1.microbiology - Bacteriology MCQs Formatted

BACTERIOLOGY
BACTERIOLOGY 6. Bacteria acquire characteristics by all

the following except
1. Bacteria are simple genetic units with all of the A. Through plasmids
following properties EXCEPT B. Incorporating part of host DNA
A. They are diploid C. Through bacteriophages
D. Through configuration
B. Their genetic material is organized into a single
Ans: B
chromosome
Ref: Ananthanarayan and Panicker’s
C. Their DNA has intervening sequences (Introns) Text Book of Microbiology, 8/E, p. 19
in almost all genes
D. They use the same genetic code as all the 7. The organism MOST resistant to
eukaryotes thermal inactivation is
Ans : C A. Bacterial spores
B. Virus
C. Spirochete
2. Coating of bacteria particles with host D. Streptococcus mutans
proteins to facilitate phagocytosis is
known as Ans: A
A. Chemotaxis Ref: Ananthanarayan and Panicker’s
B. Chemokine Text Book of Microbiology, 8/E, p. 31
C. Opsonization Explanation
D. Membrane attack complex • Therefore spores are used as sterilization
control.
Ans: C. Opsonization
Ref: Wintrobe's Clinical Hematology, 8. Which of the following structures, found
Volume 1, John p. Greer, 12/E, p. 283 external to the bacterial cell wall, are
involved in bacterial attachment to cell
3. ASO (Antistreptolysin O) test is used
surfaces
for the diagnosis of
A. Capsule
A. Rheumatoid arthritis B. Flagella
B. Typhoid fever C. Pili
C. Rheumatic fever D. Mesosomes
D. Rickettesial fever
Ans: C
Ans: C
Text Book of Microbiology, 8/E, p. 21
Textbook of Microbiology, 8/E, p. 208
Explanataion
4. Bacteria that grow best at temperatures • They are organs of adhesion originating
below 20º C are called from cell membranes, e.g.
A. Mesophilic Escherichia, Klebsiella.
• They are detected by hemagglutination
B. Psychrophilic
C. Thermophilic
D. Microaerophilic
Ans: B 9. Monotrichous, Lophotrichous, Amphitrichous
Ref: Ananthanarayan and Panicker’s and Peritrichous. These are all
Text Book of Microbiology, 8/E, p. 27 types of ______ in anatomy of a bacterial
Explanation cell.
• Mesophilic: 25–40°C A. Flagella
• Psychrophilic: < 20°C B. Ribosomes
• Thermophilic: 55–80°C C. Mesosomes
D. None of the above
Ans: A. Flagella
5. Negative staining is used to demonstrate Ref: Textbook of microbiology,
A. Bacterial spore Ananthnarayan and Panicker, 8/E, p. 20
B. Bacterial flagella
C. Bacterial capsule
D. Bacterial fimbriae 10. Which of the following fulfill all the
35. Ans: C criterias of Koch's postulates?
Ref: Ananthanarayan and Panicker’s A. Treponema pallidum
Text Book of Microbiology, 8/E, p. 19 B. Mycobacterium leprae
C. N Gonorrhoeae
D. None of the above
BACTERIOLOGY
Ans: D. None of the above B. Bacterial
Ref: Textbook of microbiology, C. Viral
Ananthnarayan and Panicker, 8/E, p. 6 D. Parasitic
Ans: B
11. Which of the following statement is Text, Book of Microbiology, 8/E, p. 393
true in the case of Endotoxins? Explanation
A. Highly antigenic Botryomycosis is caused by Staphylococcus.
B. Proteins in nature
C. Heat stable 16. Endotoxin is released from
D. Action is often enzymatic A. C. albicans
B. S. Sanguis
Ans: C. Heat stable C. Gram negative bacteria
Ref: Textbook of microbiology, D. Actinomyces viscosus
Ananthnarayan and Panicker, 8/E,
p. 643 Ans: C
12. Black pigmented anaerobes include all Text Book of Microbiology, 8/E, p. 82
the above except
A. Tannerella 17. Which component of the cell wall is
B. Porphyromonas responsible for endotoxic activity
C. Bacteroides A. Region I
D. Prevotella B. Region II
C. Region III
Ans: D. Prevotella D. Bovine antigen
Ref: Koneman’s Color Atlas and
Textbook of Diagnostic Microbiology, Ans: C
Elmer W. Koneman, 6/E, p. 921 Ref: Ananthanarayan and Panicker’s
13. Ipratropium bromide is used for Explanation
A. Renal colic • The lipopolysaccharide present on the
B. Organophosphorus poisioning cell walls of gram negative bacteria
C. Bronchial asthma consists of 3 regions
D. Miosis 1. Region I – polysaccharide portion
determining antigen specificity
Ans: D
2. Region II – core polysaccharide
3. Region III – glycolipid portion
Text, Book of Microbiology, 8/E, p. 24
responsible for endotoxins
14. The process of attenuation can be activities
achieved by all EXCEPT
18. Plasmid is transmitted to other bacteria
A. Growing bacteria in adverse
in
environment
A. Transformation
B. Growing bacteria in unconventional
B. Transduction
host
C. Conjugation
C. Serial passage in an experimental
D. All of the above
host
D. Repeated cultures in artificial media Ans: C
Ans: C
Explanation
• Plasmids are circular DNA molecules
Explanation
present in the cytoplasm of bacteria,
Reduction of virulence is known as
capable of autonomous replication
attenuation. This can be achieved by:
• By their ability to transfer genes from
• Passage through unfavourable hosts
one cell to anther by conjugation, they
• Repeated cultures in artificial media
have become important vectors in
• Growth in high temperature
genetic engineering
• In the presence of weak antiseptic
• Prolonged storage in culture 19. Which of the following is NOT a
characteristic of exotoxins?
15. Botryomycosis is a ............. disease
A. Produced in minute amounts
A. Fungal
B. Released from bacterial cell wall
BACTERIOLOGY
C. Destroyed by proteolytic enzymes 22. A 12 year old boy developed sore throat grayish
D. Weakly antigenic pseudomembrance covering tonsils and pharynx.
The causative agent is?
Ans: D
Ref: Ananthanarayan and Panicker’s A. Gram positive bacillus
Text Book of Microbiology, 8/E, p. 78 B. Gram negative baccilus
Explanation C. Single standard positive sense rna viruses
D. A gram negative catalase positive coccus
arranged in cluster
Ans: A
23. A patient present with frontal abscess. Foul

smelling pus is aspirated. Pus shows red
fluorescence on ultraviolet examination. The most
likely organism causing the frontal abscess is
A. Bacteroides
B. Peptostreptococcus
C. Pseudomonas
D. Acanthamoeba
Ans: A
24. True about bacteria

A. Mitochondria always absent
B. Sterols always present in cell wall
C. Divide by binary fission
D. Can be seen only under electron microscope
Ans:- (a) and (c) Mitochondria always absent and

20. The number of bacteria in the oral cavity is greater: Divide by binary fission
A. In the morning Ref:- Ananthnarayan 8/e, p 12, 17
B. After meals Explanation:-
C. At night
D. After brushing  Only bacteria having sterol in its cell membrane:
Ans:B. After Meals Mycoplasma
 Bacteria can be seen by:
21. Microorganisms which grow in the presence or
absence of oxygen? - Optical or light microscopy
A. Microaerophilic - Phage contrast microscopy
B. Facultative anaerobic - Dark field or dark ground microscopy
C. Obligate aerobic - Electron microscopy
D. Anaerobic -
Ans:B. Facultative anaerobic
25. A diabetic patient developed cellulitis due to
Ref: Burton’s Microbiology for the Health Sciences,
9/E, p. 63 S.aureus, which was found to be methicillin
Explanation resistant on the antibiotic sensitivity testing. All
Classification of Bacteria Based on Oxygen the following antibiotics will be appropriate
Requirement except:
• Strict or Obligate Anaerobes: Cannot tolerate A. Vancomycin
oxygen. E.g.: Clostridium tetani
B. Imipenem
• Strict or Obligate Aerobes: Requires oxygen, lack of
C. Teicloplanin
oxygen kills organism. E.g.: Pseudomonas
• Facultative Anaerobes: Can live with or without D. Linezolid
oxygen. E.g.: Staphylococcus , E. coli
• Aero Tolerant: Do not use oxygen, but oxygen Ans:- B Imipenem
doesn’t harm them. E.g.: Lactobacillus Ref:- Harrison 18/e p 1168
• Microaerophiles: Requires very low oxygen Explanation:-
concentration and higher CO2 concentration. E.g.:
Imipenem is not effective against Enterococcus
Campylobacter.
faecium, MRSA, clostridium difficle, Burkholderia
cepacia as they produce metallobetalactamases.
BACTERIOLOGY
Though it is effective against methicillin sensitive 27. Which of the following statement is most correct
staph.aureus. regarding resistance to methicillin in MRSA
A. Resistance is produced as a result of alteration
Treatment of MRSA
in penicillin binding protein
Drug of choice Alternative Investigatory
Vancomycin TMP-SMX Oritavancin B. Resistance is produced by production of β
Minocycline Tigecycline lactamase
Ciprofloxacine, Ceftobipirole C. Resistance is mediated by plasmids
Levofloxacin D. Expression of resistance is enhanced by
Quinupristin/ incubating at 38◦C during susceptibility testing
dalfopristin
Linezolid Ans:- A Resistance is produced as a result of
Daptomycin alteration in penicillin binding protein
Antibiotic resistance Ref:- Katzung 10/e p 727
Agent Mechanism of Site Explanation:-
resistance
Penicillins Β-lactamase Plasmid Production of novel penicillin binding protein (PBP
Methicilin Altered Chromosome 2 α or 2) is responsible for methicillin resistance”.
binding Protein in synthesized by mec A gene which is part
Cephalosporin protein of a large mobile genetic element called SCC mec.
Chloramphenicol Acetyl Plasmid
transferase It is hypothesized that the genetic material was
Erythromycin Methylation of Plasmid acquired via horizontal transfer from a related
ribosome species, S. sciuri.
Streptomycin Altered Chromosome
Drug resistance in staphylococcus
ribosomal
protein A. Penicillin resistance
Vancomycin Van A gene Chromosome
 Production of β latamase
Quinolones Mutation in
- Plasmid mediated inducible enzyme
topoisomerase
IV which is transmitted by transduction
(more commonly) or conjugation. Now
only <5% of strains of staph are sensitivity
Note : Mechanism of vancomycin resistance to penicillin.
involves the replacement of the last D-alanine
- Hospital strains mostly form type A
residue of peptidoglycan precursors with D-lactate
penicillinase.
or D-serine resulting respectively in high level and
- Same plasmid carry genes for resistance to
low level resistance.
tetracycline, erythrocmycin,
26. Staphylococcus aureus differs from aminoglycoside too.
staphylococcus epidermidis by  Altered penicillin binding protein
A. Is coagulase positive - Due to production of novel penicillin
B. Forms white colonies binding protein PBP2a, this protein is
C. A common cause of UTI synthesized by mecAgene.
D. Causes endocarditis of prosthetic valve - Chromosomally mediated, expressed more
at 30◦C than at 37◦C.
Ans:- A Is coagulase positive
- Responsible for resistance against
Ref:- Ananthanarayan 8/e p 202
penicillinase resistant penicillin such as
Explanation:-
methicilin, cloxacillin. Strains are called
Property Staphylococcus Staphylococcus MRSA (Methicillin resistant staph.
aureus epidermidis Aureus)
Coagulase Positive Negative - MRSA escape methicillin by synthesizing
Mannitol Ferments Not ferment an extra PBP called PBP-2A which carries
Pathogenicity Pathogenic Less
out function of those PBPs that are
pathogenic
inactivated by methicillin.
Colony Golden White
 Tolerance to penicillin
Hemolysis Show Not show
Cause In normal In prosthetic - Bacteria only inhibited not killed.
endocarditis native valve valve B. Vancomycin
BACTERIOLOGY
- Intermediate susceptible strain: Also B. Vibrio cholera
known as VISA (vancomycin-intermediate C. Entamoeba histolytica
S.aureus). for these VISA strain MIC D. Staphylococcus aureus
(minimal inhibitory concentration) of
vancomycin is 4-8 µg/ml. the mechanism Ans:- D Staphylococcus aureus
Ref:- Harrison 17/e p 816
of resistance is increased cell wall
Explanation:-
synthesis and alteration in the cell wall.
- Resistant strain: Also known as VRSA Learn this table by heart, every year there is
(vancomycin resistant strain): This is due question on food poisoning.
to presence of van A gene
Bacterial food poisoning
C. Others
Incubation period, Symptoms Common
- Plasmid mediated resistance to
organism food source
tetracycline, erythromycin, 1 to 6 H
aminoslycosides. Staphylococcus Nausea, Ham,
aureus vomiting, poultry,
28. A patient in an ICCU is on CVP line. His blood diarrhea potato or
culture shows growth of Gram-positive cocci egg, salad,
mayonnaise,
which are catalase positive and coagulase
cream
negative. The most likely etiological agent is
pastries
A. Staph.aureus Bacillus cereus Nausea, Fried rice
B. Staph.epidermidis vomiting
C. Streptococcus pyogenes 8 to 16 H
D. Enterococcus faecalis Clostridium Abdominal Beef,
perfringens cramps, poultry,
Ans:-B Staph.epidermidis diarrhea legumes,
Ref:- Harrison 17/e p 873 (vomiting gravies
Explanation:- rare)
B. cereus Abdominal Meats,
Gram +ve, catalase +ve, coagulase –ve bacteria is cramps, vegetables,
coagulase-negative staph. diarrhea dried beans,
vomiting cereals
S. epidermidis is uniquely adapted to colonize >16H
prothestic devicese due to its capacity to elaborate Vibrio cholera Watery Shelfish
the extracellular polysaccharide (glycocalyx or diarrhea
slime) that facilitates formation of protective biofilm Enterotoxigenic Watery Salads,
on the device surface. This slime production also Escherichia coli diarrhea cheese,
protect the bacteria against antibiotics. meats
Enterohemorrhagic Bloody Ground
Coagulase (-) ve staphylococcus E.coli diarrhea beef, raw
S.epidermidis S.saprophyticus vegetables
Novobiocin sensitive Novobiocin resistant Salmonella spp. Inflammatory Beef,
Predilection for growth Not so diarrhea poultry,
on implanted foreign eggs, dairy
bodies products
Most common cause of Cause UTI in sexually Campylobacter Inflammatory Poultry, raw
prosthetic value active young women jejuni diarrhea milk
endocarditis Shigella spp. Dysentery Potato or
egg salad,
lettuce, raw
Remember: Both are present on normal skin and are
vegetables
not usually pathogenic.
Vibrio Dysentery Mollusks,
29. A cook prepares sandwiches for 10 people going parahaemolyticus crustaceans
for picnic. Eight out of them develop severe
gastroenteritis within 4-6 hrs of consumption of - S.aureus is MC cause of food poisoning in
the sandwiches. It is likely that on investigations west.
the cook is found to be carrier of
A. Salmonella typhi 30. Staphyloccus can cause
BACTERIOLOGY
A. Ecthyma A. Staphylococcus epidermidis
B. Erythrasma B. Staphylococcus aureus
C. Furuncle C. Staphylococcus saprophyticus
D. Impertigo contagiosa D. Enterococcus
E. Sycosis barbae
Ans:- C Staphylococcus saprophyticus
Ans:- C and E Ref:- Harrison 17/e p 879
Ref:- Harrison 17/e p 875,885 Explanation:-
Explanation:-
Staphylococcus saprophyticus cause UTI in young
Skin and soft tissue infection of S. aureus women due to its enhanced capacity to adhere to
uroepithelial cells. A 160 KDa hemagglutinin
- Folliculitis: Superficial infection of ostia of adhesions may contribute to this affinity.
hair follicle.
- Faruncles (boils): More extensive painful Note:- S. Saprophyticus is novobiocin resistant
lesions that tends to occur in hairy moist
33. The following is characteristic feature of
region of body and extend from hair
staphylococcus food poisoning except
follicle to become a true abscess, e.g.
A. Optimum temperature for toxin production is
buttock
37◦C
- Carbuncle: Mostly located in lower neck
B. Intradietic toxin are responsible for intestinal
and are even more severe and painful.
symptoms
- Acute paronychia: MC cause is S.aureus
C. Toxin can be destroyed by boiling for 30
- Bullous impetigo: Impetigo is most
minutes
frequently diagnosed bacterial infection.
D. Incubation period is 1-6 hours
- Ecthyma: it is deeper form of impetigo
caused by staph. Or strep. Ans:- C Toxin can be destroyed by boiling for 30
- Cellulitis minutes
- Hiradenitis suppurativa: Recurrent Ref:- Harrison 17/e p 877-878
follicular infections in region such as axilla Explanation:-
- Sycosis barbae is chronic folliculitis of
Staphylococcal food poisoning
beard hair follicle.
31. All of the following statement are true about - Staphylococcal food poisoning is due to heat
staphylococci except stable preformed toxin mostly after consuming
A. A majority of infection caused by coagulase –ve milk products
staph. Are due to staph. Epidermidis - Toxin is produced optimally at 35◦C to 37◦C
B. B-Lactamase production is under plasmid and is resistant to the action of gut enzymes
control - As disease is due to toxin, secondary spread is
C. Expression of methicillin resistance in not there
staphylococcus aureus increases when it is - Main d/d is B.cereus food poisoning.
incubated at 37◦Con blood agar - IP-1-6 hours
D. Methicillin resistance in staph. Aureus is - Mechanism- Acts by stimulating vagus nerve
independent of b-Lactamase production and vomiting center of brain
- No antibiotics are given for staphylococcal
Ans:- C Expression of methicillin resistance in food poisoning.
staphylococcus aureus increases when it is - Treatment is conservative and there is no need
incubated at 37◦Con blood agar of any antibiotic.
Explanation:-
34. Staph. Aureus causes vomiting in 6-8 hours. The
Methicillin resistance is expressed more when mechanism of action is
staph. is incubated at 30◦C than at 37◦C. A. Stimulation of CAMP
B. Vagal stimulation
Refer Ans. No.3 for full explanation.
C. Stimulation of CGMP
32. Which one of the following Gram positive D. Acts through ganglioside GM receptor
organism is most common cause for UTI among
sexually active women
BACTERIOLOGY
Ans:- B Vagal stimulation consisting of masses of bacteria generally
Ref:- Harrison 17/e p 875 staphylococcus aureus.
Explanation:-
38. Staphylococcus in stool occurs in
Staph. food poisoning result from heat stable A. Staphylococcal food poisoning
preformed enterotoxin. Due to preformed nature B. Ischiorectal abscess
incubation period is short. Toxin stimulates the C. Toxic shock syndrome
vagus nerve and vomiting center of brain. It also D. May be a normal finding
appears to stimulate intestinal persistaltic activity. E. Pseudomembranous colitis
35. A child after consuming food in a party complains
Ans:- A Staphylococcal food poisoning
of diarrhea within 1-5 hours. The diagnosis is
A. S.aureus
Explanation:-
B. Streptococcus
C. Clostridium perfringes - In case of staphylococcal food poisoning food
D. Clostridium botulinum remnant and faeces are inoculated on selective
medium like ludlams or salt milk agar or
Ans:- A S.aureus Roberson cooked meat medium containing
Ref:- Harrison 17/e p 816 10% NaCl.
Explanation:- - TSS is due to systemic effect of absorbed toxin
Incubation period in food poisoning of S.aureus is from site such as vagina, so there is no
1-6 hours. possibility of finding staph. in case of TSS.
- Normal intestinal flora usually don’t contain
36. Synergohymenoropic toxin of staphylococci
staph.aureus. so it is not a normal finding.
consist of
- Pseudomembranous colitis is caused by
A. α toxin
clostridium difficle.
B. β toxin
C. γ toxin
39. A 25-year old IV drug abuser presents with fever
D. δ toxin
for 3 weeks. ECHO shows tricuspid vegetation.
E. Panton valentine toxin
The most likely organism associated with
endocarditis in this case is
Ans:- C and E
Ref:- Ananthanarayan 8/e p 198 A. Staph.aureus
Explanation:- B. Candida albicans
C. Pseudomonas
Synergohymenotropic toxins are a family of D. Strep.viridans
bicomponent toxin that acts through the synergistic
action of two non-associated secretory proteins. Ans:- A Staph.aureus
Staphylococcal leucocidin (Panton-Valentine toxin) Ref:- Harrison 17/e p 789,790
and gamma hemolysin are the example of Explanation:-
synergohymenotropic toxins.
Endocarditis in IV drugs addicts
37. Which of the following organisms is implicated in Right sided (more Left sided
the causation of botryomycosis common)
A. Staphylococcus aureus Staph.aureus Varied (staph, aureus,
B. Staphylococcus albus enterobacter,
polymicrobial)
C. Pseudomonas aeruginosa
D. Streptococcus pneumonia
E. Streptococcus pyogenes 40. The single most important laboratory
test for determining the virulence of
Ans:- A Staphylococcus aureus staphylo-cocci is
Ref:- Ananthanarayan 7/e p 402 A. Mannitol fermentation
Explanation:- B. Hemolysis of sheep erythrocytes
C. Detection of coagulase
Botyromycosis is a chronic granulomatous D. The catalase test
condition similar to mycetoma, usually involves the
skin and characterized by granules in the pus, Ans: C
BACTERIOLOGY
Explanataion Option b
• Coagulase test can be done using two
method - Micrococci are catalase and oxidase
– Tube coagulase test–detects free positive Gr+ve cocci. They are strict
coagulase aerobes and are non-pathogenic.
– Slide coagulase test–detects bound - Micrococci are differentiated from
Coagulase staphylococci by Hugh and Deifson
oxidation fermentation test in which
41. Impetigo is a staphylococcal infection micrococci shows oxidative pattern while
of the staphylococci show fermentative pattern.
A. Skin
B. Ear
C. Floor of the mouth
D. Eye
Ans: A. Skin
Ref: Textbook of microbiology,
p. 199 Anaerobic cocci
Streptococci Features Gram +ve Gram –ve
Organism Peptostreptococci Veillonellae
42. Which is false regarding gram-positive cocci? Peptococcus
A. Staph. Saprophyticus causes UTI in females Inhabitation Intestine, vagina Mouth, intestine
B. Micrococci are oxidase positive and mouth and genital
tract
C. Most enterococci are sensitive to penicillin
Diseases Puerperal sepsis No disease is
D. Penumococci are capsulated
identified till
now
Ans:- C Most enterococci are sensitive to
Visceral abscess
penicillin
UTI, wound
Ref:- Harrison 17/e p 888-889
infection
Explanation:-
Gangrenous
- Unlike streptococci enterococci are not appendicitis
Treatment Sensitive to
reliably killed by penicillin or ampicillin
penicillin,
alone at concentration achieved clinically
chloramphenicol
in the blood or tissues. and
- Antimicrobial susceptibility testing should metronidazole
be performed routinely on enterococcal
isolates.
43. A patient of RHD developed infective
Enterococci resistance to penicillin is via two mechanism endocarditis after dental extraction. Most likely
organism causing this is
Penicillin Resistance A. Streptococcus viridians
Penicilase production Altered penicillin binding B. Streptococcus pneumoneae
protein
C. Streptococcus pyogenes
Seen in E.faecalis Common in E.faecum
D. S.aureus
Vancomycin, Vancomycin plus
ampicillin/sulbactam, gentamycin is used
Ans:- A Streptococcus viridians
amoxicillin/clavulanate,
imipenem may be used in Ref:- Harrison 17/e p 789
combination with Explanation:-
gentamycin
This is café of subacute bacterial endocarditis
(SABE) as patient has rheumatic heart disease (so
Other options damaged heart valves)
Option a Endocarditis
Native valve Prosthetic Injection
- Staph. Saprophyticus specially causes UTI valve drug
in sexually active young women. users
BACTERIOLOGY
Community Early late primary response
nosocomial (<12 among infants too
associated month) Doesn’t confer long Immunity is relatively
(>12 lasting immunity (<3 long lasting
month) years)
Most Staph.aureus Coagulase Staph. Nasopharyngeal Reduce carriage
common staph aureus viridians (-) aureus carriage is not affected
organism ve staph (usually Use is limited to control Licensed for routine use
streptococci right of epidemics and in in persons 11-55 years of
sided) individuals who are at age and for high risk
high risk (asplenia, individuals.
complement
Preference: deficiencies, laboratory
workers, travellers to
- MC cause of SABE- S.Viridans
highly endemic areas,
- MC cause of acute bacterial endocarditis-
military persons)
S.aureus
- MC cause of prosthetic valve endocarditis-
S.epidermidis Gonococci
- MC cause of endocarditis in iv drug users- 45. The best site to obtain a swab in asymptomatic
S.aureus gonorrhea is
A. Endocervix
Gram-negative Cocci
B. Urethra
Neisseria C. Lateral vaginal wall
D. Posterior fornix
Meningococci
44. Xavier and Yogender stay in the same hotel of Ans:- A Endocervix
same university, Xavier develops infection due to Ref:- Harrison 17/e p 919
Explanation:-
group B meningococcus. After few days Yogender
develops infection due to Group-C Diagnosis of Gonococcal infection
meningococcus. All the following are true
statement except SPECIMEN
In acute gonorrhea In chronic gonorrhea
A. Educate students about meningococcal
Endocervical culture-80- Morning drop secretion
transmission and take preventive measures.
90% sensitivity
B. Chemoprophylaxis to all against both group B Urethral discharge-50% Exudates after prostatic
and group C sensitivity massage
C. Vaccine prophylaxis of contacts of Xavier High vaginal swab are Centrifugal deposits of
D. Vaccine prophylaxis of contacts of Yogendra not satisfactory urine when no urethral
discharge
Ans:- C Vaccine prophylaxis of contacts of Xavier Rectal wall swab-if there
Ref:- Park 21/e p 155 is history of rectal sex
Explanation:-
For group B meningococcal infection no vaccine is Microscopy Presence of gram

available, as polysaccharide of Group B negative diplococci
meningococci is sialic acid homopolymer that is inside polymorphs is
poorly immunogenic in humans. suggestive
Fluorescent antibody
MENINGOCOCCAL VACCINE technique, increases the
Tetravalent Tetravalent conjugated sensitivity of
polysaccharide vaccine vaccine microscopy
Contains purified Contains capsular Transport media Stuart’s or Amies
polysaccharide capsule polysaccharide of media.
of A,C,W,Y A,C,W,Y conjugated to For longer holding
diphtheria toxoid period culture media
Poorly immunogenic in Induce T-cells with self CO2
children under 18 dependent response generating system
months resulting in enhanced (such as JEMBEC or
Gono-pak systems)
BACTERIOLOGY
may be used. catalase-ve, identified as a group of streptococci.
Culture media Acute- chocolate agar Following test is used
or muller-hinton agar A. Bacitracin sensitivity
Chronic- selective B. Novobiocin sensitivity
media like thayar
C. Optochin sensitivity
martin medium
D. Hemolysis
Serology CFT: Done in chronic
case or with metastatic
Ans:- A Bacitracin sensitivity
lesion
Chemiluminescent DNA In high risk patient
probe undergoing screening Explanation:-
for STD’s
Sensitivity to bacitracin is employed as a convenient
Blood culture (e.g. of In suspected cases of
method for differentiating Str. Pyogenes from other
synovial fluid) disseminated infection.
hemolytic streptococci
Pustule-A vesicle filled with leukocyte. MC cause is

- Preferred method of diagnosis of
virus. MC bacterial cause is strep. Pyogenes
gonococcal infection in children is a
standardized culture, from urethra and Remember
cervix however, cervical specimen are not
- Str. Pygenes is the etiologic agent in most
recommended in preppubertial girls
of the streptococcal skin infection
unless necessary.
- Vancomycin is the drug of choice
- Optochin sensitivity and bile solubility is
46. A boy with skin ulcer on leg, culture revealed beta
used to differentiate penumococci from
hemolysis. School physician said that similar
strep. Viridians group.
hemolysis was seen in organism from sorethroat,
what s the similarity between both?
48. All are true about streptococcus except
A. A protein is same for both
A. M-protein is responsible for production of
B. C carbohydrate antigen is different
mucoid colonies
C. C carbohydrate antigen is the same
B. M-protein is responsible for virulence
D. Strain causing both are same
C. Mucoid colonies are virulent
Ans:- C C carbohydrate antigen is the same D. No resistance to penicillin has been reported
Ref:- Jawez 25/e p 195,196
Ans:- A M-protein is responsible for production of
Explanation:-
mucoid colonies
B hemolytic streptococci causing both skin infection Ref:- Ananthanarayan 8/e p 207
and sore throat can be none other than group A Explanation:-
streptococci.
“Mucoid colonies are due to production of capsule
- The basis by which Lancefield classified of hyaluronic acid not due to M-protein”
streptococci in to groups A-H and K-V is c
Growth characteristic of strep. Pyogenes
carbohydrate. So, different group A
streptococci have same c carbohydrate. In - On blood agar virulent stains forms matt
group A, c carbohydrate is rhannose-N or mucoid colonies while avirulent form
acetyl gloycosamine glossy colonies.
- Based on the M protein Griffith divided. - M,T,R are proteins found on outer part of
Group A carbohydrate in to 80 subtypes. cell wall and forms the basis of Griffith
Sore throat strains and skin strains of classification
streptococci differ in their M-protein. Skin  M protein-Acts as virulence factor
infection is usually caused by M-types and antibody against it are
49,57,59-61 protective
 T and R protein-No relation to
47. A person from village is complaining of virulence
development of pustules. Extract from pus has - Streptococci (except enterococci) are
shown gram positive cocci, showing hemolysis, usually susceptible to penicillin so option
d is not completely wrong. As option a is
BACTERIOLOGY
completely wrong, that would be the  Acute rheumatic fever
answer.  High level of ASO titre are
usually found
49. Toxin involved in the streptococcal toxic shock  Titres>300 or 350 are taken as
syndrome is significant
A. Pyrogenic toxin  Acute glomerulonephritis
B. Streptokinase  ASO titres are often lowe
C. Hemolysin - Streptozyme test-Passive slide
D. Neurotoxin hemagglutination test
Becomes positive after nearly all types of
Ans:- A Pyrogenic toxin streptococcal infection whether of throat or
Ref:- Jawetz 25/e p 198
skin.
Explanation:-
- Anti DNA are B and Antihyaluronidase-
Streptococcal TSS is caused by pyrogenic exotoxin Useful for retrospective diagnosis of
streptococcal pyoderma or for acute
Pyrogenic exotoxin= Erythrogenic
glomerulonephritis for which ASO titre is
toxin=Dick=Scarlatinal toxin
of much less value.
- Produced by group A streptococci (type
1,2,3,12 and 28) 51. Lance field grouping of streptococci is done by
- Associated with streptococcal toxic shock using
syndrome and scarlet fever A. M protein
- There are 3 types of pyrogenic exotoxin. B. Group C peptidoglycan cell wall
A,B, and C C. Group C carbohydrate antigen
- A (MC cause of streptococcal TSS) and C D. M antigen
are coded by bacteriophage gene, while B
Ans:- C Group C carbohydrate antigen
is chromosomal
Ref:- Ananthanaryan 8/e p 205
- Acts as superantigen
Explanation:-
- Associated with streptococcal toxic shock
syndrome and scarlet fever. Lancefield classification
- DOC for streptococcal TSS is –
Classification of β-hemolyic streptococci into Group
Clindamycin
A to V (except I,J) on the basis of group specific C
carbohydrate.
50. True statement about antistreptolysin O titre is
A. In normal people the titre is <200 Griffith classification
B. In acute glomerulonephritis the titre is low
Serological typing of group A streptococcus
C. ASO titre >200 indicate rheumatic fever
pyogenes on the basis of M proteins into types 1,2,3,
D. Streptozyme test is an active hemagglutination etc
test
Group C Carbohydrate
Ans:- B In acute glomerulonephritis the titre is
low - Present in middle layer of cell wall
Ref:- Ananthanarayan 8/e p 212 - This antigen is an integral part of cell wall.
Explanation:- - Serological grouping of streptococci
depend on C carbohydrate for which it has
Retrospective diagnosis of streptococcal infection to be extracted from cell wall.
- ASO (Anti Streptolysin O) titre - Method for extraction are
 Estimation of antibody against  Lancefields acid extraction
streptolysin is a standard method (organism are grown in
serological test for retrospective Todd Hewitt broth)
diagnosis of streptococcal  Fullers method
infection  Maxted’s method
 ASO titre> 200 are indicative of  Rantz and Randall’s method
prior streptococcal infection. (Autoclaving)
 Raised after throat infection only
Streptococcal Group C carbohydrate
BACTERIOLOGY
Group A Rhamnose N-acetyl glucosamine Ans:-B Pyrogenic exotoxin
Group B Rhamnose glusamine polysaccharide Ref:- Jawetz 24/e p 238
Group C Rhamnose N-acetylgalactosamine Explanation:-
Group D Glycerol teichoic acid
Remember
52. An outbreak of streptococcal pharyngitis has
- MC cause of toxic shock syndrome-
occurred in a remote village. In order to carry out
staphylococci
the epidemiological investigations it is necessary
- MC cause of streptococcal TSS-Pyrogenic
to perform the culture of the patient suffering
exotoxin A=erythrogenic/Dick/Scarlatinal
from the disease. The transport media of choice
toxic
would be
- MC cause of staphylococcal TSS-
A. Salt manitol media
TSST=pyrogenic exotoxin C=Enterotoxin
B. Pike’s media
type F.
C. Stuart media
- DOC of TSS (both streptococcal and
D. Carry blair media
staphylococcal) is clindamycin.
Ans:- B Pike’s media
Ref:- Ananthanarayan 8/e p 211-212 54. The commonest organism causing cellulitis is
Explanation:- A. Streptococcus pyogenes
B. Streptococcus faecalis
Pikes media is transport media for Streptococci
C. Streptococcus viridians
Throat culture is the gold standard for diagnosis of D. Microaerophilic streptococci
streptococcal pharyngitis
Ans:- A Streptococcus pyogenes
Diagnosis of streptococcal pharyngitis Ref:- Harrison 17/e p 885
Explanation:-
Specimen: Throat specimen collected by vigorous
rubbing of a sterile swab over both tonsillar pillar Cellulitis
Latex agglutination or enzyme immunoassay of - Diffuse spreading infection of skin (dermis

swab specimen is a useful adjunct to throat culture. and subcutaneous tissue) especially of
These rapid diagnostic tests are highly specific but lower leg
less sensitive. So, a positive result in an indication
- Caused by strep pyogens (MC), staph, C1
for treatment, but negative should be confirmed by
perfringens, E.coli
throat culture.
- Major portal of entry for lower leg
Culture cellulitis is toe web tinea pedis with
fissuring of skin.
- Throat culture is diagnostic gold standard
- Skin become peud orange in appearance;
for pharyngitis.
recurrent attack may sometimes affect
- Swab are either plated immediately or sent
lymphatic vessels producing permanent
to laboratory in Pike’s medium (used as
swelling called as solid edema.
transport media)
- Streptococcus cellulitis tends to develop at
- Specimen is plated on blood agar and
sites where lymphatic drainage is
incubated at 37◦C anaerobically or under
disrupted.
5-10% CO2.
- Sheep blood agar is recommended for
55. True about streptococcus
primary isolation because it is inhibitory
A. Lancefield classification is based on M protein
for Haemophilus.
B. Group G not found in human
C. Group B causes neonatal meningitis
53. Streptococcal toxic shock syndrome is due to the
D. Group C can be isolated from vaginal flora
following virulence factor
E. Group D causes urinary tract infection
A. M-protein
B. Pyrogenic exotoxin Ans:- C and E
C. Streptolysin O Ref:- Ananthanarayan 8/e p 206
D. Carbohydrate cell wall Explanation:-
BACTERIOLOGY
Streptococcal Organism Disease state
Lancefield
Group A S pyogenes RTI, pyoderma,
rheumatic fever, Option C
glomerulonephritis
Streptokinase (Fibrinolysin)
Group B S agalactiae Neonatal
meningitis - Streptococci of group A, C and G produce
Group C Strepto. Pharyngitis, a substance called streptokinase which is
Equisimilis endocarditis
actively fibrinolytic for human fibrin.
Group D Enterococcal UTI, endocarditis
Streptokinase is produced maximally in
Non- Endocarditis
the early stage of growth.
enterococcal
Group F Minute Rarely cause - Streptokinase converts plasminogen to
streptococci atypical plasmin, which in turn lyse fibrin.
pneumonia - Streptokinase facilitates the spread of
Group G Commensal Tonsillitis, infection by breaking down fibrin barrier
in throat endocarditis, UTI around the lesion.
Not typed Viridians Endocariditis (by
- Therapuitically it is used for the treatment
streptococci S. sanguis)
of early myocardial infarction and other
Dental caries (by S.mutans)
thromboembolic phenomenon.
56. Streptococcus all are true except Option D

A. Streptodornase cleaves DNA
There are three types of pyrogenic exotoxin.
B. Streptolysin O is active in reduced state Exotoxin A and C are encoded by bacteriophage
C. Streptokinase is produced from serotype A,C,K while type B is coded by chromosome.
D. Pyrogenic toxin A is plasmid mediated
57. Antigenically similar to streptolysin O
Ans:- D Pyrogenic toxin A is plasmid mediated A. Clostridial per fringenes toxin
Ref:- Ananthanarayan 8/e p 208 B. Tetanolysin
Explanation:- C. Botulinum toxin
D. Erythrotoxin
Let us consider each option
Option A Ans:- A and B

Ref:- Textbook of microbiology by DR Arora 1/e p
STREPTODORNASE 228
Enzyme that degrades DNA
Explanation:-
Four -Liquifies Anti DNAse B Mixture of
types thick pus demonstratio streptokinas
Already explained
(ABCD) -Responsible n is useful for e and
Type B for serous retrospective DNAse is
58. A 5-year old child presents with pustular lesions
is most character of diagnosis used to lyse
antigeni streptococca clots, thick on the lower legs. The culture from the lesion
c l pus pus and showed hemolytic colonies on blood agar which
fibrinous were Gram-positive cocci. Provisional diagnosis
exudates
of group A streptococcal pyoderma can be done by
A. Catalase positivity
Option B B. Optochin sensitivity
C. Bile solubility
STREPTOCOCCI HEMOLYSIN
D. Bacitracin sensitivity
Streptolysin O Streptolysin S (Serum
soluble)
Ans:- A Catalase positivity
Oxygen labile Oxygen stable
Activity only on pour Responsible for
Explanation:-
plate not on surface hemolysis seen around
streptococcal colonies Pyoderma (Impetigo)
on surface
Antigenic protein Non antigenic protein - Superficial infection of the skin, caused
elaborated in presence primarily by Group A Streptococci and
of serum staphylococci
Active only is reduced
BACTERIOLOGY
- Usual site of infection are face (particularly B. Strep.pneumonia
around nose and mouth) and the legs C. Enterococcus
- Diagnosis is based on the culture and D. Strep. Bovis
staining of indeginous lesion.
- Gram positive cocci if catalase positive, Ans:- C Enterococcus
than it is most likely to be staphylococci
Explanation:-
and if catalase negative than it is
streptococci GROUP D ENTEROCOCCI
Enterococci (E. Non enterococci
59. Group A streptococci is best diagnosed by faecalis, E. faecium) (strep. Bovis)
A. Optochin sensitivity Able to grow in Not able
B. Bacitracin sensitivity 6.5% NaC1
PYR positive PYR negative
C. Catalase negative
May shows α Non hemolytic
D. Bite solubility
hemolysis
Penicillin resistant Penicillin
Ans:- B Bacitracin sensitivity
susceptible
Ref:- Greenwood 18/e p 195
Causes UTI and Causes UTI,
Explanation:-
other nosocomial endocarditis in
Species identification of pyogenic streptococci is infection patients with GI
neoplasm
based largely on serological detection of group
antigen by immune precipitation or co-
agglutination techniques. An additional test that is - Both enterococci and non enterococci
useful in the presumptive identification of group D stereptococci can grow in
Str.pyogenes (Group A Streptococci) is bactracin presence of bile and hydrolyze esculin
sensitivity test. In contrast to most of other
(bile esculin positive)
streptococci, str. Pyogenes is Str. Agulactiae, the
other pyogenic streptococci is identified
62. A patient admitted to an ICU is on central venous
presumptively by the CAMP reaction.
line for the last one week. He is on ceftazidime
ENTEROCOCCI and amikacin. After 7 days of antibiotics he
develops a spike of fever and his blood culture is
60. Which of the following is not true regarding
positive for gram positive cocci in chains which
enterococcus?
are catalase- negative. Following this vancomycin
A. Common species are E.faecalis and E.faecium
was started but the culture remained positive for
B. It is a cause for peritonitis
same organism even after 2 weeks of therapy. The
C. It is universally susceptible to penicillins
most likely organism causing infection is
D. Can cause intra-abdominal abscess
A. Staphylococci aureus
Ans:- C It is universally susceptible to penicillins B. Viridians streptococci
Ref:- Harrison 17/e p 888 C. Enterococcus faecalis
Explanation:- D. Coagulase negative staphylococcus
Enterococci are resistant to penicillin Ans:- C Enterococcus faecalis

Ref:-Harrison 17/e p 888
Disease caused by Enterococci
Explanation:-
- UTI (Particularly who are on antibiotic
- Enterococci are catalase negative and grow
treatment)
in chains and above all resistant to
- Bacterial endocarditis
cephalosporins.
- Liver abscess, intra-abdominal abscess
- Enterococci is a frequent cause of
- Surgical wound infection.
nosocomial bacteremias and many of these
enterococci are resistant to vancomycin
- Enterococcal bacteremias is
61. A beta hemolytic bacteria is resistant to characteristically seen in ICU in patient
vancomycin, shows growth in 6.5% NaCl, is non taking cephalosporin as antibiotic.
bile sensitive. It is likely to be - Enterococci are resistant to all
A. Strep.agalactine cephalosporins, aminoglycosides and
BACTERIOLOGY
resistant to vancomycin is also becoming Unlike streptococci, enterococci are not reliably
common. killed by penicillin or ampicillin alone. Because in
vitro testing has shown evidence of syndergistic
Treatment of antibiotic resistant killing by combination of penicillin or ampicillin
enterococcal infection with an aminoglycoside, combined therapy is
Resistance Recommended therapy recommended for enterococcal endocarditis and
pattern meningitis.
B lactamase Gentamicin plus
production ampicillin/sulbactam, - Enterococci are resistant to all
amoxicillin/clavulanate, cephalosporins
imipenem, or
vancomycin
64. 45 years old Ramlal has intra abdominal sepsis.
B lactam Gentamicin plus
The causative organism was found to be
resistance, but vancomycin
no β-lactamase vancomycin, gentamycin and ampicillin resistant.
production It grows well in presence of 6.5% NaC1 and
High level Streptomycin sensitive arginine. Bile esculin hydrolysis is positive.
gentamicin isolate: streptomycin Which of the following is this organism?
resistance plus ampicillin, or A. Strep. Agalactiae
vancomycin
B. Enterococcus fecalis
C. Streptococcus bovis
Streptomycin-resistant
isolate: continous D. Streptococcus pneumonae
infusion ampicillin
Ans:- B Enterococcus fecalis
Explanation:-
Vancomycin Ampicillin plus
Growth in 6.5% NaC1 is characteristic of
resistance gentamicin
Enterococci (E.faecalis, E.faecium, E.durans)
65. Cariogenic streptococci are acidophilic and

Vancomycin No uniformly acidogenic. What does acidophilic means
and β lactam bactericidal drugs;
A. Can produce acid
resistance linezolid (all
B. Can survive in acidic medium
enterococci) or
quinupristin/dalfopristin C. Both
(E.faecium only) D. None
Ans: B
- Three phenotypes of vanomycin resistant 66. A patient admitted to an ICU is on central venous
enterococci have been identified viz. van line for the last one week. He is on ceftazidime
A; Van B; Van C; Van A is associated with and amikacin. After 7 days of antibiotics he
high grade resistance to vancomycin and develops a spike of fever and his blood culture is
teicoplanin. Van B and van C are positive for gram positive cocci in chains, which
susceptible to teicoplanin. are catalase negative. Following this, vancomycin
was started but the culture remained positive for
63. Which of the following organism, when isolated the same organism even after 2 weeks of therapy.
in the blood, requires the synergistic activity of The most likely oraganism causing infection is
penicillin +amino glycoside for appropriate A. Staphylococcus aureus
therapy B. Viridans streptococci
A. Enterococcus faecalis C. Enterococcus faecalis
B. Staph.aureus D. Coagulase negative staphylococcus
C. Streptococcus pnepumoniae Ans: C
D. Bacterioides fragilis
67. Erysipelas is caused by
Ans:- A Enterococcus faecalis A. Group B Staphylococci
Ref:- Harrison 17/e p 888 B. Group A Streptococci
Explanation:- C. Gonococci
D. Pneumococci\
BACTERIOLOGY
Ans: B B. Salmonella typhi
Ref: Ananthanarayan and Panicker’s C. Streptococcus pyogenes
Text Book of Microbiology, 8/E, p. 209 D. Legionella pneumophilia
Ans:-(c) Streptococcus pyogenes

68. All of the following lab tests can be Ref:- See below
used to distinguish streptococcus
Explanation:-
mutans from other oral streptococci,
EXCEPT Intracellular organisms are:
A. Gram staining
B. Fermentation of mannitol and a. Bacteria b. Parasites c. d.Fungi
sorbitol Viruses
C. Production of intracellular and extra are
cellular adherent polysaccharide obligate
D. Colony morphology on saliva agar intracell
ular
Ans: A parasite
Ref: Ananthanarayan and Panicker’s • Listeria Babesia Histoplas
Text Book of Microbiology, 8/E, p. 211 monocytogens ma
Explanation capsulatu
• Presence of gram ‘+’ve cocci in chains m
is indicative of streptococcal infection.
However smears are of no value in Legionella Plasmodium
infections of throat or genitalia where
streptococci may form part of the Rickettsia Cryptospori
resident flora dium
parvum
69. The most common organism related to Mycobacteria Microsporidi
dental caries is TB & a sp
A. Borrelia vincenti mycobacteria
B. Streptococcus mutans leprae
C. E. Coli Chlamydia Toxoplasma
D. Bacilli
Ans: B Neisseria
Ref: Ananthanarayan and Panicker’s meningococci
Text Book of Microbiology, 8/E, p. 217 and Gonococci
Yersinia pestis
70. Group A carbohydrate of Str. Pyogenes
cross reacts with human Bordetella
A. Synovial fluid
B. Myocardium Salmonella
C. Cardiac valves
D. Vascular intima Calymmatobact
Ans: C erium
Ref: Ananthanarayan and Panicker’s Gronunomatis
Text Book of Microbiology, 8/E, p. 208 (Donovania)
Explanation Shigella
• Antigenic relationships of streptococcus
pyogenes have been demonstrated Brucella
between
– Capsular hyaluronic acid and Pneumococci
human synovial fluid
– Cell wall protein and myocardium
– Group A carbohydrate and cardiac
valves
– Cytoplasmic membrane antigens Mnemonic:
and vascular intima
– Peptidoglycans and skin antigens  LLRM Medical College Ne Yaha Bulakar, SDS
ko Bahut Pareshaan kiya.
71. All of the following organisms are known to
survive intracellularly except Remember:
A. Neisseria meningitides
BACTERIOLOGY
 Cell Mediated Immunity play vital role against 73. An infant had high grade fever and respiratory
these organisms. distress at the time of presentation to the
emergency room. The sample collected for blood
culture was subsequently positive showing
growth of α-hemolytic colonies. On gram staining
72. Which of the following is not a common case of
these were gram-positive cocci. In the screening
neonatal sepsis in India
test for identification, the suspected pathogen is
A. Staphylococci
likely to be susceptible to the following agent
B. Klebsiela
A. Bacitracin
C. E.coli
B. Novobiocin
D. Group B streptococci
C. Optochin
Ans:- d i.e Group B Streptococci D. Cloxacillin

Ref:- Arch Dis Child Fetal Neonatal
Ans:- C Optochin
Ed2005;90:F220-FF224
Explanation:-
Explanation:-
The pathogens most often implicated in neonatal
Infant is suffering from pneumococcal pneumonia
sepsis in developing countries differ from those
(gram positive a-hemolytic cocci)
seen in developed c tries. Overall, Gram negative
organisms are more common and are mainly Pneumococci is differentiated from other a
represented by Klebsiella, Escherichia hemolytic gram-positive cocci by its susceptibility
Pseudomonas, and Salmonella. Of the Gram to optochin and bile solubility.
positive organisms, Staphylococcus aureus,
coagulase negative staphyloc (CONS), 74. In a patient of orbital cellulitis, micro organism on
Streptococcus pneumoniae, and Streptococcus culture show greenish colonies and optochin
pyogenes are most commonly isolated. sensitivity. The most likely organism is
A. Strep.viridans
Further it is stated that Group B streptococcus
B. Staphylococcus
(GBS) is generally rare or not seen at all, although
C. Pseudomonas
maternal rectovaginal carriage rates of GBS be
D. Pneumococcus
similar to those recorded in developed countries.
Neonatal Sepsis Ans:- D Pneumococcus

Ref:- Ananthanaryan 8/e p 218-219
- Neonatal sepsis specifically refers to the Explanations:-
presence ("neonate") of a bacteriamic
Penumococci is optochin sensitive and forms green
infection (such as meningitis, monia,
colonies on blood agar due to α hemolysis
pyelonephritis, or gastroenteritis) in the
setting of fever in a newborn baby. Characteristic features of pneumococci
- It is divided into two categories:
- Bile soluble, optochin sensitive
 Early Onset Sepsis (EOS): EOS
- Insulin fermenter
refers to sepsis presenting in the
- Capsulated, shows quelling reaction
first 7 days of life
- Colonies show central umbonation, appear
 Late Onset Sepsis (LOS). with
as draughtsman or carom coin
LOS referring to presentation of
- MC causative agent of lobar pneumonia,
sepsis after 7 days
adult meningitis, otitis media, sinusitis
- Diagnosis: Culturing for microorganisms
(orbital cellulitis is complication of
from a sample of CSF, blood or urine, is
sinusitis)
the gold standard test for de diagnosis of
neonatal sepsis.
75. True statement regarding pneumococcus is
Note: In western countries, Group B streptococci is A. Virulence is due to polysaccharide capsule
the most common etiologic organism responsible B. Capsule is protein in nature
for neonatal sepsis. C. Antibodies against capsule are not protective
D. Resistance to penicillin has not yet been
reported
PENUMOCOCCI
BACTERIOLOGY
Ans:- A Virulence is due to polysaccharide Bacteria which shows α or partial hemolysis
capsule includes
Explanation:- Species Common disease
caused
Virulence of pneumococci depends on its capsule, Strep. Viridians SABE, Dental caries
toxin called penumolysin and autolysin. including: S. sanguis, S.
mutans
Virulence factors of pneumococci Penumococci Lobar pneumonia,
otitis media
Capsule
S. anginosus Pyogenic infections
- Polysaccharide in nature Enterococcus including UTI, endocarditis
S.faecalis
- Protects against phagocytosis
Peptostreptococcus
- Type 3 pneumococci has abundant
capsular material and is more virulent
- Antibody against capsule are type specific 77. Most common causative organism for lobar
and protective. pneumonia is
A. Staphylococcus aureus
Penumolysin B. Streptococcus pyogenes
- Thiol activated toxin, exerts variety of C. Streptococcus pneumonia
effects on ciliary cells and PMN D. Haemophilus influenza
- Complement activating and cytotoxic
Ans:-C Streptococcus pneumonia
properties
Ref:- Robbins 7/e p 748
- Immunogenic
Explanation:-
Autolysin Remember
- By lysing the bacteria and releasing - MC-infection of pneumococci: Otitis media

bacterial components contributes to - Pneumococci is MC cause of lobar
virulence pneumonia, acute sinusitis, adult
meningitis
IgA1 protease
- MC cause of bronchopneumonia:
- Cleaves IgA1 and hence decreases the Staphylococci
function of this immunoglobulin - MC cause of atypical pneumonia :
Mycoplasma pneumonia.
C-substance and peptidoglycans
78. A 65-year old man presents with complaints of
76. The sputum specimen of a 70 year old male was chest pain, fever, cough with sputum. Sputum
cultured on a 5% blood agar. The culture showed examination reveals pus cells with Gram positive
the presence of α-hemolytic colonies next day. cocci. Blood agar showed positive results. How
The further processing of this organism is most will you differentiate this from other gram
likely to yield positive cocci.
A. Gram positive cocci in short chains, catalase A. Bacitracin sensitivity
negative and bile resistant B. Optochin sensitivity
B. Gram positive cocci in pairs, catalase negative C. Bile solubility
and bile soluble D. Positive coagulase
C. Gram positive cocci in clusters, catalase

Ans:- C Bile solubility
positive and coagulase positive
D. Gram negative coccobacilli, catalase positive Explanation:-
and oxidase positive
This is a classic presentation of pneumococcal
Ans:- B Gram positive cocci in pairs, catalase pneumonia (the most community acquired
negative and bile soluble pneumonia)
Explanation:-
BACTERIOLOGY
There is confusion between optochin sensitivity and Mortality in bacterial meningitis
bile solubility as both are unique features of Cause Mortality
penumococci H influenzae, 3-7%
meningococci, group B
- Bile solubility has got more diagnostic streptococci
importance as suggested by following line Listeria meningitis 15%
of Harrison S. pnuemococci 20%
- More than 98% of pneumococcal isolates E.Coli >20%
are susceptible to ethyl hydrocupreine
(optochin) and virtually all pneumococcal Other options have already been explained.
colonies are dissolved by bile salts
- Bile solubility of pneumococci is due to the 81. A person presents with pneumonia. His sputum
presence of autolytic amidase which are was sen for culture. The bacterium obtained was
activated by surface active agents gram positive cocci in chains and alpha
- Inulin fermentation is the other test used haemolytic colonies on sheep agar. Which of the
to differentiate pneumococci and following will help in confirming the diagnosis
streptococci. A. Novobiocin
B. Optochin
Pneumococci can ferment inulin, while streptococci C. Bacitracin
don’t. This is tested in Hiss’s serum water or serum D. Oxacillin
agar slopes.
Ans:- B Optochin
79. An eight year old child with history of pain and
discharge from right ear presents with fever, neck Explanation:-
rigidity and a positive Kerning’s sign. Discharge
was stained with gram stain which revealed gram Pneumococci are distinguished from other a
positive cocci. Which of the following is the most hemolytic streptococci by their characteristic
likely organism sensitivity to optochin.
A. H. influenza 82. Apart from Escherichia coli, the other most

B. Staphylococcus common organism implicated in acute
C. Pneumococcus suppurative bacterial peritonitis is
D. Pseudomonas A. Bacteroides
B. Klebsiella
Ans:- C Pneumococcus
C. Peptostreptococcus
D. Pseudomonas
Explanation:-
Most common Gram +ve organism causing Ans:- (b) Klebsiella

meningitis : Pneumococci Ref:- CSDT 13/e, p 465
Explanation:-
Most common Gram-Ve organism causing
meningitis: Meningococci Causative organism of acute bacterial peritonitis
This hold true for all age group Aerobic (30%) Anaerobic(10%)
- E. coli (MC) - Bacteroides
80. All are true about streptococcus penumoniae - Klebsiella - Peptostreptococci
except - Enterococci
A. Capsule aids in infection Remember: In 60% of cases mixed anaerobic and
B. Component infection is otitis media aerobic infection is found.
C. Respiratory tract of carriers is most important
83. The most common pathogens responsible for
source of infection
nosocomial pneumonia in the ICU
D. Meningitis caused by S.pneumoniae is milder
A. Gram +ve organism
than others
B. Gram -ve organism
Ans:- D Meningitis caused by S.pneumoniae is C. Mycoplasma
milder than others D. Virus infections
Explanation:-
BACTERIOLOGY
Ans:- (b) Gram -ye organisms
Ref:- Jawetz 24/e, p 739; Harrison 16/e, p 1539 86. A patient present with vomiting he had eaten rice
Explanation:- 6 hour before. The most probable cause is
A. Bacillus cereus
Guys, this is a twisted question, understand the
choice clearly. B. Staph. aureus
C. Cl. Difficle
 MC cause of nosocomial pneumonia in ICU D. All
now is S. aureus (Gram +ve) Harrison 16/e, p
1539 Ans:- A Bacillus cereus
 After this comes enterobacteriaceae followed Ref:- Ananthanarayan 8/e 247
by Pseudomonas aeruginosa (Gram -ve). – Explanation:-
- But if we take Enterobacteriaceae and P. This is a characteristic presentation of B.cereus food
aeruginosa (Gram -ve organism) together poisoning (emetic type)
they can over number S. aureus (Gram +ve
organism). Bacillus cereus food poisoning
- Produces two type of food poisoning

So, the answer will be Gram -ve organism.
a. Emetic type: it is associated with
Now word nosocomial has been replaced by contaminated fried rice; the organism
is common is uncooked rice, and its
hospital acquired pneumonia.
heat resistant spores survive boiling.
It is mediated by staphylococcal type
of enterotoxin.
BACILLUS CEREUS
b. Diarrheal type: Mediated by
84. Characteristic of Bacillus cereus food poisoning is enterotoxin resembling E.coli. IP of
A. Presence of fever diarrheal type is more in comparison
B. Presence of abdominal pain to emetic type.
C. Absence of vomiting
Diagnosis:- the presence of B cereus in patients
D. Absence of diarrhoea
stool is not sufficient to make a diagnosis of B
Ans:- B Presence of abdominal pain cereus disease, since the bacteria may be seen in
Ref:- Ananthanarayan 8/e 247 normal stool speciments; a concentration of 105
Explanation:- bacteria or more per gram of food is considered
diagnostic.
Abdominal pain is seen in both emetic and
diarrheal type of B. cereus food poisoning.
85. Noninvasive diarrhea can be caused by the 87. A person 6 hr after consuming rice pudding in
following restaurant develops vomiting. True statements
A. Shigella regarding food poisoning
B. B cereus A. Caused by Staphylococcus aureus
C. Salmonella B. Preformed toxin
D. Y enterocolitica C. Caused by vibrio parahaemolyticus
D. Heat labile toxin
Ans:- B B cereus E. Culture of food is more useful than stool
Explanation:_ Ans:- B,E
Diarrhea of B. cereus is mediated by enterotoxin
which resemble E. coli LT. The incubation period is
8-16h Clostridium
Bacteria causing invasive diarrhea CL.TETANI
- Shigella 88. A person has received complete immunization

- Salmonella against tetanus 10 years ago. Now he presents
- Enteroinvasive E. coli with a clean wound without any lacerations from
- Campylobacter jejuni
BACTERIOLOGY
an injury sustained 2.5 hours ago. He should now and syntaxin. The toxin of C.botulinum types A and
be given E cleaves SNAP-25 while type B toxin cleaves
A. Full course of tetanus toxoid synaptobrevin.
B. Single dose of tetanus toxoid
- Though botulinum toxin is the most lethal
C. Human tet. Globulin
toxini known (Lethal dose 1-2 µg) it is
D. Human tet. Globulin and single dose of toxoid
used therapeutically for many conditions.
Ans:- B Single dose of tetanus toxoid

Therapeutic uses of Botulinum toxin
Ref:- Park 21/e p 287
Muscular disorders Ophthalmic disorder
Explanation:-
s
- Management of wound depends on nature Myoclonus Strabismus
Palatal myoclonus Lower lid entropion
of wound and immune status of person.
Focal dystonias Acquired nystagmus
- All wounds should receive surgical toilet.
Tics, tremor Thyroid
ophthalmopathy
Immunization Clean wound Other wounds,
Hemi-facial spasm Dwayne’s syndrome
status of <6 hrs and e.g.
Tourette’s syndrome Oscillopsia
with (contaminated
Synkinesis Apaxia of eyelid
negligible wound)
opening
tissue
damage Tardive disorders Hyper lacrimation
Complete Nothing Nothing Rigid akinetic
immunization syndromes
within past 5 Parkinson’s
yrs progressive
Complete 1 dose of Toxoid 1 dose supranuclear palsy
immunization toxoid Hallovorden spatz
within 5-10 Stiff person syndrome
years Plastic surgery Otolaryngology
Complete T oxoid 1 Toxoid 1 Wrinkles Vocal cord polyps
immunization dose dose+Human Masseter hypertrophy Stuttering
more than 10 Tet.Ig Facial asymmet ry Hypersalivation
years (post bells)
Has not had Toxoid Toxoid complete Muscle flap paralysis
complete complete course+Human during healing
immunization course Tet Ig Genitourinary Gastroenterology
or immunity Detrusor-sphincter Achalasia
status is dyssynergia
unknown Vaginismus Cricipharyngeal
spasms
Rectal fissures
Patient in question falls in category B Rehabilitation medicine
Disorders of painful muscular spasm
Spasticity: Focal myofascial pain TMJ
89. Not true about Botulinum toxin associated muscle spasm
A. Short life span
B. Increased acetyl-choline release 90. Which of the following regarding clostridium
C. Used for treatment in Blepharospasm, static tetani is false?
and dynamic wrinkles. A. Soil and intestine of human and animals are
D. Effective for 3-4 days the reservoirs
E. Irreversibly decreases Ach in NM junction. B. Predominantly seen in dry and winter season
C. Transmission through contaminated wounds
Ans:- A and B D. No herd immunity or seen
Ref:- CMDT 08, p 893
Explanation:- Ans:- B Predominantly seen in dry and winter
season
Botulinum toxin decreases the release of Ref:- Ananthanarayan 8/e 258
acetylcholine by proteolysis of SNARE proteins. Explanation:-
The SNARE proteins are synaptobrevin SNAP-25
BACTERIOLOGY
Tetanus is more common in developing countries D. It is Gram –ve
where the climate is warm and in rural area where E. Produces endotoxin
soil is fertile
Ans:- A and B
Epidermiology of Tetanus Ref:- Ananthanarayan 8/e p 250
- Natural habitat of Clostridium tetani is soil Explanation:-
and dust. Bacilli can be found in intestine - Clostridium is obligatory anaerobic gram-
of herbivorous animals, e.g. cattle, horses. positive spore bearing bacilli.
The spores can survive for years.
- Infection is acquired by contamination of SPORES OF CLOSTRIDIA
Spherical and Oval and Central or
wound with spores.
terminal spore (= terminal (= subterminal
- Sequence of events are: introduction of Drum stick Tennis Cl. Botulinum
spores; germination, elaboration of appearance) racket) Cl.perfringenes
exotoxin and binding to the receptor Cl.tetani Cl.difficle Cl. Septicum
Cl.tetanomorphum Cl. Tertium Cl. Novyl
- It is not transmitted from person to person. Cl. histolyticum
C. sphenoides Cl.
Cochleurum Cl. Sporgenes
91. A 10-year old boy following a road traffic accident Cl. Sordelli
Cl. Chauvoei
presents to the casualty with contaminated wound
over the left leg. He has received his complete
primary immunization before preschool age and
94. All are true regarding clostridium tetani except
received a boster of DT at school entry age. All of
A. Produces heat resistant spores
the following can be done except
B. Incubation period 6-11 days
A. Infection of TT
C. 3 primary doses of vaccine needed for full
B. Infection of human antiserum
protection
C. Broad spectrum antibiotics
D. Man to man transmission is seen
D. Wound debridement and cleaning
Ans:- D Man to man transmission is seen
Ans:- B Infection of human antiserum
Explanation:-
Explanation:-
There is no man to man transmission or a tetanus
According to table given in previous answer, this
patient is not infectious.
child belongs to category B of other wounds since
wound is contaminated and child received booster Other options
at school entry (so booster>5 year but <10 year).
Option a
So, human antiserum is not needed.
- Cl. Tetani produce terminal spores which
92. The most effective way of preventing tetanus is are highly resistant to boiling, cresol,
A. Surgical debridement and toilet autoclaving for 15 min at 120◦C.
B. Hyperbaric oxygen - Spores are best destroyed by stream under
C. Antibiotics pressure at 120◦C for 20 minutes or by
D. Tetanus toxoid gamma irradiation.
Ans:- D Tetanus toxoid Option b

Explanation:- - I.P. of tetanus is usually 6-10 days
however it may be as short as one day or
Remember:- as long as several months.
Best way of prevention=Active immunization=TT

Option c
Best passive immunization=Antitoxin=Human
tetanus immunoglobulin. - Tetanus is best prevented by active
immunization with tetanus toxoid.
93. True about clostridium tetani
- The aim is to ensure a lifelong antitoxin
A. It is Gram +ve
level ≥ 0.01 IU/ml. this can be
B. Drum stick appearance
accomplished either by combined vaccine
C. Grows in aerobic environment
BACTERIOLOGY
(DPT) at interval of 48 weeks starting of 6 99. All of the following infections are often
weeks of age followed by booster at 18 associated with acute intravascular hemolysis
months of age, and a second booster (only except
DT) at 5-6 years of age. A. Clostridium tetani
- For monovalent vaccine a primary course B. Bartonella bacilliformis
of immunization consists of two doses of C. Plasmodium falciparum
TT given at interval of 1-2 months. This is D. Babesia microti
followed by a booster dose 1 year after the
initial dose. Second booster dose is Ans:- . (a) Clostridium tetani
Ref:- See below
advised after 5 year. Thus, total 4 doses of
Explanation:-
monovalent vaccine ensure lifelong
protection in an adult. Infection associated with severe hemolysis are:
- Bartonella
- Clostridium welchii
95. Gas gangrene is NOT caused by
- Malaria (Plasmodium falciparum)
A. Clostridium welchii
- Bacteremia with pneumococci,
B. Clostridium septicum
C. Clostridium emotines staphylococi, escherichia coli.
D. Clostridium tetani - Babesiosis
100. The following statements are true regarding
Ans: C
clostridium perfringens except
A. It is the commonest cause of gas gangrene
B. It is normally present in human feces
C. The principal toxin of C. perfringens is the
alpha toxin
96. A full course of immunization against, Tetanus
D. Gas gangrene producing strains of C.
with 3 doses of Tetanus toxoid, confers immunity
perfringes produces heat resistant spores
for how many years?
A. 5
Ans:- D Gas gangrene producing strains of C.
B. 10 perfringes produces heat resistant spores
C. 15 Ref:- Ananthanarayan 8/e p 249-55
D. 20 Explanation:-
Ans: C
- Gas gangrene is caused by CI. Perfringens
97. The most frequently encountered (MC by type A), CI. Novyi, CI. Septicum,
clostridial species in gas gangrene is
CI. Histolyticum and C. sordelbii
A. Clostridium botulinum
B. Clostridium perfringens - Most important toxin for gas gangrene is
C. Clostridium tetani alpha toxin= lecithinase which is
D. Clostridium difficile
Ans: B responsible Nagler’s reaction
Ref: Ananthanarayan and Panicker’s - CI. Perfringens is found in feces and
Text Book of Microbiology, 8/E, p. 254 contaminates the skin of perineum,
buttocks, thigh
98. Following active immunization with
tetanus toxoid injection, how often - Its spores are used as remote indicator of
should a booster dose be given fecal contamination of water.
A. Every year
B. Every 2 years - Spores are usually destroyed within 5
C. Every 5 years minutes by boiling but those of food
D. Twice a year poisoning strains of type A and certain
Ans: C type C strain resistant boiling for several
Ref: Ananthanarayan and Panicker’s hours.
Text Book of Microbiology, 8/E, p. 260 - Spores are destroyed by autoclaving at
Explanation
• A booster dose is recommended after 121◦C for 20 minutes.
ten years. A full course of immunization - Spores are resistant to antiseptics and
confers immunity for a period of
disinfectants in common use.
at least 10 years. Therefore 5 years is
the nearest answer.
BACTERIOLOGY
101. Gas gangrene are caused by Naegler’s reaction is due to α toxin = lecithinase C=
A. CI. Novyi phospholipidase so, given by Cl. Perfringens.
B. CI. Septicum
C. CI. Histolyticum
D. CI. Perfringes 104. Regarding, clostridium perfringens gas gangrene,
E. CI.tetani all are true, except
A. Commonest cause of gas gangrene
Ans:- A,B,and D B. Naegler reaction positive
Ref:- Harrison 17/e p 903 C. Most common toxin is hyaluronidase
Explanation:-
D. Food poisoning strain of clostridium
Clostridium causing Gas Gangrene perfringens produced heat resistant spores.
Common Less Doubtful
pathogenic Ans:- C Most common toxin is hyaluronidase
Cl. Perfringens Cl. Cl. Ref:- Anathanarayan 8/e 249-255
Histolyticum Bifermentons Explanation:-
Cl. Septicum Cl.fallax Cl. Sporogenes
Already explained
Cl. Novyi Cl. Tetani
Cl. Sordelbii 105. True about treatment of gas gangrene after
contaminated road traffic accident
A. IV administration of anti-gas gangrene serum
B. Penicillin
102. Gastrointestinal enteritis necroticans caused by C. Immediate suturing
A. CI.difficile D. Surgical debridement
B. CI. Perfringes E. Irrigation of anti-gas gangrene serum
C. Botulinum
D. C. jejuni Ans:- A,B,D
E. Pseudomonas Ref:- Harrison 18/e p 1205
Explanation:-
Ans:- B CI. Perfringes
Ref:- Harrison 17/e p 904 Treatment of gas gangrene
Explanation:- - Emergent surgical exploration and
Necrotizing enteritis (enteritis necroticians, or pig thorough debridement is most important
bel) is caused by β toxin produced by type C strains - Penicillin G 4 million units IV plus
of C-perfringens following ingestion of high protein Clindamycin, 600-900 mg IV. If patient is
meal in conjunction with trypsin inhibitors by a allergic to penicillin then cefoxitin is used
susceptible host who has limited intestinal along with clindamycin.
proteolytic activity. Source of organism is patient - Passive anti-gas gangrene serum to be
own intestinal flora. administered via intramuscular or
intravenous route as prophylaxis
Clinical features
- Hyperbaric oxygen therapy may be
- Acute abdominal pain, diarrhea, vomiting, considered after surgery and antibiotics
shock and peritonitis, 40% of patient die. have been initiated.
- Pathological studies show an acute
ulcerative process of the bowel restricted
to small intestine.
106. The tissue and pus aspirate to be
collected for diagnosis of Gas gangrene.
103. Nagler’s reaction is shown by It should ideally be transported using
A. CI.tetani A. Buffered Glycerol saline
B. CI.botulinum B. Todd – Hewitt broth
C. Robertson’ Cooked Meat Medium
C. CI. Perfringes
D. Hanks Balanced salt solution
D. CI. Septicum
Ans: C. Robertson’ Cooked Meat
Ans:- C CI. Perfringes Medium
Ref:- Ananthanarayan 8/e p 252 Ref: Textbook of Microbiology,
Explanation:- Ananthnarayan & Panicker, 8/E, p. 257
BACTERIOLOGY
107. Which of the following agents of gas virus burgdorferi Vibrio
gangrene is capsulated? -Varicella-zoster Clostridium species
A. Cl.septicum virus - tetani Brucella
B. Cl.novyi Coxsackievirus Viridans species
C. Cl.perfingens streptococci Bacillus
D. Cl.histolyticum species
Leptospira
Ans: C. Cl. perfingens species
Ananthnarayan & Panicker, 8/E, p. 251
110. Regarding gas gangrene one of the following is

108. Heat stable enterotoxin causing food poisoning is
correct
caused by all the following except
A. It is due to clostridium botulinum infection
A. Bacillus cereus
B. Clostridial species are gram negative anaerobes
B. Yersinia enterocolitica
forming spores
C. Staphylococcus
C. The clinical features are due to the release of
D. Clostridium perfringens
protein endotoxin
Ans:- (d) Clostridium perfringens D. Gas is invariably present in the muscle
Ref:- Ananthnarayan 7/e, p 252; Harrison 17/e, p compartments
986
Ans:- D Gas is invariably present in the muscle
Explanation:-
compartments
Heat stable enterotoxin: Ref:- Ananthanarayan 8/e p 249
Explanation:-
1. Staph aureus enterotoxin.
2. Enterotoxin of K. pneumoniae. - Clostridia are Gram positive (so produce
3. Emetic type toxin of B. cereus (Diarrheal type is exotoxin as endotoxin are usually
LabileToxin). produced by gram negative bacteria)
4. ST of ETEC (LT is same as toxin of V-cholera). - Cl. Botulinum doesn’t cause gas gangrene
5. Yersinia enterocolitis (by some strains). - Gas gangrene is characterized by rapid
6. Clostridium botulism toxin (Relatively stable) and extensive necrosis of muscle,
accompanied by gas formation (clinically
109. Which of the following can cause rhabdomyo- as crepitations) and systemic toxicity.
lysis
A. Clostridium perfringes 111. An 18-year old male presented with acute onset
B. Streptococcus descending paralysis of 3 days duration. There is
C. Clostridium difficle also a history of blurring of vision for the same
D. Cl. Tetani duration. On examination, the patient has
quadriparesis with areflexia. Both the pupils are
Ans:- . (a, b, d) Clostridium perfringens, non reactive. The most probable diagnosis is
Streptococcus and Cl. tetani Rhabdomyolysis A. Poliomyelitis
Explanation:-
B. Botulism
Viral causes Bacterial causes Fungal C. Diphtheria
causes D. Prophyria
-Influenzae types Francisella Rickettsia
A and B (most tularensis species Ans:- B Botulism
common Streptococcus Candida Ref:- Harrison 17/e p 902
-HIV pneumoniae Salmonella Explanation:-
-Ebstein-Barr Group B species
virus streptococci Aspergillus Diagnosis of botulism should be considered in
-Echovirus - Streptococcus Listeria patient with symmetric descending paralysis with
Cytomegalovirus pyogenes species• bilateral cranial neuropathies in addition of
-Adenovirus - Staphylococcus Legionella following features:
Herpes simplex epidermidis species
virus - Escherichia coli Mycoplasma - Absent fever
Parainfluenza Borrelia species - Patient remain responsive
BACTERIOLOGY
- Heart rate normal or slow D. Clostridium botulinum
- Sensory deficits don’t occur except for
blurred vision. Ans:- D Clostridium botulinum
Explanation:-
Important points Cl. Botulinum belong to category A of potential

bioterrorism agents
- Cl. Botulinum produce exotoxin which
differs from other exotoxin in that it is Category A
produced intracellularly and appears in
- Anthrax (Bacillus anthracis)
the medium only on death/ autolysis of
- Botulism (Clostridium botulinum toxin)
cell.
- Plague (Yersinia pestis)
- Toxin production is determined by
- Small pox (Variola major)
bacteriophage at least in types C and D
- Tularemia (Francisella tularensis)
toxin.
- Viral hemorrhagic fevers
- All toxins are neurotoxin except C2 which
is cytotoxin. Category A agents are the highest priority
- Toxin acts by blocking production or pathogens because they
release of Ach. at synapse and
a. Can be easily disseminated or transamitted
Neuromuscular junction (=
from person to person
parasympatholytic= effect of atropine) so
b. Possess high mortality rates
cause constipation, paralysis, etc.
c. Require special action for health preparedness.
- Human disease is caused by type A, B, E,
and rarely F.
- MC type of botulism is Infant botulism
which is produced by eating of honey 114. True regarding pseudomembranous colitis are all
containing spores, so toxin is produced except
inside. A. It is caused by clostridium difficle
- Food borne botulism and wound botulism B. The organism is a normal commensal of gut
are produced by preformed toxin. C. It is due to production of phospholipase A
- Diagnosis may be confirmed by D. It is treated by vancomycin
demonstration of bacillus or toxin in food
Ans:- C It is due to production of phospholipase A
or feces.
- A retrospective diagnosis may be made by Explanation:-
detection of antitoxin in the patient serum
but it may not be seen in all cases. Cl. Difficle cause pseudomembranous colitis (PMC)
due to the production of toxin A (enterotoxin) and
112. Subterminal spores are found in toxin B (cytotoxin) not phospholipase A.
A. Clostridium sordelli - Toxin A is potent neutrophil

B. Clostridium sporogenes chemoattractant and both toxin A and B
C. Clostridium difficle glucosylate the GTP binding protein of
D. Clostridium tertium Rho subfamily resulting in disruption of
E. Clostridium botulinum cytoskeleton causing loss of cell shape
adherence with consequent fluid leakage.
Ans:- A,B,E
- Asymptomatic fecal carriage of Cl. Difficle
in healthy neonates is very common. It
also colonizes the colon of 3% of healthy
adults.
- For Cl. Difficle associated diarrhea
113. Most important and potential agent that can be
(CDAD) three events are essential.
used for bioterrosism
A. Plague Diagnosis
B. Small pox
C. TB - Diagnosis of CAD is based on combination
of clinical criteria:
BACTERIOLOGY
 Diarrhea (≥ 3 unformed stools per treated with anticancer drugs, AIDS,
24 hours for > 2 days) agranulocytosis, diabetes.
 Toxin A or B detected by stool
culture or pseudomembrane seen 116. The following statements are true regarding
in colon. botulism except
- Endoscopy is a rapid diagnostic tool in A. Infant botulism is caused by ingestion of
seriously ill patient with suspected PMC performed toxin
but a negative result does not rule out B. CI. Botulinum A,B,E and F cause human
CDAD. disease
C. The gene for botulinum toxin is coded by
Treatment bacteriophage
- Discontinue offending antibiotic D. CI. Bratii may cause botulism
- DOC
Ans:- A Infant botulism is caused by ingestion of
- Metronidazole
performed toxin
- DOC
- For relapse metronidazole Explanation:-
- If not respond > 48 hrs, give vancomycin.
- Infant botulism is caused by ingestion of
spores which produce toxin in gut.
- Most of these infants recover with
115. A patient of acute lymphocytic leukemia with supportive therapy alone
fever and neutropenia develops diarrhea after - Spores of botulinum are highly resistant to
administration of amoxicillin therapy, which of heat, and can withstand 100◦C for several
the following organism is most likely to be the hours.
causative agent?
A. Salmonella typhi 117. Which species of clostridium does not cause
B. Clostridium difficle gangrene?
C. Clostridium perfringens A. CI. Perfringens
D. Shigella flexneri B. CI. Histolyticum
C. C. novyii
Ans:- B Clostridium difficle D. C. sporogenes
Explanation:- Ans:- D C. sporogenes
- It is a typical presentation of CDAD (Cl.
Difficle associated diarrhea)
- Historically, MC antibiotics causing
CDAD- clindamycin, ampicillin and
118. Which of the following is not transmitted by
cephalosporins.
soil??
- Now second and third generation
A. Coccidiodomycosis
cephalosporins particulary cefotaxine,
B. Tetanus
ceftriaxone cefuroxine and ceftazidine are
C. Brucella
the agents frequently responsible for this
D. Anthrax
condition.
- Antibiotics alters the normal intestinal Ans:- Ans. (c) Brucella
flora which allows overgrowth of non- Ref:- Park 19/e, p 242
pathogenic organism. This is called as Explanation:-
superinfection.
Modes of transmission of Brucella:
- Superinfection also occurs by candida
albicans, resistant staphylococci, proteus  Contact infection (MC): Through direct
and pseudomonas. contact with infected tissue, blood, urine,
- Superinfections are common when host vaginal discharge. Mostly occupational.
defence is compromised as in steroid  Food borne infection: Through ingestion of
therapy, leukemia and other malignancies raw milk, dairy products.
BACTERIOLOGY
 Air borne infection: In the environment of Remember: For Animal suspected to have died due to
slaughter house. anthrax, autopsy is not permitted as the split blood can
contaminate soil.
Infection transmitted through soil:
120. Polypeptide capsule is seen in
 Man-soil-man-All the disease transmitted A. Corynebacterium diphtheriae
fecorally, e.g. typhoid, hepatitis A. B. Clostridium welchii
 Soil as storehouse of spores-tetanus, C. Staphylococcus aureus
D. Bacillus anthracis
mycosis, botulism.
Ans: D
119. Which of the following is true regarding anthrax Ref: Ananthanarayan and Panicker’s
A. M.Fadyean reactions shows capsule Text Book of Microbiology, 8/E, p. 19
B. Humans are usually resistant to infection Explanation
• Polysaccharide capsule – pneumococcus
C. Less than 100 spores can cause pulmonary
• Polypeptide capsule – anthrax
infection
• Both capsule and slime layer – streptococcus
D. Gram stain shows organism with bulging Salivarius
spores
E. Sputum microscopy helps in diagnosis.
121. An abattoir worker developed pustule which later
Ans:- A,B,E
progress to necrotic ulcer. Which of the following
stain is useful emonstration of organism from
Explanation:-
smear made from pustule?
Diagnosis of Anthrax A. Polychromic methylene blue
B. Chalkofluor white
1. Microscopy
C. Geimsa
- Examination of cut piece of ear or swab
D. Modified kinyon stain
soaked in blood of animals, it reveals gram
positive bacilli and positive M’Fadyean
Ans:- A Polychromic methylene blue
reaction presumptive diagnosis is made. Ref:- Ananthanarayan 8/e p 245
- Immunofluorescent microscopy confirms Explanation:-
the diagnosis.
2. Any large gram positive bacillus with It is case of cutaneous anthrax in abattoir worker
(slaughter house worker)
morphology and cultural features of anthrax,
i.e. non motile, non hemolytic on blood agar, - Cutaneous anthrax is also common in dock
catalase positive, presumptive report of workers (who carry loads of hides and
anthrax can be given. skin on their bare backs), butchers,
farmers, veterinarians, workers involved
Initial Further For
in meat packing
confirmation confirmation epidemiological
studies and - Pulmonary anthrax is common in workers
strain of wool factories,
characterization - Intestinal anthrax occur in communities
Lysis by By PCR for MLVA who eat carcasses of animals dying of
gamma phage bacillus (multiple locus anthrax.
and direct specific variable
- Stains used in case of anthrax
fluorescent chromosomal number tandem
 Grams stain
antibody test markers repeat analysis)
(DFA) for and AFLP  Sudan black B
capsule specific (amplified  Polychrome methylene blue
staining and fragment length (stains capsule= MFadyean
for polymorphism reaction)
polysaccharide can be done
cell wall
antigen
122. A man, after skinning a dead animal, developed a
pustule on his hand. A smear prepared from the
lesion showed the presence of gram-positive
bacilli in long chains which were positive for
BACTERIOLOGY
McFadyean’s reaction. The most likely
aetiological agent is 123. A malignant pustule is a term used for
A. Clostridium tetani A. An infected malignant melanoma
B. Listeria monocytogenes B. A carbuncle
C. Bacillus anthracis C. A rapidly spreading rodent ulcer
D. Actinomyces sp D. Anthrax of skin
Ans:- C Bacillus anthracis Ans:- D Anthrax of skin

Ref:- Ananthanarayan 8/e p 242 Ref:- Ananthanarayan 8/e p 245
Explanation:- Explanation:-
This is typical presentation of cutaneous anthrax. Cutaneous anthrax is also known as Hide Porter’s
disease or malignant pustule.
Bacillus Anthrax
- Gram positive, aerobic, catalase positive,

non-motile, capsulated (polypeptide in 124. Malignant pustule is caused by
nature), spore forming bacilli. A. B anthracis
- Spore are formed in culture or in the soil B. Leishmaniasia
but never in the animal body during life C. Basal cell carcinoma
and do not cause bulging of vegetative D. Pyoderma
cells (In comparison of Clostridium
Ans:-A B anthracis
spores)
- Spores are highly stable and can remain
viable for decades. This remarkable
stability makes them an ideal bio-weapon.
- Chain of bacilli have bamboo stick or box 125. Malignant pustule are seen in infection with
car like appearance. A. Treponema pallidum
- When blood film containing anthrax bacilli B. Campylobacter granulomatosis
is stained with polychrome methylene C. Bacillus anthrax
blue and then examined under D. H ducreyi
microscope, amorphous purplish material E. Pdeudomonas aeruginosa
representing capsular material is noticed
around bacilli. This is called M’Fadyean’s Ans:- C Bacillus anthrax
reaction (characteristic of anthrax bacilli) Ref:- Already explained
and is used for presumptive diagnosis of 126. An abattoir, worker presented with a malignant
anthrax in animals. pustule on his hand that progressed to form an
ulcer. Smear was taken from the ulcer and sent to
Cultural characteristic
laboratory for investigation. The diagnosis is
- Agar: Frosted glass appearances A. Cutaneous anthrax
- Microscopy: Medusa head appearance B. Carbuncle
- Gelatin stab: Inverted fir tree appearance C. Ulcerating melanoma
- String of perals reaction-For differentiating D. Infected rodent ulcer
B. anthrax from B. cereus and other
aerobic spore bearers. Ans:- A Cutaneous anthrax
Ref:- Ananthanarayan 8/e 242
Clinical features
- Anthrax is zoonotic disease primarily of

herbivores. Human are more resistant than
127. A man, after skinning a dead animal, developed a
animals.
pustule on his hand. A smear prepared from the
 Human become infected when
lesion showed the presence of gram positive
spores are introduced into body
bacilli in long chains which were positive for
by contact with infected animal
mcfadyean’s reaction. The most likely aetiological
or contaminated animal products,
agent is
insect bites, ingestion, inhalation.
A. Clostridium tetani
BACTERIOLOGY
B. Listeria monocytogenes  Campylobacter species primarily C. fetus, C.
C. Bacillus anthracis jejuni have also been isolated from blood.
D. Actinomyces sp
Ans:- C E.COLI
129. With reference to infection with Escherichia coli

the following are true except
CAMPYLOBACTER A. Enteroaggregative E.coli is associated with
persistent diarrhea
128. A child was diagnosed to be suffering from
B. Enterohemorrhagic E.coli cause hemolytic
diarrhea due to campylobacter jejuni. Which of
uremic syndrome
the following will be correct environmental
C. Entero-invasive E.coli produces a disease
conditions of incubation of culture plates of the
similary to salmonellosis
stool sample
D. Entero toxigenic E.coli is a common cause of
A. Temperature of 42◦C and microaerophilic
traveller’s diarrhea.
B. Temperature of 42◦C and 10% CO2
C. Temperature of 37◦C and microaerophilic Ans:- C Entero-invasive E.coli produces a disease
D. Temperature of 37◦C and 10% CO2 similary to salmonellosis
Ans:- A Temperature of 42◦C and microaerophilic Explanation:-
Explanation:- Enteroinvasive E.coli produce disease similar to
shigellosis not salmonellosis.
Diagnosis of C. jejuni diarrhoea
Enteroinvasive E.coli (EIEC
Specimen stool
- Also called atypical E.coli as many strains
Direct microscopy: Dark field or phase contrast
don’t ferment lactose or ferment it late
microscope shows gull wing shaped C.jejuni with
- Cause illness similar to shigellosis
characteristic darting motility.
- Ability to penetrate cells is due to presence
Culture: Growth occurs under microaerophilic of plasmid which codes for virulence
conditions 5% O2 and 85% N2 with added CO2 marker antigen (VMA)
(10%). Though C. jejuni grows well at 36-37◦C but - Diagnosis
incubation at 42◦C prevents growth of other faecal  Sereny test
bacteria and thus helps in selective growth  Cell penetration of Hela or HEP.2
Culture media for campylobacter in culture is diagnosis
Selective media Remember
- CVA medium Enteropathogenci E.coli Diarrhea in infants and

- Skirrow medium (EPEC) children
- Charcoal cefoperazone deoxycholate agar Enterotoxigenic E.coli Travellers diarrhea
(ETEC)
(CCDA) medium
Enteroinvasive E.coli Diarrhea to dysentery
- Charcoal based selective medium (CSM)
(EIEC) similar to shigellosis
- Charcoal based medium containing Enterohemorrhagic E.coli Hemolytic uremic
cefoperazone, amphotericin & teicoplan (EHEC) syndrome
(CAT) medium Enteroaggregative E.coli Persistent diarrhea
- Campy BAP selective media
Enrichment culture 130. A 20-year old man presented with hemorrhagic

colitis, the stool sample grow Escherichia coli in
- Preston enrichment medium pure culture. The following serotype of E.coli is
- Compy-thio medium likely to be the causative agent
- Campylobacter enrichment broth A. 0 157:H7
 Fecal specimens are the preferred sample for B. 0 159:H7
isolating campylobacter species from patients C. 0 107: H7
with gastrointestinal infections. D. 0 55: H7
BACTERIOLOGY
Ans:- A 0 157:H7 This complication is probably mediated by the
Ref:- Ananthanarayan 8/e 277 systemic tranlocation of shiga toxin
Explanation:-
Further more HUS is only a rare uncommon
Enterohemorrhagic E.coli (EHEC)=Shigatoxigenic complication of hemorrhagic colitis or else it can be
E.coli (STEC)=Verotoxigenic E.coli (VTEC): said that most cases of HUS are associated with
EHEC, but only few cases with hemorrhagic colitis
- These strains produce verocytotoxin (VT)=
progress to HUS.
shiga like toxin (SLT)
- Cause diarrheal disease ranging in severity Pathogenesis of HUS
from mild diarrhea to fatal hemmorhagic
- There is systemic translocation of Shiga
colitis and hemolytic uremic syndrome
toxin, where erythrocytes serve as carrier
- Primary target of VT is vascular
of stx to endothelial cell located in small
endothelial cells
vessels of Kidney and brain.
- VT is composed of an active A subunit and
- Subsequently there is thrombolic
five B units that mediate binding
microangiopathy which manifest as
- Typical EHEC is serotype 0 157: H7 and
combination of fever, thrombocytopenia,
few others such as 0 26:H1
renal failure and encephalopathy.
- Diagnosis of EHEC diarrhea can be made
by demonstration of bacilli or VT in feces
133. All are true about EHEC except
- Usually 0 157:H7 serotype does not
A. Sereny test is positive
ferment sorbitol so, use of sorbitol mac-
B. Ferments sorbitol
conkey medium helps in screening of o:157
C. Causes HUS
VTEC.
D. Elaborates Shiga like exotoxin
131. A microbiologist wants to develop a vaccine for Ans:- A Sereny test is positive
prevention of attachment of diarrheagenic E.coli Ref:- Ananthanarayan 8/e 277
to the specific receptors in the gastrointestinal Explanation:-
tract. All of the following fimbrial adhesions
Sereny test is positive in cases of EIEC not EHEC.
would be appropriate vaccine candidates except
A. CFA-1 Mostly 0157:H7 serotype of EHEC don’t ferment
B. Pi-Pili sorbitol but some 0157:H7 and non 0157 strain
C. CS-2 ferment sorbitol so, option B (Ferments sorbitol) is
D. K88 partly correct.
Sereny test-Installation of suspension of freshly

Ans:- B Pi-Pili
isolated EIEC or shigella in to the eyes of guinea
pigs leads to mucopurulent conjunctivitis.
Explanation:-
134. All of the following are true except
Pi Pili is related in pathogenesis of pyelonephritis
not GIT pathology A. E.coli is an aerobe and facultative anerobe
B. Proteus forms uric acid stones
132. All of the following are true about HUS except C. E.coli is motile by peritrichate flagella
A. Infection may be transmitted by food D. Proteus caused deamination of phenylalanine
B. HUS is caused by serotoxin-producing to phenylpyrivic acid
Escherichia coli
C. HUS is more common in children Ans:- B Proteus forms uric acid stones
D. HUS is rarely associated with haemorrhagic Ref:- Harrison 17/e p 942-943
colitis Explanation:-
Proteus results in formation of struvite stone not

Ans:- D HUS is rarely associated with
uric acid stone
haemorrhagic colitis
Ref:- Harrison 18/e p 1251 - Uric acid stone forms in acidic urine in
Explanation:- presence of hyperuricemia
- All members of Enterobacteriaceae are
50% of all cases of HUS and 90% of HUS cases in
children are caused by STEC/EHEC. aerobes or facultative anerobes.
- Features of proteus bacilli
BACTERIOLOGY
 Non lactose fermenter RBC’s on microscopy. The most likely etiological
 Differs from other enterobacteria agent is
by presence of enzyme A. Enteroinvasive E.coli
phenylalanine deaminase which B. Enteropathogenic E.coli
is responsible for deamination of C. Enterotoxigenic E.coli
phenylalanine to phenyl pyruvic D. Enteroaggregative E.coli
acid (PPA test)
 By producing urease it degrades Ans:- A Enteroinvasive E.coli
urea to NH3 and Co2, NH3,
Explanation:-
raises urinary pH. NH4+ (formed
from NH3) precipitate PO43- EIEC cause illness resembling Shigellosis i.e.
mg2+to form MgNH4PO4 ranging from mild diarrhea to frank dysentery.
(Struvite)
Causes of bloody diarrhea
 The result is stone of struvite
Organism Incubation
admixed with CaCO3
period
 This precipitation of organic Shigella >16h
compounds also contribute to the EHEC >16h
formation of biofilin on catheter. EIEC >16h
As proteus resides in biofilm and Campylobacter 2-6 days
stones it can be eradicated only jejuni
by removal of stones and/or
catheter.
 Some strains (X-strinas) are
agglutinated by sera from typhus 138. Which of these are true about E.coli
fever patient (weil felix reaction) A. The L.T (labile toxin), in ETEC acts via CAMP
B. UTI causing E.coli attaches through pilli
C. The ST (Stable toxin) of ETEC is responsible for
causing hemolytic uremic syndrome
135. E.coli attached to a surface with the help of
D. EIEC invasiveness is under plasmid control
A. Fucose
E. In EPEC, the toxin helps in invasion
B. Concanavalin
C. Phytohemagglutinin Ans:- A,B,D
D. Lactin Ref:- Ananthanarayan 8/e p 272-276
Explanation:-
Ans:- A Fucose
Ref:- Still searching Enterotoxins of E.coli
Stable heat Heat labile Verocytotoxin=shiga
136. Most common organism causing UTI toxin toxin like toxin
A. E.coli Acts Acts Inhibits protein
B. Streptococci through through synthesis
C. Klebsiella activation of activation of
D. Staphylococci saprophyticus CGMP CAMP
Ans:- A E.coli
- Fimbriae (P fimbriae0 or pilli binds to
epithelium of urinary tract and helps in
Explanation:-
causing UTI.
E.coli cause 80% of acute UTI in patients with out - HUS is cuased by verocytotoxin =Shiga
catheterization. like toxin EHEC not by ST of ETEC.
Strains of E.coli causing UTI are called - Invasiveness of EIEC is due to plasmid
extraintestinal pathogenic strains of E.coli. coated outer surface antigen called
virulence marker antigen.
137. A 20-year old male had pain in abdomen and mild - EPEC or Enteroadherent E.coli causes
fever followed by gastroenteritis. The stool diarrhea by disruption of brush border not
examination showed presence of pus cells and by toxin or invasion.
BACTERIOLOGY
139. M.C cause of liver abscess B subunit recognizes the receptor glycolipid Gp3 on
A. Streptococcus host cells.
B. Staph aureus
Toxin acts by inhibiting protein synthesis
C. E.coli
D. Staph pyogenes - Diptheria toxin -- Pseudomonas toxin
- Verocytotoxin or Shiga like toxin of E. coli
Ans:- C E.coli 0157-- Shiga toxin of Sh dysenteriae I
140. True about enterotoxigenic E.coli 142. All of the following bacteria test Urease positive
A. Causes epidemic diarrhoea in children in except
developing countries A. E.coli
B. Not a cause of travellers diarrhoea B. Proteus
C. Invasive C. Klebsella
D. Spread by contaminated water D. Staphylococcus
Ans:- D Spread by contaminated water Ans:- . (a) E. coli

Ref:- Ananthanarayan 8/e 276 Ref:- See below
Enterotoxigenic E.coli Urease test is positive in urease producing bacteria

which includes
- Affect all age group. ETEC diarrhea is
endemic in the developing countries - Proteus
- MC cause of travellers diarrhea - S. aureus
(indistinguishable from cholera) - Morganella
- Produce either or both LT and STa. - Klebsiella
however, toxin alone does not lead to - Yersinia
diarrhea - Cryptococcus
- Produce diarrhea, only when it adheres to - Diptheroids
intestinal mucosa by fimbrial or - Mycobacterium except MAC
colonization factor antigen and produce - H. Pylori
toxin.
Mnemonic:
- Source of infection: Contaminated water or
food. - PSM KY CD Med Hai
141. Which of the following toxins acts by inhibiting 143. Preformed toxin is important in food poisoning
protein synthesis due to all except
A. Cholera toxin A. S. aureus
B. Shiga toxin B. Clostridium botulism
C. Pertussis toxin C. ETEC
D. LT of enterotoxigenic E. coli D. B.cereus
Ans:- (b) Shiga toxin Ans:- Ans. (c) ETEC

Ref:- Ananthnarayan 8/e 284, 7/e, p 286; Harrison Ref:- Ananthnarayan 8/e, p 198, 263, 247, 7/e, p 196,
17/e, p 963 247, 264
Shiga toxin, a protein encoded by the iron regulated Preformed toxins have role in:
chromosomal gene. It is composed of two peptide
- Staphylococcal food poisoning
subunits-
(enterotoxin)
A subunit is N-glycosidase that hydrolyzes adenine - Botulism food poisoning
from specific sites of ribosomal RNA of mammalian - Emetic type of food poisoning of B. cereus
60s-ribosomal subunit, irreversibly inhibiting (resemble staph enterotoxin)
protein synthesis.
BACTERIOLOGY
In case of preformed toxin, incubation period Inflammation or abscess
is 'short' in comparison to when organism has of Cowper’s gland
to produce toxin testine. Seminal vesiculitis
3rd generaton
144. The virulence factor of Neisseria gonorrhoeae cephalosporin-cefixime
includes all of the following except and ceftriaxone
A. Outer membrane proteins DOC
B. IgA proteins
C. M protein
146. Which of the following is not true about Neisseria
D. Pilli
gonorrhea
A. It is an exclusive human pathogen
Ans:- C M protein
Ref:- Ananthanarayan 8/e p 227 B. Some strains may cause disseminated disease
Explanation:- C. Acute urethritis is most common manifestation
in males
M protein is the virulence factor of strept. Pyogenes D. All strains are highly sensitive to penicillin
not of gonococci.
Ans:- D All strains are highly sensitive to
Virulence factors of Neisseria gonorrhea
penicillin
Capsular
Ref:- Harrison 17/e p 914-918
polusaccharide
Explanation:-
Outer membrane
proteins Let us consider each option
Pilli Opacity associated
protein (protein II) Option a
Porin (protein I and III Lipoprotein H.8
IgA1 protease Transferring and - N. gonorrhoeae is a exclusive human
lactoferrin binding pathogen.
protein
Lipooligosaccharide Option b
(endotoxin)
- Few strains of N.gonorrhoea disseminate
through blood stream causing arthritis,
145. All are true about Neisseria gonorrhea except skin lesions, endocarditis, meningitis (rare)
A. Gram positive cocci
B. Causes stricture urethra Option c
C. Involves seminal vesicles and spreads to
- Commonest presentation of gonococcal
epididymis infection
D. Drug of choice is ceftriaxone
 Males: Acute urethritis
 Female: Mucopurulent urinitis
Ans:- A Gram positive cocci
Option d
Explanation:-
- Gonococcal resistance to antimicrobial
Gonococcal infection in males
agents
MC Clinical Acute urethritis
 Gonococci has acquired
manifestation
Major symptoms Urethral discharge and resistance to sulfonamides,
dysuria usually without penicillin, fluoroquinolones
urinary frequency or  They acquire resistance either by
urgency chromosomal mutation or by
Other features Epididymitis acquisition of R factors (plasmid)
(uncommon)
Prostatitis (rare) Chromosomal mutation: Two types of
Edema of penis and chromosomal mutation have been described
balanitis
Urethral stricture and 1. Single step drug specific mutation, leading to
periurethral abscess or high level resistance
fistulae (= Watercan
perineum)
BACTERIOLOGY
2. Mutation involving several chromosomal loci 148. Which deficiency would cause neisseria infection
that determine the level as well as pattern of A. C 9
resistance. B. C8
C. C7
Plasmid borne resistance: Gonococci contains D. C6
several plasmid: 95% gonococci have a small,
E. C5
cryptic plasmid of unknown function. Two other
plasmids contain gene that codes for β lactamase, Ans:- A,B,C,D,E
hence resistance to penicillin. Tetractycline Ref:- Harrison 17/e p 911
resistance is also acquired by plasmid. Explanation:-
- Alteration in DNA gyrase and - Complement is required for bactericidal

topoisomerase IV have been implicated as activity and for efficient
mechanism of fluoroquinolone resistance. opsonophagocytosis, individuals deficient
in any of the late complement components
147. Which is the true statement regarding gonococcal (C5-C9) cannot assemble the membrane
urethritis attack complex (MAC) which is required
A. Symptoms are more severe in females than in to kill Neisseria. Thus the incidence of
males meningococcal disease is higher among
B. Rectum and prostate are resistant to gonococci these patients.
C. Most patients present with symptoms of - Surprisingly these patients typically
dysuria develop less severe disease than
D. Single dose of ciprofloxacin is effective in complement sufficient individuals, and
treatment tends to have disease due to uncommon
E. Commonly leads to arthritis sero-groups.
Ans:- C and D
HELICOBACTER
Explanation:-
149. Helicabacter pylori is not associated with
Gonococcal infection in Females: A. Gastrointestinal lymphoma
B. Gastric cancer
- Initial infection involves urethra and
C. Gastric leiomyoma
cervix uteri
D. Peptic ulcer
- Cervicitis is MC manifestation
- Vaginal mucosa is resistant due to Ans:- C Gastric leiomyoma
stratified squamous epithelium but can Ref:- Harrison 17/e p 947
involve in anestrogenic women Explanation:-
(prepubertal, postmenopausal)
Important features of H.pylori
- Infection spreads to endometrium,
fallopian tube, bartholin gland, - Gram –ve cocobacilli motile with
peritoneum with perihepatic inflammation lophotrichous flagella.
(Fitz-Hugh-Curtis syndrome) - 80% of duodenal ulcer and 60% of gastric
- Proctitis occur in both sexes. ulcer are related to H.pylori
- Increase the risk of
Gonococcal infection in males – Already explained
 Gastric adenocarcinoma –Gastric
Disseminated gonococcal infection (DGI) or MALT lymphoma
Arthritis. Occur in very few patient. DGI also cause  Reflux esophagitis –Autoimmune
skin lesion, meningitis, endocarditis etc gastritis
 Oesophageal adenocarcinoma
Treatment
- Urea breath test is most consistently
- 3rd generation cephalosporin cefixime and accurate test for diagnosis
ceftriaxone. - Microbiologic culture is most specific but
- Single dose ciprofloxacin, ofloxacin, insensitive.
levofloxacin etc also affective. 150. Infection with Helicobacter pylori is associated
with
BACTERIOLOGY
A. Acute gastritis fever, diarrhea,
B. Chronic gastritis pneumonia
C. Eosinophilic gastritis
D. Recurrent esophagitis - MC extrapulmonary site of Legionella is
Ans:- B
heart
 Selective media- Buffered
151. Urease test is positive in
charcoal yeast extract (BCYE)
A. H.pylori
agar
B. S.aureus
 Treatment: Macrolides and
C. Klebsiella
quinolones
D. Bacillus cereus
 B-lactams are not effective.
E. Pseudomonas
153. Anju, a 28 years female, has diarrhea, confusion,

Ans:- a, b, c) H. pylori, S. aureus and Klebsiella
high grade fever with bilateral penumonitis.
Organism causing this
A. Legionella
LEGIONELLA B. Neisseria meningitidis
C. Streptococcus pneumonia
152. A 60 years old man is diagnosed to be suffering D. H. influenzae
from legionnaires disease after he returns home
from attending a convention. He could have Ans:- A Legionella
acquired it Ref:- Harrison 17/e p 930
A. From a person suffering from the infection Explanation:-
while traveling in the aeroplane Clinical features suggestive of Legionnaire’s disease
B. From a chronic carrier in the convention center
C. From inhalation of the aerosol in the air - Diarrhea
conditioned room at convention center - High fever (>40◦C or> 104◦F)
D. By sharing an infected towel with a fellow - Numerous neutrophils but no organisms
delegate at the convention revealed by grams staining of respiratory
secretions
Ans:- C From inhalation of the aerosol in the air - Hyponatremia (serum sodium level of
conditioned room at convention center <131 meq/L)
Ref:- Harrison 17/e p 928 - Failure to respond to B-lactam drugs
Explanation:- (penicillins or cephalosporins) and
Important features of Legionella aminoglycoside antibiotics
- Occurrence of illness in an environment in
- Aerobic, Gram negative motile, which the potable water supply is known
nonencapsulated bacilli to be contaminated with Legionella.
- Natural habitat are aquatic bodies such as - Onset of symptoms within 10 days after
stagnant water, mud, hot springs discharge from the hospital.
- Outbreaks are associated with
contaminated water source such as air Remember: MC extrapulmonary site in heart in
conditioning cooling towers. which it causes myocarditis, pericarditis.
- Multiple modes of transmission-
Listeria Monocytogenes
Aspiration (MC), aerosolization, direct
instillation. 154. A 30-year old woman with a bad obstetric history
- No man to man transmission, no animal presents with fever. The blood culture from the
reservoir patient grows Gram-positive small to medium
- It causes coccobacilli that are pleomorphic, occurring in
short chains, Direct wet mount from the culture
Manifestations shows tumbling motility. The most likely
Pneumonia Pontaic fever
organism is
Atypical penpumonia Acute febrile self
A. Listeria monocytogenes
limiting illness
Presents with high B. Corynebacterium sp
BACTERIOLOGY
C. Enterococcus sp bacteria would be helpful in differentiating it
D. Erysipelothrix rhusiopathiae from other bacterial agents?
A. Ability to grow on blood agar
Ans:- A Listeria monocytogenes B. Ability to produce catalase
C. Fermentative attack on sugars
Explanation:-
D. Motility at 25◦C
Tumbling motility is characteristic of Listeria
monocytogenes- (other three are non-motile) Ans:- D Motility at 25◦C
Listeria monocytogenes is Explanation:-
- Catalase positive, non sporing gram - This is a case of Late onset neonatal
positive, cocco bacilli meningitis of Listeria monocytogenes as
- Tendency to occur in chains culture reveals Gram-positive bacillus.
- Characteristically show tumbling motility - Bacterial cause of nenonatal meningitis are
at 25◦C and at 37◦C is non-motile because  E.coli >Group B streptococci
peritrichous flagella are produced (Strep.agalactiae)> other gram-
optimally at 20 to 30◦C but only scantily or negative bacilli>
not at all at 37◦C. L.monocytogenes.
- Grows best between 30◦C and 37◦C - E.coli is Gram-negative bacilli while group
(temperature range is 1 to 45◦C) b streptococci is gram-positive cocci.
- Aerobic or microaerophilic.
Important bacterias causing meningitis
- Intracellular as well as able for direct cell
Features List E. Stre Stap H.
to cell spread so not eliminate by eria coli ptoc hylo Inf
antibodies and cause infection in deficient occi cocc lue
cell mediated immunity. i nz
ae
Ability to + + + + +
Lab diagnosis of Listeria Monocytogenes
grow on
- Specimen: Blood, pus, CSF, swab from blood
agar
cervical and vaginal secretion, cord blood. Productio + + - + +
- Microscopy: Usually negative. In rare case n of
extra and intracellular coccobacilli may be catalase
Fermenta + Both
seen.
tion of acid
- Culture: Listeria can grow on ordinary sugars and
media,but growth is better on blood agar gas are
or tryptose phosphate agar. On blood agar. produ
ced
Listeria form small colonies surrounded
Motility + - - + -
by a narrow zone of β hemolysis. at 25◦C
- Biochemical test: L. monocytogenes is
always D.xylose negative and d.methyl-D-
Remember:
mannoside positive.
- Rapid detection:- selective enrichment - Catalase production and β hemolysis is
broths based on immunoassays are used to differentiate Listeria
commercially available for rapid detection monocytogenes from other Listeria not
of Listeria from food species from other bacterias.
- Serological test and PCR assays are not - Only listeria and E.coli are motile in above
useful in diagnosing clinical infection at mentioned bacterias.
present. 156. In patient with listeria meningitidis who is
allergic penicillin the treatment of choice is
155. A 3-week-old child presented to the pediatrician A. Vancomycin
with meningitis. A presumptive diagnosis of late B. Gentamycin
onset of perinatal infection was made. The CSF C. Trimethoprim-sulphamethoxazole
culture was positive for gram-positive bacilli D. Ceftriaxone
which of the following characteristics of this
BACTERIOLOGY
Ans:- C Trimethoprim-sulphamethoxazole C. Chemoprophylaxis of close contacts of cases is
Ref:- Harrison 17/e p 897 recommended
Explanation:- D. The vaccines is not affective in children below
2 years of age
- DOC for listeriosis (non-pregnant,
neonate, pregnant) is ampicillin or
Ans:- A The source of infection is mainly clinical
penicillin often in combination with cases
amnoglycosides. Ref:- Park 21/e p 155
- During last month of pregnancy (in case of Explanation:-
penicillin allergy), may be treated with
Source of infection are carriers not cases.
erythromycin
- Otherwise in all cases of penicillin allergy Meningococcal meningitis or cerebrospinal fever
DOC is trimethoprin sulfamethoxazole.
- It is caused by N. meningitides, a gram-
NEISSERIA negative diplococcic.
- Fatality of typical untreated cases is about
157. The following bacteria are most often associated
80%
with acute neonatal meningitis except
A. Escherichia coli Agent: Group A and C and to lesser extent Group B
B. Streptococcus agalactiae cause major epidemics
C. Neisseria meningitidis
Source: Carriers are the most important source of
D. Listeria monocytogenes
infection. Clinical cases present only a negligible
Ans:- C Neisseria meningitidis source of infection.
Ref:- Forfar and Arneils
Environmental Factors: Seasonal variation is well
Explanation:-
established. Outbreaks occur more frequently in the
Causes of meningitis dry and cold months.
Neonatal <1 month Mode of transmission: Mainly by droplet infection.
- Bacterial causes Incubation period: Usually 3-4 days
Diagnosis: Recovering gram-negative diplococcic

Organis Ecoli Gp B Other L.
m > streptococ gram monocytoge (within pus cells) from sterile body fluids such as
ci> negati nes CSF, blood
ve
bacilli Treatment: Antibiotics save the lives of 95% of
> patients provided that it is started during the first 2
Frequen 34% 30% 8% 6% days of illness.
cy
Other bacterias are : Staph, other streptococci, Cases: 3rd generation cephalosporins are DOC
pneumococcus, pseudomonas, Haemophilus,
Meningococcus. Carriers: Rifampicin
- Viral and protozoal infections: TORCH, Prophylaxis
Varicella zoster and HIV. Chemoprophylaxis: Rifampicin (the DOC unless the
- Spirochetal and fungal infections organism is known to be sensitive to sulfadiazine).
 1-11 months: N. meningitidis>
It is suggested for close contacts. Mass
Strep pneumonia> H. influenza
chemoprophylaxis is restricted to closed and
 1-20 years: N. meningitidis> Strep
medically supervised communities.
pneumonia> H. influenza
 More than 20 years: Strep Vaccinization: Immunity last for 3 years
penupmoniae (MC)
159. Conjugate vaccine are available for the prevention
of invasive disease caused by all of the following
158. The following statements about meningococcal
bacteria except
meningitis are true except
A. H. influenza
A. The source of infection is mainly clinical cases
B. Strep pneumonia
B. The disease is more common in dry and cold
C. Neisseria meningitidis (Group-C)
months of the year
BACTERIOLOGY
D. Neisseria meningitidis (Group-B) D. Protective immune status of individual against
TB
Ans:- Neisseria meningitidis (Group-B)
Ref:- Ghai 6/e p 197-198 Ans:- A Previous or present sensitivity to tubercle
Explanation:- proteins
Already explained
Explanation:-
160. Which of the following is true regarding Neisseria
- Tuberculin test denotes Type IV
meningitidis infection
hypersensitivity to tuberculoprotein but
A. It is the most common cause of meningitis in
not cellular immunity
children
- Positive tuberculin test indicates exposure
B. All strains are uniformly sensitive to
to bacilli either in the form of infection or
sulfonamides
immunization with or without clinical
C. In children less than 2 years the vaccine is not
disease
effective
- It does not indicate that active infection is
D. In India sero type B is most common cause
present (except in infants and young
Ans:- A and C children)

Ref:- Park 21/e p 155 - It does not indicate whether person is able
Explanation:- to mount immune response against bacilli
or not (as in lepromin test)
- MC cause of neonatal meningitis E.coli - It does not indicate resistance or
- MC cause of meningitis in age group 1 susceptibility to TB (as in Schik’s test).
month to 20 years is N. meningitidis.
- MC cause of meningitis >20 years: Strep 163. Which of the following regarding the interferon-
pneumoniae
gamma release assays used for the diagnosis of
- Sulphonamides once the mainstay, are not
tuberculosis is correct?
used now due to widespread resistance. A. 1st generation quantiferon-TB used ESAT-6
- MC serotype is not given in park or any
B. 2nd generation quantiferon-TB (gold) used
other book so as the rule first written is the
ESAT-6 and CFp-10
most common so group A is MC not group C. These tests can distinguish between
B
M.tuberculosis and M.bovis
- Vaccine (not available for group B) is D. None of the none tubercular mycobacteria give
contraindicated in pregnancy and a positive reaction with this test
ineffective in children <2 years.
Ans:- B 2nd generation quantiferon-TB (gold) used
161. A young lady of age 22 years with sore thorat for 3 ESAT-6 and CFp-10
days, along with the fever and headache, on Ref:- Harrison 18/e p 1352
examination she was found severely dehydrated, Explanation:-
her BP was found to be 90/50mmhg and tiny red
- In vitro assays that measure T-cell release
spots were found on the distal cuff of
of IFN γ in response to stimulation with
sphygmanometer. Most common cause is?
the highly TB specific antigen ESAT-6 and
A. Brucella sueis
CFP-10. Presently two such assays are
B. Neisseria meningitides
available.
C. Brucella abortus
a. T.SPOT TB: An enzyme linked
D. Chlamydia trachomatis
immunosorbant assay.
Ans:- B
b. Quantiferon-TB GOLD:- whole blood
enzyme linked immunosorbant assay.
- IGRA are more specific than the TST as
162. Tuberculin test denotes they are negligibly effected by previous
A. Previous or present sensitivity to tubercle BCG vaccination and sensitization by non
proteins tubercular mycobacteira
B. Patient is resistant to TB - IGRA require blood to be drawn from
C. Person is susceptible to TB patient and delivered to lab where test is
done, in contrary to tuberculin test in
BACTERIOLOGY
which PPD is injected. So, these test can be C. Positive reaction in children <2 is not important
repeated without boosting response. like in adult
- In near future IGRA are supposed to D. Usually red after 48-72 hours
replace tuberculin skin test as preferred E. False +ve in post measles state
skin test for detection of latent tuberculin
infection. Ans:- D Usually –ve after treatment
Ref:- Ananthanaryan 8/e p 356
- M.marinum, M.kansasii, M.szulgai also
Explanation:-
have ESAT 6 and CFP 10 and may cause
false positive reactions. - Tuberculin test is the only means of
- Currently IGRA is preferred over TST in estimating prevalence of infection in a
population above 5 years of age. In population
children under 5 years TSF is preferred - It is of three types
and in individuals who are at high risk of  Montoux intradermal test
progression to active TB either test can be  Heaf test- for testing large groups
used.  Tine multiple puncture test-not
recommended
164. Collection of urine sample of a patient of TB - Standard PPD (purified protein derivative)
kidney is done contains 50,000 tuberculin units per
A. 24 hrs urine milligram
B. 12 hrs urine - WHO advocates PPD tuberculin known as
C. In early morning PPD RT-23 with Tween 80
D. Any time - For routine testing 1 TU used, while
clinically 5 TU used.
Ans:- C In early morning
Ref:- Harrison 17/e p 1011 Montoux test
Explanation:-
- 0.1 ml of 1 TU injected intradermally
Genitourinary TB - Examined after 72 hours and induration is
- Accounts for 15% of all extrapulmonary measured horizontally in mm
cases. >10 mm: Positive

- Urinary frequency (MC), dysuria, <6 mm: Negative
hematuria and flank pain are common 6-9 mm: doubtful that is the reaction may
presentation be due to M. tuberculosis or atypical

mycobacteria
Diagnosis >20 mm: Strong reactors-Greater chance of
developing TB
- Urinalysis gives abnormal result in 90% of
<5 mm: more risk of developing TB than
cases
those with 6-9 induration
- Culture of three morning urine specimens
- Positive reaction indicates that person has
yields a definitive diagnosis in nearly 90%
got previous exposure to M.tuberculosis
cases
but it does not prove that person is
- Culture negative pyuria in acidic urine
suffering from disease.
raises the suspicion of TB
- Positive reaction is significant in younger
- IVP-calcification, ureteral stricture and
age groups (<2 year)
Hydronephrosis may seen.
- Negative test cant taken as exclusion of TB
Genital TB since dermal hypersensitivity to tuberculin
can also be lost in immunosuppressive
Female>male states which gives false –ve result e.g.
MC site in Female-Fallopian tube malignancy, Hodgkin’s disease, post
MC site in male- Epididymis
measles state, corticosteroid therapy.
genitourinary TB respond well to chemotherapy.
- Repeat test may appear to be negative or
165. True about Mantoux test exerts a booster effect.
A. <5 mm always +ve - Positive tuberculin test may occasionally
B. Usually –ve after treatment revert to negative upon INH treatment.
BACTERIOLOGY
- After infection patient becomes tuberculin B. Dorset media
positive in 3-6 weeks (=I.P of TB) C. LJ media
- After 8 weeks of BCG vaccination it D. Nutrient agar
becomes positive. E. Mac’Conkey media
166. True regarding Mycobacterium tuberculosis is Ans:- B and C

A. Products visible colonies in 1 week time on
Explanation:-
Lowenstein Jenson media
B. Decolorized by 20% sulphuric acid Media for M.Tuberculosis
C. Facultative aerobe
Solid Liquid
D. Niacin positive
Lowenstein Jensen Dubos contain Tween
Ans:- D Niacin positive media (most widely 80
used)
Ref:- Ananthanarayan 8/e p 348-349
Dorset egg media Middle brook’s
Explanation:-
Loeffler’s media Proskauer
Mycobacteria tuberculosis is Pawlowsky media
- Gram positive, non motile, noncapsulated,

non sporing - Selective agent inhibiting other bacteria in
- Obligate aerobic LJ media is Malachite green
- Acid (resist decolorization by 20% H2SO4) - Human tubercle bacilli do not grow in
and alcohol fast. presence of para-nitrobenzoic acid
- Generation time 14-15 hours - Traces of fatty acid is toxic for tubercle
- Colonies appear slowly in about 2 weeks bacilli in culture media.
and may sometimes take upto 8 weeks - Optimum pH for M.tuberculosis: 6.4-7.0
- Niacin, Neutral red, Nitrate reduction test
positive (3 N is positive ) Other options
- Peroxidase and Urease test is also positive NNN media- For Leishmania donovani
Nutrient agar- Simple media
167. Which of the following are acid fast positive with Mac Conkey media- Differential as well as
20% sulphuric acid indicator media for lactose and non-lactose
A. M.avium fermenters.
B. M.leprae
C. M.tuberculosis 169. Not easily culturable but well viable and used in
D. Nocardia epidemiology are
E. Rhizopus A. Staph.
B. Mycobacterium TB
Ans:- C M.tuberculosis C. E.coli
Ref:- See below D. Salmonella
Explanation:-
Ans:- B Mycobacterium TB
Features M. tuberculosis M. leprae
Acid fastness Resist Resist
Explanation:-
decolorization decolorization
by 20% H2SO4 by 5% H2SO4 - S.aureus: grow rapidly on ordinary media
Alcohol Present Absent within a temperat ure range of 10-42◦C
fastness
- E.coli: good growth occurs on ordinary
Culture Possible Not possible
media
Niacin Positive (also Negative
some strain of - Salmonella: grow readily on simple media
M. microti) over range pH 6-8 and temperature 15-
Generation 14-15 hours 12-13 days 41◦C
time - M.TB: grow slowly, colonies appear in 2-8
weeks. Culture remain viable at room
temperature for 6-8 months and may be
168. Selective media for TB bacilli is
stored upto 2 year at -20◦C.
A. NNN media
BACTERIOLOGY
172. Basanti, 29 year aged female from Bihar present
170. True about tuberculin test are all except with active TB. She delivers baby. All of the
A. Recent conversion in adult is an indication for following are indicated except
ATT A. Administer INH to the baby
B. INH prophylaxis is started if the test is positive B. Withhold breastfeeding
C. No risk in negative C. Give ATT to mother for 2 years
D. May be false negative in immunocompromised D. Ask mother to ensure proper disposal of
patients sputum
Ans:- C No risk in negative Ans:- B Withhold breastfeeding

Ref:- Park 21/e p 178 Ref:- Nelson 17/e p 971
Risk of developing TB is more in patient with If the mother is suspected of having active disease
montoux result <6 mm i.e negative or detection of an acid fast bacilli in sputum shows
evidence of current tuberculosis disease, besides
Indication of Chemoprophy laxis
giving ATT to mother certain additional steps are
i. Contacts of open cases who show recent necessary to protect the infant. The most important
montoux conversion. a. INH therapy
ii. Children with positive montoux and a TB INH therapy for new borns is so effective that
patient in the family. separation of mother and infant is no longer
iii. Neonate of tubercular mother considered mandatory
iv. Patient of leukemias, diabetes, silicosis or - Separation should done (until mother
those who are HIV positive but are not become non-infectious) only if:
anergic or are on corticosteroid therapy  Mother is so ill so as to require
who show a positive montoux hospitalization
 She is expected to become non-
Now drug used for chemoprophylaxis adherent with her treatment.
- Combination of Isoniazid (5 mg/kg) and  There is strong suspicion that she
Rifampicin (first line) has drug resistant tuberculosis.
- Isoniazid for 12 months (second line) - INH treatment of infant should be
continued until the mother has been
In a country like India chemoprophylaxis is not
shown to be sputum culture negative for
recommended because of limited resource and high
prevalence at least 3 months.
b. Appropriate treatment of mother and other
171. Cavitation is most often seen in family members
A. Mycoplasma pneumonia - Though there is controversy in the
B. Tuberculosis pneumonia question as according to some books
C. Streptococcal pneumonia breast feeding is contraindicated and
D. Staphylococcal pneumonia isolation of infant from the mother having
active TB should done.
Ans:- B Tuberculosis pneumonia
- But as all other three options are totally
correct and as Indian child must have
Explanation:-
breastfeeding. I have to go with Nelson
Pneumonia pattern Etiologic organism only.
Lobar distribution Streptococcus
pneumonia
Bulging fissure Klebsiella
Cavitation Tuberculosis 173. The most common focus of Scrofuloderma is
Pneumotocele Staphylococcus A. Lung
Alveolar nodules Varicella, tuberculosis B. Lymph node
Pulmonary edema Viral/pneumocystis C. Larynx
pneumonia D. Skin
BACTERIOLOGY
Ans:- B Lymph node - Other procedures: More complicated
Ref:- Dashore Manual of Skin Disease P 85 diagnostic procedures (BAL) may be
Explanation:- required in certain cases.
- Scrofuloderma is a type of cutaneous Treatment

tuberculosis
- It results from direct extension of Many MOTT infections are benign with no need for
infections from underlying tuberculous treatment. MOTT infections are naturally resistant
focus, ie infected lymph glands, muscles or to conventional antibiotics and it is necessary to use
several ATT at the same time in order to overcome
bones
drug resistance.
- Patients immunity is poor or moderate
- Lab investigations- demonstration of 175. Scotochromogens are
bacilli in smears of biopsy material, A. Mycobacterium gordonae
culture. B. Mycobacterium marinum
C. Mycobacterium intracellulare
174. True about mycobacterium other than D. Mycobacterium avium
tuberculosis E. Mycobacterium kansaii
A. Causes disseminated infection
B. Occurs in persons with normal immunity Ans:- A Mycobacterium gordonae
C. Causes decreased efficacy of BCG due to cross Ref:- Greenwood 16/e p 216E
immunity Explanation:-
D. Person to person transmission is seen Scotochormogens
Ans:- C Causes decreased efficacy of BCG due to - M. szulgai

cross immunity - M. scrofulaceum
Ref:- park 21/e p 177 - M.gordonae
Explanation:- - Mnemonic: Sundar sushil girl
MOTT (Mycobacteria Other Than Tuberculosis)
MOTT are mycobacterial species that may cause

176. Which of the following organisms does
human disease but do not cause tuberculosis.
NOT react with gram’s stain?
Spread: Unlike tuberculosis, which is spread from A. Actinomyces israelii
B. Candida albicans
person to person, MOTT infections are not
C. Mycobacterium tuberculosis
considered contagious. There is no evidence that
D. Streptococcus mutans
the infection can be transmitted from one person to
another. The mode of infection with MOTT is not Ans: C
clear. Ref: Ananthanarayan and Panicker’s
Text, Book of Microbiology, 8/E, p.348
Clinical features: Like tuberculosis, a MOTT
infection primarily affects the lungs and the 177. Ziehl Nielsen’s staining is routinely
symptoms are similar. Usually MOTT infections performed from sputum samples for the
progress slowly. detection of
A. Mycobacterium tuberculosis
Symptoms include: Fever, weight loss, cough, loss B. Bacillus anthracis
of appetite, night sweats, blood in the sputum. C. Streptococcus pneumonia
D. Mycoplasma pneumonia
Diagnosis: MOTT infections can be more difficult to
diagnose than tuberculosis. A diagnosis is generally Ans: A
based on the following Ref: : Ananthanarayan and Panicker’s
Text, Book of Microbiology, 8/E, p.353
- Medical history including above
symptoms
- Chest x-ray 178. Mycobacterium tuberculosis is best
- Sputum culture: Several sputum cultures demonstrated by
are often necessary A. Gram’s stain
B. H and E stain
C. Ziehl–Neelsen stain
D. PAS Stain
BACTERIOLOGY
Ans: C Kale azar
Ref: Ananthanarayan and Panicker’s -
Text Book of Microbiology, 8/E, p. 348 Brucellos
Explanation is
• They appear as red acid fast bacilli in
blue background of pus cells and
epithelial cells 182. All the following are common nosocomial
infection except
179. Lowenstein Jensen medium is
A. Staph.aureus
selectively used to cultivate
B. P. aeruginosa
A. Vibrio cholera
B. Mycobacterium tuberculosis C. Enterobacteriaceae
C. Salmonella typhi D. Mycobacterium
D. Treponema pallidum
Ans:- (d) Mycobacterium
Ans: B Ref:- . Harrison 17/e, p 835-838
Ref: Ananthanarayan and Panicker’s Explanation:-
Most important group of hospital pathogens are:
180. The commoly used fluorescent dye in
- Enteric gram negative bacilli:
the detection of tubercle bacilli
 E.coli
A. Acridine orange
B. Thioflavin  Klebsiella
C. Congo red  Enterobacter
D. Auramine and rhodamine  Proteus
 Serratia
Ans: D
- S. aureus
Text Book of Microbiology, 8/E, p. 353 - Pseudomonas aeruginosa and other
pseudomonas iv.
181. The single most common cause of pyrexia of - Tetanus spores v.
unknown origin is - Yeast (Candida albicans), moulds
A. Mycobacterium tuberculosis (Aspergillus mucor)
B. Salmonella typhi - Protozoa (E. histolytica, Plasmodia, P.
C. Brucella sp carinii, T. gondii)
D. Salmonella paratyphi A
Nosocomial infection Most common causative
Ans:- (a) Mycobacterium tuberculosis organism
Ref:- Harrison 16/e, p 117 Urinary tract infection E. coli; Candida
Explanation:- (MC Nosocomial
infection)
Fever of unknown origin
Early onset pneumonia Strept pneumoniae
Infections Neopla Non- Miscella Undaig (within 4 days
(33%) sm infectio neous nosed Late onset pneumonia S. aureus, P. aeruginosa
(17%) us (15%) (14%) Surgical wound S.aureus, coagulase
inflamm infections negative staphylococcus
atory Infections related to Coagulase negative
(21%)
vascular acess Staph, S. aureus
Mycobact Lymp
erium TB homa
-- - Remember:
Abdomin Leuke
al abscess mia - Candida is now the MC pathogen in
- -Solid nosocomial UTI in ICU patients. Harrison
Endocard tumou 17/e, p 837
itis – rs
- Examples of some emerging and
UTI -
potential, epidemic problems in hospitals
Viral
infections are: Chickenpox TB, Group A streptococci,
: CMV Aspergillus, Legionella
EBV -
BACTERIOLOGY
upper respiratory tract, and testes), sparing warmer
areas of the skin (the axilla, groin, scalp, and
183. Injection abscesses due to use of contaminated
midline of the back)
vaccines occurs in infections
caused by Thus, ovary is the answer of exclusion.
A. M. kansasii
B. M. ulcerans Complications of M.leprae
C. M. chelonae
D. M. smegmatis - Eye: uveitis, cataracts, glaucoma, corneal
insensitivity and lagophthalmus
Ans: C - Testes: orchitis followed by impotence
Ref: Ananthanarayan and Panicker’s - Nerve abscesses: Mostly seen in BT form,
Textbook of Microbiology, 8/E, p. 362
ulnar nerve is mostly frequently involved
- Extremities: planter ulceration (most
frequent complication of leprous
M.LEPRAE
neuropathy), footdrop, charcot’s joints.
184. The main cytokine, involved in erythema - Nose: epistaxis, saddle-nose deformity or
nodosum leprosum (ENL) reaction, is anosmia.
A. Interleukin-2
B. Interferon-gamma 186. In the management of leprosy, Lepromin test is
C. Tumor necrosis factor-alpha most useful for
D. Macrophage colony stimulating factor A. Herd immunity
B. Prognosis
Ans:- C Tumor necrosis factor-alpha C. Treatment
Ref:- Harrison 17/e p 1023 D. Epidemiological investigations
Explanation:-
Ans:- B Prognosis
TNF plays a central role in pathobiology of ENL.
Type I lepra reaction Type II lepra reaction Explanation:-
Downgrading or Erythema nodosum
Lepromin test
reversal reaction leproticum
Type IV Type III hypersensitivity - It is intradermal test which shows delayed
hypersensitivity type IV hypersensitivity
TNF play a central role IFNγ and IL-2 are main
- It is biphasic
cytokines involved
a. Early reaction of Fernandez: read in
Edema is characteristic Vasculitis and
microscopic feature panniculitis are seen 24-48 hours (analogous to tuberculin
Treatment: DOC- DOC- Thalidomide reaction)
Glucocorticoid Clofazimine b. Late reaction of Mitsuda
Other drugs: Chloroquine  Peak in 4 week
Clofazimine Glucocorticoids  It is more meaningful
Chloroquine NSAID’s and
- It distinguishes between persons who can
Analgesics Antibiotics
mount CMI against lepra bacillus antigens
Thalidomide-Ineffective and those who cannot.
- So, finally lepromin test is of little
diagnostic valve but has more prognostic
185. Leprosy affects all the following except
valve.
A. Testes
- It is used to
B. Ovaries
 Classify the lesions of leprosy
C. Eyes
 To assess prognosis and response
D. Nerves
to treatment
 To assess resistance of individual
Ans:- B Ovaries
Ref:- Harrison 17/e p 1022 to leprosy
Explanation:-  To verify the identity of
candidate lepra bacilli.
Mycobacterium leprae grows best in cooler (the - Antigen used in lepromin test
skin, peripheral nerves, anterior chamber of the eye,
BACTERIOLOGY
 Modern antigens contain 4*107 A. It is negative in most children in first 6 months
lepra bacilli per ml. of life
 Standard lepromins derived from B. It is a diagnostic test
armadillo derived lepra bacilli C. It is an important aid to classify type of leprosy
(lepromin A) replacing human disease
derived human lepromin H D. BCG vaccination may convert lepra reaction
from negative to positive
187. Which of the following is true regarding globi in a
patient with lepromatous leprosy Ans:- B It is a diagnostic test
A. Consist of lipid laden macrophages
Explanation:-
B. Consist of macrophages filled with AFB
C. Consist of neutrophils filled with bacteria Already explained
D. Consist of activated lymphocytes
191. Under leprosy eradication program the
Ans:- B Consist of macrophages filled with AFB management of single lesion is
Ref:- Ananthanarayan 8/e p 364 A. Single dose of Rifampicin and Dapsone
Explanation:- B. Rifampicin and Dapsone for 6 months
C. Rifampicin, Ofloxacin and Minocycline single
- Acid fast lepra bacilli may lie
dose
extracellularly or intracellularly in large
D. Rifampicin and Monocycline for 6 months
undifferentiated histiocytes (type of
macrophage) called as Virchows Lepra Ans:- C Rifampicin and Monocycline for 6 months
cells or Foamy cells Ref:- Harrison 17/e p 1026
- Bacilli are bound together by lipid like Explanation:-
substance the glia forming masses known
Form of leprosy WHO recommended
as Globi.
regime
Tuberculoid Dapsone 100 mg/d
188. The following drug is not used for the treatment (paucibacillary) unsupervisedplus
of type II lepra reaction rifampicin
A. Chloroquin Single skin lesion 600 mg/mth supervised
B. Thalidomide (paucibacillary) for 6 month
C. Cyclosporine Lepromatous Single dose of
D. Corticosteroids (multibacillary)>6 skin R 600 mg Rifampicin
lesion O 400 mg Ofloxacin
Ans:- C Cyclosporine M 100 mg Minocycline
Ref:- Harrison 17/e p 1026 Lepromatous Dapsone 100 mg/d plus
(multibacillar)> 6 skin clofazimine 50 mg/d
Explanation:-
lesion unsupervised; and
Cyclosporine has no role in lepra reaction Rifampicin 600 mg plus
Clofazimine 300 mg
For more details, refer above answer monthly (supervised)
for 1 year
189. The following test is not used for diagnosis of
leprosy.
A. Lepromin test 192. The characteristic finding in a case of leprosy is
B. Slit skin smear A. Culture test is positive in 2-3 months in LJ
C. Fine needle aspiration cytology media
D. Skin biopsy B. Long contact with tuberculoid leprosy can
transmit the disease
Ans:- A Lepromin test C. CMI is seen in Lepromatous leprosy
Ref:- Ananthanarayan 8/e p 374 D. Macule lesion heals spontaneously
Explanation:-
Ans:- B Long contact with tuberculoid leprosy can
Lepromin test is not used for diagnosis
transmit the disease
190. Which of the following statement about lepromin Ref:- Harrison 17/e p 1022
test is not true Explanation:-
Transmission of leprosy
BACTERIOLOGY
- Nasal droplet infection Antibodies to PGL-1 may also be seen in exposed
- Contact with infected soil and contact with individual without clinical leprosy.
a tuberculoid leprosy case carries a very
Thus PGL-1 serology is of little diagnostic utility in
low risk.
tuberculoid leprosy.
- Insect vectors
- Direct dermal inoculation (during
tattooing)
195. Which one of the following statement is true
- Household contact with infected
regarding pathogenicity of Mycobacteria species
lepromatous case
A. M.tuberculosis is more pathogenic than
- Skin to skin contact (though can transmit
M.bovis to humans
infection) is generally not considered as
B. M.kansasii can cause disease indistinguishable
important route of transmission
from tuberculosis
- Physicians and nurses caring for leprosy
C. M.africanum infection is acquired from
patients and the coworkers of these
environ-mental source
patients are not at risk leprosy
D. M.marinum is responsible for tubercular
- According to park 18/e p 254 All patients
lymphadenopathy
with active leprosy must be considered
infectious. Ans:- B M.kansasii can cause disease
indistinguishable from tuberculosis
193. Exacerbation of lesions in patients of borderline Explanation:-
leprosy seen in Features M. M.bovis

A. ENL (erythema nodosum leprosum) tuberculosis
B. Lepra reaction type I Shape Curved long Straighter,
C. Jarisch-Herxheimer reaction rod shorter, stouter
D. Resolving leprosy Staining Less uniform More uniform
O2 Obligate Microaerophilic
Ans:- A, B requirement aerobe
Ref:- Harrison 17/e p 1023 Colonies Dry, rough, Flat, smooth,
Explanation:- raised, moist, break up
irregular easily
Reactional state Type of leprosy Growth Eugenic Dysgenic
Type I lepra reaction Borderline leprosy
Type II lepra reaction Exclusively in
(ENL) Borderline lepromatous 196. Which of the following are photo chromogens?
(BL) and lepromatous A. M.kansasii
leprosy B. M.scorfulsorum
Lucio’s phenomenon Diffuse lepromatous C. M.marinum
form of LL D. M.TB
Jarisch Hexhimer reaction is seen in syphilis patient E. M.Leprae
taking penicillin.
Ans:- A and C
194. Antibodies against PGL-1 are seen in Ref:- Ananthanarayan 8/e p 359
Explanation:-
A. M. leprae
B. M.tuberculosis - M.siniae
C. Borrelia - M.narinum
D. Brucella - M.kansasii
- M.asiaticum
Ans:- A M. leprae
- Mnemonic; Sini Marry King of Asia
Explanation:-
197. Which of the following is a slow grower
IgM antibodies to PGL-1 are found in 95% of A. M.kansasii
patients with untreated lepromatous leprosy, and B. M.chenolae
60% of patients with tuberculoid leprosy. C. M.fortuitum
D. M.abscessus
BACTERIOLOGY
Ans:- A M.Kansasii - Caused by Burkhoderia pseudomallei
Ref:- Ananthanarayan 8/e p 359 (pseudomonas pseudomallei).
Explanation:- - It is free living small, motile
(differentiating feature from pseudo,
M.Kansasii is a slow growing atypical mycobacteria
belonging to photochromogens mallei) aerobic gram negative bacillary
saprophyte normally found in soily ponds
and rice paddies.
- It grows at 42◦C and oxidize glucose,
PSEUDOMONAS AND YERSINIA
lactose and is oxidase positive.
198. Which one of the following drugs is an - It forms colonies that vary from mucoid
antipseudomonal penicillin? and smooth to rough and wrinkled and in
A. Cephalexin colour from cream to orange
B. Cloxacillin - MC form of meliodosis is Acute
C. Piperacillin pulmonary infection
D. Dicloxacillin - Acute pulmonary infection vary from mild
bronchitis to extensive necrotizing
Ans:- C Piperacillin
pneumonia
- Chronic pulmonary infection mimics TB
Explanation:-
- It also cause acute,localized skin infection
with ulceration or abscess that is
associated with nodular lymphangitis and
regional lymphadenitis.
- Also cause suppurative parotitis
particularly in children.
Antimicrobial agents active against pseudomonas
- Progression of disease is more common in
aeruginosa
Antipseudomon Antipseudom Carbapenems/ chronic debilitated patient (DM, chronic
al penicillins onal other agents renal disease, alcoholics).
cephalospori
ns Diagnosis
Piperacillin Ceftazidime Imipenem/cilas
- Considered in patient present with acute
tatin
lower respiratory tract illness, parotitis,
Mezlocillin Cefoperazone Meropenem
Ticarcillin Cefepime Polymyxin B lymphadenitis or unusual skin or
Ticarcillin/clavul Colistin subcutaneous lesion or chest X-ray suggest
anate TB (upper lobe infiltrate) in absence of
Monobactams Aminoglycosi Fluoroquinolo tubercle bacilli in sputum
des ne - Grams stain of appropriate specimen will
Aztreonam Tobramycin Ciprofloxacin show small gram-negative bacilli; bipolar
Gentamicin
regularly staining (safety pin appearance)
Amikacin
is seen by Wright’s stain or methylene blue
stain.
199. The following statements are true regarding - Positive serologic test is evidence of past
meliodosis except infection.
A. It is caused by Burkholderia mallei - X-ray – upper lobe infiltrate occasionally
B. The agent is a gram negative aerobic bacteria with thin walled cavities.
C. Bipolar staining of etiological agent is seen
with methylene blue
D. The most common form of meliodosis is 200. Pseudomonas aeruginosa
pulmonary infection. A. Produces heat stable enterotoxin
B. Causes Shanghai fever
Ans:- A It is caused by Burkholderia mallei C. Cannot be destroyed at 55º at 1 hr
Ref:- Harrison 17/e p 955 D. Does not produce any pigment
Explanation:- Ans: B
Meliodosis Textbook of Microbiology, 8/E, p. 316
BACTERIOLOGY
201. Which bacteria acts by inhibiting protein - Follow up: Follow up examination of stool
synthesis and urine should be done 3-4 months after
A. Pseudomonas discharge of patient and again after 12
B. Staphylococcus months to prevent the development of
C. Streptococcus carrier stage.
D. Klebsiella
Carriers
Ans:- (a) Pseudomonas
- Identification: Culture of duodenal
Ref:- Ananthnarayan 8/e, p 284, 7/e, p 321
drainage establishes the presence of
Explanation:-
salmonella in the biliary tract in carriers
Already explained, The VI antibody is seen in up to 80% of
carriers.
- Treatment: Ampicillin or amoxicillin (4-6 g
SALMONELLA a day) together with probenecid can
achieve eradication of carrier stage in
202. True about maximum isolation period of enteric
about 70%
fever
- Cholecystectomy with concomitant
A. Till three consecutive negative urine/ stool
ampicillin therapy is the most successful
culture samples are obtained from patient
approach for treatment of carriers.
B. After chloramphenicol treatment for 72 hours
- Surveillance: The carriers should be kept
C. Disappearance of fever
under surveillance and are prevented from
D. Widal test negative.
handling food, milk for others.
Ans:- A Till three consecutive negative urine/ b. Sanitation
stool culture samples are obtained from patient - Protection and purification of drinking
Ref:- Park 21/e p 214 water supplies, improvement of basic
Explanation:- sanitation and promotion of food hygiene
are essential measures of controlling
Control of Typhoid fever
typhoid.
a. Control of reservoir
b. Control of sanitation Immunization
c. Immunization - Immunization does not give 100%
The weakest link in the chain of transmission is protection, but it definitely lowers both the
sanitation which can be achieved easily incidence and seriousness of infection.
a. Control of reservoir: Reservoir may be case

or carrier
Cases
- Early diagnosis and treatment: with early 203. Which of the following is enrichment
diagnosis and treatment, carrier stage can medium?
be prevented. A. Blood agar
B. Selenite F broth
- Isolation: owing to the infectious nature of
C. MacConkey agar
typhoid fever, cases should be isolated till
D. Nutrient broth
three bacteriologically negative stools and
urine reports are obtained on three Ans: B
separate days. Ref: Ananthanarayan and Panicker’s
- Disinfection: Stools and urine are sole
source of infection. They should be 204. Leucopenia is characteristic of
received in closed containers and A. Appendicitis
disinfected with 5% cresol for at least 2 B. Enteric fever
hours. All solid clothes and linen should C. Meningitis
D. Myocardial Infarction
be soaked in a solution of 2% chlorine and
steam sterilized. All the medical and Ans: B
paramedical person should disinfect their Ref: Ananthanarayan and Panicker’s
hands. Text Book of Microbiology, 8/E, p. 297
BACTERIOLOGY
Explanation Diagnosis of typhoid
Leucopenia and relative lymphocytosis
is characteristic of enteric fever Cases (BASU)
205. Which of the following is least likely to cause Blood culture (B)
infective endocarditis - Test of choice in first week (Diagnostic
A. Staphylococcus albus gold standard)
B. Streptococcus faecalis - Becomes negative on treatment with
C. Salmonella typhi antibiotics.
D. Pseudomonas aeruginosa
Widal test:
Ans:- . (c) Salmonella typhi
Ref:- Jawetz 25/e, p 748; Mandell's Principal & - Agglutinins usually appear by end of first
Practice of Infectious Disease 6/e, p 998; week. Titre increase steadily till the 3rd or
Braunwald's Heart Disease 7/e, p 1637 4th week after which it declines gradually.
Explanation:- - Maximum titre is found in 3rd week.
Though both salmonella and pseudomonas cause Stool culture (S)

endocarditis, pseudomonas is a more common
etiologic agent than sal-monella - Salmonella are shed in feces throughout
the course of disease, even in
Organism causing endocarditis
convalescence. A positive fecal culture
Streptococci - S. viridans (30- Enterococci occur in carriers also, so cant differentiate
(MC) (60- 40%) (5-18%) between case and carrier.
80%) Other streptococci
(15-25%) Urine culture
- Culture is positive in 25% of cases during

Staphylococci - Coagulase CoNS (1-3%)
(20-35%) positive (10-27%) 2nd or 3rd week.
Gram Enterobacteriaceae Pseudomonas - Less useful than blood culture.
negative
bacilli (1.5- II. Carriers
13%)
- Widal reaction- No value in detection of
HACEK
Group of carriers
Organisms - Demonstration of Vi agglutinins indicate
Fungi Candida Cryptococcus carrier state.
- This is usefull screening test which is
confirmed by culture
Remember:
- Isolation of bacillus from feces or bile.
 Among streptococci MC cause are S. Cholangogue purgatives increase chance
sanguis, S. bovis, S. mutans, S. mitior. of isolation.
 Among enterobacteriaeeae MC cause - - Tracing of carriers in cities is done by
Salmonella. Sewer Swab Technique or by filtration of
 P. aeroginosa is MC gram negative bacilli sewage through Millipore membrane and
causing endocarditis. culturing the membrane on Wilson and
Blair media.
206. In patient with typhoid, diagnosis after 15 days of
onset of fever is best done by 207. Salmonella typhi is the causative agent of typhoid
A. Blood culture fever. The infective dose of S.typhi is
B. Widal A. One bacillus
C. Stool culture B. 108-10 10bacilli
D. Urine culture C. 102-105 bacilli
D. 1-10 bacilli
Ans:-B Widal test
Ref:- Ananthanarayan 8/e 294-296 Ans:- C 102-105 bacilli
Explanation:- Ref:- Harrison 17/e p 957
Explanation:-
BACTERIOLOGY
Infective dose of salmonella varies from 103 to 106 - Selective media for salmonella: SS agar,
colony forming units. Deoxycholate citrate agar.
Organism Infective dose

209. A 24 year cook in a hostel is suffering from enteric
Shigella 10-1000
Vibrio >1010 (if source of fever 2 years back. The chronic carrier state in
infection is water) 102 - patient is diagnosed by
104(if source of A. Vi agglutination best
infection is food) B. Blood culture in brain heart infusion broth
Campylobacter 104 C. Widal test
jejuni D. C. reactive protein
Yersinia 108-109
enterocolitica Ans:- A Vi agglutination best
EHEC 10-100 Ref:- Ananthanarayan 8/e 290
Explanation:-
208. There has been an outbreak of food borne
Vi antigen-polysaccharide antigen enveloping the O
salmonella gastroenteritis in the community and antigen because of which many strains of S.typhi
the stool sample is received in the laboratory. fails to agglutimate with the O antiserum
Which is the enrichment medium of choice
A. Cary-Blair medium Antigens of Salmonella
B. V-R medium H antigen O antigen Vi.antigen

C. Selenite F medium Present on Integral part of Envelops the O
D. Thioglycholate medium flagella cell wall antigen
Heat labile Phospholipid- Surface
Ans:- C Selenite F medium protein protein- polysaccharide
Ref:- Ananthanarayan 8/e 289,299 polysaccharide
Explanation:- complex
Strongly Identical with Acts as
Selenite F and Tetrathionate broth are commonly immunogenic endotoxin so, is virulence factor
employed enrichment media of salmonella. less and is poorly
immunogenic immunogenic
Salmonella Gastroenteritis=Food poisoning
Antibody Antibody Antibody
- May be caused by any Salmonella except formation is formation is production is
rapid and in slow and titre slow and titres
S.typhi
high titre is low is slow
- MC caused is S. typhimurium
- Human infection occurs due to ingestion
of contaminated foods. 210. Which one of the following enteric
- Most frequent soruce-Poultry, meat, milk organisms is anaerogenic and non
motile?
and milk products
A. Shigella sonnei
- IP-16-48 hours
B. Salmonella typhi
- Clinical features : Diarrhea, vomiting, C. Proteus mirabilis
fever D. Klebsiella pneumonia
- Diagnosis: Isolation of Salmonella from
Ans: A. Shigella sonnei
feces
- Treatment: No antibiotics
Ananthnarayan & Panicker, 8/E, p. 283
Remember
Differential media for salmonella 211. Pus cell in diarrhea seen in
- MacConkey and Deoxycholate media: A. Vibrio cholera
Form colorless colonies due to absence of B. EPEC
lactose fermentation C. Rotavirus
- Wilson and Blair bismuth sulphite D. Shigella
medium: Jet black colonies are formed due E. Campylobacter
to production of H2S
Ans:- (d) and (e) Shigella and Campylobacter
Explanation:-
BACTERIOLOGY
Mechanism where the organism live on close relation
to plankton.
- Noninflammatory(enterotoxin)
- Human become infected incidentally, but
- Inflammatory(invasion or cytotoxin)
- Penetrating enterocolitica, once infected can acts as vehicle for
Location spread.
- Proximal small bowel - Man is the only reservoir of cholera
- Colon or distal small bowel infection. He may be the case or carrier.
- Dista small bowel
Carriers in cholera
Illness Preclinical or Contact or Chronic
- Watery diarrhea convalescent healthy carrier
- Dysentery or inflammatory diarrhea carrier carrier
- Enteric feve Incubatory- -Result from -Can excreate
last for 2-3 subclinical up to 10 years
Stool findings weeks after infection -Gallbladder
- No fecal leukocytes; mild or no increase in attack -Duration is infected.
fecal lactoferrin less than 10
- Fecal Polymorphonuclear leukocytes; days
substantial increae in fecal lactoferrin -Gallbladder
- Fecal mononuclear leukocytes is not infected
Examples of pathogens involved

213. The endotoxin of the following gram-negative
- Vibrio cholerae, enterotoxigen c bacteria does not play any part in the
Escherichia coli (LT and /or ST), pathogenesis of the natural disease
Clostridium perfringens, Bacillus cereus,S. A. Escherichia coli
aureus, shigelloides, rotavirus, Norwalk- B. Klebsiella sp
like viruses, enteric adenoviruses, Giardia C. Vibrio cholera
lamblia, Cryptosporidium spp., D. Pseudomonas aeruginosa
microsporidia
Ans:-C Vibrio cholera
- Shigella spp., Salmonella
Ref:- Ananthanarayan 8/e p 306-307
spp.,Campylobacter jejuni,
Explanation:-
enterohemorrhagic E. coli, enteroinvasive
E. coli, Yersinia substantial enterocolitica, Beside cholera toxin, V.cholerae also posses the
Vibrio parahaemoly-increase in lipopolysaccharide O antigen (LPS endotoxin)
parahaemolyticus, Clostridium fecal which apparently plays no role in pathogenesis of
lactoferrin Entamoeba histolytica cholera but is responsible for the immunity induced
- Salmonella typhi, Y. Campylobacter fetus by killed vaccine.
leukocytes. Other options
VIBRIO E.coli- pathogenesis is mediated by endotoxin,

adhesions, capsule present in some strain,
212. About V.cholerae all statements are true except
enterotoxin.
A. Nonhalophilic
B. Cannot grow in ordinary media Pseudomonas- exotoxin produce tissue necrosis by
C. Cansurvive outside the intestine blocking protein synthesis
D. Man is the only reservoir of cholera
- Endotoxin plays a role in causing fever,
Ans:- B Cannot grow in ordinary media shock, oligouria, leulkocytosis, DIC,

Ref:- Ananthanarayan 8/e p 302 ARDS.
Explanation:-
Klebsiella- Pathogenesis is mediated by endotoxin
- Cholera grows well on ordinary media. and fimbriae or other adhesion.
- Growth is better on alkaline medium.
Remember- Endotoxin levels can be assayed by
NaC1 is required for optimal growth
Limulus test
though high concentrations are inhibitory
- Option c- Natural habial of V.cholerae is Plague toxin also has no role in natural disease.
coasted salt water and brackish estuaries,
BACTERIOLOGY
214. The endotoxin of which gram –ve bacteria doesn't Ans:- . (c) Vibrio parahemolyticus
play any role in its pathogenesis Ref:- Harrison 17/e, p 814
A. Vibrio cholera Explanation:-
B. Shigella toxin
Non-inflammatory (Enterotoxin) mediated acute
C. Klebsiella toxin diarrheas are:
D. All of the above
Ans:- B - Vibrio cholera
- ETEC (LT or ST)
215. Rice water stools are seen in infections - Clostridium perfringens
with - Bacillus cereus
A. Proteus - S. aureus
B. Shigella - Aeromonas hydrophila
C. Vibrio cholera
- Plesiomonas shigelloides
D. Salmonella
- Norwalk like viruses
Ans: C
- Rota virus
Text Book of Microbiology, 8/E, p. 306 - Girdia lamblia
Explanation - Enteric adenoviruses
• The cholera stool is a colorless watery - Cryptosporidium
fluid with flecks of mucus said to - Cyclospora sp
resemble water in which rice has been - Microsporidia
washed. Hence it is called as rice
water stools. It has a characteristic Vibrio parahemolyticus produce no
sweet offensive odor enterotoxin, it cause enteritis by invasion of
intestinal epithelium.
216. Microorganisms invading the GIT causing gastro-
enteritis Ananthnarayan 8/e, p 312
A. EHEC 218. The endotoxin of the following gram negative
B. Shigella bacteria doesn’t play any part in the pathogenesis
C. Vibrio parahemolyticus of the natural disease
D. Campylobacter A. E.coli
E. Salmonella B. Klebsiella
C. Vibrio cholera
Ans:- . (b, c, d) and (e) Shigella, Vibrio
D. Pseudomonas
parahemolyticus, Campylobacter and Salmonella
Explanation:-
Ans:- (c) i.e. Vibrio
Invasive Diarrhea Ref:- Ananthanarayan 8/e, p 307
Explanation:-
Minimal Variable Severe
inflammatio inflammation Lipopolysaccharide 0 antigen (endotoxin) of V.
n Cholera plays no role in the pathogenesis of
cholera, but is responsible the immunity induced by
killed vaccine.
Rotavirus Salmonella Shigella
Norwalk Campylobacter EIEC
agent Aeromonas Entamoeb
219. Which of the following is NOT a live
Vibrio a
attenuated vaccine?
parahaemolyticu histolytica
A. Tuberculosis (BCG)
s Yersinia
B. Typhoid
C. Varicella zoster virus
217. Toxins are implicated the major pathogenic D. Cholera
mechanism in all of the following bacterial
diarrheas except Ans: D. Cholera
A. Vibrio cholera
B. Shigella sp
p. 622
C. Vibrio parahemolyticus
D. Staphylococcus aureus
BACTERIOLOGY
Yersinia pestis protein 100 mg/dl and glucose 10 mg/dl. The
grams stain shows the presence of Gram-negative
220. A girl from shimla presented to opd with fever, coccobacilli. The culture shows of bacteria only on
hypotension, malaise and axillary and inguinal chocolate. Agar and not on blood agar. The
lymphadenophaty. Culture in glucose both shows causative agent is
stalactite growth. Most likely causative organism A. Neisseria meningitides
is B. Haemophilus infulenzae
A. Yersinia pestis C. Branhamella catarrhalis
B. Francisellatularensis D. Legionella pneumophila
C. Brucella abortus
Ans:- B Haemophilus infulenzae
D. Coxiella bumetti
Ans: A
Explanation:-
HEMOPHILUS See the morphology of asked bacteria, you will
221. All the following are true about H.influenzae know the answer
except H influenza Gram negative

A. It can be part of normal flora of some persons coccobacilli
B. The serotyping is based on bacterial outer N meningitidis Gram negative cocci
membrane protein Legionella Gram negative
C. It requires Hemin and NAD for growth in coccobacilli
culture medium B catarrhalis Gram negative cocci
D. Type b is responsible for invasive disease
Ans:- B The serotyping is based on bacterial outer

membrane protein 223. A 2 years old child is brought to the emergency
Ref:- Ananthanarayan 8/e p 331 with history of fever and vomiting. On
Explanation:- examination he has neck rigidity. The csf
examination shows polymorphs more that 2000/ml
H. infulenzae strains have been classified on the
protein 100 mg/dl and glucose 10mg/dl. The gram
basis of capsular polysaccharide (not on the basis of
outer membrane protein) stain shows the presence of gram negative
coccobacilli. The cultureshows growth of bacteria
Important features of H.influenzae only on chocolate agar and not on blood agar. The
- Gram –ve coccobacilli causative agent is
- Require factor V (nicotinamide nucleotide) A. Neisseria meningitides
and factor X (hemin) for growth. So grow B. Haemophilus influenza
well chocolate agar as factor V is free in C. Branhamella catarrhalis
chocolate agar (Growth is poor in blood Ans:- B
agar).
Antigenic structure 224. A 30-year-old man present with urethritis. All of
a. Capsular antigen- basis of classification the following can be causative agent except
Most isolates of acute invasive infection A. N. gonorrhoeae
belongs to type b B. Chalmydia trachomatis
b. Bacterial outermembrane protein C. Trichomonas vaginalis
c. Lipooligosaccharide D. Hemophilus ducreyi
- Non capsulated strains of H.influenzae can

Ans:- (d) Hemophilus ducreyi
colonize the upper respiratory tract of
Ref:- Ananthnarayan 8/e 231, 7/e, 229
childrens and adults. Explanation:-
222. A 2 years old child is brought to the emergency Causes of urethritis are:
with history of fever and vomiting. On - Neisseria gonorrhoea (MC)
examination he has neck rigidity. CSF - Ureoplacma urealyticun
examination shows polymorphs more that 200/ml; - Herpes virus,
BACTERIOLOGY
- Gardenella vaginalis - Fluid toxoid
- Candida albicans - Adsorbed toxoid
- Chlamydia trachomatis Adsorbed toxoid is purified toxoid
absorbed into soluble aluminium
- Mycoplasma hominis
compounds usually aluminium
- Cytomegalovirus
phosphate or less often hydroxide .
- Acinetobacter woffi, Ac calcoaceticus Adsorbed toxoid is much more
- Trichomonas vaginalis immunogenic than fluid toxoid
Option Pertussis component in DPT (whole
b killed bacteria of bordetella pertussia)
vaccine enhances the potency of the
diphtheria toxoid.
225. A patient with history of discharge from right ear Most serous complication of DPT is
neurological which is primarily due to
for past 1 year presented with severe ear ache. The
pertussis component.
discharge was cultured and the organism was
Duration of immunity after whole cell
found to be gram positive cocci. The least likely pertussis vaccination is short lived, with
cause is little protection remaining afte 10-12
A. Pseudomonas years
B. Streptococcus pneumoniae Option To reduce complications of whole killed
C. Staphylococcus c bacteria of pertussis in DPT. Acellular
vaccine developed
D. Haemophilus influenza
-Protection against pertussis by vaccines
correlated best with the production of
Ans:- (d) Hemophilus influenza
antibody to pertactin, fimbriae and
Ref:- See below
pertussis toxin.
Explanation:-
All acellular pertussis vaccines currently
H. influenzae is a gram (-)ve coccobacilli available contain pertussis toxoid.
Acellular vaccine is more immunogenic
Otitis media has less adverse effects. It is given as
Acute otitis media DTap
Chronic otitis media -DTaP has replaced DTP in 1997. DTaP is
a tetanus toxoid, reduced diphtheria
Etiologic bacteria Pneumococci > H. influenzae > toxoid and acellular pertusis vaccine
Moraxella > Streptococcus pyogenes Staph aureus > formulated for adolescent and adults.
Pseudomonas Option Quadriple vaccine of DPT with
d H.influenza B is available in India but
Infectious disease by Nonathan 2/e, 856 conjugate vaccine (e.g. Hib vaccine) do
not interfere with immunogenicity of
simultaneously given other vaccines.
Corynebacterium
226. The following statements are true about DPT 227. Positive Schick’s test indicates that person is
vaccine except A. Immune to diphtheria
A. Aluminium salt has an adjuvant effect B. Hypersensitive to diphtheria
B. Whole killed bacteria of Bordetella pertussis C. Susceptible to diphtheria
has an adjuvant effect D. Carrier to diphtheria
C. Presence of acellular pertussis component
Ans:- C Susceptible to diphtheria
increases its immunogenicity
D. Presence of H.influenza type B component
Explanation:-
increases its immunogenicity
Schick test
Ans:- D Presence of H.influenza type B
component increases its immunogenicity - Intradermal test which provide
Ref:- Ananthanarayan 8/e p 238 information regarding
Explanation:- a. Immune status
b. Hypersensitivity and susceptibility to
Lets consider each choice one by one
diphtheria toxin before giving active
Option Two types of diphtheria toxoid are in use immunization
a now
BACTERIOLOGY
- In one arm toxin is injected (test arm) and Diagnosis of Diphtheria
in other arm heat inactivated toxin is
i. Isolation by culture
injected (control arm)
Swabs are inoculated on
Type of Observation Inference - Loeffler’s serum slope (growth is rapid) :
reaction For growth diagnosis
Negative No reaction No - Tellurite blood agar (growth is delayed but
reaction in both arm susceptibility. it is particularly important in isolation of
(toxin is No bacilli from convalescent, contacts,
neutralized hypersensitivity
carriers) : Selective media
by patient is
- Blood agar (for differentiating
circulating immune to
antitoxin) diphtheria staphylococcal and streptococcal
Positive No change in No pharyngitis)
reaction control arm, hypersensitivity ii. Demonstration of toxicity of isolated strain
Red flush in susceptibility In vivo test- done by infected broth
test arm that present emulsion of culture subacutaneously
persist
(animal will die) and intracutaneously into
Pseudopositive Red flush Hypersensitivity
animal will not die guinea pigs
reaction equally on present
(schick’s both arm No susceptibility
negative) that fades In vitro test
very quickly - Elek’s gel precipitation test, tissue culture
Combined Test arm Hypersensitivity test on agar overlay of cell culture
reaction shows present monolayer.
positive and Susceptibility
- ELISA
control arm present
- PCR for detection of toxigene
shows Dose of vaccine
pseudo- should be
Control of Diphtheria
positive reduced
reaction i. Cases
- Antitoxin + penicillin or erythromycin
228. A child presents with a white patch over the ii. Carriers
tonsils; diagnosis is made by culture in - Erythromycin
A. Loeffler medium iii. Contacts
B. LJ medium a. When primary immunization or
C. Blood agar booster dose was received within the
D. Tellurite medium previous 2 years
- No further treatment
Ans:- Loeffler medium b. When primary immunization or
Ref:- Ananthanarayan 8/e p 233 booster dose was received more than
Explanation:- 2 years ago
In a child with white patch over tonsils, probable - Only a booster dose of diphtheria toxoid.
diagnosis is diphtheria. c. Nonimmunized close contacts
- Prophylactic penicillin or erythromycin
Culture media for corynebacterium are - 1000-2000 units of diphtheria antitoxin
i. Loefflera serum slope: Growth is very - Active immunization against diphtheria
rapid and colonies seen in 6-8 hr, before iv. Community
other bacteria grows. It is also used for - Only effective control is by active
M.tuberculosis. diphtheria is emergency immunization with diphtheria toxoid of all
condition, so Loeffler’s slopes is preferred infants with subsequent booster doses
media in this child. every 100 years thereafter.
ii. Tellurite blood agar media: Selective
media blood agar media: Selective media 229. True about corynebacterium diphtheria are all
but growth is delayed and may take about except
2 days to appear. A. Iron is required for toxin production
BACTERIOLOGY
B. Toxin production is responsible for local injected subcutaneously into a
reaction 250 g guinea pig, will on average
C. Nonsporing noncapsular and nonmotile cause no observable reaction.
D. Toxin production is by lysogenic conversion.  L+ (Limes tod) dose of diphtheria
toxin is the smallest amount of
Ans:- B Toxin production is responsible for local toxin that when mixed with one
reaction
unit of antitoxin and injected
subcutaneously into a 250g
Explanation:-
guinea pig will on an average kill
Mechanical complications of diphtheria are due to the animal within 96 hours.
the membrane while the systemic effects are due to - It would be expected that the difference
the toxin between the L+ dose and Lo dose would
be equal to 1 MLD. But when the
- Toxin acts mainly systemically though
estimations are actually made, it is found
there are partial local effects.
to vary from 10 to 100 MLD or more. This
- It has affinity for myocardium, adrenals
discrepancy is due to the presence of
and nerve endings
varying amount of toxoid in toxin
- Toxin acts by inactivating EF-2 thus
preparation. This is called as Ehrlich
inhibiting protein synthesis.
phenomenon.
- Toxin production is influenced by iron
concentration in the medium. Toxin
231. True about corynebacterium diphtheria includes
production is optimal at 0.14 µg/ml and is
all of the following except
suppressed at 0.5µg/ml
A. Deep invasion is not seen
- Toxigenicity of diphtheria bacillus
B. Elek’s test is done for toxigenicity
depends on symbiotic bacteriophages, so it
C. Metachromatic granules are seen
shows lysogenic or phage conversion i.e,
D. Toxigenicity is mediated by chromosomal
nontoxigenic strain- toxigenic strain by
change
infecting with beta phage.
Ans:- D Toxigenicity is mediated by chromosomal

change
230. Ehrlich phenomenon is seen in Ref:- Harrison 17/e p 890
A. Mycobacterium TB Explanation:-
B. Proteus
Corynebacteriophage beta carries the structural
C. Staphylococcus
gene (tox+) encoding diphtheria toxin and a family
D. Corynebacterium of closely related corynebacteriophage are
E. Mycoplasma responsible for toxigenic conversion of tox-c,
diphtheria to tox+ phenotype.
Ans:- D Corynebacterium
Ref:- Ananthanarayan 8/e p 238-239 - Elek’s gel precipitation test is in vitro test
Explanation:- for toxin detection.
- Diphtheria toxin undergoes spontaneous

232. Positive Schick’s test indicates that the person is
denaturation into toxoid. This toxiod also
A. Immune to diphtheria
combines equally with antitoxin. So, in any
B. Hypersensitive to diphtheria
sample, it would be difficult to estimate
C. Susceptible to diphtheria
the level of toxin as sample will contain a
D. Susceptible and hypersensitive to diphtheria
variable amount of toxoid which will
vitiate standardization of antitoxin. Ans:- D Susceptible and hypersensitive to
- Due to the above mentioned issue, two diphtheria
other units for measurement of toxin have Ref:- Ananthanarayan 7/e p 237
been introduced, the Lo and L+ doses. Explanation:-
 Lo (Llimes nul) dose of
Already explained
diphtheria toxin is the largest
amount of toxin that when mixed 233. In a completely and adequately immunized child
with one unit of antitoxin and against diphtheria, the throat swab was collected.
BACTERIOLOGY
It showed the presence of C. diphtheria organisms C. Throat swab and culture
on Albert staining. These organisms can have one D. Chest X-ray
of the following properties on further processing
A. It can grow on potassium tellurite media Ans:- A Widal test
B. It would show a +ve Elek’s gel precipitation
Explanation:-
test
C. It can be pathogenic to experimental guinea pig Widal is test for diagnosing typhoid which is not a
D. It can produce cytotoxicity in tissue culture cause of pharyngitis, so there is no need to perform
widal in this child.
Ans:- A It can grow on potassium tellurite media
Ref:- Ananthanarayan 8/e p 236 237. Which of the following is true about diphtheria
Explanation:- except
A. Faucial diphtheria is more dangerous than
This child is carrier of diphtheria.
laryngeal diphtheria
Potassium tellurite is selective media for isolation of B. Laryngeal diphtheria mandates tracheostomy
diphtheria bacillus from convalescent contact, C. Child is infectious with faucial diphtheria
carriers, other three test are done for testing D. Myocarditis may be a complication
virulence only when isolated strain is C. diphtheria. E. Palatal paralysis is irreversible
234. A 12 years old child presents with fever and Ans:- A and E
cervical lymphadenopathy. Oral examination Ref:- Dhingra 3/e p 348
shows a grey membrane on the right tonsil Explanation:-
extending to the anterior pillar. Which of the
Diphtheria
following medium will be ideal for the culture of
the throat swab for a rapid identification of the - Causative agent
pathogen Corynebacterium diphtheria (Gram
A. Nutrient agar positive bacillus)
B. Blood agar - Incubation period
C. Loeffler’s serum slope 2-6 days
D. LJ medium - Depending on site present as
 Nasal diphtheria –Mildest,
Ans:- C Loeffler’s serum slope
Toxemia is minimal
 Faucial diphtheria (most
Explanation:-
common)= Nasopharyngeal
Already explained diphtheria-More severe than
nasal diphtheria
235. Regarding Schick’s test which of the following is
 Laryngotracheal diphtheria-Most
false
severe, maximum obstructive
A. Erythematous reaction in both arms indicate
symptom, trancheostomy may be
hypersensitivity
essential.
B. Positive test means that persons is immune to
- Complications
diphtheria
 Myocarditis- occurs towards the
C. Diphtheria antitoxin is given intradermally
end of 1st or beginning of 2nd
D. Test done to find out immune status against
week
diphtheria
 Peripheral neuropathy of
Ans:- B Positive test means that persons is descending type
immune to diphtheria  Renal failure.
Explanation:- 238. Metachromatic granules are found in
A. Diphtheria
Already explained
B. Mycoplasma
236. A child with fever and pharyngitis which of the C. Gardenerella vaginalis
following investigation should not to be done D. Chlamydia
A. Widal test E. Staphylococcus
B. ASO
BACTERIOLOGY
Ans:- A Diphtheria B. It would show a positive elek’s gel
Ref:- Ananthanarayan 8/e p 232 precipitation test
Explanation:- C. It can be pathogenic to experimental guinea
pigs
Metachromatic Granules
D. It can produce cytotoxicity in tissue cultures
- It is type of intracytoplasmic inclusions Ans:- A
characteristically seen in diphtheria bacilli
- Also known as volutin or metachromatic 243. Positive shick’s test indicates that person is
or Babes-Ernst granules. A. Immune to diphtheria
- Strongly basophilic bodies consist of B. Hypersensitive to diphtheria
polymetaphosphate. C. Susceptible to diphtheria
- They are reservoir of energy and D. Carrier of diphtheria
phosphate Ans:- C
- They are more frequent in cells growing
under nutritional deficient condition
244. Diphtheria toxin acts by

239. Clinical diphtheria is caused by A. Increasing levels of cramps
A. Corn. Diphtheria B. Inhibiting protein synthesis
B. C. pyogenes C. Inhibiting acetyl choline release
C. C. ulcerans D. Inhibiting glucose transport
D. Streptococcus pyogens Ans: B
E. Pseudodiphtheriticum Ref: Ananthanarayan and Panicker’s
Ans:- A Corn. Diphtheria Explanation
Ref:- Harrison 17/e p 890 • Diphtheria toxin acts by inhibiting
Explanation:- protein synthesis, specifically; fragment
A inhibits polypeptide chain
Clinical diphtheria is caused only by C. diphtheria elongation in the presence of NAD by
inactivating the elongation factor, EF – 2
C. ulcerans can cause diphtheria like lesions (but
not diphtheria)
240. False about C. diphtheria 245. Actinomycosis is caused by

A. Toxin production is chromosome mediated A. Virus
B. Toxic production is phage mediated B. Bacteria
C. Toxic to heart and neuron C. Fungus
D. Toxin inhibits protein synthesis D. Unknown factor
Ans:- A Toxin production is chromosome Ans: B

mediated Ref: Ananthanarayan & Panicker’s, 8/E,
Ref:- Ananthanarayan 8/e p 233 p. 391
241. Diphtheria toxin acts by 246. Which of the following is the most predominant
A. Inhibiting acetyl choline release constituent of sulfur granules of Actinomycosis
B. Inhibiting glucose transport A. Organisms
C. Increasing levels of cyclic amp B. Neutrophils and monocytes
D. Inhibiting protein systhesis C. Monocytes and lymphocytes
Ans:- D D. Eosinophils
Ans:- A Organisms
242. In a completely and adequately immunized child
Ref:- Ananthanaryana 8/e 393
against diphtheria, the throat swab was collected.
Explanation:-
It showed the presence of corynaebacterium
diphtheriae like organisms on albert staining. Actinomycetes are true bacteria (possess cell wall,
These organisms can have one of the following prokaryotic nuclei, etc) bearing superficial
properties on further laboratory processing resemblance to fungi (form mycelium or branching
filaments)
A. It can grow on potassium tellurite medium
BACTERIOLOGY
Actinomyces cause actinomycosis in human - Involve subcutaneous and deeper tissue
destructing the contagious bone and
MC cause is A.israelii
fascia.
MC type of actinomycosis- Cervicofacial (Lower
jaw) Site:-
247. A patient comes with history of unresponsive Foot (MC), hand, gluteal region and thigh often
fever and cough. X-ray revealed pneumonia. called as Madura foot.
Sputum examination showed gram positive, - It was first described from Madurai (South
partially acid fast bacteria with branching India)
filaments that grows on sheep blood agar. The - Presents as abscess, tumors, with multiple
most likely etiologic agents is sinuses discharging pus with sulphur
A. Actinomycetes granules.
B. Nocardia - Granules are tightly clumped colonies of
C. Aspergillosis causative agent.
D. Pneumococci
Ans:- B Nocardia
Ref:- Harrison 17/e p 994-995 250. The attachment of the actinomyces
species to the tooth surface is facilitated
248. Characteristic infection of Nocardia asteroids is by
A. Diarrhea A. Fimbriae
B. Secondary dissemination to liver B. Cilia
C. Flagella
C. Brain abscess
D. Pseudopodia
D. Colonic diverticula
Ans: A. Fimbriae
Ans:- C Brain Abscess Ref: Koneman’s Color Atlas and
Ref:- Harrison 18/e p 1323 Textbook of Diagnostic Microbiology,
Explanation:- Elmer W. Koneman, 6/E, P.192
- Subacute abscess is the typical

extrapulmonary manifestation of nocardia,
251. ‘Sulphur granules’ are diagnostic feature
the most common site of dissemination is
of
brain. A. Histoplasmosis
- Nocaridal brain abscess are usually B. Sulfide poisoning
supratentorial, multiloculated, may be C. Actinomycosis
single or multiple. Brain abscess tend to D. Toxoplasmosis
burrow into ventricles and may extend out
Ans: C
into subarachnoid space. Otherwise Ref: Ananthanarayan and Panicker’s
meningitis is uncommon and is usually Text Book of Microbiology, 8/E, p. 391
due to spread from nearby abscess.
249. The causative organism of Mycetoma is

A. Nocardia
252. All the following statements are true regarding
B. Dimorphic fungus
cervicofacial actinomycosis, EXCEPT:
C. Aspergillus
D. Dermatophytes A. 10–20% of Actinomycosis occur in cervicofacial
region
Ans:-A Nocardia B. The discharging pus contains visible sulphur
Ref:- Ananthanarayan 8/e p 393 granules
Explanation:- C. Cultures on blood agar often produce a typical
‘molar tooth’ morphology
Mycetoma
D. There is usually history of trauma such as tooth
- Chronic granulomatous disease extraction or a blow to the jaw
Ans:A. 10–20% of Actinomycosis occur in cervicofacial
region
Ref: Ananthanarayan, 8/E, p. 391
BACTERIOLOGY
Explanation Viruses (influenza A
• Refer to Q. No. 5 of year 2014. and B, RSV, Adeno,
rhino, rubeola, varicella,
253. Presence of sulphur granules in discharging etc)
pus confirms the diagnosis of:
A. Candidiasis
B. Actinomycosis Klebsiella is associated with community acquired
C. Blastomycosis pneumonia classically in alcoholics (also in
D. Zygomycosis diabetics and chronic lung disease). It usually
affects upper lobes producing expansion of lobes
Ans: B. Actinomycosis
(bulging fissure) and Red current jelly sputum.
Ref: Ananthanarayan, 8/E, p. 391
255. All are features of ureplasma urealyticum except
Explanation A. Non gongococcal urethritis
• Diagnosis of Actinomycosis can be done by B. Salpingitis
– Culture
C. Epididymitis
– Sulphur granules in pus
D. Bacterial vaginosis
_ White or yellowish
_ Range about 5 mm
Ans:- B Salpingitis
_ On microscopy they present peripheral club like structure
which represent “Antigen-
Antibody” complexes Explanation:-
Additional Information
Ureaplasma urealyticum are T.form mycoplasmas
• Actinomycetes is also called Ray fungus
which are urease positive.
• It is considered as Transition between bacteria and fungi
• Actinomycetes which causes disease It causes
– In human—A. Israeli
– In cattle—A. bovis - Nongonococcal urethritis (MC cause is
• These are medically important bacteria Chlamydia trachomatis also caused by U.
• In humans it presents as ‘4’ clinical forms urealyticum and M. genitalium)
– Cervicofacial—more common
- Epididymitis (no role of M. homins)
– Thoracic
- Chorioaminonitis
– Abdominal
– Pelvic - Postpartum fever
- Proctitis
- Reiter’s syndrome
MYCOPLASMA - Acute salpingitis
- Pneumonia and chronic lung disease in
254. Atypical pneumonia can be caused by the VLBW infants
following microbial agents except - PID and bacterial vaginosis: by M.
A. Mycoplasma hominsis and U. urealyticum
B. Legionella pneumophilia - Infertility in both men and women
C. Human corona virus - Late abortion
D. Kelbsiella penumoniae - Low birth weight infant
- Balanoposthitis
Ans:- D Kelbsiella penumoniae
- Cervicitis and vaginitis
Ref:- Robbins 7/e p 751
Explanation:-
256. In reference to Mycoplasma, the following are
A typical pneumonia is characterized by patchy true except
inflammatory changes in the lung, largely confined A. They are inhibited by penicillins
to alveolar septa and pulmonary interstitium. B. They can reproduce in cell free media
C. They have an affinity for mammalian cell
Causes of atypical pneumonia
Mycoplasma (MC) Coxiella burnetti (Q membrane
fever) D. They can pass through fiters of 450nm pore
Legionella pneumonia Pneumocystii carnii size
Francisella tularensis Histoplasma
capsulatum Ans:- A They are inhibited by penicillins
Chlamydia psittacosis, Coccidiodis immitis Ref:- Ananthanarayan 8/e p 387-89
Chlamydia penumoniae Explanation:-
BACTERIOLOGY
- Mycoplasmas are devoid of cell walls and Q fever is air-borne disease
so they are resistant to B. lactams and
Lice act as vector in following diseases:
lysozmes that act on cell wall.
- Due to lack of cell wall they are highly Disease Causative agent
pleomorphic and pass through bacterial Epidemic typhus R prowazekii
filters of 450 nm since size varies from 50- Relapsing fever Borrelia recurrentis
300nm in diameter. Trench fever Rochalimaea Quintana
- Parasitic mycoplasma requires cholesterol Dermatitis
Pediculosis
or other sterols as an essential growth
factor
- They have affinity for mammalian cell Note: Relapsing fever can be tick-borne also.
membrane
260. Which one of the following statements is true
- It typically colonizes mucosal surfaces of
regarding Chlamydia pneumoniae
respiratory, git and genitourinary tracts.
A. Fifteen serovars have been identified as human
- Mycoplasma occur as granules and
pathogen
filaments
B. Mode of transmission is by the air-borne bird
- They multiply by asynchronous binary
excreta
fission producing budding forms and
C. The cytoplasmic inclusions presents in the
chains of beads
sputum specimen are rich in glycogen
- Some species get attached to suitable host
D. The group specific antigen is responsible for
cells carrying neuraminic acid receptors by
the production of complement fixing
bulbous enlargement.
antibodies
Ans:- D The group specific antigen is responsible

257. The cell wall deficient bacteria for the production of complement fixing
A. Rickettsiae antibodies
B. Mycoplasma Ref:- Ananthanarayan 8/e p 416
C. Chlamydiae Explanation:-
D. Ehrlichiae
Genus or group specific heat stable LPS antigen is
Ans: B. Mycoplasma responsible for CFT while serovar specific major
Ref: Ananthnarayan, 8/E, p.372 membrane protein is responsible for
microimmunofluorescence.
Characteristic of chlamydiae
258. The cell wall deficient bacteria
Feature c.trachomati c. C psittaci
A. Rickettesiae
s pneumonia
B. B. Mycoplasma Inclusion Round, Round, Large,
C. C. Chlamydiae morphology vascuolar dense variable
A. D. Escherichia shape,
dense
Ans: B Glycogen in Yes No No
Ref: Ananthanarayan and Panicker’s inclusions
Text Book of Microbiology, 8/E, p. 16 Elementary Round Pear Round
body shaped
morphology round
Susceptible Yes No No
RICKETTSIAE to
sulfonamide
259. Lice are not the vectors of s
DNA <10% 100% <10%
A. Relapsing fever 4
homology to
B. Q fever C
C. Trench fever pneumonia
D. Epidemic typhus Plasmid Yes No Yes
Serovars 15 1 >4
Natural host Humans Humans Birds
Ans:- B Q fever
Mode of Person to Airborne Airborne
Ref:- Ananthanarayan 8/e p 410 transmission person person to bird excreta
Explanation:- mother to person to humans
infant
BACTERIOLOGY
Major Trachoma, Pneumonia Psittacosis, because of transplacental transfer of maternal IgG
diseases STDs, , pneumonia, antibody.
infants bronchitis, fever of
pneumonia, sinusitis unexplaine As IgM antibody don’t cross placenta, neonatal IgM
LGV d origin
antibody can be detected in cord or neonatal serum
with the syphilis capita M or 195 IgM FTA-ABS test.
261. Reactive arthritis is caused by
Important points about Congenital syphilis
A. Staphylococcus
B. H.influenzae - Transmission across placenta can take
C. N.gonorrhoe place anytime, but lesion appear after 4
D. C. trachomatis month of gestation.
- Earliest sign of congenital syphilis-
Ans:- (d) C. trachomatis Rhinitis, snuffles
Ref:- CMDT 10, p 776 - Residual stigmata of congenital syphilis-
Explanation:- Hutchinson’s teeth, Mulberry molars,
- Reactive arthritis (formerly called Reiter Rhagades
syndrome) is the clinical tetrad of - DOC of congenital syphilis-Penicillin G.
uretheritis, conjunctivitis (or uveitis), mu-
Caution: According to Harrison 18/e p 1388 no
cocutaneous lesions and aseptic arthritis.
commercially available IgM test is recommended
- Most cases develop within days weeks
for evaluation of infant with suspected congenital
after either a dysenteric infection or syphilis.
urogential infection.
- Associated infection 263. False +ve VDRL is seen in
A. Lepromatous leprosy
GI B. Infectious mononucleosis
- Shigella C. HIV
- Salmonella
D. Pregnancy
- Yersina
- Compylobacter
Ans:- B Infectious mononucleosis
urogenital
Explanation:-
- Chlamydia trachomatus
- Ureoplasma urealyticum The modern VDRL and RPR test are 97% to 99%
specific and false positive test are now limited to
Arthritis is most commonly assymetric, and
following conditions
frequently involves the large joints (most
commonly ankle and knee); Sacroiliatis and Causes of false-positive VDRL
ankylosing spondylitis is observed in atleast Acute false positive Chronic false-positive
20% of patients; especially after frequent reaction<6 months reaction>6 months
recurrences. Recent viral illness of Aging
immunization
SPIROCHETES Genital herpes Autoimmune disorders
HIV infection SLE
SYPHILLUS Malaria Rheumatoid arthritis
Parenteral drug used Parenteral drug used
262. Congenital syphilis can be diagnosed by Other
A. IgM FTA BS Infective endocarditis Hepatitis infection
B. IgG FTA ABS Pregnancy Infectious
C. VDRL mononucleosis
D. TPI
Infectious mononucleosis is acute infection of EBV

Ans:- A IgM FTA BS
and can give false +ve VDRL
Explanation:- - Leprosy is also mentioned a cause of false
Newborn infant of mother with reactive VDRL or +ve VDRL: but with use of newer non-
FTA-ABS shows +ve test irrespective of infection lipoidal VDRL test, leprosy no longer give
false positive result.
BACTERIOLOGY
- False negative VDRL Ans: D
Seen when very high antibody titre is present Text Book of Microbiology, 8/E, p. 376
(Prozone Phenomenon)
Note: VDRL measures IgM and IgG directed 267. The spirochete which is associated with
against cardiolipin-lecithin-cholesterol antigen fusospirochetosis is
complex. A. Treponema pallidum
B. Treponema pertenue
264. About yaws all are true except C. Borrelia burgdorferi
A. Caused by T pertenue D. Borrelia Vincenti
B. Transmitted non-venerally
Ans: D
C. Secondary yaw can involve bones
D. Later stages involves heart and nerves Text Book of Microbiology, 8/E, p. 380
Explanation
Ans:-D Later stages involves heart and nerves • Borrelia vincenti is almost always
Ref:- Harrison 17/e p 1046 associated with fusiform bacilli (fusobacterium
Explanation:- fusiforme)
• This symbiotic, infection is known as
Features Yaw (pian, Pinta (carate, fusospirochetosis, e.g.: Vincent’s
framboesia) azul) angina
Organism T.pallidum T. carateum
subspecies 268. Borrelia vincenti is a
pertenus A. Mycoplasma
Mode of Skin to skin Skin to skin B. Mycobacteria
transmission C. Spirochete
Usual age Early childhood Late childhood D. Chlamydia
Primary Ulcerative Non ulcerative Ans: C
lesion papilloma papule with Ref: Ananthanarayan and Panicker’s
(mother yaw) satellite Text Book of Microbiology, 8/E, p. 379
Site Extremeties Extremities, 269. Teichoic acid is present in

face A. Cell wall of gram–positive organisms
Secondary Cutaneous B. Cytoplasm of gram–positive organisms
lesion papulosquamous C. Cell wall of gram–negative organisms
lesion, D. Cytoplasm of gram–negative organisms
osteoperiositis
Ans: A
Relapses Common Rare
Late Destructive Nondestructive
complication gummas of skin, macules
Explanation
bone, cartilage
Feature Gram positive Gram negative
Treatment Benzathine Benzathine Thickness Thicker Thinner
penicillin penicillin Variety of Few Several
aminoacids
Aromatic and Absent Present
265. Most commonly used treponemal test in diagnosis sulphur
of syphilis is containing
aminoacids
A. TPI (Treponema pallidum immobilization)
Lipids Absent or scanty Present
B. TPIA (Treponema pallidum immune adherence) Teichoic acid Present Absent
C. TPHA(Treponema palliclum Haemagglutination)
D. FTA ABS (Fluroescent treponemal antibody
absorption test)
Ans:-C 270. The term viable not cultivable (VNC) is used for
A. M.leprae
266. Which of the following is the most B. M.tuberculosis
specific test to diagnose syphilis? C. Trepenoma pallidum
A. VDRL test D. Salmonella
B. Wasermann test E. Staph.
C. RPR test
Ans:- . (a) and (c) Leprae, Treponema
D. FTA– ABS
pallidum
BACTERIOLOGY
275. Lyme disease is
271. Which human infection spreads through urine A. Caused by Borrelia vincentii
A. Leptospira B. Transmitted by flea bite
C. Diagnosed by demonstration of
B. Legionella
specific IgM antibody
C. Plague
D. The etiological agent can be grown
D. Diphtheria in modified Kelley’s medium
Ans:- (a) Leptospira Ans: D

Ref:- See below Ref: Ananthanarayan and Panicker’s
Explanation:- Textbook of Microbiology, 8/E, p. 381
Disease Mode of infection

Leptospira. Water contaminated by the urine
276. The gram negative bacteria most
of carrier animals enter the body
numerous in the oral cavity are
through cut or abrasions on the
A. Streptococci
skin
B. Veillonellae
Legionella or through intact mucosa of
C. Salmonella
mouth, nose or conjunctiva.
D. Eikenella
Plague Inhalation of aerosols produced
by AC, cooling towers Ans: B
Diptheria Bite of rat flea, droplet infection Ref: Ananthanarayan and Panicker’s
Droplet infection Text Book of Microbiology, 8/E, p. 266
272. Which organism cannot be cultured in cell free

media 277. On an average in the saliva of an adult
A. Klebsiella rhinoscleromatis man the lactobacilli count is
A. 50,000/ml
B. Klebsiella ozaenae
B. 75,000/ml
C. Treponema pallidum
C. 70,000/ml
D. Pneumocystis jiroveci D. 30,000/ml
E. Rhinosporidium seeberi
Ans: B
Ans:- . (c, d, e) Treponema pallidum, Pnemocystis Ref: Oral Microbiology and Infectious
jiroveci, Rhinosporidium seeberi Diseases, Schustee & Burnett, 2/E, p. 174
Ref:- Ananthanarayan 8/e, p 278, Har 18/e, p 1380
278. Lophotrichous flagella are seen in
Explanation:-Klebsiella can be grown very well on A. Spirilla
ordinary media. B. Vibrio
C. Pseudomonas
MISCELLANEOUS QUESTIONS
D. Klebsiella
273. The most frequent non sporing anaerobic bacilli
Ans: A
isolatead from clinical specimens is
A. Bacteroides fragilis Text Book of Microbiology, 8/E, p. 20
B. Clostridium tetani
C. Prevotella melaninogenica
D. Fuscobacterium nucleatum
Ans:-A
279. Multiple drug resistance of bacteria
depends on which of the following
274. The urine sample of a patient has been
A. Resistance transfer factor (rtf)
sent to the laboratory to look for
B. Colicigenic factor (col)
leptospira. The specimen is to be
C. Fertility factor (f)
screened by use of the
D. All of the above
A. Scanning microscope
B. Inverted microscope Ans: A
C. Dark ground microscope Ref: Ananthanarayan and Panicker’s
D. Electron microscope Text Book of Microbiology, 8/E, p. 66
Ans: C. Dark ground microscope
Ref: Textbook of Microbiology,
Ananthnarayan & Panicker, 8/E, p. 382 280. Isolation is not useful for all except
BACTERIOLOGY
A. Mumps Ans:- (d) Shock and disseminated intravascular
B. Measles coagulation are common in Bacteroides
C. Hepatitis A bacteremia
D. Pneumonic plague Ref:- Ananthnarayan 8/e, p 267 - 268
Explanation:-
Ans:- . (d) Pneumonic plague
Anaerobic Gram negative bacilli. includes
Ref:- . Park 19/e, p 103
Bacteroides, Fusobacterium, Leptotrichia,
Explanation:-
Prophyromonas, Prevatella. Bacteroides are MC
Periods of isolation recommended anaerobes isolated from clinical specimen.
Disease Duration of isolation  They are Non-sporing, Non-motile, strict

anaerobes and capsulated (Virulence
Chickenpox Until all lesions crusted; factor).
Measles usually about 6 days
 They are classified on the basis of colonial,
German measles after onset of rash From
biochemical features (Sacchrolytic effects)
the onset of catarrhal
Cholera, Diphtheria stage through 3rd day of and on characteristics of short chain fatty
Shigellosis rash None, except that acid patterns in gas liquid
Salmonellosis women in the first chromatography.
Hepatitis A trimester or sexually  MC isolate of Bacteroides is B. fragilis.
Influenza Polio active, non-immune  They grows well on media such as brain
Tuberculosis women in child years not
heart infusion agar in an anaerobic
(sputum +) using contraceptive
atmosphere containing 10% Co2.
Herpes zoster measures should not be
Mumps exposed 3 days after  B. fragilis (also Prevotelle melaninogenic)
Pertussis tetracyclines started, possess lipopolysaccharides (endotoxin)
Meningococcal until 48 hours of that are less biologically potent than
meningitis antibiotics (or negative endotoxins associated with aerobic gram
cultures after treatrror negative bacteria. Due to this relative
Streptococcal Until 3 consecutive
biologic inactivity, infection caused by
pharyngitis negative stool cultures
Bacteroides less frequently produce the
3 weeks 3 days after
onset 2 weeks adult, 6 clinical signs of sepsis.
weeks pediatric Until 3  First line therapy for anaerobes includes
weeks of effective Metronidazole, Ticarcillin/Clavulanic acid,
chemotherapy Piperacillin/tazobactan, Imipenem.
6 days after onset of rash
 Resistance to metronidazole is seen in <2%
Until swelling subsides 4
cases, i.e. not uniformly sensitive. ...
weeks or until
paroxysms cease Harrison 17/e, p 1005, Tab. 157-2
Until the first 6 hours of 
effective — antibiotic 282. A 40-year old woman presented to the
therapy completed gynecologist with complaint of profuse vaginal
discharge. There was no discharge from the
cervical as on the speculum examination. The
281. With reference to Bacteroides fragilis the
diagnosis of bacterial vaginosis was made based
following statements are true except
upon all of the following findings on microscopy
A. B.fragilis is the most frequent anaerobe isolated
except
from clinical smaples
A. Abundance of gram variable coccobacilli
B. B.fragilis is not uniformly sensitive to metroni-
B. Absence of Lactobacilli
dazole
C. Abundance of polymorphs
C. The lipopolysaccharide formed by B.fragilis is
D. Presence of clue cells
structurally and functionally different from the
conventional endotoxin Ans:- . (c) Abundance of polymorphs
D. Shock and disseminated intravascular Ref:- Shaw's 13/e, p 129; COGDT 10/e, p 670
coagulation are common in bacteroides Explanation:-
bacteremia
Bacterial Vaginosis
BACTERIOLOGY
 Defined as Alteration in normal vaginal prominent member of resident flora and remain so
flora rather than true infection for life."
 Causative organism:
"In the pharynx and trachea, similar flora establish
- G. vaginalis
itself whereas few bacteria are found in normal
- H. vaginalis
bronchi. Small bronchi and alveoli are normally
- Mobiluncus sterile."
 Microscopy of vaginal secretions in
bacterial vaginosis shows: "Stomach acidity keep the number of
- Characteristic clue cells microorganisms at a minimum (103-105) unless
obstruction at the pylorus favours the proliferation
- Decreased or absent lactobacillus
of gram positive cocci and bacilli."
- Decreased leucocytes.
 Clinical criteria for diagnosis: "Antimicrobials drugs taken orally can, in humans,
- Homogenous white non inflammatory temporilly suppress the drug susceptible
discharge with fishy odour. components of the fecal flora."
- Microscopic presence of >20% clue cells.
- Vaginal discharge with pH > 4.5
- Fishy odor with or without addition of 284. Which of the following are bacteria
10% KOH. A. Bacteriophage
 Treatment: Metronidazole for both B. Chlamydia
pregnant and non-pregnant women. C. Mycoplasma
D. Spirochete
Remember:
Ans:- . Ans. (b, c) and (d) Chlamydia, Mycoplasma
 Clue cells represent epithelial cells
and Spirochete
adherant to G. vaginalis.
Ref:- See below
 Bacterial vaginosis is most prevalent Explanation:-
vaginal infection.
Bacteriophage are virus infecting bacteria
283. It is true regarding the normal microbial flora
285. Normal commensal of skin
present on the skin and mucous membranes that
A. Staph. Aureus
A. It cannot be eradicated by antimicrobial agents
B. Candida albicans
B. It is absent in the stomach due to acidic PH
C. Bacteroides fragilis
C. It establishes in the body only after the
D. Propiobacterium
neonatal period
E. Corynebacterium
D. The flora in the small bronchi is similar to that
of the trachea Ans:-A,B,D,E
Ref:-Ananthanarayan 8/e p 588
Ans:- (c). It establishes in the body only after the
neonatal period 286. Most common agents responsible for human, bite
Ref:- . Jawetz 25/e, p 159-160 in infections are
Explanation:- A. Gram -ve bacilli
B. Gram +ve bacilli
Term "normal microbial flora" denotes the
C. Spirochaete
population of microorganisms that inhabit the skin
D. Anaerobic streptococci
and mucous membranes of healthy normal persons.
They are not essential to life.
Ans:- D Anaerobic streptococci
MC resident organisms of upper respiratory tract is Ref:-CMDT-08 p 114
streptococci of viridans group. Explanation:-
MC resident bacteria of large intestine is Human bites

bacteroides species.
- Human bites are usually inflicted by
Lines from Jawetz clears all choice to you – children; in adults bites are associated
with alcohol use and closed fist injury.
"Mucus membranes of mouth and pharynx are
often sterile at birth within 4-12 hrs after birth,
viridans streptococci become establish as most
BACTERIOLOGY
- Bites inflicted by children rarely get D. Bacteriophage
infected and bites by adults become
infected in 15-30% of cases. Ans:- . (a) Bacteriostatic
Ref:- . Jawetz 25/e, p 58
- Bacteriology of bite infection
Explanation:-
 Human bites are mixture of
aerobes and anaerobes (54%) or Bacteriostatic -Chemical or substance inhibiting
due to aerobes only (44%) growth without killing.
 Streptococcus, staphylococcus
Bactericidal -Chemical or substance killing
and Eikenella corrodens are most
organism.
common aerobes.
 Prevotella and fusobacterium are Sterilization -The process by which article or
the most common anaerobe. medium is freed of all living microorganism either
287. Prokaryotes are characterized by in the vegetative or spore state
A. Absence of nuclear membrane
Bacteriophage - Virus infecting bacteria
B. Presence of microvilli on its surface
C. Presence of smooth endoplasmic reticulum 289. HACEK group includes all of the following except
D. All of the above A. Hemophilus arophilus
B. Acinetobacter baumanni
Ans:- (a) Absence of nuclear membrane C. Eikenella corrodens
Ref:- Ananthnarayan 8/e, p 13, 7/e, p 7 D. Cardiobacterium hominis
Explanation:-
Ans:- (b) Acinetobacter baumanni
Differences between prokaryotic and eukaryotic
Ref:- Harrison 17/e, p 926; 18/e, p 1233
cells
Explanation:-
Character Prokaryote Eukaryotes
HACEK organism are a group of fastidious, slow
s
growin& Gram negative bacteria whose growth
Nucleus ( Main basis of classification)
requires an atmos-phere of CO2. Species belonging
• Nuclear membrane Absent Present
to this group include:
• Nucleolus Absent Present
Deoxyribonucleoprot Absent Present More
- Hemophilus species
ein One than one
- Actinobacillus actinomycetemcomitans
• Chromosome (Circular) (linear)
• Mitotic division Absent Present - Cardiobacterium hominus
Cytoplasm - Eikenella corroders
-Cytoplasmic Absent Present - Kingella kingae
streaming
- Pinocytosis Absent Present Endocarditis is the most common disease
-Mitochondria Absent Present caused by them.
-Lysosomes Absent Present
-Golgi apparatus Absent 70s Present 80s
Ribosomes
290. In the gut, anaerobic bacteria outnumber the
Chemical composition
aerobes by a ratio of
-Sterols Absent Present
-Muramic acid - Present Absent A. 10:1
Amoeboid + + B. 100:1
movement – + + C. 1000:1
Flagella and PiIli - Plasma Ribosomes D. 10,000:1
Phosphorylation site membrane (Mitochondri
(Mesosome a) Ans:- (c) 1000:1
s) Ref:- Jawetz 25/e, p 162
Explanation:-
288. A substance, when added to a culture causes Anaerobes outnumber facultative organism by 1000
inhibition of multiplication but on removal causes fold.
enhanced growth. This substance is called
Normal flora of intestinal tract
A. Bacteriostatic
B. Bactericidal - At birth the intestine is sterile, but
C. Sterilization organism are soon introduced after birth.
BACTERIOLOGY
- In breastfeed children lactic acid  Cultures of P. melaninogenica
streptococci and lactobacilli seen. and even dressings from wounds
- Microorganism are minimum (103-105g/ of infected with the bacillus give
contents) in stomach. characteristic cence when
- In upper intestine lactobacilli and exposed to ultraviolet light.
enterococci predominate.
- In colon Bacteroides fragilis is the most Remember: Anaerobes causing brain absecess - B.
fragilis, Peptostreptococcus, Provotella etc.
common organism found.
- Intestinal bacteria are important in 293. In a patient with UTI, CLED (cysteine lactose
synthesis of vitamin K. electrolyte deficient) Media is preferred over
291. With reference to Bacteroides fragilis all of the MacConkey’s media because
following statement are true except A. It is a differential medium
A. It is the most frequent anaerobe isolated from B. It inhibits swarming of proteus
clinical sample C. Promotes growth of pseudomonas
B. It is not uniformly sensitive to metronidazole D. Promotes growth of S., aureus and candida
C. The lipopolysaccharide formed by B. fragilis is
structurally and functionally different from Ans:- . (d) Promotes growth of S. aureus and
conventional endotoxin Candida
D. Shock and DIC are common in bacteremia due Ref:- MM 13/e, p 453; Scot Microbiology 9/e, p 81
to B.fragilis
294. Endotoxin from gram negative organism is
Ans:- (d) Shock and DIC are common in
A. Polysaccharide
bacteremia due to B. fragilis
B. Glycoprotein
Ref:- Ananthnarayan 8/e, p 267, 7/e, p 268
Explanation:- C. Lipoprotein
D. Lipopolysaccharide
Already explained, refer Ans. 5
Ans:- (d) Lipopolysaccharide
292. A patient present with frontal abscess. Foul Ref:- Ananthnarayan 8/e, p 78, Table (9.1), 7/e, p 67
smelling, pus is aspirated. Pus shows red. Explanation:-
Fluorenscence on ultra-violet examination. The
most, likely organism causing the frontal abscess Distinguishing features of exotoxins and endotoxins
is Exotoxins Endotoxins
A. Bacteroides
B. Peptostreptococcus -Proteins -Lipopolysaccharides -
C. Pseudomonas -Heat labile Heat stable
D. Acanthamoeba -Actively secreted by -Form part of cell wall;
do not diffuse irsz
cells; diffuse into
Ans:- . (a) Bacteroides surrounding medium -
surrounding
Ref:- Ananthnarayan 8/e 267; Jawetz 25/e, p 274 Obtained only by cell
medium -Readily lysis
Explanation:-
separable from -No enzymic action -
This is a case of brain abscess secondary to P. cultures by physical Effect nonspecific;
melaninogenicus (formerly called as Bacteroides means such as action common to all
melaningenicus) filtration -Action endotoxins
- No specific tissue
usually enzymic
- Provotella includes anaerobic gram affinity
-Specific -Active only in very
negative bacilli which are inhibited by 20%
pharmacological large doses
bile.
effects for each -Weakly antigenic -
- MC isolate is P. melaninogenicus
exotoxin -Specific Neutralization by
(Previously called Bacteroides
tissue affinities -- antibody ineffective -
melaningenicus) Can't toxoided -
Active in very
 P. melaninogenica forms black or Generally formed by
minute doses
brown colour colonies gram negative bacons
-Highly antigenic
 Colony colour is not due to
-Action specifically
melanin but due to a hemin
neutralized by
derivative
BACTERIOLOGY
antibody -Can be - Yersinia enterocolitica
toxoided -Generally - Vibrios
formed by gram - Enteric bacteria
positive including - Enteroviruses
some gram negative - Intestinal parasites (Giardia, E. histolytica,
shigella, vibrio B. coli, Cryptosporidium, Fasciola
cholera, ETEC, V. hepatica, E. vermicularis etc)
parahemolyticus, 298. Treatment of partner is required in all infection
Aeromonas Y. except
enterocolitica, P. A. Candida
aeroginosa B. Herpes
C. Trichomonas
D. Gardnerella
295. Exotoxins are
A. Lipopolysaccharide in nature Ans:- (d) Gardnerella
B. Produced by gram -ve bacilli Ref:- Harrison 17/e, p 827; Shaws 12/e, p 98 - 100
C. Highly antigenic Explanation:-
D. Very stable and resistant to chemical agents "Treatment of male partners with metronidazole
Ans:- (c) Highly antigenic does not prevent recurrence of bacterial
Ref:- Ananthnarayan 8/e, p 78, 7/e, p 67 vaginosis/gardeacilla with vaginal discnarge."
296. Which of the following is a bacteria taxonomically Treatment of sexual partners is required in:
A. Chlamydia
- Candi cliasis
B. Rickettsia
- Herpes genitalis
C. Mycoplasma
- Trichomoniasis.
D. Prion
E. Bacteriophage
299. MC commensal gut flora in adult
Ans:- (a, b) and (c) Chlamydia, Rickettsia and A. Lactobacillus
Mycoplasma B. Bacteroides
Ref:- See index of any Microbiology Book C. E.coli
Explanation:- D. Klebsiella
Prion is proteinaceous infectious particle, without Ans:- (a) and (b) Lactobacillus and Bacteroides
nucleic acid, cause slow virus disease. Ref:- Ananthnarayan 8/e, p 590, 7/e, p 601; Jawetz
Bacteriophage is the virus that infects bacteria
25/e p 162
297. Stool examination is required for diagnosis of Explanation:-
infection with Normal flora of intestinal tract
A. Staph. Food poisoning
B. Clostridia - At birth, intestine is sterile but organism
C. Shigella are soon introduced with food.
D. Campylobacter - Stomach's acidity keep the number of
E. E. vermicularis microorganism at a minimum (103-105 g of
contents) level, as tinal contents becomes
Ans:- (a, b, c, d) and (e) All are correct options alkaline, resident flora gradually increases.
Ref:- . Jawetz 25/e, p 720; Harrison 17/e, p 814 Tab. - In the upper intestine, lactobacilli and
(113-1) enterococci predominate but in lower
Explanation:- ileum and caecum, flora is fecal.
Following infections required stool examination for - In duodenum there are 103-106 bacteria per
diagnosis gram of contents, in the jejunum and ileum
105-108 bacteria per gram; and in the
- Toxins (of staphylococcus, Clostridia, caecum and transverse colon 108-1010
Vibrios, Toxigenic E.coli) bacteria per gram. In the sigmoid colon
- Shigella iii and rectum, there are 1011 bacteria per
- Salmonella gram of contents and constitutes 60% of
- Campylobacters fecal mass
BACTERIOLOGY
- In normal adult colon, 96-99% of resident Nonsporing
bacterial flora consist of anaerobes -
Gram positive
bacteriodes sp. especially B. fragilis,
fusobacterium sp; anaerobic lactobacilli - Eubacterium
e.g. bifidobacterium; clostridium (C. - Propionibacterium
perfringe's) and anaerobic gram positive - Lactobacillus
cocci (Peptostreptococcus). - Mobiluncus
 Only 1-4% are facultative aerobes - Bifidobacterium
(gram-negative coliform bacteria, - Actinomyces
enterococci, pseudomonas etc.)
Gram-negative
IMPORTANCE
- Bacteroides
a. Protection: Normal flora displace and inhibit - Provotella
potential pathogen, indirectly by compteting for - Porphyromonas
nutrients and receptors or directly through the - Fusobacterium
production of anti microbial factors such as lactic - Leptotrichia
acid.
Spirochetes
b. Immunity: Commensal organism are important
for the development and function of the mucosal A. Treponema
imimune system. They induce the secretion of IgA, B. Borrelia
modulate local T-cell response and cytokine
profiles. 301. The difference between gram +ve and gram -ve
organism is the gram-ve organism contains
c. Metabolic function: Intestinal bacteria produce
A. Teichoic acid
short chain fatty add that control intestinal
B. Muramic acid
epithelial cell differentia-tion. They synthesize
C. N-acetyl neuraminic acid
witamin K, biotin and fotate and enhance ion
D. Aromatic amino acids
absorption.
d. Anti-cancer: Certain bacteria metabolize dietry Ans:- (d) Aromatic amino acids
carcinogens Ref:- Ananthnarayan 8/e, p 17, 7/e, p 12
Explanation:-
300. Obligatory anaerobes are all except Cell Wall

A. Clostridia botulinum Features Gram Gram
B. Eikenella corrodens positive negative
C. Bacteroides bacteria
D. H.pylori
Plasmolysis Late Early
Ans:- (b) and (d) Eikenella corrodens and H.
pylori Thickness Thicker Thinner
Ref:- Ananthnarayan 8/c, p 265, 7/e, p 266 (Peptidoglycan)
Explanation:- Variety of Few Several
aminoacids
ANAEROBIC BACTERIA Aromatic and Absent Present
sulphur
Cocci
containing
A. Gram positive aminoacids
- Peptostretptococcus Lipids Absent or Present
- Peptococcus scant
B. Gram-negative Veillonella Teichoic acid Present Absent
Bacilli
Endospore forming 302. A male patient presented with granulomatous

penile ulcer. On wright geimsa stain tiny
- Clostiridia organisms of 2 microns within macrophages seen.
What is the causative organism
BACTERIOLOGY
A. LGV - Enteroroccal resistance to glycopeptides
B. Calymmatobacterium granulomatis (vancomycin and teicoplanin) is the result
C. Neisseria of alteration of the D-alanyl-D-alanine
D. Staph aureus target to D-alanyl-D-lactate of D-alanyl-D-
serine, which bind glycopeptides poorly
Ans:- . (b) Calymmatobacterium granulomatis due to the lack of a critical site for
hydrogen bonding
Explanation:-
Option 'd' Harrison 18/e, p 1
"In donovanosis bacteria appear as round
coccobacilli of 1-2 pm, with in cystic spaces in large - Panicillin resistance in pneumococci is
morphonuclear ce show bipolar condensation of due to alteration in PBP (penicillin binding
chromatin, giving a safety pin appearance in protein), which is acquired transformation
stained smears".
through horizontal transfer gene from a
related streptococci species.
303. With reference to antibiotic resistance all of

following statements are true except
A. The most common mechanism is production of
neutralizing enzymes by bacteria 304. Spirochete commonly seen in the oral environment is:
B. Plasmid mediated resistance is exclusively A. Treponema denticola
transferred vertically B. Streptococcus mutans
C. Complete elimination of target is the C. Candida albicans
D. Porphyromonas gingivalis
mechanism by which enterococci develop
Ans:A. Treponema denticola
resistance to vancomycin Ref: Oral Microbiology at a Glance, 1/E, p. 46
D. Alteration of target lesions leads to
development of resistance in pneumococci
305. Vincent’s angina is caused by:

Ans:- b i.e. Plasmid mediated resistance is
A. Streptococci
exclusively transferred vertically
B. Corynebacterium
Ref:- Goodmoon and Gilman's 12/e pg. 1377-1378
C. Fusospirochetal complex
Explanation:- D. Treponema pallidum
Ans: C. Fusospirochetal complex
- Drug resistance is more commonly
Ref: Ananthanarayan, 8/E, p. 280-381
acquired by horizontal transfer. Horizontal
Explanation
transfers occurs through transformation, • Vincent angina is caused by Borrelia vincentii
transduction of conjugation. It largely • B. vincentii is always associated with fusiform bacilli
depends on mobile genetic elements like (fusobacterium fusiformis). This
plasmids, bacteriophages. Other mobile symbiotic infection is known as “fusospirochetosis”.
elements like transposons, integrin's also
Additional Information
participate in acquiring resistance. • Necrotizing ulcerative gingivitis is an inflammatory
- Once acquired resistance in transmitted condition involves primarily the free
vertically to its progeny. gingival margin, crest of gingival and interdental
Other options papilla. On rare occasion the lesion spread
to soft palate and tonsillar areas in such instances the
Option 'a' - Goodmonn and Gillmann 12/e,
term Vincent angina is applied.
p 1541
- Drug inactivation is a common mechanism

of drug resistance. Example: Resistance to 306. A 50 year old chronic alcoholic male agricultural
aminoglycosides and beta lactams are ker presented with high grade fever of one week
usually secondary to production of duration with spells of chills and rigor.
aminoglycoside modifying enzymes and Examination the respiratory system revealed
beta lactams respectively bilateral crepitations with scattered rhonchi.
- Option 'c' Goodmonn and Gillmann 12/e, Multiple abcutaneous nodules were found on the
p 1541 extensor surface of the left forearm, arm and left
leg. Direct microscopy of the pus aspirated from
BACTERIOLOGY
the skin nodule revealed plenty of gram negative
bacilli with bipolar staining. Culture revealed
distinct rough corrugated- white colonies on
blood agar. The organisms were motile and
oxidase positive. The most likely diagnosis is
A. Plague
B. Melioidosis
C. Bartonellosis
D. Actinomycosis

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BACTERIOLOGY

BACTERIOLOGY 6. Bacteria acquire characteristics by all

23. A patient present with frontal abscess. Foul

24. True about bacteria

Ans:- (a) and (c) Mitochondria always absent and

For group B meningococcal infection no vaccine is Microscopy Presence of gram

Pustule-A vesicle filled with leukocyte. MC cause is

Latex agglutination or enzyme immunoassay of - Diffuse spreading infection of skin (dermis

56. Streptococcus all are true except Option D

Option A Ans:- A and B

Enterococci are resistant to penicillin Ans:- C Enterococcus faecalis

65. Cariogenic streptococci are acidophilic and

Ans:-(c) Streptococcus pyogenes

Ans:- d i.e Group B Streptococci D. Cloxacillin

Neonatal Sepsis Ans:- D Pneumococcus

- By lysing the bacteria and releasing - MC-infection of pneumococci: Otitis media

likely to yield positive cocci.

A. Gram positive cocci in short chains, catalase A. Bacitracin sensitivity

negative and bile resistant B. Optochin sensitivity

B. Gram positive cocci in pairs, catalase negative C. Bile solubility

and bile soluble D. Positive coagulase

C. Gram positive cocci in clusters, catalase

A. H. influenza 82. Apart from Escherichia coli, the other most

Most common Gram +ve organism causing Ans:- (b) Klebsiella

- Produces two type of food poisoning

Bacteria causing invasive diarrhea CL.TETANI

- Shigella 88. A person has received complete immunization

Ans:- B Single dose of tetanus toxoid

Ans:- D Tetanus toxoid Option b

Best way of prevention=Active immunization=TT

110. Regarding gas gangrene one of the following is

Important points Cl. Botulinum belong to category A of potential

A. Clostridium sordelli - Toxin A is potent neutrophil

Ans:- C Bacillus anthracis Ans:- D Anthrax of skin

- Gram positive, aerobic, catalase positive,

- Anthrax is zoonotic disease primarily of

129. With reference to infection with Escherichia coli

Selective media Remember

- CVA medium Enteropathogenci E.coli Diarrhea in infants and

Enrichment culture 130. A 20-year old man presented with hemorrhagic

Sereny test-Installation of suspension of freshly

Proteus results in formation of struvite stone not

Ans:- D Spread by contaminated water Ans:- . (a) E. coli

Enterotoxigenic E.coli Urease test is positive in urease producing bacteria

Ans:- (b) Shiga toxin Ans:- Ans. (c) ETEC

- Alteration in DNA gyrase and - Complement is required for bactericidal

153. Anju, a 28 years female, has diarrhea, confusion,

Neonatal <1 month Mode of transmission: Mainly by droplet infection.

- Bacterial causes Incubation period: Usually 3-4 days

Diagnosis: Recovering gram-negative diplococcic

- Viral and protozoal infections: TORCH, Prophylaxis

Ans:- A and C children)

cases. >10 mm: Positive

presentation be due to M. tuberculosis or atypical

166. True regarding Mycobacterium tuberculosis is Ans:- B and C

- Gram positive, non motile, noncapsulated,

Ans:- C No risk in negative Ans:- B Withhold breastfeeding

- Scrofuloderma is a type of cutaneous Treatment

D. Person to person transmission is seen Scotochormogens

Ans:- C Causes decreased efficacy of BCG due to - M. szulgai

MOTT (Mycobacteria Other Than Tuberculosis)

MOTT are mycobacterial species that may cause

leprosy seen in Features M. M.bovis