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Worksheets610 Micro E4 (new content)
Total questions: 47
Worksheet time: 25mins
What species would show up as positive Enterobacterales on the spot-indole test?
Escherichia coli and Klebsiella oxytoca
Vibrio vulnificus and Pseudomonas aeruginosa
Klebsiella aerogenes, Klebsiella pneumonia, and Citrobacter koseri
Streptococcus viridans
Which two Gram negative enterics are typically Oxidase positive?
Pseudomonas and Acinetobacter
Stenotrophomonas and Shigella
Pseudomonas and Vibrio
Morganella and Yersinia
The Gram negative enteric Escherichia coli is the #1 cause of UTIs, about half the cause of Gram negative bacteremias, and what other conditions?
Replacement valve and pacemaker infections
Gastroenteritis and meningitis
Melioidosis and Rickettsia
Central venous catheter and community pneumonia
What best describes ETEC (enterotoxigenic E. coli) pathogenesis?
Plasmid enterotoxins (STa/B & LT-I/II) cause hypersecretion of fluids and electrolytes
Dx by HeLa/Hep-2 cell adherence
Plasmid mediated attachment/effacement forms cuplike pedestals
Plasmid mediated aggregation (stacked bricks) shorten microvilli and cause hemorrhage and mononuclear infiltration
What best describes EPEC (enteropathogenic E. coli) pathogenesis?
Plasmid enterotoxins (STa/B & LT-I/II) cause attachment of cuplike pedestals
Dx by commercial immunoassays and PCR
Plasmid mediated attachment/effacement forms cuplike pedestals
Plasmid mediated aggregation (stacked bricks) shorten microvilli and cause hemorrhage and mononuclear infiltration
What best describes EAEC (enteroaggregative E. coli) pathogenesis?
Plasmid enterotoxins (STa/B & LT-I/II) cause attachment of cuplike pedestals
Dx by PCR to test for plasmids
Plasmid mediated attachment/effacement forms cuplike pedestals
Plasmid mediated aggregation (stacked bricks) shorten microvilli and cause hemorrhage and mononuclear infiltration
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?
STEC
EAEC
EIEC
Klebsiella pneumoniae
A culture shows mucoid colonies; indole test is negative; blaKPC PCR positive. What would the pathogen be?
Klebsiella oxytoca
Vibrio vulnificus
Moraxella morganii
Klebsiella pneumoniae
What infections are expected of both Enterobacter and Citrobacter?
Nosocomial UTI and wound infections
Elderly meningitis and brain asbcesses
Community acquired UTI and wound infections
Community acquired pneumonia
(Multiple answers) Aside from redness, what is characteristic of Serratia?
Oxidase +
Common ampC occurrence with inducible overexpression
Ferments lactose so slowly it appears negative
Pneumonia, bacteremia, and endocarditis
Which 3 bacteria are known for "stably derepressed" ampC plasmids?
Citrobacter and Serratia
Vibrio dysenterieae
Enterobacter (highest risk w 3rd gen cephalosporins)
E. coli and Klebsiella aerogenes
Your tech reports a "swarmed" culture with a strong ammonia smell. What do you report?
Proteus
Klebsiella vulnificus
Salmonella chloereae
Staphylococcus aureus
What pathogen grows green on a Hektoen enteric agar due to lack of H2S and no sugar fermentation?
Shigella
Salmonella
Klebsiella
Streptococcus
What pathogen grows black on a Hektoen enteric agar due to H2S?
Shigella
Salmonella
Klebsiella
Streptococcus
What presentation would lead you away from Salmonella?
Bacteremia transmitted by contaminated food/water
Gastroenteritis
Pneumonia showing severe extensive bullae
Enteric fever lasting >7d including rose spots and hepatosplenomegaly
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?
Finish course a day before travel; redose if returning after 10 yrs
Finish course 2 wks before travel; redose if returning after 2 yrs
Finish course a week before travel; redose if returning after 5 yrs
Finish course a week after travel; redose if exposure suspected
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?
Finish course a day before travel; redose if returning after 10 yrs
Finish course 2 wks before travel; redose if returning after 2 yrs
Finish course a week before travel; redose if returning after 5 yrs
Finish course a week after travel; redose if exposure suspected
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?
Stool culture and PCR
Series of Hektoen, MacConkey, and TSI agars consecutively
Antisera slide agglutination
MALDI-TOF MS after isolating pure colony
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?
Burkholderia burgdorferi
Providencia stuartii
Risperdal sustenna
Pseudomonas aeruginosa
What are some of the intrinsic resistance mechanisms used by Pseudomonas?
Type 3 secretion systems
gyrA and parC for fluoroquinolones
ETA, LasB, and phospholipase C
porins and efflux pumps
Pseudomonas resistance using BL lysis, AG modification, and anti-fluoroquinolone enzymes are through what mechanism?
Intrinsic
Virulence
Adaptive
Acquired/horizontal transfer
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?
Pseudomonas
Acinetobacter
Citrobacter
Streptococcus
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?
Stenotrophomonas maltophilia
Moraxella catarrhalis
Cytomegalovirus zoster
Providencia stuartii
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?
Salmonella
Shigella
Burkholderia
Rickettsia
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)?
Safety pin bipolar Gram stain
Wrinkly metallic appearance on Ashdown's media
Earthy smell on Ashdown's media
Grape smell on Ashdown's media
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?
Vibrio vibriaeticus
Vibrio vulnificus
Haemophilus influenzae
Vibrio cholerae
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?
Vibrio vulnificus bacteremia
Vibrio cholerae
Influenza parahaemolytica
Burkholderia burgoldferi
Which of the following rapid diagnostic tests is incorrectly matched?
Helicobacter pylori - breath urease test
Legionella - urinary antigen test
Vibrio - halophilic biochemical tests
Pseudomonas aeruginosa - Mantoux TST
Which of the following is an incorrect statement regarding beta lactamases?
Group 3 (metallo-beta lactamases) are common in the US
The MERINO trial found slightly higher mortality risk in Zosyn than in meropenem in resistant infections
Easily detectable using double disk diffusion and phenotypic susceptibilities
Many are plasmid mediated
Which of the following are strong inducers of cephalosporinase resistance?
Narrow spectrum cephalosporins
Cephamycins
Vancomycin
Aminopenicillins (+/- clavulanate)
What resistance enzyme group does KPC and OXA-48-like enzymes fall into?
Beta lactamases
Carbapenemases
Cephalosporinases
gyrA
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?
gyrA or parC
Cephalosporinase
porins
efflux pumps
What best describes the common resistance mechanism for Septra?
target bypass by overproduction of dihydropteroate synthetase and reductase
efflux pumps actively transport sulfamethoxazole out of the cell
beta lactamases like TEM-1 hydrolyze trimethoprim and sometimes sulfamethoxazole
pathogens secrete immune sensitizers that lead to patients developing sulfa allergies
What would be an incorrect statement for Mycobacterium?
Mycolic acid in the cell wall resists acid and alcohol stains
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
Most individuals (90%+) will present with an active case of tuberculosis
Which of the following are rapidly growing Mycobacterium?
M. catarrhalis
M. chelonae
M. fortuitum
M. abscessus
Which diagnostic is incorrect?
Active tuberculosis - chest Xray or CT based on clinical symptoms
Latent TB - Mantoux PPD
Atypical pneumonia - urease breath test
Nocardia - acid fast staining, cultures, and susceptibilities
Listeriosis is most common in which of the following demographics?
Pregnant
newborns
>60 years old
chronic kidney disease
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?
Staphylococcus aureus
Treponema pallidum
Listeria monocytogenes
Mycoplasma bovis
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?
Positive PCR for superoxide dismutase - Actinomyces
sulfur granules and woody hard mass - Actinomyces
Positive acid fast staining - Nocardia
Excessively large abscesses on jaw - Nocardia
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?
Chlamydia
Mycoplasma
Mycobacterium
Legionella
Which of the following is not a feature of the order Enterobacterales?
Various virulence factors including LPS and O polysaccharide
Many are motile and have mechanisms for adherence
Commonly unable to ferment carbs
Sex pili for transferring resistance mechanisms
What is the most common way to diagnose Rocky Mountain Spotted Fever (Rickettsia)?
RT-PCR
Blood cultures x2
Gram stain and confirmatory MALDITOFMS
Patient history and symptoms (fever, myalgia, nausea, rash on palms/soles)
Which of the following is an incorrectly matched common term - causative pathogen?
Actinomyces - Lumpy Jaw
Lemierre's jugular septic thrombophlebitis - Fusobacterium necrophorum
Ehrlichia, Rickettsia, others - Lyme
Coxiella burnetti - Q fever
What is the major bacteria that requires a 2 step family specific and non-family specific testing regimen for diagnosis?
Treponema pallidum
Norovirus
Borrelia burgdorferi
Fusobacterium
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?
Bacteroides fragilis
Treponema pallidum
Staphylococcus aureus
Plasmodium falciparum
Which of the following are likely producers of beta lactamases?
Gram negative anaerobes
Klebsiella spp.
Borrelia burgdorferi
Treponema pallidum
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?
Fusobacterium necrophorum (Lemierre's)
Falciparum necrophorum (Lemierre's)
Streptococcus bovis (CoNS)
Bacteroides fragilis (syphilis)
