MICROBIOLOGY – 2

REMEMBER ALL QUESTIONS ARE VERY IMPORTANT

RED FOR MOST IMP QUE

BLUE FOR SAME QUE BUT DIFFERENTLY ASKED

+ FOR HOW MANY TIMES IT ASK

SKIN & MUSCULOSKELETAL SYSTEM

(1) CASE: DERMATOPHYTOSES....TINEA CAPITIS [7M] +++

A patient presented to Skin OPD with ring shaped pruritic scaly skin lesion with central clearing and
raised edges in scalp region. Culture of skin scrapping reveals velvety colonies with red pigment on
reverse. Lactophenol cotton blue preparation of culture shows many microconidia & few pencil-shaped
macroconidia.

a. is the most probable clinical diagnosis and etiological agent? (2)

b. Write laboratory diagnosis of this condition. (5)

(1.1) Dermatophytes [7M]

(1.2) Discuss different clinical types of Dermatophytes infection.

(2) CASE: GAS GANGRENE[7M] ++

A 50-year-old man met with a road traffic accident in which he sustained multiple fractures with open
wounds. He was taken to the nearest hospital two days later, & started supportive therapy and
antibiotics. There was h/o edema and pain at the site of injury with increased discoloration and crepitus
on palpation. Microscopic examination of the wound discharge showed the presence of thick, brick-
shaped, gram-positive bacilli along with gram-positive cocci.

a. What is the most probable clinical diagnosis and causative agent/s? (3)

b. Describe Pathogenesis and Laboratory diagnosis of this condition. (4)

(2.1) A 50-year-old man met with a road traffic accident in which he sustained multiple fractures with
open wounds and a crush injury of the leg. He was taken to the nearest hospital two days later, at which
time, he was found to be in shock. He was started on supportive therapy and antibiotics. There was.
edema and pain at the site of injury with increased discoloration and a serous discharge. The area
around the wound exhibited crepitus on palpation. Microscopic examination of the wound discharge
showed the presence of thick, brick-shaped, gram-positive bacilli along with gram-positive cocci. [7M]

i. What is gas gangrene?

ii. Describe its pathogenesis.

(3) CASE: STAPHYLOCOCCUS INFECTION.....ABSCES/ FOLLICULITIS [12M] +++

A 55-year-old male was admitted to the hospital with complaints of severe pain in the lateral aspect of
his left calf and a small amount of pus discharge from the ingrown hair. On physical examination, the
local area was found to be red, warm, and tender. Pus was aspirated and was subjected to Gram stain
(showed gram-positive cocci in clusters), and culture on blood agar (showed golden yellow pigmented
beta-hemolytic colonies).

a What is the clinical diagnosis and its causative organism? (2 marks)

b. List the infections caused by this organism. (2 marks)

c. List the virulence factors of this organism. (2 marks)

d. discuss the laboratory diagnosis. (4 marka)

e. List drug resistance mechanisms develop in organisms (2 marks).

(3.1) Drug resistance in staphylococcus aureus: Mechanism and control measures. (5+2 Marks)

(4) Classify fungal infections of skin and soft tissues. (2 marks). Describe etiology, clinical manifestations
and laboratory diagnosis of mucormycosis.......[RESPI INEFC] (5 maries)

(5) Etiopathogenesis and laboratory diagnosis of Maduramycosis. (4+3 Marks)

(6) Pathogenesis and Laboratory diagnosis of Herpes simplex (3+4M) ++++

(6.1) Define viral exanthems. (1 mark). Write 4 viral agents name only causing viral exanthematous
lesions (2 mark). Write in detail about any one agent including its pathogenesis, clinical manifestations.
Laboratory diagnosis, treatment and vaccines available for the same. (4 marks)

(6.2) Herpes simplex virus: morphology, pathogenesis, clinical manifestations and Lab diagnosis.
(1+2+2+2 Marks)

(6.3) A 7-year-old boy had developed multiple painful vesicles over the lips and buccal mucosa. His
parents revealed that two children of his school had a similar presentation few days back. Scrapings
taken from the lesion demonstrated presence of multinucleated giant cell (Tzanck smear).

a. What is the most probable diagnosis?[1M]

b. Write in details about manifestation and complication found in this condition [3M]

c. How is this infection diagnosed in the laboratory? [3M]

(7) Describe Varicella-Zoster Virus Infections.[7M]

(8) Cutaneous Larva Migrans [7M] ++

(8.1) Cutaneous larvae migrans: lifecycle, clinical features, diagnosis, treatment. (1+2+2+2M)

(9) CASE: MEASLES

A 6-year-old child presents with a high fever, cough, coryza, conjunctivitis, and a characteristic rash
starting from the face and spreading to the rest of the body. The child's parents report that the child was
not vaccinated with the MMR vaccine,

a. What is the most likely diagnosis?

b. Describe the pathogenesis and complications associated with this infection.

(10) CASE: STREPTOCOCCUS PYOGENS ++

A 5-year-old girl presented with tender, Lright red, subcutaneous swelling on malar area of the face with
indurated peau d'orange texture of involved skin along with fever and chills. A clinical diagnosis of
cellulitis was made. The culture of the aspirated ous revealed beta-hemolytic pin point colonies

a. What is the most likely etiologic agent?

b. Describe the virulence factors and the other clinical manifestations produced by the etiological agent?

c. Briefly discuss the laboratory diagnosis of this clinical condition.

(10.1) A 5-year-old child presents with a red, swollen, and painful lesion on the lower leg, which is
rapidly spreading. The lesion is warm to the touch, and the child has a fever. The child's history reveals a
recent episode of pharyngitis on examination, diagnosis of cellulitis was made. Aspirated pus gram stain
shows gram positive cocci in chain, culture revealed beta-hemolytic pinpoint colony which was catalase
negative.

a. What is the most likely organism responsible for this condition?

b. Describe the pathogenesis of agent causing this infection.

(11) Cutaneous filariasis. [7M]

RESPIRATORY SYSTEM

(1) CASE: TB [12M] ++++

A 50-year-old man presented with a history of low-grade fever with an evening rise in temperature and
productive cough for the past two months. More recently, he had expectorated blood-tinged sputum.
He also gave a history of loss of weight (around 10 kg over the past four appetite. A chest X-ray revealed
a nodular infiltrate in the apical area of the right upper lobe.

a. What is the most probable clinical diagnosis and most likely etiological agent? (2)

b. Describe the various laboratory methods used to diagnose this infection. (6)

c. Write the antimicrobial resistance and prophylactic measures for this causative agent. (4)

(1.1) CASE: TB

Sunita aged 24 years female was admitted to the hospital with complaints of low-grade fever, weight
loss and chronic cough with expectoration for past 6 months.Sputum examination revealed long, slender
and beaded acid-fast bacilli. [12 Marks]

a) Write down the most probable diagnosis and the causative organism (1+1)

b) Describe the pathogenesis and laboratory diagnosis of this disease (3+5)

c) Write down the prophylaxis of this disease (2)

(1.3) Describe in detail about Laboratory diagnosis of Tuberculosis.[7M]

(1.4) Kinyon stain of sputum from a man with cough and expectoration showed red coloured
filamentous bacilli. Describe the pathogenesis and laboratory diagnosis of this condition. (3+4 Marks)

(2) CASE: DIPHTHERIA [7M] +++

A five-year-old child presented to the outpatient ward with a history of pain in the throat and difficulty
in swallowing accompanied by low-grade fever for the past two days. His tonsillar pillars were covered
with a greyish-white, elevated membrane which bleed on touch.[7M]

a. What is the most probable clinical diagnosis and etiological agent? (2)

b. Describe pathogenesis and Laboratory diagnosis and prophylactic measures for this condition. (5)

(2.1) Pathogenesis and Laboratory diagnosis of Diphtheria (3+4M)

(2.2) A 9 years old female child brought to emergency department with high grade fever, throat pain,
neck oedema, inability to swallow and stridor. On examination, white patch was found on the fauces,
which started bleeding on touch. Vaccination status was unknown.

a. What is the clinical diagnosis and most probable pathogen?

b. Explain pathogenesis of possible pathogen.

c. Explain laboratory diagnosis of possible pathogen.

(3) CASE: COVID -19[7M] +++

40-year-old patient presented with complain of dry cough, fever and sore throat. Nasopharyngeal swab
was taken & sent for COVID 19 testing which came Positive. The resident doctor who examines patient
without wearing mask was also turned positive subsequently.

a. What is the most probable etiological agent? (1)

b. Describe Pathogenesis and Laboratory diagnosis of this condition. (4)

c. Write the infection prevention control measures for this condition. (2)

(3.1) Describe in details about Post Exposure Prophylaxis of Covid 19 Infection [7M]

(3.2) CASE: COVID -19 PNEUMONIA [12M]

65 years old patient (without wearing any mask) with complaints of dry cough, sore throat, fever, loss of
taste sensation visited a hospital. The security guided him to go to the casualty. The resident doctor
(without mask) took history. examined the patient. On examination his temperature was 101" fernhit,
PR 100/minute, Respiratory rate 26/minute, Spo2 92%, chest x ray showed ground glass opacities &
consolidation. His throat swab was sent for examination. Subsequently resident & security get above
symptoms.

1. What is your probable diagnosis? Identify the infection control breaches. (2 marks)

2.Describe the Laboratory diagnosis of this Disease. (5 marks)

3. Discuss infection control measures to prevent the transmission of above infection. (4 marks)

4. Name 2 vaccines licensed in India for above condition. (1 marks)

(4) Write short note on Bacterial atypical pneumonia.[7M] ++

(4.1) Enumerate microbial agents of Atypical pneumonia. Explain Laboratory diagnosis of Hemophilus
influenza.

(5) Write down the classification and laboratory diagnosis of Non-tuberculosis mycobacteria infection
(NTM). [7M]
(6) CASE : INFLUENZA [12M] ++

A 60-year-old woman with a history of chronic obstructive airway disease was admitted to the
emergency ward with a cough and fever of 39°C. Her fever and cough showed rapid progression and she
later developed dyspnea with respiratory distress. Her blood gas analysis was consistent with hypoxia
and her chest X-ray showed bilateral ground-glass opacities with areas of consolidation. Her
nasopharyngeal aspirate was subjected to PCR. She succumbed to the infection despite supportive care
and oseltamivir antiviral therapy.

a.What is the probable diagnosis? (1)

b. Differentiate between antigenic drift and shift. (3)

c. Write in detail about specimen collection and lab diagnosis of Influenza. (8)

(6.1) HINI 2009 pandemic flu. [7M]

(7) CASE: MUCORMYCOSIS ++

A 65 years old male patient of Diabetic ketoacidosis admitted in ICU developed orbital pain and facial
pain since 5 days. On examination, eschar was found in nose and Nasal swab sent for microscopy. KOH
preparation revealed broad aseptate hyphae.

a. Identify the most probable pathogen.

b. Discuss laboratory diagnosis of the pathogen.

(7.1) Mucormycosis [7M]

CNS
(1) CASE: RABIES [7M] +++++

A 29-year-old male was brought to emergency department with complains of fever, anorexia and
vomiting for past 3 days followed by delirium, hallucinations and severe spasms on drinking fluids. His
relative informed that patient was bitten by stray dog three month back.

a. What is most probable clinical diagnosis and etiological agent? (2)

b. Describe pathogenesis, Laboratory diagnosis and prophylaxis of this disease of this condition. (5M)

(1.1) Discuss laboratory diagnosis and treatment for Rabies. [7M]

(1.2) Laboratory diagnosis of Rabies and vaccines available for human ane. (4+3M).

(1.3) CASE: RABIES [7M]

A five-year-old boy who was bitten by a rabid dog and presented to the emergency department with
multiple scratches on the upper arms and neck. His parents stated that the dog was a stray that lived in
their locality (and hence could be observed). Wound toilet was performed, followed. by the application
of povidone-iodine. The wound was left open. The boy was given tetanus toxoid (as his booster was due),
and a Vero cell culture vaccine was started. He completed the course (0, 3, 7, 14, and 28 days post
exposure). The dog died two days later. Its brain was sent to the veterinary lab and tested positive for
Negri bodies on histopathology.

i. What are Negri bodies?

ii. Write in detail about vaccines used against Rabies.

(3.4) Discuss Post exposure prophylaxis of Rabies.

(2) CASE: CRYPTOCOCCAL MENINGITIS [7M] +++++

A 36 years old male patient with history of HIV/AIDS presented to casualty with high grade fever,
headache and seizers. CSF microscopy revealed budding yeast cells surrounded by a halo.

a. What is most probable clinical diagnosis and etiological agent? (2)

b. Describe pathogenesis and laboratory diagnosis of this condition. (5)

(2.2) Write short note on Cryptococcal Meningitis including its pathogenesis, clinical features, laboratory
diagnosis and treatment. [7M]

(2.3) A 58 years old female on Anti-retroviral therapy presented to hospital with headache, fever,
altered sensorium-and Loss of vision. CSF examination revealed low glucose, elevated proteins and
lymphocytosis. Negative stain reveled round budding yeast cells with clear halo surrounding.

a. What is the most probable clinical diagnosis and pathogen associated with it?

b.Discuss laboratory diagnosis in detail.

(2.4) Describe in detail about Cryptococcal meningitis [7M]

(3) CASE: TETANUS [12M] ++

A 30 years old crush injured woman developed trismus followed by muscle pain and stiffness, back pain
and difficulty in swallowing in five days. She had undergone abortion conducted by a village quack.
Specimen collected from devitalized tissue reveled Gram Positive Bacilli with terminal and spherical
spores (drum stick)

a) What is the probable diagnosis of this clinical condition? Naune the causative organism (1+1)
b) Describe in detail the pathogenesis and laboratory diagnosis of this clinical condition (4+4)

c) Add a note on vaccination to prevent this disease (2)

(3.1) CASE: TETANUS [12M]

A 32 year old man came after 3-5 days following a bullet injury, developed trismus followed by muscle
pain and stiffness, back pain and difficulty in swallowing. Excised tissue bits from the necrotic deposits of
the wound revealed gram-positive bacilli with terminal spores.

a.What is the probable diagnosis of this clinical condition? (1)

b. Describe active and passive immunoprophylaxis against this condition. (4)

c. Describe pathogenesis, clinical manifestation and laboratory diagnosis of this condition. (7)

(4) Enlist parasitic infections of CNS. Write in detail about one of free-living amoebae infection. (3+4
Marks)

(5) Write briefly about clinical manifestation and laboratory diagnosis of tuberculous meningitis. (3+4
Marks)

(6) Define Prions diseases. Write in detail about mechanism with Clinical manifestation and lab diagnosis.
(1+4+2 Marks) ++

(7) CASE: NEUROCYSTISARCOSIS ++

A 21 years old vegetarian female presented with recurrent episodes of seizure, headache, vomiting and
vertigo. MRI scan of brain showed cystic lesion in brain parenchyma. On Surgical resection of cysts, they
were yellowish white, oval, containing bladder like sac with a white spot.

a.What is the most probable clinical diagnosis and pathogen associated with it?

b. Discuss lifecycle of pathogen in this condition.

GENITOURINARY SYSTEM
(1) CASE: SYPHILLIS [7M] ++++++

A 20-year-old male truck driver presented with a genital ulcer of 10 days' duration. The ulcer was
painless. The man had a history of unprotected sexual contact with a commercial sex worker about two
weeks before this. On examination, the ulcer was found to be circumscribed, indurated and partially
healed and inguinal lymph nodes were enlarged.
a. What is most probable clinical diagnosis and etiological agent? (2)

b. Describe pathogenesis, Laboratory diagnosis and prophylaxis of this disease of this condition. (5M)

(1.1) CASE: SYPHILLIS [12M] ++

A 20-year-old male who works as a truck driver presented to the Skin and Venereal Disease clinic with a
genital ulcer which was painless for the previous 10 days. He had had unprotected sexual contact with a
commercial sex worker about two weeks previously. On examination, the ulcer was found to be
circumscribed, indurated and partially healed. The inguinal lymph nodes were enlarged.

a. What is the clinical diagnosis and its causative organism? (2 marks)

b. Describe clinical manifestations of this condition. (4 marks)

c. What are the various diagnostic modalities? (4 marks)

d. How will you treat this condition? (2 marks)

(1.2) Enumerate four sexually transmitted infections. Write Laboratory diagnosis of any one of them.
(2+5M)

(1.3) A 30 years old male with history of multiple sexual partners presented to a STD clinic with painless
hard indurated genital ulcer and painless hard lymphnodes

a. What is the most probable clinical diagnose and pathogen associated with it?

b.Discuss different clinical presentations of the disease.

c.Discuss in details about Serological methods of diagnosis.

(1.4) A 23-year-old male having a history of sexual exposure with a commercial sex worker is presented
to a STD clinic with painless hard indurated genital ulcer and painless hard lymph node.

a. What is the clinical diagnosis?[1M]

b. Write down in details about clinical manifestation of this condition.[4M]

c. Discuss the laboratory diagnosis.[5M]

d. Write down in details about the treatment of this condition.[2M]

(2) CASE: UTI [7M]

70 years old man complains of urgency, increased frequency of passing urine and suprapubic pain
midstream urine specimen was sent for culture which yielded 105 colony forming unit per ml.

a. What is most probable clinical diagnosis and etiological agents? (3)

b. Describe pathogenesis and laboratory diagnosis of this condition. (4)

(3) CASE: CHLAMYDIAL TRACHOMATIS URETHRITIS [12M]

A 27 years woman had developed mucopurulent discharge followed by development of dysuria and
urethral irritation. She had a history of multiple sex partners. Microscopy of urethral swab revealed
sterile pyuria and presence of compact inclusion bodies which are letter stained by Lugol's iodine (12
marks)

1. Differential diagnosis of above infection. What is the most probable etiological diagnosis? (2+1 marks)

2. What are the other manifestations produced by the causative agent? (2Marks)

3. How is this infection diagnosed in the laboratory? (5 marks)

4. Discuss infection control measures to prevent the transmission of this infection. (2 marks)

HOSPITAL INFECTION CONTROL

(1) HAI. Enlist major types of HAI. Explain Standard precaution & write Detail about Hand Hygiene. Write
in detail about bundle care approach for prevention of devise associated infection. [12M] +++

(1.1) Enumerate different types of Healthcare Associated Infections (HAI). Discuss common etiological
agents and laboratory diagnosis of any one HAI type.

(1.2) Care bundle approach for prevention of device associated infections [7M]

(2) Enlist the agents used for disinfection in hospital and Write in detail about moist heat Sterilisation.
(2+5M)

(2.2) Define sterilisation & Disinfection. Write in detail about ETO sterilization method including its
principle, uses, quality control etc. [7M]

(3) Enumerate different Chemical sterilant agents. Discuss mechanism of action, advantage,
disadvantage and uses of any one High level disinfectant.

MISCELLANEOUS
(1) CASE: LYMPHATIC FILARIASIS [7M]..........[GIT]

A 65-year-old man presents with a gradually increasing swelling of the left limb over many years,
significant weakness, loss of appetite, and weight loss. On examination, he was found pale with left
lower limb enlargement. His inguinal lymph nodes were enlarged. Peripheral blood smear reveals
microfilaria.

a. What is most probable clinical diagnosis and etiological agent? (2)

b. diagnosis of this condition. (3)

c. Write preventive measures of it. (2)

(2) Define congenital infections. (1 mark). Write only name of any 4 agents causing congenital infections.
(2 marks). Write in detail about any of them including clinical manifestations, laboratory diagnosis and
treatment. (4 marks)

(3) Discuss the importance of healthcare as a right and barriers to implementation of healthcare as a
universal right? [7M]

(4) Pathogenesis and Laboratory diagnosis of Candida albicans (3+4)....[CVS/BLOOD]

(5) Life Cycle and Laboratory Diagnosis of Ancyclostoma duodenale (Hook worm) (3+4).....[GIT]

(6) Enumerate any four ocular parasitic infections. Write a note on any one. (2+5M)

(7) Oncogenic Viruses [7M] ++

(8) Enumerate any four arboviral infections common in India. Write a note on any one. (2+5M).

(9) Describe about Clinical features and Laboratory Diagnosis Chandipura viruses.[7m]

(10) Define consent? Describe the types of Consent in details.[7M]

(11) Define healthcare-associated infections. Mention its major types. Concept of HICC with its
constitution and functions. (1+2+4 Marks)

(12) Describe and discuss the role of autonomy and share responsibility as a guiding principle in patient
care. (7 Marks) ++

(12.1) What is Autonomy? describe in detail about confidentiality in laboratory report. [7M]

(13) Vaccination schedule for upto 10 year (Pediatrics) [7M]

BEST OF LUCK