Name:………………………………………..……Group 1

12.02.2007 (4 year program of medical studies)

1. Staphylococci are routinely differentiated from Streptococci by:

a) production of beta-hemolysin

b) production of leukocidin

c) catalase test

d) all of the above

2. Virulence factors of S.pneumoniae include:

a) M surface protein

b) Capsules

c) Deoxyribonuclease

d) CF (clumping factor)

3.Differentiation between S.aureus and S.epidermidis is based on:

a) staining according to Gram

b) coagulase production

c) hemolysin production

d) sensitivity to antibiotics

4. A 55-year-old male was admitted to a local hospital with fever and chills. The patient had received multiple courses of antibiotics. Blood cultures grew a Gram positive cocci, which tested positive with group D streptococcal antisera. The isolate was resistant to penicillin and vancomycin. Which of the following is the most likely pathogen?

a) Streptococcus pneumoniae

b) Enterococcus faecium

c) Streptococcus pyogenes

d) Streptococcus agalactiae

5. Toxic shock in menstruating women may develop due to:

a) use of oral contraceptives

b) application of intravaginal tampons

c) use of intrauterine appliances

d) none of the above

6. MRSA denotes:

a) staphylococci not stained by Gram technique

b) methycillin resistant S.aureus

c) encapsulating S.aureus

d) S.epidermidis strains resistant to antibiotics

7. Biofilms adhere to artificial body parts and catheters produce:

a) Staphylococcus epidermidis

b) Streptococcus pneumoniae

c) Streptococcus viridans

d) Streptococcus pyogenes

8. A 71-year-old male was admitted from his nursing home because of recent aggravation of an exfoliative skin condition that has plagued him for several years. He had been receiving a variety of topical antibiotic regimens over the last year or two. He now has a temperature of 38.9°C (102°F). The skin of upper chest, extremities, and neck shows erythema with diffuse epidermal peeling and many pustular lesions. Cultures obtained from these lesions were reported back from the laboratory as yielding a Gram-positive organism that is highly salt(NaCl) tolerant. What lab result is used to confirm the species of the causative agent?

a) bacitracin sensitivity

b) bile solubility

c) catalase production

d) coagulase production

9. A 3-year-old child develops acute glomerulonephritis following impetigo. The bacteria is a catalase-negative, Gram-positive coccus that has M 12 surface protein. What is the most likely causative agent?

a) Enterococcus faecium

b) Staphylococcus aureus

c) Streptococcus pneumoniae

d) Streptococcus pyogenes

10. Which of the following bacteria is most likely to be alpha-haemolytic?

a) Streptococcus pyogenes

b) Staphylococus aureus

c) Streptococcus pneumoniae

d) Streptococcus agalactiae

Name:………………………………………..……Group 2

12.02.2007 (4 year program of medical studies)

1.What organism is most likely responsible for bacterial meningitis in infants during the first month of life:

a) Enterococcus faecalis

b) Staphylococcus aureus

c) Streptococcus agalactiae

d) Streptococcus pneumoniae

2.High ASO titers point to:

a) S.aureus induced infection experienced in the past

b) S.pyogenes

c) S.pneumoniae

d) S.saprophyticus

3. Enterococci induce most frequently:

a) food poisoning

b) diseases of respiratory system

c) urinary tract infections

d) veneral diseases

4. Development of staphylococcal alimentary intoxications depends upon:

a) presence of viable bacteria

b) enterotoxin

c) hemolysin

d) bacterial cell wall

5. What causative agent is most likely responsible for oedema, hematuria, proteinuria in a patient who had impetigo 3 weeks ago:

a) S.aureus

b) S.epidermidis

c) S.agalactiae

d) S.pyogenes

6. A 51-year- old man was admitted to the hospital: unresponsive, with epileptiform movements, fever and stiff of his neck. Chest examination reveled lobbar pneumonia. Because of the fever and unconsciousness, lumbar puncture was done promptly to examine the CSF: had a heavy concentration of gram-positive cocci in pairs(diplococci), the most likely microbial etiology of his infections is:

a) Staphylococcus aureus

b) Streptococcus pyogenes

c) Streptococcus pneumoniae

d) Staphylococcus epidermidis

7. What is the typical pathologic lesion caused by staphylococci?

a) furuncles

b) duodenal ulcer

c) swollen lymph nodes

d) non of the above

8. To which antibiotic most of S. aureus are resistant:

a) Gentamicin

b) Tetracycline

c) Cefoxitin

d) Penicillin

9. What characterizes staphylococcal food poisoning:

a) short incubation period (six hours)

b) toods tend to be protein-rich

c) Gastrointestinal infection

d) all of the above

10. What are the post streptococcal diseases?

a) acute rheumatic fever

b) acute glomerulonephritis

c) a and b

d) non of the above

Name:………………………………………..……Group 3

12.02.2007 (4 year program of medical studies)

1. A child presents with impetigo with bullae. Gram-positive, beta-hemolytic, catalase-positive, coagulase-positive cocci are isolated. Which of the following are the most likely microorganisms:

a) group A streptococci

b) group B streptococci

c) Staphylococcus aureus

d) Staphylococcus epidermidis

2. S.aureus exfoliative toxins:

a) peeling of mammalian cell membranes and thus cell lysis

b) are important causes of toxic shock syndrome in menstruating women

c) cause bullous impetigo

d) act as virulence factors in staphylococcal pharyngitis, requiring prompt antitoxin administration

3. Which of the following laboratory criteria would establish Staphylococcus.aureus. rather than Streptococcus pyogenes, as the causative organism?

a) growth on blood agar

b) production of catalase

c) motility

d) presence of Gram positive cocci

4.The typical staphylococcal skin lesions include:

a) urticaria

b) abscesses and furuncles

c) rash

d) indurated chancre

5. Streptococcus agalactiae is also known by its Lancefield group which is:

a) group A

b) group B

c) group C

d) group D

6. Which of the toxins produced by S. pyogenes plays the basis role in the pathogenesis of scarlet fever?

a) Streptococcal pyrogenic exotoxin (SPE_s)

b) Hyaluronidase

c) Streptolysin O

d) all of the above

7. A 32-year-old woman bacame ill four days after the onset of her menstrual period. She presented in the emergency room with fever, elevated white blood cell count( 16.000/mm³), and a rash on her trunk and extremities. She complained of fatigue, vomiting and diarrrhea. She had recently eaten at a fast-food restaurant, but otherwise had prepared all her meals at home. The patient described most likely has:

a) staphylococcal food poisoning

b) scalded skin syndrome

c) infection with a Staphylococcus saprophyticus

d) toxic shock syndrome

8.Which of the following is a characteristic of Streptococcus pyogenes ?

a) Gram-negative cocci usually arrange in diplococci or chains

b) endotoxin

c) catalase

d) fimbriae

9. What antigen is most useful in identifying nephritogenic strains of Group A streptococci which may induce glomerulonephritis?

a) capsular antigen

b) cell wall carbohydrates

d) M proteins

d) outer membrane proteins

10. Pneumococcal pneumonia or meningitis rarely occurs in the absence of what virulence factor?

a) capsule

b) heat shock proteins

c) outer membrane

d) periplasmic space

Name:………………………………………..……Group 1

19.02.2007 (4 year program of medical studies)

1. H.influenzae capsule type b consists of:

a) lipopolysaccharides (LPS)

b) polyribose - ribitol phosphate (PRP)

c) outer membrane protein (OMP)

d) lipooligosaccharide (LOS)

2. Which of the following bacteria induce lesions to ciliated epithelial cells:

a) H.influenzae

b) P.aeruginosa

c) B.pertussi

d) S.aureus

3. A patient presented to the eye casualty with a painful eye. Coneal scrappino showed the Gram negative bacilli. What is the most common predisposing factor for this infection?

a) S. aureus

b) P. aeruginosa

c) H. influenzae typ b

d) N. gonorrhoeae

4. Bordetella pertussis, called whooping cough, can best be detected by which of the following procedures?

a) Culture of respiratory secretions in HeLa cells after centrifugation of the inoculated tubes

b) Culture of respiratory secretions on Regan-Lowe agar

c) Direct microscopy of sputum by Gram stain

d) Fluorescent antibody detection of the organism in sputum

5. Which of the following is a preferred third - generation cephalosporin with good activity against childhood meningitis?

a) Ceftazidine

b) Ceftriaxone

c) Penicillin

d) Streptomycin

6. There are variety of unusual bacteria that infect humans. While rare disease caused by these microorganisms is serious and occasionally difficult to identify. Which of the following statements best characterizes Moraxella catarrhalis?

a) A gram-negative, pleomorhic rod that can cause endocarditis

b) A gram-negative rod, fusiform-shaped, that is associated with periodontal disease but may cause sepsis.

c) The causative agent of sinusitis, bronchitis, and pneumonia

d) The causative agent of rat-bite fever

7. The virulence factors N.memingitidis responible for or thought to faciliate adherence to the nospharyngeal mucosa are:

a) fagella and spores

b) exotoxins and enterotoxins

c) pili and IgA 1 protease

d) outer membrane proteins (OMP)

8. Meningococcal vaccins:

a) are prepared from the cell wall of N. Menigitidis

b) are serogroup - specific, capsular poysaccharides

c) are particilarly effective in yhe prevention of disease due to serogroup B

d) rarely prevent dissemination of organisms from the primary site

9. Several days after an unprotected sexual encounter, a healthy 21-years old male develops pain and pus on urination. A Gram stain reveals gram-negative diplococci. Which of the following structures is most responsible for adherence of the offending microbe to the urethral mucosa?

a) capsule

b) fimbriae

c) flagella

d) the F pili

10. Several Neisseria species are a part of the normal flora (commensals) of the human upper respiratory tract. Which of the following statements accurately describes the significance of these bacteria?

a) As a part of the normal flora, Neisseriae provide a natural immunity in local host defense.

b) As a part of the respiratory flora, they are the most common cause of acute bronchitis and pneumonia

c) Commensal bacteria stimulate a cell-mediated immunity (CMI)

d) Normal flora such as nonpathogenic Neisseriae provide effective nonspecific B-cell-mediated humoral immunity.

Name:………………………………………..……Group 2

19.02.2007 (4 year program of medical studies)

1. Etiologic agent of meningitis in infants and children aged 2 months to 5 years:

a) Haemophilus influenzae type b

b) Streptococcus pneumoniae

c) Neisseria meningitidis

d) All of the above

2. Acellular B.pertussis vaccine contains:

a) LPS

b) polysaccharide capsule

c) tracheal cytotoxin

d) FHA, pertactin, pertussis toxoid

3. What is the treatment for pertussis?

a) Vancomycin

b) Penicillin

c) ceftazidine

d) Erythromycin

4. A hyperemic edema of the larynx and epiglottis that rapidly leads to respiratory obstruction in young children is most likely to be caused by which of the following organisms?

a) Haemophilus hemolyticus

b) H. influenzae

c) K. pneumoniae

d) Neisseria meningitides

5. A sputum sample was brought to the laboratory for analysis. Gram stain revealed the following: rare epithelial cells, 8 to 10 polymorphonuclear leukocytes per high-power field, and pleomorphic gram-negative rods. As a laboratory consultant, which of the following interpretations should you make?

a) The appearance of the sputum is suggestive of H. influenzae

b) The patient has pneumococcal pneumonia

c) The sputum specimen is too contaminated by saliva to be useful

d) There is no evidence of an inflammatory response

6. The person who contracts gonorrhoea is most likely to have acquired it via which of the following.

a) gastrointestinal tract

b) genital tract

c) nasal tract

d) skin

7. N. gonorrhoeae is fastidious pathogen found in sites often contaminated with normal flora. What is the best medium for isolation.

a) Loffler's medium

b) Sheep blood agar

c) Thayer-Martin agar

d) Thisulfate citrate bile salts sucrose medium

8. Primary gonococcal disease:

a) never initiates in the pharynx or rectum

b) occur only as acute male or female urethritis

c) is usually treated with penicillin

d) results in acute inflammatory response characterized by polymorphonuclear leukocytes attracted to the primary site by LOS and host complements.

9. Pelvic inflamatory disease (PID) is caused by:

a) S. aureus

b) S. pyogenes

c) N. meningitidis

d) N. gonorrheoeae

10. N. gonorrhoeae attaches to mucosal cells of the:

a) oral - pharyngel area

b) genitals

c) eyes

d) all of the above

Name:………………………………………..……Group 3

19.02.2007 (4 year program of medical studies)

1. Sings of H.ducreyi (chancroid or soft chancre) include:

a) vomiting

b) stiff neck

c) diarrhea

d) painful, friable ulcer on the genitals

2. How is pertussis prevented?

a) IPV vaccine

b) DTaP vaccine

c) H i b vaccine

d) Hep B vaccine

3. Which of the following is the causative agent of swimmer's ear?

a) H. influenzae

b) P. aeruginosa

c) N. meningitidis

d) H. Parainfluenzae

4. A 2-year-old child has a high fever and is irritable. He has a stiff neck. Gram stain smear of spinal fluid reveals gram-negative, small pleomorphic coccobacillary organisms. What is the most appropriate procedure to follow in order to reach an etiological diagnosis?

a) Culture the spinal fluid in chocolate agar and identify the organism by growth factors

b) Culture the spinal fluid in mannitol-salt agar

c) Perform a catalase test of the isolated organism

d) Perform a latex agglutination test to detect the specific antibody in the spinal fluid

5. Bordetella pertussis is a Gram-negative rod that causes severe respiratory disease. Which one of the following statements best characterizes this microorganism?

a) It produces at least one protein toxin consisting of two subunits, A and B, that cause severe

spasmodic cough, usually in children

b) It produces a toxin that blocks protein synthesis in an infected cell and carries a lytic

bacteriophage that produces the genetic information for toxin production

c) It secretes an erythrogenic toxin that causes the characteristic signs of scarlet fever

d) It secretes an exotoxin that has been called “verotoxin” and “Shiga-like toxin”; infection is

mediated by specific attachment to mucosal membranes

6. N. meningitidis causes meningitis in all age groups. Which of the following is a characteristic physiological trait?

a) It causes spontaneous abortion and has tropism for placental tissue due to the presence of the erythritol in allantoic and amniotic fluid.

b) It has a capsule of polyglutamic acid, which is toxic when injected into rabbits.

c) It possesses N-acetylneuraminic acid capsule and adheres to specific tissue by pili found on the bacterial cell surface.

d) It secretes two toxins, A and B, in the large bowel during antibiotic therapy.

7. Most gonococcal strains that produce disseminated diseuse:

a) are sensitive to killing by normal human serum

b) are A-H-U-auxotrophs

c) do not contain LOS

d) are relatively resistance to penicillin

8. Measures to prevent and control gonorrheae do not include:

a) vaccination

b) the use of condoms

c) treatment of case contact

d) test for cure following therapy

9. Young men (20 years old) with a yellow purulent discharge and dysuria following an incubation period 7 to 14 days. Which of the following is the etiologic agents.

a) H. ducreyi

b) N. gonorrhoeae

c) S. aureus

d) Ps. aeruginosa

10. First day of life, watery exudet and hyperemia. What is causative agent:

a) N. gonorrhoeea

b) no infected agent - silver nitrate susceptibility

c) S. epidermidis

d) B. pertussis

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