I&i Exam 1 Janda Questions

Front 1

A gram positive, rod shaped bacterium is isolated from the blood and cerebrospinal fluid of a 72 year old man with adenocarcinoma of teh lung. the organism is found to be weakly β-hemolytic on sheep blood agar and is catalast-positive. The likely identity of this organism is:

What additional test would be most helpful in confirming the identity of this isolate?

Back 1

Listeria monocytogenes.

Motility at room temperature

Front 2

The most sensitive methods for the detection of Chlamydia trachomatis in endocervical and urethral specimens is:

Back 2

A nucleic acid amplification test. NAAT

Front 3

The patient is a 20-year-old woman who is admitted through the emergency department with the sudden onset of fever to 104 degrees F and a severe headache. Physical examination reveals nuchal rigidity and the beginnings of a petechial rash. A lumbar puncture is performed and gram stain of the spinal fluid shows many PMNs and many gram negative diplococci both inside and outside of the PMNs. Which is most likely the cause of this patient's infection?

Back 3

Neisseria meningitidis

Front 4

Additional history regarding the patient with Neisseria meningitidis meningitis reveals that
she has had several serious infections (i.e., meningitis three years earlier
and bacteremia without meningitis two years earlier) with the same
organism. On the basis of this information, which one of the following is
the most likely predisposing condition in this patient?

Back 4

She is deficient in one of the terminal components of the complement cascade.

Front 5

A 24-year-old male patient presented to the emergency department of the
local hospital with a 3-day history of severe pharyngitis and a rash on his
face and upper trunk. A throat swab is collected and a direct latex
agglutination test for group A streptococci performed on the specimen is
negative. Culture of the patient’s throat on sheep blood agar produces
pure growth of a weakly β-hemolytic, Gram-positive rod. The organism is
shown to be catalase-negative. The most likely agent causing this man’s
pharyngitis is:

Back 5

Arcanobacterium haemolyticum

Front 6

A 48 year-old homeless man is found comatose on the street by law
enforcement officers and is brought to the hospital. Physical examination
reveals a thin, cachectic male and laboratory tests show that he is HIV-1
antibody-positive and is suffering from cirrhosis. A vegetation on his mitral
heart valve is demonstrated by transesophageal echocardiogram. Six
sets of blood cultures are collected over two days, but all are negative
after one week. Blind subculture of the blood culture bottles to freshly
prepared rabbit blood agar agar grows a small gram-negative rod after
three weeks incubation in three of the blood culture sets. Serum is also
sent for Bartonella antibody detection by indirect immunofluorescence and
the following titers are reported by the reference laboratory.

Agent Titer

Bartonella henselae 32
Bartonella clarridgeiae 64
Bartonella quintana 512
Coxiella burnetii 32

The likely identity of the isolate recovered from the blood culture as the
cause of this patient’s endocarditis is:

Back 6

Bartonella quintana (trench fever)

Front 7

Growth of “fried egg” colonies on glucose agar medium within 24 to 48
hours is characteristic of:

Back 7

Mycoplasma hominis (I'm human and like to eat eggs)

Front 8

Non-typeable strains of Haemophilus influenzae would be most commonly
seen in which of the clinical settings listed below:

Back 8

Exacerbations of chronic bronchitis in a 60 year old adult

Front 9

Diphtheria toxin:

Back 9

is only produced by Corynebacterium diphtheriae strains that
contain a lysogenic bacteriophage carrying the structural gene for
the toxin

Front 10

Growth in a 48-hour gelatin stab culture that shows lateral filamentous
growth resembling a test tube or bottle brush is most characteristic of:

Back 10

Erysipelothrix rhusiopathiae

Front 11

Amy, 8-year-old girl, was playing with Godzilla, her 10-month old male cat.
Godzilla was not amused at the time and bit the child on the hand. The
child’s mother washed the wound thoroughly and applied a bandage.
Three days later, Amy complained of pain at the wound site and stated
that she felt tired and “hot”. Mom takes Amy’s temperature and documents
a fever of 103
o
F. Mom then takes Amy to the hospital and the child is
admitted. Purulent drainage is expressed from the wound and two sets of
blood cultures were also collected. An organism with the following
characteristics was isolated from both the bite wound and the blood
cultures:
Non-hemolytic, Gram-negative coccobacillus growing on sheep
blood and chocolate agars
No growth on MacConkey agar
Oxidase-positive
Catalase-positive
Indole-positive
Ornithine decarboxylase-positive

The likely identity of this organism is:

Back 11

Pasteurella multocida (should have Paseurized the cat)

Front 12

A 58-year-old woman is admited to the hospital with possible endocarditis.
History is unremarkable except for the fact that she underwent a root
canal procedure three weeks prior. Three sets of blood cultures (2
collected on admission and two collected the next day) become positive
with a pleomorphic gram-negative rod. On gram stain from the bottles, the
rods are gram-negative, appear tear-drop shaped and some have
swellings on the ends. In some microscopic fields the organisms appear
in small rosette-like clusters. On subculture, colonies are not observed on
sheep blood and chocolate agars until after 48 hours incubation. A battery
of biochemical tests are set up and the following reactions are observed.

Small, gram-negative coccobacilli
Growth on sheep blood agar and chocolate agar
No growth on MacConkey agar
Oxidase-positive
Catalase-negative
Acid from glucose, maltose, and sucrose
No acid from lactose
Urease-negative
Indole-positive

The identity of this organism is:

Back 12

Cardiobacterium hominis (her human heart is infected)

Front 13

Haemophilus ducreyi is the cause of:

Back 13

Chancroid.

Front 14

Hector and Monica got married and decided to go to Greece for their
honeymoon. Although they stay at the Hyatt Regency in Mykonos, they
decide to attend a large party and cookout given by a group of
townspeople on a nearby beach. The food includes mutton, locally
prepared cheeses, bahklavah, and waaaaay too much Roditys wine.
Three weeks after returning to Naperville, both Hector and Monica
experience recurrent fevers, malaise, and arthralgias. What do you think
may be the reason for their recurrent fevers:

Back 14

They have contracted Brucellosis. My dad, Bruce, says to never eat raw dairy.

Front 15

The most common sexually transmitted disease is

Back 15

Chlamydia!

Front 16

A 71-year-old male is hospitalized after having a stroke. After being in the
hospital for 12 days, the patient develops signs and symptoms of
pneumonia, and a bronchosopy specimen is collected and submitted for
aerobic and anaerobic bacteriology. On Gram-stain, many WBC’s are
seen, along with rare Gram-positive cocci, but the predominant organism
seen are long, fusiform, Gram-negative bacteria with pointed ends. After
4 days, an organism having this morphology is isolated on CDC anaerobic
blood agar. This organism is most likely:

Back 16

Fusobacterium nucleatum.

Fusiform bacteria - fusobacterium

Front 17

A 27-year-old metalworker experiences a penetrating eye injury when a
small shard of metal enters his eye. Within 8 hours of the injury, the eye is
inflamed and painful. When he arrives in the Emergency Department of
the nearby hospital, visual acuity is almost totally gone. Some of the eye
drainage is collected and submitted for culture and Gram stain. On the
gram stain, many large, Gram-positive bacilli are observed. The aerobic
culture grows many β-hemolytic colonies having a “ground glass” surface
morphology. The likely etiology agent of this man’s endophthalmitis is:

Back 17

Bacillus cereus. Blindness is CEREUS!

Front 18

A 58 year-old male with poorly controlled diabetes develops pneumonia
and presents to his family physician for evaluation. On X-ray, the
physician notes patchy infiltrates throughout the lungs and admits the
patient to the hospital. The patient is producing copious amounts of
yellow-green sputum, and some of this material is submitted for aerobic
culture. Observation of a Gram stain of this material reveals many PMN’s
and clusters of thin, beaded, Gram-positive bacilli, many of which
demonstrate significant chaining and branching. After 4-days, small
colonies of organisms showing similar morphology grow on the blood agar
and chocolate agar plates. What is the likely etiology of this patient’s
pneumonia:

Back 18

Nocardia Asteroides complex.

Front 19

The M-2 class decides to have an “international banquet” and UIC allows
the students to use the kitchen of the cafeteria. The menu includes
spaghetti with Marinara sauce, Chicken Vesuvio with roasted potatoes,
and Chicken Fried Rice with Dumplings. Within 24 hours of the banquet,
most of the M-2 class is experiencing diarrhea, and some students also
experience vomiting. Based on the menu, what agent would you suspect
to have caused the gastroenteritis?

Back 19

Bacillus cereus - from improperly refrigerated rice.

Front 20

Mindy and her girlfriends decide to celebrate her new job by going down to
Rush Street for dinner and an evening of drinking and dancing. At
Mother’s she meets Stan, a trader who works at the stock exchange. One
thing leads to another, and three days later, Mindy experiences lower
abdominal pain and an abnormal vaginal discharge with some bleeding.
What do you suspect is going on with Mindy?

Back 20

Gonorrhea.

She should have GONE home instead.

Front 21

For gonorrhea infection, what type of specimen should be collected and
how should it be processed

Back 21

An endocervical specimen should be collected and inoculated onto
modified Thayer-Martin medium

Front 22

A patient undergoes surgery following a ruptured appendix. Three weeks
after discharge, the same patient experiences lower abdominal pain along
with fever. Repeat surgery reveals the presence of an intra-abdominal
abscess. The abscess is drained and pus is sent to the lab for aerobic
and anaerobic culture. E. coli and viridans streptococci are isolated from
the aerobic culture. When the anaerobic culture is examined after 48
hours incubation, black colonies are noted on the bile-esculin-gentamicin
agar plate. Gram staining of these colonies reveals pleomorphic Gram-
negative bacilli. This organism is probably:

Back 22

Bacteroides fragilis. Most commonly found in peritoneal infections. Abscesses are fragile!

Front 23

Chlamydia trachomatic preferentially infects:

Back 23

Cervical columnar epithelial cells.

Front 24

Which of the following statements concerning the organisms that cause
brucellosis is correct?

Back 24

Brucellae are found in the reticuloendothelial cells and often cause
granulomatous lesions

Front 25

The specimen of choice for recovery of Brucella species is:

Back 25

Bone marrow - the worst

Front 26

A 30 year-old female presents to her gynecologist with dysuria, frequency,
and lower abdominal pain. On examination, the physician notes a low-
grade fever. The patient submits a clean-catch, midstream urine
specimen for culture and urinalysis (UA). The UA reveals bacteria, pyuria,
and is positive for nitrites. Culture reveals >100,000 colony forming units
of a Gram-negative, β-hemolytic, oxidase-negative rod, that is spot indole-
positive. Red-pink colonies are noted on the MacConkey agar plate. The
likely cause of this patient’s urinary tract infection is:

Back 26

E. coli
Front to back, ladies.

Front 27

Based on your suspicions regarding the above isolate (E. coli), what would you
suspect the methyl-red (MR), Voges-Proskauer (VP), and citrate (C)
reactions would be for this indole-positive, Gram-negative organisms,
respectively?

Back 27

MR+, VP-, C-
My mom IS Madonna Reda
She's NOT a VP
She's NOT a C-word

Front 28

A 65-year-old male patient consults his urologist because of recurrent
urinary tract symptoms. The patient has a history of urolithiasis diagnosed
during two previous hospitalizations. A straight-catheterized urine
specimen is submitted for culture. After 48 hours, >100,000 tiny gray
colonies are noted on both the blood agar and CNA agar plates, with no
growth on MacConkey agar. A gram stain of the growth reveals
pleomorphic Gram-positive bacilli. The organism is also catalase-positive.
The technologist inoculates a Christianson’s urea agar slant, and after
about 30 minutes, the technologist notes that the slant of the tube is
already red (alkaline). What is the likely organism causing this patient’s
UTI?

Back 28

Corynebacterium urealyticum
If it's lysing urea, it's making the solution more alkaline with ammonia.

Front 29

Actinomyces israelli:

Back 29

grows as molar tooth colonies on anaerobic culture media.
This is horrible...
Nazi's took Jewish (Israeli) molars.

Front 30

Members of the genus Mobiluncus are

Back 30

associated with bacterial vaginosis.
Another reason not to get mobile with your uncle.

Front 31

A patient presents tro the ER with a spreading cellulitis of the lower right
leg. An aspirate from the leading of the cellulitis shows boxcar-shaped
gram-positive and gram-negative bacilli (i.e., short fat rods with blunt
ends). Culture of the aspirate under anaerobic conditions results in the
growth of a colony with a double-zone of β-hemolysis. The Gram stain of
the colony shows Gram-positive boxcar-shaped bacilli. This organism is
probably:

Back 31

Clostridium perfringens
Gas gangrene

Front 32

Most clinical bacteriology laboratories perform bacterial identifications
based on:

Back 32

Phenotypic criteria - it's the easiest

Front 33

A 24-year-old man presents to the City of Chicago STD clinic with a
genital ulcer. On questioning, the patient states that the lesion is
extremely painful and he fears that he may have caught "herpes". On
examination, you see a lesion that is approximately 1 cm in diameter with
a ragged border. The lesion is not indurated and the central areas of the
lesion is covered with a grey, membranous scab. On questioning the
patient, you find that he was on leave from the Navy and had spent the
last few months in Southeast Asia, where he had sexual contact with two
prostitutes. Based on this history what is your clinical impression?

Back 33

Haemophilus ducreyi

Large ulcer - chancroid.

Front 34

A patient presents to the dermatology clinic with a lesion on the side of his
neck. On examination, the lesion is violaceous, approximately 1 cm in
diameter, and dome-shaped. The patient stated that, when he nicked the
lesion while shaving, it bled profusely. The patient's medical record
provides additional information: the patient was diagnosed with AIDS in
1999, andhas been hospitalized with Pneumocytis jiroveci pneumonia on
two occasions. The patient lives in an apartment with three other people,
a dog, and two recently adopted shelter kittens. This patient is likely
infected with:

Back 34

Bartonella Henselae
I bet the cats were named Bart and Ella :)

Front 35

You are moonlighting at a clinic located on the campus of a near-north
side college. A 22-year-old male presents with burning on urination, and a
urethral discharge. The patient states that his last sexual contact had
occurred five days previously. You collect some of the urethral discharge
with a swab and prepare a Gram-stain. What would you expect to see on
the slide?

Back 35

PMNs with intracellular and extracellular gram-negative diplococci - Gonorrhea

Front 36

The patient is a 58-year old male with a history of alcohol abuse of long
standing. He had suffered a fall in his apartment 10-days prior to
presentation and had struck his head on a table edge. Other than a
headache immediately after the fall, he had no other symptoms until
today, when he awoke with a severe frontal headache and a feeling of
“fullness and congestion” in his sinuses A dental consult in his chart noted
that the patient had severe gingivitis, with accumulation of significant
plaque and bleeding. A CT scan shows the presence of a brain abscess.
The patient is taken to surgery, where the abscess is drained. Some of
this material is sent to the lab for culture. On direct Gram stain, many
PMNs and moderate numbers of small gram-negative bacilli are observed.
This brain abscess is likely due to:

Back 36

A member of the AACEK group. Gingivitis gives it away

Front 37

After two days, the lab reports that a fastidious gram-negative bacillus was
isolated from the abcess material (question 44) on blood and chocolate
agars, but no growth was observed on MacConkey agar. The organism
was oxidase-positive, catalase-negative, did not ferment glucose, and
"pitted" the agar under the colonies during growth. The identity of this
organism is: (from the AACEK group)

Back 37

Eikenella corrodens. It corrodes the medium it's on

Front 38

A 34-year-old women arrives at the ER in labor during her 32nd week of
pregnancy. She is acutely septic, with a fever of 103
o
C, and is
hypotensive. She is finally stabilized and delivers a child that is also
acutely septic. Blood cultures are drawn from both the mother and infant,
and the baby also undergoes a lumbar tap. On Gram-stain of the baby’s
CSF, many WBCs and many Gram-positive bacilli are seen. Organisms
with similar morphology are also recovered from the blood cultures that
were drawn from both mother and baby. What is the likely agent causing
infection in the mother and baby?

Back 38

Listeria monocytogenes.
Don't eat raw hot dogs when you're pregnant!

Front 39

Listeria monocytogenes has the following properties:

Back 39

Catalase-positive, growth of black colonies on bile-esculin agar, and "umbrella motility" at 25 degrees
Black cats need umbrellas in the cold.

Front 40

A 7-month old male is brought by his grandmother to the Emergency
Department. The child is noted to be in respiratory distress, with a fever of
102
o
C. The grandmother reports that the child has experienced extremely
severe coughing spells and that, following his coughing, the child had
vomited twice. A CBC revealed a total WBC count of 40,000 cells/ml with
a relative lymphocytosis. What is your working diagnosis?

Back 40

The patient may have pertussis.

Coughing so hard he voms, probably whooping cough.

Front 41

The Elek test is an immunodiffusion procedure for detecting toxigenic
strains of:

Back 41

Corynebacterium diphtheriae

Front 42

A member of the genus Haemophilus that requires X factor but not V
factor is:

Back 42

Haemophilus ducreyi
It requires a different kind of V factor. Chancroid

Front 43

A plump Gram-negative bacillus is isolated after 3 days from a joint fluid
apirate collected from a 4- year-old male child that had been inoculated
into an aerobic blood culture bottle. On the sheep blood agar subculture,
the colonies are noted to be surrounded by a zone of beta-hemolysis,
which becomes most evident after 48 hours. The isolate is found to be
oxidase-positive, catalase-negative, and indole-negative. What is the
likely identity of this organism?

Back 43

Kingella Kingae

Front 44

Joe is a fisherman who recently went on a fishing excursion to Alaska.
While wrestling a large walleyed pike into his boat, he cut his hand on one
of the spines along the fish’s back. He placed a bandaide on the lesion
and forgot about it. Six days later, the cut had evolved into a violaceous
spreading lesion with a raised, indurated border. In the ER, the physician
aspirates material from the leading edge of the wound and sends the
material to the microbiology lab. On the Gram stain of this material,
moderate numbers of Gram-positive bacilli are observed. Given this
history, Joe’s infection is probably due to:

Back 44

Erysipelothrix rhusiopathiae
Sounds like it could also be the name of an ancient fish.

Front 45

The cultural characteristic that is NOT TYPICAL of Bacillus anthracis is:

Back 45

A positive motility test.

Front 46

The best specimen for diagnosis of chlamydial inclusion conjunctivitis of
the newborn is:

Back 46

Direct fluorescent antibody performed on a conjunctival smear.
The best diagnosis is direct.

Front 47

A weak β-hemolytic reaction on sheep blood agar is typical of both group
B streptococci and Listeria monocytogenes. These two species can be
differentiated by:

Back 47

Catalase test AND Gram stain

Front 48

A 65 year-old woman who resides in Chicago presents with a recent
history of fatigue, weakness, shortness of breath, and easy bruising, and
is admitted to the hospital. Acute myelonegous leukemia is diagnosed and
appropriate chemotherapy is initiated. The patient then develops a fever
of 40
o
C after 2 weeks of chemotherapy and three sets of blood cultures
are collected, one from each of three properly prepared sites. Two of the
three blood cultured are reported as positive for Gram-positive bacilli.
Subcultures of the blood cultures only grow on blood agar plates that are
incubated anaerobically. The organism is catalase-negative and is
resistant to vancomycin by microbroth and disk diffusion susceptibility
testing methods. Which of the following organisms is likely responsible for
this elderly woman’s bacteremia?

Back 48

Lactobacillus species.
She's immune compromised and has lactobacillus in the vagina.

Front 49

Harry presents to his local physician in Barrington with a 5-day history of
fatigue, weakness, and low grade fevers. On physical exam, the
physician notes right axillary lymphadenopathy and an ulcerated lesion on
his right arm. Harry denies having had any recent injury to the area, but
does state that he and his buddies from the American Legion had just
recently returned from a hunting trip in Northern Louisiana. He did not
recall having any injuries or insect bites while on the trip, but he does state
that they camped outdoors and ate game that they had caught while
camping. What do you suspect is going on with this patient?

Back 49

Tularemia. People in Louisiana eat squirrels.

Front 50

A newborn baby develops bilateral pneumonia and conjunctivitis two
weeks after a normal vaginal delivery at 34 weeks gestation. The baby
was born after the mother presented to the Emergency Department. The
mother is a sexually active 23-year-old who has had multiple unprotected
sexual contacts since she was 18 years old. There is no record that she
has had received any pre-natal care. Along with the pneumonitis and
conjunctivitis, the baby is fretfull and agitated, but is essentially afebrile.
Based on the history and presentation, what is the likely cause of the
baby’s infection?

Back 50

The baby has Chlamydia trachomatis infection.

Front 51

A 75 year-old women is admitted with a diagnosis of necrotizing
tracheobonchitis. A tracheal aspirate and a deep sputum specimen yield
pure cultures of a non-lipophilic, Gram-positive, catalase-positive bacillus
that is non-hemolytic, asaccharolytic and urease-positive after overnight
incubation. On susceptibility testing, the isolate is susceptible to ampicillin,
cephalothin, vancomycin, and gentamicin. The likely identity of this isolate
is:

Back 51

Cornynebacterium pseudodiphtheriticum. Like diphtheria but not quite as bad.

Front 52

Which of the following IS NOT a hallmark of inhalational anthrax?

Back 52

Patchy lung infiltrates indicative of bronchopneumonia

Front 53

A 64 year-old patient with acute myelogenous leukemia has been
hospitalized for 10 days when he suddenly becomes febrile and
hypotensive. Blood cultures are drawn from both a central venous line and
a peripheral skin site. After 2 days, both sets of blood cultures become
positive for a pleomorphic Gram-positive bacillus. On subculture, growth
of tiny, non-hemolytic colonies is noted on the blood agar plates, but no
growth is seen on the chocolate agar plates. The organism is found to be
catalase-positive and urease-negative. On antimicrobial susceptibility
using a microtiter broth dilution method supplemented with lysed sheep
blood, the organism is shown to be resistant to penicillin, cephalothin,
gentamicin, erythromycin, and ciprofloxacin, and is susceptible only to
vancomycin. What is the likely identity of this organism?

Back 53

Corynebacterium jeikeium.

You're totally going to live through this multi-drug resistant infection.... JeiKei!

Front 54

A catalase-positive, Gram positive coccus that is able to clot rabbit
plasma with EDTA is:

Back 54

Staphylococcus aureus
Rabbits are really common, so is staph aureus

Front 55

You are sitting home one night studying when you receive a phone call
from the University Health Service that a member of your study group has
been hospitalized with meningococcal meningitis. You are asked to come
to health service to receive antibiotic for chemoprophylaxis. What is the
agent that you will likely be prescribed?

Back 55

Rifampin. Gotta ramp up your ability to fight infection.

Front 56

The treatment of choice for brucellosis is:

Back 56

Tetracycline and aminoglycoside.
T&A will cure just about anything.

Front 57

The exotoxin produced by Corynebacterium diphtheriae has the following
mode of action:

Back 57

Inactivates EF-2 (elongation factors 2), thereby inhibiting protein synthesis.

Kills any cell it infects.

Front 58

A 60-year-old male from a rural area outside of Mexico City presents to a
hospital in Dallas with a grossly enlarged foot that is covered in multiple
draining sinus tracts. The man has had these lesions for several months
and states that, while not painful, the swelling has compromised his
ambulatory ability. X-ray of the foot reveals swelling of the subcutaneous
tissues and osteomyelitis. Specimens of the drainage from the sinus tracts
and from a biopsy specimen are collected and inoculated onto blood,
chocolate, and MacConkey agars. After 4 days incubation at 35
o
C in an
incubator with 5% CO 2 , glabrous, firm colonies are noted on the blood and
chocolate agar plates. A Gram-stain reveals thin, beaded, branching Gram-
positive bacilli. The likely cause of this patient’s subcutaneous infection is:

Back 58

Nocardia brasiliensis

Brasil and Mexico are both south of here.

Front 59

What other characteristic would be typical of the organism isolated from the
patient in Question 69? Nocardia brasiliensis

Back 59

The organism would be acid fast with the modified acid fast procedure.

Brazilians know how to get their acid fast.