1.
The infectious diseases department of a hospital admitted a patient with nausea, liquid stool with mucus and blood streaks, fever, weakness. Dysentery was suspected. What method of laboratory diagnostics should be applied to confirm the diagnosis?
2. A 6-year-old child with suspected active tuberculous process underwent the diagnostic Mantoux test. What immunobiological preparation was injected?
3.
Stool culture test revealed in a 6-month-old bottle-fed baby the strain of intestinal rod-shaped bacteria of antigen structure 0-111. What diagnosis can be made?
4. Bacteriological examination of the
urine of the patient with pyelonephritis revealed microorganisms that produced yellow-green pigment and a characteristic odor in meat-peptone agar. What are they called?
5. A smear from the tonsillar coating of a patient with suspected diphtheria was found to contain blue bacilli with a thickening at the poles. What method of smear staining was used?
6. A patient has been hospitalised with provisional diagnosis of virus B hepatitis. Serological reaction based on complementation of antigen with antibody chemically bound to peroxidase or alkaline phosphatase has been used for disease diagnostics. What is the name of the applied serological reaction?
7.
A patient has been hospitalised with provisional diagnosis of botulism. What serological reaction should be used to reveal botulinum toxin?
8.
In a village, a case of anthrax had been registered. Medical services began epidemiologically indicated specific prophylaxis of population against anthrax. What preparation was used for this purpose?
9.
A 55-year-old patient with a characteristic rash, fever, dizziness has been admitted to a hospital. He has been provisionally diagnosed with typhus. No similar cases have been reported. In his youth (15 years old) the patient suffered typhus in a boarding school. What disease is it?
10.
In one of Polessye regions there was an outbreak of helminthiasis manifested by cramps and facial edmata. The developed preventive measures in particular included ban for eating infested pork even after heat processing. What helminthiasis was the case?
11.
A patient who has recently arrived from an endemic area presents with elevated body temperature, headache, chills, malaise, that is with the symptoms which are typical for a common cold. What laboratory tests are necessary to prove or to disprove the diagnosis of malaria?
12.
An outbreak of an intestinal infection occurred in a kindergarten on the eve of New Year holidays. Bacteriological examination of patients’ faeces didn’t reveal any pathogenic bacteria. Electron microscopy revealed roundish structures with clear outer edges and a thick core resembling a wheel. Specify the most likely causative agent of this infection:
13.
A smear of streptobacillus preparation stained by Ozheshko method has been studied microscopically with oil immersion. What structural feature of the bacteria has been studied?
14.
At a bacteriological laboratory animal skins are analyzed by means of Ascoli precipitation test. What is detected if the reaction is positive?
15.
A 12-year-old boy has been hospitalized for suspected food poisoning. The fecal samples were inoculated on the Endo agar, which resulted in growth of a large number of colorless colonies. What microorganism is most likely to be EXCLUDED from the list of possible causative agents of the disease?
16.
Bacteriological examination of purulent discharges from the urethra revealed some gram-negative bean- shaped bacteria located in the leukocytes. They can be identified as the causative agent of the following disease:
17.
A hospitalized patient bitten by a rabid animal has an avulsive wound of shin. What kind of vaccine must be given to prevent rabies?
18.
A smear of sputum from the patient with suspected lobar pneumonia was stained with the use of the following stains and reagents: solution of gentian violet, Lugol’s solution, 96o alcohol, water magenta. What staining method was applied in this case?
19.
A patient has severe catarrhal symptoms. Material growth on Bordet-Gengou agar showed mercury-drop-like colonies. Examination of the blood smears revealed some small ovoid gram-positive bacilli sized 1-3 microns. What microorganisms were isolated?
20.
The laboratory for especially dangerous infections conducts microscopic examination of pathological material from a patient with suspected plague. The sample was stained by Burri-Gins technique. What property of the causative agent can be identified by this technique?
21. A patient has been admitted to the infectious diseases department for malaise, fever up to 38oC , jaundice. A few months ago, the patient underwent blood transfusion. The doctor suspected viral hepatitis B. What are the principal methods of laboratory diagnosis of hepatitis B?
22.
A miner consulted a physician about the appearance of body rash followed by a loss of appetite, bloating, duodenal pain, frequent bowel movements, dizziness. Ovoscopic probes of feces and duodenal contents revealed some eggs covered with a transparent membrane through which 4-8 germinal cells could be seen. What disease is likely to have occurred in the patient?
23.
In the surgical ward, the dressing material was undergoing sterilization in an autoclave. Through an oversight of a nurse the mode of sterilization was changed and the temperature in the autoclave reached only 100oC instead of the due 120oC . What microorganisms can stay viable under these conditions?
24.
Typical manifestations of food poisoning caused by C. botulinum are double vision, abnormal functioning of the swallowing and breathing. These symptoms develop as a result of:
25.
A patient consulted a physician about chest pain, cough, fever. Roentgenography of lungs revealed eosinophilic infiltrates which were found to contain the larvae. What kind of helminthiasis are these presentations typical for?
26.
A patient consulted a dentist about limited mouth opening (trismus). He has a history of a stab wound of the lower extremity. What infection may cause these symptoms?
27.
A female patient consulted a physician about digestive disorder, extended abdominal pain. Examination revealed drastic decrease in hemoglobin concentration. It is known from the anamnesis that while living in the Far East the patient used to eat freshly-salted caviar. Some relatives living with her had the similar condition. What is the most likely diagnosis?
Explanation
· Diphyllobothrium latum causes diphyllobothriasis. A fish tapeworm. In contrast to the other cestodes, which have suckers , the scolex of D. latum has two elongated sucking grooves by which the worm attaches to the intestinal wall. Infection by D. latum causes little damage in the small intestine. In some individuals, megaloblastic anemia occurs as a result of vitamin B12 deficiency caused by preferential uptake of the vitamin by the worm. Transmission: ingestion of larvae from raw freshwater fish. Caviar is prepared from fish.
· Echinococcus granulosus causes Echinococcosis. It is composed of a scolex and only 3 proglottids, making it one of the smallest tapeworms. The scolex has a circle of hooks and 4 suckers similar to Taenia solium. Dogs are the most important definitive hosts. The intermediate hosts are usually sheep. Humans are almost always dead-end intermediate hosts. Transmission: ingestion of eggs from dog faeces. Disease – hydatid cysts in liver causing anaphylaxis if antigens released.
· Taeniasis: there are two important human pathogens in the genus Taenia: T. solium (pork tapeworm) and T. saginata (beef tapeworm)
· Trichiniasis (Trichinosis) is caused by Trichinella spiralis (nematode- roundworm). Transmission: fecal-oral; undercooked meat (especially pork). A few days after eating undercooked meat, usually pork, the patient experiences diarrhea followed by 1-2weeks later by fever, muscle pain, periorbital edema and eosinophilia.
· Ascaridiasis (Ascariasis) caused by Ascaris lumbricoides (giant roundworm). The major damage occurs during larval immigration rather than from the presence of the adult worm in the intestines. The principal sites of tissue reaction are the lungs, where inflammation with an eosinophilic exudates occurs in response to larval antigens. Ascaris pneumonia with fever, cough and eosinophilia can occur with a heavy larval burden.
28. Analysis of sputum taken from a patient with suspected pneumonia revealed rather elongated gram-positive diplococci with somewhat pointed opposite ends. What microorganisms were revealed in the sputum?
29.
The contents of vesicles that appeared on the mucous membrane of a patient with variola was sent to a virological laboratory. Which of the listed changes were revealed during the smear microscopy?
30.
Serological diagnostics of infectious diseases is based upon specific interaction with antigens. Specify the serological reaction that underlies adhesion of microorganisms when they are affected by specific antibodies in presence of an electrolyte:
31.
In order to determine toxigenicity of diphtheria bacilli a strip of filter paper impregnated with antitoxic diphtherial serum was put on the dense nutrient medium. There were also inoculated a microbial culture under examination and a strain that is known to be toxigenic. If the microbial culture under examination produces exotoxin, this will result in formation of:
32.
A patient underwent esophagogastroduodenoscopy. Analysis of the biopsy material enabled doctors to diagnose him with helicobacteriosis. What property of the bacteria found in this patient had to be obligatory taken into account during their cultivation?
33.
There was a record of some anthrax cases among animals in a countryside. The spread of disease can be prevented by means of immunization. What kind of vaccine should be used?
34.
A bacteriological laboratory received sputum sample of a patient suffering from tuberculosis. Bacterioscopic examination of smears and detection of tuberculosis bacillus can be realized by one of enrichment methods that involves processing of sputum only with solution of caustic soda. What is this method called?
35. Vomiting matters of a patient suspected of having cholera were delivered to the bacteriological laboratory. The material was used for preparing a \"hanging drop\" specimen. What type of microscopy will be applied for identification of the causative agent by its mobility?
36.
During examination of a patient a dentist revealed a lot of \"white spots zones of enamel demineralization. What microorganisms take part in the development of this process?
37.
A 4 year old child presents with general weakness, sore throat and deglutitive problem. After his examination a doctor suspected diphtheria and sent the material to the bacteriological laboratory. In order to determine the diphtheria causative agent the material should be inoculated into the following differential diagnostic medium:
38.
Sanitary bacteriological research on water by the membrane filter method revealed two red colonies on a membrane filter (Endo agar) through which 500 ml of analyzed water were passed. Calculate the coli index and coli titer of the analyzed water:
39.
A 55-year-old male patient was hospitalised to a surgical clinic for suspected septicemia. What material should be taken for analysis?
40.
A man died from an acute infectious disease accompanied by fever, jaundice, haemorrhagic rash on the skin and mucous membranes as well as by acute renal insufficiency. Histological examination of renal tissue (stained by Romanovsky-Giemsa method) revealed some convoluted bacteria looking like C and S letters. What bacteria were revealed?
41.
A culture of monkey cells (Vero) and a group of mouse sucklings were infected with an inoculum taken from a child with provisional diagnosis \"enterovirus infection\". There was no cytopathic effect on the cell culture but mouse sucklings died. What enteric viruses might have caused disease of this child?
42.
Microscopic examination of a gram- stained scrape from a patient’s tongue revealed oval, round, elongated chains of dark-violet gemmating cells. What disease can be caused by this causative agent?
43. A patient working at a pig farm complains about paroxysmal abdominal pain, liquid feces with admixtures of mucus and blood, headache, weakness, fever. Examination of large intestine revealed ulcers from 1 mm up to several cm large, feces contained oval unicellular organisms with cilia. What disease should be suspected?
44.
A male patient has been diagnosed with gastric ulcer. Bacteriological examination of biopsy material from the affected part of stomach revealed small colonies of gram-negative, oxide reductase-positive flexibacteria that grew on the chocolate agar on the fifth day. Which of the following microorganisms is the most likely causative agent?
45. A patient has food poisoning. Laboratory analysis revealed a culture of anaerobic gram-positive spore-forming bacteria. What is the most likely kind of the isolated causative agent?
Explanation
1. Some bacteria can form spores at the end of the stationary phase when nutrients are limited. Spores are highly resistant to heat and chemicals. Have dipicolinic acid in their core and they have no metabolic activity. Examples of species that form spores and the disease they cause:
|
Species
|
Disease
|
|
Bacillus anthracis
|
Anthrax
|
|
Bacillus cereus
|
Food poisoning
|
|
Clostridium botulinum
|
Botulism
|
|
Clostridium difficile
|
Antibiotic-associated colitis
|
|
Clostridium perfringens
|
Gas gangrene/Food poisoning
|
|
Clostridium tetani
|
Tetanus
|
|
Coxiella burnetii
|
Q fever
|
46.
A pregnant woman was registered in an antenatal clinic and underwent complex examination for a number of infections. Blood serum contained IgM to the rubella virus. What is this result indicative of?
47.
After inoculation of the material obtained from the pharynx of an angina patient onto the blood-tellurite agar, grey colonies could be observed. They were 4-5 mm in diameter, radially striated (in form of rosettes). Microscopical examination revealed gram-positive bacilli with clavate swollen ends arranged in form of wide-spread fingers. Identify these microorganisms:
48.
Examination of a patient with pustular skin lesions allowed to isolate a causative agent that forms in the blood agar roundish yellow middle-sized colonies surrounded by haemolysis zone. Smears from the colonies contain irregular- shaped clusters of gram-positive cocci. The culture is oxidase- and catalase-positive, ferments mannitol and synthesizes plasmocoagulase. What causative agent was isolated?
49.
Clinical diagnosis of a female patient was gonorrhoea. What examination method can be applied for confirmation of this diagnosis?
50. During regular examination of schoolchildren it was revealed that a 10 year old girl had asymmetric oval eggs with a larva in the scrape from her perianal folds. What diagnosis should be made?
51.
Researchers of a bacteriological laboratory examine tinned meat for botulinic toxin. For this purpose a group of mice was injected with an extract of the material under examination and antitoxic antibotulinic serum of A, B, E types. A control group of mice was injected with the same extract but without antibotulinic serum. What serological reaction was applied?
52.
During the repeated Widal’s agglutination test it was noticed that the ratio of antibody titers and O-antigens S.typhi in the patient’s serum had increased from 1:100 to 1:400. How would you interpret these results?
53.
A patient has acne on his face. Microspcopic examination of scrapings from the affected areas revealed living porrect vermiform arthropoda 0,2-0,5 mm large with four pairs of short extremities in the front part of their bodies. What is the laboratory diagnosis?
54.
Among junior children of an orphanage an outbreak of intestinal infection with signs of colienteritis was registered. In order to identify isolated causative agent it is necessary to:
55. A virological laboratory obtained pathological material (mucous discharges from nasal meatuses) taken from a patient with provisional diagnosis \"influenza\". What quick test will allow to reveal specific viral antigen in the material under examination?
56.
A 7 year old child often suffers from streptococci angina. Doctor suspected development of rheumatism and administered serological examination. The provisional diagnosis will be most probably confirmed by presence of antibodies to the following streptococci antigen:
57. A patient has been suffering from elevated temperature and attacks of typical cough for 10 days. Doctor administered inoculation of mucus from the patient’s nasopharynx on the agar. What microorganism is presumed?
58.
Microscopical examination of a microbial culture revealed fusiform spore-forming microorganisms that get violet-blue Gram’s stain. What microorganisms were revealed?
59.
Material taken from a patient with provisional diagnosis \"influenza\" was referred to a laboratory. For virological examination the hemadsorption reaction was applied. This reaction can be applied for detection of the following viruses:
60. While studying a microslide obtained from the punctuate of a regional lymph node and stained by Romanovsky-Giemsa method a physician revealed some light-pink thin microorganisms with 12-14 regular spiral coils and pointed ends, up to 10-13 micrometer long. This might be the causative agent of the following disease:
61.
Bacteriological examination of purulent discharges from the urethra revealed gram-negative bacteria looking like coffee beans. They were localized in the leukocytes and could decompose glucose and maltose to acid. These are the causative agents of the following disease:
62.
Study of bacteriological sputum specimens stained by the Ziel-Neelsen method revealed some bright-red acid-resistant bacilli that were found in groups or singularly. When inoculated onto the nutrient media, the signs of their growth show up on the 10-15 day. These bacteria relate to the following family:
63. In a 2-year-old child with catarrhal presentations and skin rash a pediatrician suspected scarlet fever. The child was given intracutaneously a small dose of serum antibody to the streptococcal erythrogenic toxin; on the site of injection the rash disappeared. What do the reaction results mean?
64.
A bacteriological laboratory has received smears from the sputum of a patient with a chronic pulmonary disease. Microscopical examination of the smears stained by the Ziehl-Neelsen technique revealed red bacilli. What property of the tuberculosis bacillus has shown itself?
65.
A woman delivered a dead child with multiple developmental defects. What protozoan disease might have caused the intrauterine death?
66.
Retrospective diagnostics of bacterial dysentery involved serological analysis of blood serum intended for determination of Shigella antibody titre. Which of the following reactions should be applied for this purpose?
67.
During the regular sanitary-epidemiological inspection of a pharmacy, the bacteriological analysis of air was performed. The air was found to have bacilli, yeast fungi, hemolytic streptococci, micrococci. Which of the detected microorganisms indicate the direct epidemic danger?
68.
A 65-year-old man has purulent abscess on his neck. Analyses revealed a culture of gram-positive cocci with plasmocoagulase activity. This culture relates most likely to:
69.
Blood of a patient with presumable sepsis was inoculated into sugar broth. There appeared bottom sediment. Repeated inoculation into blood agar caused growth of small transparent round colonies surrounded by hemolysis zone. Examination of a smear from the sediment revealed gram-positive cocci in form of long chains. What microorganisms are present in blood of this patient?
70.
In order to estimate toxigenity of diphtheria agents obtained from patients the cultures were inoculated on Petri dish with nutrient agar on either side of a filter paper strip that was put into the centre and moistened with antidiphtheric anti-toxic serum. After incubation of inoculations in agar the strip-like areas of medium turbidity were found between separate cultures and the strip of filter paper. What immunological reaction was conducted?
71.
A patient with clinical signs of encephalitis was delivered to the infectious diseases hospital. Anamnesis registers a tick bite. Hemagglutination-inhibition reaction helped to reveal antibodies to the causative agent of tick-borne encephalitis in the dilution 1:20 which is not diagnostic. What actions should the doctor take after he had got such result?
72.
A 40 year old man noticed a reddening and an edema of skin in the area of his neck that later developed into a small abscess. The incised focus is dense, yellowish-green. The pus contains white granules. Histological examination revealed drusen of a fungus, plasmatic and xanthome cells, macrophages. What type of mycosis is the most probable?
73. A patient recovered from Sonne dysentery and was once more infected with the same causative agent. What is such infection form called?
74.
Skin of a man who died from cardiac insufficiency has an eruption in form of spots and specks. There are also bedsores in the area of sacrum and spinous vertebral processes. Microscopical examination of CNS, skin, adrenal glands revealed in the vessels of microcirculatory bed and in small arteries destructive-proliferative endothrombovasculitis with Popov’s granulomas; interstitial myocarditis. What diagnosis corresponds with the described picture?
75.
A man was admitted to the hospital on the 5th day of disease that manifested itself by jaundice, muscle aching, chill, nose bleedings. In course of laboratory diagnostics a bacteriologist performed dark-field microscopy of the patient’s blood drop. Name a causative agent of this disease:
76.
Examination of a child revealed some whitish spots looking like coagulated milk on the mucous membrane of his cheeks and tongue. Analysis of smears revealed gram-positive oval yeast-like cells. What causative agents are they?
77.
Bacteriological examination of a patient with food poisoning required inoculation of a pure culture of bacteria with the following properties: gram-negative movable bacillus that grows in the Endo’s medium in form of colourless colonies. A representative of which species caused this disease?
78. Examination of a young man in the AIDS centre produced a positive result of immune-enzyme assay with HIV antigens. Patient’s complaints about state of his health were absent. What can the positive result of immune-enzyme assay be evidence of?
79.
Reaction of passive hemagglutination conducted with erythrocytic typhoid Vi-diagnosticum helped to reveal some antibodies in the dilution of the patient’s serum at a ratio of 1:80 that exceeds the diagnostic titer. Such result witnesses of:
80.
A patient has symptoms of inflammation of urogenital tracts. Examination of a vaginal smear revealed big monocellular, pear-shaped organisms with the pointed spike at the posterior end of body, big nucleus and undulating membrane. What protozoa were found in the smear?
81. A laboratory received a material from a patient’s wound. Preliminary diagnosis is gaseous gangrene. What microbiological method should be applied to determine species of causative agent?
82.
Slime, blood and protozoa 30-200 microns long have been revealed in a man’s feces. The body is covered with cilias and has correct oval form with a little bit narrowed anterior and wide round shaped posterior end. At the anterior end a mouth is visible. In cytoplasm there are two nuclei and two short vacuoles. What are the described features typical for?
83.
From the nasopharynx of a 5-year-old child it was excreted a microorganism which is identical to Corynebacterium diphtheriae dose according to morphological and biochemical signs. But this microorganism does not produce exotoxin. As a result of what process can this microorganism become toxigenic?
84.
A man who was bitten by the unknown dog applied to the surgeon. Wide ragged wounds were localized on the face. What curative-prophylactic aid should be given to prevent rabies?
85.
A patient who came to the doctor because of his infertility was administered to make tests for toxoplasmosis and chronic gonorrhoea. Which reaction should be performed to reveal latent toxoplasmosis and chronic gonorrhoea of the patient?
86. A person was selling \"homemade pork\" sausages at the market. State sanitary inspector suspected falcification of the sausages. What serological immune reaction can identify food substance?
87. The donor who didn’t donate the blood for a long time was investigated with IFA method. Anti-HBs antibodies were revealed. What does positive result of IFA in this case mean?
88.
Scraps of the mycelium of a fungus, spores, air bubbles and fat drops were discovered on microscopy of the patient’s hair excluded from the infected areas. What fungus disease is characterised by this microscopic picture?
89.
Parents with an ill child consulted an infectionist. They had been working in one of Asian countries for a long time. The child has sallow skin, loss of appetite, laxity, enlarged liver, spleen, peripheral lymph nodes. What protozoal illness can be suspected?
90. A large-scale reaction with parapertussis and pertussis diagnosticums was made in order to make serological diagnostics of the whooping cough. At the bottom of the test-tubes with diagnosticum of Bordetella parapertussis a granular sediment formed. What antibodies did this reaction reveal?
