Question 1. A child comes to OPD with history of black central arch rashes on his body, what is your diagnosis:
- Meningococcemia
- Dengue hemorrhagic fever
- Leptospirosis
- Scrub thypus
Answer. (1) (Meningococcemia)
Children with meningococcemia are presented with variety of lesions but, characteristically, petechial lesions distributed on the trunk and extremities (although the lesions can be located anywhere) and on mucous membranes.
Read And Learn More: Micro Biology And Immunology Multiple Choice Question And Answers
Question 2. Neisseria vaccine (MCV-4 and MPSV-4) strains are not protective against:
- A
- B
- C
- W135
Answer. (2) (B)
Neisseria vaccines (MCV-4 and MPSV-4) is protective for group A,C,Y and W-135, but not against group B
Question 3. For, prophylaxis of meningococcal meningitis, drug used is
- Rifampicin
- Ceftriaxone
- Tetracycline
- Azithromycin
Answer. (2) (ceftriaxone)
Chemoprophylaxis aims at eradicating the colonization of close (household and kissing) contacts of the primary cases (carriers)
- Ceftriaxone (single dose, IM) is the drug of choice
- Alternatively, rifampicin and ciprofloxacin can be given.
Question 4. Treatment of choice for meningococcal meningitis is
- Ceftriaxone
- Ciprofloxacin
- Tetracycline
- Gentamicin
Answer. (1) (Ceftriaxone)
- Ceftriaxone is the treatment of choice for meningococcal meningitis
Question 5. A 23-year-old female presents with fever and altered sensorium for two days with the following rash on legs. Her BP is 70/50 mm Hg and neck stiffness is present.
Lumbar puncture reveals cloudy turbid CSF with 4200 cells/uL, Protein level 168 and Glucose of 21 mg/dL. Which of the following correctly describes the organism causing this condition?
- Gram Negative Diplococci (kidney-shaped), Oxidase positive
- Gram Negative Diplococci, ferments glucose and maltose
- Gram Positive cocci catalase negative, bacitracin sensitive
- Gram Positive Diplococci (lanceolate), catalase negative, optochin sensitive
Answer. (2) (Gram Negative diplococcic, ferments glucose and maltose)
The clinical history of meningitis with a typical purpuric rash is seen in Meningococcal infection. Meningococci are Gram Negative diplococci, ferment glucose and maltose both,in contrast to gonococci which ferment only glucose.
Question 6. Patient gives h/o low grade fever, skin rash and increased WBC counts. What will you do next?
- Blood culture
- CT scan for meningococci
- Serology
Answer. (1) (Blood culture)
Definitive diagnosis of meningococcal meningitis is done by CSF or blood culture.
Serology (antibody detection) only helps in retrospective diagnosis.
Question 7. A 16-year-old male patient presents with headache, fever and neck stiffness for the past 24 hours. Similar history was present one year back. CSF analysis shows WBC count–400/ml, with 90% neutrophils. Gram staining shows gram negative diplococci. The immune system affected in this condition is:
- B lymphocytes
- T lymphocytes
- Immunoglobulins
- Complement system
Answer. (4) (Complement system)
- This is most probably a case of pyogenic meningitis due to Meningococcus.
- Late complement (C5-C9) deficiency is an important risk factor for meningococcal infection
Question 8. Waterhouse-Friedrichsen syndrome is a complication seen in infection with:
- Neisseria gonorrhoeae
- Neisseria meningitidis
- Escherichia coli
- Mycobacterium tuberculosis
Answer. (2) (N. meningitidis)
Question 9. Which among the following differentiates Neisseria meningitidis from Neisseria gonorrhoeae?
- It is oxidase positive
- It ferments glucose
- It ferments
- It reduces nitrates
Answer. (3) (It ferments maltose)
- Meningococcus can ferment glucose and maltose whereas Gonococcus can ferment only glucose.
Question 10. Virulence factors for Meningococci:
- Capsule
- Pili
- Endotoxin
- Coagulase
- M. protein
Answer. (1, 2, 3) (Capsule, Pili, Endotoxin)
Virulence factor of Meningococcus:
- Option d: Coagulase is a Virulence factor for Staphylococcus
- Option e: M protein is a Virulence factor for Streptococcus.
Question 11. Conjugate vaccines are available for the prevention of invasive disease caused by all of the following except:
- H influenzae
- Strep pneumoniae
- N. meningitidis (group C)
- N. meningitidis (group B)
Answer. (4) (N. meningitidis…)
Question 12. A 33 years old sexually active male is having urethral discharge since last 8 months along with burning sensation while micturition. Gram staining smear of urethral swab Sample is showing following picture causative organism is
- Chlamydia trachomatis
- Neisseria gonorrhoeae
- Mycoplasma hominis
- Ureoplasma urealyticum
Answer. (2) (Neisseria gonorrhoeae)
- Picture shows gram-negative cocci in pair, kidney shaped- suggestive of gonococcus
Question 13. Causes of non-gonococcal urethritis:
- Chlamydia trachomatis
- Mycoplasma hominis
- Treponema pallidum
- Mycoplasma genitalium
- Candida albicans
Answer. (All are true)
Question 14. In the following Gram-stained specimen, identify the bacteria seen?
- Neisseria gonorrhoeae
- Staphylococcus aureus
- Streptococcus pyogenes
- Hemophilus influenzae
Answer. (1) (Neisseria gonorrhoeae)
- Intracellular Gram-negative kidney-shaped diplococcic-Suggestive of gonococci
Question 15. Patient has multiple sexual partners with discharge per vaginum. Cervical swabs of a suspected gonorrhea patient is likely to show:
- Gram-positive diplococci and oxidase positive
- Gram-positive diplococci and oxidase negative
- Gram-negative diplococci and oxidase negative
- Gram-negative diplococci and oxidase positive
Answer. (4) (Gram negative diplococci…)
- N. gonorrhoeae is Gram-negative kidney shaped diplococci and oxidase positive
Question 16. Which organism is responsible for causing severe purulent neonatal conjunctivitis?
- Staphylococcus
- Streptococcus
- Gonococcus
- Chlamydia
Answer. (3) (Gonococcus)
- Gonococcus causes severe purulent neonatal conjunctivitis (ophthalmia neonatorum); whereas Chlamydia infection of eye in neonate produces mucous discharge.
Question 17. A 19-year-old male patient comes to the emergency department with complaints of urethral discharge, 1 week after having unprotected sex. Gram staining reveals numerous neutrophils, some gram-negative intracellular diplococci. He was treated with ceftriaxone 250 mg I.M; 5 days later he returns with the same complaints. What is the diagnosis?
- Chlamydia trachomatis
- Penicillin-resistant Neisseria gonorrhoeae
- Reinfection with Neisseria gonorrhoeae
- Ureaplasma urealyticum
Answer. (2) (Penicillin resistant…)
It is a case of drug resistance of infected strain, not a case of reinfection.
- H/o urethral discharge with ↑ neutrophils, and gram negative intracellular diplococci—Suggestive of Gonococcus.
- DOC for Neisseria gonorrhoeae infection is—ceftriaxone
- However, some strains fail to respond to beta lactams due to – i) production for beta-lactamase; they are called as PPNG (Penicillinase producing Neisseria gonorrhoeae) or ii) may be due to altered penicillin-binding protein 2. (Resistance to ceftriaxone is due to altered PBP2)
- Reinfection may be seen only with infected women with antibody to gonococcal OMP called Rmp (reduction modifiable protein); because Rmp antibodies block the effect of bactericidal antibodies to porin and LOS. Reinfection is NOT seen following treatment.
Question 18. True about Neisseria gonorrhoeae?
- Kidney shaped
- Isolated in PIKES medium
- It is not transmitted through sexual contact
- Protein II is useful for typing
Answer. (1) (Kidney shaped)
Question 19. Gonococci can be identified by?
- Growth on MacConkey medium
- Growth at 22°C
- By the fermentation of glucose
- Growth in 45 to 60% bile
Answer. (3) (By the…)
- Gonococcus cannot grow on MacConkey medium
- Gonococcus can grow at 37 °C but not at 22°C
- Gonococcus can ferment glucose
- Gonococcus cannot grow in presence of 40% bile (It is a property of Enterococcus)
Question 20. The virulence factor of Neisseria gonorrhoeae includes all of the following except:
- Outer membrane proteins
- IgA protease
- M proteins
- Pili
Answer. (3) (M proteins)
Question 21. Which is the true statement regarding gonococcal urethritis?
- Symptoms are more severe in females than in males
- Rectum and prostate are resistant to gonococci
- Most patients present with symptoms of dysuria
- Single dose of ciprofloxacin is effective in treatment
- Commonly leads to arthritis
Answer. (3) (Most patients present with symptoms of dysuria)
‘Acute urethritis is the most common clinical manifestation of gonorrhea in males and major symptoms are Urethral discharge and dysuria, usually without urinary frequency or urgency’ ………Harrison 20/e p1125
About Other Options
- Fluoroquinolones offered the advantage of antichlamydial activity when administered for 7 days
- Third-generation cephalosporins have remained highly effective as single-dose therapy for gonorrhea
- Adult vagina is resistant to Gonococcus, so infection is less severe in female
- In males, it can involve rectum and prostate and epididymitis. (never involve testes).
Question 22. A patient has history of sexual intercourse with a commercial sex worker 3 days back, has developed genital discharge resembling ‘flow of seed’. What medium should be used for culture of the discharge material?
- Mannitol salt agar
- Thayer-Martin media
- Potassium tellurite agar
- TCBS
Answer. (2) (Thayer-Martin media)
- Genital discharge resembling ‘flow of seed’… Suggestive of Gonococcal urethritis
- Selective media for culture of Gonococcus: Thayer-Martin medium.
Question 23. Cause of angular conjunctivitis and all options was of moraxella:
- Moraxella catarrhalis
- Moraxella lacunata
- Moraxella bovis Moraxella polymorpha
Answer. (2) (M. lacunata)
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