Old Micro Written Exams Flashcards

Question

Best concentration technique for Fasciola?

Answer 1

Sedimentation concentration

Answer 2

1) Cimex lectularis | 2) Cimex hemipterus

Answer 3

1) Heat room to 50 celcius for 90 minutes | 2) Wash in hot water and dryer max setting for 30 min

Answer 4

Thickened peptidoglycan layer 1) Teicoplanin 2) Telavancin 3) Oritavancin

Answer 5

1) Confirm isolate ID | 2) GRD Etest

Answer 6

Population analysis profile

Answer 7

1) Physical security 2) Personnel suitability and reliability 3) Infectious material and toxin accountability 4) Incident and Emergency response 5) Information security

Answer 8

1) Neisseria meningititis 2) Hepatitis B 3) Typhoid 4) Influenza 5) Primary polio series

Answer 9

1) TB skin test 2) HBV 3) HIV 4) Hepatitis C 5) Varicella serology

Answer 10

1) Produces acid from maltose | 2) Beta hemolysis (positive for kingae)

Answer 11

Hemin? | Chocolate agar?

Answer 12

1) N. elongta 2) N. weaveri 3) N. bacilliformis

Answer 13

1) N. meningititis 2) N. lactamica 3) N. sicca

Answer 14

1) Carbapenemase 2) Efflux 3) Porin deletion (OprD)

Answer 15

1) Aztreonam | 2) Colistin

Answer 16

Dilute the sample

Answer 17

Treat the sample with a reducing agent (2-mercaptoethanol or pronase)

Answer 18

1) Narrow budding 2) Capsule 3) Round shape 4) Variation in size

Answer 19

Mucicarmine

Answer 20

Cryptococcus neoformans and Cryptococcus gattii

Answer 21

1) Molecular methods | 2) Capsule typing (A, D, AD = neoformans, B, C = gattii)

Answer 22

Induction phase = Amphotericin B 0.7-1 mg/kg IV daily x 2 weeks + Flucytosine 25 mg/kg q6h po x 2 weeks Consolidation phase = Fluconazole 400 mg po daily x 8 weeks Maintenance phase = Fluconazole 200 mg po daily for >=1 year *(can stop maintenance phase after a minimum of 1 year if: successful introduction of HAART, CD4 >100, and low or nondetectable VL for >3 months)

Answer 23

Modified Hodge Test or Disk Inhibition assay with Meropenem with and without Boronic Acid

Answer 24

1) E. Coli 2) K. pneumoniae 3) Pseudomonas 4) Enterobacter cloacae Acinetobacter, Kleb oxy, Salmonella, Enterobacter aerogenes, Citrobacter

Answer 25

HSCT patients and neutorpenic patients with hematological malignancies

Answer 26

1) Piptazo 2) Dietary galactomannan 3) Cross reaction with alternaria, paeciliomyces

Answer 27

Voriconazole 6 mg/kg IV q12h x 1 days, then 4 mg/kg IV q12h x 2 weeks then step down to oral 200 mg q12h

Answer 28

Persisters

Answer 29

1) Determination of MBC via broth dilution 2) Kinetic Time-kill Assay 3) Serum bacteriocidal in vivo test

Answer 30

1) HMPV | 2) Norovirus

Answer 31

1) Cross reaction with RF 2) Previous positive with HRP2 persistence 3) Cross reaction with Leish or Trypano

Answer 32

1) Low parasitemia 2) Prozone effect 3) P. falciparum strain that does not produce the HRP2 Ag

Answer 33

Tissue biopsy from nape of neck for DFA

Answer 34

Negri bodies (eosinophilic intracytoplasmic inclusions) in cells of CNS

Answer 35

PCR of saliva

Answer 36

1) Signs or symptoms of congenital syphilis 2) Mother had positive syphilis test in pregnancy and was not treated 3) Mother treated with anything other than Penicillin in pregnancy 4) Mother positive in the last month of pregnancy 5) Mother treated but less than 4 fold decrease in titres

Answer 37

1) Acute infection 2) Immunosuppressed patient 3) Monitor treatment 4) Positive Hep C Ab test 5) Monitoring chronic patient

Answer 38

1) Window period 2) Previous infection with decreased sAb 3) Chronic infection with low levels of sAg 4) False positive

Answer 39

UL54 polymerase mutation | UL97 mutation - unable to phosphorylation of ganciclovir

Answer 40

1) Phenotypic - culture in presence of the drug | 2) Genotypic - sequencing

Answer 41

1) Interlab samples with another lab 2) Intralab samples with different technologists looking at the same sample 3) Split samples and do with 2 different methods? Read the CLSI...

Answer 42

1) Check for inhibitors in the sample | 2) Ensure the reaction conditions were such that genetic material could be amplified

Answer 43

a) JC Virus (also HSV and VZV) | b) PML

Answer 44

a) HSV, Herpes Encephalitis b) PCR of the CSF for HSV c) Acyclovir 10 mg/kg IV q8h x 21 days

Answer 45

1) Should not eat deli meats while pregnant 2) Should not consume unpasteurized cheeses (especially soft ones) while pregnant 3) Should not consume unpasteurized milk while pregnant 4) Should wash fruits and vegetables thoroughly prior to consumption 5) Thoroughly cook raw meat to safe internal temperature 6) Keep fridge less than 4.4 degrees celcius and freezer less than -17.8 7) Wash hands, knives, cutting boards after handling raw food 8) Do not eat refrigerated pates and meat spreads 9) Do not eat refrigerated smoked seafoods unless it’s been cooked

Answer 46

``` Neisseria meningititis = 7 days Haemophilus influenza = 7 days Streptococcus pneumoniae = 10-14 days GBS = 14-21 days Aerobic GNB = 21 days Listeria = 21 days ```

Answer 47

``` H7N9 = Avian species, especially poultry MERS-CoV = Bats or Camels ```

Answer 48

``` H7N9 = 10 days MERS-CoV = 14 days ```

Answer 49

1) Lebanon 2) Saudi Arabia 3) Oman 4) Jordan 5) Kuwait 6) Qatar 7) Yeman 8) United Arab Emerits 9) France 10) Italy 11) Egypt 12) Iran 13) Algeria

Answer 50

Induction phase = Amphotericin B 0.7-1 mg/kg IV daily x 2 weeks + Flucytosine 25 mg/kg q6h po x 2 weeks Consolidation phase = Fluconazole 400 mg po daily x 8 weeks Maintenance phase = Fluconazole 200 mg po daily for >=1 year *(can stop maintenance phase after a minimum of 1 year if: successful introduction of HAART, CD4 >100, and low or nondetectable VL for >3 months)

Answer 51

Major: 1) Blood culture positive for IE - VGS, NVS, Strep gallolyticus, HACEK, S. aureus, Enterococcus without focus from 2 separate sets - Organisms consistent with IE from persistently positive blood culture (>=2 bottles >12 hr apart, all of 3 bottles or majority of >=4 from >1 hr from first to last) - Single positive culture for Coxiella burnettii or anti Phase I IgG >1:800 2) Evidence of Endocardial Involvement (Echo positive for IE) a) New or partial dehiscence of a PV b) Abscess in the tissues surrounding a heart valve c) New regurgiant murmur d) intracardiac mass Minor: 1) Fever (>38) 2) Predisposition (PV, Turbulent or reguritent flow, IVDU) 3) Vascular phenomenon (emboli, ICH, subconjuntival hemorrhages, Janeway lesions) 4) Immunologic phenomenon (GN, Roth’s spots, Osler’s nodes, RF) 5) Positive blood cultures that do not meet defintions of major criteria or serological evidence of active infection with organism consistent with IE Definitive IE = Pathological/Culture positive OR 2 major OR 1 major and 3 minor OR 5 minor Possible IE = 1 major and 1 minor OR 3 minor

Answer 52

1) Allogenic Hematopoetic Stem Cell transplant recipient 2) Hematological malignancy with neutropenia 3) Lung Transplant patients 4) Heart Transplant patients 5) GVHD 6) CGD 7) HIV

Answer 53

Voriconazole 6 mg/kg IV q12h x 1 day, then 4 mg/kg q12 h

Answer 54

``` a) PCP (shouldn’t be that acute) Nocardia Legionella NTM (Mycobacterium avium, Mycobacterium kansasii) TB Mycoplasma pneumonia ``` b) Tests = PCR for CMV, pp65 antigen assay, shell vial assay with DFA Treatment = Gancyclovir + CMV immune globulin

Answer 55

1) Erysipilothrix rhusopathiae | 2) Streptococcus iniae

Answer 56

1) Aeromonas hydrophila 2) Vibrio vulnificus 3) Mycobacterium marinum 4) Edwardsiella tarda 5) Erysipilothrix rhusopathiae

Answer 57

``` Syndrome = Loeffler’s syndrome Parasites: 1) Nectator 2) Ancyclostoma 3) Ascaris 4) Strongyloides 5) Toxocara ```

Answer 58

1) TB Skin Test 2) Hepatitis B serology 3) Hepatitis C serology 4) HIV serology

Answer 59

a) 1) Place the patient on airborne precautions 2) Ensure the staff are fit testing for N95 respirators 3) Notify public health 4) Ensure the patient will have DOT with medication 5) Contact tracing 6) Identify the index case b) TB Skin testing results prior to exposure Follow up TB skin testing Assess any TB skin test conversions

Answer 60

1) Mycobacterium tuberculosis 2) Measles virus 3) Varicella virus 4) SARS 5) Smallpox

Answer 61

a) Airborne until day 5 of the rash b) Measles gamma globulin within 6 days of the exposure Can also give measles vaccine within 72 hours of the exposure c) Ask if she has previous had measles, the measles vaccine or if she was born before 1970. Also check if she is pregnant or not.

Answer 62

Calcium dependant depolarization of the cell membrane by binding to the cell membrane, causing inhibition of DNA, RNA and protein synthesis

Answer 63

Contraindication = Pneumonia

Answer 64

1) Pseudomonas aeruginosa 2) Acinetobacter species (baumannii or calcoaceticus complex) 3) Enterococcus species (especially faecalis)

Answer 65

E. faecalis = Imipenem | E. faecium = Imipenem? Or none?

Answer 66

When covering for Morganella morganii, Proteus mirabilis, Proteus penneri, Proteus vulgaris, Providencia rettgeri as they can have higher MICs to Imipenem. Burkholderia cepacia is intrinsically resistant to imipenem but meropenem can have activity. Also when there is a risk for seizures.

Answer 67

1) Negative pressure airflow 2) Single room 3) Air exhausted outdoor or HEPA filtered if recirculated 4) 6-12 air exhanges per hour 5) Patient to remain in room or wear mask when leaving

Answer 68

1) Patient isolation 2) Strict hand hygiene 3) Restrict visitors 4) Close the unit to new patients 5) Increase cleaning and disinfection of the unit 6) Exclude ill employees until 48 hours after symptoms resolved 7) Dedicate equipment to patients 8) No meetings or gatherings in outbreak zone

Answer 69

A. Common Source Outbreaks a. Point Source Outbreak with no Propigation (Summer BBQ) b. Continuing Source Outbreak (Contaminated Water Supply) c. Intermittent Outbreaks (Seasonal) B. Person to Person Spread a. Index Case with Limited Spread (Returning traveller infects others) b. Propigated Spread – Disseminated Outbreak originating from an index case with propagated spread

Answer 70

``` Extended shedding of the virus in stools Can survive for days on surfaces Nonenveloped virus that can resist disinfection Low infectious dose Multiple modes of transmission Short incubation period ```

Answer 71

1) Travel to an endemic area 2) Microbiology Laboratory workers 3) Outbreaks 4) Close contacts of a positive case of Neisseria meningitis 5) Military personnel 6) Healthy persons aged 12-24 years 7) Functional or anatomical asplenia 8) Congenital immunodeficiency 9) Patients treated with eculizumab

Answer 72

1) Functional or anatomical asplenia 2) Bone marrow transplant recipients 3) Solid organ transplant recipient 4) HIV positive 5) Immunosuppression therapy 6) Sickle cell or other hemoglobinopathies 7) Congenital immunodeficiencies 8) Malignant neoplasms including lymphoma and leukemia

Answer 73

1) Anyone with influenza presenting in the first 48 hours after symptom onset 2) Over 65 years 3) Children aged 1-5 4) Underlying asthma 5) Diabetics 6) COPD 7) Pregnant women and up to 4 weeks post partum 8) <18 on Chronic Aspirin 9) Obesity 10) Nursing Home 11) Malignancy

Answer 74

1) Allergy to any components of the vaccine 2) Previous intussceception 3) Immunocompromised 4) Uncorrected congenital abnormality of the GI tract that would predispose to intusseception

Answer 75

Instill wound with rabies immunoglobulin Give rabies vaccine Wash wound with soap and water (but it’s 10 days old..) If the wound has been stitched remove the stitches? Contact

Answer 76

Tissue biopsy from the nape of the neck for DFA or PCR | Can also do PCR from the CSF or saliva

Answer 77

Furious – hydrophobia, delirium, agitation, aerophobia | Paralytic – Ascending paralysis

Answer 78

1) Incarceration 2) Contact with positive individual 3) Owning a dog 4) Skin trauma 5) Cosmetic body shaving 6) IVDU 7) Native and Aboriginal communities 8) MSM 9) Group homes

Answer 79

Raltegravir

Answer 80

Dolutegravir

Answer 81

Sofosbuvir Semepravir Teleprivir Bocepravir

Answer 82

1) Alcohol 2) High Hepatitis B viral load (>2000) 3) eAg positivity 4) sAg >1000 IU/mL (in eAg negatives) 5) Male 6) Prolonged replication phase 7) Hepatitis D superinfection 8) Age >50

Answer 83

Native valve = Vancomycin x 6 weeks | Prosthetic valve = Vancomycin x 6 weeks + Rifampin x 6 weeks + Gentamycin x 2 weeks

Answer 84

Surgical intervention Patient decolonization Repeat blood cultures in 2-4 days Look for source of seeding infection

Answer 85

1) Time since initial surgery (<30 days) 2) Organism 3) Presence of a sinus tract 4) Joint loosening

Answer 86

Penicillin

Answer 87

1. Pure red cell aplasia 2. Transient aplastic crisis 3. Fetal hydrops 4. Arthropathy 5. Papular purpuric gloves and socks syndrome

Answer 88

a) Parvovirus serology Parvovirus PCR b) Intrauterine transfusion

Answer 89

1. Mutation in 14-a-demethylase | 2. Efflux pump

Answer 90

Mutation in the B 1,3 glucan synthase

Answer 91

Flucytosine

Answer 92

Aspergillus terres

Answer 93

1. Pancreatitis 2. Kidney Injury 3. Hematological Disorder – thrombocytopenia, aplastic anemia 4. Neurological Disorder – GBS, Bell’s palsy, Neuralgic amyotrphy, Acute transverse myelitis, Acute meningoencephalitis 5. Arthralgias 6. Urticarial rashes

Answer 94

a) Burkholderia pseudomallei b) Meropenem + TMP-SMX x 14 days or Ceftazidime + TMP-SMX x 14 days The initial regime then needs to be followed with TMP-SMX for at least 3 months for the eradication phase

Answer 95

1. Bartonella henselae 2. Fransicella tularensis 3. Chlamydia trachomatis 4. Listeria monocytogenes 5. Mycbacterium tuberculosis 6. Treponema pallidum Perinodes Ocular Glandular Syndrome

Answer 96

Morulae (intracytoplasmic inclusions) in neutrophils

Answer 97

Doxycycline 100 mg po bid x 10 days

Answer 98

1) Attached tick identified as Ixoides scapularis adult or nymph 2) Tick estimated to be attached for >=36 hours (degree of engorgement) 3) Prophylaxis can begin within 72 hours of removing tick 4) Local rate of infection of ticks with B. burgdorferi is >=20% 5) Doxycycline is not contraindicated

Answer 99

Doxycycline 200 mg po x 1

Answer 100

1. Listeria monocytogenes 2. Bacillus cereus 3. Staphylococcus aureus 4. Clostridium perfringes

Answer 101

He may have already been IgG positive from another flavivirus or previous Dengue. Likely has acute Dengue

Answer 102

1. Severe Plasma Leakage a. Shock b. Fluid accumulation with respiratory distress 2. Severe bleeding 3. Severe Organ Involvement a. Liver: ALT or AST >1000 b. CNS: Impaired consciousness c. Failure of heart and other organs

Answer 103

a) No b) No c) Yes d) Yes

Answer 104

1. Myocarditis 2. Megaesophagus 3. Megacolon

Answer 105

Peripheral blood smear to see the trypomastigoes in the acute stage Biopsy to see the amastigotes in the later phase

Answer 106

1. Bite of a reduvid bug 2. Blood transfusion 3. Organ transplant 4. Vertical transmission from mother to fetus

Answer 107

Macrocyclic

Answer 108

1) Bactericidal 2) Narrower spectrum 3) Decreased recurrence of C. difficile for non-NAP1 strains 4) Less renal toxicity

Answer 109

1. Chlamydia trachomatis 2. Mycoplasma genitalium 3. Trichomonas vaginalis 4. Herpes Simplex Virus 5. Ureaplasma urelyticum 6. Candida albicans 7. Adenovirus

Answer 110

1. CCR5 tropism assay for Maraviroc treatment in HIV | 2. Il28B polymorphism for Interferon and Hepatitis C

Answer 111

Recently had the intranasal live flu vaccine and has an URTI with Adenovirus

Answer 112

1. Unknown if it represents colonization vs infection (the PCR may be too sensitive) 2. Only detects virus which the PCR has primers too, cell culture can grow many types of viruses 3. Can not type viruses for surveillance

Answer 113

Screening ELISA for IgG and IgM antibody to lyme (C6 peptite ELISA) Nonreactive reported as negative Reactive or Intermediate then have a western blot done If there are >=5/10 positive IgG bands or >=2/3 positive IgM bands it is reported as Reactive for IgG or IgM respectively If there are less bands than that the sample is reported as NonReactive

Answer 114

European lyme: 1) Borrelia garinii 2) Borrelia afzeli These would give a positive ELISA Ab screen but may be negative on Western blot. Need to request European Lyme serology if questioning these pathogens.

Answer 115

Acute EBV infection

Answer 116

There is no PCR test however can test the CSF for different proteins (14-3-3, tau, SP100). Also with brain material can use immunohistochemistiry stain to detect the abnormally folded prion proteins. If you have frozen tissue can to an analysis for protease resistant forms. There is an investigational assay called protein misfolding cyclic amplification (PMCA)

Answer 117

Examination of brain material for: 1) neuronal loss 2) reactive gliosis 3) vacuolation of the neuropil (spongiform change)

Answer 118

Call the ordering physician and ask them to collect blood and CSF samples for culture and/or PCR instead if N. meningititis is suspected Also treat empirically and call infection control

Answer 119

Provided she followed routine micro precautions she is safe The greatest risk is in disturbing colonies of growth Furthermore the technologists risks in working with Neisseria meningitis may be reduced if they previously had the vaccine

Answer 120

Salmonella Typhi

Answer 121

Salmonella Paratyphi C | Salmonella Dublin

Answer 122

1) Vi is blocking it (boil the sample) 2) It is a rough strain and does not make complete O antigens 3) Mucoid and won’t agglutinate the O antisera

Answer 123

Salmonella Typhi = Citrate Neg, Lysine Pos, Small H2S, O Group D, Vi Positive Salmonella Paratyphi A = Citrate Neg, Lysine Neg, H2S Neg, O Group A, Vi Negative

Answer 124

1. Binding/Attachment to cell receptor – Entry inhibitors 2. Fusion/Uncoating – Fusion Inhibitors 3. Reverse Transcription – NNRTI, NRTI 4. Integration into the host genome – Integrase inhibitors 5. Transcription and Translation 6. Processing – Protease Inhibitors 7. Assembly 8. Budding/Release

Answer 125

HIV2 | HIV1 Group O

Answer 126

1) Grow it around a streak of Staphylococcus aureus 2) Add pyridoxal to the agar 3) Use a pryidoxal disk on blood agar for satelitting test

Answer 127

The organism is may have higher MICs to penicillin Susceptibility testing can be done and there are CLSI criteria Suggest susceptibility testing and while awaiting results if concerned about endocarditis would add Gentamicin to the treatment.

Answer 128

Made from non-absorbent material Able to withstand disinfectants Resistant to scratches Smooth surfaces without cracks and grooves Flooring should be slip resistant

Answer 129

Bench top surfaces BSLII cabinet Designated area Lockable doors

Answer 130

``` Advantages: Improved technology Standardized procedures May be able to offer extended laboratory hours Cost reductions ``` Disadvantages: Transportation logistics for specimens Doctors do not have an on site laboratory to consult May delay reporting of certain tests Physical space required

Answer 131

Advantages: - No cross reaction with BCG vaccine - Patient does not have to return for a second reading - Less subjectivity in interpreting the test - Positive result does not cause skin discomfort to the patient Disadvantages: - Costly - Requires specimen to be processed quickly - Special equipment and technical expertise required

Answer 132

Geobacillus stearothermophilus – resistant to heat

Answer 133

1. Chemical indicator (Autoclave tape) 2. Mechanical indicator (Print out from the machine which indicates that the correct temperature and pressure were met) 3. Biological Indicator

Answer 134

1. Quadravalent meningococcal vaccine 2. Hepatatis B vaccine 3. Annual influenza vaccine 4. Typhoid vaccine 5. Polio 6. Hepatitis A vaccine 7. Rabies vaccine 8. Japenese Encephalitis vaccine 9. Yellow Fever Vaccine 10. Smallpox

Answer 135

Increase sensitivity ``` Sedimentation concentration Floatation concentration (Zinc Sulfate) ```

Answer 136

Modified Acid fast stain for Cyrptosporidium | Modifed Trichrome stain for Microsporidium

Answer 137

Penicillium marneffii

Answer 138

<3% Pre analytical QI = Volume of blood per bottle Number of bottles collected Specimen Labelling

Answer 139

1. Turn around time for gram stain 2. Gram correlation to final ID 3. Satisfaction of physican with reporting modality 4. Time until the patient is put on organism specific antibiotics 5. Time until final report is issued to the physician 6. Accuracy of the report issued 7. Number of corrected and amended reports

Answer 140

1. Glucose fermenters 2. Gram negative bacilli 3. Facultative anaerobes 4. Non spore forming

Answer 141

Gram negative bacilli Catalase positive Motile

Answer 142

Rapid identification of organisms Strain typing Antimicrobial resistance

Answer 143

To increase chance of ID of an organism Inactivate organism Improve sample stability

Answer 144

``` Ebola Marburg Crimean-Congo Machupo Dengue virus Lassa Fever Rift Valley Fever Hantaan ```

Answer 145

a) Louse, Epidemic typhus b) Sandfly, Oroya fever and Verruga Peruana c) Sandfly, Leishmaniasis d) Chyrsops fly

Answer 146

e) Tick, Colorado Tick Fever Virus f) Tick g) Tick h) Tick

Answer 147

1. Piptazo or Amox-Clav 2. Dietary Galactomannan 3. Paeciliomyces 4. Alterneria 5. GI gut bacteria (Bifidobacterium)

Answer 148

Test for B-1,3 D glucan

Answer 149

Histoplasma capsulatum Blastomyces dermatitidis Coccidiodes imitans

Answer 150

Tape the plates Specimen should be in a BSC Level II Cabinet Refer to reference lab equipped to process these specimens

Answer 151

1) Pigment: Rubrum=red, Mentagrophytes=not red 2) Spiral hyphae: T. mentagrophytes=yes, T. rubrum=no 3) Microconidida: T. mentagrophytes=globose, T. rubrum=teardrop (birds on a wire) 4) Urease: T. mentagrophytes=positive, T. rubrum=negative 5) Hair perforation test: T. mentagrophytes=positive, T. rubrum=negative 6) Macroconidia: T. mentagrophytes=cigar shaped, T. rubrum=pencil shaped

Answer 152

tcdC which usually inhibits toxin production is mutated (partial deletion) which allows for hyperproduction of toxins

Answer 153

Toxin Immunochromographic assay | PCR

Answer 154

``` Advantages - Able to detect TB from direct samples - Able to assess for rifampin resistance directly from the sample - Does not require live cultures (safety) - Little training required Disadvantages - Expensive - Limited throughput - Only detect M. tuberculosis - Decreased sensitivity in smear negative - Detects dead and alive organisms - Has to be maintained at 30 degrees ```

Answer 155

``` Phenotypic o Pigment o Niacin Accumulation o Nitrate reduction o Colonly morphology o Temperature o Growth Rate ``` Genotypic - Line Probe Assay - 16s rRNA Gene Sequencing - hsp65 - Accuprobe Assay

Answer 156

1. Lactobacillus 2. Leuconostoc 3. Pediococcus 4. Weisiella 5. Erysipilothrix

Answer 157

Throat Swab – PCR or Culture for Measles NP Swab – PCR or Culture for Measles Blood – IgG, IgM Serology Urine – PCR or Culture for Measles b) Within 7 days of the rash onset (14 days for urine)

Answer 158

Serology – may detect past infection Urea breath test – Affected by PPI or bismuth, False negative with GI bleeding Stool antigen test – Affected by PPI or bismuth, False negative with GI bleeding

Answer 159

- There will appear to be more ESBLs due to the lowered break points - No longer have to confirm ESBL with MAST testing (only for epidemiology or infection control)

Answer 160

MIC Method (ETest) Microbroth Dilution Disk Diffusion Agar Dilution

Answer 161

- Carbapenemase - Efflux Pump - Porin mutation

Answer 162

Nephrotoxicity | Neurological disturbances

Answer 163

1. Modified Hodge Test | 2. Disk Inhibition Assay with Meropenem, Boronic Acid, EDTA (Rosco Test)

Answer 164

1. Requires calcium in the media 2. There are no disk diffusion criteria 3. There are only MIC values for susceptible (not intermediate or resistant) Should not be tested for respiratory tract infections

Answer 165

Norovirus and Sapovirus (the Caliciviruses)

Answer 166

- Electron microscopy - Antigen assay - PCR

Answer 167

``` Selective = BCYE Agar with antibiotics – Cefamandole, Polymyxin B, Ansiomycin (BMPA) NonSelective = BCYE Agar without antibiotics ``` Limitations = 1. Only detects Legionella pneumonphila serogroup 1 2. May be negative in the first day of illness 3. May be negative in those with a low burden of disease

Answer 168

The decolorizer used in each stain is different Modified Acid Fast uses 0.5-1% H2SO4 Acid Fast uses 3% Acid Alcohol or HCl

Answer 169

- Level of HCV below the lower limit of detection of the test - Patient cleared the infection in the past - Successfully treated for HCV - False positive antibody test - False negative PCR assay - Maternal HCV antibodies in babies - Passively acquired HCV antibodies from transfusion

Answer 170

1. Only 1 isolate per patient counted in the antibiogram 2. Only routinely tested antibiotics included 3. Antibiogram is created at least annually 4. Presented as percent of isolates susceptible to the given antibiotic 5. Only use final, verified results 6. Only species with data on >=30 isolates 7. Only diagnostic isolates, not surveillance ones

Answer 171

1. Pasteurella 2. Streptococcus 3. Staphylococcus 4. Capnocytophaga

Answer 172

1) Quadravalent HPV vaccine is recommended in males >=9 years old who have sex with men 2) Quadravalent HPV vaccine is recommended in males 9-26 years of age for the prevention of penile, perianal, perineal intraepithelial neoplasias and associated cancers 3) Quadravalent HPV vaccine is recommended in males 9-26 years of age for the prevention of anal intraepithelial neoplasias grade 1, 2, and 3, anal cancer and anogenital warts. 4) Any MSM >27 should be strongly considered

Answer 173

1) Rilpilvirine | 2) Atazanavir

Answer 174

Elvitegravir

Answer 175

1) Ritonavir | 2) Cobisistat

Answer 176

Treat for 5-7 days after line removal | If she was bacteremic with the line in then she would need antibitoics for 4-6 weeks

Answer 177

``` West Nile Virus CMV HTLV EBV Rabies ```

Answer 178

``` Pregnancy Malnutrition Diabetes Seizure Disorder Substance Abuse Renal Failure ```

Answer 179

Rifampin induces hepatic microsomal enzymes accelerating the clearance of the OCP.

Answer 180

Inhibits uric acid excretion

Answer 181

Visual acuity testing | Red-green color perception testing

Answer 182

Nocardia: | TMP-SMX 2.5 – 5 mg/kg po of the trimethoprim component twice daily

Answer 183

Sporothrix: | Itraconazole 200 mg po daily x 2-4 weeks after lesions are resolved

Answer 184

Fransicella tularensis

Answer 185

Fetal ultrasound PCR for Toxo from Amniotic fluid No amniocentesis before 18 weeks gestation as per SOGC

Answer 186

b) Spiramycin 1 g 18h | c) Spiramycin

Answer 187

a. Measles 6 days after the exposure (immunoglobulin) Incubation period for measles is 10 days. Vaccine is live, attenuated. Can not give measles vaccine to pregnant women or those with cell mediated immunity deficits. OK to give to asymptomatic HIV infected kids. b. VZV 10 days following the exposure (VARiZIg) Incubation period for varicella (chicken pox) is 14 days c. Hepatitis B 14 days from a sexual exposure, 24 hours from needlestick, ocular, or mucosal exposure?? Newborns – 12 hours if mom known positive Newborns – 7 days if mom found after delivery d. Hepatitis A 14 days (Immunoglobulin) Indicated for persons 40 years, immunocompromised all ages, and patients with chronic liver diseases. All other people should get the vaccine for PEP instead of immunoglobulin. Note that for Hep A (and measles) its just general immunoglobulin, it’s not specific for the virus. e. Rabies Anytime

Answer 188

a. A man was bit by a raccoon while he was trying to scare it away from his garbage can. The raccoon could not be recovered. Provoked raccoon, not recovered = Yes b. A girl is bit while playing with her uncles dog at a party. No, dog is available for monitoring, should be monitored for 10 days for any signs of rabies. c. A couple noticed that a bat flew into their cottage house while they were sleeping. There is also a 10 year old son in the cottage. No for the adults only if they had evidence of bite or scratch on their skin. Yes for the kid because he was an unattended child

Answer 189

Hepatitis B – baby born to a known positive mother Rabies immunization following a bat bite Hepatits A vaccine if patient is between 12 months and 40 years of age after exposure to hepatitis A Tetanus immunization along with immunoglobulin Measles in nonimmune person Meningococcal within 7 days (daycare, sleeping in same house, respiratory procedures without protection, saliva contact, 8 hours on a plane) Varicella

Answer 190

1) Pregnancy 2) Immunocompromised 3) Anaphylaxsis to any components of the vaccine 4) Active tuberculosis

Answer 191

``` a. Herpes B Monkey b. Sin Nombre virus Deer Mouse (Hantavirus) c. Rabies Bats d. Chlamydia psittaci Birds ```

Answer 192

Continue on the same thearpy

Answer 193

If not already on therapy would start with Zidovudine-Lamivudine + Lopinavir/Ritonavir Tenofivir-Lamivudine + Lopinavir/r

Answer 194

Use condoms consistently and correctly Patient could start ARVs to decrease chance of transmission Partner could use pre-exposure prophylaxis (PrEP) therapy with Emtricitabine + Tenofovir once daily No intercourse if active lesions (HSV) Abstain until viral load is negative

Answer 195

Non-occupational exposure: 1) Darunavir/r + Tenofovir + Emtricitabine 2) Raltegravir + Tenoforir + Emtricitabine 3) Atazanavir/r + Tenofovir + Emtricitabine

Answer 196

Voriconazole (6 mg/kg IV q12 hr x 2 doses, then 4 mg/kg IV q12h)

Answer 197

1) Allogenic Hematopoetic Stem Cell transplant recipient 2) Hematological malignancy with neutropenia 3) Lung Transplant patients 4) Heart Transplant patients 5) GVHD 6) CGD 7) HIV

Answer 198

Micafungin: Noncompetitive inhibition of the synthesis of 1-3B-D Glucan Liposomal Amphotericin B: Disrupts fungal cell wall by binding egosterol which leads to pore formation and leakage of cellular contents

Answer 199

Daily blood cultures until documented negative Ophthalmic exam by an ophthalmologist to look for endophthalmitis even if they don’t have any ocular symptoms Remove the line Treatment for candidemia is 2 weeks after blood cultures are negative. Also symptoms should have resolved and in neutropenic patients only d/c therapy after the neutropenia has resolved (ANC >500).

Answer 200

Prior to a transurethral resection of the prostate | Prior to urological procedure that mucosal bleeding is anticipated

Answer 201

``` Francisella tularensis Coxiella brunettii Hantavirus Leptospirosis Bacillus antrhasis (can be transmitted with direct skin lesions) – instead say pulmonary anthrax LCV ```

Answer 202

Phase II titers for IgG >=200 and for IgM >=50 Or document a 4 fold rise by immunofluorescent antibody testing in anti-phase II IgG between acute serum and convalescent serum 3-6 weeks later Chronic infections would be suggested with an IgG titer to phase I >800, or the peristance of anti phase I IgG>800 6 months after completion of therapy.

Answer 203

a. Ceftriaxone 2g IV daily x 6 weeks + Gentamycin 1 mg/kg per day q8h x 2 weeks + Doxycycline 100 mg po BID x 6 weeks If culture confirmed then Doxy x 6 weeks + 2 weeks Gent b. Q fever

Answer 204

Rickettsia africae Rickettsia aktari (Rickettsial pox) Orientia tsutsugamuchi – Scrub typhus

Answer 205

Staining of tissue biopsy with Wright-Geimsa: Looks for Amastigotes Cutlure of tissue with Schniders Drisophila Media: Looks for promastigoes

Answer 206

Amphotericin B x 14 days Mitefozine x 30 days Stiboluconate (Antimony derivative) IM

Answer 207

Stapylococcus aureus

Answer 208

PCR - saliva, throat swab, buccal swab, urine, CSF Serology Culture

Answer 209

``` Oochitis Aseptic Meningits Sensioneural hearing loss Endocardial Fibroelastosis Oophritis Pancreatits ```

Answer 210

1) Initiate antibiotics with Ceftriaxone 2g IV x 7-10 days | 2) Place the patient on respiratory droplet isolation until 24 hours of antibiotics

Answer 211

1) Prophylaxis for close contacts with rifampin 600 mg PO BID x 2 days or Cipro 500 mg po x 1 or Ceftriaxone 250 mg IM x 1. Household or intimate contact, medical personel with contact with oral secretions 2) Vaccination if appropriate (dormatories, military)

Answer 212

a. Strongyloides serology b. Tuberculosis c. Hepatitis B Virus JC Virus HPV

Answer 213

Muriform cells (aka sclerotic, Copper Penny or Medlar bodies)

Answer 214

1) Fonsecaea pedrosoi 2) Cladophilophora carrionii 3) Fonsecaea monophora 4) Philophora verrucosa

Answer 215

1) Itraconazole 2) Terbinafine 3) Liquid nitrogen 4) Surgical Excision

Answer 216

1) Vancomycin | 2) Daptomycin

Answer 217

Vancomycin

Answer 218

``` a. XRay Bone and Gallium Scan Probe to bone Bone culture ``` b. 1) Intravenous Antibiotics 2) Debridement 3) Consult Vascular Surgery

Answer 219

No need for work up or treat

Answer 220

The instruments are not being properly pre-cleaned | The scope is not being cleaned prior to disinfection

Answer 221

1) Critical = Sterilization 2) Semi-Critical = High Level Disinfection 3) Non-Critical = Cleaning with low level disinfection

Answer 222

1) Staphylococcus aureus 2) Coagulase negative Staphylococci 3) Salmonella species 4) VGS

Answer 223

Inhibits protein synthesis by inhibiting the RNA polymerase

Answer 224

Mainly distributed in the GI tract Very little excreted by the kidneys Bacteriocidal

Answer 225

Less risk for recurrence of C. difficile in patients with non-NAP1 strains

Answer 226

1) Cohort patients and staff 2) Increased environmental cleaning 3) Perform active surveillance cultures on patients 4) Ensure high levels of hand hygiene compliance 5) Strictly enforce contact precautions 6) Dedicated nursing 7) Dedicated instruments 8) Communicate frequently with hospital staff 9) Archive all potential isolates for typing

Answer 227

1) Hair removal with clipping or depilatories instead of shaving 2) Ensure timely and appropriate administration of prophylactic antibiotics 3) Redose prophylactic antibiotics for long procedures 4) Maximize diabetes control prior to operation if possible 5) Chloroxidine daily washes 6) Chlorohexidine instead of iodine 7) Wound closer without tension 8) Gental retraction

Answer 228

``` Syndrome = Lemierre’s Syndrome Organism = Fusobacterium necrophorum ```

Answer 229

Endemic – fecal-oral transmission Sporatic – zoonosis ??? Not sure on this one

Answer 230

First fix the smear with heat or methanol. Then flood the slide with crystal violet and leave for at least 15 seconds, remove crystal violet with water and flood slide with iodine for at least 15 seconds. Remove the iodine with water and then decolorize the slide with acetone-alcohol for 15 seconds, rinse with water and then flood the stain with counterstain of safranin for at least 15 seconds.

Answer 231

``` Mycoplasma Chlamydia Treponema Rickettsia Coxiella Legionella Leptospira ```

Answer 232

Streptococcus pneumonia Clostridium clostridiforme Bacillus species

Answer 233

1) KOH test using 3% potassium hydroxide 2) Test for cell wall aminopeptidase (in gram negatives) using either GramSure disk or APNA K915 disks. 3) Vancomycin disk diffusion susceptibility testing (Kirby Bauer) 4) CNA plate

Answer 234

Women over 30 years of age with ASCUS (atypical squamous cells of undetermined significance) on cytology (until age 69)

Answer 235

``` Methenamine Silver Stain (Grocott) Papanicolaou’s Stain Toluidine blue O Stain Rapid Geimsa-like Stain PAS (Periodic Acid Schiff Stain) ```

Answer 236

The clinical scenario fits with a diagnosis of PCP. BAL is more sensitive In HIV negative patients the sputum is less sensitive

Answer 237

Urethral swab for culture and ask for susceptibility testing

Answer 238

Alterations in Penicillin Binding Protein 2 (PBP2) encoded by penA gene. Specifically the presence of a mosaic PBP2 in N. gonorrhea resistant to 3rd generation cephalospsorins.

Answer 239

Sample should be sent in a sterile container and kept moist to prevent drying. Sample should be at room temperature and transported to the laboratory as soon as possible. The tissue should be minced and not ground. Tissues pieces should be pressed into the agar so they are partially embedded. 2-4 pieces of tissue per media and no streaking. A small portion of tissue should be ground for microscopy smears. If suspecting H. capsulatum then the tissue should be ground instead.

Answer 240

1) Sabarose dextrose agar without antibiotics – supports growth of all fungi, inhibits bacteria 2) Brain Heart Infusion Agar with sheep blood and without antibiotics – Supports the growth of all fungi, and many bacteria. Since this is a sterile site would want an agar without antibiotics as well. 3) Mycosel Agar – contains chloramphenicol, cycloheximide and glucose. Inhibits bacteria and many pathogenic fungi but allows the grows of dimorphic fungi. Allows growth of all dimorphics and Dermatophytes Inhibits Cryptococcus, Aspergillus fumigatus, Scedosporium prolificans, Penicillium marneffei, some Candida and most Zygomyces.

Answer 241

1) Potato dextrose agar (PDA) 2) Rapid sporulation agar (RSA) 3) Potato flake agar (PFA) 4) Cornmeal Agar

Answer 242

``` : i. Bacillus anthracis – Risk group 3 ii. Influenza A H2N2 – Risk group 3 Also the 1918 flu strain iii. Hepatitis B – Risk group 2 iv. Cladophilophora bantania – Risk group 3 Because it can cause serious disease, CNS phaeohyphomycosis. Infection can be contracted through inhalation. Handle with extreme care v. Herpes B – Risk group 4 ```

Answer 243

Variola virus (Smallpox)

Answer 244

Inform the Minister of Health and provide details of the incident, the pathogen involved and any other information the Minister may require.

Answer 245

Alter the treating physician of a possible diagnosis of anthrax Transfer the organism into level 3 containment facility

Answer 246

Egg yolk reaction (should be positive) Penicillin susceptibility (should be penicillin S) Demonstrate capsule formation with India Ink staining, or McFayden’s stain It's also nonmotile and nonhemolytic

Answer 247

``` Category A. Proper packaging Wrapped in absorbant material Primary receptacle that is water proof Secondary container that is waterproof Third container (box) Properly labeled Inform receiving lab ```

Answer 248

a. Staph aureus and penicillin - Resistant b. Morganella and imipenem – Susceptible (higher MICs) c. Stenotrophomonas and Septra - Susceptible d. Burkholderia and colistin - Resistant e. Klebsiella and ampicillin – Resistant

Answer 249

Phenotypic testing measures viral replication in the presence of antivirals whereas genotypic testing looks for the genes known to cause resistance. Genotypic is molecular Phenotypic requires culture

Answer 250

Hepatitis C Virus | ???

Answer 251

HIV CMV HSV

Answer 252

Blind passage DFA Hemadsorption

Answer 253

a. Naegleria fowleri Acanthamoeba Balamuthia mandrillaris b. Wet mount of CSF to look for trophozoites

Answer 254

Ensure that a thick smear is ordered with each thin smear to improve sensitivity Have the ED/clinic order 3 sets of smears on patients suspected of having malaria at 12 hour intervals

Answer 255

Implement a rapid malaria test as well Ensure training of technologists is adequate Proficiency testing

Answer 256

Microscopy with thin smears – Advantage = able to speciate the organism and determine a percent parasitemia Immunochromographic rapid test – Advantage = fast turn around time, easy to perform, no specialized equipment Fluorescent DNA/RNA stains – Advantage = rapid NAAT = Advantage – Increased sensitivity

Answer 257

To diagnose Active TB | When serial testing is required (ex Health care setting)

Answer 258

Very Major = Resistant isolate called sensitive Major = Sensitive isolate called resistant Minor = Sensitive or resistant isolate called intermediate or an intermediate isolate called sensitive or resistant. Categorical agreement = Percentage of agreement between the categories Sensitive, Intermediate, and Resistant between the new test and the gold standard. (Number of categorical matches / Number of samples tested) x 100

Answer 259

% Very Major Errors = ≤3% % Major Errors = ≤3% Minimum categorical agreement required = ≥90% Combined Major Error and Minor errors should be ≤7%

Answer 260

1) True cryptococcal infection: False negative crytococcal antigen test due to prozone effect 2) True cryptococcal infection: False negative cryptococcal antigen test due to low titers of cryptococcal antigen. 3) False positive india ink due to WBC instead of the antigen.

Answer 261

1) True cryptococcal infection: False negative India ink stain due to low sensitivity of this staining method 2) No cryptococal infection: False positive cryptococcal Ag test due to rheumatoid factor, sinuresis fluid, Trichosporin, Capnocytophaga

Answer 262

An echinocandin (ie micafungin, caspofungin): 1) Cryptococcus and dimorphic fungi are resistant to echinocandins 2) Echinocandins do not get into the CSF

Answer 263

Coccidioides immitis | Histoplasma capsulatum

Answer 264

1) Oxidase - positive 2) Catalase - positive 3) Urease - positive 4) Positive slide agglutination reaction with specific B. abortus and/or B. melitensis antisera 5) Nitrate – positive

Answer 265

1) Tape the plates 2) Perform all work on the culture in a Class II or higher biological safety cabinet 3) Label plates as potential Brucella 4) Do not work up the specimen, instead refer to a reference laboratory 5) Slow growing gram negative bacilli should be referred out if suspiction is high 6) Wash hands 7) Avoid any methods that could generate aerosols

Answer 266

1) Analyse and present a cumulative antibiogram report at least annually 2) Include only final, verified test results 3) Include only species with testing data for ≥30 isolates 4) Eliminate duplicates by including only the first isolate from a patient 5) Report % susceptible and do not include intermediates 6) Only report drugs from routine susceptibility testing, not special requests

Answer 267

Ciprofloxacin (Fluoroquinolones) Tetracycline (Tetracylcines) Azithromycin (Macrolides) Clindamycin Cefazolin (1st and 2nd genearation Cephalosporins except Cefuroxime IV) Cefoxotin, Cefotetan (Cephamycins) Agents administered only by the oral route

Answer 268

Modified Hodge Test False positive: - Different type of carbapenemase other than KPC which would also destroy the ertapenem in the agar and allows the Ecoli to grow - CTX-M and AmpC hyperproduction

Answer 269

OXA or SME

Answer 270

1) Strand displacement assay (SDA) 2) Transcription Mediated Amplification (TMA) 3) LAMP (Loop Amplification) 4) NASBA (Nucleic Acid Sequence Based Amplification) - RNA to cDNA with reverse transciptase, degrade RNA, add RNA polymerase and make new RNA

Answer 271

1) Mycobacterium tuberculosis 2) Histoplasma capsulatum 3) Blastomyces dermatitidis 4) West Nile Virus 5) HIV 6) Brucella 7) Coxiella 8) Rabies

Answer 272

Herpes B Virus (came from the monkey cells) | Can be transmitted to lab workers

Answer 273

1) Check for transcription errors, contamination, or defective panel, plate or card 2) Check previous reports on the patient to determine if the isolate was encountered or confirmed earlier 3) Repeat organism ID and AST with initial method to confirm they reproduce 4) Confirm organism ID with second method performed in house or at a reference lab 5) Confirm AST with a second method (in house or referecene lab)

Answer 274

1) Streptococcus pneumonia 2) Shigella species 3) Neisseria gonorrhea 4) Aeromonas (can’t speciate it) 5) Acinetobacter complex differentiation

Answer 275

To improve it could look at different types of extraction methods, look at a broader range of protein sizes Use a different matrix Extraction procedure

Answer 276

1. Bacitracin - Micro S, Staph R 2. Modified Oxidase - Micro Pos, Staph Neg 3. Furazolidone - Micro R, Staph S 4. Lysostaphin - Micro R, Staph S 5. Strict Aerobe - Micro Yes, Staph No 6. Acid from glycerol aerobically - Staph Yes, Micro No

Answer 277

a. GNB, Ox negative, not swarming, beta hemolytic Indole test, if positive call E.Coli b. GNB, Ox negative, swarming, Indole positive No further workup, Identify as Proteus vulgaris c. GPC, catalase negative, PYR positive If Beta heme and greater than 1 mm, Identify as Enterococcus

Answer 278

1) Penicillin zone edge test – Use a 10 U penicillin disk with standard disk diffusion procedure. If the edge of growth around the disk is sharp (cliff) it’s B-lactamase positive. If it’s fuzzy (beach) it’s negative. 2) Nitrocefin-based test – Perform the test from growth taken from the zone margin surrounding a penicillin or cefoxitin disk.

Answer 279

O Antigen – Heat stable, Somatic antigen H Antigen – Flagellar antigen Vi antigen – Heat labile Capsular polysaccharide

Answer 280

1) The O antigen may initially test negative if the Vi antigen is positive due to the Vi antigen blocking the binding of antibodies against the O Ag. Need to boil the sample to destroy the Vi antigen so that the O antigen can then test positive with Group D. 2) The strain may be rough and not make complete O antigens 3) The strain may be mucoid and not agglutinate with any O antisera

Answer 281

1) Work in a BSC Level II 2) Wear gloves 3) Wear a lab coat 4) Proper waste disposal 5) Hand hygiene

Answer 282

Isospora – Acid Fast Stain Cyclospora – Acid Fast Stain Microsporidium – Modified Trichrome Stain Cryptosporidium – Acid Fast Stain

Answer 283

1) Penicillium species 2) Histoplasma capsulatum 3) Blastomyces dermititidis 4) Paeciliomyes 5) Alternaria 6) Fusarium

Answer 284

1) Increase sensivity for Aspergillus | 2) Aid in the diagnosis of a fungal infection that is not aspergillus (positive B-D glucan, negative GM)

Answer 285

Prior infection with EBV VCA IgM– Appears at clinical presenation, gone in 4-8 weeks VCA IgG– Appears at clinical presentation, lasts lifelong EBNA – Appears 3-4 weeks after onset, lasts lifelong

Answer 286

EBV positive donor, EBV negative recipient. The recipient will be at increased risk post transplant lymphoproliferative disorder (PTLD). He will require routine testing for EBV viral load. One regime may be monthly monitoring for 3-6 months then every 3 months for 1 year. If he is found to have an increasing viral load immunosuppression may be decreased or rituximab started.

Answer 287

1) To diagnose congenital CMV infection 2) CMV in the CSF to diagnose encephalitis 3) Aqeuous or vitreous humor for CMV retinitis 4) CMV donor positive, recipient negative transplant patients

Answer 288

1) Point source outbreak – rapid peak with slower decline | 2) Continuous common source – slow peak and then plateau with slow decline

Answer 289

``` Phenotypic: Phage typing Susceptibilities Capsule serotyping MALDITOF ``` ``` Genotypic: PFGE MLST Ribotyping Single Locus Sequence Typing Multiple Locus Variable Number Tandem Repeat Analysis ```

Answer 290

No previous infection with Hepatitis B Serology consistent with recent vaccination Patient is not yet immune to hepatitis B virus

Answer 291

The child received the intranasal live vaccine for influenza that contains both influenza A and influenza B which explains the positive flu A and flu B PCR results. The child is infected with adenovirus. Adenovirus is causing his mild rhinorrhea.

Answer 292

1) Rotavirus 2) Norovirus 3) Adenovirus 4) Astrovirus Detect via electron microscopy or PCR of stool samples. Also could use antigen detection.

Answer 293

1) Completed successful treatment of HCV infection, sustained virological response 2) Currently on HCV treatment, rapid virological response 3) HCV Infection with low levels of HCV RNA 4) False positive Anti-HCV Ab test 5) Maternal Ab if it’s a baby 6) Past infection that cleared spontaneously

Answer 294

Borrelia recurrensis

Answer 295

1) Body Louse | 2) Head lice

Answer 296

Ascites fluid Peritoneal biopsy Send the ascites fluid for an Adenosine Deaminase (specific for TB)

Answer 297

Concentrate fluids by centrifugation | Grind tissues then plate directly to media

Answer 298

1. Dispose of reagents safely 2. Identify if they were used for any testing after expiration date and verify those results Starting a new lot: 1. Visually inspect reagents for any damage or leakage 2. Check expiry dates 3. Label with contents, concentration, storage requirements, date prepared and expiration date 4. QC the reagents

Answer 299

1. The lab is not able to give results from unapproved tests 2. The test has not been verified or validated in the laboratory, therefore results can not be reported 3. Follow protocol for unknown GBS status

Answer 300

``` Cause = Chlamydia trachomatis or Neisseria gonorrhoeae Treatment = Ceftriaxone 250 mg IM x 1 + Doxycylcine 100 mg po BID x 10 days ``` For other bacteria (enterics), usually older men: Levofloxacin 500 mg PO daily x 10 days For MSM: Ceftriaxone 250 mg IM x 1 + Levofloxacin 500 mg PO Daily x 10 days

Answer 301

Ampho B = binds to egosterol and disrupts fungal cell membrane, leakage of intracellular contents Echinocinins = Inhibits Beta 1,3 beta-D-glucan synthase (enzyme responsible for polysacc formation of the cell wall Azoles = interferes with egosterol synthesis, increased cell permeability and leakage of contents Resistance to polyenes = Candida lustaniae, Aspergillus teres, Scedosporium apiospermum Vorconazole = Zygomyces, Sporothrix Itraconazole = Scedosporium, Zygomyces Fluconazole = C. krusei, Sporothrix, Aspergillus, Scedosporium, Demateacious fungus, Zygomyces Posaconazole = None Echinocandins = C. neoformans, Trichosporon, Fusarium, Zygomyces, Dimorphics, Scedosporium

Answer 302

``` Pregnancy Decrease risk to negative partner Acute infection HIV associated nephropathy HIV RNA >100,000 Hepatitis B or C Coinfection Age >50 High Cardiovascular risk or Cardiovascular disease ```

Answer 303

Fever, chills Purulence at the insertion or exit site Letheary, altered LOC, hemodynamic instability, hypothermia, acidosis

Answer 304

``` Cutaneous dissemination Pneumonitis Meningoencephalitis Hepatitis Pancreatitis ```

Answer 305

It treats Wolbachia which is an endosymbiotic bacteria that lives within in Oncocercas volvulans. Important in the filaria’s fertility and reproduction. Treating with Doxy decreased the number of wolbachia and microfilaria but has no effect on the adult worms.

Answer 306

Rx for Onchocercisis is: Doxy 200 mg/day x 6 weeks and then Ivermectin 150 mcg/kg po for a single dose and consider retreatment every 3-6 months until asymptomatic. Ivermectin only kills the microfilaria not the adults. DEC is contraindicated for the treatment of Onchocerciasis.

Answer 307

Leptospira Others: Aeromonas, Free Living Ameobas, Schistosomiasis

Answer 308

First episode severe = Vancomycin 125 mg po QID x 10-14 days Complicated Severe = Vancomycin 500 mg po with Metronidazole 500 mg IV q8h Severe = Age >60, WBC >15, Increased serum Cr >=1.5 x normal. No hard fast rules, left up to clinical judgement

Answer 309

Carbapenemase – Metalo-beta-lactamase (NDM1)

Answer 310

``` Early = Low birth weight, HSM, LAN, Snuffles, Rash, Jaundice Late = Facial features (frontal bossing, saddle nose, protuberant mandible), keratitis, sensioneuronal hearing loss, hutchinson's teeth, anterior bowing of the tibia, seizures, intellectual disability ```

Answer 311

Maternal treatment is inadequate if mother was treated <4 weeks before birth, or had a treatment with nonpenicillin agent, or evidence of maternal reinfection, inappropriate dose, no documentation of maternal treatment, maternal titres did not decrease 4 fold after treatment for early syphilis or did not remain stable or low for late syphillis

Answer 312

a. Hepatic reactions b. Optic neuritis c. Peripheral neuropathy d. Pulmonary toxicity e. Hemolytic anemia f. Renal impairment g. Antibiotic associated diarrhea

Answer 313

a. 19A b. 1 c. 3 d. 5 e. 7F f. 6A

Answer 314

``` Trimethoprim/Sulfamethoxazole Levofloxacin Ceftazidime Minocyline Chlormaphenicol Ticarcillin/Clavulinate ```

Answer 315

Sigmoid sinus thrombosis, intracranial abscess, skull based osteo, mastoid abscess Ceftazidime 2 g IV q8h x 4-6 weeks Ciprofloxacin 750 mg po BID x 4-6 weeks

Answer 316

To monitor: Hand hygiene, draping the patient | Maintaining: Wipe port with an appropriate aseptic prior to access, use sterile devices to access the port, ???

Answer 317

When visilbly soiled Prior to touching the patient or patients environment Before putting gloves on After removing gloves After touching a patient or patient environment Before clean/aseptic procedures

Answer 318

This is actually intermediate (0.25-2) by the CLSI (>4) but the IDSA calls this resistant (>0.5) Treat like enterococcus IE: Native valve = Pen G 18-30 million U q24h IV divided q4h x 6 weeks + Gentamycin 3 mg/kg q24 hours in 1 dose x 6 weeks 4 weeks if native valve and sypmtoms less than 3 months 6 weeks of native valve and symptoms <3 months, or prosthetic valve

Answer 319

a. Persistent vegetation despite systemic antibiotic b. Anterior mitral valve leaflet vegetation, esp if >10 mm c. >=1 embolic event in first 2 weeks of therapy d. Aortic or mitral insufficiency with signs of ventricular failure e. Heart failure unresponsive to medical Rx f. Valve perfortation or rupture g. New heart block h. Large abscess or extension of abscess despite appropriate antimicrobials i. Persistently positive blood cultures >5-7 days j. Infection with a difficult to treat pathogen (fungi, highly resistant)

Answer 320

Treatment = Voriconazole 6 mg/kg IV q12h x 1 day, then 4 mg/kg IV q12h Adverse Events of Voriconazole = Visual toxicity and hallucinations, photosensitivity skin rash, renal impairment

Answer 321

a. Mucor b. Rhizomucor c. Rhizopus d. Cunninghamella e. Absidia (Lichtheimia) f. Saksenaea g. Apophysomyces h. Scencephalastrum i. Bacidiobolus

Answer 322

a. M184V mutation of the reverse transcriptase – NRTIs (lamivudine, didanuzine, abacavir). Hypersus to AZT, Tenofovir, Stavudine b. Q151M mutation of the reverse transcriptase – All NRTIs except Tenofovir c. K103N – NNRTI – Efavrinz, Neverapine d. K65R – Tenofovir (increased sus to AZT) e. L90M – All protease inhibitors f. TAM mutations (Thymadine analogues) – resistance to AZT, Tenofovir, and Stavudine

Answer 323

Rotavirus vaccine – Rotatrix and Rotateq

Answer 324

a. <=28+6 weeks gestation who are less than 12 months old at the start of RSV season

Answer 325

Schistosomiasis (Katyama Fever) 1. Schistosoma mansoni 2. Schistosoma japonicum

Answer 326

Trichosporon | Treatment = azole – Voriconazole 6 mg/kg IV q12h X 1 day, then 4mg/kg q12h.

Answer 327

Trichosporon, Geotrichum, Coccicioides, Malbrachea, Hormograchiella, Arhrographia, Geomyces, Neoscytalidium

Answer 328

a. Pili – adhere to cell surfaces, biofilm, motility b. Pyoveriden – compete with host proteins for iron chelation c. Pyocyanin – reacts with oxygen to form oxygen radicals causing tissue damage d. Flagella – motility, biofilm, adherence e. Quarum sensing molecules – cell to cell communication f. LPS - Endotoxin g. Secretory systems i. Type 1 – alkaline protease (inhibits fibrin formation) ii. Type 2 – exotoxin A, phospholipase C, protease IV, elastase iii. Type 3 – Directly injects exotoxin (Exo U, Y, S, T) into cell cytoplam

Answer 329

Splenic rupture Airway obstruction from massive lymphoid hyperplasia Rash following ampicillin, amoxicillin, or penicillin Hemolytic anemia Neurologic – Encepahlitis, GBS, transverse myelitis, optic neuritis

Answer 330

``` Ticarcillin-Clavunlinate Doxycycline Colistin Meropenem Tigecycline (no interpretive criteria) – does not work for Pseudomonas ```

Answer 331

* Previous infection with a different dengue serotype * Children <1 year old with circulating maternal antibodies * Elderly

Answer 332

a. Fusobacterium necrophorum b. Archanobacterium haemolyticum c. Corynebacterium diptheriticum d. Neisseria gonorrhoeae e. Mycoplasma pneumonia f. Syphillis

Answer 333

* Compensated cirrhosis with Hep B DNA >2000 IU/mL with any ALT * Decompensated cirrhosis with detectable Hep B DNA with any ALT * Acute liver failure * Clinical complications of cirrhosis * Prevention of reactivation of chronic Hep B during immunosuppression or chemotherapy

Answer 334

Discontinuation of tenofovir, lamivudine or emtricitabine can result in an acute exacerbation of hepatitis

Answer 335

Immunization of children 6 weeks – 17 years of age Adults with HIV, HSCT, Immunosuppressed >=50 years old (UpToDate, but NACI doesn’t recommend >65) Splenectomy – First give PCV13 then 8 weeks later give PSV23, with a PSV23 booster 5 years later

Answer 336

Clarithromycin 500 mg po BID + Ethambutol 15 mg/kg/day + Rifabutin 300 mg po q24h

Answer 337

For adults and older children = no treatment, repeat TST in 8 weeks Child <=5 years = INH 10 mg/kg/day for 3 months then repeat TST, if negative – stop. If positive continue INH for 9 months total Neonate = INH 10 mg/kg/day for 3 months, then repeat TST. If repeat is negative, CXR is normal and mother is smear negative. If repeat TST positive, or CXR abnormal then INH + RIF for total of 6 months

Answer 338

* Arrythmias/QT prolongation * Dermatological - Photosensitivity, skin malignancies, Steven Johnsons * Hepatic toxicity * Visual effects * Renal toxicity * Skeletal effects (fluorosis, periostitis) * Pancreatitis

Answer 339

1) Rheumatoid factor present in the sample 2) Cross reaction with Trichosporon asahii 3) Specimen was placed in an anerobic transport vial 4) Sample was exposed to soap or disinfectant 5) Cross reaction with Capnocytophaga canimorsum 6) Hydrox-Ethyl Startch (from colloids) 7) Malignancy 8) Rothia bacteremia

Answer 340

a. Window period between sAg and sAb, do HBV DNA test b. Undetectable sAb level due to declining levels after years of infection c. Undetectable sAg level due to low level after years of infection d. False positive core Ab How to resolve – repeat the test, Hep C IgM, HepB DNA PCR

Answer 341

a. Contamination rate b. Percent of positive cultures c. Volume of blood obtained d. Adequate number of bottles

Answer 342

Strep bovis: Pen G 12-18 million U divided in 4-6 doses x 2 weeks PLUS Gentamycin 3 mg/kg q24 hours x 2 weeks, Enterococcus: Pen G 18-30 million U/24 hrs divided in 6 doses x 4-6 weeks PLUS Gentamycin 3 mg/kg/24hr divided in 3 doses x 4-6 weeks

Answer 343

``` Drug resistance Dead organism Adherence Drug-drug interactions False positive NTM in the smear ```

Answer 344

Workplace Hazardous Materials Information System Canada’s national hazard communication standard All laboratory employees require WHMIS training Have MSDS available

Answer 345

``` Class A = Compressed Gas Class B = Flammable and Combustable material Class C = Oxidizing Material Class D = 1. Materials causing immediate and serious toxic effects 2. Materials causing other toxic effects 3. Biohazardous infectious materials Class E = Corrosive Material Class F = Dangerously Reactive Material ```

Answer 346

a. Prior syphilis (treated or untreated) b. Early primary syphilis c. Prozone effect of RPR (false negative due to high antibody content) d. Infection with a non-venereal syphilis (endemic syphilis, yaws, pinta) e. False positive TP-PA result due to nonspecific interactions f. Tertiary syphilis

Answer 347

a. Rotavirus – Group A is culturable, but difficult. b. Norovirus (Caliciviridae family) – non culturable c. Adenovirus - Culturable d. Astrovirus – Culturable e. Sapovirus (Caliciviridae family) – non culturable EM limitations – concentration of virus must exceed 10^6 to 10^7/gram of stool which is the lower level of detection, low viral burden may be missed, requires specialized microscope, requires trained individuals.

Answer 348

a. Cyclospora cayetanensis – Modified Acid fast stain b. Isospora belli – Modified Acid fast stain c. Toxoplasmosis gondii – Geimsa stain d. Acanthamoeba – Modified Field’s Stain or Calcoflour white stain with fluorescent microscopy or trichrome stain

Answer 349

Hookworm - Large buccal cavity, Inconspicuous genital primordium, Tapered tail Strongiloides - Short buccal cavity, Prominent genital primordium, Notched tail

Answer 350

a. Cryptococcus species b. Trichosporon species c. Rhodoturula species d. Sporobolomyces salmonicolor e. Candida krusei f. Candida lipolytica

Answer 351

1. Leuconostoc species 2. Pediococcus species 3. Weissella confusa

Answer 352

MRSA = mecA gene and nuc gene (the nuc gene looks that it’s Staph aureus) C. diff = tcdB gene (toxin B) Flu = matrix gene VRE = vanA and vanB genes

Answer 353

Reagent preparation room Sample preparation room Amplification room

Answer 354

Designated pipettes for each area of the lab (the 3 different rooms) Aerosol resistant pipettes Calibrated 2 times per year Cleaned every 3 months

Answer 355

Ethidium gels – gloves, fume hood, face shield, proper disposal UV – Self contained UV imaging system

Answer 356

* Charcoal cefoperazaone dexoycholate agar * Charcoal based selective media * Campylobacter blood agar plate (brucella agar base, sheeps blood, vanco, trimethoprim, polymyxin B, ampho B and cephalothin)

Answer 357

* 42 degrees celcius (to supressed other GI growth and jejuni prefers 42 degrees, fetus only grows at 37 degrees) * Microaerophilic * 5-7% O2, 5-10% CO2, 80-90% N2

Answer 358

1. Coxsiella brunetii 2. Bartonella spp. 3. Tropheryma whipelli 4. Brucella spp. 5. Chlamydia species 6. Legionella species 7. Non-candida fungi 8. Rickettsia

Answer 359

Specimen types = buccal swab, throat swab, saliva, urine, CSF Max duration = 9 days for buccal, throat, saliva 14 days urine Acute serology = 7 days, Conval = 7-10 days post acute Incubation period of 18 days, short prodromal illness, with parotitis first unilateral then bilateral within 2-3 days, followed by aseptic meningitis. Men can have orchitis 4-10 days after parotitis. Isolation duration = 5 days after onset of parotitis, droplet isolation

Answer 360

POC is rapid Does not have to be done in a lab setting Increased access to testing for some patients Earlier decisions can be made regarding treatment

Answer 361

1. Porin mutation to decrease uptake of meropenem (OprD) 2. Carbapenemase 3. Efflux pump Drug options = aztreonam, colistin, ticarcillin-clavulinic acid

Answer 362

Grows within the zone of a fosfomycin disk on blood agar Selective media = Cystine tellurite blood agar or Tinsdale Agar base medium CTBA grows gun metal grey TIN grows with a brown/black halo around the colony Catalse positive Nitrate reduction negative, Motility negative, Urea negative, Reverse CAMP negative Non lipophilic Neisser or Loeffler’s blue stain – chromatic granules Confirm toxin production or not – Elek test or modified Elek test – to look for precipitate of toxin with antitoxin. Screen with PCR first and then do Elek test on the ones that are positive.

Answer 363

``` Internal control Positive control Negative control Blank control Patient known positive ```

Answer 364

1) Contamination rates 2) Positivity rates 3) Bottles adequately filled with blood 4) Number of bottles collected 5) Transit time from collection to incubation 6) Reporting time for gram stains of positive cultures 7) Time to positivity 8) Amended reports issued 9) Physician satisfacation 10) Specimen labeling

Answer 365

1) Shipping temperatures 2) Time from collection to arrival in laboratory 3) Specimens damaged in transit 4) Specimens unlabeled or mislabeled 5) Specimen requisitions 6) Proper transport media

Answer 366

1) Time to reporting of results 2) Accuracy of reports issued 3) Client satisfaction audits 4) Reporting of critical results

Answer 367

a. Sulfur granules b. Splendor-Hoeppeli phenomena (filaments radiating away from the bacteria with intensely eosinophilic material, asteroid like) c. Pencillin d. Eikenella, Fusobacterium, Capnocytophaga, Staphylococcus, Streptococcus Others that could cause this: Nocardia, Actinomadura, Streptomyces madurae

Answer 368

Pasteurella multocida

Answer 369

``` Oxidase = Positive Catalase = Positive Urease = Negative Ornithine Decarboxylase = Positive Indole = Positive Acid from maltose Nitrate = positive ```

Answer 370

Hybrid Capture Assay Amplicor HPV Test (PCR) TMA

Answer 371

Increase specificity for diagnosing high grade lesions | Decrease amount of individuals requiring colposcopy

Answer 372

16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59

Answer 373

May detect incident infection that may spontaneously clear in 6-18 months. Leads to unnecessary colposcopy

Answer 374

Identical: 0 genetic events, 0 different bands closely related: 1 genetic event, 2-3 different bands possibly related: 2 genetic events, 4-6 different bands unrelated: >=3 genetic events, >=7 different bands

Answer 375

``` S.aureus = Not strict, Grows in salt, R to bacitracin Micrococcus = Strict aerobe, Grows in salt, S to bacitracin Rothia = Not strict, No growth in salt, S to bacitractin ```

Answer 376

T. rubrum - Hair perf neg, Urease neg | T. mentagrophytes - Hair perf pos, Urease pos

Answer 377

1) Decreased uptake (changes in outer membrane permeability, decreased inner membrane transport, or active efflux) 2) Aminoglycoside Modifiying Enzymes (phosphotransferase, modify the drug) 3) Modification of the target site by mutation in ribosomal proteins or 16S RNA or posttranscriptional methylation of 16S RNA

Answer 378

Heterogeneous Vancomycin Intermediate Staphylococcus aureus. A subpopulation of S. aureus that have increased MIC to vancomycin (in the intermediate range).

Answer 379

MIC 4-8 Mechanism = Increase in cell wall thickness by accumulation of peptidoglycan precursors which prevent diffusion of the drug into the organism.

Answer 380

MIC >=16 Mechanism = vanA gene conferring vancomycin resistance by altering peptidoglycan cross-linking targets. (D-Ala-D-Ala to D-Ala-D-Lac, or D-Ala-D-Ser)

Answer 381

a. β-metallobetalactamase - Inhibition assay using meropenem with and without dipicilonic acid, increase in zone diameter with the addition of dipicolinic acid or EDTA b. ESBL – Disk inhibition assay using cefotaxime and ceftazidime with and without clavulinic acid with a >=5 mm diameter with addition of clavulinic acid. (MAST test) c. AmpC – MAST test, but with no change in zone diameter and resistance to Cefoxitin. Or cloxacillin d. TEM-1 – None (or what about the nitrocefin test

Answer 382

Francisella tularensis

Answer 383

Cysteine Thiosulfate ?Iron

Answer 384

i. Multiple patients presenting with a similar illness ii. Patient presenting with an illness consistent with a diagnosis of an agent of possible bioterrorism iii. Cultivation of an organism with an unusual drug resistance iv. Atypical disease presentations v. Shorter incubation time that usual vi. Following a specific threat vii. Recurrence of a rare disease viii. Disease during an unusual season

Answer 385

1) Viral load below the limit of detection for the assay | 2) Inhibitors present

Answer 386

1) Fix smear with heat or methanol 2) Flood slide with crystal violet for 30 sec, rinse with water 3) Flood slide with Iodine, let sit for 30 sec, rinse with water 4) Decolorize with Acetone-Alcohol until run off is clear, rinse with water 5) Counterstain with Safranin for 30 sec - 1 minute, rinse with water

Answer 387

1) Clostridium clostridiforme | 2) Streptococcus pneumoniae

Answer 388

1) Ferment glucose 2) Gram stain negative 3) Catalase positive 4) Faculative anaerobes 5) Non-sporing 6) Reduce nitrate to nitrite (there are some exceptions)

Answer 389

1) Coxiella 2) Mycoplasma 3) Chlamydia 4) Treponema 5) Ureaplasma

Answer 390

1) Mycobacterium tuberculosis 2) Mycobacterium africanum 3) Mycobacterium bovis 4) Mycobacterium caprae 5) Mycobacterium microti 6) Mycobacterium canettii 7) Mycobacterium pinnipedii

Answer 391

1) Mycobacterium marinum 2) Mycobacterium kansasii 3) Mycobacterium szulgai (Can cause adult pulmonary disease) 4) Mycobacterium flavescens (Rapid grower)

Answer 392

1) NALC-NaOH (N-acetyl –L-cysteine Sodium Hydroxide)* most common 2) Oxalic acid 3) HCl 4) Benzalkonium chloride-triodium phosphate 5) Cetylpyridnium chloride

Answer 393

``` Minimum = 2% Maximum = 5% ``` Too many mycobacteria are lost in the decontamination process

Answer 394

1) Citrobacter freundii 2) Proteus vulgaris 3) Edwardsiella tarda 4) Proteus mirabilis 5) Morganella 6) Erysipilothrix rhusiopathie

Answer 395

gyrA gene – altered target for quinolone binding to active site (QRDR of topioisomerase enzyme)

Answer 396

1) Hrp2 (Histine rich protein 2) – P. falciparum 2) Aldolase – All species of Plasmodium 3) Plasmodium Lactate Dehyrodgenase (pLDH) – Antibodies specific to both P. falciparium and all Plasmodium species

Answer 397

1) Restricted access with controlled access system (record of all persons entering and exiting) 2) Full coverage dedicated protective clothing to be worn 3) Routine cleaning to be done by specifically trained staff 4) All specimens to be opened in a BSCII cabinet 5) All material decontaminated prior to removal

Answer 398

1) Exhaust air Hepa filtered 2) Anteroom with a walk through shower 3) Negative pressure airflow 4) Windows to be nonopening and sealed 5) Mechanism in place so both doors can not be opened at the same time

Answer 399

``` Brucella suis (swine) Brucella melitensis (goats/sheep) Brucella abortus (cattle) Brucella canis (canines) ```

Answer 400

a. EBV b. CMV Acute HIV Neisseria gonorrhea

Answer 401

Parvoviridae

Answer 402

Paramyxoviridae

Answer 403

1) Polymerase Chain Reaction (PCR) 2) Strand displacement assay (SDA) 3) Transcription Mediated Amplification (TMA) 4) Ligase Amplification Reaction (LAR) 5) Nucleic Acid Sequence Based Amplification (NASBA) 6) LAMP

Answer 404

Class D = Oxa-48 = E. coli, Acinetobacter Class A = KPC = Klebsiella pneumoniae Class B = IMP = K. pneumoniae, Pseudomonas, Acinetobacter

Answer 405

1) Rhodococcus equi 2) Gordonia 3) Mycobacterium 4) Tsukamurella

Answer 406

1) TMP-SMX 2) Imipenem 3) Ceftriaxone 4) Amoxicillin-Clavulinic Acid Also criteria for: Amikacin, Cipro, Clarithromycin, Linezolid, Minocycline, Moxifloxacin, Tobramycin Secondary = Cefepime, Cefotaxime, Doxycycline

Answer 407

1) Rapid 2) Minimal technical training required 3) More sensitive than O&P

Answer 408

1) Does not allow for dection of other potential pathogens 2) Can only be used on stool samples 3) Only detects the cysts

Answer 409

1) Duodenal aspirates | 2) Duodenal biopsy

Answer 410

1) mef gene – Codes for an efflux pump: Erythromycin R, Clindamycin S 2) erm gene – Ribosomal methylation: Erythromycin R, Clindamycin R. Higher Erythro MIC

Answer 411

Listeria monocytogenes

Answer 412

1) Catalase – positive 2) Bile esculin – positive 3) Room Temperature Tumbling motility – positive 4) CAMP – Positive 5) VP – positive 6) Methyl Red – Positive 7) Beta hemolytic 8) Hippurate – Positive 9) H2S from Glucose – Negative

Answer 413

Leuconostoc

Answer 414

1) Pediococcus (LAP+, PYR-, tetrads or clusters) 2) Weissella 3) Enterococcus gallinarum 4) Enterococcus casseliflavus

Answer 415

Chronic infection | Phase I >800, and Phase II is <200

Answer 416

1) Use a patients previous positive sample as a control in your test 2) Back it up with another method of testing

Answer 417

1) Thayer Martin Agar | 2) Martin Lewis Agar

Answer 418

1) Oxidase positive | 2) Gram stain to show gram negative diplococci

Answer 419

1) Hybridization probes 2) DFA 3) Utilizes glucose, not maltose or lactose or sucrose 4) Chromogenic Enzyme Substrate Tests 5) DNA Sequencing 6) MALDI-TOF

Answer 420

Clinical diagnosis, even if EIA was negative could be too early and you should treat anyways.

Answer 421

1) CSF IgM 2) Serum IgG and IgM 3) Blood PCR 4) Plaque Reduction Neutralization Assay

Answer 422

1) Eastern Equine Encephalitis 2) St. Louis Encephalitis 3) Powassan virus 4) Western Equine Encephalitis 5) WNV

Answer 423

Hemolysis Motility Penicillin Susceptibility

Answer 424

Real time PCR for toxin genes (pXO1, pXO2 and a Bacillus chromosomal target) Others: - Demonstration of lysis by y-phage - Fluorescent Ab detection of the capsule

Answer 425

1) Capule (antiphagocytic, encoded by pXO2) 2) Exotoxins (encoded by pXO1) = a. Edema toxin (Edema factor + Protective antigen) b. Lethal toxin (Lethal factor + Protective antigen)

Answer 426

1) Specific DNA probe 2) Immunodiffusion test for exoantigen 3) Cultivation for spherules in special synthetic Converse medium 4) Animal inoculation for in vivo production of spherules

Answer 427

Neuraminidase gene (NA gene)

Answer 428

H274Y Influenza Resistance Mutations to NAIs: Flu A/H3N2 E119V, R292K Flu A/H1N1 H274Y Flu B R152K The H1N1 H274Y resistance mutation is the reason why most H1N1 are resistant to Oseltamivir, but they are still susceptible to Zanamivir. With the pandemic flu (pH1N1) those were now sensitive to Oseltamivir again.

Answer 429

1) All personnel to clear the area 2) Hold breath if not in PPE 3) Exit for at least 1 hour 4) Warning signs alerting others 5) Wear proper PPE before going in 6) Clean up spill safely 7) Post exposure follow up of personnel

Answer 430

1) DFA (C&T) 2) Methenamine Silver Stain (C only) 3) Giemsa (C&T) 4) Calcoflour White (C only) 5) Papanicolaou (C only) 6) Toludine Blue O (C +/-T) 7) DiffQuik

Answer 431

1) Typability - % of typable isolates among the total number of isolates subtyped (data to lead to the designation of subtypes) 2) Reproducibility 3) Discrimatory Power 4) Convenience Parameters (Rapidity, cost, technical demands, accessiblility, ease of data management)

Answer 432

1) PFGE (SmaI) 2) MLST – Sequence based 3) Single-Locus Sequence Typing (spaA for S. aureus) – Sequence based 4) Multiple-Locus Variable-Number Tandem-Repeat analysis (MLVA) – Sequence based 5) Ribotyping (RFLP) 6) Repetative Sequence-Based PCR

Answer 433

1) Too short of an incubation time, re read after 18 hours 2) False negative due to production of staphylokinase (lyses the clot) 3) Plasma used was not sterile 4) Colony tested was not pure 5) Low inoculum 6) Presence of fibrinolysin that can dissolve the clot (activity increased at 37 degrees, that’s why it is kept at room temp after 4 hours)

Answer 434

Charasteristics: 1) Activate a large number of T-cells (20%) independent of processing and presentation by an antigen presenting cell 2) Does not require a co-receptor Organisms: 1) Staphylococcus aureus 2) Streptococcus pyogenes

Answer 435

1) Clostridium tertium 2) Clostriudium histolyticum 3) Clostridium carnis 4) Clostridium septicum (Pubmed…) Rapid test = Catalase (Clostridium Neg, Bacillus Pos) Also, Clostridium sporulate only anaerobically. Most Clostridium are catalase negative (can’t find which are catalase positive)

Answer 436

1) Amphotericin B – Binds to egosterol and alters cell membrane permeability causing cell contents to leak out 2) Caspofungin – Inhibits 1-3-B-D-glucan synthase, disrupting cell wall synthesis

Answer 437

1) Remove the central catheter | 2) Repeat blood cultures until negative

Answer 438

1) ETEC: Enterotoxogenic E. coli 2) EHEC: Enterohemorrhagic E. coli 3) EPEC: Enteropathogenic E. coli 4) EAEC: Enteroaggregative E. coli 5) EIEC: Enteroinvasive E. coli ETEC Heat stable and heat liable enterotoxins, fimbrial adhesins, secretory diarrhea EHEC Shiga toxin, intimin-Tir mediated attaching and effacing EPEC Localized adherence via fundle forming pilus, intimin-Tir mediated attaching and effacing EAEC Aggregative adherence via several fimbriae, Pet and other toxins, microvillus atrophy EIEC Cellular invasion, intracellular motility, and cell-to-cell spread

Answer 439

1) Local wound management – cleaning and flushing of wound with soap and water 2) Post exposure prophylaxis with Rabies Ig – into wound 3) Vaccine administration (Day 0, 3, 7, 14. Add day 28 if immunosuppressed) 4) Arrange to have bat tested if available

Answer 440

Sporothrix schenckii

Answer 441

Itraconazole 200 mg po daily

Answer 442

1) Nocardia 2) Cutaneous Leishmaniasis 3) Mycobacterium marinum 4) Mycobacterium chelonae 5) Cryptococcus 6) Francisella tularensis

Answer 443

Streptococcus iniae

Answer 444

Penicllin G

Answer 445

1) Anaphylaxis to previous varicella vaccine or immediate hypersensitivity or anaphylaxis to any vaccine components 2) Pregnancy 3) Impaired immune function 4) Active infective with tuberculosis

Answer 446

1) Pregnant women 2) Elderly patients 3) Children less than 1 year old 4) Diabetic patients 5) Immunosuppressed patients 6) Patients with chronic lung diseases 7) Cardiac disease

Answer 447

MF59 – Oil in water adjuvant

Answer 448

1) Roseola Infantum 2) Infectious mononucleosis 3) Infant Febrile Seizures 4) Meningoencephalitis (rare)

Answer 449

1) Tuberculosis 2) SARS 3) Measles 4) Varicella 5) MERS CoV 6) Smallpox 7) Monkeypox

Answer 450

1) Retinitis 2) Microcephaly 3) Intracerebral calcifications 4) Jaundice 5) HSM 6) Purpura

Answer 451

Primary infection during pregnancy

Answer 452

Detection of CMV in the urine or saliva (PCR or culture)

Answer 453

``` Treatment for index person: Rifampin Isoniazid Pyrazinamide Ethambutol ``` Pediatric presentations = Fever, Growth delay, Weight loss Management: 4 year old – Can diagnose with a positive TST or IGRA, abnormal chest Xray or physical exam and epi link. Gastric aspirate and then treat 2 year old – Treat for active or latent depending on CXR, history, physical and gastric aspirate

Answer 454

1) Permethrin Hair Rinse 2) Pyrethrin Shampoo 3) Lindane Shampoo (poisonous – not for children <2) 4) Topical Ivermectin

Answer 455

Trypanosoma cruzi

Answer 456

b. How is this organism acquired normally? Bite of a triatome bug (Rhodnis prolixus) c. What is the most accessible test? Blood films d. What is the most useful test? PCR

Answer 457

``` Acute = Nifurtimox or Benznidazole Chronic = Support therapy ```

Answer 458

Neisseria meningititis | Neisseria gonorrhea

Answer 459

Start IV antibiotics with Ceftriaxone Place patient on Contact and Droplet precautions Notify treating physician Notifly infection control

Answer 460

1) Neisseria gonorrhea 2) Staphylococcus 3) Streptococcus

Answer 461

Clindamycin 900 mg IV q8h PLUS Gentamicin 1.5 mg/kg IV q8h (first give a loading dose of 2 mg/kg IV) +/- Doxycylcine (if you think it’s CT or GC)

Answer 462

Clindamycin 450 mg po QID for a total of 14 days OR | Doxycycline 100 mg po BID

Answer 463

1) Pork 2) Bear meat 3) Wild boar 4) Walrus

Answer 464

Cyclospora cayetanensis (used to be called Cryptosporidium grande) TMP-SMX 1 ds tab BID x 7 days

Answer 465

1) Initiate Amphotericin B + Flucytosine 2) LP to determine pressure and repeat LPs to control increased ICP as needed 3) Initiate HAART therapy 2-10 weeks after starting treatment for crypto meningitis 4) Stabilize patient from dehydration 5) Repeat LP at 2 weeks for sterility

Answer 466

1) Strongyloides stercoralis 2) Hookworm 3) Ascaris lumbricoides 4) Paragonimus westermani 5) Wucheria bancrofti 6) Brugia species

Answer 467

P. knowlesi Chloroquine phosphate (600 mg base po x 1 immediately, then 300 mg base at 6, 24, and 48 hours)

Answer 468

Toxoplasmosis Primary CNS lymphoma b. What treatment should be started? Sulfadiazine + Pyrimethamine Use above for 6 weeks then half the dose of each for maintenance therapy until CD4 is >200 with HAART

Answer 469

False negative due to prozone effect | Low antigen concentration

Answer 470

a. What is the name of this clinical picture? Immune Reconstitution Inflammatory Syndrome (IRIS) b. What are the 2 most likely pathogens? Tuberculosis MAC c. What test should be done? Biopsy with pathology, fungal, routine, mycobacterial culture d. What treatment should be started? Anti TB treatment?

Answer 471

Cefazolin IV or Cloxacillin IV or Ceftriaxone x 6 weeks + Rifampin PO x 6 weeks if debride and retention or 1stage exchange (If 2 stage exchange or permanent ressection then no rifampin) Then oral therapy with Cipro or Levo + Rifampin for 3 months with a hip, or 6 months with a knee in all patients who have had debridement and retention or 1-stage exchange Consider chronic suppression in Debride and retention or 1 stage exchange indefinitely with Keflex, Clox, Septra or Minocycline

Answer 472

1) Pseudomonas aeruginosa | 2) MRSA

Answer 473

E. coli b. Culture + for lactose fermenter on MacConkey, yellow on BAP. Oxidase, DNase, sorbitol negative. What is the most likely organism now? Cronobacter sakazakii (Enterobacter cloacae is sorbitol positive, Elizabethkingia is oxidase positive) c. Baby improves, then worsens after 4-5 d of treatment. 2 possible explanations? Organism has intrinsic AmpC type resistance Secondary infection with another organism Abscess

Answer 474

1) HSV 2) CMV b. For each one, please discuss tests and specimens for diagnosis. HSV – CSF for PCR CMV – CSF for PCR or shell vial or culture. Also collect urine and saliva swab for same. c. For each, list measures to prevent further transmission in hospital. Contact isolation for HSV if skin lesions CMV is standard precautions

Answer 475

Bordetella pertussis

Answer 476

Droplet isolation until 5 days after effective antibiotic therapy has been initiated or 3 weeks in untreated patient Chemoprophylaxis for close contacts with Azithromycin x 5 days (Close contact = household, daycares)

Answer 477

Elevated MIC associated with clinical failure May represent heteroresitant population of vancomycin intermediate isoaltes, giving vancomycin will select for the resistant population? Necrotizing pneumonia has a PVL toxin and vanco does not reduce the production of toxins.

Answer 478

Linezolid 600 mg IV q12h x 14 days Tigecycline 50 mg IV q12h x 14 days Telavancin 10 mg/kg IV q24h x 21 days

Answer 479

Binds to the cell membrane and causes rapid depolarization inhibiting DNA, RNA and protein synthesis b. What are the 2 main indications? Skin and skin structure infections caused by susceptible isolates Staphyloccocus aureus bloodstream infections c. What are 2 drugs to be monitored when administered alongside daptomycin? HMG-CoA Reductase Inhibitors 1) Atorvastatin 2) Simvastatin Tobramycin activity is decreased

Answer 480

Inhibit protein synthesis by binding to the 30S ribosomal subunit

Answer 481

Inhibit cell wall synthesis by binding to penicillin binding proteins

Answer 482

Morganella Proteus Providencia Pseudomonas aeruginosa

Answer 483

Pseudomonas aeruginosa Stenotrophomonas Burkholderia Acinetobacter

Answer 484

1. Type of wound – Contaminated or Dirty 2. Duration of surgery 3. American Anesthesiology score 3,4, or 5 (Patients comorbidities )

Answer 485

1) Prospective audit with intervention and feedback 2) Formulary restriction and preauthorization requirements for specific agents 3) Education 4) Guidelines and Clinical Pathways 5) Antimicrobial order forms 6) Dose optimization 7) Conversion from parentral to oral formulations 8) De-escalation of therapy

Answer 486

1) Site of infection (Laryngeal more contagious) 2) Smear positivity 3) Proximity of contacts 4) Duration of exposure 5) Cough 6) Crowding and room ventilation 7) Treatment 8) Cavitary disease

Answer 487

Vancomycin 15-20mg/kg/dose q12h x 6 weeks | +/- Gentamycin 1 mg/kg q8h x 6 weeks

Answer 488

Large Abscess despite appropriate antibiotic thearpy Heart failure unresponsive to medical management >=1 embolic event during first 2 weeks of antibiotics Anterior Mitral leaflet vegetation >1 cm Persistent vegetation after systemic embolization Increase in vegetation size despite antibiotics Valve perforation or rupture New heart block Fungal IE

Answer 489

1) Self limited Febrile Illness 2) Endocarditis 3) Post Q fever Fatigue Syndrome 4) Pneumonia 5) Hepatitis 6) Osteomyelitis 7) Q fever in infancy 8) Q fever in the immunocompromised host 9) Q fever in pregnancy

Answer 490

1) Brucella abortus 2) Yersinia entercolitica 3) Coxiella burnetii 4) Cryptosporidium parvum (cows) 5) Listeria

Answer 491

1) Shiga toxin producing E.coli (STEC) 2) Shigella 3) Norovirus 4) Cyclospora cayetanensis (Raspberries) 5) Salmonella 6) Bacillus cereus

Answer 492

Clostridial necrosis Clostridium septicum

Answer 493

1) GBS bacturia during the pregnancy 2) Previous infant with GBC infection 3) Positive GBS screen after 36 weeks 4) No GBS screening swab collected prior to labour onset

Answer 494

CMV pneumonitis b. What would be the most useful test in the management of the patient? Resistance testing of CMV isolate c. What are 2 steps in the management of this patient that should be undertaken? Decrease immunosuppression Change therapy to Cidofovir or Foscarnet If UL97 mutant (activation one) then Cidofovir will work If the mutation is UL54 (polymerase) then there may be cross resistance to Cidofovir too

Answer 495

1) BK virus 2) Adenovirus 3) JC Virus 4) HSV 5) CMV 6) HHV6

Answer 496

II and III (multivorans and cenocepacia)

Answer 497

1) Necrotizing pneumonia | 2) Hematogenous dissemination

Answer 498

Klebsiella oxytoca 1) Meningitis 2) Endophthalmitis

Answer 499

Acute bacterial rhinosinusitis of the ethmoid sinus Proptosis, ophalmopelegia, pain with eye movements Brain abscess, orbital abscess, cavernous sinus thrombophlebitis, vision loss Vancomycin + Ceftriaxone Need anaerobic coverage if any intracranial extension. Add metronidazole or do Vanco + PipTazo.

Answer 500

1) Didanosine 2) Zidovudine 3) Atazanavir

Answer 501

Rifampin for 4 months duration

Answer 502

Discoloration of body fluids (orange) Hepatotoxicity Drug interations

Answer 503

1 - Growth is pure | 2 - Growth of the coryneform is in heavy amounts and exceeds the growth of respiratory flora

Answer 504

Corynebacterium pseudodiptheriticum

Answer 505

``` 1 – Bile escuin positive 2 – Room temperature tumbling motility positive 3 – CAMP test positive 4 – VP Positiive 5 – Acid production from glucose 6 – Hippurate hydrolysis positive ```

Answer 506

1) PFGE 2) Multilocus variable-number tandem-repeat analysis 3) Multilocus sequence typing 4) Mixed genome DNA microarray 5) Random Amplification of Polymorphic DNA (RAPD) 6) Amplified fragment length polymorphism 7) Ribotyping 8) MALDI-TOF

Answer 507

Trimethoprim-Sulfamethoxazole Alternative: Moxifloxacin (bacteriocidal) Drug of choice is Ampicilin + Gentamycin for synergy

Answer 508

Clostridium septicum

Answer 509

Myonecrosis | Neutropenic enterocolitis

Answer 510

Complement Fixation ELISA Indirect Hemmaglutination

Answer 511

40% | SOGC says 30-50%

Answer 512

``` Blood CSF Swab/scrapings of any skin or mucous membrane lesions Conjuntivae Nasopharynx Mouth Rectum ```

Answer 513

Culture PCR DFA EIA

Answer 514

Acylovir: 60 mg/kg/day divided q8h. 14 days if only skin, eyes, mouth At least 21 days if disseminated or CNS disease followed by 6 months of oral suppressive

Answer 515

1) Multiple patients presenting with a similar illness 2) Patient presenting with an illness consistent with a diagnosis of an agent of possible bioterrorism 3) Cultivation of an organism with an unusual drug resistance 4) Atypical disease presentations 5) Shorter incubation time that usual 6) Unusual season 7) Unusual demographics

Answer 516

Moderate to severe disease = Streptomyc in 10 mg/kg q12h IM x 10 days or Gentamicin 1.7 mg/kg q8h IV x 10 days Mild Disease = Ciprofloxacin 500 mg po BID x 14 days or Doxycycline 100 mg po BID x 14 days Meningitis = Streptomycin or Gentamicin + Chloramphenicol 20 mg/kg IV q6h or Strep/Gent with Doxycycline 100 mg IV BID x 14-21 days

Answer 517

8) Entamoeba hartmanni 9) Entamoeba coli 10) Entamoeba polecki 11) Entamoeba dispar 12) Endolimax nana 13) Iodamoeba butschii 14) Chilomastix mesnili 15) Entamoeba gingivalis 16) Entamoeba moshkovskii 17) Trichomonas hominis

Answer 518

Iron hematoxylin Modified Trichrome Stain Modified Kinyoun’s Acid Fast Stain

Answer 519

1) Colonies on CHROMagar - A is light green, D is dark 2) Growth at 42-45 degrees - A grows, D does not 3) Chlamydospores on Cornmeal Agar - A single, D in clusters 4) Colonies on Staib agar - A is smooth, D is rough 5) Assimilation of sugars - A + for Xyl, MDH, The, D neg for all

Answer 520

``` 1) Vibrio static disks (O129) Vibrio = Susceptible (except V. cholera 0139) Aeromonas = Resistant 2) Salt Tolerance Vibrio = Growth in presence of 6.5% NaCl Aeromonas = No growth in 6.5% NaCl 3) Growth on TCBS Agar (Thiosulfate-Citrate-Bile Salts-Sucrose) Vibro = Growth Aeromonas = No growth 4) String Test (with 0.5% sodium deoxycholate) Vibrio = Positive Aeromonas = Negative ```

Answer 521

Ciprofloxacin 500 mg PO BID?? + Clinda | Up To Date suggests 1st GC + Levo + Doxy? Seems like overkill…

Answer 522

3) Acute infection, during the window period 4) Previous HBV exposure with waning sAb titres 5) Chronic HBV infection with sAg below the limit of detection 6) False positive anti-HBc

Answer 523

1) E.Coli 2) Enterobacter cloacae 3) Serratia marcescens 4) Pseudomonas aeruginosa 5) Salmonella 6) Morganella Phenotypic confirmatory tests = Disk inhibition assay with a carbapenem with and without boronic acid

Answer 524

``` Metallo-beta-lactamase = Disk inhibition assay with a carbapenem with and without EDTA AmpC = Disk based inhibitor test using Cefoxitin with or without cloxacillin ```

Old Micro Written Exams Flashcards

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