MCEM Microbiology MCQ

1. Orbital cellulitis: (a) The infection has not breached the orbital septum If the infection has not breached the orbital septum it is a pre-septal ( or periorbital ) cellulitis (b) Streptococcus is the most common pathogen. Staphylcoccus Aureus is the most common pathogen. . (c) Klebsiella is a common pathogen in young children Haemophilus is a common pathogen in young children (d) Polymicrobial infection is common. Polymicrobial infection is common. (e) Extension from con uncti!itis is the most common source. Extension from paranasal sinus infection is the most common source. ". Streptococci# (a) $umans are the only host of S. pneumoniae and most carriage is asymptomatic Humans are the only host of S. pneumoniae and most carriage is asymptomatic (b) %hildren under 1 year of age are especially susceptible to acute pneumonia from S. pneumoniae. hildren under ! year of age are especially susceptible to acute pneumonia from S. pneumoniae. (c) The produced toxin neuraminidase is the main pathogenicity determinant of S. pneumoniae. "he capsule is the main pathogenicity determinant of S. pneumoniae. (d) Otitis Externa& pharyngitis and acute pneumonia are the most common infections related to strep pneumonia Acute otitis media# sinusitis and acute pneumonia are the most common infections related to strep pneumonia (e) S. Pneumonia is generally sensiti!e to rifampicin S. Pneumonia is generally sensiti$e to rifampicin '. The follo(ing are true (ith regard to gastroenteritis# (a) The incubation period for staphylococcus aureus is approximately 1)*1" hours. "he incubation period for staphylococcus aureus is approximately !-% hours. (b) The incubation period for bacillus cereus is approximately 1"*1+ hours. "he incubation period for bacillus cereus is approximately !-& hours. (c) The incubation period for scrombotoxin is approximately '*+ hours. "he incubation period for scrombotoxin is approximately !'-%' minutes. (d) The incubation period for salmonella is approximately 1"*,- hours. "he incubation period for salmonella is approximately !(-)* hours. ,. Pyelonephritis# .ppropriate .ntibiotics# (a) /entamicin +entamicine is renal and oto-toxic and blood le$els should be monitored. (b) %iprofloxacin. A ,uinolone -hich inhibits ./A gyrase. (c) %efuroxime Tru e Tru e Tru e Tru e Tru e Fals e Fals e Fals e Fals e Fals e

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MCEM Microbiology MCQ

0ut not early cephalosporins such as cephradine (d) %o*.moxycla! Ampicillin and cla$ulinic acid. (e) .mpicillin )'-&'1 of coliforms -ill be resistant to ampicillin and coliforms are a fre,uent cause of pyelonephritis )'-&'1 of coliforms -ill be resistant to ampicillin. +. Otitis Externa# (a) 0f there is associated peforation of the tympanic membrane the topical antibiotic of choice is an aminoglycoside. 0ecause of reports of ototoxicity topical aminoglycosides are contraindicated in cases of perforated eardrums. (b) .n effecti!e treatment is the insertion of ribbon gau1e dressing soa2ed (ith aluminium acetate solution. Or the insertion of ribbon gau1e soa2ed (ith corticosteroid ear drops. (c) 0f a systemic anti*bacterial is re3uired flucloxacillin is the drug of choice for anti*pseudomonal acti!ity. 2lucloxacillin is usually an appropriate anti-bacterial for cases of otitis externa but if anti-pseudomonal acti$ity is re,uired then ciproxin ( or an aminoglycoside ) is re,uired. (d) 4eomycin is indicated for long term prophylaxis. /eomycin may be used for a -ee3 or so as excessi$e use may result in s3in infections. (e) %hloramphenicol is an appropriate choice for topical infections. !'1 of patients -ill not tolerate the $ehicle in the chloramphenicol preparation ( propylene glycol ) due to hypersensiti$ity. 5. .cute Sinusitis 6# (a) 0s not a cause of localised tenderness. Acute sinusitis is a cause of localised tenderness# fe$er and facial pain. (b) $. 0nfluen1a is not a common causati!e organism 7alse H. Influen4a is a common causati$e organism in acute sinusitis. (c) E. %oli is a common organism E. oli is not a common causati$e organism of acute sinusitis. (d) Strep Pyogenes is not a fre3uent causati!e organism Strep Pyogenes is a fre,uent causati$e organism of acute sinusitis as is strep pneumonia and H. influen4a. (e) 8etronida1ole is first line therapy. Amoxicillin is first line therapy for acute sinusitis. 9. The follo(ing associations are correct# (a) 6ello( fe!er is transmitted to humans by the bite of a mos3uito. 5ello- fe$er is transmitted to humans by the bite of a mos,uito. (b) :abies is a ;4. !irus 6abies is an 6/A rhabdo$irus. (c) 0nfection by entry of lar!ae through s2in* hoo2(orm Tru e Tru e Tru e Tru e Tru e Fals e Fals e Fals e Fals e Fals e Tru e Tru e Tru e Fals e Fals e Fals e Tru e Tru e Fals e Fals e

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MCEM Microbiology MCQ

"he lar$al form7s of some helminths can sur$i$e in soil or -ater. (d) 7aecal*oral spread * shigellosis Particularly among children in residential institutions. (e) $ep . is spread by inocculation Hep A is spread by ingestion of contaminated foods. -. The common cold# (a) :hino!irus is a rare causati!e organism. 6hino$irus and orona$irus are the ( most common pathogens accounting for &'1 of cases (b) %orona!irus is not a common pathogen 6hino$irus and orona$irus are the ( most common pathogens accounting for &'1 of cases (c) 0nfection (ith one serotype of rhino!irus does not confer immunity against other serotypes. "his is -hy the common cold is so common (d) %ommon colds are usually follo(ed by lo(er respiratory tract infections ommon colds are not usually follo-ed by lo-er respiratory tract infections (e) %ommon colds are less fre3uent in the first fe( years of life ommon colds are more fre,uent in the first fe- years of life. <. .cute otitis media in children# (a) Streptococcus pneumonia is a common organism ( =,)> of cases ) Streptococcus pneumonia is a common organism ( 8)'1 of cases ) (b) Organisms that colonise the nasopharynx fre3uently cause acute otitis media. 9icroorganisms enter the middle ear $ia the eustachian tube -hich is shorter and more hori4ontal in young children. (c) $aemophilus influen1a may cause up to ,)> of cases. Haemophilus influen4a may cause up to )'1 of cases. (d) 8oraxella catarrhalis may cause acute otitis media in up to 1+> of cases. 9oraxella catarrhalis( :rd commonest organism) may cause acute otitis media in up to !&1 of cases. (e) %hlamydia pneumoniae may be a causati!e organism& particularly in children younger than 5 months. hlamydia pneumoniae may be a causati$e organism# particularly in children younger than % months. 1). Epididymo*orchitis# (a) ?egins (ith sudden se!ere testicular pain. "esticular torsion begins -ith sudden se$ere testicular pain -hile the pain of epididymo-orchitis is typically more gradual in onset. (b) 0s a complication of gonococcal urethritis and prostatitis. Is a complication of gonococcal urethritis and prostatitis (c) 0s a manifestation of genital infection (ith ureaplasma spp (d) ;oes not complicate the mumps !irus. ;rchitis may occasionally complicate the mumps $irus. Tru e Tru e Tru e Tru e Tru e Fals e Fals e Fals e Fals e Fals e Tru e Tru e Fals e Fals e

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MCEM Microbiology MCQ

(e) 0s not associated (ith tuberculosis. Epididymitis can be caused by mycobacterium tuberculosis. 11. Tetanus# (a) The exotoxin inhibits the release of /.?. from presynaptic ner!e terminals. "he exotoxin inhibits the release of +A0A and glycine from presynaptic ner$e terminals (b) Tetanus is associated (ith muscular laxity. "etanus is associated -ith muscular rigidity# $iolent muscular contractions and autonomic instability. (c) The incubation period is from 1" to ", hours. "he incubation period is from ! day to ! month. (d) There is an association bet(een puncture (ounds and tetanus. "here is an association bet-een puncture -ounds and tetanus. (e) 8inor abrasions cannot cause tetanus. 9inor abrasions can cause tetanus. 1". Staph .ureus# (a) Staphylococcus .ureus is the most in!asi!e species of staphylococcus and is differentiated from other species by possessing the en1yme coagulase Staphylococcus Aureus is the most in$asi$e species of staphylococcus and is differentiated from other species by possessing the en4yme coagulase (b) .symptomatic carriage of Staph .ureus is found in ,)> of healthy people& in the s2in& axilla or perineum Asymptomatic carriage of Staph Aureus is found in )'1 of healthy people# in the s3in# axilla or perineum (c) %atalase catalyses the con!ersion of fibrinogen to fibrin. oagulase catalyses the con$ersion of fibrinogen to fibrin (d) Staph .ureus produces coagulase (hich brea2s do(n host tissues. Staph Aureus produces extracellular lytic en4ymes ( e.g lipase ) -hich brea3 do-n host tissues (e) Staphylococcus pneumonia follo(s influen1a& progresses rapidly& is ca!itating and has a high mortality. Staphylococcus pneumonia follo-s influen4a# progresses rapidly# is ca$itating and has a high mortality 1'. Emergency complications of malignancy (a) 7or neutorpaenic patients (ith bacteraemia the standard of therapy is commonly an aminoglycoside combined (ith an antipseudomonal b*lactam 7or neutorpaenic patients (ith bacteraemia the standard of therapy is commonly an aminoglycoside combined (ith an antipseudomonal b*lactam. (b) %ommon organisms for neutropaenic bacteraemia include E %oli /ram negati!e bacilli including E %oli& Klebsiella& and pseudomonas are common. (c) %ommon organisms for neutropaenic bacteraemia include staph. epidermidis. /ram positi!e cocci including staph epidermidis& staph aureus and strep !iridans are common. (d) %ommon organisms for neutropaenic bacteraemia include strep. !iridans /ram positi!e cocci including staph epidermidis& staph aureus and strep !iridans are common. (e) @ancomycin should be considered for se!ere mucositis (ith neutropaenic Tru e Tru e Tru e Tru e Tru e Fals e Fals e Fals e Fals e Fals e Tru e Fals e

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MCEM Microbiology MCQ

bacteraemia. @ancomycin should be considered for se!ere mucositis (ith neutropaenic bacteraemia. 1,. Otitis Externa# (a) :arely relapses 2re,uently is chronic and relapsing. (b) %an occur in any age group And is characterised more by inflammation than infection ie a type of chronic dermatitis (c) /ram negati!e bacilli are rarely responsible. Proteus and pseudomonas. andida and aspergillus also isolated. (d) .ural toilet and topical antibiotics such as polymyxin are an appropriate approach to management Aural toilet and topical antibiotics such as polymyxin are an appropriate approach to management (e) Pseudomonas infection in diabetics rarely re3uires treatment. Almost al-ays re,uires treatment and can progress to meningitis. 1+. The follo(ing are true# (a) The incubation period for shigella is "*' days. "he incubation period for shigella is (-: days. (b) The incubation period for rota!irus is 1*, (ee2s. "he incubation period for rota$irus is !-< days. (c) The incubation period for giardia lamblia is "*, days. "he incubation period for giardia lamblia is !-) -ee3s. (d) The incubation period for E %oli 1"*9" hours "he incubation period for E oli !(-<( hours Tru e Tru e Tru e Tru e Tru e Fals e Fals e Fals e Fals e Fals e Tru e Tru e Tru e Tru e Fals e Fals e Fals e Fals e e e

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15. %at ?ites# (a) $a!e lo( infection rates if untreated &'1 (b) $a!e a high ris2 of de!eloping tenosyno!itis .ue to long narro- teeth (c) Staphylococcus aureus is often associated (ith infection. Staphylococcus aureus is often associated -ith infection. (d) Pasteurella 8ultocida is often associated (ith infection. Pasteurella 9ultocida is often associated -ith infection. (e) .naerobes are not associated (ith cat bites Anaerobes are associated -ith cat bites. Staphylococcus aureus #Pasteurella 9ultocida # Streptococcus#=lebsiella#enterobacter and anaerobes are associated -ith cat bites 19. .ntibiotics in clinical use# (a) Auinolones bind to the +)S ribosome interfering (ith protein synthesis. >uinolones inhibit bacterial ./A gyrase. Erythromycin binds to the &'S ribosome

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MCEM Microbiology MCQ

interfering -ith protein synthesis. (b) 7luoro3uinolones are less acti!e than 3uinolones against pseudomonas and %hlamydia. 2luoro,uinolones are more acti$e than ,uinolones against pseudomonas and hlamydia (c) Erythromycin is acti!e against gram positi!e cocci& many anaerobes including bacteroides& mycoplasma and %hlamydia Erythromycin is acti$e against gram positi$e cocci# many anaerobes not including bacteroides# mycoplasma and hlamydia (d) Erythromycin does not cross the placenta Erythromycin crosses the placenta (e) Erythromycin is excreted in the bile Erythromycin is excreted in the bile 1-. 0n necrotising fasciitis# (a) The most common sole organism is strep pyogenes "he infection may be mixed -ith aerobes and anaerobes or strep pyogenes may be the exclusi$e agent. (b) 0nfection is isolated to the epidermis and the dermis. Infection spreads along the deep fascial planes (c) @ery rarely in!ol!es anaerobes. Anaerobes are commonly present in necrotising fasciitis. (d) ?lood cultures are usually positi!e (e) .ntibiotics alone are generally sufficient. Effecti$e treatment depends on early surgical resection of infected tissue. 1<. Septicaemia# (a) 8ortality is approximately 1)> Around :'1 of patients die directly or indirectly from sepiticaemia. (b) Bhite %ell count C"))) is associated (ith a better outcome ?o- @0 7s are associated -ith -orse outcomes. (c) %orticosteroids should almost al(ays be started. "he role of corticosteroids is not clearly defined and they should not al-ays be started. (d) $ypotension at initial presentation is associated (ith a (orse outcome Hypotension at initial presentation is associated -ith a -orse outcome. (e) Single pathogen infections generally ha!e better outcomeDs. Polymicrobial infections are associated (ith (orse outcomes. "). $aemophilus 0nfluen1a# (a) 0s a small gram negati!e bacillus Haemophilus Influen4a is a small gram negati$e bacillus. (b) 0s a pathogen in humans only Human pathogen only. (c) +)> of healthy people are carriers. Tru e Tru e Tru e Tru e Fals e Fals e Fals e Fals e

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MCEM Microbiology MCQ

&'1 of healthy people are carriers (d) "+> of people carry encapsulated strains &1 of people carry encapsulated strains (e) Transmission is by direct contact or by inhalation of respiratory tract droplets. "ransmission is by direct contact or by inhalation of respiratory tract droplets. Tru e Tru e Fals e Fals e

MCEM Microbiology MCQ