Microbiology - Infections, GPR, Branching GPR

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riki3719
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226623
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Microbiology - Infections, GPR, Branching GPR
Updated:
2013-07-10 23:20:36
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Infections
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CNS, Skin, Tissue, Bone, Steriles
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  1. A 63 year old man presents to the ED with a severe headache, fever, and mental statues changes. Upon examination, the patient has signs and symptoms of endocarditis. Thereis no evidence of increased intracranial pressure. There is no nuchal rigidity. There are no signs of IV drug abuse.

    Which pattern would you expect to find from the initial diagnostic workup:

    a. Single frontal abscess: CSF with decreased glucose, increased protein content
    b. Thickened lepto-meninges: CSF with normal glucose and slightly elevated protein content
    c. Multiple small abscesses: CSF with increased protein content and increased PMNs
    d. Diffuse inflammatory brain parenchyma: CSF with increased RBCs and decreased protein content

    Blood cultures are obtained before antibiotic therapy starts. Which organism is the most likely pathogen to be isolated?

    a. HIV
    b. Pseudomonas aeruginosa
    c. Staph aureus non-MecA variant
    d. HSV
    Multiple small abscesses: CSF with increased protein content and increased PMNs

    Staph aureus non-MecA variant
  2. Which aseptic meningitis pattern requires antimicrobial therapy to prevent progression into encephalitis?

    A. VZV
    B. Neisseria meningitidis
    C. HSV type 1
    D. E. coli in neonates
    E. Listeria spp.
    C. HSV type 1
    (this multiple choice question has been scrambled)
  3. A frankly purulent CSF sample requires what kind of follow up?

    A. Antibiotic coverage for fastidious gram positive pathogens
    B. Surgical incision and drainage
    C. Reporting to the Health Department followed by prophylaxis of the patient's contacts
    D. Reporting to the CDC and aerosol precautions for the patient
    C. Reporting to the Health Department followed by prophylaxis of the patient's contacts
    (this multiple choice question has been scrambled)
  4. Which one of the following statements about impetigo is false?

    A. It responds well to first line antibiotics
    B. It can be caused by NF of the organ affected
    C. It is a severely impairing disease with significant mortality
    D. It is highly contagious
    C. It is a severely impairing disease with significant mortality
    (this multiple choice question has been scrambled)
  5. A 39 year old man presents to the outpatient department with redness on his right thigh. The patient has a fever and does not feel well. The affected area is warm to the touch and crackles when examined. It is hard to determine where the lesion starts and the unaffected skin ends. The patient relates that the lesion has enlarged since he noticed it in the morning. Answer the following three questions:

    What is the patient's diagnosis?

    a. Erysipelas
    b. S. aureus-induced psoriasis
    c. Anerobic cellulitis
    d. Scalded skin syndrome

    Antimicrobial therapy does not need to cover which one of these potential pathogens?

    a. Anaerobes
    b. Aerobic gram positive cocci
    c. Microaerophilic Streptococcus
    d. Keratin loving fungi

    What therapeutic option is best for this patient?

    a. Immediate discharge on oral antibiotics
    b. Admission for IV antibiotics
    c. Observation with a prescription to start antibiotics if the fever persists
    d. Leg amputation
    • Anerobic cellulitis
    • Keratin loving fungi
    • Admission for IV antibiotics
  6. A red lesion of the skin that can only be seen but not felt is called:

    A. Pustule
    B. Ulcer
    C. Macule
    D. Papule
    C. Macule
    (this multiple choice question has been scrambled)
  7. Which of the following statements about ulcers is true:

    A. Occur commonly in patients who have acute meningitis
    B. Can reach the fascia at the base layer of the skin
    C. Occur less commonly in diabetic patients
    D. Occur when the epidermis is attacked by anti-fibrin antibodies
    B. Can reach the fascia at the base layer of the skin
    (this multiple choice question has been scrambled)
  8. Which of the following pathogens is most commonly associated with cardiac tamponades?

    A. Influenza A
    B. Strep pyogenes (GAS)
    C. S. aureus
    D. Toxoplasma gondii
    A. Influenza A
    (this multiple choice question has been scrambled)
  9. A patient with end stage renal disease on continuous ambulatory peritoneal dialysis is suffering from peritonitis. A gram stain of the ascites fluid is negative. Which organism would you expect to find from a culture of the fluid incubated in BAP?

    A. Anaerobes
    B. E. coli
    C. Coxsackie virus type 23
    D. S. epidermidis
    D. S. epidermidis
    (this multiple choice question has been scrambled)
  10. A 45 year old male with high risk sexual behavior complains of pain in his left knee. Isolating the most likely pathogen would require which one of the following sets of conditions:

    A. Viral culture on RMK cells
    B. PCR with an HIV primer set
    C. Thayer Martin agar plates
    D. Shell vial culture on human adenocarcinoma cells
    E. Aerobic culture on BAP
    C. Thayer Martin agar plates
    (this multiple choice question has been scrambled)
  11. Which one of the following procedures is an example of a clean-contaminated operation?

    A. Uncomplicated appendectomy
    B. Gallbladder removal
    C. Gunshot wound repair
    D. Hernia repair
    A. Uncomplicated appendectomy - hernia repair is clean, gallbladder removal is contaminated
    (this multiple choice question has been scrambled)
  12. A 78 year old patient compains of a very painful axilla. On examination, a hair follicle is enlarged, redden and exquisitely painful. Which one of the following organisms is the most likely pathogen?

    A. S. aureus
    B. VZV
    C. Neisseria sicca
    D. Treponema pallidum
    A. S. aureus
    (this multiple choice question has been scrambled)
  13. A 56 year old female present to the office with erythema on her cheeks and legs. The lesions are well demarcated and there are no vesicles. Which one of the following organisms is the most likely pathogen?

    A. HSV type 2
    B. Strep agalactiae (GBS)
    C. Strep pyogenes (GAS)
    D. VZV
    C. Strep pyogenes (GAS)
    (this multiple choice question has been scrambled)
  14. What defines early onset neonatal meningitis?

    A. Meningitis <10 days after childbirth
    B. Viral meningitis within 7 days of a mycobacterial infection
    C. Meningitis quickly after cold-like symptoms
    D. Meningitis <7 days after childbirth
    D. Meningitis <7 days after childbirth
    (this multiple choice question has been scrambled)
  15. A vaccine has been effective in reducing the incidence of meningitis due to which one of the following pathogens?

    A. HSV type 2
    B. H. influenzae type B
    C. Influenza B
    D. S. aureus
    B. H. influenzae type B
    (this multiple choice question has been scrambled)
  16. Profound leukocytosis is found in which one of the following encephalitis presentations?

    A. Eastern equine encephalitis
    B. West Nile encephalitis
    C. HIV encephalitis
    D. Venezuelan encephalitis
    A. Eastern equine encephalitis
    (this multiple choice question has been scrambled)
  17. A 28 year old patient who has a history of IV drug abuse is suffering from mental status changes. An MRI shows signs of a large abscess near the central cerebral artery. There is a heart murmur. Neurosurgery debrides the would and leaves a drain. Some of the tissue is sent to the lab for gram stain and culture. What would you expect to find on the gram stain?

    A. Many lymphocytes but no organisms seen
    B. Clusters of tiny gram positive cocci
    C. Engorged glial cells surrounded by treponemal organisms
    D. Gram negative rods and PMNs
    D. Gram negative rods and PMNs
    (this multiple choice question has been scrambled)
  18. What is the most common type of culture used to determine the pathogen causing osteomyelitis?

    A. Viral culture
    B. Bone tissue culture
    C. Blood culture
    D. Bone marrow aspiration
    C. Blood culture
    (this multiple choice question has been scrambled)
  19. A patient with peritonitis has an ascites culture done which grows a mixture of gram positives and gram negatives. An anaerobic culture also has growth. What is the most likely etiology of this peritonitis?

    A. Peritonitis secondary to a perforated bowel diverticulum
    B. Peritonitis secondary to PID
    C. Complicated tertiary peritonitis with multiple resistant organisms
    D. Spontaneous bacterial peritonitis
    A. Peritonitis secondary to a perforated bowel diverticulum
    (this multiple choice question has been scrambled)
  20. A 25 year old female became ill with nausea, vomiting, and cramping 4 hours after having attended a party as a well known restaurant. Within 24 hours, her symptoms had resolved and she was able to eat and drink. Several other guests who attended the party had also gotten ill. The NYS Department of Health was brought in to investigate. They recovered a large spore-forming gram positive rod in the filling used to prepare the stuffed mushrooms.

    What is the most likely cause of this infection?

    a. Bacillus anthracis
    b. Bacillus cereus
    c. Bacillus spoiligeous

    What mechanism did the bacteria use to cause the patient to become ill?

    a. Emetic toxin
    b. Neuraminidase
    c. Enterotoxin
    • Bacillus cereus
    • Emetic toxin (1-6 hours)
  21. How do we screen for Bacillus cereus in the lab?

    A. Culture
    B. Serology
    C. ELISA
    D. PCR
    A. Culture
    (this multiple choice question has been scrambled)
  22. Bacillus anthracis causes three forms of anthrax.
    • Cutaneous anthrax
    • Inhalation anthrax (Woolsorters Disease)
    • Gastrointestinal anthrax
  23. You have filamentous colonies on a BAP. The gram stain of the bacteria shows a large spore-forming gram positive rod. The catalase test is performed and it is positive. What other two colony characteristics would you look for that could suggest you might have Bacillus anthracis?
    • Medusa head, comma shaped
    • Beta hemolytic
  24. A gram positive rod is recovered from a necrotic ulcer. The gram stain and culture morphology is suggestive of Bacillus anthracis. When working with this organism, what precautions should be taken?

    A. Universal precautions only need to be used
    B. Biochemical tests and subculturing can be performed at the bench
    C. A biological safety hood along with PPE should be used
    D. PPE only needs to be worn
    C. A biological safety hood along with PPE should be used
    (this multiple choice question has been scrambled)
  25. What is the second most common contaminate found in bacterial cultures?

    A. Coagulase negative staph
    B. Listeria monocytogenes
    C. Lactobacillus spp.
    D. Corynebacterium spp.
    D. Corynebacterium spp.
    (this multiple choice question has been scrambled)
  26. This organism has a mildew odor.
    Nocardia
  27. This organism looks like Chinese letters in the gram stain.
    Corynebacterium spp.
  28. This organism causes Bacterial Vaginosis.
    Gardnerella vaginalis
  29. This organism causes Woolsorter's Disease.
    Bacillus anthracis
  30. This organism is an opportunistic pathogen in hospitalized patients.
    Corynebacterium JK
  31. This organism is normal vaginal flora.
    Lactobacillus spp.
  32. This organism is associated with clue cells.
    Gardnerella vaginalis
  33. This organism causes erysipeloid.
    Erysipelotherix rhusiopathiae
  34. This organism produces large amount of toxin.
    Corynebacterium diphtheriae gravis
  35. PF + LF = EF

    Which organism is associated with this equation?
    Bacillus anthracis
  36. The symptoms from this organism mimic GAS.
    Arcanobacterium hemolyticum
  37. Which enriched media(s) is/are used to isolate Corynebacterium diphtheriae?

    A. Tinsdale Agar
    B. Lowenstein Jensen Agar
    C. Charcoal Yeast Extract Agar (CYE)
    D. Loeffler's Agar
    D. Loeffler's Agar - used for isolation; Tinsdale agar is differential
    (this multiple choice question has been scrambled)
  38. A small gram positive rod isolated from a throat culture collected postmortem was suspected to be Corynebacterium diphtheriae. It was subcultured to Tellurite selective media. Which of the following describes colony morphology that would be consistent with diphtheriae?

    A. Brown/black colonies with black halo
    B. Beta hemolytic colonies with small zone of hemolysis
    C. Wet blistery brown colonies
    D. Cerebroid, cream colonies
    A. Brown/black colonies with black halo
    (this multiple choice question has been scrambled)
  39. A diagnosis of diphtheriae can be made when what clinical symptom is observed?
    Pseudomembrane on the tonsils/throat.
  40. What type of stain(s) could be used to show the metachromatic granules that are characteristic of Corynebacterium?

    a. Gram stain
    b. Kinyoun stain
    c. Babes-Ernst stain
    d. Trichrome stain
    e. Methylene blue stain
    f. Toluidine O stain
    Babes-Ernst stain, Methylene blue stain, Toluidine O stain
  41. Which Corynebacterium is highly resistant to antibiotics, transfer resistance to other organisms, and is extremely important to identify in the hospital setting?

    A. C. jeikeium
    B. C. ulcerans
    C. C. urealyticum
    D. C. xerosis
    A. C. jeikeium
    (this multiple choice question has been scrambled)
  42. The colony morphology of Listeria monocytogenes looks very similar to what other bacteria?

    A. Strep pyogenes (GAS)
    B. Arcanobacterium hemolyticum
    C. Staph aureus
    D. Strep agalactiae (GBS)
    D. Strep agalactiae (GBS)
    (this multiple choice question has been scrambled)
  43. List 4 groups of individuals that have increased risk of becoming infected with Listeria.
    • Elderly
    • Immunocompromised
    • Pregnant women
    • Newborns
  44. A gram positive rod was recovered in a blood culture from a 28 year old female that was 4 months pregnant. It grew on BAP at 24 hours in CO2. It was suspected to be Listeria monocytogenes. Which combination of growth characteristics and biochemical reactions would confirms the technologist's suspicions?

    A. Alpha hemolytic, catalase negative, nonmotile, esculin positive, H2S positive
    B. Beta hemolytic, catalase positive, nonmotile, esculin negative, H2S negative
    C. Alpha hemolytic, catalase negative, motile, esculin positive, H2S positive
    D. Beta hemolytic, catalase positive, motile, esculin positive, and H2S negative
    D. Beta hemolytic, catalase positive, motile, esculin positive, and H2S negative
    (this multiple choice question has been scrambled)
  45. A small gram positive rod was isolated from a puncture wound on a male patient. He had recently been working at a slaughter house and stuck a meat hook into his right thigh which became infected. The following colony morphology and biochemical reactions were recorded. Which would be consisten with Erysipelothrix?

    A. Beta hemolytic, catalase positive, nonmotile, esculin negative, H2S negative
    B. Alpha hemolytic, catalase negative, motile, esculin positive, H2S positive
    C. Beta hemolytic, catalast positive, motile, esculin positive, H2S negative
    D. Alpha hemolytic, catalase negative, nonmotile, esculin negative, H2S positive
    D. Alpha hemolytic, catalase negative, nonmotile, esculin negative, H2S positive
    (this multiple choice question has been scrambled)
  46. How can an individual become infected with Listeria?
    Listeria is a food contamination - infection may occur by ingestion
  47. Erysipelothrix is primarily a pathogen of what group?

    A. Cows and dogs
    B. Pigs and humans
    C. Humans and sheep
    D. Pigs and turkeys
    D. Pigs and turkeys
    (this multiple choice question has been scrambled)
  48. Animals that become infected with Erysipelothrix have the following symptoms: diarrhea, fever, septicemia, arthritis, lesions, and anorexia. What is this disease called?

    A. Erysipelas
    B. Erysipeloid
    C. Woolsorters Disease
    D. Mycetoma
    A. Erysipelas
    (this multiple choice question has been scrambled)
  49. Which organism is reverse CAMP test positive?

    A. Corynebacterium diphtheriae
    B. Arcanobacterium
    C. Listeria monocytogenes
    D. Bacillus anthracis
    B. Arcanobacterium
    (this multiple choice question has been scrambled)
  50. Long thin chaining gram positive rods are characteristic of which of the following?

    A. Corynebacterium ulcerans
    B. Gardnerella vaginalis
    C. Bacillus cereus
    D. Lactobacillus species
    D. Lactobacillus species
    (this multiple choice question has been scrambled)
  51. Which two characteristics are true to Gardnerella?

    a. Pinpoint colonies after 48 hours
    b. Catalase positive
    c. Esculin positive
    d. Pleomorphic gram variable coccobacillus
    Pinpoint colonies after 48 hours, pleomorphic gram variable coccobacillus
  52. A 25 year old patient presented to his physician with a large lump on the lower right jaw. The lump began as a small nodule under the skin and over time had grown so that it could easily be seen. Upon physical exam, the lump was hard to the touch. A biopsy was performed and revealed dense fibrotic tissue. Additional material was removed from the more purulent center and sent for lab testing.

    From this particular site, what organism should the lab suspect?
    What might they find in the material that would be diagnostic for this organism?
    What would the gram stain look like?
    How should the material that is plated by incubated?
    What would a typical colony look like?
    • The lab should suspect an aerobic Actinomyces spp.
    • Within the material there is likely to be sulfur granules.
    • The gram stain shows a dense, dark mycelia surrounded by gram negative rods.
    • The materila should be incubated in both aerobic and anaerobic conditions at 37C.
    • A colony of Actinomyces spp. would have a molar tooth looking colony.
  53. Which organisms are partially acid fast?

    a. Nocardia
    b. Streptomyces
    c. Actinomyces
    d. Rodococcus
    e. Gordonia
    f. Actinomadura
    g. Tsukamurella
    Nocardia, Rodococcus, Gordonia, Tsukamurella
  54. Nocardia is ubiquitous in nature. It is not very virulent but does cause infection in what type of patient? What is the most common disease caused by Nocardia?
    • Will cause infection in patients with chronic pulmonary disease.
    • Most common disease is pneumonia.
  55. What two organisms cause a subcutaneous infection called Madura Foot?

    a. Nocardia
    b. Streptomyces
    c. Actinomyces
    d. Rodococcus
    e. Gordonia
    f. Actinomadura
    g. Tsukamurella
    Nocardia and Actinomadura
  56. What characteristics do branching gram positive rods share with fungi?

    a. Grow on fungal media
    b. Colony morphology resembles fungal growth
    c. Produce aerial hyphae
    d. Both are acid fast organisms
    e. Slow growing
    Grow on fungal media, colony morphology resembles fungal growth, produce aerial hyphae, slow growing
  57. Streptomyces rarely causes disease even though they are frequently found in nature. How has medicine benefited from these organisms?
    Streptomyces is known for its production of many antibiotics (Streptomycin, Erythromycin, etc). This is due to its secondary metabolism and has been a huge benefit to medicine.
  58. What biochemical tests are used to differentiate branching gram positive rods?

    A. Urea, glucose, motility, catalase
    B. Xanthine, cytosine, guanine, pyridine
    C. Tyrosine, xanthine, casein, starch
    D. Starch, arabinose, maltose, urea
    C. Tyrosine, xanthine, casein, starch
    (this multiple choice question has been scrambled)
  59. When a physicial requests a culture for Nocardia or Streptomyces, what type of media can be used for primary recovery and isolation?

    A. Fredrickson agar
    B. Tinsdale agar
    C. CIN agar
    D. BCYE agar
    D. BCYE agar
    (this multiple choice question has been scrambled)
  60. Rodococcus, Gordonia, and Tsukamurella are hard to characterize biochemically. What three characteristics are used to identify them?

    A. Colony morphology, time to detection, gram stain
    B. Gene sequencing, colony morphology, acid fast stain results
    C. Acid fast stain results, gene sequencing, gram stain
    B. Gene sequencing, colony morphology, acid fast stain results
    (this multiple choice question has been scrambled)
  61. Actinomadura microscopic morphology helps to differentiate it from other aerobic gram positive rods. Which of the following is characteristic for Actinomadura?

    A. Filamentous gram positive rods with chains of conidia
    B. Gram positive coccobacilluary
    C. Branching long thin gram positive rods
    D. Thick gram positive rods with occasional branches
    A. Filamentous gram positive rods with chains of conidia
    (this multiple choice question has been scrambled)
  62. It is difficult to treat infections caused by Streptomyces. What is the recommended duration of therapy in these cases?

    A. 4 weeks
    B. 6 months
    C. 2 months
    D. 10 months
    E. 24 months
    D. 10 months
    (this multiple choice question has been scrambled)

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