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Classification of viruses is made by:

A. Complement fixation serology

B. Electron microscopy
C. Nucleic acid composition
D. Cellular inclusion bodies
C True viruses have nucleic acid that is either RNA or DNA, and this serves as the basis for initial classification. Members
of these classes are further divided into groups that cause human disease based upon the mode of transmission, tissues
invaded, diseases produced, and antigenic characteristics
Which virus is the most common etiological agent of viral respiratory diseases in infants and children?
A. Respiratory syncytial virus (RSV)
B. Measles virus
C. Coxsackie A virus
D. Coxsackie B virus
A RSV is the cause of croup, bronchitis, bronchiolitis, and interstitial pneumonia. Children under 1 year old who are
hospitalized are the most susceptible group
The most common viral syndrome of pericarditis, myocarditis, and pleurodynia (pain upon breathing) is caused by:
A. Herpes simplex virus
B. Respiratory syncytial virus
C. Epstein-Barr virus
D. Coxsackie B virus
D Coxsackie A virus, Coxsackie B virus, and the echoviruses are most commonly implicated in myocarditis and other
syndromes, including acute cerebellar ataxia and hepatitis. Like poliovirus, infections are more common in the summer
and fall and gain entry through the gastrointestinal tract.
Which of the following viruses is implicated along with Epstein-Barr virus as a cause of infectious mononucleosis?
A. Cytomegalovirus (CMV)
B. Coxsackie A virus
C. Coxsackie B virus
D. Hepatitis B virus
A CMV infection in a previously healthy individual causes a self-limited mononucleosis syndrome. CMV is an opportunistic
pathogen that may produce lifelong infections and can cause a variety of diseases, including congenital and neonatal
infection, hepatitis, pneumonia, and disseminated infection in immunocompromised patients
The most common causes of viral pneumonia in adults are:
A. Influenza and adenovirus
B. Hepatitis A and B viruses
C. Coxsackie A and B viruses
D. Herpes simplex and CMV
A Influenza and adenoviruses are the main causes of respiratory infections, including the common cold, tracheobronchitis,
and pneumonia. Adenoviruses also cause conjunctivitis, keratitis, cystitis, and gastroenteritis.
Which virus belonging to the Reoviridae group causes gastroenteritis in infants and young children but an asymptomatic
infection in adults?
A. Coxsackie B virus
B. Rotavirus
C. Respiratory syncytial virus
D. Rhabdovirus
B Rotaviruses have been implicated in both nosocomial infections and epidemic gastroenteritis. Children 3-24 months old
are most commonly affected. Diarrhea begins after an incubation period of 3 days, lasts for 2-10 days, and is associated
with vomiting and dehydration. In immunosuppressed children, rotavirus causes a chronic infection
A very small, single-stranded DNA virus that causes a febrile illness with a rash and is called the fifth childhood disease
after rubeola, rubella, varicella, and roseola is:
A. Rotavirus
B. Adenovirus type 40
C. Coxsackie A virus
D. Parvovirus B19
D Parvovirus causes a fever and characteristic "slapped cheek" rash in young children. Adults are usually immune, but
immunocompromised persons may exhibit an arthritis or anemia (the virus infects immature RBCs in the bone marrow)
Hepatitis B virus can be transmitted by:
A. Acupuncture
B. Tattoos
C. Sexual contact
D. All of these options
D Although the most common mode of transmission of hepatitis B is via needle puncture, it may also be transmitted by
other parenteral means, including sexual transmission and contact with contaminated blood through broken skin or
mucous membranes.
Which virus has been implicated in adult gastroenteritis resulting from ingestion of contaminated food (especially shellfish)
and water?
A. Norwalk-like viruses
B. Rotavirus
C. Hepatitis C virus
D. Coronavirus
A Norwalk-like viruses are small RNA viruses that have been implicated in epidemics of community gastroenteritis as well
as sporadic infections. Unlike rotaviruses, which cause gastroenteritis in infants and young children, Norwalk-like viruses
produce infections in all age groups
Which virus is associated with venereal and respiratory tract warts and produces lesions of skin and mucous membranes?
A. Polyomavirus
B. Poxvirus
C. Adenovirus
D. Papillomavirus
D The human papillomaviruses (HPVs) cause genital warts. Several strains, including HPV-6, HPV-11, HPV-16, and
HPV-18, are associated with cervical and vaginal neoplasia. Because the virus cannot be cultured in vitro, diagnosis is
usually made using DNA probes. A diagnostic characteristic of infected cells is koilocytosis, a perinuclear clearing in the
squamous epithelium accompanied by nuclear atypia.
A clinical test used for the detection and identification of viral infections other than culture is:
A. Hemagglutination
B. Hemadsorption
C. Viral antigen detection
D. All of these options
D In addition to serological tests for antibodies against the virus and DNA probes that identify viral DNA or RNA, the
methods above aid in the rapid diagnosis of several viruses. Various species of animal RBCs are used for identification of
viruses that contain receptors that agglutinate the RBCs. Some influenza A and parainfluenza viruses may be detected
only by hemagglutination or hemadsorption. Testing for viral antigen in culture is used for detection of RSV, CMV, and
varicella zoster
Which technique is used for the confirmation of infection with human immunodeficiency virus (HIV-1)?
A. Western blot (immunoblot) assay
B. Enzyme-linked immunosorbent assay (ELISA)
C. Complement fixation
D. p24 Antigen testing
A The Western blot assay is most often used to confirm a positive serological test of antibodies to HIV. A sample is
confirmed positive if antibodies are demonstrated against two of the three major regions (env, pol, and gag). However,
because the Western blot detects antibodies it may miss people in the window phase of infection, is not confirmatory for
neonatal infections due to the presence of maternal antibodies, and has a long turnaround time resulting in loss of contact
with the patient. For these reasons, the CDC is evaluating a new approach using a simultaneous test for antibodies to
both HIV-1 and HIV-2 and p24 antigen to screen for infection. Positives would be tested by separate immunoassays to
identify whether the infection is HIV-1 or HIV-2. Samples testing negative for both of these would be tested by a nucleic
acid amplification method such as PCR for viral RNA
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A 13-year-old boy was admitted to the hospital with a diagnosis of viral encephalitis. History revealed that the boy
harbored wild raccoons from nearby woods. What is the best method to determine if the boy has contracted rabies?

A. Remove the brainstems from all of the raccoons and examine for cytopathic effects
B. Request immunofluorescent test for antibody on the saliva from all of the raccoons
C. Request immunofluorescent test for antigen in cutaneous nerves obtained by nuchal biopsy of the patient
D. Isolate the virus from the saliva of both the animals and the patient
C Using direct immunofluorescence, rabies antigen can be detected in the cutaneous nerves surrounding the hair follicles
of the posterior region of the neck (nuchal biopsy) and in epithelial cells obtained by a corneal impression. Antibodies to
rabies can be detected in the serum and CSF of infected persons within 8-10 days of illness; however, infection usually
occurs several months before the onset of symptoms. Isolation of virus from the saliva of the patient may be
accomplished by mouse inoculation or by inoculation of susceptible cell culture lines with subsequent detection by
immunofluorescent antibodies.
A 65-year-old woman was admitted to the hospital with acute respiratory distress, fever, myalgia, and headache. Influenza
A or B was suspected after ruling out bacterial pneumonia. Which of the following methods could be used to confirm
influenza infection?
A. Influenza virus culture in Madin-Darby canine kidney
B. Hemagglutination-inhibition test for antibodies in the patient's serum
C. Direct examination of nasal epithelium for virus using fluorescent antibody stain
D. All of these options
D Influenza virus types A, B, and C may be grown and isolated in embryonated hen eggs or cell cultures using Madin-
Darby canine kidney (MDCK), rhesus monkey, or cynomolgus monkey kidney cells. Cell culture using MDCK cells is the
most rapid technique, permitting identification within 1-3 days. The hemagglutination inhibition test can be used to titer
antibody to influenza virus and to distinguish virus subtypes, if specific antiserum is available. Direct fluorescent and
enzyme immunoassays using monoclonal antibodies to nucleoprotein antigens in infected nasal epithelium are used for
rapid diagnosis of both influenza A and influenza B infections.
The most rapid definitive diagnosis of a genital herpes simplex (HSV-2) infection in a 20-year-old man is made by which
A. Direct immunofluorescence test for viral antigen in vesicle fluid
B. Titer of serum and seminal fluid for antibodies to herpes simplex
C. Detection of antiherpes simplex in seminal fluid
D. Cell culture of vesicle fluid
A Direct immunofluorescence testing of vesicle (lesion) fluid for virus using fluorescein-conjugated antibodies is the most
rapid method for diagnosis of genital herpes infection. Immunofluorescence and immunoperoxidase methods are also
used to distinguish HSV-1 and HSV-2. PCR and real-time PCR are more sensitive rapid methods for detection and
identification. Viral cell culture is also very sensitive and may yield a positive result within 24 hours when fluid contains a
high concentration of virus. Vero cells or primary human embryonic cells are inoculated with vesicle fluid and examined for
cytopathic effects (CPE), the most common of which are large "balloon" cells and multinucleated giant cells.
A 20-year-old female college student complained of a sore throat and extreme fatigue. The physician noted
lymphadenopathy and ordered a rapid test for infectious mononucleosis antibodies that was negative. Bacterial cultures
were negative, as were serological tests for influenza A and B, HIV-1, CMV, hepatitis B, and antistreptolysin O. What
would be the next line of viral testing to establish a diagnosis?
A. Herpes simplex
B. Rubella
C. Epstein-Barr
D. West Nile
C Epstein-Barr virus serological testing for IgM-VCA (viral capsid antigen) during the acute phase would be indicated
because testing for infectious mononucleosis antibodies may or may not be positive. Patients who present with an
infectious mononucleosis-like syndrome should be tested for both EBV and CMV. Both viruses cause the same symptoms
during the acute phase of the illness
A 60-year-old male gardener from New York State was hospitalized with flulike symptoms and eventually diagnosed with
encephalitis. While working in his garden, he noticed several dead birds around his bird feeder. The region was known to
be heavily infested with mosquitoes. What is the most likely cause of his illness?
A. West Nile virus
B. Epstein-Barr virus
C. Parvovirus
D. Hantavirus
A West Nile virus causes neurological diseases with meningitis and encephalitis at the top of the list. The animal
reservoirs are birds, with humans being accidental hosts. Transmission of West Nile virus is from mosquito to bird. The
primary site of infection for Norwalk and rotavirus is the gastrointestinal area and for hantavirus the pulmonary sector
A 30-year-old male patient who was a contractor and building inspector in the southwestern United States complained of
difficulty breathing and was admitted to the hospital with severe respiratory disease. The physician noted a high fever and
cough. Two days before, the patient had inspected an old warehouse, abandoned and infested with rodents. The patient
was given intravenous antibiotics, but 2 days into therapy the pneumonia worsened and he developed pulmonary edema.
Which organism should be suspected of causing his illness?
A. Hantavirus
B. Rotavirus
C. West Nile virus
D. Norwalk-like virus
A Hantavirus is transmitted by a rodent host, the deer mouse, and is endemic in the southwestern United States. The
name of the hantavirus responsible for outbreaks in this region is the Sin Nombre virus. Breathing in excrement from the
mouse is the most common route of infection, and the lung is the site of initial infection. Diagnosis is usually made using
an IgM ELISA assay.
A 3-year-old female was admitted to the hospital following a 2-day visit with relatives over the Christmas holidays.
Vomiting and diarrhea left the child severely dehydrated. No other members of the family were affected. All bacterial
cultures proved negative. A stool sample should be tested for which virus?
C. Hepatitis D
D. Rotavirus
D Rotavirus is one of the most common causes of gastroenteritis in infants and young children (6 months to 2 years old).
Vomiting and diarrhea are also common symptoms of Norwalk virus infections, but the prevalence of rotavirus during the
winter months and the lack of illness in other family members make rotavirus a more likely cause. Commercial availability
of immunoassays for rotavirus makes its diagnosis easier to establish and rule out than infection with Norwalk-like viruses
A 25-year-old male patient was diagnosed with HIV-1 by enzyme immunoassay, testing positive twice, and the diagnosis
was confirmed by Western blot testing. Which laboratory test should be performed prior to initiating antiviral therapy?
A. Quantitative plasma virus concentration (viral load testing)
B. Quantitation of CD4 lymphocytes
C. Phenotype/genotype resistance testing
D. All of these options
D The decision to initiate antiviral therapy is based upon the presence or absence of symptoms, CD4 lymphocyte count,
and the viral load. For example, treatment is usually withheld from patients with CD4 counts > 350/μL and viral load <
55,000/mL and is instituted in asymptomatic patients if the CD4 count is < 200/μL regardless of viral load. Treatment
failure within the first year with three-drug regimens is 35%-45%, and drug resistance testing (genotype and/or phenotype
testing) is recommended to identify drug-resistant strains prior to initiating treatment.
A 6-month-old male infant was hospitalized with a respiratory infection. He was diagnosed with apnea and bronchiolitis.
Further testing revealed congenital heart disease. Bacterial cultures were negative for Streptococcus pneumoniae and
Haemophilus influenzae. What further testing should be done?
A. Respiratory syncytial virus (RSV)
B. Rotavirus
C. Norwalk virus
A Respiratory syncytial virus (RSV) is spread by large particle droplets such as dust and is one of the most common
causes of hospitalization for respiratory illness of infants less than 1 year old. RSV causes bronchiolitis, pneumonia, and
croup in infants and upper respiratory illness in children. It has also been found to cause nosocomial infection in nursing
homes. Diagnosis is made by EIA, fluorescent antibody (FA) staining, and cell culture
A young male hunter encountered a fox in his path during a walk in the woods. The fox was staggering but appeared
nonthreatening. The man tried to avoid contact but was attacked and bitten on the leg. The bite broke the skin but was not
deep. Wildlife officials were unable to locate the fox for testing. What procedure should take place next for the hunter?
A. Spinal tap with CSF testing for rabies virus
B. Administration of hyperimmune antirabies globulin and rabies vaccine
C. Biopsy of the wound site
D. Throat culture and blood culture
B Rabies virus can be detected by FA staining and PCR testing. The virus replicates at the site of the bite and penetrates
the surrounding tissue, finding its way to the central nervous system. Since the source cannot be tested, the best course
of action is to initiate postexposure prophylaxis with antirabies globulin and to immunize the patient with rabies vaccine.
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A 40-year-old female experienced a respiratory infection after returning home from a visit to her homeland of China. A
rapid onset of pneumonia in the lower respiratory area prompted the physician to place her in isolation. She was
diagnosed presumptively with severe acute respiratory syndrome (SARS) and placed on a respirator. What type of testing
should be done next to diagnose this disease?
A. Molecular technique and cell culture
B. Latex agglutination test
C. Blood culture
D. Complement fixation
A SARS virus was discovered in China in 2003. The virus belongs to the common cold group of coronaviruses, and is
easily transmitted to health care workers having close contact with infected patients. It is the cause of a severe lower
respiratory infection that can be fatal. Laboratory confirmation may be done by PCR testing that is available commercially,
cell culture, EIA, or IFA. Typically, PCR is used on two different specimen types or the same specimen type submitted at
least 2 days apart. If both tests are positive, the infection is confirmed.
A pregnant 25-year-old female with genital lesions delivered a premature newborn with complications. The baby tested
negative for bacterial infection (cultures of blood and urine). Antigen testing of the baby's urine proved negative for group
B streptococci and Streptococcus pneumoniae. The mother tested negative for bacterial sexually transmitted diseases
and for group B streptococci. The baby was treated with acyclovir and failed to survive. What was the most likely cause of
B. Human immunodeficiency virus
C. Respiratory syncytial virus
D. Herpes simplex virus
D Herpes simplex virus type 2 infections produce genital lesions. Infants born prematurely with disseminated infection of
HSV type 2 from HSV-positive mothers have a mortality rate of 50%-60%. Testing of pregnant women for antibody and
Cesarean section delivery can prevent most neonatal HSV infections because the virus enters the fetus during the
delivery process
A young father of two small children complained of a rash on the torso of his body. The children had been diagnosed with
chickenpox and confined to their home. The father had experienced chickenpox as a child and knew he did not have the
same rash as his children. What is the most likely cause of the father's rash?
A. Herpes simplex 1 virus
B. Varicella-zoster virus
C. Herpes simplex 2 virus
D. Epstein-Barr virus
B Varicella-zoster virus is the cause of an infection with chickenpox. As an adult, the father is experiencing shingles, a
reactivation of the virus. The virus lies dormant in the sensory (dorsal root) ganglia of the spinal nerves, and its
reactivation produces a nonweeping blisterlike rash on an inflamed skin base that follows the path of the underlying
The organs of a 65-year-old male were donated soon after a fatal auto accident. Three recipients of his corneas and
kidneys died within weeks after receiving his organs. Which of the following viruses most likely caused the death of these
B. Rabies
C. Norwalk-like
D. Rotavirus
B Transmission of rabies (rhabdovirus) occurs primarily from the bite of a rabid animal, but in 20% of human rabies cases
there is no known exposure to rabid animals. Donor tissues are not routinely tested for rabies. Diagnosis is performed by
fluorescent antibody staining of the infected tissues, and electron microscopy that shows the presence of bullet-shaped
virus particles.
While on a 7-day cruise to Vancouver and Alaska, a number of passengers reported to the ship's medical staff
complaining of vomiting and diarrhea. Which is the most likely virus to have infected these mainly adult passengers?
A. Rotavirus
B. Parainfluenza
C. Respiratory syncytial
D. Norwalk or Norwalk-like viruses
D Adult gastroenteritis caused by Norwalk and Norwalk-like viruses follows a 1-2 day incubation. Diagnosis is usually
made on the basis of clinical criteria and confirmed by enzyme immunoassay, RT-PCR, or immune electron microscopy.
Hepatitis E virus, also of the Caliciviridae family, also causes gastroenteritis 1-2 days following exposure, but is not
endemic in the United States and other developed countries.
A patient tested positive for HIV-1 infection using a reverse transcriptase-polymerase chain reaction (RT-PCR) method.
However, 1 week later a second blood sample was collected and sent to a reference lab that performed a confirmatory
test by Western blot. The Western blot test was negative. What best explains these results?
A. The samples for RT-PCR and Western blot were not from the same patient
B. RT-PCR is more sensitive for early detection
C. The RT-PCR result was falsely positive
D. The RT-PCR test detected HIV-2 and the Western blot is specific for HIV-1
B Western blot is a test for antibodies to HIV, and sufficient antibodies are not usually present in the first 3-4 weeks of
infection to cause a positive test. In some persons, antibodies do not appear until 3 months after initial HIV infection. RT-
PCR detects viral RNA, and reduces the window phase of infection to approximately 1 week. Real-time PCR tests for HIV-
1 have 100% specificity at a cutoff of 20-40 copies RNA/mL. PCR is the preferred test for neonates because it avoids
detection of maternal antibody, and is replacing Western blot as the confirmatory test of choice.
A pregnant women was seen by her obstetrician with signs of flulike illness during her second trimester. NAT tests were
ordered for Toxoplasma gondii, rubella, cytomegalovirus, and herpes simplex 1 and 2. All test results were negative.
However, after delivery, the newborn exhibited signs of an infection and failed to survive. Which virus causes a 90%
transplacental infection rate when found in the mother?
A. Hepatitis A
B. Hepatitis B
C. Hepatitis D
D. Hepatitis G
B Tests for toxoplasmosis, German measles, CMV, and HSV comprise a panel of infectious agents known at a TORCH
panel. The TORCH panel consists of serological tests for antibodies to these organisms, and has largely been replaced
by more sensitive NAT tests when infection is suspected. The "O" in TORCH stands for "other" and other viruses that
cause transplacental infection such as HBV and HIV should be considered.
An immunocompromised patient was admitted to the hospital with a diagnosis of hemorrhagic cystitis. Which combination
of virus and specimen would be most appropriate to diagnose a viral cause of this disorder?
A. BK virus—urine
B. Human papilloma virus—skin
C. Hepatitis B virus—serum
D. Epstein-Barr virus—serum
A The BK virus, a polyoma virus, is transmitted by direct contact with infected respiratory secretions. It has
tropism for the urinary system, and often causes a latent, asymptomatic infection in the kidney. However, in
immunocompromised patients, the virus is often implicated in renal and bladder infections. Kidney failure caused by BK
virus is a significant concern in bone marrow and renal transplant recipients

The incorrect match between organism and the appropriate diagnostic procedure is:
A. Onchocerca volvulus—examination of skin snips
B. Cryptosporidium—modified acid-fast stain
C. Echinococcus granulosus—routine ova and parasite examination
D. Schistosoma haematobium—examination of urine
C The appropriate procedure for the diagnosis of E. granulosus (hydatid disease) would involve the microscopic
examination of hydatid fluid aspirated from a cyst. Immature scolices and/or hooklets would be found in the centrifuged
fluid sediment and could be identified under the microscope.
In a patient with diarrhea, occasionally Entamoeba histolytica/E. dispar (four nucleated cysts, no chromatoidal bars) are
identified as being present; however, these cells, which are misdiagnosed as protozoa, are really:
A. Macrophages
B. Polymorphonuclear leukocytes
C. Epithelial cells
D. Eosinophils
B As polymorphonuclear leukocyte (PMN) nuclei in stool begin to fragment and appear to be four nuclei, they will
resemble E. histolytica/E. dispar cysts. However, E. histolytica/E. dispar cysts are rarely seen in cases of diarrhea. The
species name E. histolytica is reserved for the true pathogen, whereas E. dispar is used for the nonpathogenic species.
Unfortunately, morphologically they look identical. The only time E. histolytica could be identified morphologically would be
from trophozoites containing ingested red blood cells (RBCs). Nonpathogenic E. dispar would not contain ingested RBCs.
The correct way to report these organisms is Entamoeba histolytica/E. dispar (no trophozoites containing ingested RBCs)
or Entamoeba histolytica (trophozoites seen that contain ingested RBCs). Physicians may treat based on patient
Charcot-Leyden crystals in stool may be associated with an immune response and are thought to be formed from the
breakdown products of:
A. Neutrophils
B. Eosinophils
C. Monocytes
D. Lymphocytes
B When eosinophils disintegrate, the granules reform into Charcot-Leyden crystals.
Parasitic organisms that are most often transmitted sexually include:
A. Entamoeba gingivalis
B. Dientamoeba fragilis
C. Trichomonas vaginalis
D. Diphyllobothrium latum
C T. vaginalis has been well documented to be a sexually transmitted flagellate.
The incorrect match between the organism and one method of acquiring the infection is:
A. Trypanosoma brucei rhodesiense—bite of sand fleas
B. Giardia lamblia—ingestion of water contaminated with cysts
C. Hookworm—skin penetration of larvae from soil
D. Toxoplasma gondii—ingestion of raw or rare meats
A East and West African trypanosomiasis (T. b. rhodesiense and T. b. gambiense) are caused when infective forms are
introduced into the human body through the bite of the tsetse fly, not sand fleas
Upon examination of stool material for Cystoisospora belli, one would expect to see:
A. Cysts containing sporozoites
B. Precysts containing chromatoidal bars
C. Oocysts that are modified acid-fast variable
D. Sporozoites that are hematoxylin positive
C C. belli oocysts in various stages of maturity would be seen in the concentration sediment or possibly the direct, wet
preparation; these oocysts would stain positive with modified acid-fast stains.
Which specimen is the least likely to provide recovery of Trichomonas vaginalis?
A. Urine
B. Urethral discharge
C. Vaginal discharge
D. Feces
D T. vaginalis is site specific. The organisms are found in the urogenital tract; thus, the intestinal tract is not the normal
site for these organisms
Which of the following is the best technique to identify Dientamoeba fragilis in stool?
A. Formalin concentrate
B. Trichrome-stained smear
C. Modified acid-fast-stained smear
D. Giemsa's stain
B Because there is no known cyst form, the best technique to recover and identify D. fragilis trophozoites would be the
trichrome-stained smear
One of the following protozoan organisms has been implicated in waterborne and foodborne outbreaks within the United
States. The suspect organism is:
A. Pentatrichomonas hominis
B. Dientamoeba fragilis
C. Giardia lamblia
D. Balantidium coli
C For a number of years, G. lamblia has been implicated in both waterborne and foodborne outbreaks from the ingestion
of infective cysts within contaminated water and food.
A Gram stain from a gum lesion showed what appeared to be amoebae. A trichrome smear showed amoebae with a
single nucleus and partially digested PMNs. The correct identification is:
A. Trichomonas tenax
B. Entamoeba histolytica/E. dispar
C. Entamoeba gingivalis
D. Entamoeba polecki
C E. gingivalis is known to be an inhabitant of the mouth and is characterized by morphology that resembles Entamoeba
histolytica/E. dispar. However, E. gingivalis tends to ingest PMNs, whereas Entamoeba histolytica/E. dispar do not.
An Entamoeba histolytica trophozoite has the following characteristics:

A. Central karyosome in the nucleus, ingested RBCs, and clear pseudopodia

B. Ingested RBCs, clear pseudopodia, and uneven chromatin on the nuclear membrane
C. Ingested RBCs, clear pseudopodia, and large glycogen vacuoles in cytoplasm
D. Large, blotlike karyosome, ingested white blood cells (WBCs), and granular pseudopods
A The trophozoite of E. histolytica has evenly arranged chromatin on the nuclear membrane; a central, compact
karyosome in the nucleus; clear pseudopodia; and ingested RBCs in the cytoplasm
A 12-year-old girl is brought to the emergency department with meningitis and a history of swimming in a warm-water
spring. Motile amoebae that measure 10 µ in size are seen in the CSF and are most likely:
A. Iodamoeba bütschlii trophozoites
B. Endolimax nana trophozoites
C. Dientamoeba fragilis trophozoites
D. Naegleria fowleri trophozoites
D N. fowleri are free-living soil and water amoebae that
cause primary amoebic meningoencephalitis, or PAM.
The number of cases reported is few; however, the
infection is very acute and almost always fatal
Characteristics of the rhabditiform (noninfective) larvae of Strongyloides stercoralis include a:
A. Short buccal capsule and large genital primordium
B. Long buccal capsule and pointed tail
C. Short buccal capsule and small genital primordium
D. Small genital primordium and notch in tail
A The rhabditiform larvae of S. stercoralis are characterized by the short buccal capsule (mouth) and large genital
primordium, whereas hookworm larvae have a long buccal capsule and very small genital primordium.
Visceral larva migrans is associated with which of the following organisms?
A. Toxocara—serology
B. Onchocerca—skin snips
C. Dracunculus—skin biopsy
D. Angiostrongylus—CSF examination
A Toxocara spp. are the cause of visceral larva migrans and occur when humans accidentally ingest the infective eggs of
the dog or cat ascarid. The larvae migrate through the deep tissues, including the eye. The test of choice is the serology
The following organisms are linked with specific, relevant information. The incorrect combination is:
A. Strongyloides stercoralis—internal autoinfection
B. Echinococcus granulosus—hydatid examination
C. Toxoplasma—serology
D. Balantidium coli—common within the United States
D B. coli is a ciliate that can cause watery diarrhea in humans and is associated with pigs; however, it is not commonly
found within the United States. It is the largest of the intestinal protozoa and can be found in proficiency testing
specimens. Therefore, although it is not common, laboratories must still be able to identify these organisms.
Examination of 24-hour unpreserved urine specimen is sometimes helpful in the recovery of:
A. Trichomonas vaginalis trophozoites
B. Schistosoma haematobium eggs
C. Enterobius vermicularis eggs
D. Strongyloides stercoralis larvae
B S. haematobium blood flukes reside in the veins over the bladder. When the eggs are passed from the body, they are
often found in urine; egg viability can also be determined in unpreserved urine.
The examination of sputum may be necessary to diagnose infection with:
A. Paragonimus westermani
B. Trichinella spiralis
C. Wuchereria bancrofti
D. Fasciola hepatica
A P. westermani adult worms are found in the lung, and eggs may be coughed up in the sputum. Consequently, both
sputum and stool (if the sputum containing the eggs is swallowed) are the recommended specimens for examination for
the eggs.
Two helminth eggs that may resemble one another are:
A. Diphyllobothrium latum and Paragonimus westermani
B. Opisthorchis sinensis and Fasciolopsis buski
C. Taenia saginata and Hymenolepis nana
D. Ascaris lumbricoides and Trichostrongylus
A Both D. latum and P. westermani eggs are operculated and approximately the same size. The morphology is similar,
although D. latum has a knob at the abopercular end and P. westermani has a thickened abopercular end and shoulders
into which the operculum fits.
Eating poorly cooked pork can lead to an infection with:
A. Taenia solium and Trichinella spiralis
B. Taenia saginata and Hymenolepis nana
C. Trichuris trichiura and Hymenolepis diminuta
D. Diphyllobothrium latum and Ascaris lumbricoides
A Both T. solium (pork tapeworm) and T. spiralis can be acquired from the ingestion of raw or poorly cooked pork.
An operculated cestode egg that can be recovered from human feces is:
A. Clonorchis sinensis
B. Diphyllobothrium latum
C. Paragonimus westermani
D. Dipylidium caninum
B D. latum is the only operculated cestode egg that is found in humans; the infection is acquired from the ingestion of raw
freshwater fish.
The adult tapeworm of Echinococcus granulosus is found in the intestine of:
A. Dogs
B. Sheep
C. Humans
D. Cattle
A Although the hydatid cysts are found in sheep or in humans (accidental intermediate host), the adult tapeworms of E.
granulosus are found in the intestine of the dog
In infections with Taenia solium, humans can serve as the:
A. Definitive host
B. Intermediate host
C. Either the definitive or the intermediate host
D. None of these options
C If humans ingest T. solium cysticerci in uncooked or rare pork, the adult tapeworm will mature within the intestine
(human will serve as definitive host); if eggs from the adult tapeworm are ingested, then the cysticerci will develop in
human tissues (accidental intermediate host), causing cysticercosis
Humans acquire infections with Diphyllobothrium latum adult worms by:
A. Ingestion of freshwater crabs
B. Skin penetration of cercariae
C. Ingestion of water chestnuts
D. Ingestion of raw freshwater fish
D The ingestion of raw freshwater fish containing the encysted larvae of D. latum will result in the development of an adult
tapeworm within the human intestine.
Humans can serve as both the intermediate and definitive host in infections caused by:
A. Enterobius vermicularis
B. Hymenolepis nana
C. Schistosoma japonicum
D. Ascaris lumbricoides
B In infections with H. nana, humans serve as both intermediate and definitive hosts. When ingested, the oncosphere
penetrates the intestinal mucosa, develops into the mature cysticercoid (human is intermediate host), and returns to the
gut, where the adult tapeworm matures (human is definitive host)
Babesia has been implicated in disease from both splenectomized and nonsplenectomized patients. Morphologically, the
parasites resemble:
A. Plasmodium falciparum rings
B. Leishmania donovani amastigotes
C. Trypanosoma cruzi trypomastigotes
D. Microsporidial spores
A Babesia is an intracellular parasite that closely resembles the ring forms (early trophozoites) of P. falciparum. Often in
babesiosis, there are more rings per cell and the ring form is the only stage seen.
Organisms (and infections) that under normal conditions cannot be transmitted in the laboratory are:
A. Cryptosporidium—cryptosporidiosis
B. Taenia solium—cysticercosis
C. Ascaris lumbricoides—ascariasis
D. Enterobius vermicularis—pinworm infections
C A. lumbricoides eggs require a period of development in the soil before they are infective for humans. The other
organisms listed can be transmitted within the laboratory or in the hospital setting.
Toxoplasma gondii is characterized by:
A. Possible congenital infection and ingestion of oocysts
B. Cosmopolitan distribution and possible difficulties with interpretation of serological results
C. Neither A nor B
D. Both A and B
D Infection with T. gondii is acquired through the ingestion of rare or raw meats, infective oocysts from cat feces, or as a
congenital transmission. The organism has a cosmopolitan distribution and although serological testing is generally the
test of choice, the results may be very difficult to interpret in certain situations (e.g., congenital infection and
immunocompromised patients).
Oocysts of Cryptosporidium spp. can be detected in stool specimens using:
A. Modified Ziehl-Neelsen acid-fast stain
B. Gram stain
C. Methenamine silver stain
D. Trichrome stain
A The oocysts of Cryptosporidium spp. can be found and identified using microscopic examination of fecal smears stained
with modified acid-fast stains. They appear as purple-red-pink round objects, measuring approximately 4-6 μ. Often, the
four sporozoites and residual body can be seen within the oocyst wall.
Which microfilariae are usually not found circulating in the peripheral blood?
A. Brugia malayi
B. Wuchereria bancrofti
C. Onchocerca volvulus
D. Loa loa
C The microfilariae of O. volvulus are normally found in the fluid right under the outer layer of skin. Therefore, the skin
snip is the proper specimen to examine.
Massive hemolysis, blackwater fever, and central nervous system involvement are most common with:
A. Plasmodium vivax
B. Plasmodium falciparum
C. Plasmodium ovale
D. Plasmodium malariae
B The pathogenic sequelae of malarial infections with P. falciparum are the most severe of the five species of human
malaria. They can include massive hemolysis, blackwater fever, and multiple organ involvement, including the central
nervous system (cerebral malaria).
Organisms that should be considered in a nursery school outbreak of diarrhea include:

A. Endolimax nana, Giardia lamblia, and Entamoeba coli

B. Giardia lamblia, Dientamoeba fragilis, and Cryptosporidium spp.
C. Cryptosporidium spp., Trichomonas vaginalis, and Entamoeba coli
D. Pentatrichomonas hominis, Dientamoeba fragilis, and Endolimax nana
B G. lamblia, D. fragilis, and Cryptosporidium have been implicated in nursery school outbreaks. Among the many
protozoa and coccidia found in the human, these three organisms have become the most likely parasites in this type of
The incorrect match between disease and symptoms is:

A. Paragonimiasis—hemoptysis
B. Cryptosporidiosis—watery diarrhea
C. Toxoplasmosis in compromised host—central nervous system symptoms
D. Enterobiasis—dysentery
D Infections with E. vermicularis (the pinworm) may cause anal itching, sleeplessness, and possibly some vaginal irritation
or discharge; however, dysentery (bloody diarrhea) has not been associated with this infection.
The formalin-ether (ethyl acetate) concentration procedure for feces is used to demonstrate:
A. Motility of helminth larvae
B. Protozoan cysts and helminth eggs
C. Formation of amoebic pseudopods
D. Trophozoites
. B The ova and parasite examination contains three components: the direct wet film (demonstrates protozoan trophozoite
motility), the formalin-ethyl acetate concentration (demonstrates protozoan cysts, coccidian oocysts, and helminth eggs),
and the trichrome or iron hematoxylin stained smear (confirms protozoan cysts and trophozoites)
Cysts of Iodamoeba bütschlii typically have:

A. Chromatoidal bars with rounded ends

B. A heavily vacuolated cytoplasm
C. A large glycogen vacuole
D. Many ingested bacteria and yeast cells
C The cyst of I. bütschlii is characterized by a large glycogen vacuole that is seen on the wet smear (stains brown with
iodine) and on the permanent stained smear (vacuole will appear clear). Occasionally, the vacuole will be so large that the
organism will collapse on itself
The miracidial hatching test helps to demonstrate the viability of eggs of:
A. Taenia species
B. Schistosoma species
C. Hookworm species
D. Opisthorchis species
B The determination of egg viability is important in schistosomiasis; therefore, the miracidial hatching test is helpful in
demonstrating the egg viability of Schistosoma species. Once the eggs are hatched, the living miracidium larvae will be
visible in the water
Organisms that should be considered in a waterborne outbreak of diarrheal disease include:
A. Giardia lamblia and Cryptosporidium spp.
B. Endolimax nana and Entamoeba histolytica
C. Blastocystis hominis and Trichomonas vaginalis
D. Toxoplasma gondii and Schistosoma mansoni
A Both G. lamblia and Cryptosporidium have been implicated in waterborne outbreaks or diarrheal disease. These
infections would result from the ingestion of G. lamblia cysts and/or Cryptosporidium oocysts.
Fecal immunoassays have become more commonly used to diagnose infections with:
A. Endolimax nana and Blastocystis hominis
B. Giardia lamblia and Cryptosporidium spp.
C. Ascaris lumbricoides and Trichuris trichiura
D. Strongyloides stercoralis and Trichomonas vaginalis
B Rapid fecal immunoassays have become more widely used for the diagnosis of infections with G. lamblia and
Cryptosporidium. For these two organisms, the fecal immunoassays are more sensitive than the routine O&P examination
Primary infections with the microsporidia may originate in:
A. The lung
B. The nervous system
C. The gastrointestinal tract
D. Mucocutaneous lesions
C With the possible exception of direct inoculation infection in the eye, the microsporidia are thought to initially infect the
gastrointestinal (GI) tract through ingestion of the infective spores; infections in other body sites are thought to
disseminate from the GI tract.
Eye infections with Acanthamoeba spp. have most commonly been traced to:
A. Use of soft contact lenses
B. Use of hard contact lenses
C. Use of contaminated lens care solutions
D. Failure to remove lenses while swimming
C The majority of eye infections with Acanthamoeba spp. have resulted from the use of contaminated eye care solutions,
primarily the use of homemade saline. It is recommended that all solutions be discarded at the expiration date. Continued
use may increase the risk of environmental contamination of the fluids
Select the most sensitive recovery method for Acanthamoeba spp. from lens care solutions or corneal biopsies.
A. The trichrome staining method
B. The use of monoclonal reagents for the detection
of antibody
C. The use of non-nutrient agar cultures seeded with Escherichia coli
D. The Giemsa's stain method
C Currently, the most sensitive method for the recovery of Acanthamoeba spp. from clinical specimens is the non-nutrient
agar culture seeded with E. coli. The amoebae feed on the bacteria; both trophozoites and cysts can be recovered from
the agar surface.
The microsporidia are protozoans (now classified with the fungi) that have been implicated in human disease primarily in:
A. Immunocompromised patients
B. Pediatric patients under the age of 5 years
C. Adult patients with congenital immunodeficiencies
D. Patients who have been traveling in the tropics
A Although the microsporidia have been known as pathogens in many groups of animals, their involvement in humans
has primarily been in immunocompromised patients, especially those with AIDS. Microsporidia can be found in different
tissues, and currently there are approximately 10 genera implicated in human disease
When staining Cystoisospora belli oocysts with modified acid-fast stains, the important difference between these methods
and the acid-fast stains used for acid-fast bacilli (AFB) is:
A. The staining time is much longer with regular AFB acid-fast stains
B. The decolorizer is weaker than acid alcohol used for AFB decolorizing
C. A counterstain must be used for the modified methods
D. The stain is more concentrated when staining for AFB
B The decolorizer in modified acid-fast stains (Kinyoun's cold method, modified hot method) is usually 1% sulfuric acid
rather than the stronger acid alcohol used in the routine AFB stains.
The incorrect match between symptoms and disease is:
A. Dysentery—amebiasis
B. Malabsorption syndrome—giardiasis
C. Cardiac involvement—chronic Chagas disease
D. Myalgias—trichuriasis
D T. trichiura (whipworm) may cause diarrhea and occasionally dysentery in very heavy infections; however, the worms
are confined to the intestine, and myalgias are not seen in this helminth infection
The incorrect match between organism and characteristic is:
A. Chilomastix mesnili—Shepherd's crook and lemon shape
B. Plasmodium malariae—"band troph"
C. Hymenolepis nana—striated shell
D. Wuchereria bancrofti—sheathed microfilariae
C H. nana has a thin eggshell containing a six-hooked embryo (oncosphere) and polar filaments that lie between the
eggshell and the embryo. The striated eggshell is generally associated with Taenia spp. eggs.
The incorrect match between method and method objective is:
A. Direct wet examination—detection of organism motility
B. Knott's concentration—the recovery of operculated helminth eggs
C. Baermann's concentration—the recovery of Strongyloides
D. Permanent stained fecal smear—confirmation of protozoa
B The Knott concentration is designed to allow the recovery of microfilariae from a blood specimen. Dilute formalin (2%) is
used; blood is introduced into the formalin, the red cells lyse, and the sediment can be examined as a wet preparation or
permanent stained smear (Giemsa's or hematoxylin-based stain) for the presence of microfilariae.
The incorrect match between organism and characteristic is:
A. Dientamoeba fragilis—tetrad karyosome in the nucleus
B. Toxoplasma gondii—diagnostic serology
C. Echinococcus granulosus—daughter cysts
D. Schistosoma mansoni—egg with terminal spine
D The egg of S. mansoni is characterized by a large lateral spine; S. haematobium has the characteristic terminal spine.
There are few procedures considered STAT in parasitology. The most obvious situation would be:
A. Ova and parasite examination for giardiasis
B. Baermann's concentration for strongyloidiasis
C. Blood films for malaria
D. Culture of amoebic keratitis
C The request for blood films for malaria should always be considered a stat request. Any laboratory providing these
services should be available 24 hours a day, 7 days a week. In cases of P. falciparum malaria, any delay in diagnosing
the infection could be fatal for the patient.
An immunosuppressed man has several episodes of pneumonia, intestinal pain, sepsis with gram-negative rods, and a
history of military service in Southeast Asia 20 years earlier. The most likely cause is infection with:
A. Trypanosoma cruzi
B. Strongyloides stercoralis
C. Naegleria fowleri
D. Paragonimus westermani
B A latent infection with S. stercoralis acquired years before may cause severe symptoms in the immunosuppressed
patient ("autoinfective" capability of life cycle and migratory route of the larvae through the body).
In a pediatric patient, the recommended clinical specimen for recovery of Enterobius vermicularis is the:
A. Stool specimen
B. Sigmoidoscopy scrapings
C. Duodenal aspirates
D. Series of Scotch tape preparations
D In a pediatric patient, the most appropriate diagnostic test for recovery of Enterobius vermicularis eggs is a series of
Scotch tape preparations.
Which parasite causes eosinophilic meningoencephalitis, a form of larva migrans causing fever, headache, stiff neck, and
increased cells in the spinal fluid?
A. Necator americanus
B. Angiostrongylus cantonensis
C. Ancylostoma braziliense
D. Strongyloides stercoralis
B Eosinophilic meningoencephalitis is a form of larva migrans and is caused by A. cantonensis, the rat
lungworm. This Pacific area infection is associated with CSF symptoms and sometimes eye involvement.
"Cultures of parasites are different from bacterial cultures; no quality control is needed." This statement is:
A. True, if two tubes of media are set up for each patient
B. True, if the media are checked every 24 hours
C. False, unless two different types of media are used
D. False, and organism and media controls need to be set up
D Duplicate cultures should be set up, and specific American Type Culture Collection (ATCC) strains should be cultured
along with the patient specimens to confirm that the culture system is operating properly. This approach is somewhat
different from that used in diagnostic bacteriology and mycology
Protozoan cysts were seen in a concentration sediment and tentatively identified as Entamoeba coli. However, the
organisms were barely visible on the permanent stained smear because:
A. The organisms were actually not present in the concentrate sediment
B. There were too few cysts to allow identification on the stained smear
C. E. coli cysts were present but poorly fixed
D. The concentrate and permanent stained smear were not from the same patient
C As E. coli cysts mature, the cyst wall becomes more impenetrable to fixatives. Consequently, the cysts may be visible in
the concentrate sediment but appear very distorted or pale on the permanent stained smear.
When humans have hydatid disease, the causative agent and host classification are:
A. Echinococcus granulosus—accidental intermediate host
B. Echinococcus granulosus—definitive host
C. Taenia solium—accidental intermediate host
D. Taenia solium—definitive host
A The cause of hydatid disease is E. granulosus, and the human is classified as the accidental intermediate host.
Infection occurs when humans accidentally ingest the eggs of E. granulosus and the hydatid cysts develop in the liver,
lung, and other organs of the human instead of sheep (normal cycle).
A 45-year-old hunter developed fever, myalgia, and periorbital edema. He has a history of bear meat consumption. The
most likely causative agent is:
A. Toxoplasma gondii
B. Taenia solium
C. Hymenolepis nana
D. Trichinella spiralis
D Bear meat is another excellent source of T. spiralis. In this case, the patient had evidently consumed poorly cooked
bear meat, thus ingesting the encysted larvae
of T. spiralis.
In a condition resulting from the accidental ingestion of eggs, the human becomes the intermediate rather than the
definitive host. The correct answer is:
A. Trichinosis
B. Cysticercosis
C. Ascariasis
D. Strongyloidiasis
B The accidental ingestion of T. solium eggs can result in the disease called cysticercosis. The cysticerci will develop in a
number of different tissues, including the brain, and the human is the accidental intermediate host.
A transplant patient on immunosuppressive drugs developed increasing diarrhea. The most likely combination of disease
and diagnostic procedure is:
A. Trichinosis and trichrome stain
B. Microsporidiosis and modified trichrome stain
C. Toxoplasmosis and Gram stain
D. Paragonimiasis and wet preparation
B The fact that the patient has received a transplant, is on immunosuppressive drugs, and has continuing diarrhea
suggests microsporidiosis; the appropriate diagnostic test would be modified trichrome staining of fecal material.
After returning from a 2-year stay in India, a patient has eosinophilia, an enlarged left spermatic cord, and bilateral
inguinal lymphadenopathy. The most likely clinical specimen and organism match is:
A. Tin blood films—Leishmania
B. Urine—concentration for Trichomonas vaginalis
C. Tin blood films—Babesia
D. Tick blood films—microfilariae
D Based on the history, the most relevant procedure to perform is the preparation and examination of thick blood films for
the recovery and identification of microfilariae. The symptoms suggest early filariasis
Patients with severe diarrhea should use "enteric precautions" to prevent nosocomial infections with:
A. Giardia lamblia
B. Ascaris lumbricoides
C. Cryptosporidium spp.
D. Cystoisospora belli
C Cryptosporidium oocysts (unlike those of C. belli) are immediately infective when passed in stool, and nosocomial
infections have been well documented with this coccidian
A 60-year-old Brazilian patient with cardiac irregularities and congestive heart failure suddenly dies. Examination of the
myocardium revealed numerous amastigotes, an indication that the cause of death was most likely:
A. Leishmaniasis with Leishmania donovani
B. Leishmaniasis with Leishmania braziliense
C. Trypanosomiasis with Trypanosoma gambiense
D. Trypanosomiasis with Trypanosoma cruzi
D T. cruzi, the cause of Chagas disease, has two forms within the human: the trypomastigote in the blood and the
amastigote in the striated muscle (usually cardiac muscle and intestinal tract muscle).
When malaria smears are requested, what patient information should be obtained?
A. Diet, age, sex
B. Age, antimalarial medication, sex
C. Travel history, antimalarial medication, date of return to United States
D. Fever patterns, travel history, diet
C Travel history (areas of drug resistance), the date of return to the United States (primary versus relapse case), and
history of antimalarial medication and illness (severe illness, few organisms on smear) are very important questions to
ask. Without this information, a malaria diagnosis can be missed or delayed with severe patient consequences.
In an outbreak of diarrheal disease traced to a municipal water supply, the most likely causative agent is:
A. Cryptosporidium spp.
B. Cystoisospora belli
C. Entamoeba histolytica
D. Dientamoeba fragilis
A Cryptosporidium oocysts have been transmitted through contaminated municipal water supplies. Such outbreaks have
been well documented.
Within the United States, sporadic mini-outbreaks of diarrheal disease have been associated with the ingestion of
strawberries, raspberries, fresh basil, mesclun (baby lettuce leaves), and snow peas. The most likely causative agent is:
A. Dientamoeba fragilis
B. Cyclospora cayetanensis
C. Schistosoma mansoni
D. Cystoisospora belli
B The coccidian C. cayetanensis has been linked to mini-outbreaks of diarrheal disease. Epidemiological evidence
strongly implicates various berries, basil, mesclun, and snow peas as likely causes. These outbreaks are very sporadic
and tend to occur primarily in March through May
Which of the following statements is true regarding onchocerciasis?
A. The adult worm is present in the blood
B. The microfilariae are in the blood during the late evening hours
C. The diagnostic test of choice is the skin snip
D. The parasite resides in the deep lymphatics
C The adult O. volvulus reside in subcutaneous nodules, and the microfilariae are found in the fluids right under the outer
layers of skin; thus, the appropriate diagnostic test is the microscopic examination of skin snips for the presence of
The most prevalent helminth to infect humans is:
A. Enterobius vermicularis, the pinworm
B. Ascaris lumbricoides, the large intestinal roundworm
C. Taenia saginata, the beef tapeworm
D. Schistosoma mansoni, one of the blood flukes
A The pinworm, E. vermicularis, is the most common parasitic helminth infection throughout the world, and the eggs are
infective within just a few hours. Some have said, "You either had the infection as a child, have it now, or will have it again
when you have children."
A helminth egg is described as having terminal polar plugs. The most likely helminth is:
A. Hookworm
B. Trichuris trichiura
C. Fasciola hepatica
D. Diphyllobothrium latum
B The eggs of T. trichiura (the whipworm) have been described as being barrel shaped with a thick shell and two polar
Ingestion of which of the following eggs will result in infection?
A. Strongyloides stercoralis
B. Schistosoma japonicum
C. Toxocara canis
D. Opisthorchis sinensis
C The eggs of T. canis are infectious for humans and cause visceral larva migrans. These ascarid eggs of the dog can
infect humans; the eggs hatch and the larvae wander through the deep tissues, occasionally the eye. In this case, the
human becomes the accidental intermediate host.
Plasmodium vivax and Plasmodium ovale are similar because they:
A. Exhibit Schüffner's dots and have a true relapse in the life cycle
B. Have no malarial pigment and multiple rings
C. Commonly have appliqué forms in the red cells
D. Have true stippling, do not have a relapse stage, and infect old red cells
A Both P. vivax and P. ovale infect young red cells, have true stippling (Schüffner's dots), contain malarial pigment, and
have a true relapse stage in the life cycle.
The term internal autoinfection can be associated with the following parasites:
A. Cryptosporidium spp. and Giardia lamblia
B. Cystoisospora belli and Strongyloides stercoralis
C. Cryptosporidium spp. and Strongyloides stercoralis
D. Giardia lamblia and Cystoisospora belli
C Both Cryptosporidium and S. stercoralis have an internal autoinfection capability in their life cycles. This means that the
cycle and infection can continue even after the patient has left the endemic area. In the case of Cryptosporidium, the cycle
continues in patients who are immunocompromised and unable to self-cure.
Microsporidia have been identified as causing severe diarrhea, disseminated disease in other body sites, and ocular
infections. Routes of infection
have been identified as:
A. Ingestion
B. Inhalation
C. Direct contamination from the environment
D. Ingestion, inhalation, and direct contamination
D Infectious routes for microsporidial infections have been confirmed as ingestion and inhalation of the spores; direct
transfer of infectious spores from environmental surfaces to the eyes has also been reported.
An immunocompromised patient continues to have diarrhea after repeated ova and parasites (O&P) examinations
(sedimentation concentration, trichrome permanent stained smear) were reported as negative; organisms that might be
responsible for the diarrhea include:
A. Cryptosporidium spp., Giardia lamblia, and Cystoisospora belli
B. Giardia lamblia, microsporidia, and Endolimax nana
C. Taenia solium and Endolimax nana
D. Cryptosporidium spp. and microsporidia
D Routine O&P examinations usually do not allow the detection of Cryptosporidium spp. oocysts and microsporidial
spores; special stains are required. Modified acid-fast stains for coccidia and modified trichrome stains for the
microsporidial spores are recommended.
Confirmation of an infection with microsporidia can be achieved by seeing:
A. The oocyst wall
B. Sporozoites within the spore
C. Evidence of the polar tubule
D. Organisms stained with modified acid-fast stains
C Confirmation of an infection with microsporidial spores can be achieved by seeing evidence of the polar tubule within
the spores (horizontal or diagonal line across/within the spore).
Early ring stages of the fifth human malaria, Plasmodium knowlesi, resemble those of:
A. Plasmodium malariae
B. Plasmodium ovale
C. Plasmodium falciparum
D. Plasmodium vivax
C The early ring stages of Plasmodium knowlesi resemble those of P. falciparum.
Parasite stages that are immediately infective for humans on passage from the gastrointestinal tract include:
A. Schistosoma spp. eggs
B. Toxoplasma gondii bradyzoites
C. Giardia lamblia trophozoites
D. Cryptosporidium spp. oocysts
D Cryptosporidium spp. oocysts are immediately infectious when passed in the stool, regardless of the stool consistency
Older developing stages (trophs, schizonts) of the fifth human malaria, Plasmodium knowlesi, resemble those of:
A. Plasmodium malariae
B. Plasmodium ovale
C. Plasmodium falciparum
D. Plasmodium vivax
A The older developmental stages of Plasmodium knowlesi (trophs, schizonts) resemble those seen in infections with P.
malariae (band forms, rosette schizonts).
Autofluorescence requires no stain and is recommended for the identification of:
A. Entamoeba histolytica cysts
B. Toxoplasma gondii tachyzoites
C. Dientamoeba fragilis trophozoites
D. Cyclospora cayetanensis oocysts
D Autofluorescence requires no stain and is often recommended for confirmation of Cyclospora cayetanensis oocysts.
Key characteristics of infection with Plasmodium knowlesi include:

A. Rapid erythrocytic cycle (24 hr), will infect all ages of RBCs, and can cause serious disease
B. Erythrocytic cycle limited to young RBCs and causes a relatively benign disease
C. The possibility of a true relapse from the liver, infection in older RBCs, and causes serious disease
D. Extended life cycle (72 hr), will infect all ages of RBCs, and disease is similar to that caused by P. ovale
A Key characteristics of an infection with Plasmodium knowlesi include a rapid life cycle (24 hr), the potential to infect all
ages of RBCs, and the possibility of serious symptoms similar to those seen with P. falciparum infections. There is no
relapse from the liver with this species.
Microsporidial infections can be confirmed using:
A. Light microscopy and modified trichrome stains
B. Phase contrast microscopy and routine trichrome stains
C. Electron microscopy and modified acid-fast stains
D. Fluorescence microscopy and hematoxylin stains
A An infection with microsporidia can be confirmed using modified trichrome stains (10X the normal dye content found in
routine trichrome stains) and light microscopy. The internal polar tubule will be visible within some of the spores; this will
serve as confirmation of the infection.
Although the pathogenicity of Blastocystis hominis remains controversial, newer information suggests that:
A. Most organisms are misdiagnosed as artifacts
B. Numerous strains/species are included in the name, some of which are pathogenic and some are nonpathogenic
C. The immune status of the host is solely responsible for symptomatic infections
D. The number of organisms present determines
B The name Blastocystis hominis contains approximately
10 different strains/species that are morphologically identical; some are pathogenic and some are nonpathogenic.
Because we cannot separate these organisms by morphology, this probably explains why some patients are symptomatic
and some remain asymptomatic with this infection.
Potential problems using EDTA anticoagulant and holding the blood too long prior to preparation of thick and thin blood
films include:
A. Changes in parasite morphology, loss of organisms within several hours, and poor staining
B. Loss of Schüffner's dots, poor adherence of the blood to the glass slide, and parasites beginning the vector cycle within
the tube of blood
C. Neither A nor B
D. All of these options
D There are many changes that occur if blood is held longer than 1-2 hours prior to thick and thin blood film preparation.
These include changes in parasite morphology, loss of parasites, poor staining, poor adherence of the blood to the slide,
and the parasites beginning that portion of the life cycle that normally occurs within the vector. These changes are merely
one reason that the ordering, specimen collection, processing, examination, and reporting for thick/thin blood films are
considered STAT procedures.
Which of the following is a key characteristic of the thick blood film?
A. The ability to see the parasite within the RBCs
B. The ability to identify the parasites to the species level
C. The examination of less blood than the thin blood film
D. The necessity to lake the RBCs during or prior to staining
D With the thick blood film, there is more blood per slide than on the thin film, resulting in greater sensitivity. It is difficult to
identify the parasite to the species level from the thick blood film. The RBCs are "laked" while drying or during staining,
making it impossible to observe the parasites within the RBCs