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610 Micro E4 (new content)

Total questions: 47

Worksheet time: 25mins

Name
Class
Date
1.

What species would show up as positive Enterobacterales on the spot-indole test?

a)

Escherichia coli and Klebsiella oxytoca

b)

Vibrio vulnificus and Pseudomonas aeruginosa

c)

Klebsiella aerogenes, Klebsiella pneumonia, and Citrobacter koseri

d)

Streptococcus viridans

2.

Which two Gram negative enterics are typically Oxidase positive?

a)

Pseudomonas and Acinetobacter

b)

Stenotrophomonas and Shigella

c)

Pseudomonas and Vibrio

d)

Morganella and Yersinia

3.

The Gram negative enteric Escherichia coli is the #1 cause of UTIs, about half the cause of Gram negative bacteremias, and what other conditions?

a)

Replacement valve and pacemaker infections

b)

Gastroenteritis and meningitis

c)

Melioidosis and Rickettsia

d)

Central venous catheter and community pneumonia

4.

What best describes ETEC (enterotoxigenic E. coli) pathogenesis?

a)

Plasmid enterotoxins (STa/B & LT-I/II) cause hypersecretion of fluids and electrolytes

b)

Dx by HeLa/Hep-2 cell adherence

c)

Plasmid mediated attachment/effacement forms cuplike pedestals

d)

Plasmid mediated aggregation (stacked bricks) shorten microvilli and cause hemorrhage and mononuclear infiltration

5.

What best describes EPEC (enteropathogenic E. coli) pathogenesis?

a)

Plasmid enterotoxins (STa/B & LT-I/II) cause attachment of cuplike pedestals

b)

Dx by commercial immunoassays and PCR

c)

Plasmid mediated attachment/effacement forms cuplike pedestals

d)

Plasmid mediated aggregation (stacked bricks) shorten microvilli and cause hemorrhage and mononuclear infiltration

6.

What best describes EAEC (enteroaggregative E. coli) pathogenesis?

a)

Plasmid enterotoxins (STa/B & LT-I/II) cause attachment of cuplike pedestals

b)

Dx by PCR to test for plasmids

c)

Plasmid mediated attachment/effacement forms cuplike pedestals

d)

Plasmid mediated aggregation (stacked bricks) shorten microvilli and cause hemorrhage and mononuclear infiltration

7.

Your tech reports a case of person-person transmitted E. coli. PCR is positive for Stx 1 & 2, serology shows O157:H7, and microscopy shows hemorrhagic colitis. What is your diagnosis?

a)

STEC

b)

EAEC

c)

EIEC

d)

Klebsiella pneumoniae

8.

A culture shows mucoid colonies; indole test is negative; blaKPC PCR positive. What would the pathogen be?

a)

Klebsiella oxytoca

b)

Vibrio vulnificus

c)

Moraxella morganii

d)

Klebsiella pneumoniae

9.

What infections are expected of both Enterobacter and Citrobacter?

a)

Nosocomial UTI and wound infections

b)

Elderly meningitis and brain asbcesses

c)

Community acquired UTI and wound infections

d)

Community acquired pneumonia

10.

(Multiple answers) Aside from redness, what is characteristic of Serratia?

a)

Oxidase +

b)

Common ampC occurrence with inducible overexpression

c)

Ferments lactose so slowly it appears negative

d)

Pneumonia, bacteremia, and endocarditis

11.

Which 3 bacteria are known for "stably derepressed" ampC plasmids?

a)

Citrobacter and Serratia

b)

Vibrio dysenterieae

c)

Enterobacter (highest risk w 3rd gen cephalosporins)

d)

E. coli and Klebsiella aerogenes

12.

Your tech reports a "swarmed" culture with a strong ammonia smell. What do you report?

a)

Proteus

b)

Klebsiella vulnificus

c)

Salmonella chloereae

d)

Staphylococcus aureus

13.

What pathogen grows green on a Hektoen enteric agar due to lack of H2S and no sugar fermentation?

a)

Shigella

b)

Salmonella

c)

Klebsiella

d)

Streptococcus

14.

What pathogen grows black on a Hektoen enteric agar due to H2S?

a)

Shigella

b)

Salmonella

c)

Klebsiella

d)

Streptococcus

15.

What presentation would lead you away from Salmonella?

a)

Bacteremia transmitted by contaminated food/water

b)

Gastroenteritis

c)

Pneumonia showing severe extensive bullae

d)

Enteric fever lasting >7d including rose spots and hepatosplenomegaly

16.

You're asked about the live oral vaccine Ty21a. The patient is traveling to a Salmonella endemic area in a month. What dosing do you recommend?

a)

Finish course a day before travel; redose if returning after 10 yrs

b)

Finish course 2 wks before travel; redose if returning after 2 yrs

c)

Finish course a week before travel; redose if returning after 5 yrs

d)

Finish course a week after travel; redose if exposure suspected

17.

You're asked about the inactivated injection ViCPS. The patient is traveling to a Salmonella endemic area in a month. What dosing do you recommend?

a)

Finish course a day before travel; redose if returning after 10 yrs

b)

Finish course 2 wks before travel; redose if returning after 2 yrs

c)

Finish course a week before travel; redose if returning after 5 yrs

d)

Finish course a week after travel; redose if exposure suspected

18.

You're notified of a Gram negative bug invading M cells in intestinal Peyer's patches eventually causing apoptosis. You suspect Shigella. What are the most reasonable tests to order?

a)

Stool culture and PCR

b)

Series of Hektoen, MacConkey, and TSI agars consecutively

c)

Antisera slide agglutination

d)

MALDI-TOF MS after isolating pure colony

19.

Your tech hands you morphology results showing Gram negative bacteria growing in pairs that are mucoid, producing a grape odor, producing pigments, and expressing beta hemolysis. What do you suspect?

a)

Burkholderia burgdorferi

b)

Providencia stuartii

c)

Risperdal sustenna

d)

Pseudomonas aeruginosa

20.

What are some of the intrinsic resistance mechanisms used by Pseudomonas?

a)

Type 3 secretion systems

b)

gyrA and parC for fluoroquinolones

c)

ETA, LasB, and phospholipase C

d)

porins and efflux pumps

21.

Pseudomonas resistance using BL lysis, AG modification, and anti-fluoroquinolone enzymes are through what mechanism?

a)

Intrinsic

b)

Virulence

c)

Adaptive

d)

Acquired/horizontal transfer

22.

Your tech reports distinctly plump coccobacilli that are resistant on numerous E-Tests. The bacteria is noted to be taken from the oropharynx of a patient not currently showing symptoms of infection. What bacteria might this be?

a)

Pseudomonas

b)

Acinetobacter

c)

Citrobacter

d)

Streptococcus

23.

Your hospital is having an uptick of MDR infections that are oxidase -, catalase + Gram negative aerobes. Other notable factors are remarkably small bacteria with polar flagella and causing pneumonia and wound infections after antibiotic exposure. What pathogen might it be?

a)

Stenotrophomonas maltophilia

b)

Moraxella catarrhalis

c)

Cytomegalovirus zoster

d)

Providencia stuartii

24.

You are performing media cultures to diagnose an obligate aerobe with flagella causing pulmonary infections in the immunocompromised. It is appearing yellow on both BCSA and OFPBL. What might it be?

a)

Salmonella

b)

Shigella

c)

Burkholderia

d)

Rickettsia

25.

There has been a bioweapons attack in your area and you're responsible for identifying the pathogen. Patients are experiencing lymphangitis, fever, sepsis, pneumonia, and skin lesions. What would lead you towards melioidosis (Burkholderia pseudomallei)?

a)

Safety pin bipolar Gram stain

b)

Wrinkly metallic appearance on Ashdown's media

c)

Earthy smell on Ashdown's media

d)

Grape smell on Ashdown's media

26.

You're evaluating a couple who recently traveled. One presents with rice-water diarrhea, vomiting, and hypovolemic shock. The other is completely healthy due to taking the live attenuated oral vaccine Vaxchora 10 days before exposure. What pathogen do you ask the lab to test for?

a)

Vibrio vibriaeticus

b)

Vibrio vulnificus

c)

Haemophilus influenzae

d)

Vibrio cholerae

27.

An immunocompromised patient you were treating for chronic liver and kidney diseases starts chatting with you at KMart. You notice they're not doing well and they have a developing bullae on their arm. They said they haven't been feeling well after eating some questionable oysters. What do you recommend they get checked for?

a)

Vibrio vulnificus bacteremia

b)

Vibrio cholerae

c)

Influenza parahaemolytica

d)

Burkholderia burgoldferi

28.

Which of the following rapid diagnostic tests is incorrectly matched?

a)

Helicobacter pylori - breath urease test

b)

Legionella - urinary antigen test

c)

Vibrio - halophilic biochemical tests

d)

Pseudomonas aeruginosa - Mantoux TST

29.

Which of the following is an incorrect statement regarding beta lactamases?

a)

Group 3 (metallo-beta lactamases) are common in the US

b)

The MERINO trial found slightly higher mortality risk in Zosyn than in meropenem in resistant infections

c)

Easily detectable using double disk diffusion and phenotypic susceptibilities

d)

Many are plasmid mediated

30.

Which of the following are strong inducers of cephalosporinase resistance?

a)

Narrow spectrum cephalosporins

b)

Cephamycins

c)

Vancomycin

d)

Aminopenicillins (+/- clavulanate)

31.

What resistance enzyme group does KPC and OXA-48-like enzymes fall into?

a)

Beta lactamases

b)

Carbapenemases

c)

Cephalosporinases

d)

gyrA

32.

You have identified a resistance mechanism in the cell wall of a sample. They are comprised of three proteins - inner, outer, and membrane fusion - and they actively transport out toxins. What have you found?

a)

gyrA or parC

b)

Cephalosporinase

c)

porins

d)

efflux pumps

33.

What best describes the common resistance mechanism for Septra?

a)

target bypass by overproduction of dihydropteroate synthetase and reductase

b)

efflux pumps actively transport sulfamethoxazole out of the cell

c)

beta lactamases like TEM-1 hydrolyze trimethoprim and sometimes sulfamethoxazole

d)

pathogens secrete immune sensitizers that lead to patients developing sulfa allergies

34.

What would be an incorrect statement for Mycobacterium?

a)

Mycolic acid in the cell wall resists acid and alcohol stains

b)

Mycobacterium tuberculosis has a possible infectious dose of 1 viable cell but also doesn't grow fast enough to practically culture in an active case

c)

Most individuals (90%+) will present with an active case of tuberculosis

35.

Which of the following are rapidly growing Mycobacterium?

a)

M. catarrhalis

b)

M. chelonae

c)

M. fortuitum

d)

M. abscessus

36.

Which diagnostic is incorrect?

a)

Active tuberculosis - chest Xray or CT based on clinical symptoms

b)

Latent TB - Mantoux PPD

c)

Atypical pneumonia - urease breath test

d)

Nocardia - acid fast staining, cultures, and susceptibilities

37.

Listeriosis is most common in which of the following demographics?

a)

Pregnant

b)

newborns

c)

>60 years old

d)

chronic kidney disease

38.

You're watching a bacteria sample taken from a patient with concurrent GI and CNS symptoms from the same pathogen. You notice that it survives phagocyte attack and escapes vacuoles. The patient reports sickness following an outbreak at Jimmy Johns. What might this bacteria be?

a)

Staphylococcus aureus

b)

Treponema pallidum

c)

Listeria monocytogenes

d)

Mycoplasma bovis

39.

You need to differentiate a sample between Nocardia and Actinomyces. The sample is a filamentous facultative G+ bacteria infecting the lungs. Which of the following would be correct assumptions?

a)

Positive PCR for superoxide dismutase - Actinomyces

b)

sulfur granules and woody hard mass - Actinomyces

c)

Positive acid fast staining - Nocardia

d)

Excessively large abscesses on jaw - Nocardia

40.

You're evaluating a patient with walking pneumonia from a suspected atypical bacteria. The patient is elderly with asthma and positive serology to Chlamydia and Mycoplasma. It is noted that they are febrile and bradycardic without sepsis. What is the most likely pathogen?

a)

Chlamydia

b)

Mycoplasma

c)

Mycobacterium

d)

Legionella

41.

Which of the following is not a feature of the order Enterobacterales?

a)

Various virulence factors including LPS and O polysaccharide

b)

Many are motile and have mechanisms for adherence

c)

Commonly unable to ferment carbs

d)

Sex pili for transferring resistance mechanisms

42.

What is the most common way to diagnose Rocky Mountain Spotted Fever (Rickettsia)?

a)

RT-PCR

b)

Blood cultures x2

c)

Gram stain and confirmatory MALDITOFMS

d)

Patient history and symptoms (fever, myalgia, nausea, rash on palms/soles)

43.

Which of the following is an incorrectly matched common term - causative pathogen?

a)

Actinomyces - Lumpy Jaw

b)

Lemierre's jugular septic thrombophlebitis - Fusobacterium necrophorum

c)

Ehrlichia, Rickettsia, others - Lyme

d)

Coxiella burnetti - Q fever

44.

What is the major bacteria that requires a 2 step family specific and non-family specific testing regimen for diagnosis?

a)

Treponema pallidum

b)

Norovirus

c)

Borrelia burgdorferi

d)

Fusobacterium

45.

Your preceptor is asking you to diagnose an ID patient. They report severe neurologic decline over the past few years with lesions present on MRI. PMH shows non-specific cardiovascular disease. The lab reports a positive FTA-ABS and a positive VDRL. Microscopy shows spirochetes. What pathogen is causing this patient's symptoms?

a)

Bacteroides fragilis

b)

Treponema pallidum

c)

Staphylococcus aureus

d)

Plasmodium falciparum

46.

Which of the following are likely producers of beta lactamases?

a)

Gram negative anaerobes

b)

Klebsiella spp.

c)

Borrelia burgdorferi

d)

Treponema pallidum

47.

Your preceptor is asking you to diagnose an infection. The causative pathogen is an abnormal oral colonizer. The patient is a young adult recently diagnosed with mononucleosis and is now experiencing sepsis and multi-organ abscesses. What infection do you suspect?

a)

Fusobacterium necrophorum (Lemierre's)

b)

Falciparum necrophorum (Lemierre's)

c)

Streptococcus bovis (CoNS)

d)

Bacteroides fragilis (syphilis)