Note: Answer this with full honesty.

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Check-up Test: Nov 29, 2020 (53 days to go til’ RMT)
Microbiology and Parasitology

1)      Microbiology – (70%)
a)      Bacteriology – (49%)

i)        Collection, Transport, Processing and Staining of Specimens – (5%)

1. First thing to be done for collection of sputum sample?

A. Instruct the patient to Gargle with water
B. Ask if the patient does not smoke before the collection
C. Ask the patient’s data
D. Explain the procedure to the patient

2. Non-acid fast bacteria stains

A. Yellow
B. Blue
C. Orange
D. Pink

3. Critical step in gram stain?

A. Flood heat
B. Adding iodine solution
C. Decolorizer
D. Counter-stain with Safranin

4. Nonspecific staining of cellular structures

A. Hematoxylin
B. Nile blue
C. Hoeschst Stain
D. Fluorochroming

5. Nasopharyngeal swabs are for

A. Neisseria, H. influenza, B. pertussis
B. Neisseria, E. Coli, Staph
C. H. influenza, B. pertussis, Staph
D. Neisseria, E. Coli, B pertussis
 6. Late chlamydia specimen must be
A. Still accepted but must be prioritized
B. Rejected
C. Informed to the physician
D. Accepted but analyze the specimen very carefully
7. AFB stains
A. Pink
B. White
C.Red
D. Blue
8. It is used to differentiate mycobacteria?
A. CBC
B. Urinalysis
C. PCR
D. Acid Fast Stain

ii)       Culture Media – (5%)

9. Preferred medium for isolation of B. pertussis?
A. Regan-Lowe
B. Mannitol Salt Agar
C. Egg saline medium
D. Biphasic medium

10. K Tellurite
A. white colony
B. gray black colony
C. red colony
D. brown colony

11. Cystine Tellurite

A. F. tularensis
B. C. diptheriae
C. H. influenza
D. B. pertussis

12. Cystine glucose

A. C. diptheriae
B. B. pertussis
C. Neisseria
D. F. tularensis
 13. Significant colony count in urine
A. 200,000
B. 150,000
C. 100,000
D. 50,000

iii)     Bacteria (Aerobes) – (33%)

Morphology and staining characteristics – (5%)
Cultural characteristics – (5%)

14. Golden yellow colonies in BAP

A. S. aureus
B. P. aeruginosa
C. F. tularensis
D. S. marcescens

15. Alpha-prime
A. F. tularensis
B. C. perfringens
C. S. aureus
D. C. difficile

16. Cystitis
A. C. difficile
B. S. saprophyticus
C. P. aeruginosa
D. F. tularensis

17. Commonly isolated in ICU –

A. P. aeruginosa
B. C. Difficile
C. F. Tularensis
D. E. Coli

18. P. aeruginosa
A. Grows in 30 and 35 degrees Celsius
B. Grows in 22 and 25 degrees Celsius
C. Grows in 42 and 35 degrees Celsius
D. Grows in 35 and 45 degrees Celsius
 19. Which sentence that describes P. aeruginosa
A. Flat, serrated colonies with confluent growth on BAP
B. Round colonies that grows in extremely hot temperature
C. Golden yellow colonies with confluent growth on BAP
D. It is commonly isolated in ICU that grows in 30-35 degrees celcius

20. Salmonella bacterial culture

A. 2-3 specimen(blood) within 20 hours
B. 2-3 specimen(blood) within 48 hours
C. 2-3 specimen(blood) within 24 hours
D. 2-3 specimen(blood) within 72 hours

21. rare bacterial infection that most often affects your joints and digestive
system.
A. Whipple disease

B. Septic arthritis
C. Osteomyelitis
D. Streph throat

Work-up for identification: biochemical, differential and confirmatory tests – (14%)

21. Clumping factor
A. Amylase
B. Coagulase
C. Factor IX
D. Thrombin

22. Percentage of H2O2 in Superoxol Test

A. 30% H2O2 
B. 20% H2O2 
C. 10% H2O2 
D. 5% H2O2 

23. MR and VP reaction

A. Adjacent
B. Collateral
C. The same
D. Opposite
24. Chromogenic β-lactamase result
A. Size formation
B. Color formation
C. Opacity
D. Shape formation

25. Demonstrate Streptolysin

A. Anaerobic culture
B. Aerobic culture
C. Gram stain
D. Smear

26. Negative CAMP test

A. Niacin and nitrate negative
B. There is an enhancement of hemolysis
C. No enhancement of hemolysis
D. There is a small enhancement of hemolysis

27. Bile solubility

A. S. pneumonia
B. S. saprophyticus
C. P. aeruginosa
D. F. tularensis

28. Similar to C. diptheriae

A. S. pneumonia
B. C. ulcerans
C. P. aeruginosa
D. F. tularensis

29. Acetamide Test

A. P. aeruginosa (35˚C for 7 days)
B. P. aeruginosa (35˚C for 6 days)
C. P. aeruginosa (35˚C for 5 days)
D. P. aeruginosa (35˚C for 3 days)

30. Bronchiseptica
A. Bordetella oxidase & urease (+)
B. urease (+)
C. Bordetella oxidase (+)
D. Bordetella oxidase & urease (-)

31. H. parahemolyticus
A. Requires II factor
B. Requires III factor
 C. Requires IV factor
D. Requires V factor

32. H. ducreyi
A. Requires X factor
B. Requires V factor
C. Requires VII factor
D. Requires IX factor

Serologic/molecular tests – (3%)

33. Detects carbohydrates in Streptococcus group

A. Quellung
B. Kauffman
C. Lancefield
D. Flourochroming

34. Capsular swelling

A. Quellung
B. Kauffman
C. Lancefield
D. Flourochroming

35. Salmonella serotyping

A. Quellung
B. Kauffman
C. Lancefield
D. Flourochroming

Susceptibility tests – (4%)

36. Inhibit cell wall synthesis
A. Clindamycin
B. Gentamicin
C. Amoxicillin
D. Penicillin
37. Inhibit cell wall synthesis
A. Clindamycin
B. Gentamicin
C. Vancomycin
D. Penicillin
 38. Inhibit protein synthesis
A. Clindamycin
B. Gentamicin
C. Vancomycin
D. Penicillin

39. Clindamycin – Inhibit protein synthesis

A. Clindamycin
B. Gentamicin
C. Amoxicillin
D. Penicillin
40. ESBL
A. Extended Spectral Beta-Lactamase
B. Extended Spectrum Beta-Lactase
C. Extended Spectrum Beta-Lactamase
D. Extended Spectral Beta-Lactose

Bacteriologic examination of water, food, milk and utensils – (2%)

41. S. marcescens
A. Yellowish milk
B. Red milk
C. Blue milk
D. Stormy fermentation of Milk
42. P. aeruginosa
A. Yellowish milk
B. Red milk
C. Blue milk
D. Stormy fermentation of Milk

43. C. perfringens
A. Yellowish milk
B. Red milk
C. Blue milk
D. Stormy fermentation of Milk

v)      Mycobacteria – (2%)
44. AFB smear measures
A. 2-3cm
B. 1-2cm
C. 0.5-1cm
D. 1-3cm
 45. MPT 64
A. M. bovis
B. M. audouinii
C. E. floccosum
D. M. tuberculosis
46. Niacin and nitrate positive
A. M. bovis
B. M. audouinii
C. E. floccosum
D. M. tuberculosis

47. Niacin and nitrate negative

A. E. floccosum
B. M. audouinii
C. M. bovis
D. M. tuberculosis

48. M. bovis
A. Tween 90 positive
B. Tween 80 positive
C. Tween 60 positive
D. Tween 70 positive

49. Which among the following is the gold standard in measuring iron stores?

a. Ferritin

b. Transferrin

c. Hemoglobin

d. Prussian Blue Stain

50.

vi)      Other bacteria with unusual growth requirements (Spirochetes, Chlamydia,

Mycoplasma, Rickettsia) – (2%)

b)      Mycology – (4%)
i)        Collection, transport and examination of clinical specimens – (2%)

 Basic, branching, intertwining structure of molds – Mycelia

 Stain for sharp delineation of fungal elements by fluorescent microscopy –
Calcoflour white
  Presumptive test for candida that uses serum – Germ tube
 Positive hair-baiting test – V-shaped penetration of the hair shaft
 Ascospore – Saccharomyces
 Farmer lung’s disease – Aspergillus fumigatus
 Macroconidia absent – M. audouinii
 Microconidia absent – E. floccosum
Epidermophyton – Skin, nails
 Microsporum – Skin, hair
 Tricophyton – Skin, hair, nails
 T. mentragophytes – Positive hair-baiting test
 T. rubrum – Red pigment, teardrop shaped conidia
ii)       Culture – (2%)

 AMAN medium stain – Lactophenol cotton blue

 Cornmeal agar – Chlamydospores
 Czapek – Aspergillus
 Rice agar – M. canis
 Urease media – Cryptococcus neoformans
 Birdseed – Phenol oxidase

c)       Virology – (4%)
i)        General characteristics, transmission and diseases – (2%)

 1st step in viral replication – Adsorption/Attachment and Penetration

 Part of virus where envelope is acquired – Nuclear or cytoplasmic membrane
 ssDNA virus – Parvovirus
 dsRNA – Reovirus
 Largest virus - Poxvirus
 Largest RNA Virus – Paramyxovirus
 Virus that causes acute central nervous system disease in humans and animals
– Rabies
 Acid sensitive - Rhinovirus
 Ether sensitive – Herpes virus

ii)       Collection, transport and examination of clinical specimens – (2%)

 CMV isolation is recommended using – Human embryonic fibroblasts
 Grape-like cluster - Adenovirus
 d)      Equipment and instrumentation – (5%)
i)        Manual – (3%)

 How to prepare agar – Add agar to water*

 RPM for centrifugation of bacteria – 3500-5000 RPM for 10mins

ii)       Automated – (2%)

e)      Quality assurance and safety – (8%)

i)        Collection of specimen – (2%)

 Lyophilization of pure culture – freeze at -20 to -30˚C

 Mineral oil – Anaerobes

ii)       Quality control – (2%)

 Settings of rpm marked on the face of the rheostat control on the centrifuge should be checked –
Monthly
 Oxidase, Catalase, Coagulase – Tested each day, when vial is first opened

                                                                 
iii)     Safety – patient/staff – (2%)

 BSC II – Laminar flow

 Sterilize needles for sputum – Dip in 70% alcohol + sand

                                                      
iv)     Safety – workplace/environment – (2%)

 AFB is killed by – Boiling 10mins, Autoclave

 Autoclave - 121˚C, 15 psi(lbs/in2), 15mins
 Not killed by sterilization – Prions

2)      Parasitology – (30%)
a. Parasites – life cycle, morphological characteristics, epidemiology, prevention and control, manner of
reporting, counting – (21%)
1. Nematodes – (5%)
 First stage of nematodes – Rhabditiform
 Viviparous – Produces larva
  Oviparous – Produces egg
 Parasite most prevalent in orphanage – Unholy Three
 Larvae that passes through the lungs – Ascaris, Stronglyloides, Hookworm
 Roundworm that inhabits the small intestine and is usually demonstrated as rhabditiform larvae in fecal specimen –
Threadworm
 Ascaris egg lacking its mammillated coat – Decorticated
 lumbricoides vector – Cockroach
 Resembles Trichiuris – C. philippinensis
 S. stercoralis – Chinese lantern
 Adult Trichinella – Intestine
 Unsheathed microfilariae – O. volvulus
 Longest nematode – D. medinensis
 Internal autoinfection – S. stercoralis
 External autoinfection – E. vermicularis

2. Trematodes – (5%)
 1st IH of flukes – Snail
 2nd IH of P. westermani – Fresh water crabs
 2nd IH of Echinostoma – Snail
 2nd IH of Fasciola/Fasciolopsis – Aquatic vegetation
 Parasite found in sheep/cattle, not common in PH – F. hepatica
 Eggs with abopercular thickening – P. westermani
 Small lateral spine – S. japonicum
 Prominent lateral spine – S. mansoni
 Terminal spine – S. haematobium
 Schistosomule – Cercaria minus tail
 Swimmer’s itch – Schistosoma
 C. sinensis – Old fashioned light bulb
 Mode of transmission of Clonorchis – Ingestion of metacercaria

3. Cestodes – (5%)
 Head of tapeworm - Scolex
 Body of tapeworm – Strobila
 Finger-like uterine branches – T. solium
 Tree-like uterine branches – T. saginata
 3rd Taenia specie – Taenia asiatica
 Hexacanth embryo in a radially striated shell – Taenia
 Hexacanth embryo that lacks polar filaments – H. diminuta
 Egg of D. latum – Operculated
 1st IH of D. latum – Copepods
 2nd IH of D. latum – Fresh water fish
 Spirometra – May resemble D. latum
  Found in IH of E. granulosus – Hydatid cyst
 Double-pored tapeworm – D. caninum
4. Protozoa – (5%)
 Motile, reproducing, feeding stage – Trophozoite
 Organ most often involved in extraintestinal amoebiasis – Liver
 E. histolytica – Ingest RBC
 Differentiates hartmanni and histolytica – Size
 E. gingivalis – Ingests WBC
 E. nana – Cross-eyed cyst
 Often mistaken for cyst of amoeba – B. hominis
 Largest intestinal protozoa – B. coli
 Undulating membrane – Trichomonas, Trypanosoma
 Intestinal flagellate is described as – Pear-shaped
 T. vaginalis – Jerking, tumbling motility
 Ping pong disease – T. vaginalis
 Vector of African sleeping sickness – Glossina species
 DH for Plasmodium species – Female Anopheles mosquito
 Principal vector for malaria – Flavirostris
 Plasmodium species that can cause relapse – P. vivax, P. ovale
 Not recommended for Venipuncture – Malaria, Babesia, Hemoflagellates
 Blood specimen preferred for protozoa – Finger puncture
 90% cases of malaria caused by – P. vivax and falciparum
 Toxoplasma gondii – cat

5. Ectoparasites – (1%)
 Crabs – Ectoparasite

B. Parasitologic Techniques – (5%)

Routine – (2%)

 Iodine – Destroys trophozoites

 Stain to demonstrate uterine arrangement of Taenia species – India ink
 Chromatoid bodies on Trichrome stain is colored as – Bright to red
 Stain for Naegleria, Acanthamoeba – H&E, Wright’s
 To detect stippling, prepare blood films – 30mins to 1hr
 Reagent for kato-thick smear – Malachite green, glycerine, cellophane

Concentration – (2%)
 Zinc sulfate specific gravity – 1.18
  Flotation techniques – Operculated eggs and eggs with spines not recovered

Others – (1%)
 Sheather’s sugar flotation – Cryptosporidium
 Baermann funnel - Strongyloides

Quality assurance – (4%)

Collection and preservation of specimen – (2%)

 Stool for more than 1hr is stored at – Refrigerator

 Stool preservative – Polyvinyl alcohol, Schaudinn