You answered the question correctly.

The colonies seen in the upper frame, grown after 48 hours incubation aerobically at
35C, and the accompanying gram stain in the lower frame are uncommonly
associated with human disease, but have been associated with septicemia,
bronchopneumonia, osteomyelitis and other infections, particularly in intravenous
drug users. The most likely identification is:

The correct answer is highlighted below

Clostridium septicum
Bacillus circulans
Listeria monocytogenes
Lactobacillus species

Feedback

The clue to the identification of the colony seen in the upper frame is the gram stain in
the lower frame, in which are seen short, rounded, gram positive bacilli, many of
which possess distinct spores. As the colonies grew aerobically, the presence of
spores indicates Bacillus species. The colonies are spreading, smooth, yellow-white
and non-hemolytic. The lack of hemolysis and the small size of the bacterial cells
suggests a species other than Bacillus cereus, the species causing most human
infections. The isolate was identified as Bacillus circulans, which is consistent with
the gram stain morphology. Clostridium septicum also produces spores; however, this
species is an anaerobe and would grow poorly if at all and not produce spores
aerobically. Listeria monocytogenes and Lactobacillus species are gram positive
bacilli; however, neither of these produce spores.

Question Difficulty: Level 7

 You answered the question incorrectly.

Match the names of the organisms listed with the appropriate bucket indicating
whether each more commonly causes clinical disease via toxin production or via
direct invasion.

Your answers are on the left. The correct answers are on the right and highlighted.

Toxic infection Clostridium botulinum

Toxic infection Vibrio cholerae
Invasive infection Yersinia enterocolitica
Toxic infection Shigella sonnei

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Clostridium botulinum (toxins A, B and E most common), Vibrio cholerae (cholera

enterotoxin) and Shigella sonnei (shiga toxin) produce disease not by invasion of the
tissues, but by the release of toxins that act on specific receptors. Botulinum toxin is
an extremely potent neurotoxin, preformed in poorly preserved canned foods
contaminated with Clostridium botulinum organisms. The toxin blocks acetylcholine
release at peripheral nerve endings. Shiga and cholera-type toxins bind to gangliosides
in the epithelial cell membranes, primarily blocking sodium absorption, resulting in a
severe watery diarrhea syndrome. Yersinica enterocolitica, on the other hand,
produces enteritis by direct penetration of the bowel mucosa, resulting in terminal
ileitis, lymphadenitis and acute enterocolitis.

Question Difficulty: Level 9

You answered the question correctly.

The Optochin (ethylhydrocupreine hydrochloride) disc is MOST often used for the
identification of which organism?

The correct answer is highlighted below

Staphylococci aureus
Hemophilus influenzae
Streptococci pyogenes
Streptococci pneumoniae
 Staphylococci epidermidis

Feedback

The optochin test detects whether or not an organism is suseptible to optochin

(ethylhydrocupreine). Optochin tests the fragility of the bacterial cell membrane and
causes S. pneumoniae to lyse due to changes in surface tension. The optochin test is
widely used in the form of filter paper discs, impregnated with ethylhydrocupreine
hydrochloride, which are applied directly to inoculated plates before incubation. So,
optochin inihibits pneumococci but does not affect other a-hemolytic streptococci.

Question Difficulty: Level 4

You answered the question incorrectly.

Examples of organisms where molecular methods currently provide GREATER
specificity in identification (compared to current phenotypic methods) include:
(Choose all that apply.)

The correct answers are highlighted below

Corynebacterium and related genera

Klebsiella species
Nocardia and related genera
Dimorphic mycologic pathogens

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Even if organisms of interest easily survives transport and is readily recovered in

culture, current phenotypic identification protocols, based on biochemical reactions,
may not provide clear cut identification, especially among closely related species.
More frequently, molecular techniques such as sequencing methods are relied upon
for the definitive identification of Nocardia and Corynebacterium species. Molecular
methods for the confirmation of dimorphic fungal pathogens is also a common
practice.
Enterobacteriaciae such as Klebsiella can still be reliably and easily identified by
phenotypic (biochemical) methodologies.

Question Difficulty: Level 9

 You answered the question correctly.

This Gram-positive, catalase negative coccus is shown on sheep blood agar (beta-
hemolytic) with a disk of 0.04 U bacitracin and trimethoprim sulfamethoxadole. A
beta lysine-producing Staphylococcus aureus is streaked perpendicular to it. What is
the presumptive identification of this organism?

The correct answer is highlighted below

Streptococcus agalactiae
Streptococcus dysgalactiae
Staphylococcus lugdensis
Streptococcus pyogenes

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Streptococcus pyogenes is the correct answer. Streptococcus pyogenes is susceptible

to bacitracin, resistant to SXT, and is CAMP negative. Streptococcus agalactiae is
CAMP positive and you would see a large arrowhead where the isolate meets the
Staphylococcus aureus. Streptococcus dysgalactiae is susceptible to SXT and
resistant to bacitracin. Staphylococcus lugdensisis catalase positive.
 Question Difficulty: Level 6

You answered the question correctly.

Which two of the following organisms are gram positive?

The correct answers are highlighted below

Pasteurella
Erysipelothrix
Aeromonas
Lactococcus

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Erysipelothrix, a genus of bacteria containing a single species, are short gram-positive

rods. Lactococcus, a microbe formerly included in the genus Strep Group N1, are
gram-positive, catalase negative, non-motile cocci that are found singly, in pairs, or in
chains. Pasteurella and Aeromonas are both gram-negative microbes.

Question Difficulty: Level 7

You answered the question correctly.

Which of the following enzymes, produced by Staphylococcus aureus is responsible

for preventing penicillin antibiotics from being effective against a Staph infection?

The correct answer is highlighted below

Beta-lactamase
Coagulase
Catalase
Hyaluronidase

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Beta-lactamase is the enzyme, produced by Staphylococcus aureus, that is responsible
for preventing penicillin antibiotics from being effective against a Staph infection.
Beta-lactamase breaks down the beta-lactam antibiotics, e.g., penicillins,
cephalosporins, carbapenems and monobactams allowing S. aureus to be resistant to
these antibiotics.

Catalase distinguishes staphylococci from streptococci. The production of coagulase

distinguishes S. aureus from other staphylococci. Hyaluronidase aids S. aureus in skin
colonization/infection spread.

Question Difficulty: Level 4

You answered the question correctly.

The bacterial species commonly found in association with deep tissue actinomycosis
is:

The correct answer is highlighted below

Capnocytophaga ochracea
Streptococcus adjacens
Haemophilus aphrophilus
Actinobacillus actinomycetemcomitans

Feedback

The species name, actinomycetem comitans was first applied to this organism by
Klingler in 1912. "Comitans" is a contraction from the Latin, comitatus, which refers
to "escorts", particularly to the well borne-men attached to a king or chieftain (vis-a-
vis the secret service!). In any case, it is not uncommon to recover A.
actinomycetemcomitansfrom deep tissue infections primarily infected with
Actinomyces israeli and other Actinomycyes species (Tyrell, et al: Thoracic
actinomycosis complicated by Actinobacillus actinomycetemcomitans: case report
and review of the literature. Respir Med 86:341-343, 1992). The other bacterial
species listed in this exercise have shown no unique association with actinomycosis.

Question Difficulty: Level 3

 You answered the question incorrectly.

An occupation or avocation that should be avoided to prevent infection with

Francisella tularensis is:

The correct answer is highlighted below

Hunting and skinning small game

Raising quarter horses
Slaughtering pigs
Managing a dog kennel

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Francisella tularensis is a small gram negative cocco-bacillus that uses rabbits,

rodents, squirrels and other small mammals as reservoirs. Humans may become
infected through the bites of infected deerflies, ticks and spiders; or, less commonly
from the bites of squirrels or other rodents. Another common source of cutaneous
infection is the skinning of rabbits or squirrels, as the organism has the capability of
penetrating even the most minute breaks in the skin. Dogs, pigs and horses are
resistant to infection and do not pose a mode of transmission to humans, although
cases of tularemia have been reported following the bite or scratch of domestic cats,
which are susceptible to the organism.

Question Difficulty: Level 4

You answered the question correctly.

Which one of the following does NOT have capsular material as a defense
mechanism?

The correct answer is highlighted below

H. influenzae
K. pneumoniae
N. meningitidis
 S. aureus
S. pneumoniae

Feedback

S. aureus does not have capsular material as a defense mechanism. H. influenzae, K.

pneumoniae, N. meningitidis, and S. pneumoniae each have capsular material use as a
defense mechanism. This capsular material is an antiphagocytic substance which
helps deter bacterial death by macrophages and other white blood cells.

Question Difficulty: Level 6

You answered the question incorrectly.

India Ink is used to:

The correct answer is highlighted below

Visualize flagella
Visualize shape
Visualize capsule
Visualize cytoplasm

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India ink can aid in the visualization of the polysacchride capsules of yeast such as
Cryptococcus neoformans.

Question Difficulty: Level 5

You answered the question correctly.

Which of the following has a life cycle that most closely resembles that of
Plasmodium sp:

The correct answer is highlighted below

 Dracunculus medinensis
Blastocystis hominis
Babesia microti
Toxocara canis

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Like malaria, Babesia is a protozoan which infects red cells and produces a febrile
illness. Unlike malaria, which is spread by mosquitoes, Babesia is transmitted by
ticks.

Question Difficulty: Level 4

You answered the question correctly.

Each of the following bacterial species work synergistically to produce bacterial

vaginosis except:

The correct answer is highlighted below

Streptococcus agalactiae
Prevotella species
Gardnerella vaginalis
Mobiluncus curtisii

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Gardnerella vaginalis, Mobiluncus species, and various anaerobes, including

Prevotella species, Porphyromonas asaccharolytica, Fusobacterium nucleatum and
Peptostreptococcus species act in synergy to produce bacterial vaginosis (Spiegel CA:
Gardnerella vaginalis, in Mandel's Principles and Practice of Infectious Diseases,
Churchill Livingston, 3rd Ed, pp 1733-1735, 1990). Although beta hemolytic
streptococcus group B (Streptococcus agalactiae) may inhabit the vaginal canal,
particularly during pregnancy, it is not associated with bacterial vaginosis; rather, may
be a cause of postpartum and neonatal sepsis.

Question Difficulty: Level 7

 You answered the question correctly.

A gram-negative rod isolated from a burn patient produced a bluish green pigment
and the following test results:

Characteristic fruity odor

TSI: alkaline/alkaline
Motility: positive
Oxidase: positive
Oxidative/Fermentation Glucose: oxidative utilization only

The MOST probable genus of this isolate is:

The correct answer is highlighted below

Acinetobacter
Alcaligenes
Moraxella
Pseudomonas

Feedback

The organism that most closely fits the clinical and laboratory picture is a
Pseudomonas species. This microbe is associated with a bluish green pigment as well
as a characteristic fruity odor. The biochemical tests also match the expected results
for
Pseudomonas.

Question Difficulty: Level 3

You answered the question correctly.

Which one of the following combinations of organisms would be appropriate positive

and negative controls to verify the specific test functions listed?

The correct answer is highlighted below

Beta hemolysis Escherichia coli and Streptococcus pyogenes

 Catalase Staphylococcus aureus and Staphylococcus epidermidis
Hydrogen sulfide production proteus mirabilis and Salmonella typhi
Indole Escherichia coli and Klebsiella pneumonia
Carbohydrate fermentation Alcaligenes faecalis and Acinetobacter baumannii

Feedback

Escherichia coli and Klebsiella pneumoniae are two good quality control choices for
the indole test. E. coli is indole positive, while K. pneumoniae is indole negative. A
positive reaction is noted when there is a red layer at the top of the tube after the
addition of Kovcs reagent, while the negative result is a lack of color change in the
top of the tube after the addition of Kovcs reagent.

Question Difficulty: Level 6

You answered the question correctly.

Exudate from a burn submitted on a swab for bacterial culture grew a gram-negative
bacillus that was oxidase-positive, produced an alkaline slant and butt on TSIA, was
resistant to numerous antibiotics, and produced a green, water-soluble pigment. This
organism would be identified as:

The correct answer is highlighted below

Pseudomonas fluorescens
Pseudomonas aeruginosa
Stenotrophomonas maltophilia
Burkholderia cepacia

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Pseudomonas aeruginosa is the correct answer. Pseudomonas fluorescens,

Stenotrophomonas maltophilia, and Burkholderia cepacia do not produce a green,
water-soluble pigment.

Question Difficulty: Level 4

 You answered the question incorrectly.

The test used for the identification of specific capsular serotypes of Streptococcus
pneumoniae is:

The correct answer is highlighted below

Optochin
Bile solubility
Quellung
Hippurate hydrolysis

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The Quellung test is performed by mixing a light suspension of the suspected

organism with a small amount of type specific antiserum on a glass slide and
observing for the "swollen" appearance of the capsule to detect serogroup matches of
S. pneumoniae. Optochin susceptibility and bile solubility are helpful in
distinguishing S. pneumoniae from other alpha hemolytic streptococci, but do not
serve to distinguish the various serogroups. Hippurate hydrolysis is a test useful in the
differential identification of group B streptococci but has no use in the work up of
pneumococci.

Question Difficulty: Level 6

You answered the question incorrectly.

The pathogenicity of Staphylococcus aureus, as well as the frequency with which this
organism produces infections, can be attributed to:

The correct answers are highlighted below

Exfoliative toxin and enterotoxins

A porous cell wall
 Natural colonization/reservoir for infection
Hyaluronidase

Feedback

Staphylococcus aureus colonizes approximately 25 - 30 % of the general population,

providing significant reservoirs of organism for transmission. In addition, it produces
a number of different enzymes and toxins, including (but not limited to) exfoliative
toxin, enterotoxins, hyaluronidase and lipase, and beta lactamases.

The cell wall of S. aureus is not porous. Structural components of its cell wall
function as a protective barrier, aid in adherence to mucous membranes, and allow the
organism to resist phagocytosis.

Question Difficulty: Level 9

You answered the question incorrectly.

Hippurate hydrolysis is an important characteristic in the definitive laboratory

identification of streptococci. The positive ninhydrin reaction, seen in the left tube in
the photograph, is produced by:

The correct answer is highlighted below

Streptococcus agalactiae
Streptococcus bovis
Streptococcus pneumoniae
Enterococcus faecalis
Feedback

Streptococcus agalactiae (group B beta hemolytic streptococcus) is unique among the

streptococci (except for occasional strains of Group G streptococci) in its ability to
hydrolyze hippurate to benzoic acid and glycine. The positive blue reaction seen in
the left tube in the photograph illustrates the presence of glycine, after the addition of
ninhydrin reagent. All of the other streptococci listed in this exercise and
Enterococcus species do not hydrolyze hippurate.

Question Difficulty: Level 6

You answered the question incorrectly.

Illustrated in this photograph is an agar plate on which an unknown species has been
inoculated. A 5ug novobiocin disk, a 100ug furazolidone disk, and a 0.04ug bacitracin
("A") disk had been applied immediately after inoculation of the plate. Based on the
pattern of the zones of inhibition to these three antibiotics, the most likely
identification is:

The correct answer is highlighted below

Micrococcus luteus
Staphylococcus saprophyticus
Streptococcus pyogenes
Staphylococcus epidermidis

Feedback
Resistance to furazolidone is one of the key characteristics by which members of the
genus Micrococcus (resistant) can be separated from members of the genus
Staphylococcus (susceptible). Micrococcus species also are susceptible to novobiocin
and to bacitracin, although the zone of inhibition to the "A" disk is often small (as
shown in this photograph). In addition to the resistance to furazolidone, S.
saprophyticus can also be ruled out in this exercise since it is resistant to novobiocin,
where the unknown organism shown here is susceptible. S. epidermidis is also
susceptible to furazolidone and is resistant to the "A" disk. Streptococcus pyogenes
would also be susceptible to furazolidone but would give a much larger zone of
inhibition around the "A" disk than is seen in this photograph.

Question Difficulty: Level 8

You answered the question correctly.

The most likely primary site of infection represented by the Staphylococcus species
growing on the surface of this agar plate with a 2mm zone of inhibition around a 5ug
novobiocin disk is:

The correct answer is highlighted below

The genital tract

The urinary tract
The respiratory tract
The central nervous system

Feedback
Although a narrow zone of inhibition is observed around the novobiocin disk seen in
this photograph, a zone of less than 12mm is considered resistant. Resistance to
novobiocin is one of the key characteristics in the identification of Staphylococcus
saprophyticus. The most common site of infection with this bacterial species is in the
urinary tract of healthy, sexually active women (Hovelius, et al: Rev Infect Dis 6:328-
337, 1984). This organism can also cause prostatitis in older men, catheter related
sepsis and endocarditis; however, is virtually never associated with infections of the
lungs, genital tract or central nervous system. The only exception in the latter would
be infection of a CNS shunt or catheter.

Question Difficulty: Level 5

You answered the question incorrectly.

Match the names of each of the bacterial species listed with its most likely appearance
on the agar plates illustrated in the photographs. Image A is xylose-lysine-
deoxycholate (XLD) agar, Images B and C are Hektoen Enteric (HE) agar, and Image
D is DNA agar.

Your answers are on the left. The correct answers are on the right and highlighted.

Salmonella typhimurium A
Morganella morganii B
Enterobacter cloaecae C
Serratia marcescens D

Feedback
Morganella morganii does not produce H2S gas, is lactose negative and does not
hydrolyze DNA. Therefore, it would appear as the clear, lactose negative colonies
seen in Image B. Of the bacterial species listed, only Serratia marcescens is capable
of hydrolyzing DNA; thus, would appear as the colonies in Image D. Although S.
marcescens could produce colonies similar to those seen in Image B, by elimination
in this exercise, Image D is the correct match. Salmonella typhimurium produces both
H2S and decarboxylates lysine. Thus, the black colonies (H2S) and the red ring around
the colonies (lysine decarboxylation) are key colony characteristics when grown on
XLD agar. Of the species listed, only Enterobacter cloacae is a lactose fermenter;
therefore, will produce the colonies seen in Image C.

Question Difficulty: Level 9

You answered the question correctly.

Which of the following statements about Rickettsia is false:

The correct answer is highlighted below

They are obligate intracellular parasites

They are gram negative bacilli
Associated diseases are usually diagnosed by serology
They are cultured in many hospital laboratories

Feedback

Various Rickettsial species cause typhus, Rocky Mountain spotted fever,

Rickettsialpox, and Q fever. Rickettsial organisms are cultured only by research and
reference laboratories, and the diagnosis is usually achieved by a combination of
clinical findings, and acute and convalescent serology. Early diagnosis of Rocky
Mountain spotted fever can also be made by immunoflourescence testing of a skin
biopsy, where Rickettsia can often be found within endothelial cells of capillary
vessels.

Question Difficulty: Level 5

You answered the question correctly.

Match the names of each of the infectious diseases listed with its most likely
corresponding mycobacterial agent.

Your answers are on the left. The correct answers are on the right and highlighted.

Regional ileitis (Chron's disease) Mycobacterium paratuberculosis

Swimming pool granuloma Mycobacterium marinum
Bairnsdale ulcer Mycobacterium ulcerans
Urinary bladder carcinoma Mycobacterium bovis

Feedback

The designation Bairnsdale ulcer has been used for the cutaneous lesions caused by
Mycobacterium ulcerans, after the Australian town where the infection was first
recognized (Radford AJ: Aust NZ J Med 5:162-169, 1973). BCG strains of
Mycobacterium bovis have been used in urinary tract irrigation fluids as a stimulus for
the production of anti-tumor antibodies in cases of carcinoma in situ of the urinary
bladder. Although controversial and currently unsettled, some workers have linked
regional enteritis (Crohn's disease) with intestinal infections with Mycobacerium
paratuberculosis (Chiodini RJ, et al: JCM 20:966-971, 1984). Swimming pool
granuloma is a term used to describe a subcutaneous infection, usually of the knees
and elbows, caused by Mycobacterium marinum, a mycobacterial species that may
colonize the water in swimming pools and fish tanks. The port of entry is through skin
abrasions that may occur when swimmers scrape their knees or elbows on roughened
concrete walls of swimming pools.

Question Difficulty: Level 7

You answered the question incorrectly.

Individuals with latent tuberculosis infections (LTBI) harbor viable Mycobacterium

tuberculosis organisms, but have no symptoms of disease and are not infectious.
Approximately what percentage of persons with LTBI who are not treated will
develop active disease at some point?

The correct answer is highlighted below

5 - 10%
30 - 40%
50 - 60%
70 - 80%
Feedback

About 5 - 10% of persons infected with M. tuberculosis, who are not treated, will
develop tuberculosis disease during their lifetime.

Question Difficulty: Level 8

You answered the question incorrectly.

The diagnosis of diphtheria must be confirmed by:

The correct answer is highlighted below

Observing metachromatic granules in a methylene blue stain of an oropharyngeal

swab
Recovering Corynebacterium diphtheriae in culture
Performing a biochemical identification of a culture isolate
Determining that a culture isolate is a toxin producing strain

Feedback

In a case of suspected diphtherial pseudomembranous pharyngitis, although

microscopic observation of a gram stain of an oropharyngeal swab may reveal a
predominance of gram positive bacilli with a diphtheroidal arrangement that show
metachromatic granules in a methylene blue stain, and an isolate both
morphologically and biochemically consistent with C. diphtheriae is recovered in
culture, the final confirmation of diphtheria infection cannot be made until it is
demonstrated that the strain in question produces diphtheria toxin. Non-toxin
producing strains of C. diphtheriae can colonize the upper respiratory tract of humans
and only those strains infected with B phage that produce diphtheria toxin will result
in the full blown syndrome.

Question Difficulty: Level 7

You answered the question incorrectly.

The tubes below are the Hugh and Liefson O/F basal medium with glucose and a pH
indicator of bromthymol blue. The image below demonstrates a typical reaction for
which organism?

The correct answer is highlighted below

Escherichia coli
Shigella sonnei
Aeromonas hydrophila
Pseudomonas aeruginosa

Feedback

Pseudomonas aeruginosa is the correct answer because the tubes demonstrate a

glucose non-fermenter and Pseudomonas is the only non-glucose fermenter listed. If
glucose had been fermented, both tubes would be yellow, demonstrating fermentation.

Question Difficulty: Level 7

 You answered the question incorrectly.

In order to speciate a swarming Proteus organism found on an eosin methylene blue

agar plate, the BEST approach would be to:

The correct answer is highlighted below

inoculate to a 4% agar plate and subculture to McConkeys

determine motility and lysine decarboxylase activity
determine Indole production, phenylalanine and urease activity
determine utilization of sodium acetate and citrate
inoculate a tube of thioglycolate broth

Feedback

In order to speciate a swarming Proteus mirabilis organism found on an eosin

methylene blue agar plate, the BEST approach would be to determine Indole
production, phenylalanine and urease activity. P. mirablis is strongly urease and
phenylalanine positive. P. mirabilis is usually indole-negative- which is helpful to
differentiate this organism from P. vulgaris which is indole-positive.

Question Difficulty: Level 5

You answered the question correctly.

Illustrated in this photograph, reading from left to right, are biochemical reactions for
indole, Voges Proskauer, Simmons citrate and Christensen's urea. The bacterial
species providing the best fit for the reactions illustrated is:

The correct answer is highlighted below

Salmonella typhimurium
Citrobacter koseri
Klebsiella oxytoca
Enterobacter cloacae

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The bacterial species that best fits the four positive reactions of the characteristics
shown here is Klebsiella oxytoca. The partial or weak urease reaction (slant only) in
particular is in keeping with the genus Klebsiella, although some Enterobacter species
may show a similar reaction. In this exercise, however, Enterobacter cloacae is ruled
out because none of the species produce indole. K. oxytoca is the only Klebsiella
species that is indole positive. Salmonella typhimurium does not produce indole and is
urease inactive; Citrobacter koseri is VP negative.

Question Difficulty: Level 6

You answered the question correctly.

My home is in the stomach coat,

Urea serves as my anecdote.

The correct answer is highlighted below

 Bordetella canis
Campylobacter jejuni
Helicobacter pylori
Staphylococcus intermedius

Feedback

The slender, undulating bacteria seen at the tip of the arrow in the biopsy shown in the
photomicrograph is consistent with Campylobacter species or Helicobacter species.
The positive urea reaction shown in the photograph rules out Campylobacter species,
all members of which do not possess urease activity. Although Bordetella
bronchiseptica has high urease activity, it is not found in the stomach. Staphylococcus
intermedius, and other coagulase negative staphylococci also hydrolyze urea and may
reside in the stomach mucosa; however, they are cocci and not the bacilli shown here.
The high urease activity allows H. pylori to surround itself with an ammonia cloud,
thus neutralizing the effects of the low acid pH of the gastric acid and permitting
habitat in such a hostile environment.

Question Difficulty: Level 3

You answered the question incorrectly.

The most common rapid slide test (MONOSPOT) for infectious mononucleosis
employs:

The correct answer is highlighted below

Horse erythrocytes
Sheep erythrocytes
Intact beef erythrocytes
None of the above

Feedback

A positive spot test shows agglutination of horse erythrocytes when added to patient
serum previously absorbed with guinea pig kidney, but not when added to patient
serum previously absorbed with beef erythrocyte stroma. The test is generally simple,
sensitive, and specific, but false negative are common in young children with
mononucleosis.
 Question Difficulty: Level 5

You answered the question correctly.

What is the most helpful feature in differentiating the Zygomycetes from the other
hyaline molds in the clinical mycology laboratory?

The correct answer is highlighted below

The production of rhizoids

The production of spores within sporangia
The formation of aseptate hyphae

Feedback

The production of spores within sporangia is unique to the Zygomycetes.

Although the production of rhizoids and the formation of aseptate hyphae are
characteristics of the Zygomycetes, these are not constant characteristics for all
species or at all times during maturation. Only Rhizopus and Absidia species regularly
produce rhizoids and occasional septations can be seen in the hyphae of each of the
Zygomycetes as the colonies mature, particularly in the sporangiophores.

Question Difficulty: Level 7

You answered the question incorrectly.

Illustrated in this photograph are latex agglutination reactions of an unknown beta
hemolytic streptococcus recovered from a blood culture. Of the choices in this
exercise, the most likely primary infection with the bacterial species represented is:

The correct answer is highlighted below

Endometritis in a pregnant female

Liver abscess
Deep wound cellulitis
Acute suppurative pharyngitis

Feedback

The answer to this question may best be derived by the process of elimination. Beta
streptococci of all groups can be associated with each of the infections listed in this
exercise. However, among the different groups, there are some more likely
associations. Endometritis in a pregnant female is more likely to be caused by S.
agalactiae (group B), liver abscess by S. milleri(anginosus) (group F) and acute
suppurative pharyngitis by S. equi (group C). Deep wound cellulitis is not
uncommonly caused by Streptococcus group G, and would be the best answer here by
elimination in view of better candidates among the choices for the other conditions
listed.

Question Difficulty: Level 7

You answered the question correctly.

The media used to isolate Legionella pneumophilia should contain which of the
following additives?

The correct answer is highlighted below

X and V factors
Hemin and vitamin K
Charcoal and yeast extract
Dextrose and laked blood
Lactose and vitamin E

Feedback

When yeast extract and activated charcoal are added into Feeley Gorman (F-G) agar,
the components enhanced the ability to support the growth of Legionella spp. Yeast
extract serves as the protein source. Activated charcoal decomposes hydrogen
peroxide and other toxic products to allow for a better yield of Legionella spp.
growth.

Question Difficulty: Level 5

You answered the question correctly.

Influenza B or C related illnesses tend to be more severe than those caused by

influenza A

The correct answer is highlighted below

True
False

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Influenza A viruses typically cause more severe infections than those of influenza B
or C viruses.

Question Difficulty: Level 4

 You answered the question incorrectly.

Which of the following statements about the HBV vaccine is INCORRECT?

The correct answer is highlighted below

The vaccine is effective in 90% of cases.

Employers may require a fee to administer the vaccine.
Side effects are rare and minimal.
The vaccine is administered over a six-month period.

Feedback

Employers CANNOT charge employees a fee to administer the vaccine. The OSHA
Standard requires that the vaccine be administered free to employees who may be
exposed to infection.
The vaccine is at least 90% effective when administered as prescribed by the
manufacturer, which involves three doses administered over a six-month period.

Side effects are rare but may include redness and pain at the site of injection

Question Difficulty: Level 4

You answered the question correctly.

Match the illustrations with the corresponding description of colony edges:

Your answers are on the left. The correct answers are on the right and highlighted.

Irregular A
Plateau B
Crenated C

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A- Irregular

B- Plateau

C- Crenated

Question Difficulty: Level 3

You answered the question incorrectly.

Which of the following is NOT a possible cause of cell death after HIV infection?

The correct answer is highlighted below

Cytoplasmic leakage
Depletion of T-lymphocytes, replaced by syncytia
Penetration of the membrane by the HIV spike
Depletion of cellular components

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The gp120 protein spikes are scattered about the surface of the HIV virus particle.
The spikes help the virus attach to macrophages. The spikes themselves do not
penetrate cell membranes.

Question Difficulty: Level 7

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Most individuals infected with the 2009 Influenza A H1N1 virus do not require
treatment.

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True
False

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Most individuals infected with the 2009 Influenza A H1N1 virus do not require
treatment as the body is able to effectively produce an immune response against the
virus. In some individuals, such as those who may be hospitalized or those with
underlying conditions, may require treatment.

Question Difficulty: Level 6

You answered the question correctly.

A three-year-old female was seen in a local ear, nose and throat specialist for chronic
ear pain. She had been treated several times for otitis media by her pediatrician with
no resolution. Drainage from her ear grew an acid fast bacillus that gave the following
biochemical reactions:

Iron Uptake- Positive

Nitrate reduction- Positive
Arylsulfatase - Positive
MacConkey agar growth, 5 days- Positive

It should be identified as:

The correct answer is highlighted below

Mycobacterium avium complex

Mycobacterium fortuitum
Mycobacterium chelonae
Mycobacterium kansasii

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B is the correct answer since only Mycobacterium fortuitum is positive for iron
uptake, nitrate, arysulfatase, and growth on MacConkey agar without crystal violet in
five days.

Question Difficulty: Level 8

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Which of the following does not pose a significant risk of transmitting bloodborne
pathogens?

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Blood
Semen
Pleural fluids
Sweat
Bloody urine

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Sweat is a body fluid that does not pose a high risk of bloodborne pathogen
transmission. Each of the other fluids listed can transmit bloodborne pathogens.

Question Difficulty: Level 3

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Illustrated in this photograph is a sulfide indole motility (SIM) tube (left) and an
esculin hydrolysis slant (right) after inoculation with an unknown gram positive
bacillus and incubation at 30C for 24 hours. Based on the reactions observed, the
most likely identification is:

The correct answer is highlighted below

Listeria monocytogenes
Erysipelothrix rhusiopathiae
Kurthia species
Lactobacillus species

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The tip of the arrow pointed to the SIM tube illustrates the typical subsurface
umbrella-shaped motility characteristic of Listeria monocytogenes. The motility is
best demonstrated at incubation temperatures of 25 - 30C. The hydrolysis of esculin
as indicated by the black pigment in the right tube helps to confirm this identification
as all of the other bacterial species listed are esculin negative. This is an important
differentiation from Kurthia species, most strains of which are motile. E.
rhusiopathiae and Lactobacillus species are not motile.

Question Difficulty: Level 5

 You answered the question correctly.

An eleven year old boy developed signs and symptoms of acute appendicitis. At
surgery, the appendix was found to be ruptured and encased in a 3 cm in diameter
abscess. Aspiration material was inoculated to an anaerobic blood agar plate. Small,
gray, nonhemolytic, semiopaque colonies grew anaerobically in 36 hours. The upper
photograph illustrates the gram stain features of the organism; the lower photograph is
a Presumpto plate indicating the biochemical reactions (reading clockwise from the
12 o'clock quadrant): growth in 20% bile agar, indole negative, esculin hydrolysis
positive and lecithinase negative. The bacterial species most likely associated with the
abscess is:

The correct answer is highlighted below

Bacteroides fragilis
Fusobacterium nucleatum
Porphyromonas asaccharolytica
Prevotella intermedia

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Bacteroides fragilis is the anaerobe most commonly recovered from human

infections, particularly those that occur "below the diaphragm". It is commonly
associated with parappendiceal abscesses. The organism grows readily on anaerobic
blood agar in an anaerobic atmosphere and produces small, gram negative bacilli with
rounded ends, as seen in the upper photograph. Characteristic of the genus is the
ability to grow in 20% bile and to hydrolyze esculin (shown by the growth in the bile
quadrant and black pigment in the esculin quadrant in the lower photograph), two key
characteristics that separate the B. fragilis group from Prevotella species and
Porphyromonas species, which are negative for both. Fusobacterium nucleatum can
also be associated with intra abdominal cavity abscesses; however, the bacterial cells
are slender and tapered and growth is inhibited by 20% bile, esculin is not produced
but the indole reaction is positive.

Question Difficulty: Level 4

You answered the question correctly.

Beta-lactam antibiotics interfere with cell wall synthesis by:

The correct answer is highlighted below

Binding with a transpeptidase

Preventing the final stage of peptidoglycan synthesis
Interfering with PBPs
All of the above

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Transpeptidase enzymes catalyze the final stage of peptidoglycan synthesis during

cell wall formation. Beta-lactam antibiotics bind with these enzymes, interfering with
their function. The transpeptidase enzymes are also referred to as PBP's, or penicillin-
binding proteins.

Question Difficulty: Level 3

You answered the question correctly.

Beta-lactam antibiotics interfere with cell wall synthesis by:

The correct answer is highlighted below

Binding with a transpeptidase

Preventing the final stage of peptidoglycan synthesis
Interfering with PBPs
 All of the above

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Transpeptidase enzymes catalyze the final stage of peptidoglycan synthesis during

cell wall formation. Beta-lactam antibiotics bind with these enzymes, interfering with
their function. The transpeptidase enzymes are also referred to as PBP's, or penicillin-
binding proteins.

Question Difficulty: Level 3

You answered the question correctly.

In order to avoid falsely elevated spinal fluid cell counts one should:

The correct answer is highlighted below

Use an aliquot only from the first tube collected

Use only those specimens showing no turbidity
Centrifuge all specimens before counting
Select an aliquot from the last tube collected

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In order to avoid falsely elevated spinal fluid cell counts one should select an aliquot
from the last tube collected. Cellular elements can enter the spinal fluid collection
tube when the the skin is pierced or punctured in a way that causes increased bleeding
(traumatic tap), leading to falsely elevated spinal fluid counts. Often, laboratories will
perform spinal fluid cell counts on tubes 1 and 4 or tube 4 only, in order to assess the
validity of the cell count and to ensure that traumatic taps did not affect the fluid
count results.

Question Difficulty: Level 5

You answered the question incorrectly.

The well circumscribed cutaneous papule with the distinct outer erythematous border
illustrated in the upper photograph developed over a period of 5 days at the site of a
tick bite. The lower photograph illustrates colonies growing on a buffered charcoal
yeast extract agar plate that had been inoculated with material from the ulcer bed three
days before. Tiny, pale-staining gram negative coccobacilli were seen on gram stain.
The most likely causative agent is:

The correct answer is highlighted below

Bacillus anthracis ("malignant pustule")

Erysipelothrix rhusiopathiae (erysepeloid)
Francisella tularensis
Streptococcus pyogenes (pyoderma)

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Although the pustule seen in the upper photograph may be observed during the
evolution of the cutaneous infections causes by each of the bacterial species listed, in
this exercise, it is specifically characteristic of Francisella tularensis. A pustule such
as this develops at the site of the bite of an infected tick, caused by the proliferation of
the injected organisms within the subcutaneous tissue. The inflamed area first
develops into a painful, erythematous pustule, that in time ulcerates centrally and
becomes covered by a dark gray or black eshcar. F. tularensis has a growth
requirement for cysteine and cystine, which is provided by the yeast extract in the
BCYE agar. The other bacterial species listed do not have this growth requirement
and will grow well on routine blood agar. Of pustule-producing bacterial species
listed, only F. tularensis is gram negative. Bacillus anthracis is a spore-forming gram
positive bacillus, Erysipelothrix rhusiopathiae a non-spore forming gram positive
bacillus and Streptococcus pyogenes a gram positive coccus in chains.
 Question Difficulty: Level 6

You answered the question correctly.

A Gram-negative rod from a stool culture produces red colonies with black centers on
XLD (Xylose Lysine Decarboxylase) agar. When it is inoculated to triple sugar iron
agar and lysine iron agar, it should appear as which of the sets of tubes in the
photograph below?

The correct answer is highlighted below

Left
Middle
Right
None of these

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The set on the left is the correct answer because if a colony is red with black centers
on XLD, it will have H2S on TSIA and LIA, be a nonlactose fermenter, and lysine
positive. This isolate is likely to be Salmonella. The middle tubes are H2S negative
and lysine negative. The right set of tubes demonstrate lactose or sucrose fermentation
and no production of H2S.

Question Difficulty: Level 5

You answered the question incorrectly.

The colonies growing on the surface of a thiosulfate citrate bile sucrose (TCBS) agar
plate (the green color indicates lack of sucrose fermentation) were identified as Vibrio
vulnificus. The serious untoward complication of infections with this bacterial species
is:

The correct answer is highlighted below

Life-threatening septicemia
Cholera-like diarrheal syndrome
Progressive cellulitis and gas gangrene
Severe electrolyte imbalance

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Vibrio vulnificus has been incriminated in several cases of fatal septic infection, either
after ingestion of contaminated seafood or following wound infections upon exposure
in contaminated sea water (Janda JM, et al: Clin Micribiol Rev 1:245-267, 1988). This
bacterial species has the particular predilection for reaching the blood stream, either
by invading the intestinal mucosa in cases of gastrointestinal infection or via the
subcutaneous lymphatics in wound infections. A diarrheal syndrome is usually not
part of the picture and electrolyte imbalance usually does not ensue. The wound
infections do not produce gas gangrene.

Question Difficulty: Level 8

You answered the question correctly.

A 22 year old construction worker incurred 3rd degree burns to the chest and arms
when a boiler he was installing blew up. On the 5th hospital day the weeping wounds
became infected, exuding what was described as green pus. The photograph illustrates
the gram stain prepared on a direct smear of the exudate. The most likely bacterial
cause of the infection is:

The correct answer is highlighted below

Chryseobacterium indologenes
Alcaligenes faecalis
Acinetobacter baumannii
Pseudomonas aeruginosa

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Pseudomonas aeruginosa is the nonfermenter that is most frequently recovered from

clinical specimens. It is a bacterial species that will accumulate wherever moisture
tends to accumulate, and is one of the most frequent causes of infections in patients
with burns (Bodey, et al: Rev Infect Dis 5:279-313, 1983). It is a slender gram
negative bacillus, similar to that seen in the photomicrograph. The clue to its
identification is the description of "green pus", usually with a grape-like odor, from
the production of pyocyanin. Neither the bacterial cells of Chryseomonas indologenes
(which you will remember was Flavobacterium) and Alcaligene faecalis may appear
similar to those seen in the photomicrograph; however, neither of these species are
commonly associated with burn infections and do not produce pyocylanin. Although
Acinetobacter baumannii may be associated with wound and burn infections, the
bacterial cells are short and coccobacillary and would not be confused with P.
aeruginosa.

Question Difficulty: Level 3

You answered the question incorrectly.

Which of the following serological tests would be used for the diagnosis of Q-fever:

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Weil-Felix test
Quellung test
EIA or indirect immunoflourescence
Cold agglutinin test

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These tests are more sensitive and specific for Q fever than the traditional
complement fixation test.

Question Difficulty: Level 7

You answered the question correctly.

If a TSI agar slant shows a neutral or slightly alkaline slant, acid butt, no/gas
production, and no H2S production, the organism might be:

The correct answer is highlighted below

Salmonella typhi
Proteus vulgaris
 Shigella dysenteriae
Proteus mirabilis

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Salmonella and Proteus both produce H2S, while Shigella does not. Therefore, out of
the choices listed, it could only be Shigella.

Question Difficulty: Level 6

You answered the question incorrectly.

Which method is employed if the following procedural steps were used to identify M.
kansasii?

1 - Extraction
2 - Denaturization
3 - Hybridization
4 - Hydrolysis of excess reagent
5 - Detection of acridinium ester

The correct answer is highlighted below

Polymerase chain reaction

Indirect fluorescent microscopy
Nucleic acid probes
Lysis-centrifugation
Double-diffusion electrophoresis

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The steps listed here are included within the nucleic acid probes procedure for M.
kansasii:

1 - Extraction
2 - Denaturization
3 - Hybridization
4 - Hydrolysis of excess reagent
5 - Detection of acridinium ester
 Question Difficulty: Level 8

You answered the question correctly.

Each of the following properties inherent in a bacterium contribute to the virulence

except:

The correct answer is highlighted below

Presence of a polysaccharide capsule

Production of a proteolytic enzymes
Production of opsonins
Presence of surface membrane attachment receptors

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Opsonins are not inherent part of the bacterial cell, nor are they produced by the
bacterium. Opsonins are factors present in body fluids that actually work to the
disadvantage of the bacterium, enhancing their susceptibility to phagocytosis. The
presence of a polysaccharide capsule helps to prevent phagocytosis and protect
against the oxidative burst of neutrophil lysosomal granules if phagocytosis does
occur. The production of proteolytic enzymes such as leukocidens, beta lactamases
and lecithinases serve as virulence factors to help destroy phagocytes, neutralize
antibiotics and interrupt host cell membranes respectively. Many bacterial cells can
cause infections only if they can attach via surface receptors that are complementary
to host mucous membrane surfaces, such as the uropathogenic strains of E. coli that
attached to the urothelium of the kidney drainage system and urinary bladder.

Question Difficulty: Level 5

You answered the question correctly.

Humans become infected with sylvatic plague by:

The correct answer is highlighted below

 Ingesting food or water contaminated with rat urine
The bite of a rodent
Wading in water infested with rats
The bites of rat fleas

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In the western United States, the agent of sylvatic plague, Yersinia pestis, is carried by
prairie dogs, mice, wild rabbits and rats. The organism is transferred from rodent to
rodent or to humans from the bites of infected rat fleas. A bite wound by one of these
rodents would e a most unlikely mode of infection. Ingestion of contaminated water
or food or wading in rat infested waters do not represent modes of infection by this
organism.

Question Difficulty: Level 6

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Which nitrogenous base would bind with thymine in forming double-stranded DNA?

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Adenine
Cytosine
Uracil
Guanine

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Thymine and adenine base pair while cytosine base pairs with guanine.

Question Difficulty: Level 5

 You answered the question correctly.

Which two of the following organisms are gram positive:

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Haemophilus
Enterobacteriaceae
Peptostreptococcus
Streptococcus

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Peptostreptococcus and Streptococcus are both gram positive organisms.

Haemophilus and members of the family Enterobacteriaceae are gram negative
organisms.

Question Difficulty: Level 5

You answered the question incorrectly.

The bacterial species shown in this composite photograph of a chocolate agar plate
and accompanying gram stain, recovered from an autopsy blood culture of a patient
dying with Waterhouse Friderichsen syndrome is most likely:
The correct answer is highlighted below

Moraxella catarrhalis
Neisseria gonorrhoeae
Neisseria meningitidis
Acinetobacter baumannii

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Of the bacterial species listed in this exercise, Neisseria meningitidis is the primary
cause of Waterhouse Friderichsen syndrome. The small, entire, opaque, smooth
colonies (illustrated on the chocolate agar plate in the upper frame) are consistent with
N. meningitidis and the gram stain (lower frame) shows gram-negative diplococci.
Waterhouse Friderichsen syndrome is a fatal, disseminated form of meningococcemia
in which microthrombi from throughout the vasculature secondary to disseminated
intravascular coagulation (DIC), with the terminal event being acute bilaterial
hemorrhage into the adrenal glands. Other bacterial species, notably certain strains of
Staphylococcus aureus, Pneumococcus pneumoniae and Haemophilus influenzae, on
occasion can cause Waterhouse Friderichsen syndrome. However, N. meningitidis is
by far and away the leading cause.

Question Difficulty: Level 5

You answered the question incorrectly.

"If a pregnant woman be attacked,

by erysipelas of the womb,
it is fatal." Hippocrates
The correct answer is highlighted below

Streptococcus pyogenes
Streptococcus agalactiae
Listeria monocytogenes
Brucella abortis

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The rapidly fatal disease of pregnant women in older times, called erysipelas or
"Peurperal Fever", shown by Semmelweis to be transmitted from patient to patient in
birthing suites, via the unwashed hands of the nurses, physicians and midwives.
Streptococcus pyogenes (group A streptococci) produces small, translucent colonies
surrounded by a wide zone of beta hemolysis, as shown in the upper photograph and
gram positive cocci in chains (lower photomicrograph). Group A streptococcus is the
most universal agent causing this syndrome, although other bacterial species such as
E. coli and C. perfringens may from time to time be involved. Group B streptococci
(S. agalactiae), although an agent of infection during childbirth, is more likely to
severely affect the neonate than the mother, although infrequent cases of puerperal
sepsis cannot be totally ruled out. Listeria monocytogenes also can be involved in
abortion, maternal endometritis and neonatal meningitis; however, the mode of
transmission is usually through ingestion of contaminated foods and not via the
mechanism described here. Brucella abortis also can result in abortion and paranatal
infections; however, the acute fevers are not usually experienced, rather a more
chronic, low grade, undulating pattern is more common.

Question Difficulty: Level 8

You answered the question incorrectly.

For each of the spot tests illustrated in the photographs, match each of the bacterial
species for which the positive reaction shown is most helpful in making a presumptive
identification:

Your answers are on the left. The correct answers are on the right and highlighted.

Aeromonas hydrophila A
Staphylococcus intermedius B
Beta streptococcus, group A C
Escherichia coli D

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The "test most helpful in making the presumptive identification" is the key to the
answers to this question. The "best" presumptive test for Staphylococcus intermedius
is catalase (Image B). Escherichia coli is also catalase positive; however, this is a
general characteristic for all of the Enterobacteriaceae and a positive spot indole
reaction (Image D) is the "best" presumptive test. Aeromonas hydrophila is also
indole positive; however, the test that is used to differentiate this species from the
Enterobacteriaceae is the oxidase test (Image A). Aeromonas hydrophila is
cytochrome oxidase positive; all the Enterobacteriaceae are oxidase negative. A
positive PYR reaction (Image C) is helpful in the presumptive identification of
Streptococcus group A, which separates this species from other beta hemolytic
streptococci (members of the genus Enterococcus are also PYR positive).

Question Difficulty: Level 9

 You answered the question correctly.

Within the genus Campylobacter, the laboratory test most helpful in selectively
identifying Campylobacter jejuni is:

The correct answer is highlighted below

Indoxyl acetate
Hippurate hydrolysis
Nitrate reduction
Susceptibility to nalidixic acid

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Of all the identification characteristics listed in this exercise, only hippurate

hydrolysis is 100% specific for Campylobacter jejuni. All other Campylobacter
species, including the closely related C. coli and C. fetus, are negative for this
characteristic. Although C. jejuni reacts positive in the indoxyl acetate test, other
species are positive as well. Most of the campylobacter species reduce nitrates;
therefore, this is not a discriminatory test. Although the antibiotic susceptibility
profile of naladixic acid = Susceptible, and cephalothin = Resistant is characteristic of
C. jejuni, and virtually confirms the identification of most clinical isolates, other less
frequently encountered Campylobacter species give that profile as well, making these
tests not 100% discriminatory.

Question Difficulty: Level 5

You answered the question correctly.

Illustrated in this photograph is a blood agar plate inoculated with a beta hemolytic
streptococcus obtained from a throat culture of a patient with acute pharyngitis. A
0.04ug bacitracin (left) disk and a SXT disk (right) had been placed in the areas of
streaking. The reactions observed allow the most likely presumptive identification of
a streptococcus belonging to Lancefield group:

The correct answer is highlighted below

Group A
Group B
Group C
Group G

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The zone of growth inhibition around the bacitracin (left) disk is presumptive
evidence for a beta hemolytic streptococcus, group A. It should be remembered that
approximately 10% of group C and group G streptococci may produce narrow zones
of hemolysis around the bacitracin (left) disk; however, each of these species is also
susceptible to SXT (right). Occasional strains of group B streptococci may also be
susceptible to bacitracin and they also are resistant to bacitracin; however, it would be
an extremely rare isolate from throat cultures. Therefore, the reactions shown in this
photograph along with the site of recovery allows the most likely report of, "beta-
hemolytic streptococcus, presumptive group A by bacitracin."

Question Difficulty: Level 4

You answered the question correctly.

This organism has been placed in tryptocase soy broth and then streaked on a nutrient
agar plate. Strips contain X, V, and XV were place on the plate and it was incubated
24 hours with CO2. What is the identification of this organism?

The correct answer is highlighted below

Brucella abortus
Haemophilus influenzae
Haemophilus parainfluenzae
Pasteurella multocida

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Haemophilus influenzae is the correct answer. Only Haemophilus spp. require X and
V factors for growth on nutrient agar. Haemophilus influenzae is the only organism
choice listed that requires both X and V.

Question Difficulty: Level 5

 You answered the question correctly.

Match the names of each of the bacterial species with its most likely appearance in the
gram stains shown in the photographs.

Your answers are on the left. The correct answers are on the right and highlighted.

Campylobacter species A
Pseudomonas species B
Brucella species C
Neisseria species D

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The bacterial cells of Pseudomonas species are straight, relatively long and slender, as
seen in Image B. Neisseria species are characterized by gram negative diplococci.
Image D is from a case of Neisseria gonorrhoeae urethritis, illustrating the
characteristic intracellular location of the bacterial cells. The bacilli of Campylobacter
species are very thin, and are curved or corkscrew-like, as seen in Image A. Brucella
species produce extremely tiny, cocco-bacilli, as seen in Image C.
 Question Difficulty: Level 8

You answered the question correctly.

It may be of surprise that the identification of a gram positive bacillus may be

suspected based on the Gram stain morphology. Match each of the names of each the
bacterial genera listed with the letter of its most likely photomicrograph.

Your answers are on the left. The correct answers are on the right and highlighted.

Nocardia species A
Lactobacillus species B
Bacillus species C
Corynebacterium species D

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The observation of gram positive bacilli with spores in a Gram stained preparation,
obtained from a culture grown aerobically is diagnostic of Bacillus species (Frame C).
The shape, size and position of the spores can be used as an aid in making a species
identification. Nocardia species can be suspected if thin, filamentous, branching,
poorly staining gram positive bacilli are observed (Frame A). These bacterial cells are
also partially acid-fast positive. Corynebacterium species typically produce short
gram positive bacilli that have the property of aligning in an Oriental letter
arrangement (Frame D). Lactobacillus species produce regular, rectangular, non-spore
forming gram positive bacilli, that have some tendency to align in short chains (Frame
B).
 Question Difficulty: Level 8

You answered the question correctly.

Host cells (e.g., white blood cells, epithelial cells) will appear what color on a
properly stained Gram stain?

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Blue
Pink
They do not pick up either stain and will appear colorless

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Host cells will stain pink on a properly stained Gram stain.

Question Difficulty: Level 6

You answered the question incorrectly.

The India ink preparation is used as a presumptive test for the presence of which
organism?

The correct answer is highlighted below

Aspergillus niger in blood

Cryptococcus neoformans in CSF
Histoplasma capsulatum in CSF
Candida albicans in blood or body fluids
Trichomonas vaginalis in vaginal secretions

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The India ink preparation is used as a presumptive test for the presence of
Cryptococcus neoformans. Upon staining with India Ink, C. neoformans shows
distinct, wide capsules surrounding the yeast cells. C. neoformans affects
predominantly immunocompromised hosts and is the commonest cause of fungal
meningitis; worldwide. In addition, 7-10% of patients with AIDS are affected.

Question Difficulty: Level 3