Gram(+)

1) ........... consists mainly of bacteria, can provide useful nutrients (vitamin

K and folic acid) and release compounds with antibacterial activity against
pathogenic bacterium, and contribute to host defense by competing with invaders for
space and nutrients and maintaining normal PH environment. (Normal Flora.)

2)Colonization of GI tract is more rapid after vaginal delivery or C-section?

Vaginal delivery.   Because during a regular vaginal birth, infants come in contact
with a rich dose of their mother's bacteria as they are pressed through the birth
canal. On the other hand, C-section babies don't get this exposure, which is likely
to be vital in developing the immune system and helping it to mature.

3)Genetic information of a bacterial cell is contained in a single circular

molecule of double-stranded DNA, which constitutes the ..........?
bacterial chromosome.

In many bacteria, additional genetic information is contained on ....... which are

small circular extrachromosomal DNA molecules that can replicate independently of
the chromosome.
plasmid.

Prokaryotic ribosomes have a sedimentation constant of 70S, smaller than the 80S
ribosomes of eukaryotes. This difference is responsible for the .......... of
antibiotics.
Selectivity.

......... in prokaryotes is functional analogue of the mitochondria in eukaryotes.

Cell (cytoplasmic) membrane.  


........ are small, circular, nonchromosomal, double-stranded DNA molecules.

Capable of self-replication. Contain genes that confer protective properties such
as antibiotic resistance or virulence factors or their own transmissibility to
other bacteria.
Plasmid.

............. is the major surface antigens of the Gram-positive bacteria,

while .......... is the major surface antigens of the Gram-negative bacteria.
Lipoteichoic acids, polysaccharides of lipopolysaccharides (LPS).

Peptidoglycans is much thicker in ......... comprising up to 50% of the cell wall

material, but much thinner in ....... composed of only one or two sheets comprising
5-10% of the cell wall material.
Gram-positive bacteria, Gram-Negative bacteria.

........ is a phospholipid protein bilayer present external to the peptidoglycan
layer. The outer surface of the lipid bilayer is composed of molecules of
lipopolysaccharides (LPS) which consist of a complex lipid called lipid A
chemically linked to polysaccharides.
Outer membrane (Gram negative only).  

....... is the space between the cytoplasmic and outer membranes. Contains many
hydrolytic enzymes, including β-lactamases.
Periplasmic space.
........ doesn't assume a defined recognizable shape, because they lack a rigid
cell wall. They are also resistant to cell wall inhibitors, such as penicillin and
cephalosporins.
 Mycoplasma.
Motile bacteria use ......... to migrate towards regions where there is a higher
concentration of nutrients and solutes and away from disinfecting substances.
Flagella.
Moist heat at  ....... C for 10-20 minutes is needed to kill spores while 60C is
sufficient to kill vegetative forms.
121.
Thermal resistance of spores is provided by their high content of  .......
and ......?
Ca and dipicolinic acid.
......... is Enzyme that cleaves IgA, allowing bacteria to adhere to and colonize
mucous membranes. Secreted by S pneumoniae, H influenzae type b, and Neisseria
(SHiN).
IgA proteases.
In case of foreign bodies that is contaminated with S. Epidermidis, the bacteria
multiply and communicate with one another to induce synthesis of an extracellular
polysaccharide matrix (biofilm) that encases the bacteria. This extracellular
matrix is called ........?
Biofilm
........ refers to the mechanism by which an infectious agent such as a protozoan,
bacterium or virus alters its surface proteins in order to evade a host immune
response.
Antigenic variation.
........ is responsible for the toxic properties of LPS that lead to Gram-negative
sepsis and endotoxic septic shock.
Lipid A.
........ can be modified by chemicals or heat to produce a toxoid that still
immunogenic, but no longer toxic so can be used as a vaccine.
Exotoxins.

Which phase of bacterial growth curve?

- The initial number of bacterial cells remains constant.

- During this period, the cells adapt to their new environment.
- Enzymes and intermediates are formed to permit growth.
Lag phase.

Which phase of bacterial growth curve?

- There is marked increase in cell number and its rate is accelerated exponentially
with time giving a characteristic linear plot on a logarithmic scale.
Exponential (logarithmic, log) phase.
Which phase of bacterial growth curve?
- Exhaustion of nutrients and accumulation of toxic products cause growth to
decrease.
- There is slow loss of cells through death which is just balanced by formation of
new cells through growth and division.
- The number of viable bacteria remains constant.
Stationary phase.
Which phase of bacterial growth curve?
- The death rate increases and exceeds the multiplication rate due to nutrient
exhaustion and accumulation of toxic metabolic end products
- The number of viable bacteria decrease.
Decline or death phase.
........ is a mechanism to incorporate short, linear pieces of DNA into the
chromosome to stabilize it. There must be some sequence homology. Recombinase A is
required. There is a one-to-one exchange of DNA.
Homologous recombination.

......... is the mechanism used to combine Circular pieces of DNA nto the
chromosome to stabilize it.. It requires no homology. No DNA is lost. It requires
restriction endonucleases.
Site-specific recombination.

 ........ are viruses that parasits bacteria (the bacteria cell serves as a host
for the virus). It consists of Head containing the nucleic acid core surrounded by
a protein coat (capsid) and Tail consists of a hollow core surrounded by a
contractile sheath which ends in a base plate to which tail fibers attaches.
Bacteriophages (or phages).

......... is the uptake of naked DNA from the environment by competent cells.
Captured DNA is incorporated by homologous recombination.
Transformation.

........  is gene transfer from one bacterial cell to another involving direct
cell-to-cell contact. Sex pili (genes on F factor) play a role in establishing
cell-to-cell contact.
Conjugation.

....... occurs when an error is made in the life cycle of a virulent phage. During
the lytic phage cycle, the bacterial DNA is fragmented, and any fragment of DNA
(whether chromosomal or plasmid) may be incorporated into the phage head. The phage
particle can then transfer the incorporated bacterial DNA into another bacterial
host.
Generalized transduction.
......... may occur when an error is made in the life cycle of a temperate
(lysogenic) phage. Temperate phages introduce their genomic DNA into the bacterial
chromosome at a specific site and then excise it later to complete their life
cycle. If errors are made during the excision process, then bacterial chromosomal
DNA can be carried along into the next generation of viruses.
Specialized transduction.
........ is A “jumping” process involving a transposon (specialized segment of
DNA), which can copy and excise itself and then insert into the same DNA molecule
or an unrelated DNA (plasmid or chromosome).
Transposition.

........ is Gram-positive cocci in clusters, Catalase positive, Coagulase-positive,
ferments mannitol on mannitol salt agar and forms golden yellow colonies on blood
agar surrounded with a zone of β-hemolysis.

Staphylococcus aureus.
......... is an important adhesion expressed by S. aureus. It leads to attachment
of the organism to traumatized tissue and blood clots
The clumbing factor (fibrinogen-binding protein).
........ binds with the Fc portion of lgG antibodies at the complement-binding
site, preventing complement activation. This results in decreased production of
C3b, leading to impaired opsonization and phagocytosis.
Protein A.

........ interact with major histocompatibility complex molecules on antigen
presenting cells and the variable region of the T lymphocyte receptor to cause a
nonspecific polyclonal widespread activation of T lymphocytes.
Superantigen.

What is the most likely diagnosis?
26 years old patient presenting with nausea, vomiting and abdominal cramps after 3
hours of eating mayonnaise-containing food (macaroni salad)?
Staphylococcal food poisoning.
............. is capable of producing a highly heat-stable protein toxin called
enterotoxin that causes a syndrome characterized by nausea, vomiting and abdominal
cramps following ingestion of preformed exotoxin (exotoxin formed prior to
ingestion).
Staphylococcus aureus.
What is the most likely diagnosis?
26 years old female presenting with Fever, vomiting, diarrhea, muscle pain and
erythroderma, and hypotension + she admits using vaginal tampons that are left in
place for extended period?
Toxic shock syndrome (TSS). TSST acts as a superantigen.
What is the most likely diagnosis?
4 years old child presenting with moist, red, scalded skin +
- Nikolsky's sign (skin slipping off with gentle pressure), epidermal necrolysis,
fever and pain associated with the skin rash?
Staphylococcal scalded skin syndrome (SSSS).  

Staphylococcal Scalded Skin Syndrome (SSSS) is caused by certain strains of
Staphylococcus species that produce the ......?
Exfoliatin exotoxin.
........ is the most common cause of tricuspid endocarditis in intravenous drug
users.
S. aureus.
........ is Gram-positive cocci, Catalase positive, Coagulase negative, Novobiocin
sensitive and does not ferment mannitol.
Staph epidermidis.
What is the most likely Cause?
9 month age child presenting with symptoms of meningeal irritation after insertion
of ventriculoperitoneal shunt for treatment of congenital hydrocephalus?
Staph epidermidis.
After attachment of  the Staph epidermidis to the implanted foreign bodies,
bacteria multiply and communicate with one another to induce synthesis
of .......... that encases the bacteria.
extracellular polysaccharide matrix (biofilm).
S. epidermidis are frequently resistant to methicillin; therefore, ......... is
recommended for therapy of serious infections caused by methicillin-resistant
strains.
vancomycin, combined with rifampin or gentamicin or both.
What is the most likely Cause?
Sexually active young female presenting with urgency, frequency, hesitancy + urine
culture shows Catalase positive, Coagulase negative, and Novobiocin resistant
microorganism?
Staphylococcus saprophyticus.
....... is
- Gram-positive cocci in chains, Catalase negative, β-hemolytic on blood agar,
Bacitracin sensitive and Pyrrolidonyl arylamidase (PYR) positive.  

Streptococcus pyogenes (Group A Streptococcus; GAS).
M protein is one of the cell surface proteins of S. pyogenes and represents the
most important virulence factor. It enables the bacteria to colonize skin
and ......?
inhibit phagocytosis.
Streptolysin O (SLO) is a highly immunogenic protein and induces specific antibody
formation (its detection is the basis for the anti-streptolysin O test). Antibodies
to Streptolysin O (ASO) titer of > 200 is significant for .......?
rheumatic fever.

What is the most likely diagnosis?

14 years old child presenting with rash that appears on the neck, armpits, and
groin that subsequently generalizes to the rest of the body (palms and soles are
spared) that resembles sandpaper-like" rash, strawberry tongue, circumoral pallor,
3 days after streptococcal pharyngitis?

Scarlet fever.
......... is blistering eruption eventually leading to formation of a golden yellow
crust (honey-crusted lesion), is usually seen in children and newborns, frequently
occurs periorally, and can be caused by either Staphylococcuseureus and/or
Streptococcus pyogenes.

Impetigo.
Cellulitis and erysipelas manifest as areas of skin erythema, edema, and warmth.
They differ in that erysipelas involves ........, whereas cellulitis involves
the ......?
the upper dermis and superficial lymphatics, deeper dermis and subcutaneous fat.
...... follows pharyngitis but not skin infection, whereas ...... is preceded by
either skin or throat infection.
ARF, AGN.
Many patients with rheumatic heart disease eventually require cardiac surgery but
early treatment of streptococcal pharyngitis with ...... will decrease the need for
cardiac surgery in these patients.
Long acting penicillin.
Antibodies to M protein of Streptococcus pyogenes cross-react with epitopes on
heart myosin and sacrolemmal membrane proteins causing ........?
ARF.

What is the most likely diagnosis?
18 Years old patient presenting with Hypertension, hematuria, nephritic range
proteinuria, and RBC casts in the urine following a GAS infection?
Acute poststreptococcal glomerulonephritis.
The renal damage in Acute poststreptococcal glomerulonephritis is due to .........
deposition on the glomerular basement membrane and activation of complement.
Ag-Ab immune complexes.
....... is
- Gram-positive cocci, B-hemolytic on blood agar, Bacitracin resistant, Hippurate
test positive, and CAMP test positive.
Streptococcus agalactiae (Group B Streptococci; GBS).

........ produces CAMP factor, which enlarges the area of hemolysis formed by S.
aureus.

Streptococcus agalactiae (Group B Streptococci; GBS).
In women who culture positive for GBS or in women who have had an infant affected
by GBS in the past, intrapartum ........ is indicated to prevent neonatal GBS
sepsis, pneumonia and meningitis. The incidence of group B streptococcal disease in
babies less than a week old is declining due to these recommendations.
Penicillin/Ampicillin.
...... is
- Gram-positive cocci, α hemolytic, and Optochin resistant.
Viridians Streptococci (S. Sanguis, S. Mutans).
S. mutans dextran-mediated adherence glues oral flora onto teeth, causing ........?
dental caries.
....... is
- Gram-positive Lancet-shaped diplococcic, α hemolysis on blood agar, and Optochin
sensitive.

Streptococcus pneumoniae.
The most important virulence factor of Streptococcus pneumoniae is the .......
which is antiphagocytic.
polysaccharide capsule.
.......... is most common cause of typical pneumonia (especially in sixth decade of
life), Adult meningitis, and otitis media and sinusitis in children.
Streptococcus pneumoniae.
......... is the most common cause of bacterial meningitis in adults of all ages.
On CSF Gram stain, lancet-shaped Gram-positive cocci are found in pairs.
Streptococcus pneumoniae.
....... is a Gram-positive cocci in chains, Catalase-negative, gamma-hemolytic (no
hemolysis on blood agar), can grow in hypertonic 6.5% NaCl and bile (lab test), PYR
test positive.
Enterococci (Enterococcus faecalis/faecium).
.......... are normal colonic flora that are penicillin G resistant and cause UTI,
biliary tract infections, and subacute endocarditis following GI/GU procedures
(Colonoscopy, Cystoscopy).
Enterococci (E. faecalis and E. faecium).
....... is a Gram-positive cocci in chains, Catalase-negative, gamma-hemolytic (no
hemolysis on blood agar), can grow in bile but not on 6.5% NaCl, PYR test negative.
Streptococcus gallolyticus (formerly S bovis).
Every patient with S. bovis bacteremia with or without endocarditis should be
examined for  .........?
GI tract malignancy (colon cancer).  Bovis in the blood = cancer in the colon.
........... Spore
- forming gram positive aerobic rods.
Bacillus.
........... are Spore
- forming gram positive aerobic rods, has polypeptide (poly-D-glutamate) capsule,
On microscopy it forms long chains that are described as being "serpentine" or
"medusa head" on appearance.

Bacillus anthrax.
Bacillus anthracis produces an antiphagocytic capsule that contains ........
instead of polysaccharide.
D-glutamate.
What is the most likely diagnosis?
27 years old patient who handle livestock hides presenting with skin lesion that
started with  small papule which changes rapidly to a vesicle, then a pustule, and
finally into a necrotic ulcer which blackens to form a characteristic eschar. The
lesion is painless and is surrounded by marked edema.  

Cutaneous anthrax (malignant pustule).
What is the most likely diagnosis?
27 years old patient who work in  wool processing presenting with myalgia, fever
and malaise that rapidly progress to hemorrhagic mediastinitis (widened mediastinum
on chest x-ray)?
Pulmonary anthrax.
What is the most likely diagnosis?
26 years old patient presenting with nausea, vomiting and abdominal cramps that
started 4 hours after eating fried rice in Chinese restaurant?
Bacillus cereus food poisoning (reheated rice syndrome).
........... are Spore
- forming gram positive Obligate anaerobic rods.
Clostridium.
What is the most likely diagnosis?
32 years old immigrant presenting with difficulty opening the jaw with
characteristic smile, Contractions of back muscles, resulting in backward arching
after being wounded by rusted nail while walking barefooted?
Tetanus.

Tetanospasmin toxin is a neurotoxin that acts centrally at the level of ........
and work by inhibiting the release of ........?
the brain stem and anterior horn cells of the spinal cord, the inhibitory
neurotransmitters glycine and gamma-aminobutyric acid (GABA) from these inhibitory
neurons.
An immunized mother will be able to pass ........ through the placenta to the fetus
and provide passive immunity against neonatal tetanus until the child receives its
first tetanus vaccination at two months of age.
lgG.
Infant botulism is frequently transmitted due to consuming .........., adult
botulism results from consuming ........, typically in canned food.
C. botulinum spores in honey, preformed toxin.
The botulinum toxin is specific for peripheral nerve endings at the neuromuscular
junction where it inhibits the release of .........?
acetylcholine.


What is the most likely diagnosis?

27 years old patient presenting with diplopia, dysphagia, descending, symmetric
flaccid paralysis of motor nerves after eating canned salmon?
Adult botulism.
What is the most likely diagnosis?
6 months child presenting with constipation and weak sucking ability and
generalized weakness after consuming honey?
Infant botulism (floppy baby syndrome).
Culture and isolation of Clostridium botulinum and bioassay of its toxin are time-
consuming procedures, that's why we use tests based on ..........?
ELISA methodology and polymerase chain reaction techniques.
Local injection of ........... into the dystonic sternocleidomastoid muscle results
in muscular relaxation because the toxin prevents presynaptic release of
acetylcholine, the neurotransmitter responsible for muscle contraction, from the
nerve terminal at the neuromuscular junction.
botulinum toxin (Botox).
What is the most likely diagnosis?
25 years old patient presenting with rapid-onset muscle pain, fever, hemorrhagic
bullae with dusky surrounding skin, and tissue edema/crepitus after traumatic
penetrating injury in his lower limb?

Gas gangrene (myonecrosis). Lecithinase, also known as phospholipase C or alpha
toxin, is an enzyme that catalyzes the splitting of phospholipid molecules in cell
membranes causing cell lysis (including RBC hemolysis), tissue necrosis and edema.
Clostridium  Perfringens can also cause a late-onset food poisoning characterized
by ...........?
transient watery diarrhea.
Spontaneous gas gangrene (nontraumatic) is caused by Clostridium septicum. Most
cases of spontaneous gas gangrene are triggered by breakdowns in the
gastrointestinal mucosa like .......... or .........?
colonic malignancy, Inflammatory bowel disease.
What is the most likely diagnosis?
60 years old patient was hospitalized 2 weeks ago due to pneumonia presenting with
watery diarrhea, abdominal pain, and multiple White/yellow membrane-like plaques
seen on colonoscopy + the patient was given a long course of fluoroquinolones for
treatment of pneumonia?

pseudomembranous colitis.
............. is the best method for diagnosing C difficile colitis.
PCR detection of toxin A and B genes in the stool.
Cases of suspected or proven ......... infection require additional contact
precautions, including handwashing with soap and water (alcohol-based hand
sanitizers do not kill the spores), gown for any patient contact, and nonsterile
gloves that should be changed after contact with contaminated secretions. In
addition, a dedicated stethoscope and blood pressure cuff should be left in the
patient’s room.
C difficile.

............ is Gram-positive nonspore-forming rods on blood agar, Beta hemolytic
on blood agar, demonstrates tumbling motility at 22 C, and able to multiply at 4°C.
Listeria monocytogenes.
Listeria monocytogenes can grow intracellularly. It evades killing when lysosomal
contents are dumped into phagosome by Forming rocket tails via ......... that allow
intracellular movement and cell-to-cell spread across cell membranes, thereby
avoiding antibody
actin polymerization.
Infection with listeria in Healthy adults and children with intact cell mediated
immunity are generally asymptomatic or presents with ......, but in pregnant,
neonates or immunocompromised cause Septicemia and meningitis.
mild gastroenteritis,
Listeria is not sensitive to ...... and Ampicillin is the treatment of choice.
cephalosporins.
......... is gram-positive non-spore forming rods, Aerobic, produce gray-to-black
colonies of club-shaped gram-positive rods arranged in V or L shapes on cysteine-
tellurite agar.
Corynebacterium diphtheriae.

Diphtheria toxin inhibits host cell protein synthesis by .........?
catalyzing the ADP-ribosylation of protein elongation factor 2 (EF-2).
What is the most likely diagnosis?
23 years old immigrant patient presenting with suffocation and symptoms of
respiratory obstruction + during examination there is grey white membrane in the
pharynx firmly adherent to the underling mucosa + throat swab shows
- Gray-to-black colonies of club-shaped gram-positive rods arranged in V or L
shapes on cysteine-tellurite agar?

pseudomembranous pharyngitis.
Diphtheria toxin is absorbed and disseminated through the blood to the susceptible
tissues, mainly ....... and ........?
heart muscle and peripheral nerves). Clinical manifestations include myocarditis,
arrhythmia, heart failure, neuropathy, paralysis, and coma.
Non-pathogenic Corynebacterium can cause severe pseudomembranous pharyngitis after
acquiring the Tox gene via ............?
lysogenization by a temperate bacteriophage.
Rapid administration of Diphtheria antitoxin is essential.  Diphtheria antitoxin
work by ...........?
inactivating all circulating toxin, but is ineffective against toxin that has
already gained access to cardiac or neural cells.

......... is gram positive anaerobic Branching rods, Non-acid fast. Yellow
aggregations of organisms bound together by proteins look like sulfur granules.
Sulfur granules grossly appear yellow; however, hematoxylin and eosin staining
gives them basophilic appearance under light microscope.

Actinomyces israelii.
What is the most likely diagnosis?
18 years old patient with bad oral hygiene presenting with slowly growing mass that
began in the setting of oral trauma that has recently been draining yellow pus
through the skin?

Cervicofacial actinomycosis.
Treatment of Cervicofacial actinomycosis consists of a prolonged course of
parenteral ........ and surgical debridement?
penicillin.
......... is gram positive obligate aerobic Branching rods. Partially acid fast.
Nocardia.
What is the most likely diagnosis?
34 years old patient who take immunosuppressive drugs for renal transplant
presenting with symptoms and x-ray finding that mimic tuberculosis + Gram staining
of bronchoalveolar lavage sample shows branching filament microorganism?
Cavitary bronchopulmonary nocardiosis.
Treatment of nocardiosis is ...............?
sulfonamides (high dose) or trimethoprim/sulfamethoxazole (TMP-SMX).
Acid-fastness of mycobacteria and nocardia is due to ........... of the cell wall.
the high lipid (mycolic acid) content.
Mycobacteria are facultative intracellular pathogens except .......... is obligate
intracellular pathogen.
M. leprea.
............ is Obligate aerobe, Acid fast in carbol-fuchsin (Ziehl-Neelsen stain).

Mycobacterium tuberculosis.
The growth of thick, rope like cords of mycobacterial organisms in a twisted,
"serpentine" pattern is consistent with the presence of cord factor.
- The presence of cord factor correlates with .........?
virulence.
Sulfatides (sulfolipids in cell envelope of mycobacteria tuberculosis)
inhibit ........, allowing intracellular survival.
phagosome-lysosome fusion.
What is the most likely diagnosis?
60 years old patient presenting with malaise, fatigue, night sweat and fever along
with persistent cough and bloody sputum, x-ray findings shows cavitary lesion,
calcified nodules in the apex of the lung + sputum sample is positive for acid fast
bacilli?

Pulmonary tuberculosis.
......... is obligate intracellular bacteria, Acid fast rods, can be isolated from
the nine-banded armadillo for for biochemical and immunological research.
Mycobacterium leprae.
The severity of leprosy depends on the strength of the cell-mediated immune
response, with ........ is the milder form and ........... is the more severe form.
tuberculoid leprosy, lepromatous leprosy.


Gram (-)
......... is gram-negative, kidney bean-shaped diplococcic, maltose fermenter, can
be cultured on Thayer-Martin VCN (vancomycin/colistin/nystatin) selective medium.
Neisseria meningitidis.
What is the most likely diagnosis?
34 years old patient presenting with severe headache, projectile vomiting, and
stiff neck, and nuchal rigidity + CSF Findings include elevated WBC's (neutrophils
predominant), elevated proteins, low glucose + CSF culture shows gram-negative,
kidney bean-shaped diplococcic on Thayer-Martin VCN?
Meningitis due to Neisseria meningitidis.
What is the most likely diagnosis?
34 years old patient presenting with spiking fevers, chills, arthralgias, and
myalgias, as well as purpuric cutaneous lesions and hypotension + Blood culture
shows gram-negative, kidney bean-shaped diplococcic on Thayer-Martin VCN?  

Meningococcemia.
Waterhouse-Friderichsen syndrome is a complication of meningococcemia that may
involve bilateral hemorrhagic destruction of ........., disseminated intravascular
coagulation (DIC), and shock.
adrenal gland.
.......... is gram-negative, kidney bean-shaped diplococcic, maltose nonfermenter,
can be cultured on Thayer-Martin VCN (vancomycin/colistin/nystatin) selective
medium.
Neisseria gonorrhoeae.

What is the most likely diagnosis?
27 years old male patient presenting with dysuria, frequency, urgency with purulent
urethral discharge after having unprotected sexual intercourse + Gram stain of
urethral discharge from affected patients shows Gram negative diplococci within
leukocytes?
Gonorrhea.
What is the most likely diagnosis?
27 years old male patient presenting with Mucopurulent cervicitis with cervical
motion tenderness + Gram stain of cervical discharge from affected patients shows
Gram negative diplococci within leukocytes?
Pelvic inflammatory disease (PID).
Treatment of gonococcal PID must also always include treatment for ...........?
C. trachomatis. A third-generation cephalosporin will treat the gonococcal
infection, and further treatment with azithromycin or doxycycline is required to
treat the Chlamydia, which is not sensitive to the beta-lactams.
What is the most likely diagnosis?
22 years old male patient presenting with painful, swollen, erythematous knee joint
after having unprotected sexual intercourse + synovial fluid sample is purulent
with large number of Wbc's and culture shows gram-negative, kidney bean-shaped
diplococcic, maltose nonfermenter on Thayer-Martin VCN
(vancomycin/colistin/nystatin) selective medium?
Septic arthritis.
........ is the reason why development of an effective vaccine directed against the
gonococcal pilus is so challenging.
Antigenic variation. Antigenic variation is a process by which the structural genes
for pilus proteins undergo recombination with each other to produce new antigenic
types of pili, and the array of different antigenic pilus types produced by this
mechanism theoretically may be quite large.

What is the most likely diagnosis?
19 Years old patient presenting with Runny nose, facial pain, headache + gram
staining shows Gram-negative diplococcus?
Sinusitis due to Moraxella catarrhalis.
........ gram-negative coccobacillary rod, blood-loving organism that requires both
X factor (hematin) and V factor (NAD) to grow.
Haemophilus influenzae.
Type B capsular material consists of a ribosyl and ribitol phosphate polymer called
...........?
Polyribitol phosphate (PRP).
H influenza type B used to be a major cause of severe, invasive infections
including ......... , ........ and .......... However, since the advantage of the
conjugate Hib vaccine, most H influenza infections are due to non-type B strains
that cause noninvasive disease such as ..........., ...........,
and ..............?
epiglottitis, meningitis, and bacteremia. sinusitis, bronchitis, otitis media, and
conjunctivitis
What is the most likely diagnosis?
34 years old immigrant patient presenting with severe headache, projectile
vomiting, and stiff neck, and nuchal rigidity + CSF Findings include elevated WBC's
(neutrophils predominant), elevated proteins, low glucose + CSF culture shows gram-
negative coccobacillary rod, blood-loving organism that requires both X factor
(hematin) and V factor (NAD) to grow?
Meningitis due to H. influenza type b (Hib).
What is the most likely diagnosis?
14 years old immigrant patient presenting with fever, dysphagia, drooling, and
inspiratory stridor + epiglottis  appears cherry red though inspection of the
epiglottis + lateral neck x-ray is shown below?

Epiglottis.
The change in the vaccination schedule of Hib conjugate vaccine would most likely
affect the epidemiology of ...........?
Meningitis.
Colonies of H. influenza will grow around the hemolytic S. aureus colonies
resulting in the characteristic ........?
"satellite" phenomenon.

What is the most likely diagnosis?
24 Years old patient presenting with deep, painful ulcers  with ragged borders that
are associated with a grey exudate and inguinal lymphadenopathy after unprotected
sex + Dark field microscopy failed to show any organism?

Chancroid (you "do cry" with. H ducreyi)
What is the most likely diagnosis?
12 years old child presenting with facial Cellulitis with characteristic mouse-like
odor and lymphadenitis + wound culture shows Gram-negative coccobacillary rods?

Pasteurella multocida infection.
What is the most likely diagnosis?
27 years old patient working in skinning rabbits presenting with fever, ulcer at
bite site, and regional lymph node enlargement and necrosis + culture of the ulcer
shows Gram-negative coccobacillary rods?
ulceroglandular disease due to Francisella tularensis.
Pertussis toxin (PTx) has a potent adenylate cyclase activity by ADP ribosylation
of .......... --> ↑ cAMP activity that reduces phagocytic activity locally and
helps the organism to initiate infection.
Gi (inhibiting negative regulator of adenylate cyclase, disinhibition).
Adenylate cyclase toxin is Like ..............., adenylate cyclase toxin functions
as a calmodulin-dependent adenylate cyclase that causes phagocyte dysfunction and
edema.
Edema factor of bacillus anthracis.
Tracheal cytotoxin (TCT) is not a classic bacterial exotoxin, since it is not
composed of protein, but is a peptidoglycan fragment that work by ............?
killing ciliated respiratory epithelial cells.
What is the most likely diagnosis?
8 years old immigrant child presenting with paroxysms of intense cough followed by
inspiratory gasp, and posttussive vomiting + gram staining shows Gram-negative,
aerobic coccobacillus?
Whooping cough.
What is the most likely diagnosis?
25 years old farmer presenting with fever, which is usually prolonged and
intermittent (in waves rising and falling pattern), chills, weakness, malaise, body
aches, sweating and headache + blood culture shows Gram-negative coccobacillus?
Brucellosis (undulant fever or malta fever).
.............. is Gram-negative rods that stains faintly with Gram stain; silver
stains improve visualization. Culture must be performed on buffered charcoal yeast
extract (BCYE) agar supplemented with L-cysteine and iron.
Legionella pneumophila.
What is the most likely diagnosis?
30 years old patient was on cruise trip presenting with high fever (>39 C), dry
cough, mild respiratory distress, neurological symptoms (confusion), and
gastrointestinal symptoms (diarrhea), x-ray finding shows a unilobar infiltrate +
Sputum Gram stain often shows many neutrophils, but few or no organisms.
Legionnaires' disease. The diagnosis is most commonly made by testing for
Legionella antigen in the urine.

What is the most likely diagnosis?
19 years old patient presenting with bloody diarrhea (blood and pus in stools), and
crampy abdominal pain after eating undercooked poultry + culture shows comma or S
shaped Gram-negative rod with a polar flagella that allows it to move in a
characteristic "corkscrew" fashion, Oxidase +ve, and Grows well at 42.0°C on
selective media?
Campylobacter jejuni gastroenteritis.
........... is Triple ⊕ Gram-negative comma shaped gastric bacilli with flagella
(catalase ⊕, oxidase ⊕, and urease ⊕).
Helicobacter pylori.
Urease breath test is a screening assay for the presence of .........., an indirect
means of detecting the presence of Helicobacter pylori, a major cause of duodenal
ulcer.
urease activity.
Vibrio cholerae is sensitive to stomach acid and most die in the stomach → Requires
high dose if stomach acid is normal. But can cause infection with lower infectious
dose in cases of ........., .........., and .........?
buffering capacity of food, Achlorhydria, and proton pump inhibitor therapy.
Cholera toxin increases levels of cAMP by increasing the activity of adenylate
cyclase in intestinal mucosal cells by a mechanism identical to that of .........?
the heat labile toxin produced by Enterotoxigenic E. coli (ETEC).
What is the most likely diagnosis?
23 years old patient presenting with abrupt onset of voluminous massive watery
diarrhea, The watery diarrhea is speckled with flakes of mucus and epithelial cells
"rice-water stool" + stool culture shows Gram-negative, Comma-shaped rods, Oxidase-
positive, and able to grow on alkaline enrichment medium that kills most organisms
of the normal flora of the gut?
Cholera.
Healthy patients with V. vulnificus wound contamination usually develop a mild
cellulitis, but those with ........... or .............. are at high risk for
rapidly progressive necrotizing fasciitis with hemorrhagic, bullous lesions and
septic shock (hypotension, elevated lactic acid level).

iron overload or liver disease.
........... is non-lactose fermenter, Oxidase-positive Gram-negative rods, Aerobic,
Motile, Produces pyocyanin and pyoverdine pigment (blue green), and Emits a grape-
like, fruity odor.
Pseudomonas aeruginosa.
Although they are structurally different, both diphtheria toxin and exotoxin A
ribosylate and inactivate ............., halting human cell protein synthesis and
causing cell death.
elongation factor-2 (EF-2).
............ of Pseudomonas aeruginosa contribute to chronic pneumonia in cystic
fibrosis patients due to biofilm formation.
Mucoid polysaccharide Capsule.
What is the most likely diagnosis?
18 years old patient presenting with superficial and self-limited infection of the
hair follicles following exposure to swimming pool where the chemicals have not
been maintained at appropriate levels + The culture of a pustule will reveal Gram-
negative, oxidase positive, non-lactose fermenting, motile rods that produce
pigment (pyocyanin, pyoverdine)?

Hot tub folliculitis.
The most common microorganism isolated from adult cystic fibrosis patient with
Recurrent and chronic pneumonias is ...........?
Pseudomonas aeruginosa.
What is the most likely diagnosis?
40 years old patient who was diagnosed with leukemia presenting with focal areas of
vascular destruction and cutaneous necrosis + blood culture shows Gram-negative,
oxidase positive, non-lactose fermenting, motile rods that produce pigment
(pyocyanin, pyoverdine)?

Ecthyma gangrenosum.
What is the most likely diagnosis?
40 years old diabetic patient presenting with exquisite ear pain and drainage,
granulation tissue seen within the ear canal during otoscope examination + culture
shows Gram-negative, oxidase positive, non-lactose fermenting, motile rods that
produce pigment (pyocyanin, pyoverdine)??
Malignant otitis externa (swimmer’s ear).
............ is non-lactose fermenter, nonmotile, and Non H2S producer Gram-
negative rods.
Shigella.
.......... is an essential pathogenic mechanism for Shigella infection and is the
most significant factor in causing disease.
Mucosal invasion. The production of toxins is considered less important in the
pathogenesis of shigellosis than is cellular invasion because nontoxigenic strains
have been found to cause significant disease.
............ work by inactivating the 60S ribosome of the host, thereby halting
protein synthesis and causing cell death.
Shiga and shiga like toxin of EHEC.
Salmonella is sensitive to gastric acidity, but ...... is resistant and as few as
100 cells can cause disease.
Shigella.
What is the most likely diagnosis?
27 years old patient presenting with abdominal pain, cramps, diarrhea with blood,
blood and pus in stool, fever, vomiting, and tenesmus + stool culture shows non-
lactose fermenter, nonmotile, and Non H2S producer Gram-negative rods?
Shigellosis.
What is the most likely diagnosis?
46 years old patient presenting with rapidly rising fever, and groin lymph node
enlargement + lymph node sample shows Gram-negative rods/ coccobacillus that
exhibits bipolar staining (resembling a safety pin) on Giemsa or Wright stain?
Bubonic plague due to infection with Yersinia pestis. Flea bites infected rodents
(rats) and then later uninfected human (Zoonosis)
............ is non-lactose fermenter, motile, H2S producer Gram-negative rods and
Sensitive to acid → Large infectious dose is required for successful infection
Salmonella.
Typhoid strains of Salmonella contain a ........... that inhibits neutrophil
phagocytosis, neutrophil recruitment, and macrophage-mediated destruction.
Therefore, typhoid strains are able to undergo extensive replication within the
intracellular space of macrophages with subsequent spread through the lymphatic and
reticuloendothelial system, leading to a widespread systemic disease (typhoid
fever).
capsular antigen (Vi).
What is the most likely diagnosis?
27 years old patient presenting with abdominal pain, cramps, diarrhea with blood,
and blood and pus in stool + stool culture shows non-lactose fermenter, motile, and
H2S producer Gram-negative rods?
Salmonella Food poisoning. It is worldwide infection caused by nontyphoidal
salmonella strains, commonly S. Enteritidis and S. typhimurium.
What is the most likely diagnosis?
26 years old patient presenting with abdominal cramping with fever and diarrhea,
salmon-colored "rose spots" rash, and hepatosplenomegaly + Blood cultures shows
non-lactose fermenter, motile, and H2S producer Gram-negative rods?

Typhoid fever (enteric fever). Typhoid fever (also referred to as "enteric fever'')
is a life-threatening illness caused by the bacterium Salmonella typhi or
Salmonella paratyphi. Other species of Salmonella are not associated with typhoid
fever"
.......... is the most common cause of osteomyelitis in patients with sickle cell
anemia.
Salmonella.
What is the most likely diagnosis?
17 years old patient presenting with urgency, frequency, dysuria + urine culture
shows Non-lactose-fermenting, Urease positive, and H2S producer gram negative rod?
UTI due to Proteus mirabilis infection.
......... is a lactose fermenter Enterobacteriaceae, motile, give deep purple/black
colonies in MacConkey agar and green metallic sheen on EMB agar.

Escherichia coli.
........ is the most common cause of urinary tract infection in both healthy adults
and elderly patients.
E. coli.
The most common source of E. coli bacteremia is ........?
the urinary tract (Urosepsis).
............... is the most important virulence factors expressed by uropathogenic
E coli.
Fimbriae.
.............. work by preventing binding of tRNA to the 60S ribosomal subunit and
inhibiting protein synthesis (similar to shiga toxin).
The shiga like toxin.

The Labile Toxin of Enterotoxigenic E. Coli is very similar to ............. in
both structure and mode of action.
Cholera toxin.
The LT enterotoxin activates adenylate cyclase by activating the stimulatory Gs
membrane G protein resulting in conversion of ATP to cAMP, but ........ stimulates
the activity of guanylate cyclase in intestinal epithelial cells leading to
formation of cGMP resulting also in loss of fluids from the intestine.
The ST enterotoxin. Labile on the Air and Stable on the Ground.

What is the most likely diagnosis?
24 years old patient presenting with frequency, urgency, dysuria + urine culture
shows lactose fermenter Enterobacteriaceae, motile, give green metallic sheen on
EMB agar?
Urinary tract infection (UTI) due to E. Coli infection.
............  is considered the major virulence factor among E coli strains that
cause neonatal meningitis.
The K1 capsular antigen.

.............. is characterized by microangiopathic hemolytic anemia (mechanical
hemolysis with schistocytes on peripheral blood smear), thrombocytopenia (due to
platelet consumption), and renal insufficiency (due to ↓ renal blood flow), days
after bloody diarrhea from eating undercooked Hamburger.
Hemolytic-uremic syndrome (HUS). E. coli serotype O157: H7 is the most common
strain associated with the disease.

............... is common cause of infantile diarrhea by interfering with water
absorption by mucosal cells.
EPEC P = pediatric (diarrhea in children).
........ cause bloody diarrhea with a mechanism identical to that caused by
shigella spp. but do not produce shiga toxin.
EIEC I = Invasive (dysentery).
What is the most likely diagnosis?
25 years old alcoholic patient presenting with fever, productive cough with current
jelly sputum, dyspnea + xray shows lobar infiltrate of the lung +  sputum culture
shows  Lactose-fermenting mucoid colonies on MacConkey agar?
Pneumonia due to Klebsiella pneumoniae.
19 years old patient presenting with grayish-white discharge with a "fishy" odor
that becomes more prominent with addition of potassium hydroxide (Amine whiff test)
+ Wet mount microscopy of the discharge show clue cells, which are vaginal squamous
epithelial cells covered with multiple, small adherent bacteria?

Bacterial vaginosis due to Gardnerella vaginalis. Anaerobic Gram-variable rod
(meaning they may stain either negative or positive). Bacterial vaginosis is
usually treated with metronidazole or clindamycin, but topical regimens may also be
used.
Although most infections within the abdominal cavity are polymicrobial, ...........
is a common anaerobic gram-negative bacillus that is frequently isolated.
B. fragilis.
What is the most likely diagnosis?
35 years old patient presenting with single hard, painless ulcer on his penis after
unprotected sexual intercourse + painless enlarged inguinal lymph nodes + smear of
the genital ulcer under dark field microscopy shows motile helical microorganism?

Primary syphilis (chancre) due to infection with Treponema pallidum.
What is the most likely diagnosis?
35 years old patient presenting with Fever, fatigue, myalgia, headache, and
Generalized nontender lymphadenopathy + Maculopapular rash (including palms and
soles) + RPR/FTA-ABS is positive?

Secondary syphilis due to infection with Treponema pallidum.
What is the most likely diagnosis?
35 years old patient presenting with broad-based ataxia, ⊕ Romberg sign, pupil
constricts with accommodation but is not reactive to light + CSF testing of
RPR/FTA-ABS is positive?
Tertiary syphilis (tabes dorsalis) due to infection with Treponema pallidum.
What is the most likely diagnosis?
Newborn child presenting with rhagades (linear scars at angle of mouth), snuffles
(nasal discharge), saddle nose, notched (Hutchinson) teeth, and CN VIII deafness +
RPR/FTA-ABS of the mother is positive?
Congenital syphilis.

What is the most likely diagnosis?
24 years old patient presenting with fever, chills, headache, myalgia 12 hours
after starting treatment with penicillin for syphilis?
Jarisch-Herxheimer reaction due to killed bacteria (usually spirochetes) releasing
endotoxins. Most cases are self-limited and do not require intervention.
What is the most likely diagnosis?
28 years old sewer worker presenting with fever, Conjunctival suffusion, jaundice
and azotemia, hemorrhage, and anemia?
Icterohemorrhagic leptospirosis due to infection with Leptospira interrogans.
Contact with animal urine in infected water.
What is the most likely diagnosis?
23 years old patient who was camping in New England presenting with an erythematous
macule that enlarges with an advancing erythematous border as the bacteria migrate
slowly through the skin outward from the inoculation site?

Erythema migrans (EM) due to infection with Borrelia burgdorferi. Doxycycline (1st
line as it has the advantage of simultaneously preventing or treating coexisting
human granulocytic anaplasmosis, an infection also carried by I. scapularis)
What is the most likely diagnosis?
25 years old patient presenting with sudden onset fever that persists for 3 to 7
days and is followed by an afebrile interval of several days to several weeks, then
the fever relapse?
Relapsing fever due to infection with Borrelia Recurrentis.
........... is obligate intracellular bacterium; cannot make ATP. Not seen on Gram
stain because their cell wall lacks classic peptidoglycan (due to reduced muramic
acid), rendering β-lactam antibiotics not effective in treatment.
Chlamydia trachomatis.
Serotypes ............. of chlamydia trachomatis are the Leading cause of
preventable infectious blindness in Africa.

Serotypes A, B, and C.
Serotypes ............. of chlamydia trachomatis cause disease characterized by an
initial painless small ulcer on the genital mucosa. This ulcer is followed weeks
later by swollen, painful inguinal nodes that coalesce, ulcerate, and rupture;
these are referred to as buboes. Cytoplasmic inclusions seen on Giemsa or
fluorescent antibody-stained smear?

Serotypes L1, 2, 3.
Serotypes ............. of chlamydia trachomatis cause neonatal conjunctivitis?

Serotypes D through K.
What is the most likely diagnosis?
22 years old patient presenting with headache, fever, maculopapular rash starts on
ankles and wrists and then spreads to the trunk, palms, soles, and face
(centripetal rash, from extremities to trunk)?
Rocky Mountain spotted fever. Microorganism: Rickettsia rickettsii, vector: tick
(Dermacentor). Rickettsii on the wRists, Typhus on the Trunk.
What is the most likely diagnosis?
22 years old patient presenting with headache, fever, maculopapular rash that
starts centrally and spreads out, sparing palms and soles?
Typhus. Endemic (fleas): R. typhi. Epidemic (human body louse): R. prowazekii.
Rickettsii on the wRists, Typhus on the Trunk.
What is the most likely diagnosis?
19 years old patient presenting with fever, chills, myalgia and headache +
thrombocytopenia, leukopenia and elevated liver enzymes + mulberry-like inclusions
in monocytes?
Ehrlichiosis.

MEGA berry: Monocytes = Ehrlichiosis. Granulocytes = Anaplasmosis
What is the most likely diagnosis?
19 years old patient presenting with fever, chills, myalgia and headache +
thrombocytopenia, leukopenia and elevated liver enzymes + mulberry-like inclusions
in Granulocytes?
Anaplasmosis.

What is the most likely diagnosis?
19 years old farmer presenting with fever, chills, myalgia and retroorbital
headache + thrombocytopenia, normal leukocyte count and elevated liver enzymes +
symptoms of pneumonia?
Q fever. Coxiella burnetii, no arthropod vector. Treatment: doxycycline (inhibitor
of bacterial protein synthesis).
........... is the smallest free-living (extracellular) bacteria, Resistant to the
beta-lactam antibiotics (penicillin and cephalosporins), Unstainable by the Gram
stain (but readily stained by Giemsa stain). They are the only bacteria that
contain sterol in the cell membrane and require serum enriched medium containing
cholesterol for in vitro culture (Eaton's agar).
Mycoplasma.
What is the most likely diagnosis?
22 years old patient presenting with chronic dry nagging cough, low-grade fever,
mild dyspnea + chest x-ray shows bilateral interstitial infiltrate + mild anemia +
patient serum able to agglutinate RBCs in vitro at low temperatures?
Walking pneumonia due to infection with Mycoplasma pneumoniae. Drugs that are
effective against the Mycoplasma genus include anti-ribosomal agents like the
macrolides, doxycycline, or fluoroquinolone.



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