ornithine positive
and indole negative. It should agglutinate in antisera of which serogroup?
A
B
C
D
Feedback
D is the correct answer since the biochemical results are consistent with Shigella
sonnei that agglutinates in Group D antisera. Shigella Groups A, B, and C are
ornithine negative and usually are indole positive.

The bacteria illustrated in this photomicrograph were observed in a gram stain of a
positive blood culture. The bacterial species most likely to grow out in culture is
(surprise):
Staphylococcus hominis
Micrococcus luteus
Corynebacterium jeikeium
Feedback
The bacteria seen in this Gram stain are small gram positive cocci that tend to arrange
in distinct tetrads. Tetrad arrangement of gram positive cocci is also characteristic of
Micrococcus luteus; however, the individual cells are much larger than those seen
here. Although Staphylococcus aureus cannot be totally ruled out, the cells have a far
greater propensity to arrange in grape-like clusters, and tetrad formation is less
pronounced than seen here. The bacterial cells of Corynebacterium jeikeium are
distinct short bacilli, that arrange in an Oriental letter pattern. Therefore, the most
likely identification by elimination is Staphylococcus hominus, which does have the
distinct tendency to produce small cells in tetrads as seen here.

This Gram-positive bacillus grew as a diffusely beta-hemolytic colony from a
newborn. It was catalase positive and had tumbling motility on a hanging drop
preparation. This is how it appeared on triple sugar iron agar and motility medium.
What is the most likely diagnosis?
Listeria monocytogenes
Streptococcus agalactiae
Erysipelothrix rhusiopathiae
Escherichia coli
Feedback
Listeria monocytogenes is the correct answer. The motility agar is showing motility at
the top of the tube, but not deeper; typical of this catalase-positive, gram positive
bacillus. Streptococcus agalactiae would be catalase negative and a coccus.
Erysipelothrix rhusiopathiae would be H2S-positive and catalase negative.
Escherichia coli is a gram negative bacillus.

_______________ is predominantly associated with skin and soft tissue infections

(SSTIs), such as abscesses, cellulitis, folliculitis and impetigo.
Hospital-associated MRSA
Community-associated MRSA
Feedback
Community-associated MRSA infections are predominantly skin and soft tissue

infections (SSTIs), such as abscesses, cellulitis, folliculitis, and impetigo.
Each of the following tests is helpful in the species identification of Staphylococcus

aureus except:
Thermostable endonuclease
Deoxyribonuclease
Modified dimethyl sulfoxide (DMSO) test
Tube coagulase test
Feedback
Dimethyl sulfoxide (DMSO) is used to react with cell wall constituents to make the
bacterial cell permeable to the diffusion of the oxidase reagent. This test is used to
differentiate members of the genus Micrococcus, which are modified oxidase positive,
from the members of the genus Staphylococcus which, except for rare strains of S.
caseolyticus and S. sciuri, are negative. Therefore, this test does not distinguish S.
aureus from most other staphylococci, all of which are oxidase negative.
Staphylococcus aureus, however, does uniquely produce both deoxyribonuclease and
thermostable endonuclease. Both of these tests use DNase test medium with toluidine
blue O to detect the hydrolysis of DNA by the test organism. The tube coagulase test
also is used to separate S. aureus from other staphylococci, except for rarely
encountered strains of S. hyicus, S. delphini and S. schleiferi, which may also produce
free coagulase.
Which of the following media contains the X and V factors necessary for the growth
of Haemophilus influenzae:
MacConkeys agar
Sheep blood agar
Chocolate agar
Brain-heart infusion agar
Feedback
Chocolate agar contains both the X factor (hemin) and V factor (coenzyme nicotine
adenine dinucleotide) which are necessary for growth of H. influenzae. It is prepared
by adding sheep blood to agar at 80o C to lyse the red cells.
Koch's postulates include all of the following except:

This microorganism can be isolated from specimens associated with the given
disease
Inoculation of the isolate into a susceptible experimental animal will produce
the disease
The organism can subsequently be recovered from an experimentally infected
animal
The isolated organism, when injected into a human host, will produce the
disease
Feedback
Koch's postulates did NOT include the following statement: The isolated organism,
when injected into a human host, will produce the disease.
Several patients developed subcutaneous abscesses at the sites of injection of a

preparation labeled "adrenal cortex injection" administered as part of a weight loss
regimen (MMWR 45:713, 1996). Pale-staining, filamentous acid-fast bacilli were
seen in the material aspirated from the lesions (the upper photomicrograph is
representative) and the colonies shown in the lower photograph grew out after 3 days
incubation at 35C in CO2. The most likely identification is:
Mycobacterium marinum
Mycobacterium abscessus (chelonei)
Nocardia otitidiscaviarum (caviae)
Streptomyces somaliensis
Feedback
The outbreak described in the clinical history indeed was caused by Mycobacterium
abscessus, a rapidly growing species in the fortuitum/chelonei complex. As part of an
epidemiological investigation, M. abscessus was recovered from one of the unopened
and three of the opened vials of injection fluid. The pale staining acid fast smear and
rapid growth of smooth, yellow-white colonies are consistent findings. The
identification of the isolates was confirmed biochemically. Mycobacterium marinum
causes subcutaneous infections; however, does not grow at 35C. Nocardia
otitidiscaviarum also causes subcutaneous infections; however, is only partially acid
fast and appears as branching filaments in direct smears. Streptomyces species may
rarely cause subcutaneous infections; however, are not acid fast and also produce
branching filaments.
C-reactive protein:
Is a highly specific test

Corresponds to serum complement levels
Is usually elevated in pediatric bacterial infections
Does not react with pneumococcal C-polysaccharide
Feedback
C-reactive protein was first found to precipitate pneumococcal C-polysaccharide in

patients who had recovered from pneumococcal pneumonia. It was subsequently
found to be elevated in numerous other conditions. It is often elevated in pediatric
bacterial infections, and usually not elevated in pediatric viral infections, and thus
may help the pediatrician to differentiate these entities. It can also be used to follow
the disease activity in autoimmune conditions.
The reactions in the tubes illustrated in this exercise (reading from left to right: KIA,
Pseudosel, OF glucose, closed and open) indicate that the bacterial species in question
is a:
Glucose fermenter
Glucose oxidizer
Lactose fermenter
Glucose nonoxidizer
Feedback
The lack of yellow conversion of either the slant or the deep of the KIA tube or both
indicates that the unknown bacterial species is not a glucose or a lactose fermenter.
The conversion of the open tube to a yellow color in comparison to the closed tube
which remains green, indicates that the bacterial species utilizes glucose oxidatively;
therefore, is a glucose oxidizer. A nonoxidizer would show no yellow pigment in
either the open or closed OF tubes. The production of a green pigment in the
Pseudosel tube identifies this glucose oxidizer as Pseudomonas aeruginosa.

A cerebrospinal (CSF) cell count is 1000 cells/L. The cells on differential are
predominantly lymphocytes. CSF protein is moderately elevated and the glucose is
normal. No microorganisms were observed on a Grams stain smear of the CSF
sediment. This condition is MOST likely:
Bacterial meningitis
Viral meningitis
Normal spinal fluid
Tubercular meningitis
Feedback
The test results that are associated with different types of meningitis are summarized
in the table below.
Meningiti White Blood

Differential Glucose Protein Lactate
s Cell Count
Primarily Markedly Markedly

Bacterial Elevated Elevated
neutrophils decreased elevated
Primarily Moderately
Viral Elevated Normal Normal
lymphocytes elevated
Normal or Moderate to
Lymphocytes
Fungal Elevated slightly marked Elevated
Monocytes
decreased elevation
Moderate to
Lymphocytes
Tubercular Elevated Decreased marked Elevated
Monocytes
elevation

Nocardia farcinica has been distinguished from other members of the Nocardia
asteroides complex because most strains are resistant to erythromycin and other
antibiotics commonly used to treat nocardia infections, and are more commonly
recovered from patients with severe underlying illness. Characteristics that are helpful
in the preliminary identification of this species include:
The ability to grow at 45C

Reduction of nitrates to nitrites
A white opacity around colonies on Middlebrook agar
Turning of arylsulfatase media in 2 weeks
Feedback
The ability of Nocardia farcinica to grow at 45C and to develop a white

opacification around colonies growing on Middlebrook agar were cited by Carson and
Hellyar (J Clin Microbiol 32:2270-2271, 1994) as two of the key characteristics by
which this subspecies can be separated from other members of the Nocardia
asteroides complex. All members of the Nocardia asteroides complex reduce nitrates;
therefore, this is not a differentiating characteristic. The turning of arylsulfatase media
in 2 weeks is a distinguishing characteristic for another member of the Nocardia
asteroides complex, namely, Nocardia nova (Wallace, et al: J Clin Microbiol 29:2407-
2411, 1991).
Each of the following bacterial species are commonly associated with wound
infections following a dog bite except:
Staphylococcus intermedius
Bordetella bronchicanis
Pasteurella multicida
Capnocytophaga cyanodegmi
Feedback
Although the species name of Bordetella bronchicanis (bronchiseptica) indicates an

association with dogs ("canis"), the linkage is as an agent or respiratory tract
infections in animals (tracheobronchitis or "kennel cough" in dogs, atrophic rhinitis in
pigs, pneumonia and otitis media in rabbits and guinea pigs) (Ehrhardt M, et al:
Bordetella bronchiseptica: pathogen vs commensal. Clin Microbiol Newslett 8:26-27,
1986). Although humans, particularly those who are immunosurppressed, may acquire
B. bronchicanis respiratory infections by contact with dogs, wound infections
following dog bites is not part of the clinical spectrum of this organism. In contrast,
Staphylococcus intermedius, Pasteurella multicida and Capnocytophaga cyanodegmi
are all known to be associated with dog bites, to the point that when one of these
species is recovered, either from a wound or a blood culture, an animal source must
be presumed.
What is the MOST common infective agent to be transmitted through blood

transfusion that results in morbidity and mortality?
Bacteria
Human immunodeficiency virus (HIV)
Hepatitis A virus (HAV)
Malarial parasites
Feedback
The most common infectious agent to be transmitted through blood transfusion is

bacteria. The estimated risk of contamination of blood components with bacteria is 1
in 5000 platelet units and 1 in 30,000 Red Blood Cell units.
For this reason, the inspections of red blood cell units that are done upon receipt of
blood from a supplier, immediately before use, and at defined intervals must include a
check for abnormal appearance. Comparison of bag and segment color should be
performed for red blood cell units to aid in detection of bacterially-contaminated
units. Storing Red Blood Cells above 6oC may promote the growth of bacteria.
Platelets that are stored at 20 - 24oC are a particular concern. It is a requirement that
platelet components be tested to detect the presence of bacteria.
The risk of transmission of HIV through blood transfusion is 1 in 2 million in the

United States. The statistics from Canada and Europe show this risk to be about the
same or less.
HAV is normally transmitted through the feco-oral route, but rarely can be transmitted
through blood.
The FDA recommends that donors who have a history of malaria be deferred from
donation for 3 years after becoming asymptomatic and for one year following return
from an area where malaria is endemic. The initial interview of donors has made the
transmission of malarial parasites through blood transfusion a rarity.
What two glycoproteins are expressed on the surface of influenza A viruses and are
used for subtyping of the viruses?
Hemagglutinin
Glycoprotein120 (gp120)
Glycoprotein41 (gp41)
Neuraminidase
Feedback
Influenza A viruses are subtyped based on two glycoprotein spikes expressed on their
surfaces:
1) Hemagglutinin (HA)
2) Neuraminidase (NA)
Gp120 and gp41 are associated with the human immunodeficiency virus.

An 18-year-old woman woke up in the morning to find that her left knee was hot,
swollen, and very painful. She could not walk to work and a friend offered her a ride
to the clinic. She had never had a swollen joint before. Physical exam revealed a
tender knee joint which yielded purulent synovial fluid on aspiration. Gram-negative
intracellular diplococci were seen on Gram stain. She also had a cervical discharge
that was cultured. The cause of her infection would grow best on:
Modified Thayer Martin agar at 35C with CO2

LIM (Todd Hewitt Broth w/Colistin and Nalidixic Acid) broth with refrigerated
temperature
Blood agar at 42C with microaerophiilic conditions
V (human blood) agar at 35C with CO2
Feedback
Modified Thayer Martin agar at 35C with CO2 is the correct answer. This is a typical
presentation of systemic gonorrhea and Neisseria gonorrhea grows best on MTM
medium at 35C. under CO2. Systemic gonorrhea occurs in 1% of cases and results in
purulent arthritis and rarely septicemia.

A 62 year-old female under chemotherapy for breast cancer developed fever,
abdominal pain and foul-smelling diarrhea after receiving clindamycin for 5 days. The
photomicrograph is an H & E-stained section of colon biopsy revealing focal
ulceration and an inflammatory pseudomembrane. Each of the following laboratory
findings will confirm the presumptive diagnosis of C. difficile-associated colitis
except:
Recovery of C. difficile in the stool

Detection of cytotoxin B of C. difficile
Positive latex agglutination of glutamate dehydrogenase of C. difficile
Positive EIA for C. difficile enterotoxin
Feedback
This is a trick question (or maybe a trick answer). The recovery of C. difficile in stool
specimens by itself is insufficient to establish a diagnosis of C. difficile-associated
colitis. Rather, it is also necessary to demonstrate that the strain recovered is a toxin-
producing. A positive reaction for all of the other tests listed in this exercise confirm
the diagnosis of C. difficile disease when pseudomembranous colitis as demonstrated
in the photomicrograph of the biopsy. All tests have some chance for either false
positive or false negative results and careful clinical and histopathological correlation
is needed before a causal relationship can be demonstrated.
The condition most likely to predispose a person to septicemia by viridans

streptococci is:
Hypertrophy of the prostate gland

Poor oral hygiene
Chronic obstructive pulmonary disease
Indwelling catheter
Feedback
The oropharynx is thought to be the source in most cases of viridans streptococcus
septicemia, secondary to either poor oral hygiene or periodontal disease
(Watanakunikorn and Pantelakis, Scand J Infect Dis 25:403-408, 1993). Viridans
streptococci cause urinary tract infections extremely rarely and therefore would not be
involved in any such infections secondary to outflow obstruction from prostatic
hypertrophy. Viridans streptococci also are infrequent agents of pulmonary infections
and do not often infect indwelling catheters. Therefore, the "most likely" answer in
this exercise is poor oral hygiene.
Match each of the most likely primary sites of infection listed with the corresponding
bacterial agents as represented by the microscopic Gram stain morphology of the four
images included in the photograph.
Meningitis (adult) A
Pneumonia B
Cutaneous cellulitis C
Retropharyngeal abscess D
Feedback
Within the context of this exercise and the selection of the bacterial cell morphologies
represented by the photomicrographs, the most likely cause of pneumonia would be
the gram positive diplococci shown in Frame B, representative of S. pneumoniae.
Although meningitis can be caused by gram negative bacilli, this infection in adults is
more likely to be caused by Neisseria species, as represented by the gram negative
diplococci illustrated in Frame A. Of the bacterial species shown in the
photomicrographs, cellulitis would most likely be caused by streptococci, illustrated
by the long chains of gram positive cocci seen in Frame C. Of the choices in this
exercise, a retropharyngeal abscess would most likely be caused by one of the gram
positive filamentous bacteria representing either Actinomyces species or Nocardia
species, as illustrated in Frame D.
A 42 year old chain smoker experienced an increase in cough, sputum production and
intermittent shortness of breath for over one week. A diagnosis of chronic bronchitis
with acute exacerbation was made. The photomicrograph is a gram stain of an early
morning, spontaneously expectorated sputum. Based on the gram stain, the most
likely cause of the exacerbation is:
Bordetella bronchiseptica
Moraxella catarrhalis
Klebsiella pneumoniae
Feedback
The gram stain reveals a few segmented neutrophils indicating an active infectious
process. Many gram negative organisms are present. The individual cells are short,
coccobacillary, with a few slender, elongated pleomorphic forms seen. Of the bacterial
species listed, this pleomorphism is most consistent with Haemophilus influenzae,
although Bordetella bronchiseptica cannot be totally ruled out. The latter is a bacterial
species that inhabits the respiratory tract of dogs, cats and other domestic animals and
human infections are relatively rare. Therefore, on the basis that H. influenzae is
indigenous in humans, it is more likely related to chronic bronchitis. Moraxella
catarrhalis is commonly associated with chronic bronchitis; however, the bacterial
cells are distinctly coccoid and tend to occur in pairs. Klebsiella pneumoniae is more
likely to be associated with lobar pneumonia, and produce regular, short broad bacilli
rather than the tiny, coccobacilli seen here.
The preliminary identification of bacterial species often is made based on the odor
produced by colonies recovered on primary isolation media. Match the names of the
bacterial species with its corresponding odor.
Eikenella corrodens Bleach

Eugonic Fermenter (EF4) Popcorn
Flavobacterium odoratum Peeled apples
Pasteurella multocida Mothballs
Feedback
Flavobacterium odoratum, along with Alcaligenes fecalis (odorans), produce a sweet

odor often described as peeled apples. The pitting colonies of Eikenella corrodens can
be further identified by detecting the characteristic bleach odor. Pasteurella multocida
produces large quantities of indole, imparting what has been described as the smell of
mothballs. A popcorn smell suggests the recovery of the yet unnamed CDC species,
EF4.

Which one of the following organisms is sensitive to bacitracin:
Group A Streptococcus
Group B Streptococcus
Group D Streptococcus
Staphylococci
Feedback
Group A Streptococcus is suseptible to bacitracin. Group B Streptococcus, Group D

Streptococcus, and Staphylococci are resistant to bacitracin.
Illustrated in this photograph is the surface of a thiosulfate citrate bile sucrose (TCBS)
agar plate on which are growing colonies of an unknown bacterial species from a
diarrheal stool specimen. The most likely identification is:
Vibrio cholerae
Vibro parahemolyticus
Plesiomonas shigelloides
Vibrio vulnificus
Feedback
Thiosulfate citrate bile sucrose agar is helpful in the recovery of Vibrio species from
stool specimens. The citrate inhibits the growth of E.coli and other enteric gram
negative rods that may overgrow the culture; the bile inhibits the growth of most gram
positive bacteria. Of the species listed, only Vibrio cholerae ferments sucrose,
resulting in the yellow, acid pH colonies. Bacterial species that can grow on TCBS
agar but that do not ferment sucrose are semitransparent and will appear green.
Which one of the following is NOT one of Kochs Postulates?
A bacterial species is a collection of strains that share many common

characteristics.
A given organism must be present in every case of a given infectious disease.
Inoculation of the isolate into susceptible animals produces a similar disease.
The microorganism can be isolated from specimens associated with that disease
state.
The same organism that is associated with the disease state can be recovered
from representative specimens from the experimentally infected animal.
Feedback
The only choice in the question which is not one of Koch's postulates is:
A bacterial species is a collection of strains that share many common

characteristics

Who am I, a bug so obscene

To cause the first quarantine?
Mycobacterium tuberculosis
Yersinia pestis
Vibrio cholerae
Corynebacterium diphtheriae
Feedback
The word quarantine derives from the Italian word quaranta, referring to the period of
the 40 day maritime restraint imposed by the port of Venice for ships embarking from
areas endemic for bubonic plague. Yersinia pestis is transmitted from infected rats and
other rodents to humans by the bite of rat fleas. Infected fleas die within 40 days;
therefore, by holding ships at bay for 40 days or more by these 15th Century policies,
transmission of the plague could be prevented, although the administrators of the time
did not know why. Although transmission of tuberculosis can be prevented by
respiratory isolation, the disease is long standing and obviously 40 days is insufficient
to prevent disease transfer. Transmission of Vibrio cholerae was also diminished
during periods of endemic cholera through quarantine of ships, primarily because the
acutely ill died during the period of quarantine, reducing the time they could
contaminate domestic water supplies. Transmission of diphtheria may also be reduced
during quarantine as many of those acutely ill may die before deportation. However,
in the contest of this exercise, Y. pestis is considered the best answer.
Match the organisms on the right with the culture media that bests suits their
growth/identification.
Neisseria, Haemophilus Chocolate agar

Anaerobes Chopped meat broth
Gardnerella vaginalis Columbia CNA agar w/blood
Salmonella, Shigella Hektoen enteric agar
Feedback
Neisseria, Haemophilus: Chocolate agar
Anaerobes: Chopped meat broth
Gardnerella vaginalis: Columbia CNA agar w/blood
Salmonella, Shigella: Hektoen enteric agar
This isolate is a catalase negative, gram positive coccus on sheep blood agar. The P
disk has 5g of optochin and the zone around it is 16 mm. It has been streaked
perpendicular to a beta lysine-producing Staphylococcus aureus. The presumptive
identification is:
Streptococcus pneumoniae
Streptococcus agalactiae
Streptococcus pyogenes
Viridans streptococcus
Feedback
Streptococcus pneumoniae is the correct answer since it is CAMP test negative, alpha-
hemolytic and susceptible to optochin. Streptococcus agalactiae is usually beta-
hemolytic but would be CAMP positive as indicated by an arrowhead where the
isolate is perpendicular to beta-lysin producing Staphylococcus aureus. Streptococcus
pyogenes would be beta hemolytic and resistant to optochin. Viridans streptococcus
would be resistant to optochin.
The species identification of Neisseria species is most often confirmed by observing

the specific carbohydrate utilization profile. Match each of the names of the Neisseria
species in the left column with the letter of its associated API QuadFerm reactions
(G=glucose; M=maltose; L=lactose; S=sucrose; yellow is a positive reaction).
Neisseria meningitidis A
Neisseria gonorrhoeae B
Moraxella catarrhalis C
Neisseria lactamica D
Feedback
The carbohydrate utilization profiles of the Neisseria species listed in this exercise
and as reflected in the photographs are: Neisseria lactamica, glucose, maltose and
lactose (Frame D); Moraxella catarrhalis, no reactions (Frame C); Neisseria
gonorrhoeae, glucose only (Frame B); and, Neisseria meningitidis, glucose, maltose,
and sucrose only (Frame A).
The ends of rod-shaped bacteria may appear:
budding
tapered
filamentous
rounded
Feedback
When describing rod-shaped bacteria, the terms "rounded ends" or "tapered ends"
may help to identify the type of bacteria present. The term budding frequently
describes yeast, but not rod-shaped bacteria. Filamentous may describe the
appearance of certain bacteria such as Nocardia, but is not used to describe the ends of
rod-shaped bacteria.

The bacterial species, a typical colony of which is illustrated in this photograph, and a
common bacterial cause of "swimmer's ear" can be identified as:
Serratia marcescens
Pseudomonas aeruginosa
Alcaligenes odorans
Streptococcus pneumoniae
Feedback
The photograph illustrates a colony that appears smooth to mucoid in consistency,

with a distinct green discoloration. Blood agar may assume a green discoloration from
the break down of erythrocytes and the release of pigmented biliverdin products,
either from alpha hemolysis or from deterioration. For example, most strains of
Alcaligenes odorans produce a green discoloration of the media. Streptococcus
pneumoniae is alpha hemolytic, and many strains may also appear mucoid. However,
neither of these species produce pyoverdin and neither has been associated with
"swimmer's ear". Some strains of Serratia marcesens produce pigments; however, the
hue is generally on the brown, yellow or red side of the color spectrum. The green
pigment seen in this photograph is pyocyanin, a chief identifying characteristic of P.
aeruginosa. P. aeruginosa is a hydrophilic organism and a known bacterial agent of
"swimmer's ear", at a site where moisture tends to accumulate.

Gram positive cocci isolated from a catheterized urine culture on a 76-year-old male
gave the following reactions:
Blood agar- creamy, white, opaque colonies
Catalase- positive
Slide coagulase- negative
Tube coagulase- negative
Novobiocin- susceptible
The next action the MLS should take is:
Report the isolate as coagulase negative staphylococcus

Report the isolate as Staphylococcus epidermidis
Report the isolate as Staphylococcus saprophyticus
Perform further testing to speciate the organism
Feedback
Report the isolate as coagulase negative Staphylococcus is the correct answer because
this is an isolate from a urine specimen with a coagulase negative Staphylococcus
susceptible to novobiocin. Staphylococcus saprophyticus is resistant to novobiocin.
Further testing is required to speciate coagulase negative Staphylococci but only if the
specimen is from a sterile body site, not urine.

Several methods of detection are available for the detection of Clostridium difficile in
clinical samples. Which methods have the capability for detection in less than 48
hours? (Choose all that apply.)
Cytotoxicity neutralization assay

Glutamate dehydrogenase (GDH) antigen assay
Antigenic detection of toxins A and B
Polymerase chain reaction (PCR)
Cultivation on selective media
Feedback
Although the cell cytotoxicity assay is considered a gold standard method for
detection of C. difficile, it is labor intensive and requires at least 48 hours incubation.
Culture on selective media provides good recovery of the organism, but may requires
up to 4 days for recovery, and also entails follow up testing to determine toxin
producing capability of each strain. The GDH antigen assay, assays for the detection
of toxins A and B, and PCR provide better avenues for rapid detection, although they
differ greatly in terms of sensitivity, specificity, positive and negative predictive
values.
The oxidase test is used to presumptively identify:
Escherichia
Enterobactor
Serratia
Neisseria
Feedback
Any organism which is oxidase positive can be excluded from the Enterobacteriaceae.

A nitrate test is performed on a glucose nonfermenter. When the nitrate reagents were
added, no color change occurred. When zinc dust was added, no color developed. This
test should be reported as:
Positive for nitrite and negative for nitrogen gas

Negative for nitrogen gas and negative for nitrate production
Positive for nitrogen gas and negative for nitrite production
Negative for nitrate and negative for nitrite reduction
Feedback
Positive for nitrogen gas and negative for nitrite production is the correct answer
because the nitrate to nitrite result was negative but when zinc dust was added, no
color developed. This demonstrated that no nitrate is left in the tube to be reduced;
therefore, nitrogen gas must have been produced from the nitrate.
Sheeps blood agar is least suitable for the growth of which of the following
organisms?
Streptococcus species
Feedback
Conventional sheep blood agar is not suitable for recovery of Haemophilus species.
Enzymes in native sheep blood inactivate V factor, which is required for growth of
Haemophilus species such as Haemophilus influenzae. If the agar medium is
supplemented with rabbit or horse blood, Haemophilus species will grow as rabbit or
horse blood does not contain these enzymes. Selective Haemophilus isolation media is
available: these contain beef heart infusion, peptones, yeast extract (provides V
Factor), and defibrinated horse blood (provides X Factor, which is also required for
growth of Haemophilus influenza).
Staphylococcus aureus grows rapidly on sheep blood agar. Streptococcus species also
grow on sheep blood agar. Sheep blood is used as the indicator for hemolysis.
Observation and interpretation of the hemolytic properities of streptococci helps to
determine subsequent tests for species identification.
Reference: Winn, WC Jr. Koneman's Color Atlas and Textbook of Diagnostic

Microbiology. 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins: 2006.
Acute obstructive epiglottitis, both in adults and children, is caused by the bacterial
species shown in this split screen photograph. The colonies recovered on chocolate
agar (upper frame) required both hematin and NAD, (as shown by colony growth only
between the X and V strips in the lower frame). The most likely identification is:
Haemophilus parainfluenzae
Haemophilus aphrophilus
Haemophilus haemolyticus
Feedback
Haemophilus influenzae is both X and V factor dependent for growth, and is the most
common cause of obstructive laryngitis and epiglottitis. H. parainfluenzae is only V-
factor dependent and causes only mild pharyngitis, rarely obstructive in nature. H.
aphrophilus can be part of the normal upper respiratory flora in humans, does not
cause pharyngitis, and is not X or V-factor dependent for growth. Although H.
haemolyticus is both X and V-factor dependent, it is beta hemolytic on blood agar and
is generally considered non pathogenic.
In molecular diagnostic testing, hybridization employs complementary base pair

binding of a synthetic strand to DNA or RNA.
True
False
Feedback
Hybridization is a technique used to determine presence of target DNA or RNA by

adding a synthetic strand that binds by complementary base pairing to the target.

The select reactions observed in the partial API strip illustrated in this photograph,
reading from left to right, are: ONPG negative; arginine, lysine, and ornithine
decarboxylases positive; citrate positive; H2S positive, and the remaining reactions
negative. These reactions are most consistent with bacteria belonging to the genus:
Citrobacter
Salmonella
Proteus
Edwardsiella
Feedback
The production of H2S, utilization of citrate and the decarboxylation of all three
amino acids included in the strip, provide for a presumptive identification of
Salmonella species. The beginning three biotype numbers (670) as listed in the API
profile index all point to Salmonella species, with the remaining reactions in the strip
differentiating between the various subgroups. All of other species listed in this
exercise produce H2S; however, none decarboxylate all three of the amino acids as
seen in this profile. Proteus species would also give positive reactions for urease and
TDA, both of which are negative in this strip. Most strains of Edwardsiella species
also are indole positive.
Each of the following bacterial species have the common characteristic of the failure
to decarboxylate lysine, ornithine and arginine except:
Pantoa agglomerans
Ewingella americana
Yersinia enterocolitica
Providencia stuartii
Feedback
Of the members of the Enterobacteriaceae more commonly encountered from clinical

specimens, the inability to decarboxylase either of the amino acids, lysine, arginine
and ornithine, first points to Pantoa agglomerans. Although all members of the genus
Providencia fail to decarboxylate these amino acids, the identification of Providencia
stuartii in particular is usually made by other characteristics. The less commonly
encountered Ewingella americana also shares this characteristic. Therefore, of the
species listed, only Yersinia enterocolitica can be excluded as the correct answer in
this exercise as it decarboxylates ornithine.
==========================================================
A presumptive identification of a bacterial species can often be made by observing the

type of hemolysis when grown on blood agar. Match the name of each of the bacterial
species listed with either Bucket A (alpha hemolytic) or Bucket B (beta hemolytic)
depending on its usual hemolytic activity on 5% sheep blood agar.
Bucket B Streptococcus pyogenes

Bucket A Streptococcus pneumoniae
Bucket A Streptococcus salivarius
Bucket B Streptococcus agalactiae
Feedback
Streptococcus pyogenes is the species name for group A streptococci, which are beta
hemolytic. Streptococcus agalactiae is the species name for group B streptococci,
which are also beta hemolytic. Streptococcus salivarius is one of the viridans
streptococci, which are characteristically alpha hemolytic. Streptococcus pneumoniae
also produces alpha hemolysis on 5% sheep blood agar.

Bacte Sample Question

Enviado por

Dados do documento

Título original

Direitos autorais

Formatos disponíveis

Compartilhar este documento

Compartilhar ou incorporar documento

Opções de compartilhamento

Você considera este documento útil?

Este conteúdo é inapropriado?

Direitos autorais:

Formatos disponíveis

Bacte Sample Question

Enviado por

Direitos autorais:

Formatos disponíveis

You answered the question incorrectly.

The correct answer is highlighted below

You answered the question incorrectly.

The correct answer is highlighted below

You answered the question incorrectly.

The correct answer is highlighted below

Among the nonfermenters, the production of indole points to one of the

You answered the question incorrectly.

The correct answer is highlighted below

Beta hemolysis, negative CAMP, negative catalase, growth in 6.5% salt

You answered the question incorrectly.

Streptococcus milleri (anginosus) grows on blood agar as tiny colonies, as illustrated

You answered the question correctly.

The correct answer is highlighted below

You answered the question incorrectly.

The OF dextrose activity is a key initial assessment in the presumptive identification

Bucket B Comamonas testosteroni

Several species of nonfermenters do not utilize glucose fermentatively or oxidatively,

You answered the question incorrectly.

The correct answer is highlighted below

You answered the question correctly.

The correct answer is highlighted below

Relative decrease in the protein concentration

The concentration of protein is reduced in OF medium, and the relative amount of

You answered the question incorrectly.

Actinobacillus actinomycetemcomitans Localized juvenile periodontitis

Eikenella corrodens is a normal inhabitant of the oropharynx and is involved in

Question Difficulty: Level 8

You answered the question correctly.

The bacterial cells of Nocardia species are described as gram-positive filamentous

You answered the question incorrectly.

The correct answer is highlighted below

Normal flora and not the cause of pneumonia

You answered the question incorrectly.

Enriched thioglycolate medium Anaerobes

Hektoen enteric agar is used for recovery of Salmonella/Shigella

Enriched thioglycolate medium is used for differentiation of anaerobes

Sabourand dextrose agar is used for the cultivation of fungi

Question Difficulty: Level 3

You answered the question correctly.

Bacitracin susceptibility is useful for which two of the following:

The correct answers are highlighted below

Distinguishing Staphylococci from micrococci

Question Difficulty: Level 4

You answered the question incorrectly.

A sputum brick red with flame,

The correct answer is highlighted below

Klebsiella pneumoniae is the bacterial species that causes a necrotizing pneumonia

Question Difficulty: Level 7

You answered the question incorrectly.

Thermophylic Pseudomonas aeruginosa

Question Difficulty: Level 6

The correct answer is highlighted below

Question Difficulty: Level 6

The correct answer is highlighted below

Herpes simplex virus infection

Epstein-Barr virus causes infectious mononucleosis, which is associated with atypical

Question Difficulty: Level 4

You answered the question correctly.

The correct answer is highlighted below

Public health guidelines recommend that manipulation of samples for influenza

You answered the question incorrectly.

The correct answer is highlighted below