MICROBIOLOGY

3 MBBS PART I
rd

2023

MCQs, SAQs
& Answers
Faculty of Medicine, SUSL Batch 02 (2018 AL)

FACULTY OF MEDICINE
SABARAGAMUWA UNIVERSITY OF SRI LANKA
MBBS DEGREE PROGRAMME
(BACHELOR OF MEDICINE, BACHELOR OF SURGERY)
3rd MBBS PART I EXAMINATION - 2023 (02 BATCH)
MICROBIOLOGY
MCQ PAPER

1. What are the organisms that appears as pink cocci in gram stain,
a) Neisseria gonorrhea
b) Hemophilus influenzae
c) Corynebacterium diphtheriae
d) Streptococcus pneumoniae
e) Moraxella catarrhalis

2. Regarding the cholera,

a) Causes blood and mucus diarrhoea
b) Severe dehydration is key clinical feature.
c) Rectal swabs can take for laboratory diagnosis in pandemics
d) Direct microscopy of the feces uses to diagnose.
e) Tetracycline is effective in treatment.

3. Regarding Pseudomonas aeruginosa,

a) Is an opportunistic pathogen
b) Grows in humid environment.
c) Produce blue green pigment
d) Causes lung infections in patients with cystic fibrosis
e) Co amoxiclav is effective against infection

4. Hemophilus influenza,
a) Need factor X and V for growth
b) Can survive at 4°C
c) Toxin production contributes to its virulence
d) Known to cause otitis media in children
e) Effectively treated with Benzylpenicillin

5. Regarding genus bacillus,

a) It includes spore in organism
b) Bacilli cereus is causing zoonotic disease
c) Bacilli anthracis is known to cause cutaneous lesions
d) Bacilli stearothermophilus is used as a monitor to autoclave
e) Infection cause by Bacilli species is treat by benzyl penicillin

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Faculty of Medicine, SUSL Batch 02 (2018 AL)

6. Corynebacterium diphtheriae,
a) Is documented to cause wound infections
b) Produce a membrane at the site of infection
c) Is isolated from the blood of an infected person
d) Is effectively treated with erythromycin
e) Toxin is the main virulence factor

7. Influenza A virus,
a) Undergoes antigenic shift and antigenic drift
b) Document as pandemic
c) Infection is diagnosed by antigen detection in nasopharyngeal swab
d) Infection is effectively treated with rimantadine
e) Vaccine led to lifelong immunity

8. In mumps,
a) The parotid gland swelling occurs due to efferent duct obstruction
b) Asymptomatic infections are well documented
c) Acyclovir can be given
d) Orchitis is a complication
e) Respiratory secretion contain virus

9. Major exposures for post exposure treatment (PET) of human rabies

a) Bleeding deep bites on head
b) Bleeding from multiple scratches on face
c) Saliva contamination with mucus membrane
d) Contamination of open wound with saliva
e) Multiple scratchers with oozing blood on face

10. Zoonoses in humans are caused by,

a) Pasteurella multocida
b) Pseudomonas aeruginosa
c) Campylobactor jejuni
d) Salmonella typhi
e) Leptospira icterohaemorrhagia

11. Diseases that are transmitted to human by mites,

a) Epidemic typhus
b) Scrub typhus
c) Japanese encephalitis
d) Lyme disease
e) Relapsing fever

12. Oral antifungal agents used effective in treatment of dertomycosis,

a) Voriconazole
b) Terbinafine
c) Fluconazole
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Faculty of Medicine, SUSL Batch 02 (2018 AL)

d) Clotrimazole
e) Griseofulvin

13. Regarding complement system,

a) There are four main activation pathways of complement system.
b) Classical pathway is initiated by binding C1 to Immunoglobulin.
c) Lectin pathway activated by binding plasma lectin to mannose on microbes.
d) Complement activity is inhibited by regulating proteins on microbes.
e) Alternative pathway is activated in the absence of antibodies.

14. Regarding Autoimmunity

a) Is destroying its self-tissues
b) Is initiated by innate immunity system
c) Is mediated by antibodies
d) Is mediated by cytotoxic T cells
e) Natural killer cells (NK) are involved

15. Events observe in humoral immunity against extracellular bacteria

a) Antigen Processing and presenting by antigen presenting cells
b) B cell activation by T helper cells.
c) Class switching of immunoglobulin
d) Cytotoxic T cell production by professional APC
e) Production and release of antibodies by plasma cells

SBR

16. A medical student presented to a local clinic with localized vesicular eruption on the face near
the angle of his mouth. He mentioned that he had similar eruption in the same area two months
earlier. He was given aciclovir topical apply. The reappearance of the eruption is best explained
by,
a) A prolonged period of viremia following initial infection
b) A second infection with similar virus with a different serotype
c) cell mediate immune deficiency in patient
d) Failure of the patient to comply with the medication prescribed at initial episode.
e) Reactivation of the latent infection.

17. Chronic hepatitis B carrier presented to the hospital, which indicates highly infectious factor,
a) Anti HBe Antibody
b) Anti HBc Antibody
c) HBc Antigen
d) HBe Antigen
e) HBs Antigen

18. A young man who underwent a dental procedure under general anesthesia, developed low
grade fever and malaise for a week. He was admitted to hospital for the investigations. On
examination a cardiac murmur was detect. He also had a history of rheumatic fever in his
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Faculty of Medicine, SUSL Batch 02 (2018 AL)

childhood. Blood was taken for culture after induration, gram positive cocci were seen. What is
the most likely aetiological agent?
a) Coagulase negative staphylococcus
b) Enterococci faecalis
c) Staphylococcus aureus
d) Streptococcus pneumonia
e) Viridans streptococcus

EMQ

Which of the following immune responses are most suitable for following scenarios,

19. A health care worker was treated who has got a needle prick injury while drawing blood from a
HIV positive person. He had antibodies for hepatitis B.
20. Infant admitted to peadiatric ward with severe watery diarrhoea. None of other children in the
ward had diarrhoea.
21. Cleaning of blood spill in theatre with hypochlorite.
22. Babies born in Sri Lanka are immunized at birth.

a) Cohort isolation e) Barrier nursing

b) Antisepsis f) Immunization with live vaccine
c) Passive immunization g) Chemoprophylaxis
d) Immunization by killed vaccine h) Decontamination

What are the following antibiotics is the most suitable for the scenario?

23. 20-year-old boy developed superficial abscess. Pus drained from the abscess isolated MRSA. He
was treated at the hospital and discharged with an oral antibiotic.
24. 23-year-old young woman presented with vaginitis with itching. oral antifungal was given to the
patient.
25. 68-year-old deliberated patient presented with severe respiratory distress. H1N1 diagnosed was
diagnosed after appropriate investigations.
26. 70-year-old male patient diagnosed to have UTI. Investigations isolated extended spectrum beta
lactamase producing klebsiella species.

a) Cefotaxime e) Clindamycin
b) Vancomycin f) Oseltamivir
c) Ganciclovir g) Nystatin
d) Meropenem h) Fluconazole

Which of the following immune responses are most suitable for following scenarios,

27. 38-year-old male with purulent cough and fever. Gram stain showed gram positive diplococci.
28. 30-year-old male admit to ETU with rapid spreading cellulitis with bullae of leg and high fever

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Faculty of Medicine, SUSL Batch 02 (2018 AL)

with chills. Gram stain of fluid from bullae the blood culture showed gram positive cocci in
chains.
29. 70-year-old patient undergone hemicolectomy and discharged. 5 days after he presented with
fever and confusion. Gram stain showed gram positive short chains.
30. Man, who had recovered from dengue admitted to the hospital with high fever and in
observation identified an inflammation in the IV cannula site. In gram stain showed gram
positive clusters

a) Moraxella catarrhalis e) Streptococcus bovis

b) Streptococcus pneumoniae f) Staphylococcus aureus
c) staphylococcus epidermidis g) Streptococcus pyogenes
d) Enterococcus faecalis

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Faculty of Medicine, SUSL Batch 02 (2018 AL)

FACULTY OF MEDICINE
SABARAGAMUWA UNIVERSITY OF SRI LANKA
MBBS DEGREE PROGRAMME
(BACHELOR OF MEDICINE, BACHELOR OF SURGERY)
3rd MBBS PART I EXAMINATION - 2023 (02 BATCH)
MICROBIOLOGY
SEQ PAPER

01) Four clinical scenarios are given below. For each scenario
a) Name the likely diagnosis
b) One common etiological agent
c) Select the relevant microbiological tests and
d) Describe the collection and transport of specimens for these tests
1.1. A farmer from Anuradhapura transferred to renal unit TH Anuradhapura following renal
failure with brief febrile illness and jaundice (25 marks)
1.2. A 38-year-old sexually active male with multiple sexual partners presented to the ETU with a
painless ulcer on his penis. (25 marks)
1.3. A 06-year-old boy presented with fever, sore throat and difficulty in swallowing. On
examination tonsils were enlarged with pustules. (25 marks)
1.4. ICU patient developed fever on 3rd day following ventilation with purulent tracheal discharge
and respiratory distress. (25 marks)

02)
2.1. List 3 differences between primary and secondary immune response in specific immunity (35
marks)
2.2. Identity the type of hypersensitivity mechanism and associated antibody types in the given
autoimmune conditions (50 marks)
a) Post streptococcal glomerulonephritis
b) Blood transfusion
c) Myasthenia gravis
d) Anaphylaxis
e) Grave's disease
2.3. List the vaccines which were introduced to the NIP of Sri Lanka after 2010. (15 marks)

03)
A few medical students had dinner at roadside restaurant and developed diarrhoea next day
3.1. List etiological agents that cause diarrhoea in this situation (20 marks)
3.2. Identify 4 important questions that you would ask them to confirm etiology (30 marks)
3.3. List 2 sign and symptoms for hospitalize and microbiological investigation for them (20 marks)
3.4. Name the microbiological investigation and specimen you would ask them to collect (10
marks)
3.5. List 3 etiological agent of diarrhoea that need antibiotic treatment (20 marks)
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Faculty of Medicine, SUSL Batch 02 (2018 AL)

04) Four clinical scenarios are given below. For each scenario
a) Likely Diagnosis
b) One possible Causative agent
c) Appropriate microbiological Investigation
d) Suitable Specimen & proper collection method
4.1. Thick whitish vaginal discharge in a young female with pruritus (20 marks)
4.2. Swelling of the foot with draining sinuses in an agricultural worker of 3 months duration (25
marks)
4.3. Discolored brittle toe nails in a farmer for 2 months duration (30 marks)
4.4. Multiple scaly pruritic erythematous circular lesion on skin in a child with a pet cat
at home (25 marks)

05) Explain the post prophylaxis treatments for varicella in below scenarios.
5.1. A pregnant mother in her second trimester. (15 marks)
5.2. A new born baby delivered by a mother who get infected 3 days before her delivery. (15
marks)
5.3. Mention the microbiological investigations that help to diagnose dengue in hospitals. (15
marks)
5.4. What are the durations of these given related to the onset of fever? (15 marks)
5.5. Outline how you would manage an 18 years old boy presenting with a bleeding bite wound on
the face as he was bitten by a stray dog 1 hour ago. (40 marks)

06) Justify the microbiological basis of following statements regarding specimen collection.
6.1. Wound tissue for culture is better than a wound swab for culture in an infected ulcer. (20
marks)
6.2. Thorough antisepsis of skin is important before taking blood for culture. (20 marks)
6.3. Urine should not be collected from the urine bag. (20 marks)
6.4. CSF for bacterial culture should be kept in room temperature. (20 marks)
6.5. High vaginal swab is not the best specimen for suspected gonococcal infection. (20 marks)

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Faculty of Medicine, SUSL Batch 02 (2018 AL)

Answers - MCQs

1. TFFFT b) topical & oral, causing inhibition of

2. FTTTT fungal cell-membrane synthesis and
a) Watery diarrhoea subsequently fungal cell death.
d) shooting stars in the night sky Indicated for superficial
appearance in microscopy. dermatophyte infections
e) Treatment - Rehydration via ORS, (Onychomycosis, Tinea Pedis, Tinea
Doxycycline or tetracycline Corporis, Tinea Cruris)
c) for candida
3. TTTTF d) topical
a) commonest species causing human e) Fungistatic; deposited in keratin
infections – ICU setting precursor cells and is tightly bound to
b) Saprophytes – found in water, soil, new keratin, and this increases
moist places resistance to fungal invasion (Tinea
c) produce 2 pigments; pyocyanin & corporis, cruris, or capitis, Tinea
fluorescein pedis or unguium)
e) gentamicin, ciprofloxacin,
ceftazidime, amikacin 13. FFTTT
Severe infections- imipenem, meropenem, a) There are 3 pathways: classical,
piperacillin tazobactam alternative, MBL pathway
b) Activated by antigen-antibody
4. TFFTF complexes
5. TTTTT d) bacteria also use secreted molecules
6. TTFTF to inhibit complement deposition on
7. TTTTF their surface
8. FTFTT e) Activated by bacterial cell walls,
a) Parotitis occurs endotoxins, Zymosan from yeast cell
c) Only symptomatic management walls
e) Spreads by respiratory droplets
14. TFTTT
9. TTTFT b) While autoinflammatory diseases are
10. TFTFT caused by problems with innate
11. FTFFF immunity, autoimmune disease
a) human body louse originates in the adaptive immune
b) larval form of trombiculid mite system.
c) culex spp. mosquito principal vector c) There are some autoimmune diseases
C.tritaeniorhyncus where antibodies play the major role
d) ixodid ticks in causing the clinical symptoms
e) endemic-ornithodoros autoimmune patients have. Some
ticks/epidemic- louse borne examples of antibody-mediated
autoimmune diseases are:
12. FTFFT myasthenia gravis. Graves’ disease.
a) broad spectrum, use in candida, e) Autoimmune diseases generally refer
aspergillus, fusarium sp to immune effector cells such as

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Faculty of Medicine, SUSL Batch 02 (2018 AL)

cytotoxic T lymphocytes (CTLs), 18. E

natural killer cells (NKs), 19. G
macrophages. Natural killer (NK) cells, 20. A
which are key components of the 21. H
innate immune system, have been 22. F
implicated in the development of 23. E
multiple autoimmune diseases such 24. H
as systemic lupus erythematosus, 25. F
type I diabetes mellitus, and 26. D
autoimmune liver disease. 27. B
28. G
15. FTTFT 29. D
16. E 30. F
17. D - HBe antigen indicates high infectivity

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Faculty of Medicine, SUSL Batch 02 (2018 AL)

Answers - SEQs

(01) • High antibody affinity

1.1. 2.2)
A. leptospirosis a) type 3, IgG/IgM
B. Leptospira interrogans b) type 2, IgG
C. microscopic examination of blood for c) type 5, IgG
Leptospira / isolation / urine deposit d) type 1, IgE
examination by dark field microscopy e) type 5, IgG
or culture/ PCR / microscopic
agglutination test (MAT) 2.3) FIPV / HPV
D. penicillin / tetracycline
1.2 (03)
A. Primary syphilis 3.1
B. Treponema pallidum • Salmonella typhi
C. Dark field microscopy for exudate and • Shigella dysenteriae
discharge collected from the lesion • Escherichia coli
D. Benzathine penicillin • C. jejuni
1.3 • V. parahaemolyticus
A. Acute pharyngitis Streptococcal • V. cholera
pharyngitis 3.2
B. Streptococcus pyogenes (group A - food type they ate last night
streptococci) - is diarrhea contain blood & mucus
C. Throat swab for culture in blood agar - dehydration features ( find severe
D. Penicillin diarrhea )
1.4 - high fever or mild fever
A. Hospital acquired pneumonia 3.3
B. Pseudomonas aureginosa - high fever spikes
C. Culture for tracheal discharge - diarrhea contain blood & mucus
D. Gentamicin/netilmicin/meropenem - severe dehydrated features
3.4
(02) - culture of feces
2.1) primary response - feces sample
• Usually 5-10 days
• Small peak response 3.5
• Mainly IgM antibody isotype - V. cholera
- Salmonella typhi
• Low antibody affinity
- Staphylococcus aureus
Secondary response
• Usually 1-3 days
• Large peak response
• Mainly IgG antibody isotype

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Faculty of Medicine, SUSL Batch 02 (2018 AL)

(04) d)
a) Lyme disease
Candidiasis Borrelia burgdorferri
Candida albicans Biopsy/serology (ELISA/IFA)
Gram stain/culture Blood
High vaginal swab A. Clean the skin of the venipuncture
A. With the speculum in situ, site with tincture of iodine or 10%
pass the tip of the swab povidine iodine followed by 70%
through the speculum to alcohol.
the cervical os. B. Allow to dry. Do not touch the site:
B. Insert the swab gently wear sterile gloves and using a
into the cervical os. disposable syringe and needle draw
C. Rotate the swab for 10-15 the require volume and transfer to a
seconds in the red topped tube and sent to the lab
endocervix.
D. Remove the swab and (05)
insert it into the tube
from which the swab was 1.1)
removed from. - Counseling & isolation to mother
b) (Counseling :- about Congenital
Chronic osteomyelitis varicella )
Staphylococcus aureus - Immunoglobulins (VZIG) - IM
Blood culture/Microscopy-gram - Antiviral
stain/Culture(pus) - Acyclovir 40mg/kg/day in 4 divided
Pus from discharging sinuses doses - Given from day 7-14 after
A. Collect before applying an antiseptic exposure
B. Aspirate with a sterile needle and - Vaccination- varicella/chicken pox
syringe and transport in the syringe vaccine - Live attenuated vaccine (2
itself or collected into a sterile dry doses; 4-8 wks apart)
leak proof container
c) 1.2) VZIG and acyclovir to the baby after the
Onychomycosis birth
Dermatophytes 2.2)
Culture-Sabourauds glucose agar/direct - Before 5 days- NS1 antigen
microscopy-smear with KOH - After 5 days- IgM antibodies
Nail clippings/scrapings of debris under the 3) *This is a major exposure.
nails Initially local treatment of wound should give.
A. Collect the nail shavings with a Wash and flush the wound with running
microtome blade into another slide or water and detergent. Then hyper immune
black paper rabies serum equine 40IU/ kg human 20IU/kg
B. Slide is covered with another infiltrate to site as much as possible within
slide/paper is folded to make a packet 72hrs.Same day rabies tissue culture vaccine
and send to the lab should give according to 2 site schedules over
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Faculty of Medicine, SUSL Batch 02 (2018 AL)

deltoid and repeat in Day 3, 7, and 30. misdiagnosed.

Suturing should not be done or should 6.3. Urinary tract is normally sterile and urine
postponed. Tetanus toxoid and antimicrobials collection is an aseptic procedure. Urine
should be given* specimens are tested for organisms in the
urinary tract. If urine is taken from the
urine bag it will give false culture results
(06) as the urine bag is contaminated. So,
6.1. Chronic wounds have colonized of many urine should be taken above the clamped
microorganisms. It may produce false catheter.
results. So, tissue sample is the best one. 6.4. Meningitis can be caused by Hemophilus
6.2. We use blood culture as an indication for influenzae like bacteria, they can be
sepsis, septicemia, meningitis, infective destroyed by cold temperature, so must
endocarditis UTI like conditions. not refrigerate CSF samples
These conditions can be caused by 6.5. Gonococcal infection mostly infects the
Staphylococcus epidermis, Staphylococcus cervix, uterus and fallopian tube. So,
aureus like opportunistic infectious which when taking samples swab must take in
are colonize in the skin normal flora. cervical secretions. Not the vaginal swab.
So, if skin antisepsis in not done the High vaginal swab can contaminate the
sample can be contaminated and swab with normal flora.

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