BACTERIOLOGY

( Edit View Insert Format Tools Table 12pt Paragraph )Bacteriology exam

Started: Sep 25 at 6:30am

Quiz Instructions

( a.measuring the zone of inibition around an ampicillin disc measring the zone of inhibition around an oxacillin disc pH increase if idone is reduced using chromagenic cephalosporin (nitrocefin) disc 1. Beta-lactamase production can be detected by: 1 pts Question 1 )

( a. MacConkey agar, 35°C, room air Thiosulfate citrate bile salt sucrose agar, 35°C, room air Campy CVA medium, 35°C, anaerobic conditions Campy CVA medium, 42°C, microaerophilic conditions 2. Isolation of Campylobacter jejuni requires a specific set of culture conditions. The optimal conditions for isolating this stool pathogen are: 1 pts Question 2 )

( Question 3 1 pts )

( 9/25/21, 6:13 PM ) ( Quiz: Bacteriology exam )

( https://bridgeport.instructure.com/courses/1812494/quizzes/3521468/take ) ( 10 /41 )

( ale with COPD (chronic obstructive phils and a predominance of Gram negative on the smear. What organism would you ) ( m )

( 3. A sputum specimen from a 55 year old pulmonary disease) showed many neutro diplobacilli. No other organisms are seen expect to isolate? Edit View Insert Format Tools Table 12pt Paragraph Neisseria gonorrhea Neisseria meningitidis Brahamella (Moraxella) catarrhalis Staphylococcus aureus )

( methyl red bromthymol blue bromcresol purple methylene blue 4. You have been using Clostridium tetani to test the anaerobic conditions of your anaerobic jar. You would like to introduce an oxidation-reduction indicator strip into the anaerobic methodology which would be observed without opening the jar. Which of the following should you use? 1 pts Question 4 )

( 5. In the quality control testing of modified Thayer-Martin agar, the following performance testing results are seen after 48 hours of incubation in 10% C02: 1 pts Question 5 )

( Neisseria gonorrhoea: growth Neisseria meningitidis: growth Staphylococcus aureus: no growth Escherichia coli: no growth Proteus mirabilis: no growth Candida albicans: growth You, as quality control technologist, would: Edit View Insert Format Tools Table 12pt Paragraph recheck the performance of nystatin recheck the antibiotic vancomycin recheck inhibitory action of colistin approve this batch of media )

( a.measuring the zone of inibition around an ampicillin disc. the PYR test. the porphin test. fluorescent antibody staining with specific antisera. 6. Opalescent colonies of a faint staining slender Gram negative rod were isolated on charcoal yeast extract agar from a lung biopsy performed on a patient hospitalized with pneumonia. Confirmation of the identification of this isolate can be performed by: 1 pts Question 6 )

( 1 pts Question 7 )

( he clinical laboratory to check all media nts for positive and negative reactions, )

( Edit View Insert Format Tools Table 7. A set of stock cultures is maintained in t and reagents. To check media and reage 12pt Paragraph which of the following combinations are appropriate? d. using chromagenic cephalosporin (nitrocefin) disc . Catalaase: Staph aureus, Listeria monocytogenes c. Hydrogen Sulfide Production: Salmonella typhii, Proteus mirabilis d. Indole: E. coli, Proteus vulgaris )

( most likely indicate urethral or perineal flora most likely indicate a urinary tract infection caused by the E. coli and contamination by the Corynebacterium sp most likely indicate a urinary tract infection being caused by two organisms be reported as normal flora in urine 8. A clean catch urine culture which grew out >100,000/ml E. coli and10,000/ml Corynebacterium sp. would: 1 pts Question 8 )

( 9. Nocardia asteroides can cause chronic pulmonary infections. Nocardia asteroides can be differentiated from other Nocardia species by: 1 pts Question 9 )

( Edit View Insert Format Tools Table a. stainign with the modified aid fast stain 12pt Paragraph growth on Lowenstein-Jensen medium inability to hydolyze casein, tyrosine, or xanthine hydrolysis of urea )

( Clostridium Corynebacterium Actinomyces Nocardia 10. A swab from a facial abscess was sent to the laboratory for culture. The following results were obtained: Gram stain: WBC, filamentous, long Gram positive rods, some branching BAP: No growth after seven (7) days incubation Thioglycollate: Growth in the bottom of the tube with discrete colonies, no gas produced. The organism is most likely a member of the genus: 1 pts Question 10 )

( 11. A 13 year old female patient complains of a very sore throat. The throat swab that is submitted for culture grows a variety of diphtheroids, alpha, beta, and nonhemoltyic streptococci, staphylococci, and Neisseria species. The next step is to: 1 pts Question 11 )

( pecimen )

( a. report it as normal throat flora Edit View Insert Format Tools Table b. ask for a repeat collection to get a better s 12pt Paragraph c. identify the beta-hemolytic Streptococcus species d. identify the Neisseria species )

( perform a tube coagulase test repeat the slide coagulase test report as Staph species, not aureus set up a 6.5% NaCI broth culture 12. Situation: You have isolated a Gram positive coccus which shows morphologic and colonial characteristics typical of Staph aureus. The result of a slide test for coagulase using fresh rabbit plasma is negative. Your next step would be to: 1 pts Question 12 )

( 13. A Gram positive coccus isolated from a blood culture has the following characteristics: optochin sensitivity negative Bacitracin (0.04U) sensitivity negative Bile no growth Esculin hydrolysis negative Hippurate hydrolysis positive 6.5% sodium chloride growth negative 1 pts Question 13 )

( Catalase negative This organism is most likely: Edit View Insert Format Tools Table 12pt Paragraph Enterococcus species Streptococcus pneumoniae Streptococcus pyogenes Streptococcus agalactiae )

( Group D strep, not enterococcus Non-hemolytic strep Enterococcus Strep agalactiae 14. A urine culture shows small, round, grayish colonies on BAP. The catalase is negative, the organism grows in 6.5% salt, and bile esculin is positive. The organism is: 1 pts Question 14 )

( 15. A Gram positive, non encapsulated, rod which demonstrates tumbling motility when grown at 22°C and produces beta hemolysis on BAP is: a. Corynebacterium diphtheriae 1 pts Question 15 )

b. Listeria monocytogenes

c. Gardnerella vaginails

d. Erysipelothrix rhusiopathiae

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( organism contains a blocking 0 antigen antiserum is of low potency organism possesses capsular antigens antiserum is of low specificity 16. The biochemical reactions of an organism are consistent with Salmonella species. A suspension is tested in polyvalent antiserum without resulting in agglutination. However, after 15 minutes of boiling, agglutination occurs in polyvalent and group D antisera. This indicates that the: 1 pts Question 16 )

( 17. A man on a fishing trip lacerated his finger and developed an infection with a Gram negative rod. The organism was beta hemolytic on BAP. The TSI was acid/acid and the oxidase test is positive. The most probable identification of the isolate is: Aeromonas hydrophila Providencia stuartii Pseudomonas aeruginosa 1 pts Question 17 )

( minimum antimicrocidal concentration minimum bacteriocidal concentration minimum lethal concentration minimum inhibitory concentration 18. In a broth dilution method of antimicrobial susceptibility testing, the tube with the lowest concentration of antimicrobial in which there is no visible growth is reported as the: 1 pts Question 18 ) ( d. Pseudomas cepacia Edit View Insert Format Tools Table 12pt Paragraph )

( Acinetobacter Iwoffi Acinetobacter baumanni Pseudomonas aeruginosa Stenotrophomonas maltophilia 19. A Gram negative rod is oxidase negative and utilizes glucose and maltose oxidatively only. The organism could be identified as: 1 pts Question 19 )

( 1 pts Question 20 )

( monas aeruginosa are frequently isolated as ey can be readily differentiated on the basis )

( Edit View Insert Format Tools Table 20. Acinetobacter baumanni and Pseudo opportunistic organisms from sputum. Th of: 12pt Paragraph Acinetobacter is a glucose non=oxidizer Acinetobacter will not grow on MacConkey's Acinetobacter is oxidase positive Acinetobacter is oxidase negative )

( blood sputum nasopharyngeal swab urine 21. In suspected cases of Brucellosis, the best specimen for recovery of the organism would be: 1 pts Question 21 )

( 22. An organism which requires hemin and NAD for growth would be: b.H. influenzae b. Bordetella pertussis 1 pts Question 22 )

( c. Haemophilus paraphrophilus Edit View Insert Format Tools Table d. Franciscella tularensis 12pt Paragraph )

( b. repeat the slide coagulase test b. Cefsulodin irgasan novobiocin . Cycloserine cefoxitin fructose d. Thiosulfate citrate bile salts sucrose 23. Several vacationers at a Gulf Coast seaside resort complain of severe abdominal pain and diarrhea after ingesting raw oysters. The agar that is most appropriate for screening these patients' stools is: 1 pts Question 23 )

( Gram stain: Escherichia coli, Neisseria meningitidis Indole: E, coli, Proteus vulgaris Nitrate reduction: E. coli, Pseudomonas aeruginosa Oxidase: Psedomonas aeruginosa, E. coli 24. Which of the following organisms will give the appropriate positive and negative reactions for quality control of the test listed? 1 pts Question 24 )

( 1 pts Question 25 )

( solated from an infected dog bite with a ndole test is most likely to be: )

( Edit View Insert Format Tools Table 25. A Gram negative, bipolar-staining rod i positive cytochrome oxidase and positive i 12pt Paragraph Aeromonas hydrophila Pasteurella haemolytica Pasteurella multocida Vibrio parahaemolyticus )

( Pseudomonas aeruginosa and E. coli Hemophilus influenzae and Strep pyogenes Enterococcus and E. coli Staph aureus and Strep pyogenes 26. The pair of organisms that would provide a good positive and negative control for phenylethyl alcohol blood agar is: 1 pts Question 26 )

( 27. Mycoplasmas differ from bacteria in that mycoplasmas: do not cause disease in humans cannot grow in supplemented laboratory media 1 pts Question 27 )

( c. lack cell walls Edit View Insert Format Tools Table d. lack the ability to produce energy (ATP) 12pt Paragraph )

( relapsing fever anicteric leptospirosis yaws Lyme disease 28. Borrelia burgdorferi is the causative agent of: 1 pts Question 28 )

( decreased peptone concentration and increased carbohydrate concentration use of methyl red indicator system increased tryptophan concentration increased agar concentration to inhibit oxygen penetration 29. Oxidation-fermentation medium is designed to accommodate nonfermenting organisms that are known to be weak acid producers. The modification in this medium that allows detection of weak acid production is: 1 pts Question 29 )

( 1 pts Question 30 )

( solated from a gingival abscess. The s the surface of sheep blood agar and he most probable identity is: )

( 30. A tiny Gram negative coccobacillus is i organism is a facultative anaerobe that pit gives off the odor of hypochlorite bleach. T Edit View Insert Format Tools Table 12pt Paragraph Acinetobacter baumanii Bacteroides fragilis Flavobacterium meningosepticum Eikenella corrodens )

( drug is broken down by the liver resistant the organism is to the drug drug is excreted in the urine sensitive the organism is to the drug 31. The greater the MIC the more: 1 pts Question 31 )

( 32. Twenty patients on a surgical ward develop urinary tract infections after catheterization. In each instance, the oxidase negative Gram negative rod produces the same biotype and is resistant only to tetracycline. Additional biochemical results are as follows: Phenylalanine deaminase: negative Urease: negative 1 pts Question 32 )

( oxylase: negative )

( Hydrogen sulfide: negative Lysine decarb Ornithine decarboxylase: positive Indole: positive Citrate: negative VP: negative Motility: positive Edit View Insert Format Tools Table 12pt Paragraph The most probable identity of this organism is: Escherichia coli Enterobacter aerogenes Proteus vulgaris Morganella morganii )

( chloramphenicol tetracycline erythromycin aminoglycosides 33. Renal toxicity may follow prolonged high dose treatment with: 1 pts Question 33 )

( 34. The most common error made when performing susceptibility tests (Kirby-Bauer or MIC) is: 1 pts Question 34 )

( a. use of overnight (18 hour) incubation Edit View Insert Format Tools Table b. inappropriate storage of discs, trays or pl 12pt Paragraph c. incubation at 35°C d. failure of standardize inoculum concentration )

Question 35

1 pts

( ates )

35. Gram stain of an abdominal wound exudate showed many neutrophils, no squamous cells, and pleomorphic Gram negative rods. The specimen was inoculated to an aerobic BAP, MAC and thio and an anaerobic BAP, CNA and KV. After 48 hours incubation the following results were observed:

aerobic plates = no growth

anaerobic plates = growth of Gram negative rods

Gram stain of thio = Gram negative rods and Gram positive cocci in chains The most appropriate procedure(s) to perform next would be:

a. aerotolerance testing of Gram negative rods from anaerobic BAP

b. subculture thio to aerobic and anaerobic CNA

c. subculture thio to aerobic and anaerobic BAP

d. aerotolerance testing of Gram negative rods AND subculture thio to aerobic and anaerobic plates

( 36. The most rapid and specific method for detection of Francisella tularensis is: 1 pts Question 36 )

( ecific antiserum )

( a. serological slide agglutination utilizing sp Edit View Insert Format Tools Table b. dye-stained clinical specimens 12pt Paragraph c. fluorescent antibody staining techniques on clinical specimens d. biotyping )

( Enterobacter cloacae Serratia marcescens Aeromonas hydrophila Escherichia coli 37. While swimming in a lake near his home, a young boy cut his foot as he stepped on a piece of glass from a broken bottle. An infection developed and the site was cultured. A non-fastidious Gram negative, oxidase positive , beta hemolytic, motile bacillus was recovered. The organism produced deoxyribonuclease and was most probably identified as: 1 pts Question 37 )

( 38. A Campylobacter species isolated from a stool culture gives the following biochemical reactions: nalidixic acid susceptible cephalothin resistant hippurate hydrolysis positive oxidase positive catalase positive 1 pts Question 38 )

( ampylobacter: ) ( C )

( This biochemical profile is consistent with Edit View Insert Format Tools Table 12pt Paragraph fetus jejuni coli laridis )

( Micrococcus species Leuconostoc Enterococcus faecalis Bacillus species 39. An organism that is intrinsically resistant to vancomycin is: 1 pts Question 39 )

( 40. Serum samples collected from a patient with pneumonia demonstrate a rising antibody titer to Legionella. A BAL specimen from this patient had a positive antigen test for Legionella, but no organisms were recovered from this specimen on buffered charcoal yeast extract agar after 2 days of incubation. The best explanation is that the: 1 pts Question 40 )

( a. antibody represents an earlier infection Edit View Insert Format Tools Table b. positive antigen test is a false positive 12pt Paragraph c. specimen was cultured on the wrong medium d. culture was not incubated long enough )

( Salmonella choleraesuis Edwardsiella tarda Salmonella typhi Shigella sonnei 41. A fecal specimen inoculated to XLD and HE media produced colonies with black centers. Additional test results are as follows: Glucose positive H2S positive Lysine decarboxylase positive Urea negative ONPG negative Indole positive Serological testing with the following antisera showed no agglutination: polyvalent, Group A, Group B, Group C, Group D, and Group Vi. The most probable identification of this organism is: 1 pts Question 41 )

( 42. A blood culture bottle with macroscopic signs of growth is Gram stained and the technician notes small, curved, Gram negative rods. It is subcultured to blood and chocolate agars and incubated aerobically and anaerobically. After 24 hours no 1 pts Question 42 )

( growth is apparent. The next step would b Edit View Insert Format Tools Table 12pt Paragraph subculture the bottle and incubate in microaerophilic conditions assume the organism is nonviable utilize a pyridoxal disk to detect nutritionally deficient streptococci subculture the bottle to a medium containing X and V factors )

Question 43

1 pts

( e to: )

43. A 10 year old boy was admitted to the ER with lower right quadrant pain and tenderness.

His WBC count was 200 x 103/ L (normal 5-12 x 103) with 75% neutrophils. The admitting diagnosis was appendicitis. During surgery the appendix appeared normal; an enlarged node was removed and cultured. Small Gram negative rods were isolated form the room temperature plate. The most likely organism is:

a. Prevotella melanogenicus

b. Shigella sonnei

c. Listeria monocytogenes

d. Yersinia enterocolitica

( 44. Which feature distinguishes Erysipelothrix rhusiopathiae from other clinically significant non-spore forming, gram positive, facultative anaerobic bacilli? 1 pts Question 44 )

( a. tumbling motility Edit View Insert Format Tools Table b. beta hemolysis 12pt Paragraph c. more pronounced motility 250C than at 350C d. H25 production )

( Wrong media were used Gram stain misread organism only grows at room temperature organism requires CO2 for growth 45. A urethral swab obtained from a man with a urethral exudate was plated directly to CHOC and MTM agars and a Gram was made. The smear showed Gram negative diplococci. The plates were incubated at 350C but had no growth at 48 hours. The most likely failure for organism growth is that the: 1 pts Question 45 )

( 46. The streptococci most likely to have a high MIC with penicillin are: enterococci unable to grow in 6.5% NaCI solution typed as Lancefield Group A susceptible to bacitracin 1 pts Question 46 )

( Edit View Insert Format Tools Table 12pt Paragraph Question 47 1 pts between 10 pm and 2 am in the first 7-10 days infection during febrile periods, late in the course of the disease after the first 10 days of illiness 47. Blood cultures from a suspected case of leptospiremia should be drawn: )

Question 48

1 pts

48. A 25 year old man who had recently worked as a steward on a transoceanic grain ship presented to the ER with high fever, diarrhea, and prostration. Axillary lymph nodes were hemorrhagic and enlarged. A direct smear was prepared from a lymph node aspirate and many Gram negative rods were noted. The bacilli demonstrated a marked bipolar staining reaction described as a “safety pin appearance”. The most likely identification of this organism is:

a. Brucella melitensis

b. Streptobacillus moniliforms

c. Spirillum minor

d. Yersinia pestis

( Question 49 1 pts )

( ith possible meningitis is rushed to the ) ( w )

( Edit View Insert Format Tools Table 49. CSF from a 25 year old febrile female 12pt Paragraph laboratory for a STAT Gram stain and culture. While performing the Gram stain, the technologist accidentally spills most of the specimen. The smear shows many neutrophils and no organisms. Since there is only enough CSF to inoculate one plate, the technologist should use a: c. Pseudomonas aeruginosa chopped meat glucose CHOC MTM )

( CNA CHOC XLD CYE 50. A catheterized urine specimen from an 82 year old female with recurrent infections is submitted for culture and Gram stain. The smear reveals many neutrophils, no squamous cells, Strep and Enterics/Pseudomonas. The physician requests that sensitivities be performed on all pathogens isolated. In addition to the BAP and MAC routinely used for urine cultures, the technologist might also process a(n): 1 pts Question 50 )

( 1 pts )

( Edit View Insert Format Tools Table 12pt Paragraph 51. Which of the following would you LEAST expect to culture from a case of otitis media? Moraxella catarrhalis Neisseria meningitidis Haemophilus influenzae Streptococcus pneumoniae Question 51 )

( ONPG negative sodium hippurate hydrolysis positve A disk negative CAMP test positive X factor no growth XV factor growth catalase positive esculin hydrolysis positive umbrella motility at room temperature 52. A 4 year old is admitted with symptoms of meningitis, and a direct smear of the CSF reveals smeall, pleomorphic, Gram negative coccobacilli. After 24 hours incubation at 350C, small moist, gray colonies, are found on the chocolate plate only. Which of the following biochemical data would be consistent with this isolate? 1 pts Question 52 )

( 53. The following results were obtained from a culture of unknown origin: Gram stain Gram negative diplococci 1 pts Question 53 )

( Oxidase positive Glucose positive Maltose negative Sucrose negative Edit View Insert Format Tools Table 12pt Paragraph The MOST likely source of the specimen would be the: respiratory tract blood genitourinary tract CSF )

( increased increased increased decreased decreased decreased increased decreased increased decreased increased decreased 54. A technologist is reading a Gram stain from a CSF and observes small structures suggestive of Gram negative coccobacilli. Chemistry and hematology CSF results that would indicate bacterial meningitis include: WBC Glucose Protein 1 pts Question 54 )

( 1 pts Question 55 )

( ained on CSF submitted from a patient with )

( Edit View Insert Format Tools Table 55. The following culture results were obt a shunt: 12pt Paragraph Gram stain: purple cocci in clusters; Catalase: positive; Staph latex test: no clumping Staphylococcus aureus coagulase-negative staphylococci Staphylococcus epidermidis Staphylococcus saprophyticus )

( inoculated to BAP incubated at 37OC inoculated to CHOC incubated at 560C 56. To quality control the autoclave, a vial of Bacillus stearothermophilus is autoclaved and should then be: 1 pts Question 56 )

( 57. Filters generally used in biological safety cabinets to protect the laboratory worker from particulates and aerosols generated by microbiology manipulations are: a. fiberglass 1 pts Question 57 )

( b. HEPA Edit View Insert Format Tools Table c. APTA 12pt Paragraph d. charcoal )

( indifference of additive inhibition synergism antagonism 58. If the effect of combined antimicrobial therapy is greater than the sum of the effects observed with the two drugs independently, the conditions is described as: 2 pts Question 58 )

( beta lactamase oxacillin disk diffusion penicillin disk diffusion Schlicter test 59. A 73 year old male diagnosed as having pneumococcal meningitis is not responding to his penicillin therapy. Which of the following tests should be performed on the isolate to best determine this organism’s susceptibility to penicillin agents? 1 pts Question 59 )

( 1 pts ) ( 61-65 Complete the identification of the organisms listed below based on their biochemical reactions. 61. 62. 63. 64. 65. 5 pts Question 61 )

( Edit View Insert Format Tools Table 12pt Paragraph 60. The procedure that ensures the most accurate results of oxacillin (methicillin) susceptibility testing against staphylococci is: addition of 4% NaCI incubation at 300C incubation for 48 hours addition of 2% bile Question 60 )

	#61	#62	#63	#64	#65
Oxidase	0	0	0	0	0
TSI	A/A	A/A, H2S	K/A	K/A	K/A, H2S
PAD	0	+	+	0	0

Citrate +

Lys. decarb +

0 Edit View Insert Format Tools Table

( 0 + 0 0 + + )0 12pt Paragraph

Orn. decarb.	+	0		+	+		+
Indole	0	+		+	0		+
Urea	+	+		+	0		0
DNAse	0	0		0	+		0
Motility	0	+		+	+		+
MR-VP	0/+	+/0		+/0	0/+		+/0

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Question 62

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65. A laboratory has been testing a susceptibility test system daily.

a. What criteria must be met before this testing may be done on a weekly rather than a daily basis?

Must be in clinical range for 30 days

b. List two conditions which would necessitate a return to daily testing.

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( 66. The patient was a 43-year-old female with a history of mitral valve prolapse. She was admitted with a chief complaint of intermittent fevers for 1 month and headaches for 3 weeks. Two weeks prior to developing symptoms, she had undergone a dental procedure for which prophylactic erythromycin was prescribed (she was penicillin 3 pts Question 63 )

( ent admitted that she was not compliant pset stomach. She had no skin lesions or od cultures performed on admission were ) ( u )allergic). Upon further questioning the pati with the antibiotic prescription because of hemorrhages in the nail beds. All four blo positive for Gram positive cocci in chains.

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b. What organism is most likely to be causing her infection? What is the likely source of the organism?

c. Why was the prophylactic antimicrobial therapy prescribed before the dental procedure?

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( 67. A 6-year-old female presented with a 1-week history of a febrile illness with a sore throat and headache. She was given oral ampicillin by her local physician. One day prior to hospital admission, the patient awakened with pain and swelling in the right 4 pts Question 64 )

( dmission, and in addition to a warm, swollen rade III/VI systolic heart murmur thought to ufficiency of the mitral valve). She was )ankle. She was evaluated on the day of a right ankle, she was noted to have a new be consistent with mitral regurgitation (ins

( g )Edit View Insert Format Tools Table

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admitted to the hospital with a presumptive diagnosis of acute rheumatic fever.

a. The patient had a sore throat that preceded her acute rheumatic fever. Although the results of her throat culture are unavailable, which pathogen would probably have grown from such a culture?

b. How can an "A" disc help in the identification of this organism?

c. Which type of hemolysis is seen when this organism is streaked on BAP?

d. Which serologic test may be useful in helping to confirm the diagnosis of rheumatic fever in this patient?

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( 3 pts Question 65 )

( ho was transferred to this institution with a 's spells began with repetitive coughing, g for breath. In the prior 2 days, he also )68. The patient is a 5 1/2-week-old male w 10-day history of choking spells. The child progressing to his turning blue and gaspin

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had three episodes of vomiting in association with his choking spells. His physical examination was significant for a pulse of 160 beats/min and respiratory rate of 52. The child's chest radiograph was clear. There was no evidence of tracheal abnormalities. His white cell count was 15,500/mm3 with 70% lymphocytes. A nasopharyngeal swab was diagnostic.

a. What was the organism infecting this child?

b. Why is a nasopharyngeal swab the specimen of choice for making this diagnosis?

c. What is the epidemiology of this infection, and how might it be prevented?

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( 69. This 48-year-old man had a long history of alcoholism (including alcoholic hepatitis) and was admitted to the intensive care unit with profound hypotension and 5 pts Question 66 )

( d and given intravenous fluids and remained intubated and ventilator ed fevers and was treated with broad- )gastrointestinal bleeding. He was intubate transfused with packed red blood cells. He dependent for several weeks. He develop

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spectrum antibiotics. Culture of his tracheal aspirate initially showed Staph aureus. After further antibiotic therapy, Gram stain of his tracheal aspirate showed neutrophils and Gram negative rods. His chest radiograph demonstrated an infiltrate and changes consistent with multiple small abscesses. Culture of the tracheal aspirate yielded a heavy growth of an oxidase positive, beta-hemolytic, Gram negative, lactose-nonfermenting rod that produces a greenish hue on the culture plate.

a. What is the likely agent of infection?

b. Does it commonly cause pulmonary infections in healthy individuals?

c. Which pigments does this organism produce?

d. This organism was isolated after the patient received a prolonged course of broad spectrum antibiotics. How is that possible?

e. What is the recommended therapy for this organism?

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Question 67

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( 4 pts )An 18-year-old male presented to the outpatient medical clinical for evaluation of diarrhea and abdominal discomfort. The patient first noted mild abdominal discomfort and three loose bowel movements per day 1 week prior to evaluation. Two days prior to evaluation he noted intermittent, crampy periumbilical abdominal pain. He denied fever, blood in the stool, relation of the pain to meals, drinking well water, dysuria, or hematuria.

On examination, the patient was afebrile and had normal vital signs. The abdominal examination was notable for mild lower abdominal tenderness. The fecal examination demonstrated a greenish, watery stool that was negative for occult blood.

Laboratory evaluation included a normal white blood cell count, hematocrit, and platelet count. Examination of the feces microscopically was remarkable for the presence of white blood cells. The causative agent recovered from feces was a pale staining, slightly curved, Gram negative rod.

a. On the basis of the laboratory findings, what is the likely etiology of this patient's diarrhea?

b. Is the finding of white cells in his feces consistent with the recovery of this organism?

c. What special laboratory conditions are necessary to recover this organism?

d. What is the epidemiology of this organism?

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Question 68

4 pts

71. The patient was a 19-year-old female. She was seen in the walk-in medicine clinic with complaints of right-knee and right-shoulder pain, nausea, and vomiting. On physical examination, she had a swollen right knee and decreased range of motion of her right shoulder. She also had a thick vaginal discharge. Her temperature was 38.4°C, and she had a WBC count of 15,700/mm3. She gave a history of having two recent sexual partners. Blood, vaginal, and joint fluid cultures were performed. A Gram stain of joint fluid showed numerous polymorphonuclear cells, but no organisms were seen. Both the vaginal and joint fluid cultures were positive for the agent of infection.

a. What was the etiologic agent of her infection? What in her history supports this conclusion?

b. For which other agent(s) should the patient be examined? Explain your answer.

c. Why was ceftriaxone chosen to treat this infection?

d. What should be done about her sexual partners?

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Question 69

2 pts

72. The patient was a 2,515-g female neonate born at 32 weeks gestation. Her APGAR scores were 2 and 7, and she was intubated a birth because of poor respiratory effort. The mother presented at the time of delivery with complaints of lower abdominal pain with a temperature of 39°C and white blood cell count of 25,000/mm3. The mother was given ampicillin at the time of delivery. Blood cultures taken from the infant soon after birth grew Gram positive cocci and/or coccobacilli. Two lumbar punctures were attempted, which were traumatic.

a. On the basis of the Gram stain and the patient's age, which two organisms are likely?

b. Which simple biochemical test can used to differentiate isolated colonies of these two organisms?

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Question 70

3 pts

. This 65-year-old woman was bitten by her cat on the dorsal aspect of the right middle

finger at 8:00 a.m. She rinsed the bite with water, and at 4:30 p.m. she noted pain and

swelling in the finger and the dorsum of the right hand. She then noted pain in the axilla,

red streaking up the forearm, and chills. On examination, she had a temperature of 38°C

and her right upper extremity was notable for swelling, erythema, warmth, and tenderness

on the dorsum of the hand. Two small puncture wounds were seen on the proximal phalanx of the long finger, and erythema was visible over the extensor surface of the forearm. Axillary tenderness was also noted. Laboratory studies demonstrated an elevated white blood cell count of 112,000/mm3 with a left shift. Aspiration of an abscess on her finger was sent for culture, and the patient was taken to the operating room

for incision and drainage of the abscess. An oxidase + Gram negative coccobacillus that grew on BAP but not on MacConkey agar was recovered from the abscess. (2 points)

a. Which organism was isolated on culture of the abscess?

b. What is the reservoir for this organism?

c. How do humans most commonly beco infected with this organism?

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( 74. The patient is a 16-year-old female who was well until 2 days prior to admission when she had fever to 39.9°C and vomiting. On the morning of admission, she had loose stools, continued fever, and vomiting. She was seen by an outside physician, who noted that she was hypotensive (blood pressure, 76/48 mmHg) with a heart rate of 120 beats/min and a temperature of 38°C. She had an erythematous rash. Blood, throat, and vaginal specimens were sent for culture. The patient was then given intravenous fluids and intravenous antibiotics and transported to our hospital for admission to the pediatric intensive care unit. Laboratory studies indicated abnormal liver (albumin, 2.9 g/liter; aspartate aminotransferase (AST), 76 U/liter; alanine aminotransferase (ALT), 95 U/liter) and renal (creatinine, 2.8 mg/dl) functions and 2 pts Question 71 )

( s and 18% band forms. The patient began ssion and uses tampons. sentative of which syndrome? )WBC count of 14,100 with 78% neutrophil her menstrual period 4 days prior to admi

a. The patient's symptoms are most repre

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b. The vaginal culture was positive for a heavy growth of catalase-positive, Gram positive cocci. Which organism would you expect this to be?

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( 75. Liz is visiting her friend Jane, who is about to feed her six month old baby. When Jane puts honey on a spoon and begins to give it to the child, Liz stops her, saying, “You can’t feed honey to a child this young.” Jane is shaken but argues that honey is a completely natural and very nutritious food that certainly couldn’t harm her baby. Who is right and why? 2 pts Question 72 )

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