MMI133 Study Guide - Final Guide: Bacteroides Fragilis, Staphylococcus Epidermidis, Mycobacterium Tuberculosis

The most commonly isolated gram-positive cocci are best differentiated by their:

Gram stain morphology.

catalase reaction.

hemolytic reaction.

both a and b.

both b and c.

ANSWER:

(Level 1, Objective 1)

The novobiocin resistance test is used to

determine treatment options for Staphylococcus saprophyticus.

identify S. saprophyticus.

differentiate S. saprophyticus and S. hominis ssp. novobiosepticus.

both a and b.

ANSWER:

(Level 1, Objective 2)

The slide coagulase and the Staphylococcus latex agglutination tests are similar in that both test for the presence of

protein A.

free coagulase.

clumping factor.

thermonuclease.

ANSWER:

(Level 2, Objective 2)

The esculin/PYR disk test can be used to rapidly identify

Enterococcus spp.

Streptococcus pneumoniae.

Streptococcus pyogenes.

both a and b.

both a and c.

ANSWER:

(Level 1, Objective 2)

The optochin disk test is incubated at/in _____________________.

35°C, ambient air.

35°C, CO₂.

42°C, CO₂.

25°C, a capnophilic atmosphere.

ANSWER:

(Level 1, Objective 2)

A catalase-positive, gram-positive coccus that agglutinates in a slide coagulase test as well as in saline should be

reported as Staphylococcus aureus.

reported as Staphylococcus not S. aureus.

retested using another method.

retested for the catalase reaction.

ANSWER:

(Level 2, Objectives 2 and 3)

A positive rapid esculin test appears

dark.

pink.

red after the addition of the reagent.

blue.

ANSWER:

(Level 1, Objective 3)

Yellow colonies on mannitol salt agar indicate the definitive presence of

methicillin-resistant Staphylococcus aureus.

Staphylococcus aureus.

Staphylococcus not S. aureus.

unable to definitively identify.

ANSWER:

(Level 2, Objective 4)

A catalase-negative, gram-positive coccus that is bile esculin positive and 6.5% NaCl broth positive belongs to the Lancefield antigenic group

D.

C.

B.

A.

ANSWER:

(Level 2, Objective 5)

10. A leg wound isolate presents as a yellow pigmented, beta-hemolytic, catalase-positive, gram-positive cocci in clusters. Which of the following tests would you expect to be positive for this isolate?

Novobiocin resistance

Heat-stable thermonuclease

PYR

b and c

a and b

ANSWER:

(Level 2, Objective 5)

11. A catalase-negative coccus in pairs and short chains that is susceptible to ethyl hydrocupreine will also

a. require CO₂ for growth.

b. be alpha hemolytic.

c. be bile soluble.

d. all of the above.

e. b and c.

ANSWER:

(Level 2, Objective 5)

12. The PBP2a latex agglutination test is used to detect catalase-positive, coagulase-positive, gram-positive cocci that are resistant to

a. vancomycin.

b. novobiocin.

c. oxacillin.

d. penicillin.

ANSWER:

(Level 2, Objective 6)

13. A catalase-negative, gram-positive coccus in chains that is positive for esculin and PYR hydrolysis is also vancomycin resistant. What additional antibiotic resistance can this organism exhibit?

a. high level aminoglycosides.

b. ampicillin and penicillin.

c. beta-lactamase production.

d. all of the above.

e. b and c.

ANSWER:

(Level 2, Objective 6)

14. An alpha-hemolytic, catalase-negative, gram-positive coccus that is susceptible to optochin can cause all of the following diseases except

a. pneumonia.

b. sinusitis.

c. meningitis.

d. pharyngitis.

ANSWER:

(Level 2, Objective 7)

15. The catalase-negative, gram-positive coccus that is the most common cause of neonatal sepsis and meningitis

a. has the potential to be vancomycin resistant.

b. hydrolyzes hippurate.

c. is susceptible to bacitracin.

d. is bile soluble.

ANSWER:

(Level 2, Objective 7)

16. Necrotizing fasciitis is caused by a

a. catalase-negative, gram-positive coccus that is susceptible to bacitracin.

b. catalase-negative, gram-positive coccus that produces CAMP factor.

c. catalase-positive, gram-positive coccus that produces coagulase.

d. catalase-positive, gram-positive coccus that is resistant to novobiocin.

ANSWER:

(Level 2, Objective 7)

17. Infections of indwelling devices, such as intravenous catheters, are often caused by catalase-positive, gram-positive cocci that are

a. coagulase positive and thermonuclease negative.

b. coagulase negative and novobiocin resistant.

c. caogulase positive and thermonuclease positive.

d. coagulase negative and novobiocin susceptible.

ANSWER:

(Level 2, Objective 7)

18. Which of the following factors accounts for the virulence of Streptococcus pyogenes?

a. “C” substance

b. Protein A

c. M protein

d. mecA gene

ANSWER:

(Level 1, Objective 7)

19. The virulence factor most often associated with catalase-negative, gram-positive cocci that are bile soluble is

a. capsule production.

b. vancomycin resistance.

c. hyaluronidase.

d. streptolysin S.

ANSWER:

(Level 2, Objective 7)

20. A catalase-negative, alpha-hemolytic, gram-positive coccus that is resistant to ethyl hydrocupriene is usually considered

a. a member of the normal upper respiratory flora.

b. a pathogen in an expectorated sputum specimen.

c. the causative agent of non-suppurative sequelae.

d. a common urinary pathogen.

ANSWER:

(Level 2, Objective 8)

21. A catalase-positive, coagulase-negative, gram-positive coccus in clusters is isolated from the urine of a 24-year-old female. This isolate will require

a. additional testing to identify.

b. no further testing.

c. a screen for vancomycin resistance.

d. Lancefield grouping.

ANSWER:

(Level 2, Objective 10)

22. A blood culture yields yellow-pigmented, beta-hemolytic, catalase-positive, gram-positive cocci in clusters. The department is out of Staphylococcus latex agglutination reagent. The microbiologist sets up a tube coagulase and mannitol salt agar. She incubates both at 35°C in CO₂ overnight. The next day the coagulase test is negative and the mannitol salt agar displays yellow colonies. How will you proceed with these results?

a. Report this organism as Staphylococcus aureus

b. Report this organism as Staphylococcus not S. aureus

c. Repeat the tests due to invalid results

d. Test the organism for novobiocin resistance

ANSWER:

(Level 3, Objective 10)

24. A patient, suspected to have bacterial endocarditis, had two sets of blood cultures drawn. All four bottles are positive with gram-positive cocci in pairs and chains. On sheep blood agar, the gray, transparent, alpha-hemolytic colonies are catalase negative, optochin resistant, ESC negative and PYR negative. Which of the following patient histories correlates with the presence of this organism?

a. 78-year-old male with bacterial pneumonia

b. 47-year-old female with a heart murmur and a history of dental surgery

c. 16-year-old female with a history of untreated pharyngitis

d. 3-day-old premature male

ANSWER:

(Level 3, Objective 10)

25. A translucent colony displaying subtle beta hemolysis is isolated from a placenta culture. The Gram stain revealed gram-positive cocci in pairs. The microbiologist drops 3% catalase reagent onto a colony on sheep blood agar, and it produces bubbles. He then performs a Staphyloccocus latex agglutination and the suspension remains smooth. The next step is to

a. report the organism as Staphylococcus not S. aureus.

b. report the organism as Staphylococcus aureus.

c. repeat the catalase test due to an invalid result.

d. perform a thermonuclease test due to an invalid latex agglutination result.

ANSWER:

(Level 3, Objective 10)

1. The two genera, Bacillus and Clostridium, are similar in that both are

a. catalase positive.

b. strict anaerobes.

c. spore formers.

d. strict pathogens.

ANSWER:

(Level 1, Objective 1)

2. A physician suspects her patient has erysipeloid. She calls the laboratory for help with specimen selection and collection. You recommend she collect a

a. swab of infected skin surface.

b. nasopharyngeal swab.

c. swab of sinus tract drainage.

d. full thickness biopsy.

ANSWER:

(Level 1, Objective 2)

3. To diagnose diphtheria, the appropriate specimen for collection is a

a. pharyngeal swab.

b. portion of the membrane.

c. portion of the black scab.

d. swab of the contaminated medical device.

ANSWER:

(Level 1, Objective 2)

4. Loeffler’s medium is useful in making a presumptive identification of Corynebacterium diphtheriae from a pharyngeal culture because it

a. inhibits the growth of normal upper respiratory flora.

b. detects hydrogen sulfide production.

c. enhances metachromatic granule formation.

d. detects toxin-producing strains.

ANSWER:

(Level 1, Objective 3)

5. Overlaying an agar plate with sterile olive oil ensures adequate growth of

a. Erysipelothrix rhusiopathiae.

b. Arcanobacterium haemolyticum.

c. Lactobacillus spp.

d. Corynebacterium urealyticum.

ANSWER:

(Level 1, Objective 3)

6. The breakdown of casein, tyrosine, and xanthine is used in differentiating ____________ spp.

a. Nocardia

b. Streptomyces

c. Actinomyces

d. Corynebacterium

ANSWER:

(Level 1, Objective 4)

7. A positive reaction for the inverse CAMP test appears as an arrowhead of

a. non-hemolysis for Arcanobacterium haemolyticum when tested against Group B Streptococcus.

b. non-hemolysis for Corynebacterium ulcerans when tested against Staphylococcus aureus.

c. enhanced hemolysis for Arcanobacterium haemolyticum when tested against Group B Streptococcus.

d. enhanced hemolysis for Corynebacterium ulcerans when tested against Staphylococcus aureus.

ANSWER:

(Level 2, Objective 4)

8. Nocardia, Actinomyces, and Streptomyces spp. microscopically appear as

a. palisading, clubbed, gram-positive rods.

b. gram-variable rods.

c. branching gram-positive rods.

d. long, thin, gram-positive rods.

ANSWER:

(Level 1, Objective 5)

9. Lactobacillus spp. typically produce colonies that are

a. white and chalky.

b. large, dry, and beta-hemolytic.

c. gray-white, translucent. with subtle beta-hemolysis.

d. pinpoint and alpha-hemolytic.

ANSWER:

(Level 1, Objective 5)

11. The only catalase-negative, gram-positive rod capable of producing hydrogen sulfide is also

a. intrinsically vancomycin resistant.

b. esculin positive.

c. motile.

d. gelatinase positive.

ANSWER:

(Level 2, Objectives 5 and 6)

12. A pinpoint, gray-white colony is isolated as >100,000 colonies/mL from the urine of an 89-year-old leukemic patient. The colony stains as palisading gram-positive rods. The organism should be

a. catalase negative and urea positive.

b. catalase positive and urea positive.

c. catalase negative and urea negative.

d. catalase positive and urea negative.

ANSWER:

(Level 2, Objective 6)

13. The gram-positive rod that produces an umbrella motility pattern in semisolid medium is also

a. catalase positive.

b. esculin negative.

c. non-hemolytic.

d. sodium hippurate negative.

ANSWER:

(Level 2, Objective 6)

14. The colonies of Streptococcus agalactiae and Listeria monocytogenes are nearly identical. The two organisms can be differentiated by the

a. sodium hippurate hydrolysis test.

b. CAMP factor test.

c. catalase test.

d. diseases they cause.

ANSWER:

(Level 1, Objective 7)

15. A 20-year-old female presents with pharyngitis. The rapid group A Streptococcus screen is negative, and a blood agar plate is inoculated. After 24 hours incubation, a tiny gray colony with a narrow zone of beta-hemolysis is observed. The microbiologist performs a streptococcal serotype for group A and the result is negative. She should

a. perform a Gram stain and catalase test.

b. finalize the culture as “No Group A Streptococcus isolated.”

c. repeat the streptococcal serotype after boiling the organism suspension.

d. perform an ELEK test.

ANSWER:

(Level 2, Objective 7)

17. Which of the following organisms is not considered pathogenic until it has been infected by a bacteriophage?

a. Bacillus anthracis

b. Corynebacterium pseudotuberculosis

c. C. diphtheriae

d. Actinomyces israelii

ANSWER:

(Level 1, Objective 9)

19. The modified ELEK test is used to

a. detect the metachromatic granules of Corynebacterium diphtheriae.

b. identify C. diphtheriae.

c. detect toxin-producing strains of C. diphtheriae.

d. differentiate C. jeikeium and C. urealyticum.

ANSWER:

(Level 1, Objective 9)

20. A leg wound from a 15-year-old male football player yields:

Heavy growth of Staphylococcus aureus

Light growth of Staphylococcus not S. aureus

Light growth of Diphtheroids

Light growth of viridians Streptococcus

The microbiologist should

a. report the Staphylococcus aureus and call the other organisms normal skin flora.

b. report each of the organisms isolated individually.

c. perform further testing on the diphtheroids.

d. report all four organisms as normal skin flora.

ANSWER:

(Level 2, Objective 10)

21. Individuals infected with toxigenic Corynebacterium diphtheriae must be treated with

a. penicillin.

b. DPT vaccine.

c. antitoxin.

d. a and c.

e. b and c.

ANSWER:

(Level 1, Objective 11)

22 A gray-white colony displaying subtle beta-hemolysis is isolated from a cerebrospinal fluid. The organism is a gram-positive rod that is catalase positive, motile at room temperature, and esculin positive. Which patient history is most likely associated with this culture?

a. 45-year-old female weaver

b. 2-day-old infant male delivered at 32 weeks gestation

c. 33-year-old female with recent dental surgery

d. 58-year-old cattle farmer

ANSWER:

(Level 2, Objective 12)

1) What clinical manifestation do Staphylococcus aureus and Staphylococcus epidermidis share? A) nosocomial infections B) protein A antiphagocytic factor C) hyaluronidase enzyme D) enterotoxins E) staphylokinase 2) Which of the following has been historically classified as Gram-negative bacteria but is genetically more similar to low G + C Gram-positive bacteria? A) mycoplasmas B) Mycobacterium C) Clostridium D) Propionibacterium E) Nocardia 3) What is one virulence factor that differentiates Staphylococcus aureus from other species of staphylococci? A) It has a capsule. B) It can produce coagulase. C) It produces catalase. D) It can live on the surface of the skin and in cutaneous oil glands. E) It produces lipase. 4) Over 90% of Staphylococcus aureus isolates are penicillin-resistant. Why? A) They have loosely organized polysaccharide slime layers. B) They produce coagulase. C) Cell division occurs in successively different planes, and the daughter cells remain attached to one another. D) They produce β-lactamase. E) They produce staphylokinase, which dissolves fibrin threads in blood clots. 5) A woman comes to the emergency department with fever and vomiting. She soon develops a red rash all over her body, and her blood pressure begins to drop. What is one possible diagnosis? A) erysipelas C) scarlet fever B) endocarditis D) toxic shock syndrome E) staphylococcal food poisoning 6) Bacteria collected from a severely inflamed wound are sent to the lab for analysis. The results come back as follows: Gram-positive cocci in irregular clusters, kinase and coagulase positive, and able to grow in the presence of most antibiotics except vancomycin. The bacteria in the wound are most likely _______ A) Enterococcus. C) Staphylococcus aureus. B) Staphylococcus epidermidis. D) methicillin-resistant Staphylococcus aureus (MRSA). E) Streptococcus pyogenes (group A streptococcus). 7) Which of the following statements about "flesh-eating" streptococci is FALSE? A) It is caused by a group A streptococcus. B) It is also known as necrotizing fasciitis because it travels along the fascia. C) It causes death in over 50% of cases. D) It is considered a common complication of pyoderma. E) It involves toxemia. 8) Streptococcus agalactiae is associated with which of the following diseases? A) neonatal bacteremia B) neonatal meningitis C) neonatal pneumonia D) both neonatal bacteremia and neonatal meningitis E) neonatal bacteremia, neonatal meningitis, and neonatal pneumonia 9) What differentiates virulent strains of Streptococcus pneumoniae from nonvirulent strains? A) the species-specific teichoic acid present in its cell wall B) the type of Lancefield antigen it produces C) the presence of a polysaccharide capsule that protects it from digestion after endocytosis D) the type of toxins it produces E) the extent of the hemolytic zone it produces when it is grown on blood agar 10) Otitis media may lead to dangerous meningitis in children due to infection with _____ A) Streptococcus agalactiae. B) Streptococcus pneumoniae. C) Streptococcus mutans. D) Enterococcus. E) Mycoplasma pneumoniae. 11) Which of the following streptococci is associated with dental caries? A) viridans streptococci B) Streptococcus pyogenes C) Streptococcus pneumoniae D) Streptococcus equisimilis E) Streptococcus arginosus 12) Anthrax, which means "charcoal" in Greek, derives its name from _____ A) the airborne endospores it produces. B) the staining properties of the bacillus under the microscope. C) the black eschars it produces on human skin. D) its ability to invade the bloodstream and produce toxemia. E) the high mortality it causes in infected individuals. 13) Which of the following bacteria produce one of the most deadly bacterial toxins known? A) Clostridium perfringens C) Clostridium tetani B) Clostridium difficile D) Clostridium botulinum E) Corynebacterium species 14) Which of the following bacteria can cause life-threatening pseudomembranous colitis? A) Clostridium difficile B) Staphylococcus aureus C) Streptococcus pyogenes D) Enterococcus species E) Clostridium botulinum 15) How does the toxin from Clostridium tetani produce its action? A) It fuses irreversibly to neuronal cytoplasmic membranes, blocking release of acetylcholine at synaptic clefts. B) The smaller polypeptide of its toxin can block the release of inhibitory neurotransmitters by inhibitory neurons in the central nervous system, causing simultaneous contraction of both muscles in an antagonistic pair. C) It is a pyrogenic toxin, which triggers a diffused rash and, later, sloughing of skin. D) It destroys tissues, including muscle and fat. E) It produces antibodies that attack the neuromuscular junctions in skeletal muscle and prevent them from relaxing. 16) Listeria virulence is directly related to its ability to ______ A) produce powerful toxins. B) form very resistant endospores. C) live within cells and thus avoid exposure to the immune system of its host. D) easily become a pathogen in humans. E) resist most antimicrobial agents. 17) The pus from an abscess in a patient's jaw contains microbes that form yellowish grainy masses and appear filamentous under the microscope. Neither antifungal medication nor a normal course of antibiotics has been effective in treating the infection. The abscess is likely the result of infection with A) Actinomyces. B) Mycobacterium. C) Nocardia. D) Propionibacterium. E) Streptococcus. 18) What is the most common disease caused by Propionibacterium? A) acne B) food poisoning C) pneumonitis D) folliculitis 19) Streptococcus pneumoniae is a leading cause of ______ A) acne. C) pharyngitis B) furuncles. D) primary atypical pneumonia. E) otitis media. 20) The soil bacterium Nocardia asteroides can establish opportunistic infections of the _____ A) skin C) central nervous system B) lungs D) cardiovascular system. E) skin, lungs, and central nervous system