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    20 views70 pages

    BOC 6e Micro Only

    Uploaded by

    Lindsay Otto

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    © All Rights Reserved
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    COOL @eo@d Preanalytical & Susceptibility Testing erobi0t00¥ gicrobiology items have been identified generally as appropriate for both entry level medical ne rollowing Jentsts and medical laboratory technicians. items that are appropriate for medical srry scoala rtd with an "MLS ONLY” igporalel { dose 422 Answers with Explanations 355, Au ceal & Susceptibility Testing 423 Preanalytical & Susceptiblity Testing 355 icattl ‘Gram-Positive Coce! 429 Aerobic Gram-Positive Cocci 5 NO ee Bail 432 Gram-Negative Bacilli { 15 Gra eg am-Negative Coccl 437 Aerobic Gram-Negative Cocci 1 8 Ae or Facultative Gram-Pesitive Bacili 438 Aerobic or Facultative Gram-Positive Bail se Aa hed 439 Anaerobes 398 phe 440 Fungi | 0 era 443 Mycobacteria | 4g Viuses & Other Microorganisms 445 Viruses & Other Microorganisms er 447 Parasites Preanalytical & Susceptibility Testing 4, Which of the 2 different antimicrobial agents listed below are commonly used and may us result in synergistic action in the treatment of endocarditis caused by Enterococcus * foecalis? a anaminoglycoside and a macrolide b a penicillin derivative and an aminoglycoside ¢ acell membrane active agent and nalidixic acid d amacrolide and a penicillin derivative 2. Abronchoscopy sample with the request for culture of Legionella is sent to the laboratory.: The correct plating protocol is: 2 culture on thiosulfate citrate bile salt media b incubate the culture media anaerobically ¢ reject the specimen and request a sputum sample 4 culture on buffered charcoal yeast extract agar with antibiotics ‘community hospital microbiology laboratory is processing significant numbers of stool cultures because of an outbreak of diarrhea following heavy rains and flooding in the Sounty. A media that should be incorporated in the plating protocol is: Golistin nalidixic acid for Listeria ¢ MasConkey agar with sorbitol for Campylobacter ¢ mannitol salt agar for Enterococcus species ‘osulfate citrate bile salts sucrose for Vibrie species Amale urethral discharge specimen submitted for culture should be inoculated to: a Shee? blood and phenylethyl alcohol agars @ gosin meth ; vylene blue and sheep blood agars @ credlycollate broth and chocolate agar ‘olnte and modified Thayer-Martin agars FAIMASep 2189-6609 Clinical Laboratory Gertification Examinations 355 chy 10. 1. mas hey 12. 356 The Board of Certification Study Guide 6e Microbiology Preanalytical & Susceptibility Teqy, ng The lowest concentration of antibiotic that inhibits growth of a test Organism is the: @ minimum bactericidal concentration 6 minimum inhibitory concentration © serum bactericidal concentration @ serum inhibitory concentration The steam autoclave method of sterilization requires: @ 15 Ib of pressure for 15 minutes b dry heat for 20 minutes © maximum temperature of 100°C. d a source of ethylene oxide The proper blood-to-broth ratio for blood cultures to reduce the antibacterial effect of serum in adults is: a 1:2 b 13 © 14:10 d 4:30 Penicillin resistance in Neisseria gonorrhoeae can be due to the orga a beta-D-galactosidase b beta-lactamase c¢ butyrate esterase d DNase Which selective medium is used for the isolation of Gram-positive microorganisms? a Columbia CNA with 5% sheep blood b trypticase soy agar with 5% sheep blood eosin methylene blue d modified Thayer-Martin The most sensitive substrate for the detection of beta-lactamases is: a penicillin b ampi ¢ cefoxitin d nitrocefin A Staphylococcus aureus isolate has an MIC of 4 ug/ml to oxacillin. There is uncertainty as to whether this represents an oxacillin (heteroresistant) resistant strain or a hyperproducer of beta lactamase. ‘Strain Oxacillin Amoxicillin-clavutanic acid strain A susceptible susceptible strain B susceptible resistant strain C resistant susceptible strain DB resistant resistant Based on the above results for oxacillin and amoxicillin-clavulanic acid, which strain is heteroresistant? a strainA b strain B ¢ strain C d strain D it be: An Enterococcus isolated from multiple blood cultures in a patient endocarditis should a screened for high level amninoglycoside resistance b checked for tolerance ¢ assayed for serum antimicrobial activity d tested for beta-lactamase production 9 m0 18AS? ISBN 976-089189-660 é 4 18, 16. 17. Oty 19, Preanalytical & Susceptibility Testing The procedure that assures the most accurate detection of mecA-mediated oxacillin {fietance in routine broth microdilution susceptibility testing against S aureus is: addition of 4% Nacl Fe incubation at 30°C incubation for 48 hours testing with cefoxitin susceptibility testing performed on quality control organisms using a new media lot number yielded zone sizes that were too large for all antibiotics tested. The testing was repeated using media from a previously used lot number, and all zone sizes were acceptable. The unacceptable zone sizes are best explained by the: a antibiotic disks were not stored with the proper desiccant b depth of the media was too thick ¢ depth of the media was too thin @ antibiotic disks were not properly applied to the media Campylobacter jejuni isolation requires the fecal specimen be: a inoculated onto selective plating media and incubated in reduced oxygen with added CO; at 42°C. b stored in tryptic soy broth before plating to ensure growth of the organism ¢ inoculated onto selective plating media and incubated at both 35°C and at room temperature d incubated at 35°C for 2 hours in Cary-Blair media before inoculating onto selective plating media ‘An expectorated sputum is sent to the laboratory for culture from a patient with respiratory distress, The direct specimen Gram stain shows many squamous epithelial cells (>25/Ipf) and rare neutrophils. The microscopic appearance of the organisms present include: moderate Gram-positive cocci in chains and diplocoeei moderate Gram-negative diplococci moderate palisading Gram-positive bacilli all in moderate amounts This Gram stain is most indicative of: @ apneumococcal pneumonia b an anaerobic infection ¢ a Haemophilus pneumonia d oropharyngeal flora In disk diffusion susceptibility testing, as an antimicrobial agent diffuses away from the ( disk, the concentration of antibiotic is: a increased b decreased © unchanged inoculum dependent The most appropriate method for collecting a urine specimen from a patient with an indwelling catheter is: a remove the catheter, cut the tip, and submit it for culture b disconnect the catheter from the bag, and aseptically collect urine from the terminal end of the catheter © aseptically collect urine directly from the drainage bag d aspirate urine aseptically from the catheter tubing Which of the following specimen requests is acceptable? feces submitted for anaerobic culture Foley catheter tip submitted for aerobic culture rectal swab submitted for direct smear for gonococci a b ce 4 urine for culture of acid-fast bacilli S21ee57R ISMN 978-089t69-6609 Clinical Laboratory Certification Examinations 357 6: Microbiology 20. 21. 22, 23. 24, 25. 358 The Board of Certification Study Guide 6e Preanalytical & Susceptibiii Test Which of the following groups of specimens would be acceptable for anaerobic cule a vaginal swab, eye swab b intraoral surface swab, leg tissue ¢ pleural fluid, brain abscess fluid d urine, sputum A liquid fecal specimen from a 3-month-old infant is submitted for culture. The stool g should detect Salmonella, Shigella and: ‘ulture a Campylobacter sp. b Clostridium botulinum ¢ Entamoeba hartmanni d_ enterotoxigenic Escherichia coli A cerebrospinal fluid specimen containing only 2 drops of CSF was collected by a lumba puncture from a febrile 25-yeer-old male and was submitted for a stat Gram stain and” culture, The direct specimen Gram stain was reported as many neutrophils and no microorganisms seen. The remaining drop of CSF should be inoculated to: a blood agar b CNAagar < chocolate agar d Thayer-Martin agar Adiabetic foot swab from an 82-year-old woman with recurrent infections is submitted for culture. The Gram stain reveals: many neutrophils, no squamous epithelial cells many Gram-negative bacilli many Gram-positive cocci in chains The physician requests that all pathogens be worked up. In addition to the sheep blood, chocolate and MacConkey agar plates routinely used for wound cultures, the technologist might also process a(n): a anaerobic blood agar plate b BCYE agar plate c CNA agar plate d XLD agar plate Which of the following is the most appropriate specimen source and primary media selection? a CSF Columbia CNA, MacConkey b endocervical chocolate, Martin Lewis G sputum sheep blood, Thayer-Martin, KV-laked blood d urine sheep blood, chocolate, Columbia CNA Which of the following is the most appropriate organism and media combination? a Vibrio species—Skirrow b Enterohemorrhagic E coli—phenylethyl alcohol (PEA) ¢ Campylobacter species—charcoal yeast extract d_ Yersinia enterocolitica—cefsulodin-irgasan-novobiacin (CIN) SP isBn 97080106608 2010/5 P biology Preanalytical & Susceptibility Testing Micr' & 26. 28. 30. uh 32, ‘AGram slain from a swab of a hand wound reveals: moderate neutrophils no squamous epithelial cells moderate Gram-positive cocci in clusters vroderate large Gram-negative bacilli gelect the appropriate media that will selectively isolate each organism. a KV-laked agar, Thayer-Martin b sheep blood, MacConkey ¢ Columbia CNA, chocolate @ Columbia CNA, MacConkey Upon review of a sputum Gram stain, the technician notes that all the neutrophil nuclei in the smear stained dark blue. The best explanation for this finding is the: C a iodine was omitted from the staining procedure b slide was inadequately decolorized with acetone/aicohol ¢ sputum smear was prepared too thin d cellular components have stained as expected Sodium polyanetholsulfonate (SPS) is used as an anticoagulant for blood cultures because it: a inactivates penicillin and cephalosporins b prevents clumping of red cells inactivates neutrophils and components of serum complement d facilitates growth of anaerobes An antimicrobial susceptibility method recommended to detect vancomycin-intermediate ‘Staphylococcus aureus is: a MIC broth dilution b agar dilution ¢ kinetic diffusion ' d disk diffusion When performing a disk diffusion susceptibility test, the antibiotic disks are placed on the agar 30 minutes after organism inoculation and then incubated within 15 minutes of the disk placement. This procedure will result in; a the antibiotic not diffusing into the medium, resulting in no zone b decreased zone diameters ¢ increased zone diameters d no effect on the final zone diameter An Enterobacteriaceae organism will appear to be more resistant on a disk diffusion susceptibility test if the a depth of the agar is too thin b inoculum is too concentrated ¢ the antimicrobial agent in disk is too concentrated d test interpretation occurs after 12 hours of ambient air incubation When performing antimicrobial susceptibility testing on Enterobacteriaceae, first- generation cephalosporins can be adequately represented by: cefuroxime ceftriaxone cefazolin cefonicid aoc ISBN 978-099169-6609 Clinical Laboratory Certification Examinations 359 Preanalytical & Susceptibin < 6: Microbiology ity Testing 33. An antibiotic that inhibits cell wall synthesis is: a chloramphenicol b colistin © penicillin ; sulfamethoxazole - / t require susceptibility testing to the i e of the following organisms does not re sus ti ae atinicvobial inficsted when olated from a clinically significant source? a Staphylococcus aureus clindamycin b Proteus mirabilis gentamicin ¢ Streptocaccus pyogenes penicillin d Escherichia coli levofloxacin 35. Antibiotics routinely tested and reported for Pseudomonas aeruginosa isolates include: a clindamycin b erythromycin © gentamicin d penicillin 38. An organism that must be incubated in a microaerophilic environment for optimal recovery is: a Campylobacter jejuni b Escherichia coli ¢ Pseudomonas aeruginosa Proteus mirabilis 37. Vibrio parahaemolyticus is best isolated from feces on: a eosin methylene blue (EMB) agar b Hektoen enteric (HE) agar ¢ Salmonella Shigella (SS) agar 4 thiosulfate citrate bile salts (TCBS) agar 38, Tests for Haemophilus influenzae beta-lactamase production: @ are not commercially available b include tests that measure a change to an alkaline pH © should be performed on all blood and CSF isolates d are not valid for any other bacterial species 39. Media used to support growth of Legionella pneumophila should contain the additives: a Xand V factors b hemin and vitamin K © charcoal and yeast extract d dextrose and laked blood 40. ‘The best medium for culture of Bordetella pertussis is: a phenylethyl alcohol agar b potassium tellurite blood agar © Regan-Lowe agar d Tinsdale agar 41. Amedium that can be used to re a Bordet-Gengou agar b Buffered charcoal yeast ext a ra © Loeffler agar oe aa d MacConkey agar ‘cover Francisella tularensis is: 360. The Board of Cartitication study Guide Ge ISBN a7e.cs0105-6809 €2018AS7 ie microbiology Preanalytical & S 43. 45. a BS The optimal collection of a wound specimen for culture of anaerobic a swab of lesion obtained before administration of antibiotics b- swab of lesion obtained after administration of antibiotics ¢ syringe filled with pus, obtained before administration of antibiotics syringe filled with pus, obtained after administration of antibioties A 21-year-old patient presents with pharyngitis. A thy icone for anaerobic culture. This specimen should ber est a2 IS SS a setup immediately z b rejected as unacceptable ¢ inoculated into thioglycollate broth d sent to a reference laboratory An antibiotic used to suppress or kill contaminating fungi in media is: a amphotericin B penicillin b chloramphenicol ¢ cycloheximide d streptomycin S\ A sputum specimen is received for culture and Gram stain. The Gra this specimen is seen in the image (total magnification 100): The technologist's best course of action would be to: a inoculate appropriate media and incubate anaerobically b inoculate appropriate media and incubate aerobically © call the physician and notify him of this “life-threatening” si d call the patient care area and request anew specie <~\ Refer to the following illustrat 47.” When using a control strain of Staphylococcus aureus, the technologist notices thay —~<. the zone around the cefoxitin disk is too small. Which of the following is the Most lat explanation? key a inoculation of the plates 10 minutes after preparing the inoculum b incubation of the Mueller-Hinton plates at 35°C c_use of a 0.25 McFarland standard to prepare inoculum d_use of outdated cefoxitin disks 48, In the disk diffusion method of determining antibiotic susceptibility, the size of the inhibi ss zone used to indicate susceptibility has been determined by: ibitio, Sy a testing 30 strains of 1 genus of bacteria b correlating the zone size with minimum inhibitory concentrations ¢ correlating the zone size with minimum bactericidal concentrations d correlating the zone size with the antibiotic content of the disk 49. An organism that may be mistaken for Neisseria gonorrhoeae in Gram-stained smears uterine cervix exudates is: a a Lactobacillus species b Streptococcus agalactiae Pseudomonas aeruginosa d Moraxella osloensis 50. An antimicrobial that is inappropriate to report on an Escherichia coli isolated froma wound culture i: a ampicillin b cefazolin ¢ gentamicin d nitrofurantoin 51. The susceptibility results below are reported on an Enterococcus faecalis isolated from peritoneal fluid. ampicillin: susceptible vancomycit resistant lindamyein: susceptible levofloxacin: resistant linezotid: susceptible The physician calls questioning the results. Which of the following should have been done before the report was released? a the clindamycin result should have been removed from the report since it is inactive against Enterococcus b the ampicillin result should have been changed to resistant since the isolate is vancomycin resistant the linezolid result should have been remov. ince it is inactive against is inactive ag Enterococcus ed from the report since it i d ciprofloxacin should have been added to the report since levofloxacin was resistant 362 The Board of Certification Study Guide €n 2 a oo Preanalytical & Susceptibility Testing cts performed on an isolate of Stephyfococous aude to determine MOUSE AD foe i resistance ind Based on the result seen in the image how should th reported? a erythromycin: resistant; clindamycin: resistant b erythromycin: resistant; clindamycin: susceptible ¢ erythromycin: susceptible; clindamycin: d erythromycin: susceptible; clindamyci erythromycin and clindamycin be spectrum beta-lactamases in E coli is: a ampicillin + cefepime b cefoxitin + penicillin ¢ ceftazidime + clavulanic acid d cefpodoxime + cefotaxime Enzymatic drug modification is a mechanism of resistance for which antimicrobial? a levofloxacin b sulfamethoxazole © vancomycin d gentamicin ‘The most important (bacterial sepsis) is: variable in the recovery of organisms in adult patients with bacteremia 4 ‘subculture of all bottles at day 5 of incubation b the recommended volume of blood cultured « Collection of daily blood culture sets for 3 consecutive days collection of Multiple blood culture sets from a single venipuncture Preanalytical & Susceptibility Tas, ‘Sting g : Microbiology ion and urethral discharge. A Gram stay tain of 56. A 24-year-old man presents with pain on urinati as the discharge is seen in the image: What is the most likely identification of this organism? a Acinetobacter baumannii b Neisseria gonorrhoeae ‘¢ Haemophilus ducreyi d Escherichia coli ‘A 10-year-old child with cystic fibrosis presents with cough and shortness of breath. Her ‘sputum Gram stain is seen in the image: of the organism seen i a MacConkey agar incubated in CO> b Tinsdale agar incubated in ambient air ¢ chocolate agar incubated in CO. d_ CNA agar incubated in ambient air o Mi crobiology Preanalytical & Susceptibility Testing. mage depicts a Gram stain (final magnification 1,000) of a knee fluid from a patient e imesrecently undergone knee replacement surgery: The best interpretation of this Gram stain is: a Gram-positive cocci suggestive of Staphylococcus b Gram-positive bacilli suggestive of Corynebacterium ¢ Gram-positive bacilli suggestive of Listeria 4. Gram-positive cocci suggestive of Streptococcus 3, Avaginal/rectal swab is collected from a pregnant patient to screen for group 8 Streptococcus colonization. The best medium to inoculate the specimen to is: a CNA agar 4 b LIM broth > ¢ sheep blood agar Sy d thioglycollate broth > 60. Susceptibility testing is performed on a Staphylococcus aureus isolate from a blood culture _ with the following results: oxacilin: resistant cefazolin susceptible clindamycin: susceptible erythromycin: susceptible trimeth oprim/sulfamethoxazole: susceptible vancomycin: susceptible What should the technologist do next? @ ceftriaxone should be reported instea b clindamycin should be tested for © the trimethoprim/sulfamethoxazole result should b resistant § ; ig d the cefazolin result should be changed 8. A quality control procedure on a new Staphylococcus aureu: zone sizes measuring t @ Mueller-Hinton b potency of © >acterial suspension \ incubation should | Botan &: Microbiology Preanalytical & Susceptibiy, ~ ty 62. - Te, What organism combination is appropriate to qualily control the lisied Sting te 'g characteristic ? " SS OF oFganisg, a beta-hemalysis: Staphylococcus aureus and Streptococcus pyogenes b catalase: Staphylococcus aureus and Staphylococcus epidermidis ¢ H,S production: Proteus mirabilis and Salmonella sp d indole: Escherichia coli and Proteus mirabilis 63. The antimicrabial ‘susceptibility test for an Escherichia coli isolated fro) ma 45, had the following results: Peritoneal tig “Antibiotic Buscep: resistent ty interpretation susceptible (ist generation) susceptible cefoxitin (2nd generation) susceptible gentamicin susceptible tobramycin susceptible The next best step is t @ report out the antimicrobial susceptibility results without further investigation b verify the results as it is unusual for amikacin to be resistant with gentamicin and tobramycin testing susceptible © verify the results as it is unusual for Escherichia coll to be susceptible to ampicitin verify the results as it is unusual for Escherichia coli to be susceptible to cafazolin 64. The antimicrobial susceptibility test for a Klebsiella pneumoniae isolated from a pleural igs. fluid had the following results: Antibiotic Susceptibility interpretation amikacin susceptible -ampicilin susceptible cefazolin (1st generation) susceptible cefoxitin (2nd generation) susceptible gentarnicin susceptible tobramycin susceptible The next best step is to: @ report out the antimicrobial susceptibility results without further investigation b ~erify the results as it is unusual for Klebsiella pneumoniae to be susceptible to ampicillin © verify the results as it is unusual for Klebsiella pneumoniae to be susceptible to cefazolin d verify the results as it is unusual for Klebsiella pneumoniae to be susceptible to both ampicillin and cefazolin 88. A Klebsiella pneumoniae isolate is known to produce carbapenemase; therefore, it us therapeutically will not respond to the antibiotic: @ amoxicillin, cefazolin and imipenem b colistin and rifampin ¢ sulfamethoxazole and trimethoprim-sulfamethoxazole d tetracycline and doxycycline 66. When processing a patient specimen for Gram stain and culture, the proper use of 2 biological safety cabinet includes: @ bringing into the cabinet all required media and equipment just prior to setting up each individual specimen b keeping the ultraviolet light on for the first 30 minutes of working in the cabinet © not using any heat generating equipment such as open flames or microburner! incinerators not disrupting the air curtain barter by keeping air flow and exhaust grills unobstructed 366 The Board of Certification Study Guide 6e igen avecxosao-sooo “€20/0A577 i Preanalytical & 6 Ne apna) fluid test results that are most cong, Usceptibility Testing cere f iclude: Stent with viral : nin f sed protein level ae a deotased glucose level ineased lactate level a i jononuclear leukocyte count jon Go ;nicrobial susceptibility test for Pi Tre alwing results: tie Susceptibility interpretation - ee susceplible eth susceptible creak (ist generetion) susceptible erat (2nd generation) resistant rotaxime (3°8 generation) susceptible acer susceptible tne next best step is to: icrobial susceptibility regy) i report out the antimicrot Y fesults without further im ic : a the resus as it is unusual for cefoxitin to be resistant with celacin testing susceptible the results as it's unusual for Escherichia coli to be i i el the results as itis unusual for Esch, suscenyrg fo amiciin richia coli to be susceptible to cetaseli jg. Recommended quality control surveillance of commo; nly Used microbiology equipment includes: a incubator: temperature recording on a daily basis b centrifuge: checking revolutions with ¢ refrigerator: temperature recording o d italor: revolutions per minute on a tachometer on a yearly basis Nn a weekly basis monthly basis ih. Awound specimen grew 2 colony types on shee ype on MacConkey agar. Sheep blood agar g colony type #1 swarming over entire plate, Gram st: colony type #2 white colony, Gram stain: Gram-pos P blood agar and a Single, clear colony rowth was documented as: ain: Gram-negative rod sitive cacciin clusters The best way to isolate colony type #2 from Colony type #1 is to subculture: a colony #1 to sheep blood and chocolate agars b colony #1 to sheep blood and/or MacConkey agar © colony #2 to sheep blood and chocolate agars 4 colony #2 to CNA and/or PEA agar 7 Aciferentil mecium that can be Used as a primary isolation agar producing predictable Colored colonies that can be distinguished from other organism colony typee oceakoe 4 buffered charcoal yeast extract agar b blood phenylethyl alcohol agar © campylobacter blood agar @ chromagar 2. Anicoagulents acceptable for use with blood, bone marrow and synovial fluid specimens that are to be cultured include: @ EDTA and sodium citrate heparin and sodium citrate § Sodium polyanethol sulfonate (SPS) and heparin, Sodium polyanethol sulfonate (SPS) and EDTA S2BASEP sph oy a 7 783169-6609 Clinical Laboratory Certification Examinations 36) 6: Microbiology 73. ampicillin, cefazolin and imipenem; and inhibition of cell wall synthesis, ampicillin, cefazolin and imipenem; and inhibition of DNA replication ciproftoxacin, levofloxacin and azireonam:; and inhibition of cell wall synthesig ciprofloxacin, levofloxacin and aztreonam: and inhibition of DNA replication aoge Aerobic Gram-Positive Cocci 74. 75. 77. 78, 368 The Board of Certification Study Gu The colony count from a suprapubic urine culture growing 10 colonies of Staphyigcg, Saprophyticus is: ecus a OCFU/mL b 100 CFU/mL « 1,000 CFU/mL d 100,000 CFU/mL Three sets of blood cultures were obtained from an adult patient with fever and suspects endocarditis. The aerobic battle of one set had growth of Staphylocaccus epidermidis a days of incubation. This indicates that: a there was low-grade bacteremia b the organism is most likely a contaminant ‘¢ the patient has a line infection d the blood culture bottles are defective A pregnant patient is screened at 36 weeks’ gestation for group B Streptococcus (GBS), A vaginal swab is collected and cultured in Todd-Hewitt broth with 8 ig gentamicin/mL and 48 ug nalidixic acid/mL. The broth is subcultured onto sheep blood agar after 24 hours of incubation. No GBS are seen on the subculture and the results are reported as negative. The patient later goes on to deliver an infant with early onset GBS disease. Whatis the most likely reason for the negative GBS culture? a the patient was screened too early since screening after 38 weeks is recommended b a vaginal swab was collected instead of a vaginal/rectal swab the Todd-Hewitt broth used was inhibitory to the organism d the selective broth was incubated only 24 hours before subculture Aurine isolate Gram stain shows Gram-positive cocci in clusters. The organism tested catalase positive. To identify this organism from culture, the technician should perform a coagulase test and a/an: a polymyxin B susceptibility b novobiocin susceptibility © oxidase d beta-lactamase The Gram stain from a blood culture shows Gram-positive cocci in chains. The q subcultured plates from the blood culture bottie show no growth Additional testing shou! be done to detect the presence of; a Staphylococcus saprophyticus b Aerococcus urinae © Abiotrophia defectiva d Streptococcus pneumoniaa Asc 8 ison 976-009 80-8809 90" d 6; Microbiology 2. 80. 81. 82. 83. 84. 85. 86. Aerobic Gram-Positive Cocci Viridans streptococci can be differentiated from Streptococcus pneumoniae by: a alpha hemolysis b colony morphology c catalase reaction result d bile solubility A reliable test for distinguishing Staphylococcus aureus from other staphylococci is: a oxidase b coagulase ¢ catalase d optochin susceptibility The optochin disk is used for the identification of; a Haemophilus influenzae b group A beta-hemolytic streptococci ¢ Streptococcus pneumoniae d Enterococcus In the bacitracin ‘Susceptibility test, if there is a Zone of inhibiti is following overnight incubation at 37°C, the colony most likely concer oe ek most likely consists of: a Staphylococcus aureus b Group A Streptococcus c Streptococcus pneumoniae d Group B Streptococcus Which 2 diseases are usually preceded by infection with beta-hemolytic streptococci? a rheumatic fever, undulant fever b glomerulonephritis, rneumatic fever ¢ theumatic fever, tularemia d_glomerulonephritis, undulant fever The enterotoxin produced by certain strains of hemolytic, coagulase positive Staphylococcus aureus: a is the primary cause of subacute endocarditis b creates a biofilm on indwelling catheters © causes a rapidly occurring (2-6 hours after ingestion) food poisoning d is of extremely low virulence Agamma-hemolytic Streptococcus that blackens bile esculin agar but does not grow in 6.5% NaCl broth is most likely: a group B Streptococcus b Enterococcus © group D Streptococcus (Streptococcus bovis group} @ Streptococcus pneumoniae Gram stain examination from a blood culture bottle shows dark blue, spherical organisms in clusters. Growth on sheep blood agar shows small, round, pale yellow colonies. Further tests should include: a catalase production and agglutination test for Protein A b bacitracin susceptibility and latex grouping ¢ oxidase and indole reactions d Voges-Proskauer and methyl red reactions MAOIBASC ISBN 978.089189-8609 Clinical Laboratory Certification Examinations 369 6: Microbiology Aerobic Gram-Positive Cocg; I Bcc 87, Gram-positive cocci in chains are seen on a Gram stain from a blood culture. The organism grows as a beta-hemolytic colony. Further tests that could be performed inclugg: a PYR, bacitracin, and hippurate b catalase and agglutination test for Protein A © oxidase and mass spectrometry dd Voges-Proskauer and methyl red 88. “Nutritionally variant” streptococci are: a enterococci b group D enterococci beta hemolytic streptococci d in the genera Granulicatella and Abiotrophia 89. After 24 hours a blood culture from a newborn grows catalase-negative, Gram-positive cocci. The bacterial colonies are small, translucent and beta-hemolytic on a blood agar plate. Biochemical test results of a pure culture are; bacitracin: resistant CAMP reaction: positive bile esculin: not hydrolyzed 65% NaCl broth; na growth Assuming that all controls react properly and reactions are verified, the next step would be to: a perfarm a Streptococcus group typing b report the organism as Streptococcus pneumoniae ¢ report the organism as Staphylococcus aureus d report the organism as Staphylococcus epidermidis 90. Anonhemolytic streptococcus that has been isolated from an ear culture grows up to the edge of a 0.04 unit bacitracin disk. Which of the following tests would help to determine if the organism is Enterococcus? a hydrolysis of PYR b growth in the presence of penicillin © optochin susceptibility d fermentation of mannitol 1. The organism mast commonly associated with neonatal purulent meningitis is: a Neisseria meningitidis b Streptococcus pneumoniae © group B streptococci d_ Haemophilus infiuenzae 92. A common cause of acute exudative pharyngitis is: a Staphylococcus aureus (beta-hemolytic} b Streptococcus pneumoniae © Streptococcus agalactiae d_ Streptococcus pyogenes 93. The most frequent cause of prosthetic heart valve infections occurring within 2-3 months after surgery is: a Streptococcus pneumoniae b Streptococcus pyogenes ¢ Staphylococcus aurer Staphylococcus epidermidis 370 The Boars ™ 1sen 978-089189-6609 onl i Acatheterized urine is inoculated onto blood and MacConkey agar using a 0.01 nee ‘ier 24 hours, 68 colonies of a small translucent nonhemolytic organism grew on bloo 4 ar but not MacConkey. Testing reveals small Gram-positive, catalase-negative cocci. 382 aliminary report and follow up testing would be: P i obic Gram-Positive Cocci Mi crobiology Aerobi a4. growth of 680 CFU/mL of Gram-positive cocci, optochin and bacitracin susceptibility tests to follow _ b growth of 6,800 CFU/mL of a Staphylococcus species, latex agglutination test to follow ¢ growth of 6,800 CFU/ml of a Streptococcus species, esculin hydrolysis and 6.5% NaCl rowth test to follow ¢ growth of 6,800 CFU/mL of a Streptococcus species, no further testing gg. Children who have infections with beta-hemolytic streptococci can develop: a acute pyelonephritis b acute glomerulonephritis ¢ chronic glomerulonephritis d_-nephrosis 96, A Gram-positive coccus isolated from a blood culture has the following characteristi optochin suscepti y: negative bacitracin (0.04 U) susceptibility: negative bile esculin hydrolysis: negative hippurate hydrolysis positive catalase: negative This organism is most likely: a Staphylococcus aureus b Streptococcus pneumoniae Streptococcus pyogenes d Streptococcus agalactiae $7, Abeta-hemolytic streptococci that is bacitracin-sensitive and CAMP-negalive is: a group B b group A ¢ beta-hemoyltic, not group A, B, or D d group D 98. Abeta-hemolytic Streptococcus that is bacitracin-resistant and CAMP-positive is: a group Aor B b group A ¢ group B d group D 38. Group B, beta-hemolytic streptococci may be distinguished from other hemolytic streptococci by which of the following procedures? a latex antigen grouping b growth in 6.5% NaCl broth © growth on bile esculin medium bacitracin susceptibility 100. Itis important to differentiate between Enterococcus and group D streptococci because: @ viridans streptococci are often confused with enterococci several enterococci cause severe puerperal sepsis group D streptococci are avirulent énterococci often show more antibiotic resistance than group D streptococci b © a S288 ASCP SoM a7e.c89te9-8809 ‘Clinical Laboratory Certification Examinations 371 robiology Aerobic G. 101. Streptococcus pneumoniae can be differentiated best from the reptococci b: a Gram stain b the type of hemoly: © colonial morphology d bile solubility 102, Characteristically, enterococci are: a unable to grow in 6.5% NaCl b relatively resistant to penicillin & sodium hippurate positive 4 bile esculin negative Which of the following would best differentiate Streptococcus agalactiae from Streptococcus pyogenes ? a ability to grow in sodium azide broth b a positive bile-esculin reaction ¢ hydrolysis of sodium hippurate d_bela-hemolysis on sheep blood agar Which of the following organisms is, to date, considered universally susceptible to day 103. 104, penicillin: a Haemophilus influenzae b Neisseria gonorrhoeae ¢ Streplococcus pyogenes d Corynebacterium diphtheriae 105. A beta-hemolytic Gram-positive coccus was isolated from the cerebrospinal fluid of a 2-day-old infant with signs of meningitis. The isolate grew on sheep bload agar under aerobic conditions and was resistant to a bacitracin disc, Which of the fallowing should be Performed for the identification of the organism? a oxidase production b catalase formation ¢ latex antigen grouping d_esculin hydrolysis 106. During the previous month, Staphylococcuis epidermidis has been isolated from blood cultures al 2-3 times the rate from the previous year. The most logical explanation for the increase in these isolates is that: 2 the blood culture media are contaminated with this organism b the hospital ventilation system is contaminated with Staphylococcus epidermidis ¢ there has been a break in proper skin preparation before drawing blood for culture d a relatively virulent isolate is being spread from patient to patient 107. ne le colony from a wound culture tested Catalase-positive and coagulase-negative. Ud cil eneained 8s Gram-positive cocci in clusters. Which of the following tests would differentiate between a coagulase-negative Staphylococcus and Micrococcus? @ novobiocin susceptibility b teucine aminopeptidase (LAP) production © furazolidone (100 jig/disk) susceptibilits d_ hydrolysis of bile ‘seaulin ” oy 372. The Board of Certification ‘Study Guide Ge ISBN 978-089189-6609 @2018ASCP 408. 109. 110. Mt. 112, icrobiology Aerobic Gram-Positive Cocel and coagulase negative. The organism Gram staine: organism was modified oxidase positive, bacitraci iysostaphin. What is the identification of this orga a Staphylococcus aureus b Micrococcus luteus ¢ Slaphylocaccus epidermidis d Peptostreptococcus anaerobius in (0.04U) susceptible and resistant to nism? a hippurate hydrolysis and S agalactiae b CAMP test and S pyogenes c hippurate hydrolysis and S pyogenes d CAMP test and S agalactiae Which of the following may be used as a positive quality control organism for the bile esculin test? a Staphylococcus epidermidis b Staphylococcus aureus © Streptococcus pyogenes d Enterococcus faecalis Which test is used to differentiate viridans streptococci from Streptococcus pneumoniae? a CAMP test b bacitracin disk test ¢ hippurate hydrolysis test d_ optochin test Agray, nonhemolytic, catalase-negative colony grows on a GNA plate. The following biochemical results are obtained: 65% NaCl negative bile escutin positive PYR negative bacitracin resistant hippurate hydrolysis negative CAMP Test negative The most likely identification is; a Enterococcus faecalis b Streptococcus bovis © Streptococcus viridans 4 Streptococcus pneumonia 89089-6609 Clinical Laboratory Certification Examinations 373 6: Microbiology 113. 114, 115. ns oy 416. ys74 ASIORIG CRTERERitive o4, cei load cultures that grow Gram-positive cocci after ba, : zing leg wound past operation. The infected area ie fed, Swollen, and warm fo the touch. A red line has appeared at the sight of the wound ang beginning to travel up the patient's leg. Biochemicals performed from the beta hemolytic. colonies on the sheep blood agar plate revealed the following: A 56-year-old male has 2 sets of bi admitted to the hospital with an oo: CAMP test negative hippurate hydrolysis negative PYR positive bacitracin sensitive 65% Nac! no growth bile esculin negative The most likely identification is: a Streptococcus pyogenes b Streptococcus agalactiae ¢ Staphylococcus aureus d Enterococcus faecalis: A 55-year-old man presents fo the emergency room with chest pain and is found to have suifered a heart attack, He has a past history of hypertension, and high cholesterol. The le bypass procedure. During recovery, he patient is admitted and scheduled for a trip r Ca emes seplic, developing a high grade fever and pneumonia. Gram-positive cocci ao eere. isolated from both his lungs via an induced sputum specimen and the surgical incision, produce beta-hemolytic, catalase-positive colonies on sheep blood agar. likely isolated and the biochemical test performed to confirm Identify the organism most the identification. a Staphylococcus aureus and latex agglutination b Streptococcus pyogenes and PYR ¢ Streptococcus agalactiae and latex agglutination d. Enterococcus faecium and PYR ‘Ayoung boy who routinely bites is finger nails develops a wound on his right pointer finger. ‘A culture reveals alpha hemolytic, dry colonies on the blood and CNA plates that are catalase negative, resistant to optochin, and 6.5% NaCl negative. Gram stain of the colony is Gram-positive cocci in chains. The organism most likely isolated is: a Enterococcus faecium b Enterococcus faecalis Streptococcus viridans d_ Streptococcus agalactiae ‘A patient with a prosthetic heart valve visits the dentist for her yearly checkup. Two weeks and shortness of later, she presents to her primary care physician with a high fever, chills, breath and receives a diagnosis of subacute endocarditis, Multiple blood culture sets are drawn on the patient and sent to the lab. Twenty-four hours later the bottles are positive oC bacterial growth. Which organism would you expect to grow? a Staphylococcus lugdenensis b Staphylococcus saprophyticus ¢ Streptococcus viridans d Streptococcus agalactiae The Board of Certification Study Guide 6e ison sre-cenrsa.soa 0701 8ASS f ' Gram-Negative Bacilli year-old is admitted to the ER with seve inusiti ki ay A lS year ere sinusitis. Aspiration specimens from the o nasal passage reveal a pure culture of alpha-hemolytic, depressed center colonies with ™ ag distinctive mucoid appearance on a blood agar plate. Gram stains of the colonies are shown below: Which of the following could aid in the identification of the organism recovered? a bile solubility, optochin sensitivity b hippurate hydrolysis, bile esculin ¢ bacitracin sensitivity, Lancefield grouping d PYR positive, catalase negative 118, A6-year-old male presents to his pediatrician with a severe case of tonsillitis. The us, physician collects a throat swab specimen and orders a GAS (Group A Streptococcus) probe test. The fallowing day the probe comes back negative. A culture is requested. The following results are obtained: catalase negative bacitracin disk sensitive hippurate hydrolysis negative CAMP test negative PYR negative Gram stain Gram-positive cocci in chains Which of the following organisms is most likely causing the tonsillitis? a group A beta-hemolytic streptococci b group B beta-hemolytic streptococci € group C beta-hemolytic streptococci d group D beta-hemolytic streptococci Gram-Negative Bacilli 11%. Aclean catch urine culture (obtained with a 0.01 mL calibrated loop) grows 60 colonies Escherichia coli. Which of the following represents the final colony count in CFI a 60 CFU/mL b 600 CFU/mL. Uimt: SFU/mL Yer 08-6600 . Gram-Negatiy, 6: Microbiology ly 420. When performing a stool culture, a colony type typical of an enteric pathogen ig subcultured on a bload agar plate. The resulting pure culture is screened with se, to obtain the following results: Veral tags acid butt, alkaline slant, no gas, no HzS TSI phenylalanine deaminase: negative motility: positive serological typing: Shigella flexneri (Shigella subgroup B) The serological typing is verified with new kit and controls. The best course of acti, would be to: in a report the organism as Shigella flexneri without further testing b verify reacti ‘of motility medium with positive and negative controls © verify reactivity of the TSI slants with positive and negative controls for HS product 4. verify reactivity of phenylalanine deaminase with positive and negative controls” When performing a Kovac indole test, the substrate must contain: 121, a indole b tryptophan ¢ ornithine d_ paradimethylaminobenzaldehyde The ONPG test allows organisms to be classified as a lactose fermenter by testing for which of the following? a permease b beta-galactosidase c beta-lactamase d_ phosphatase The most rapid method for detection of Francisella tularensis is: 122, 123. Sit a serological slide agglutination utilizing specific antiserum b dye stained clinical specimens c fluorescent antibody staining techniques on clinical specimens polymerase chain reaction 424. Infection of the urinary tract is most frequently associated with: a Staphylococcus aureus b Escherichia cofi © Enterococcus faecalis d Serratia marcescens 425. MacConkey media for screening suspected cases of hemorrhagic E coli 0157:H7 must contain: a indole b citrate c sorbitol d lactose 426. Members of the family Enterobacteriaceae share which one of the following characteristics? @ praduce cytochrome oxidase b ferment lactose © produce beta-hemolysis d reduce nitrate to nitrite isan o7s-oere9-1008 131. 132. g; Microbiology Gram-Negative Bacilll Which one of the following genera is amon the Enterobacteriaceae? a Proteus b Pseudomonas ¢ Gitrobacter d Shigella 428. Which one of the following Gram- rem ig the least biochemically reactive members of negative bacilli ferments glucose? a Alcaligenes faecalis b Burkholderia cepacia ¢ Acinetobacter Iwoffii Yersinia enterocolitica 499 Asputum culture from an alcoholic seen in th: sheep blood agar, The isolate grows readily 1e ER grows gray, mucoid, stringy colonies on pink colonies. The colonies yield the followi on MacConkey agar and forms mucoid, dark ing test results: ONPG: + indole: - glucose: + oxidase: = citrate: + ve: The organism is most likely: a Edwardsiella tarda b Klebsiella pneumoniae ¢ Escherichia coli d Proteus vulgaris 130. An organism was inoculated to a TSI tube and gave the following reactions: alkaline slantfacid bult, HS, gas produced This organism most likely is: a Klebsiella pneumoniae b Shigella dysenteriae ¢ Salmonella typhimurium Escherichia coli An isolate from a stool culture gives the following growth characteristics and biochemical reactions: MacConkey agar: colorless colonies Hektoen agar: yellow-orange colonies: TSI: acid slant/acid butt, no gas, no H2S urea: positive These screening reactions are consistent with which of the following enteric pathogens? a Yersinia enterocolitica b Shigella sonnei © Vibrio parahaemolyticus d Campylobacter jejuni ATSI tube inoculated with an organism gave the following reactions: alkaline stant, acid butt; no H2S, no gas produced This organism is most likely: a Yersinia enterocolitica b Salmonella typhi © Salmonella enteritidis Shella dysenteriae Crane a: 978-0691 89.6609 Clinical Laboratory Certification Examinations 377 : Microbiology Sram.Neg, 133. An organism gave the following reactions: tiga, acid slant, acid butt; no H2S gas produced positive motility: positive citrate negative lysine decarboxylase: positive urea: negative vp: negative This organism most likely is: a Klebsiella pneumoniae b Shigella dysenteriae ¢ Escherichia coli d Enterobacteria cloacae Which of the following erganisms can grow in the small bowel and cause diane, children, traveler's diarrhea, or a severe cholera-like syndrome through tha preg ction a enterotoxins? a Yersinia enterocolitica b Escherichia coli © Salmonella typhi d_ Shigella dysenteriae 135, Shigella species characteristically are: a urease po b nonmotile c oxidase positive d lactose fermenters A Gram-negative bacillus has been isolated from feces, and the confirmed biochemical reactions fit those of Shigella. The organism does not agglutinate in Shigella antisera. What should be done next? a test the organism with a new lot of antisera b test with Vi antigen ¢ repeat the biochemical tests d boil the organism and retest with the antisera 137, Biochemical reactions of an organism are consistent with Shigel/a. A suspension is tested in antiserum without resulting agglutination. However, after 15 minutes of boiling. agglutination occurs in group-D antisera. The Shigella species is: 134, 136. a dysenteriae b flexneri © boydif d sonnei re 138. 100,000 CFU/mL of a Gram-negative bacilli were isolated on MacConkey from au" specimen. Biochemical results are as follows: glucose: acid, gas produced indole: negative urea Positive TDA’ positive HS: positive The organism is most likely: a Morganella morgenii b Proteus mirabilis © Proteus vulgaris d Providencia stuartii 16-6609 378 The Board of Certification Study Guide 62 isan 978-069 Gram-Negative Bacil microbiology 6 culture had the following culture results: 153 © gneep blood swarming srimbia CNA: ao growth Macconkey= >100,000 CFU/mL nonlactose-fermenter >100,000 GFU/mL nonlaclose-fermenter with red pigment The isolates from MacConkey agar had the following biochemical reactions: test isolate 1 Isolate 2 ‘sl ak/acid alk/acid positive negative be positive negative HS positive negative the organisms are most likely: a Proteus vulgaris and Enterobacter cloacae £ Proteus mirabilis and Serratia marcescens P Morganella morganii and Klebsiella pneumoniae § Providencia stuartii and Serratia liquefaciens 440. AN g-year-old girl was admitted to the hospital with a 3-day history of fever, abdominal 40. ®¢.q, diarrhea, and vomiting. A stool culture grew many lactose-negative colonies that & Fielded the following test results: oxidase: negative Tsk acid slant/acid butt indole: negative urease: positive ornithine decarboxylase: positive sucrose positive ( H2S' negative motility at 25°C: positive The most probable identification of this organism is: a Escherichia coli b Providencia stuartit c Yersinia enterocolitica d Edwardsiella tarda 11. Afecal specimen, inoculated to xylose lysine deoxycholate (XLD) and Hektoen enteric 4s, (HE) produced colonies with black centers. Additional testing results are as follows: Biochemical screen Result Serological test Result Glucose fermentation _positive polyvalent no agglutination HS positive group A no agglutination lysine decarboxylase _ positive group By no agglutination urea negative ‘group © no agglutination ONPG negative group D no agglutination indole positive group Vi no agglutination The most probable identification is: a Salmonella enterica b Edwardsiella tarda © Proteus mirabilis d Shigella sonnei eoieRSce ispNe7e-gg91E9-6808 Cuinical Laboratory Certification Examinations 379 EE —————————E_ Gram-Negative Baciy 6: Microbiology ith lower right quadrant pai, 142. A 10-year-old boy was admitted to the emergency room Wt ain ang a tenderness which, mimicked appendicitis. The following laboratory resulls were obtained, Patient value Normal range 16-60% % segmented neutrophils 75% WBC count. 200 x 10% (200 « 10%) 13.0 * 10°%L (13.0 x 40%) it i i i the appendix appeared normal; The admitting diagnosis was appendicitis. During surgery p mals an enlarged Osdeewas removed and cullured, Small Gram-negative bacilli were isolated from the room temperature plate. The organism most likely a Prevotella melaninogenica b Shigella sonnei ¢ Listeria monocytogenes d Yersinia enterocolitica 143. A 25-year-old man who had recently worked as a steward on a transoceanic grain ship presented to the emergency room with high fever, diarrhea and prostration. Axillary lymph fodes were hemorrhagic and enlarged. A Wright-Giemsa stain of the aspirate showed bacilli that were bipolar, resembling safety pins. The most likely identification of this organism is: a Brucella melitensis b Streptobacillus moniliformis © Spirillum minus d Yersinia pestis 144. Biochemical reactions of an organism are consistent with Salmonella. A suspension is 45" tested in polyvalent antiserum A through G and Vi antiserum. There is agglutination in the Vi antiserum only. What should be done next? @ boil suspension of the organism for 10 minutes to inactivate the Vi antigen b test organism with individual antisera for agglutination ¢ report “no Safmonelia isolated” d repeat biochemical identification of the organism 145, Aclean catch urine sample from a nursing home patient is cultured using a 0.001 mL loop. It grows 67 colonies of a lactose fermenter that has the following biochemical reactions: Tsk: acid/acid oxidase: negative motility: Positive Indole: negative citrate: positive vp: positive lysine decarboxylase: negative omithine decarboxylase: positive urea: negative What should the microbiologist report? a 670 CFU/mL Serratia marsecens b 6,700 CFU/mL Providencia stuartii 67,000 CFU/mL Enterobacter cloacae d_ 67,000 CFU/mL Klebsiella oxytoca 146. Plesiomonas shigelloides is a member of the famil .cter that differentiates Pleisiomonas from other Enlorobecteiene ores Ts ohare istic a positive oxidase b glucose fermentation c reduction of nitrates to nitrites d_ growth on MacConkey agar 380 The Board of Certification Study Guide Be seansrecostenccon a0i8hs? 6: Micro biology Gram-Negative Bacilli 7, Abiood culture from a 64-year-old male with lymphoma was posilive blood culture at 4" hours incubation. The organism is a nonlactose fermenting Gram-negative bacillus on tS MacConkey agar. Further testing gives the following reactions: oxidase: negative TSI alkaline/acid, no hydrogen sulfide motility: Positive indole positive citrate: positive omithine decarboxylase: negative urea: positive phenylalanine deaminase: positive vp: negative The genus is: a Morganella b Proteus ¢ Providencia d Serratia 148, The stock cultures needed for quality control testing of motility are: a Salmonella typhimurium—Escherichia coli b Escherichia coli—Pseudomonas aeruginosa c Serratia marcescens—Escherichia coli d Klebsiella pneurnoniae—Escherichia cofi 149, The stock cultures needed for quality control testing of oxidase production ar a Escherichia coli—Klebsiella pneumoniae b Salmonella typhimurium—Escherichia coli c Escherichia coli—Pseudomonas aeruginosa d Proteus mirabilis—Escherichia coli 150, The stock cultures needed for quality control testing of deamination activity are: a Escherichia coli—Klebsiella pneumoniae b Salmonella typhimurium—Escherichia coli ¢ Escherichia coli—Pseudomonas aeruginosa d Proteus mirabilis—Escherichia coli 151, The stock cultures needed for production are: a Salmonella typhimurium—Escherichia coli b Escherichia coli—Pseudomonas aeruginosa ¢ Proteus mirabilis—Escherichia coli d Serratia marcescens—Escherichia coli quality control testing of deoxyribonuclease (DNase) 182. Quality control of the spot indole test requires the use of ATCC cultures of: a Pseudomonas aeruginosa—Proteus mirabilis b Salmonella typhi—Shigella sonnei © Escherichia coli—Proteus vulgaris @ Escherichia coli—Enterobacter cloacae 153. An organism that exhibits the satellite phenomenon around colonies of Staphylococcus aureus is: a Haemophilus influenzae b Neisseria meningitidis © Neisseria gonorrhoeae d Klebsiella pneumoniae S20BASCP (Sun 978-080189-6609 Clinical Laboratory Certification Examinations 381 6: Microbiology Gram-Negative ec ce of a skin burn is found to produce a diffusibia grac> iS 154. An organism isolated from the surfa pigment on a blood agar plate. Further studies of the organism would most likely show 4" e organism to be: a Staphylococcus aureus: b Serratia marcescens ¢ Flavobacterium meningosepticum d_ Pseudomonas aeruginosa 455. Anonfermenting Gram-negative bacillus i are strongly positive. The growth on Mueller- organism is: a Burkholderia cepacia | b Moraxella lacunata ¢ Chryseobacterium (Flavobacterivm) meningoseplicum d Pseudomonas aeruginosa ‘sj | 456. Asmall, pleomorphic Gram-negative bacillus is isolated from an eye culture. It grows on} on chocolate agar and is oxidase-variable. The most likely organism is: y a Acinetobacter Iwoffii b Haemophilus influenzae ¢ Slenotrophomonas matiophilia d Pseudomonas aeruginosa 457. Ablood culture bottle with macroscopic signs of growth is Gram stained and the technician totes small, curved Gram-negative bacilli resembling “gull wings.” It is subcultured to Bieod and chocolate agar, and incubated aerobically and anaerobically. After 24 hours, no growth is apparent. The next step should be to: a subculture the bottle, and incubate in microaerophilic conditions bb assume the organism is nonviable, and ask for repeat specimen ¢ utilize the oxidase and indole test to detect Aeromonas d subculture the bottle to a medium containing X and V factors 158, The optimal incubator temperature for isolation of the Campylobacter jejunil coli group is: isolated from @ wound, The nitrate and o} Hinton agar produces pyoverdin, The "735° oe aac b 20°C © 25°C d 42°C 159. A patient with a nosocomial pneumonia has a sputum Gram stain that shows many 8, neutrophils and numerous small Gram-negative coccobacilli. The organism grew in 24 hours as a mucoid, hemolytic colony on blood agar and a colorless colony on & MacConkey agar. The organism had the following characteristics: oxidase: negative catalase: positive: nitrate: negative ONPG: negative ornithine decarboxylase: negative lysine decarboxylase: negative The organism is: a Stenotrophomonas maltophitia b Alcaligenes faecalis © Moraxella lacunata d Acinetobacter baumannii 382 The Board of Certification Study Guide 6e ISBN 978-089189-0609 en01a ASC? g; Microbiology Gram-Negative Bacilli jo. Agastroenterologist submits a gastric biopsy from a patient with a peptic ulcer. To obtain presumptive evidence of Helicobacter pylori, a portion of the specimen should be added to which media? a urea broth b tetrathionate ¢ selenite d tryptophan 461. Acinetobacter Iwoffii differs from Neisseria gonorrhoeae in that Acinefobacter. ‘ky a exhibits a Gram-negative staining reaction b will grow on MacConkey and EMB media ¢ is oxidase-positive d produces hydrogen sulfide on a TSI slant 162. A4-year-old is admitted with symptoms of meningitis, and a Gram stain of the 43, cerebrospinal fluid reveals small, pleomorphic, Gram-negative coecobacill. After 24 hours incubation at 35°C, small, moist, gray colonies, which are oxidase variable, are found on the chocolate agar plate only. Which af the following biochemical data would be consistent with this isolate? a CTAdextrose: Positive CTA maltose: Positive ONPG: negative b sodium hippurate hydrolysis: positive Adisc: negative CAMP test: Positive ¢ Xfactor: no growth V factor: no growth XV factor: growth horse blood: no hemolysis d catalase: esculin hydrolysis: methyl red: positive “umbrella” motility at room temperature 163. A Gram stain of a touch prep from a gastric biopsy shows Gram-negative bacilli that are slender and curved. The most likely pathogen a Burkholderia cepacia b Corynebacterium urealyticum © Helicobacter pylori d Pasteurella multocida 164. A characteristic that is helpful in separating Pseudomonas aeruginosa from other members of the Pseudomonas family is: a a positive test for cytochrome oxidase b oxidative metabolism in the OF test © production of fluorescein pigment d growth at 42°C Avery bloody stool is received by the laboratory. The following day a pathogenic strain of E coliis isolated. Which sugar should this isolate be tested against to begin the identification process? 165. a mannitol b sorbitol & lactose d arabinose “SCP ISBN 978-089189-6609 Clinica? Laboratory Certification Examinations 3 8: Microbiology Gram-Nogative Baciy, covery 166. Which on. : 2 of — the following results is typical of Campylobacter jejuni: @ optimal growth at 42°C b oxidase negative © catalase negative d nonmotile 167. Optimum growth of Campylobacter jejuni is obtained on suitable media incubated at 42, in an atmosphere containing: a a 6% Oz, 10-15% COz, 85-90% nitrogen b 10% Hz, 5% COz, 85% nitrogen © 10% Hz, 10% CO2, 80% nitrogen d 25% Oz, 5% COz, 70% nitrogen 168. The porphyrin test was devised to detect strains of Haemophilus capable of ei” a ampicillin degradation b capsule production © hemin synthesis d chloramphenicol resistance 469. Haemophilus influenzae is mast likely considered normal indigenous flora in the: a oropharynx b female genital tract ¢ large intestine d_ small intestine 470. Haemophilus influenzae becomes resistant to ampicillin when the organism produces : a _acapsule of polysaccharide material b NAD ¢ porphobilinogen d the beta-lactamase enzyme 171. Anisolate on chocolate agar from a patient with epiglottitis was suggestive of ‘Haemophilus species. Additional testing showed that the isolate required NAD for growth and was nonhernolytic. The organism is most likely Haemophilus: a haemolyticus b ducreyi ¢ influenzae d parainfluenzae 172, Which of the following specimens is considered to be the most sensitive for the re of Brucella in cases of chronic infection? a blood b urine ¢ bone marrow lymph node 108 384 The Board of Certification Study Gulde 6 gon o7e.cears30s02 ©" d 6 Microbiology Gram-Negative Bacilli ~ Agenus that is found in soil and water and causes infections in Imm 173. tients has the following characteristics: lunocompromised oS "sheep blood agar: violet pigment MacConkey agar: growth 42°C incubation: growth oxidase: Positive OF glucose: fermenter indole: negative The genus is: a Campylobacter b Chromobacterium ¢ Aeromonas d Serratia 174. Which one of the following results is typical of Campylobacter fetus su bspecies fetus? & a optimal growth at 42°C b oxidase negative ¢ growth at 35-37°C d catalase negative 415, AGram-negative bacillus with bi n ipolar staining was isol: ws bya bite from a pat cat. The foll st reaione I M a wound infection caused % lowing characteristic reactions on were seen; oxidase: positive glucose OF: fermentative motility: negative MacConkey agar: no growth Which of the following is the most likely organism? a Pseudomonas aeruginosa b Pasteurella multocida © Aeromonas hydrophila d Vibrio cholerae 116. A3-year-old unimmunized female presented in the ER with a severe cough, fever, and i, flulike symptoms. The parents reported that the child had vomited a few times due to the severe coughing. A nasopharyngeal swab was used to collect the specimen and planted on a chocolate, Bordet-Gengou, and Regan Lowe media. After 5 days of incubation, colonies grew on all of the media with the growth on Bordet-Gengou described as “drops ‘of mercury.” The Gram stain showed minute coccobacilli that were catalase and oxidase positive. The most likely identification of this isolate is: a Bordetella parapertussis b Yersinia pestis © Francisella tularensis d Bordetella pertussis 177. While swimming in a lake near his home, a young boy cut his foot, and an infection developed. The culture grew a nonfastidious Gram-negative, oxidase positive, beta- hemolytic, motile bacilli that produced deoxyribonuclease (DNAse). The most likely identification a Enterobacter cloacae Db Serratia marcescens © Aeromonas hydrophila d Escherichia coli 2018 As. 58 978.089189-6609 Glinical Laboratory Certification Examinations 385 6: Mi i icrobiology Gram-Negative Bagiy, 178, Serum samples collected from a patient with pneumonia demonstrate a rising antibog iter to Legionella. A bronchoalveolar lavage (BAL) specimen from this patient had a z Positive antigen test for Legionella but no organisms were recovered on buffered charepa, yeast extract medium after 2 days of incubation. The best explanation is that the; @ antibody titer represents an earlier infection b positive antigen test is a false-positive © specimen was cultured on the wrong media d culture was not incubated long enough 478. Which characteristic best differentiates Acinetobacter species from Moraxella species? @ production of oxidase b growth on MacConkey agar c motility d_ susceptibility to penicillin 480, An organism has been identified as a member of the fluorescent group of Pseudomonas, Which of the following sets of tests should be used to determing the species of the organism? a growth at 42°C, pyocyanin production, gelatinase production b pyocyanin production, gelatinase production, OF glucose ¢ growth at 37°C, pyocyanin production, OF glucose @ gelatinase production, growth at 62°C, H2S 481, Appropriate culture requirements for a specimen trom a patient suspected of having tularemia include: a a media with cysteine such as buffered charcoal yeast extract agar b colistin nalidixic acid agar ¢ Mueller-Hinton agar with 5% sheep blood agar d Regan-Lowe media 482. A child was bitten on the arm by her sibling and the resulting wound grew a slender Gram- us negative bacilli that has the following characteristics: growth on SBA: colonies that ‘pit” the agar colonies odor: ‘ike bleach catalase: negative oxidase: positive Ts! no growth The identification of this organism is: a Moraxella catarrhalis: b Eikenella corrodens ¢ Kingeila kingae Legionella pneumophila 183. Characteristics of the genus Capnocytophaga include: as “ont all &% a_grows in ambient air b colonies are large and spreading after 2-4 days © considered “nonfermenter” d Gram-positive bacillus 386 Tho Board of Certification Study Guide 6 isan srenecree.geco <2019 AS? = Gram-Negative Bacilli microbiology ers and other shellfish were ‘udent allended a beach parly where raw oysl e jee Aeegeg The next day, he had symptoms of septicemia. The blood cultures grew Grar cons tife basil with the following characteristics: on eidase: positive jacConkey agar: pink colonies F129 (150 #9) ‘susceptible The most likely organism is: a Aeromonas hydrophila b Pseudomonas putida c Serratia marcescens d Vibrio vulnificus 485, Differentiating tests that will separate Burkholderia from Stenotrophomonas include: a Gram stain reaction b growth on MacConkey agar ¢ glucose fermentation 4 oxidase 488, A 17-year-old female with cystic fibrosis is dia D nosed with pneumonia. A sputum ws” sample grew Gram-negative bacilli yellow, smooth colonies that have the following 5X” bhigchemical reactions: oxidase: positive TSI: alk/alk glucose: oxidized fluorescence: negative lysine decarboxylase: positive The most likely organism is: a Burkholderia cepacia b Klebsiella pneumoniae c Shewanella putrefaciens d_Stenotrophomonas maltophilia 187. Characteristics of the HACEK group of bacteria include: © a association with urinary tract infections b Gram stain of pleomorphic Gram-positive bacilli © requirement of 5-10% COz for growth d requirement of 42°C for growth 188. The laboratory receives a blood cult weeks with fevers in the afternoon Positive after 5 days, and the orga Gram stain: lure from a veterinarian who has been ill for many and evenings, arthritis, and fatigue. The blood cuiture is inism has the following characteristics: ‘small, Gram-negative coceobacilli ‘sheep bleod agar; growth after 48 hours with small, smooth, raised colonies What should the microbiologist do next? @ consider the growth contamination and perform another Gram stain » perform biochemical identification for HACEK organisms & Perform identification and susceptibility testing using an automated ‘system d take extra safety precautions for possible Brucella 189. What are the m the nonfermentative Gram-negative bacilli from the Enterobact catalase, decarboxylation of arginine, motility, urease, morpholagy on blood agar oxidase, nitrate reduction, growth on MacConkey agar exidase, indole, and growth on blood agar ost appropriate screening tasts to presumptively differentiate and identify teriaceae? growth on blood agar noon Stor8S= SBN 978.080180-6600 6: Microbiology 190. mes oRty 191. Ks Oey 192. ms 193. 194, 388 Gram-Negative Baciy Which genera are positive for phenylalanine deaminase (PAD) production? a Klebsiella, Serratia, Enterobacter Proteus, Providencia, Morganella © Escherichia, Edwardsiella, Salmonella d Citrobacter, Klebsiella, Pantoea Aspecimen from a foot ulcer of a 52-year-old male diabetic patient was sent to the Microbiology laboratory for culture, The following results were obtained from a clear colony growing on the MacConkey: oxidase positive catalase positive OF tubes oxidation positive pigment production biue/green growth at 42°C positive The results indicate which of the following arganisms has been isolated from the culturey a Acinetobacter baumannii b Serratia marcescens Stenotrophomonas mattophilia d Pseudomonas aeruginosa A26-year-old female presents to her doctor with several lacerations on her right hand and a swollen knuckle. The patient tells the clinician she is a boxer and received the lacerations 2 days prior while sparring without gloves when she accidentally caught her partner in the mouth. At 48 hours a culture reveals colonies on the blood plate and chocolate plate with no growth on the MacConkey agar late, Gram stain of the colonies reveals small, slender, Gram-negative rods oxidase reaction is positive indole reaction is negative reduces nitrate to nitrite does not require X and V factors catalase is negative What is the most likely identification of this organism? a Pasturella multicoda b Eikenella corrodens ¢ Pseudomonas aeruginosa d Escherichia coli Ayyoung girl cuts her foot on a rock while swimming at the ocean. Her foot begins to show signs of infection and her parents take her to the ER. A culture grows a nor-lactose fermenting Gram-negative rod that produces copious amounts of hydrogen sulfide and 985, is indole positive and motile. The organism most likely isolated is: a Shigella spp b Escherchia spp © Edwardsiella spp d Klebsiella spp A medical technologist is working on a stool culture from a patient with severe, bloody diarrhea. She wants to set up biochemicals to differentiate Shigella and E coli. Which of the following tests would be the most appropriate? a hydrogen sulfide, ONPG, motility, urease b lactose, indole, ONPG, motility © urease, citrate, VP, hydrogen sulfide d gas, MR, urease, citrate pase? The Board of Certification Study Guide 6e isan o7e-oagte-c502 920" é ; microbiology Aerobic Gram-Negative Cocct

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