CIULLA CHAPTER 8 - PARASITOLOGY

Enterobius vermicularis infection is usually A. Because the eggs of E. vermicularis are usually
1

diagnosed by finding deposited on the perianal area, cellulose tape slides are
A. Eggs in perianal specimens recommended for collecting the eggs. Recovery is best
B. Larvae in perianal specimens if specimens are collected late in the evening or before
C. Larvae in feces bathing or defecating in the morning. The gravid female
D. Eggs in the feces worms usually migrate at night to the perianal region to
deposit eggs. Because their migration is spo- radic,
several consecutive collections may be necessary to
detect the infection.

The best direct diagnosis of Echinococcus D. When E. granulosus eggs are ingested by an
2

granulosus infection in humans is made by intermediate herbivorous host, includinghumans, they

identification of usually develop into hydatid cysts in which invaginated
A. Adult worms in the intestine larval scolices are produced. These cysts are most often
B. Adult worms in tissues in the liver or lung. Although clinical findings can provide
C. Eggs in feces a presumptive diagnosis, this is best confirmed by the
D. Hydatid cysts in tissues finding, at surgery, of encysted larval scolices. Each
scolex is capable of developing into an adult worm after
ingestion by a dog or related animal, the definitive host.

Which statement is correct for specimen collection C. Fresh liquid stools are more likely to contain motile
3

and processing? protozoan trophozoites that can be detected in saline

A. Stool samples can contain urine.
B. Stools can be frozen without affecting parasitic
structure.
C. Liquid stools are best for detecting ameba and
flagellate trophozoites.
D. Unpreserved stools can remain at room
temperature for up to 72 hours.
Cysts are the infective stage of this intestinal
4
wet mounts. Urine in stool specimens can damage
parasite morphology, as does freezing. Unpreserved
stool specimens should only be left at room temperature
up to a couple of hours before examining or placing into
a preservative.
D. Cysts are the infective stage of most intestinal

flagellate. parasites. D. fragilis is currently classified as a flagellate,

A. Balantidium coli even though it does not produce a flagellum. However,
B. Dientamoeb afragilis D. fragilis does not have a cyst stage. G. lamblia is the
C. Entamoeba coli only flagellate in the list of protozoa with a cyst stage. B.
D. Giardia lamblia coli is a cili- ate and E. coli is an ameba.

Eggs or larvae recovered in the stool are not routinely A. Although T.spiralis adults live in the intestinal
5

used to diagnose infections caused by which one of mucosa, they are rarely seen. The female deposits living
the following helminths? larvae into the mucosa or lymphatic vessels, from which
A. Trichinella spiralis they normally enter the bloodstream and are
B. Strongyloides stercomlis disseminated throughout the body. They then burrow
C. Necator americanus into muscle fibers. Although larvae may occasionally be
D. Ascaris lumbricoides liberated into the intestinal lumen, the definitive
diagnostic procedure is the demonstration of larvae in
skeletal muscle, not in feces.

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6 Many parasites have different stages of growth within B. In parasites with a sexual and asexual stage of
different hosts. The host where the sexual development, the definitive host is the host in which the
reproductive stage of the parasites exists is called the sexual stage of the parasite occurs. The intermediate
A. Commensal host is the host in which the asexual stage of the
B. Definitive host parasite is found. Vectors are arthropods, like
C. Intermediate host mosquitoes and ticks that trans- mit infectious agents. A
D. Vector commensal is an organism that benefits from an
existence with a host but does not damage the host.

Species identification of an immature amebic cyst can C. Young cysts of E. coli can have a large glycogen
7

be very difficult. The presence of a large glycogen mass that pushes two nuclei to the outer edge of the
mass is sometimes seen in cell. No cyst stage is known for D. fragilis. The cysts of
A. Dientamoeba fragilis E. nana and E. histolytica do not contain glycogen.
B. Endolimax nana
C. Entamoeba coli
D. Entamoeba histolytica

Which of the following is typical in cysts of A. Mature cysts of I. butschlii are usually ovoid, with a
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lodamoeba butschlii? single nucleus with a large eccentric karyosome. The

A. A glycogen mass cytoplasm contains a compact mass of glycogen, which
B. Blunt chromatoidal bars appears as a clear area in unstained or permanently
C. Four nuclei with large karyosomes stained preparations but stains dark brown with iodine.
D. Many ingested bacteria Chromatoid bodies are not present.

Which of the following is the most important feature D. E. histolytica and E. dispar cannot be morphologically
9

in differentiating cysts of Entamoeba histolytica from differentiated. The cyst stage of both organisms has four
E. dispar? nuclei with a centrally located karyosome. E. histolytica
A. Number of nuclei is a well-recognized intestinal parasite, whereas E.
B. Size of the cyst dispar is considered nonpathogenic. Immunologic
C. Shape of the karyosome assays to detect antigens or molecular biology assays
D. Distinguishing surface antigens by immunologic are necessary to differentiate these two species.
assays

Which of the following findings in a peripheral blood A. Although the condition may vary from patient to
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smear is especially associated with tissue-invading patient, eosinophilia is often found in association with
helminths but may also be found in a variety of infections with tissue-invading nema- todes. Eosinophilia
allergic conditions and other diseases? of 40-80% is not unusual in trichinosis and in visceral
A. Eosinophilia larva migrans. It may also be present in strongyloidiasis,
B. Leukopenia early in Ascaris and hookworm infections, and in
C. Lymphocytosis filariasis, which may also cause pulmonary eosinophilia.
D. Neutropenia

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11 A 48-year-old man from Texas developed fever and B. The symptoms and history for this patient are
weakness 16 days after a hunting trip in northwest compatible with trypanosomiasis (African sleeping
Tanzania. Several days after the onset of fever, he sickness) caused by T. brucei. The trypomastigote form
noticed a raised, tender, erythematous nodule (6-8 cm of the parasite was found in peripheral blood smears
in diameter) on the posterior aspect of his right arm. from this patient. Another key clinical sign is the
He was hospitalized in Africa and treated for 5 days presence of swollen lymph nodes at the posterior base
with a cephalosporin for presumed cellulitis. After of the neck; this is called Winterbottom's sign.
little improvement, he returned to Texas. On arrival,
the patient had a temperature of 38.9°C (102°F), a
morbilliform rash of the trunk, and right- sided,
anterior cervical lymphadenopathy. Cerebrospinal
fluid contained 12 red cells and 18 mononuclear
cells/uL and a normal protein level (32 mg/dL).
Laboratory tests of peripheral blood revealed a
hemoglobin level of 107 g/L, a white cell count of 2.4 X
9 9
10 /L, and a platelet count of 75 X 10 /L. The diagnosis
was made by finding the extracellular flagellate
parasite in a peripheral blood smear. Which of the
following is the most probable etiologic agent of this
infection?
A. Leishmania donovani
B. Trypanosoma brucei
C. Trypanosoma cruzi
D. Toxoplasma gondii

Which species of malaria parasite usually has D. The trophozoites of P.vivax often develop fine
12

ameboid trophozoites and produces small reddish pseudopodia and large vacuoles and are described as
dots in the red blood cell cytoplasm? ameboid; infected red blood cells (RBCs) con- tain
A. Plasmodium knowlesi clumps of malarial pigment called Shiiffner's dots. P.
B. Plasmodium falciparum malariae cytoplasm is much more compact, and infected
C. Plasmodium malariae RBCs lack Shiiffner's dots. P. ovale resembles P. vivax.
D. Plasmodium vivax Shiiffner's dots are generally found in P. vivax and P.
ovate-infected RBCs; however, P. ovate-infected RBCs
have fimbriated edges. Growing trophozoites of
P.falciparum seen in the peripheral blood remain in the
ring form, and infected RBCs lack malarial pig- ment.
P.knowlesi is rarely a human pathogen.

With a fecal specimen, which one of the following is C. The permanently stained smear is especially
13

the most dependable procedure for the accurate,
specific diagnosis of an intestinal amebic infection?
A. Direct saline wet mount
B. Direct iodine wet mount
C. Permanently stained smear
D. Formalin-ethyl acetate sedimentation technique
recommended for identification of trophozoites, for
confirmation of species, and for keeping a permanent
record of the organisms found. Species identification of
amebic trophozoites can rarely be made from a single
feature; permanent stains enable one to observe the
cytoplasm and cytoplasmic inclusions and the nuclear
morphologic features of many cells. Iron hematoxylin
and trichrome are commonly used stains.

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14 In an examination of stained blood films, Babesia spp. B. Babesia spp. are sporozoan parasites of RBCs that
are likely to resemble have been recognized as causing febrile illness in
A. Leishmania donovani humans. B. microti has caused a number of tick-borne
B. Plasmodium falciparum infections in the U.S. The parasites often appear as
C. Toxoplasma gondii small rings within infected RBCs, resembling P.
D. Trypanosoma cruzi falciparum trophozoites. The pathognomic form of
Babesia is the "Maltese cross," four ring forms inside a
single RBC.

Which of the following is a mercury-containing D. Polyvinyl alcohol (PVA) is a commonly used fixative
15

fixative used to preserve parasites in stool for stool specimens. This preservative contains mercury
specimens? and is used to fix fecal samples for making permanently
A. Formalin stained smears. Formalin is commonly used to preserve
B. Sodium acetate stool samples in preparation for concentration
C. Buffered glycerol procedures. Sodium acetate is used with formalin to
D. Polyvinyl alcohol preserve fecal specimens, but it does not contain
mercury and is, therefore, less toxic. Buffered glycerol is
sometimes used as a transport medium for stool
samples when performing a bacterial culture.

Examination of a fecal smear following acid-fast stain B. Although all the organisms listed have some degree
16

reveals round acid-fast positive structures 8-10 um in of acid-fast positivity, only Cyclospora forms oocysts in
diameter. You should suspect the size range of 8-10 um. The oocysts of
A. Cryptosporidium Cryptosporidium are generally 4—6um in diameter and
B. Cyclospom are generally strongly acid-fast positive. Oocysts of
C. Isospora Isospom are much larger, approximately 25 X 18 um.
D. Microsporidia Microsporidia are acid-fast variable, and this stain is not
recommended for detecting microsporidia. The spores of
microsporidia are generally 1-3 um in diameter.

A 22-year-old male presents to his family physician C. The early symptoms of trichinosis can resemble
17

complaining of fatigue, muscle pain, periorbital infectious mononucleosis. The presence of periorbital
edema, and fever. He denies travel outside the U.S. edema (swelling around the eyes) in this patient and
The physician suspects infectious mononucle- osis; hemorrhaging in the nail beds is suggestive of
however, serologic tests for infectious trichinosis. Eosinophilia also indicates a parasitic
mononucleosis are negative. The complete blood infection.
count revealed a slightly elevated white blood count,
and there were 10% eosinophils on the differential.
Which of the following should be considered part of
the differential diagnosis?
A. Ascaris lumbricoides
B. Taenia solium
C. Trichinella spiralis
D. Trypanosoma cruzi

Which Schistosoma species has a large terminal A. The ova of Schistosoma contain a spine. S.
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spine? haematobium ova have a large prominent spine on one

A. S. haematobium end. S. mansoni has a prominent lateral spine, whereas
B. S.japonicum the spine of S. japonicurn is small and inconspicuous. S.
C. S. mansoni mekongi is a rare human pathogen.
D. S. mekongi

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19 Elephantiasis is a complication associated with which D. Adult filarial helminths typically inhabit the lymph
of the following? vessels. They produce inflammation and swelling of the
A. Cysticercosis lymph vessels, often in the legs and sometimes the
B. Guinea worm scrotum. This condition is referred to as elephantiasis.
C. Hydatid cyst disease The larvae are highly motile and migrate through the
D. Filariae body.

A patient with history of human immuno- deficiency B. Although all these organisms are potential pathogens
20

virus infection presents with a 5-day history of
diarrhea and weight loss. A series of stool specimens
is collected and examined for the presence of ova and
parasites. An acid-fast stain on direct smear reveals
pink-stained round structures approximately 4 um in
diameter. The most likely pathogen is
A. Blastocystis hominis
B. Cryptosporidium sp.
C. Isospora sp.
D. Microsporidium
of immunocompromised patients, only Cryptosporidium
produces acid-fast positive oocysts about 4-6 um in
diameter. The oocysts of Isospora measure
approximately 25 X 18 um. The spores of microsporidia
are generally 1-3 um in diameter. B. hominis is generally
considered to be pathogenic in high numbers. The
diagnostic form of this intestinal parasite measures 6^40
um in diameter and is not acid-fast positive.

A 55-year-old female presents to her physician C. One of the classic signs of malaria is a fever that
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complaining of a fever that "comes and goes" and occurs in cycles. As the infection is developing, all the
fatigue. A complete blood count reveals decreased parasites are in approximately the same stage of
red blood cell count and hemoglobin. History reveals development. The fever spikes correspond to the
the patient recently traveled through Europe and release of the merozoites from infected RBCs.
Africa. You should suspect Plasmodium is an obligate intracellular parasite of
A. Cutaneous larval migrans RBCs; therefore, infections can result in decreased RBC
B. Filariasis counts and hemoglobin.
C. Malaria
D. Trichinella

The disease most commonly associated with B. Acanthamoeba is a free-living ameba rarely causing
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Acanthamoeba sp. Is human infections. This organism has been associated

A. Diarrhea with granulomatous infections of the skin and lung, as
B. Keratitis well as meningoen- cephalitis. However, the most
C. Liver abscess common presen- tation is keratitis, infection of the
D. Meningoencephalitis cornea. Most keratitis cases have been associated with
contact lenses.

A modified trichrome stain of a fecal smear can be B. The small size and variable staining of the
23

used to detect microsporidia. Which of the following
would describe the appearance of this parasite in this
stain?
A. Purple circles, 10-15 um in diameter
B. Pink ovals, 1-3 urn in diameter
C. Blue ovals, 4-6 urn in diameter
D. Fluorescent circles, 8-12 um in diameter
microsporidia make their detection difficult. Tissue
examination by electron microscopy is the most specific
diagnostic method. In the modified trichrome stain, one
of the stains (chromotrope 2R) is used at 10 times the
normal concentration. In addition, the staining time is
increased to 90 minutes. Alternatively, 15 minutes in
heated stain can be used. Under these staining
conditions, the spores of microsporidia stain as pinkish
ovals, 1-3 um.

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24 Hydatid cysts in humans are due to ingestion of a D. Echinococcus granulosus is a tapeworm that lives as
tapeworm stage normally found in canines. This stage an adult in the small intestines of carnivores, primarily
is the dogs, wolves, and other canines. When the
A. Cercaria embryonated egg from the feces of a carnivore is
B. Cercocystis ingested by the intermediate host, usually an herbivore
C. Cysticercus but sometimes a human, the liberated embryo can
D. Embryonated egg develop into a hydatid cyst. These cysts are most often
hepatic or pulmonary, and the resulting symptoms are
comparable to those of a slowly growing tumor.

Oocysts, the infective stage of Toxoplasma gondii, is A. T. gondii is a protozoan parasite of humans and a
25

found in variety of lower animals. Human infections can be

A. Cat feces congenital or can result from ingestion of material
B. Humanfeces containing oocysts from cat feces or from eating
C. Undercooked pork undercooked beef, lamb, or pork containing toxoplasma
D. Undercooked beef cysts. The life cycle of this parasite includes asexual
multiplication in a number of hosts and sexual
multiplication only in domestic cats and some closely
related species, which then excrete potentially infectious
oocysts. Pregnant women should take precautions to
avoid infection.

A 15-um pear-shaped flagellate with a visible C. All the flagellates listed are pear shaped, but only C.
26

parabasal body and "falling leaf" motility in a direct mesnili and G. lamblia are usually as large as 15 jam. B.
saline mount of a diarrheal stool specimen is most coli is a ciliate. The typical motion of G. lamblia is
probably described as "falling leaf"; C. mesnili has a stiff rotary
A. Balantidium coli motion. G. lamblia is known to cause diarrheal disease
B. Chilomastix mesnili and malabsorption, and the trophozoites may be found
C. Giardia lamblia in diarrheal feces.
D. Trichomonas hominis

This parasitic infection may result in vitamin B12 A. D. latum is a tapeworm that has been linked to
27

deficiency, and individuals with pernicious anemia are vitamin B12 deficiencies in individuals of Scandinavian
predisposed to more severe symptoms. descent. T. saginata and H. diminuta are tapeworms
A. Diphyllobothrium latum that infect the gastrointestinal tract of humans but have
B. Echinococcus granidosus not been linked to vita- min B12 deficiencies. E.
C. Hymenolepis diminuta granulosus is a dog tapeworm that causes hydatid
D. Taenia saginata disease in the tis- sue of humans.

Knowledge of nocturnal periodicity is especially C. Transmission of filariasis depends on the presence of

28

important in the diagnosis of certain infections microfilariae in the bloodstream at the time the vector
caused by bites, and the periodicity of microfilariae in the peripheral
A. Babesia blood varies with the species and sometimes with the
B. Plasmodium geographic area. Nocturnal periodicity is marked in W.
C. Microfilariae bancrofti in Africa, Asia, and the western hemisphere,
D. Trypanosoma and thick blood films for detection of these micro- filariae
should be made between 10 P.M. and mid- night. The
other choices do not exhibit nocturnal periodicity.

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29 For which of the following diseases is close contact D. Sexual intercourse with infected men is thought to be
with an infected human host the most important the most important mode of transmission of
mechanism of transmission? Trichomonas vaginalis to women. Other routes of
A. Schistosomiasis infection are direct contact with infected females or
B. Toxoplasmosis contact with infected toilet articles or toilet seats; these
C. Trichinosis are considered rare modes of transmission. Infants may
D. Trichomoniasis become infected while passing through the birth canal.
Toxoplasmosis occurs as a congenital infection, but it is
more commonly acquired by the ingestion of infected,
undercooked meat or by swallowing oocysts excreted by
infected cats. Schistosomiasis and trichinosis are not
passed from person to person.

Which of the following helminths produces an D. Typical eggs of T. trichiura are yellow to brown, with
30

elongate, barrel-shaped egg (50 X 22 um) with a colorless polar plugs. They are shaped like a football or
colorless polar plug at each end? a barrel, and they are in the cell, or unsegmented stage,
A. Ascaris lumbricoides when passed in the feces. The usual egg range is 49-65
B. Hymenolepis nana X 35-45 urn.
C. Necator americanus
D. Trichuris trichiura

Which species of Plasmodium may readily be A. The gametocytes of P. vivax, P. malariae, and P.
31

identified when crescent-shaped gametocytes are ovale are round and somewhat similar in appearance.
found in stained blood films? Those of P. falciparum have a typical crescent shape.
A. P. falciparum The gametocytes of P. falciparum may remain in the
B. P.malariae peripheral blood a month or more and are often found
C. P.ovale with the ring stages.
D. P.vivax

Cysts of Giardia lamblia A. The cysts of G. lamblia contain four nuclei and are
32

A. Contain four nuclei passed in the stool of infected animals. The trophozoites
B. Aremotilebyflagella are motile by flagella. G. lamblia does not possess an
C. Have an undulating membrane undulating membrane.
D. Are rarelyf ound in stool specimens

Migration of larva through the skin can sometimes A. The life cycle of a number of human nematodes
33

produce allergic reactions called larva migrans; this is includes migration through the skin and peripheral
associated with bloodstream. In individuals who have suffered several
A. Strongyloides stercoralis infections, allergic reactions can produce inflammation in
B. Dracunculus medinensi the skin. S. stercoralis produces symptoms in the skin
C. Onchocerca volvulus sometimes called larva migrans.
D. Loa loa

A free-living ameba that causes primary amebic D. Naegleria fowleri is found in freshwater ponds and
34

meningoencephalitis is lakes, especially those with disturbed or suspended soil.

A. Dientamoeba fragilis It has caused a number of cases of meningoencephalitis
B. Entamoeba coli in people who have swum in these bodies of water.
C. Entamoeba histolytica Essentially, all these infections have been fulminating
D. Naegleria fowleri and fatal, and they are often not diagnosed until
autopsy.

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35 Decontamination of drinking water, fruits, and C. Infectious cysts of amebae and Giardia lam- blia and
vegetables before consumption is necessary in eggs of Ascaris lumbricoides may all be ingested in
countries without well- developed public sanitation. fecally contaminated water and/or on fecally
Which of the following diseases would probably be contaminated plants. These infections are most
least affected by that kind of precaution? prevalent in areas lacking good public sanitation; that is,
A. Amebiasis sanitary disposal of human waste and adequately
B. Ascariasis treated and protected drinking water. Filiariasis is
C. Filariasis transmitted by blood-feeding insects (vectors).
D. Giardiasis

Which stage of Taenia saginata is usually infective for A. Humans are infected with T.saginata by eating beef
36

humans? containing live cysticerci, the infectious larval stage of

A. Cysticercus larva this parasite. Cattle become infected by ingesting viable
B. Embryonated egg eggs from human feces. Unlike Taenia solium, if
C. Filariform larva humans ingest T. saginata ova, infection does not
D. Rhabditiformlarva develop.

This amebic cyst has an average size of 6-8 um and is C. Cysts of E.hartmanni are differentiated from cysts of
37

usually spherical. When mature, it has four nuclei, but E. histolytica by their small size; they are otherwise
immature cysts with one or two nuclei are often seen. morphologically identical. E. hartmanni, which was
The nuclei have fine uniform granules of peripheral formerly called "small race ameba," is considered to be
chromatin and small,discrete,usuallycentral nonpathogenic. The size range for E. hartmanni cysts is
karyosomes. Chromatoidal bars with bluntly rounded 5—10 um, and for E.histolytica, the range is 10-20 um.
ends are sometimes present. Name the species.
A. Endolimax nana
B. Entamoeba coli
C. Entamoeba hartmanni
D. Entamoeba histolytica

Which stage of Trichuris trichiura is infective for D. The fertilized ova of T. trichiura are unsegmented
38

humans? when released, and embryonic development occurs

A. Proglottid outside of the host. In moist, warm, shaded soil, the first-
B. Filariform larva stage larva develops within the egg in about 2 weeks.
C. Rhabditiform larva This fully embry- onated egg is infective when ingested
D. Embryonated ovum by a susceptible host, and it hatches in the small
intestine. During development from larva to adult, the
worm usually passes to the cecum, where it embeds its
slender anterior portion in the intestinal mucosa.

An intestinal parasite is seen in an iodine- stained A. The most common form of B. hominis seen in human
39

fecal wet mount that is described as being 25 um in feces is called the "classic form." This form contains a
diameter with a homogenously stained central body central body that was previously thought to be a
surrounded by a thin ring of cytoplasm containing a vacuole. The central body can take up to 90% of the
number of nuclei. This best describes volume of the cell, displacing the nuclei to the outer
A. Blastocystis hominis edge of the cell.
B. Endolimax nana
C. Entamoeba dispar
D. lodamoeba btitschlii

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40 Sanitary disposal of human feces is the most C. Excretion in human feces of the eggs of the
important factor in decreasing the incidence of most hookworms, Taenia solium, T. saginata, and Ascaris
infections caused by intestinal parasites. Which of the lumbricoid.es, is an essential or impor- tant factor in
following diseases would not be affected by that kind perpetuating the cycle of infection with these parasites.
of sanitation? Trichinosis is caused by ingestion of the live larvae of
A. Ascariasis Trichinella spiralis encysted in the muscles of a flesh-
B. Taeniasis eating host. The adults live in the host's intestine, and
C. Trichinosis the viviparous females, after fertilization, produce larvae
D. Hookworminfection that migrate into the host's muscle tissue.

Which species of Plasmodium is characterized by the D. Typically, RBCs infected with P. ovale are larger than
41

presence of Schiiffner's dots in the infected uninfected cells, pale and often misshapen, and
erythrocytes? frequently contain Schiiffner's dots or stippling in any
A. Plasmodium falciparum stage from young ring forms onward. RBCs infected with
B. Plasmodium knowlesi P vivax are also larger than normal, oval, and contain
C. Plasmodium malariae Schuffner's dots. Ovale malaria, however, is a
D. Plasmodium ovale comparatively rare disease.

Which of the following is the largest intestinal A. Balantidium coli is the largest intestinal protozoan
42

protozoa infecting humans? infecting humans. Cysts range in size from 43 to 65 jam,
A. Balantidium coli and the trophozoites are typically 50-100 jam in length
B. Dientamoeba fragiliis and 40-70 um in width. Pigs seem to be the most
C. Entamoeba histolytica important reservoir for B. coli.
D. Giardia lamblia

The rhabditiform larvae of Strongyloides stercoralis C. The rhabditiform larvae of S. stercoralis are the
43

A. Mate and produce ova
B. Are infective for humans
C. Are the diagnostic form found in feces
D. Are found in the blood of infected humans
diagnostic stage typically passed in the feces of infected
persons. The larvae measure up to 380 um long X 20
urn wide. They have a short buccal cavity and a
prominent, ovoid, genital primordium midway along the
ventral wall of the body. The infective stage is the
filariform larva, which differs from the hookworm filari-
form larva by having a notched tail tip and a long
esophagus.

Which species of Plasmodium can have B. A malaria relapse is parasitemia developing from
44

exoerythrocytic stages capable of causing relapses exoerythrocytic stages in the liver. These persistent
months or years after initial infection? stages are found in P ovale and P. vivax infections, and
A. P . falciparum they may cause relapses up to 4 or 5 years after the
B. P. ovale primary infection. For infections caused by these
C. P. malariae species, treatment with primaquine is used to prevent
D. P. cynomolgi relapses (recurrences) after clinical cure with
chloroquine or an alternate drug.

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45 A Giemsa-stained thick blood film showed many ring A. P falciparum infections tend to produce a large
forms with no older stages, and a number of the rings number of rings that frequently have double chromatin,
had double chromatin dots. These findings are which is only occasionally found in other species. P.
characteristic of falciparum differs from other plasmodia of humans in
A. Plasmodium falciparum that only early trophozoites (ring forms) and
B. Plasmodium vivax gametocytes are found in peripheral blood except in
C. Plasmodium malaria severe cases. Sex differentiation of the gametes, when
D. Plasmodium ovale present, is difficult.

Which of the following nematode parasites is D. T. spiralis is a nematode parasite whose infectious
46

acquired from eating inadequately cooked, infected larvae may be found encysted in the muscles of flesh-
pork? eating mammals. Humans are infected most often by
A. Strongyloides stercoralis eating infected, undercooked pork. Taenia spp. are
B. Taenia saginata cestodes (tape- worms). S. stercoralis and N.
C. Taenia solium americanus are roundworms whose infectious larvae
D. Trichinella spiralis usually develop in the environment and infect by
penetration of human skin, although internal
autoinfection may also occur.

Which of the following pairs of helminths cannot be C. N. americanus and A. duodenale are two species of
47

reliably differentiated by the appearance of their
eggs?
A. Ascaris lumbricoides and Necator americanus
B. Hymenolepis nana and H. diminuta
C. Necator americanus and Ancylostoma duodenale
D. Diphyllobothrium latum and Fasciola hepatica
hookworms infecting humans. Their eggs are so similar
when found in stool specimens that they are reported as
"hookworm ova." The two hookworms can be
differentiated by the morphologic characteristics of the
adult worms, which are intestinal parasites.

Which of the following formsof Toxoplasma gondii are A. The life cycle of T. gondii includes five forms or
48

produced in infected humans? stages, but only bradyzoites and tachyzoites appear in
A. Bradyzoites the tissue phase during human infections. The crescent-
B. Macrogametes shaped tachyzoites are characteristic of acute infection.
C. Sporoblasts The slowly multiplying bradyzoites develop within cysts
D. Oocysts and are typical of chronic infections. Oocysts,
merozoites, and gametes have been found only in the
cat, where the sexual cycle of T. gondii occurs.

Hematuria is a typical sign of human infection caused D. A common sign of S. haematobium infection is the
49

by presence of blood in the urine. This is due to the

A. Trypanosoma cruzi damage caused when the eggs break out of the blood
B. Trichinella spiralis vessels of the vesicular plexus into the bladder.
C. Trichomonas vaginalis Falciparum malaria may also cause severe hematuria or
D. Schistosoma haematobium "blackwater fever."

Which of the following is the vector for Babesia? C. B. microti is a sporozoan parasite commonly found in
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A. Fleas voles and field mice. The vector is the tick Ixodes,
B. Lice normally a parasite of deer. Humans are accidental
C. Ticks hosts when bitten by an infected tick. Many B. microti
D. Mosquitoes infections within theU.S. occur in the Northeast. It is
important to differentiate this parasite from Plasmodium
in a stained blood film. Antimalarial drugs are not
effective in babesiosis.

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51 Chagas disease (American trypanosomiasis) is B. Chagas disease is found throughout the American
caused by continents. The infectious agent, T. cruzi, is transmitted
A. Trypanosoma brucei to humans by reduviid bugs, primarily the triatomids.
B. Trypanosoma cruzi Chagas disease can be acute or chronic.
C. Leishmania braziliensis
D. Dracunculus medinensis

Which of the following is the preferred anticoagulant A. Collection of blood by finger stick is pre- ferred for
52

for preparing blood smears for diagnosing malaria? preparing blood smears for the detection of malaria.
A. EDTA When a venipuncture is performed, the preferred
B. Heparin anticoagulant for malarial blood smears is EDTA
C. Sodium citrate (ethylenediaminetetraacetic acid). Heparin can be used,
D. Sodium fluoride but it may causedis- tortion of some parasite forms.

Refer to Color Plate 38. This is a photomicrograph of A. B. coli is the only ciliate that is pathogenic for
53

a trichrome stain of a fecal smear, magnification 400X. humans. It is relatively easy to detect in stool samples
The parasite measures 65 X 45 um. What is the because of its large size. The tropho- zoite, seen in
identification of this parasite? Color Plate 38, is generally oval and measures 50-100 X
A. Balantidium coli 40-70 um. A cytosome is present on the anterior end.
B. Diphyllobothrium latum
C. Giardia lamblia
D. Schistosoma japonicum

Refer to Color Plate 39. This is a photomicrograph of D. Color Plate 39 demonstrates a fertilized egg of A.
54

an iodine wet prep made from a stool sample; lumbricoides. Eggs measure 45—75 X 35 —50 um.
magnification is 400X. The ovum is about 70 X 50 um. Unfertilized Ascaris eggs typically do not float in the zinc
What is the identification of the parasite? sulfate concentration technique.
A. Hookworm
B. Enterobius vermicularis
C. Trichuris trichiura
D. Ascaris lumbricoides

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55 Refer to Color Plate 40. This is a photo- micrograph of
an iron hematoxylin stain from a fecal smear. The
magnification is 1000X. The parasite is approximately
20 um long and 15 um wide. What is the identification
of this parasite?
A. Chilomastix mesnili trophozoite
B. Giardia lamblia trophozoite
C. Trichomonas hominis trophozoite
D. Trichomonas tenax trophozoite
Refer to Color Plate 41. This is a photomicrograph of
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an iron hematoxylin stain from a fecal smear. The
magnification is 1000X. The parasite is approximately
12 um in diameter. What is the identification of this
parasite?
A. Entamoeba histolytica trophozoite
B. Entamoeba hartmanni trophozoite
C. Dientamoebafragilis trophozoite
D. Entamoeba coli trophozoite
Refer to Color Plate 42. This is a photo- micrograph of
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an iodine wet-mount from a fecal sample. The
magnification is 1000X. The parasite is approximately
25 um in diameter. What is the identification of this
parasite?
A. Entamoeba histolytica cyst
B. Entamoeba histolytica trophozoite
C. Entamoeba coli cyst
D. Entamoeba coli trophozoite
CIULLA: CHAPTER 8 – PARASITOLOGY [COMPILED BY: SRYB3] 12
B. Color Plate 40B demonstrates a G. lamblia
trophozoite; notice the two prominent nuclei.
Trophozoites of C. mesnili are approximately 6-24 jam in
length but have a single nucleus, whereas G. lamblia
trophozoites have two nuclei. Trophozoites of
Trichomonas are about the same size as G. lamblia, but
they are more round than the pear-shaped trophozoites
of G. lamblia and C. mesnili. Trichomonas spp. have a
single nucleus, and T. tenax is found in the oral cavity.
C. Color Plate 41 demonstrates a D. fragilis trophozoite.
Although this organism lacks a flagellum and
morphologically resembles the ameba, based on its
ultrastructure and molecular biology studies, it is
classified as a flagellate. Like the trichomonads, D.
fragilis does not have a cyst stage. Most trophozoites of
D. fragilis have two nuclei, like the one in this image.
C. Color Plate 42 demonstrates an E. coli cyst. These
cysts most closely resemble E. histolytica and E. dispar.
The key distinguishing feature is that E. coli cysts
contain up to eight nuclei, whereas E. histolytica and E.
dispar have up to four nuclei. It is often necessary to use
the fine adjustment to see all the nuclei. In this image,
six nuclei can be seen. Trophozoites of all three species
only contain one nucleus.
58 Refer to Color Plate 43. This is a photo- micrograph of A. Color Plate 43 demonstrates a hookworm ovum. In
an iodine wet mount from a fecal sample. The addition to size, key characteristics are the thin ovum
magnification is 400X. The ovum is approximately 70 shell and nearly symmetrical shape. Enterobius
X 38 um. What is the identification of this parasite? vermicularis, pinworm, ova appear similar, except that
A. Hookworm they have a flattened side and thicker shell. In addition,
B. Ascaris lumbricoides the ova are slightly smaller. Ova of D. latum are
C. Diphyllobothrium latum unembry- onated, operculated, and slightly larger than
D. Taenia solium hookworm ova.

Refer to Color Plate 44. This is a photomicrograph of D. Color Plate 44 demonstrates the "classic form" of B.
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a trichrome stain from a fecal smear. The hominis. After years of taxonomic uncertainty, this
magnification is 1000X. The parasite is approximately organism is currently classified as an ameba; however,
15 um in diameter. What is the identification of this rRNA studies indicate it is related to algae and water
parasite? moulds. The classic form usually seen in human feces
A. Entamoeba hartmanni varies in size from 6 to 40 jam in diameter. It contains a
B. Dientamoeba fragilis large central body, resembling a vacuole that pushes
C. lodamoeba biltschlii several nuclei to the periphery of the cell.
D. Blastocystis hominis

Refer to Color Plate 45. This is a photomicrograph of B. Color Plate 45 demonstrates a P. malariae
60

a blood smear stained with Wright's stain. Identify the trophozoite. A trophozoite stretching across the infected
parasite. RBC, called a band form, is a key characteristic of P.
A. Babesia sp. malariae. Other important char- acteristics include a lack
B. Plasmodium malariae of malarial pigment, and infected RBCs are about the
C. Plasmodium falciparum same size as uninfected RBCs. During Babesia
D. Trypanosoma cruzi infections, only ring forms are seen.

CIULLA: CHAPTER 8 – PARASITOLOGY [COMPILED BY: SRYB3] 13