The MC mechanism responsible for idiotypes

or Ab diversity
Recombination at the variable region genes
Affinity maturation is due to
Mutation at the variable region genes
Which isotype does not activate
complement system
IgD (also IgG4)
Which Isotype has highest affinity
IgG
Which Isotype has lowest affinity but highest
avidity is
IgM
 A patient suffering from CGD not susceptible
to which Shigella species
S. dysenteriae
The B cell stage predominant in Brutons
hypogammaglobulinaemia
Pre B cells
Negative selection helps in prevention of
which type of disorders
Autoimmune diseases
The cytokine responsible for pathogenesis of
Salmonella gastroenteritis
IL8
 Media used for susceptibility testing is
Mueller Hinton broth/agar
Media used for susceptibility testing of M. tuberculosis
Middle Brooke 7H10 or 7H11 agar
Most common method for susceptibility testing
Disc diffusion test (Kirby Bauer)
Most common method for susceptibility testing of M.
tuberculosis
1% proportion technique
The diffusion test which can detect MIC
E-test
D-test is used to detect inducible clindamycin
resistance to which organism
S. aureus (erm gene)
MEC (minimum effective concentration) is used for
susceptibility testing of which organisms
Fungi
 Enzymes which express resistance to penicillins and
cephalosporin I
Broadspectrum -lactamases (inhibited by -lactamase
inhibitors)
Enzymes which express resistance to cephalosporins III &
aztreonam
ESBLs (Extended-spectrum -lactamases) DOC-carbapenems

Enzymes which express resistance to cephamycins (cefoxitin

and cefotetan)
AmpC lactamases (NOT inhibited by -lactamase
inhibitors)
Chromosomal resistance as per Ambler & Bush Jacoby
classification for ESBL
AmpC lactamases DOC-cephalosporin IV (cefepime)
The most common Carbapenemases producing strain
KPC (Klebsiella pneumoniae carbapenemase)
The modified Hodge test is used for detection of
Carbapenemase resistance
 Typing methods

The MC typing method used to distinguish Classical

from El-Tor Vibrio
Biotyping
Serotype conversion in Salmonella is due to
Lysogeny
Serotyping is not applicable for which Shigella
species
S. sonnei
The typing method used for pseudomonas is
Bacteriocin typing
Phage typing is most commonly employed for
S. aureus (MC phage Gr II)
MC phage type of Salmonella in India
E1
 V-W variation in Salmonella indicates
O-agglutinability
MC zoonosis in India is due to
Leptospirosis
Serotyping in leptospirosis is done by
Microscopic agglutination test (using live
leptospira and Dark ground microscope)
Macroscopic agglutination test in leptospira
is to detect
Serogroup (using killed Ag and Passive
agglutination)
 Fluorescent stain used for Plasmodium
Acridine orange (Quantitative buffy coat)
Modified ZN stain used for oocyst of
Cryptosporidium
Kinyoun
Weber stain is used for
Microsporidium
The Leigenella species which is positive
for Kinyoun stain
L. micdadae
 Enterococcus show intrinsic resistance to
penicillin due to
Hyperproduction of PBP5
Resistance by inducing false targets is seen in
VRE (plasmid)
DOC for VRE is
Streptogramins
High level aminoglycoside resistance is seen in
Enterococcus
Bile esculin hydrolysis test is to detect
Enterococcus
Enterococcus is differentiated from S. bovis by
PYR test
MRSA: Yellow V. cholerae: Yellow
colonies on colonies on TCBS
Mannitol salt agar
with cefoxitin
H2S producer on
TSI
S. Typhi
S. Paratyphi C
Proteus

Vi
polysaccharide
Ag
S Typhi
S Paratyphi C
S Dublin
Citrobacter
Mc Intosh Fildes
Jar

Catalyst:
Molybdenum

Indicator:
Pseudomonas
aeruginosa
Q.70 Stool examination in patient reveals the following finding what is the likely route of infection of
this parasite

a) Ingestion of food of
contaminated with
the egg of larva
b) Insect bite
c) Improperly cooked
beef
d) Swimming in dirty
water pool
Egg of ascaris Egg of trichuris
50-60 m 70-80 m
Bile stained Bile stained
Rugosity barrel shaped
bipolar plugs
Egg of Egg of enterobius
ankylostoma/necator 70 m
50-60 m Non bile stained
Non bile stained plano convex
4 blastomeres
Demonstration of
Strongyloides larvae

directly
after concentration
(formalin-ethyl acetate)

after recovery of the

larvae by the Baermann
funnel technique

after culture by the

Harada-Mori filter paper
technique
Strongyloides larva in tissue
 Ascari Ankylosto Strongyloi Trichuri Enterob
s ma des s ius
Infective Egg Filariform Filariform Egg Egg
form larva larva
Route of Oral Percutaneo Percutaneou Oral Oral
Infection us s
autoinfectio
n
Gastrointesti Jenunal Jenunal Small bowel Caecum/ Carcum/
nal location lumen mucosa mucosa colonic appendi
mucosa x
Pulmonary Yes Yes Yes No No
passage
Longevity 1 year Necator2-5 Decades 5 yrs 2 mth
yrs
Ankylo 6-8
yr
Fecundity 2,40,00 Necator 5,000- 3,000 to 2000
(eggs/worm/ 0 4,000 to 10,000 7,000
day) 10,000 Larva
Egg of Taenia Egg of H. nana
-30-40 m -30-40 m
-Bile stained -Non bile stained
-straited -4 spicules
Egg of Schistosoma:
100-150 m, non
operculated

S. haematobium:
terminal spine
(Ca bladder)
S. mansoni: lateral
spine
S. japonicum: spine
inconspicuous
Egg of
Diphyllobotrium,
Fasciola &
fasciolopsis
>100 m,
operculated
indistinguisable
Eggs of
Clonorchis &
Opisthorchis

15-30 m
operculated
with shoulders

Cholangiocarcino
ma
 Cyclosp
ora 10
Cryptospori m
dium 6 m

Isospora
25-40
m
 Entamoeba Entamoeba coli
histolytica
Trophozoit
es

Size 20-30m 20-40m

Motility Very active Sluggish
Cytoplasm Clearly defined into Ectoplasm scarcely
clear ectoplasm and seen
granular endoplasm
Cytoplasm RBC, leucocytes & Bacteria & other
ic tissue debris but NO material BUT NO
inclusions BACTERIA RBC
Nucleus Not visible in Visible in unstained
unstained preparation
 Entamoeba Entamoeba coli
histolytica
Cyst

Size 6-15m 15-20m

Nucleus 1-4, central 1-8 eccentric
karyosome karyosome
Glycogen mass Visible in Large & visible in
uninucleate stage binucleate stage
Chromatoid Rounded bars Filamentous
(no difference)
 Naegleria
Lymphocytosis
protein
glucose
Ag detection by immunoflurescence
Culture on non nutrient agar with E.
coli
Wet mount of CSF (motile
trophozoites)
 Q.71 A patient presented with
headache and projectile vomiting
along with alteration in sensorium.
The following parasite was
demonstrated on india ink staining
what is the likely diagnosis
a) Cryptococcus
b) Blastomyces
c) Histoplasma
d) Coccidiodes
Brown mucoid colonies of
Cryptococcus on niger seed
agar
 Virulence factors of
cryptococcus
Production of
Sialic acid
Melanin
Urease
Superoxide dismutase
Capsule
Mannitol fermentation
Mating types
Phaeohyphomycoses
(dematiaceous)
Phaeoid or
Chromoblastomycosi
s
Verrucose cauliflower
like lesion
Causative agents
Fonsaesae
Cladophialophora sp
Rhinocladiella
Virulence: melanin
Diagnosis: sclerotic
body (copper coin)
Blastomyces (Allejomyces) dermatitidis
North American blastomycosis

Inhalation from soil

Primary infection in lungs

like MTb
Dissemination to skin,
bones & genital tract

Virulence: BYS1 (phase

specific Antigen) & BAD
(Adhesin)

Broad based budding yeast

Antigen detection in urine
Paracoccidiodomyces
South American blastomycosis

Multiple budding
yeast (Mariners
or Pilots wheel)
Ab detection
(more sensitive)
Life cycle of coccidiodomyces
 Coccidiodomyces
North America (South Western), Valley fever, Desert Rheumatism

Primary pneumonia
followed by dissemination

Ab detection
Ag detection in urine

Spherules filled with

endospore

Barrel shaped arthroconidia

Histoplasma capsulatum
North America (eastern), Non capsulated

M/E: in tissue
appear like
capsulated yeast
(hence the name)
Antigen detection
Cuture (gold
standard) tubercle
like projections on
spores
Candida albicans & dubliniensis

Germ tube (True hyphae) also Pseudohyphae with

k/a Reynaud Braun phenomenon
chlamydoconidia in corn meal
When grown in serum at 37C
agar
for 2 hrs
 Psedohyphae True hyphae
Constriction at Yes No
the base of
origin
Mechanism of Budding process Apical
development elongation
Width More than half of Less than half or
parent cell width one third of
parent cell width

Terminal cell Always smaller or Always bigger

equal to than preceding
preceding cell cell
Non albicans candida

C. tropicalis (nodal
blastoconidia) - MC
C. parapsilosis
(both nodal &
internodal
blastoconidia) MC
in HCW
C. glabrata No
pseudohyphae
C. krusei cross
match stick
blastoconidia
Rhinosporidium seeberi
(protozoa)
Sporothrix schenckii
Series of ulcer
(lymphatic spread)
Cigar shaped yeast

Rosette (flower) like

conidia on culture

Splendore hoeplii
(asteroid)
phenomenon
Also seen in
cutaneous
zygomycosis
blastomycosis
Penicillum marneffei
Penicillum marneffei
 Zygomycete (hyphomycete)
Mucormycosis
Aseptate, irregular broad ribbon like
hyphae branching at obtuse/right
angles
Profuse growth (lid throwers)
Most fulminant
Rhinocerebral mucormycosis (Rhizopus
arrhynius)
 Aspergillus
Acute (45) angle dichotomous
branching
Invasive aspergillosis
galactomannan Ag detection
Halo sign (CT scan)
Aspergilloma
Crescent sign (X ray)
Allergic bronchopulmonary
aspergillosis
Fleeting opacities (X ray)
 Dermatophytes
Trichophy
ton

Microspor
um

Epidermoph
yton
Malassezia globosa/furfur
 Q.72 This is a schematic diagram
depicting body structure of which of these
helminthes :

a) Loa loa
b) Wucheria
bancrofti
c) Brugia malayi
d) Onchocerca
volvulus
Wuchereria bancrofti

Nuclear
material do not
extend to the
tip
Loa loa

Nuclear material
extends upto tip
Manzonella
Unsheathe
d
Nuclear
material
upto tip
 Onchocerca

Infective stage: larvae deposited by

blackfly
Symptoms due to microfilariae
No microfilariae in blood
Diagnosis
Excised nodules (adult worms)
Skin snips in culture media (microfilariae) -MC
Filariae Periodi Vector Locatio Microfila Sheat
city n of rial h
adults location
Wucherer Nocturn Culex, Lymphati Blood +
ia al anophel c tissue
bancrofti esaedes
Brugia Nocturn Mansoni Lymphati Blood +
malayi al a, c tissue
anophel
es
Loa Loa Diurnal Crysops Subcuta Blood +
(deerflie neous
s) tissue
Onchocer None Simuliu Subcuta Skin, eye -
ca m neous
(black tissue
flies)
Mansonel None Culicoid Subcuta Blood, -
 Concentration of fluid
Filtration 3 m
Knotts technique (centrifugation with 2%
formalin)
Antifilarial target endosymbiont
Wolbachia
 NEMATODES
Tissue
Intestinal Lymphatic system
Small intestine Wuchereria
Ascaris Brugia
Ancylostoma Subcutaneous tissue
Strongyloides Loa loa
Trichinella Onchocerca
Capillaria Dracunculus
Caecum & Lungs
appendix Strongyloides
Enterobius Mesentery
Trichuris Mansonella
Conjuctiva
Loa loa
 Trichinella spiralis

Infective stage: encysted larvae in pork/bear

meat
Symptoms due to migrating & encysted larvae
MC muscles: Extraocular, biceps, jaw, neck,
lower back & diaphragm
< 10 larvae/gm of muscle: asymptomatic
>50 larvae/ gm of muscle: fatal
 Diagnosis
Eosinophilia
CPK
Ab detection
Muscle biopsy (at the tendon insertion)
Lemon sign
Causative agents of Eosinophilic meningitis

Nematodes:
Angiostrongylus
Gnathostoma
Toxocara
Baylisascaris species
Trematodes:
T. solium
Schistosoma species
Q.74 The following diagram depicts
blood smear of which species

a) P. Vivax
b) P. Faciparum
c) P ovale
d) P malariae
Thick
smear
P. Falciparum multiple ring
form
P. Falciparum gametocytes
P. vivax ring & amoeboid
form

Amoebo
id

Ring
P vivax amaoeboid or late
trophozoite
P vivax schizont
P vivax merozoite
Basket
like
troph of
P.
malaria
e
P malariae band form
 P vivax
Enlarged RBC, schuffners dots,
All stages (ring form of RBC, amoeboid,
merozoites >12)
P falciparum
Normal RBC, Maurers dots, Accole forms
Multiple Ring form (1/5 of RBC) & crescent
gametocyte
P malariae
Normal RBC, Zeimanns dots
Band form & basket forms, merozoites <8
P ovale
Enlarged RBC, James dots, merozoites >12
Babesia microti
Maltese
cross (also
seen in
cryptococc
us)
Splenecto
my
Tick borne
 Q.75 A 24 year old female presented
with an ulcer in the genital area. A
giemsa stained cervical smear was
taken which showed the following
image. Identify the causative agent

a) Gardnderella
vaginalis
b) Chlamydia
c) Calymmatobacteriu
m donovanii
d) Hemophilus ducreyi
Calymmatobacter (Klebsiella)
granulomatosis
Donovanosis or
Psedobubo or
Pseudoelephantiasi
s (NO
LYMPHADENOPATHY
)
Safety pin
appearing bacilli in
mononuclear cells
(PUND CELLS) -
diagnostic
 Gram
negative
coccibacilli
arranged in
parallel (School
of fish)

Safety pin
Chlamydia
Reticulate Body
(HP Body) by
Giemsa,
Casteneda,
Macchiavello,
Giminez)

MacCoy cell lines

Ab detection by
ELISA

NAAT (PCR)
testing
Leishmania donovani or infantum (L
chagasi-new world)

Tissue smear with perpendicular

kinetoplast on amastigote Gold
standard (spleen >95%, Bone
marrow 60-85%, lymph node 50%)

Napier aldehyde/antimony
(nonspecific)
Culture on NNN media
Montenegro test Positive only in
untreated cases in Sudan

Rapid immunochromatographic test

to detect Ab to rK39 - Field
Trypanosoma

T. brucei (sleeping
sickness, No
amastigotes)

T. cruzi (chagas ds)

Chagoma, Romana sign
C-shaped
trypomastigote
Amastigote in tissue
T. cruzi T brucei
 Q .76 A smear was prepared
from the genital ulcer identify
the organism responsible

a) Trichomonas vaginalis
b) Neisseria gonorrhea
c) Chlamydia
d) Treponema pallidum
Trichomonas

Frothy discharge
Wet mount
Trichrome stain
4-5 anterior flagella
(only one
morphological form)
Gardnerella vaginalis

Gram
variable
bacilli
attached to
epithelial
cells (Clue
cells)
Fishy odour
pH >4.5
 Nugent score
Score I Score II Score III
Lactobacillus Gardnerella & Mobiluncus
(Large Gram+ Bacteroides(smal (Curved Gram
rods)/HPF l Gram variable rods/HPF
neg/variable
rods/HPF
0: >30 0: 0 0: 0
1: 5-30 1: <1 1: <5
2: 1-4 2: 1-4 2: 5+
3: <1 3: 5-30
4: 0 4: >30

Total score I+II+III

0-3 Negative ; 4-6 Intermediate; 7+ Bacterial
vaginosis
Q.77 Antibody dependent enhancement is implicated in the immune pathogenesis
of which disease

a) Staphylococcal toxic shock

syndrome
b) Dengue hemorrhagic fever
c) Influenza
d) Waterhouse friederichsen
syndrome
 Factors affecting hemorrhage in
Dengue infection

Repeat infection with different serotype

Sequence of infection (Type 1 followed by
Type 2)
Serotype of infection (Type 2 most virulent)
< 12 years age
Females
Whites
Malnutrition is protective
 Diagnosis
IgM Capture ELISA
NS-1 antigen detection in serum (< 5
days)
Q.78 A patient presents with progressive
dyspnea . Chest X ray revealed a
cavitatory lesion in lower lobe of right
lung. The following histopathological
appearance was seen of resection of the
cavity. What is the most likely cause of this
disease and the number of layer that can
be seen in the wall of the parasite
a) Echinococcus with 2 layer
b) Strongyloides with 2 layers

c) Paragonimus with 3 layers

d) Cysticerosis with 3 layers

Echinococcus (hydatid cyst)
Coenurus (T. multiceps or T
serialis)
Taenia (Cysticerci)
Toxoplasma (tissue cyst)
1. Absolute criteria
a) Demonstration of cysticerci in biopsy
b) Visualization of parasite in eye by fundoscopy
c) Cystic lesion with scolex by radiology
2. Major criteria
a) Radiology suggestive of NCC
Diagnosis
b) Ab by ELISA
1)One absolute
c)Resolution of cystic lesions after treatment
2)Two major,
3. Minor criteria
one minor &
a) Radiology compatible with NCC
one
b) Clinically suggestive
epidemiologic
c) Ab by ELISA
al
d) Evidence of cysticerci outside CNS (cigar
shaped soft tissue calcification)
4. Epidemiological criteria
a) Residence in a cysticercosis endemic area
b) Travel to endemic area
c) Household contact with Taenia solium infected
person
 Q.79 A 35 year old male farmer
presents with multiple discharging
cervical sinuses. Which of these stain will
be useful for the diagnosis ? Where does
this organism normally colonise in the
body

a) Gramstain
oropharynx
b) PAS intestine
c) AFB mouth
d) Grocott Gomori
methanamine silver
skin
Actinomyces (Anaerobic)
Sunray appearance of
sulphur granules
(Gram + filamentous
surrounded by
peripheral clubs Ag
Ab complexes)

Gram stain, Brown &

Breen stain)

Culture in
thioglycollate broth or
spidery colonies on
solid media
 Pneumocystis

Giemsa: Grocott Gomori

Sporozoites 8 methenamine silver
numbers cyst (black)
Q.80 The following picture was seen
in nasal biopsy from a patient with
brain abscess . Identify the organism
seen and the stain used

a) Nocardia, Gram stain

b) Cryptococcus india
ink
c) Streptococcus gram
stain
d) Staphylococcus gram
stain
Nocardia (Aerobic)
Exogenous infection
Actinomycetoma
Primary lung
abscess
Metastasis to brain
kidney etc
Kinyoun stain
Paraffin bait
technique for
culture
 M. tuberculosis

ZN stain: slender, Auramine

long, curved & beaded Rhodamine stain
Staph. aureus Streptococcus
(Grape like clusters) (Chains)
divide in 3 plane Longest- S.
salivaris
 Diplococci

Pneumococcus Gonococcus
(lanceolate (kidney
shaped) shaped)
 Q. 73 A patient comes to your clinic
with a complaint of multiple episodes of
loose watery stool for 3 days. On
probing you discover that these episodes
start after he had ingested shellfish at a
local restaurant 3 days back and other
people who had food from that
restaurant had similar symptoms what is
the most common cause of viral
diarrhea in adult
a) Adenovirus
b) Calicivirus
c) Rota virus
d) Norovirus
Q.69 Phage mediated change in C.
diphtheria is which of the following :

a) Transformation
b) Transduction
c) Conjugation
d) None of the above
 Manifestation Serotype(s) of Indicated Virus
Coxsackievirus Echovirus (E) &
Enterovirus (Ent)
Acute A24 Ent70 (MC)
hemorrhagic
conjunctivitis
Aseptic A2, 4, 7, 9, 10 E4, 6, 7, 9, 11, 13, 16, 18,
meningitis B15 19, 30,33
Ent70, 71 (MC)
Encephalitis A9 E3, 4, 6, 7, 9, 11, 18, 25,
B15 30
Ent71 (MC)
Exanthem A4, 5, 9, 10, 16 E47, 9, 11, 1619, 25, 30
B1, 35 Ent71 (MC)
Generalized B15 E46, 7, 9, 11, 14, 16, 18,
disease of the 19
newborn
Hand-foot-&- A5, 7, 9, 10, 16 Ent71
mouth disease (MC)
B1, 2, 5
Herpangina A110, 16, E6, 9, 11, 16, 17, 25, 30
22 (MC) Ent71
B15
Myocarditis, A4, 9, 16 E6, 9, 11, 22
pericarditis B15
Paralysis A4, 7, 9; E24, 6, 7, 9, 11, 18, 30
B15 Ent70, 71
Pleurodynia A1, 2, 4, 6, E13, 6, 7, 9, 11, 12, 14,
(Bornholm) 9, 10, 16 16, 19, 24, 25, 30
B16 (MC)
Pneumonia A9, 16 E6, 7, 9, 11, 12, 19, 20,
B15 30
Ent68, 71
Nude mice: chr 11
defect

Transgenic mice:
TNF transgene
(anorectic &
RAG 1 Knock out wasted)
mice
T&B cell deficient
LABORATORY ANIMALS
NK cells intact
 Naked(nude) mice

Chr 11 defect
Vestigeal thymus
No hair on the body
SCID MOUSE
CONSTRUCTION
 Natural strain
AR
Defect in V(D)J recombination
No mature B & T cells
SCID human mice
Study of human lymphocytes
AIDS research
INBRED MICE
 Inbred mice: homozygous at all loci by
mating between brother and sister littermates.
inbreeding for 20 generations yields an inbred
strain whose progeny are homozygous at more
than 98% of all loci.

Syngeneic mice: Inbred mice Identical at all

genetic loci
Congenic mice: Inbred mice genetically
identical except at a single genetic region

e.g. BALB/c Sensitivity to radiation; Used in

hybridoma technology; Many myeloma cell
lines were generated in these mice
TRANSGENIC MOUSE
CONSTRUCTION
KNOCK OUT MOUSE
CONSTRUCTION
Characteristic Transgenic Knock out
mice mice
Cells receiving Zygote Embryonic
DNA stem (ES) cells
DNA constructs Natural gene Mutated gene
used
Means of Microinjection Transfer of ES
delivery into zygote cells into
and blastocyst and
implantation implantation
into foster into foster
mother mother
Outcome Gain of a Loss of a gene
gene
 KNOCK IN: Replacement of
endogenous gene by the gene of
choice by homologous recombination

KNOCK DOWN: Silencing of genes by

mRNA degradation using RNAi
(interference RNA)