EMRCS 2021

Microbiology

Microbiology MRCS I.V.

1/1/2021
 MRCS I.V. Course

Clinical microbiology

N. Question Ans.
What is the risk of wound infection occurring in a 43 year old woman
who is undergoing a laparoscopic cholecystectomy for uncomplicated
biliary colic?
A. 2%
1 B
B. 5%
C. 15%
D. 20%
E. 30%
A 22 year old man presents with a painless penile ulcer and marked
inguinal lymphadenopathy. Some of the exudate from the lesion is sent
for microscopy. What organism is most likely to be visualized?
A. Treponema pallidum
2 A
B. Nocardia asteroides
C. Mycobacterium tuberculosis
D. Mycobacterium leprae
E. Neisseria gonorrhoea
A 68 year old man with poorly controlled diabetes presents with severe
otalgia and headaches. On examination, there is granulation tissue within
the external auditory meatus. What is the most likely underlying infective
agent?
3 A. Pseudomonas aeruginosa A
B. Streptococcus pyogenes
C. Staphylococcus aureus
D. Actinomyces
E. Bacteroides fragilis
A 23 year old woman is admitted with sepsis and right loin pain. She has
a history of a UTI that was treated by the GP with a course of
trimethoprim that was commenced 24 hours previously. Which of the
organisms listed below is the most likely cause?
4 A. Bacteroides fragilis B
B. E-Coli
C. Clostridium difficile
D. Candida albicans
E. Mycobacterium tuberculosis

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A 30 year old aid worker becomes unwell whilst helping at the scene of a
recent earthquake. He develops vomiting and soon afterwards a diarrhoea
that is loose and extremely watery. What is the most likely infective
organism?
5 A. Campylobacter jejuni B
B. Vibrio cholera
C. Enterohaemorragic E Coli
D. Clostridium perfringens
E. Clostridium boltulinum
A 45 year old man is recovering in hospital following a total hip
replacement. He develops a profuse and watery diarrhoea. Several other
patients have been suffering from similar symptoms. Infection with which
of the following is the most likely underlying cause?
6 A. Clostridium perfringens C
B. Clostridium botulinim
C. Clostridium difficile
D. Clostridium welchi
E. Clostridium tetani
A 28 year old chef presents to the medical team with profuse bloody
diarrhoea. On further questioning he describes tenesmus. They arrange a
sigmoidoscopy which reveals necrosis and ulceration of the descending
colon mucosa. What is the most likely cause?
7 A. Ischaemic colitis C
B. Infection with Yersinia pestis
C. Infection with entero invasive E Coli
D. Infection with campylobacter
E. Infection with vibrio cholera
What is the likely risk of surgical wound infection in a 23 year old male
undergoing an elective inguinal hernia repair?
A. Between 5 and 10%
8 B. Less than 5% B
C. Between 10 and 15%
D. More than 25%
E. Between 15 and 20%
A 34 year old homosexual is admitted with diarrhoea of 3 months
9 duration. He is found to be HIV positive with a CD4 count <50. Which of A
the organisms listed below is most likely to be responsible?

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A. Cryptosporidium
B. Adenovirus
C. Norovirus
D. Vibrio cholera
E. Clostridium difficle
A 62 year old lady is unwell following a difficult acute cholecystectomy
for acute cholecystitis. Her gallbladder spilled stones intraoperatively and
she has been on ciprofloxacin intravenously for this for the past 4 days.
She now has colicky abdominal pain and profuse, foul smelling diarrhoea.
Which of the organisms below is likely to account for this illness?
10 B
A. E-Coli
B. Clostridium difficile
C. Clostridium perfringens
D. Clostridium tetani
E. Campylobacter
A 68 year old man with diabetes presents with an area of necrosis of the
perineum at the base of the scrotum, there is some surrounding erythema.
He is systemically unwell and hypotensive. Which of the following
organisms is likely to be accountable?
11 A. Clostridium tetani E
B. Staphylococcus epidermidis and streptococcus viridans
C. Bacteroides and staphylococcus saprophyticus
D. Streptococcus viridans and bacteroides
E. E-coli and bacteroides
A 53 year old man presents with an ulcerated mass at the anal verge. A
biopsy is taken and the histology demonstrates as squamous cell
carcinoma. Infection with which of the viruses below is most likely to
have contributed to the development of the condition?
12 A. Human papillomavirus 7 D
B. Human immunodeficiency virus 1
C. Human immunodeficiency virus 2
D. Human papillomavirus 16
E. Human T-lymphotropic virus 1
A 58 year old man undergoes a difficult colonoscopy for assessment of a
caecal cancer. 48 hours after the procedure he is admitted with
13 C
septicaemia. His abdomen is soft and non tender. Blood cultures grow
gram positive cocci. What is the most likely underlying organism?

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A. Staphylococcus epidermidis
B. Streptococcus pyogenes
C. Streptococcus bovis
D. Clostridium difficle
E. Bacteroides fragilis
A 29 year old female undergoes a sub total thyroidectomy. Five days post
operatively the wound becomes erythematous and discharges pus. What is
the most likely causative organism?
A. Streptococcus pyogenes
14 D
B. Haemophilus influenzae
C. Pseudomonas aeruginosa
D. Staphylococcus aureus
E. Proteus mirabilis
Which of the following cancers is not associated with the human
papillomavirus?
A. Anal cancer
15 B. Oropharyngeal cancer C
C. Tracheal cancer
D. Vulval cancer
E. Penile cancer
A 21 year old man is admitted with crampy abdominal pain and
diarrhoea. He attended a large wedding earlier in the day. Several other
guests are also affected with the same illness. Which of the organisms is
likely to be accountable?
16 A. Staphylococcus aureus D
B. E-Coli
C. Salmonella
D. Clostridium perfringens
E. Campylobacter
Which of the following is not associated with Epstein-Barr virus?
A. Burkitt's lymphoma
B. Post-transplantation lymphoma
17 E
C. Hodgkin's lymphoma
D. Nasopharyngeal carcinoma
E. Mycosis fungoides
A 28 year old lady is breast feeding her first child. She presents with
18 B
discomfort of the right breast. Clinical examination demonstrates

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erythema and an area that is fluctuant. Aspiration and culture of the fluid
is most likely to demonstrate infection with which of the following
organisms?
A. Lactobacillus caseii
B. Staphylococcus aureus
C. Streptococcus pyogenes
D. Staphylococcus epidermidis
E. Actinomycosis
A 22 year old man has undergone an inguinal hernia repair. Seven days
later he presents with an erythematous and tender wound that is
discharging a purulent material. What is the most likely cause?
A. Infection with Staphylococcus aureus
19 A
B. Discharging haematoma
C. Infection with Pseudomonas
D. Infection with Streptococcus pyogenes
E. Infection with Bacteroide
An enthusiastic watercress farmer is admitted with a protracted history of
severe abdominal pain, fevers and progressive jaundice. Imaging with
ultrasound shows mildly dilated bile ducts with hyperechoic areas within
them. What is the most likely cause?
20 A. Fasciola hepatica A
B. Clonrochis sinesis
C. Entamoeba histiolytica
D. Viral hepatitis
E. Leptospirosis
A 22 year old female is admitted to A&E with a splenic rupture. She has
not been involved in any trauma. What infection can cause spontaneous
splenic rupture?
A. Measles
21 D
B. Mumps
C. Influenza
D. Epstein-Barr virus
E. Rubella
A group of consultant surgeons are meeting at a symposium. The chef
preparing the canapes has an infection on his finger. Approximately 40
22 A
minutes after eating the canapes the group are struck down with severe
vomiting. What is the most likely underlying explanation for this process?

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A. Presence of enterotoxin from Staphylococcus aureus in the food

B. Presence of enterotoxin from Streptococcus pyogenes in the food
C. Infection with Campylobacter jejuni
D. Presence of enterotoxin from Clostridium perfringens in the food
E. Infection with Shigella soneii
What is the mechanism of action of macrolides?
A. Causes misreading of mRNA
B. Interferes with cell wall formation
23 E
C. Inhibits DNA synthesis
D. Inhibits RNA synthesis
E. Inhibits protein synthesis
A 22 year old lady is breastfeeding her first child. One week post partum
she presents with a tender indurated mass in the right breast. Infection
with which of the following is most likely?
A. Staphylococcus aureus
24 A
B. Streptococcus pyogenes
C. Streptococcus bovis
D. Klebsiella
E. Streptococcus viridans
A 58 year old man is reviewed in the clinic following a successful
cadaveric renal transplant the previous year. He has been able to return to
work as a swimming instructor. Over the past week he reports that he has
been suffering from recurrent episodes of diarrhoea. It has made him feel
lethargic and exhausted. Stool microscopy shows evidence of cysts. What
25 is the most likely source of infection? E
A. Enterobius vermicularis
B. Clonorchis sinensis
C. Giardia
D. Ascaris lumbricoides
E. Cryptosporidium
A 22 year old Chef presents with abdominal pain in the right iliac fossa.
There is an associated temperature and diarrhoea. The CT1 takes the
patient to theatre for an appendicectomy, but the appendix appears
26 normal. The terminal ileum appears thickened and engorged. Infection A
with which of the following is most likely?
A. Yersinia enterocolitica
B. Yersinia pestis

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C. Salmonella
D. Vibrio cholera
E. Entero invasive E Coli
Which of the following is true regarding the Salmonella species?
A. Rose spots appear in all patients with typhoid
B. They are normally present in the gut as commensals
27 D
C. Subsequent chronic biliary infection occurs in 75% of cases
D. A relative bradycardia is often seen in typhoid fever
E. Salmonella typhi can be categorised into type A, B and C
A 77-year-old female presents with a non-healing ulcer on her right foot.
Blood cultures grow MRSA. Which antibiotic would you consider in
addition to vancomycin to cover this?
A. Flucloxacillin
28 E
B. Ceftazidime
C. Ciprofloxacin
D. Metronidazole
E. Rifampicin
A 48 year old lady undergoes an ERCP for jaundice. 36 hours following
the procedure she develops a fever and rigors. A blood culture is taken,
which of the following organisms is most likely to be cultured?
A. Pseudomonas aeruginosa
29 E
B. Streptococcus
C. Enterobacter
D. Staphylococcus
E. Escherichia coli
In a 72 year old man undergoing a sigmoid colectomy for diverticular
disease, which of the following interventions is most likely to reduce his
risk of developing a post operative wound infection?
A. Using a plain clear incise type drape to cover the operative field
30 B. Administering mechanical bowel preparation pre operatively D
C. Shaving his abdominal wall one day prior to surgery
D. Administration of single dose of broad spectrum antibiotics prior to
the procedure
E. None of the above
A 27-year-old male presents to urology for investigation of
31 pyelonephritis. He reports malaise, pyrexia, lymphadenopathy and a C
maculopapular rash. The Monospot test is negative. Given a history of

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recent high-risk sexual behaviour you are asked to exclude a HIV

seroconversion illness. What is the most appropriate investigation?
A. Antibodies to HIV-2
B. gp120 polymerase chain reaction
C. p24 antigen test
D. CCR5 polymerase chain reaction
E. Antibodies to HIV-1
A 22 year old man presents with a 5 day history of sore throat, malaise
and fatigue. On examination, he has a large peritonsillar abscess. What is
the most likely underlying infective organism?
A. Epstein Barr Virus
32 B
B. Streptococcus pyogenes
C. Cytomegalovirus
D. Moraxella catarrhalis
E. Streptococcus viridans
Which of the following statements relating to osteomyelitis is false?
A. Is the result of haematogenous spread in most cases
B. Is due to Staphylococcus aureus in 50% cases
33 C. Should be treated by aggressive surgical debridement initially C
D. Plain radiographs may be normal in the early stages
E. The presence of associated septic joint involvement will
significantly alter management
A 32 year old woman undergoes mastectomy and latissimus dorsi flap
reconstruction for breast cancer, to provide optimal cosmesis a McGhan
implant is placed under the myocutaneous flap. Three weeks post
operatively the patient continues to suffer from recurrent wound
infections that have proved resistant to multiple courses of antibiotics.
34 Which of the organisms listed below is most likely to be responsible? A
A. Staphylococcus epidermidis
B. Staphylococcus aureus
C. Streptococcus viridians
D. Streptococcus pyogenes
E. Staphylococcus saprophyticus
A 48 year old lady is admitted with crampy abdominal pain and
diarrhoea. She has been unwell for the past 12 hours. In the history she
35 B
complains that her milk bottles have been pecked repeatedly by birds, she
otherwise has had no dietary changes. Which of the following is the most

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likely causative organism?

A. Staphylococcus aureus
B. Campylobacter jejuni
C. Clostridium difficile
D. Norovirus
E. Clostridium botulinum
A 50-year-old female with a history of rheumatoid presents with a
suspected septic knee joint. A diagnostic aspiration is performed and sent
to microbiology. Which of the organisms below is most likely to be
responsible?
36 A. Staphylococcus aureus A
B. Staphylococcus epidermidis
C. Escherichia coli
D. Neisseria gonorrhoeae
E. Streptococcus pneumoniae
A 22 year old man presents with crampy abdominal pain diarrhoea and
bloating. He has just returned from a holiday in Egypt. He had been
swimming in the local pool a few weeks ago. He reports that he is
opening his bowels 5 times a day. The stool floats in the toilet water, but
there is no blood. What is the most likely cause?
37 E
A. Cryptosporidium
B. Salmonella sp
C. E.coli sp
D. Chronic pancreatitis
E. Giardia lamblia
A 6 year old boy presents with symptoms of recurrent pruritus ani. On
examination, there is evidence of a small worm like structure protruding
from the anus. What is the most likely infective organism?
A. Echinococcus granulosus
38 B
B. Enterobius vermicularis
C. Ascaris lumbricoides
D. Ancylostoma duodenale
E. Clonorchis sinensis
A 54-year-old female is admitted one week following a cholecystectomy
with profuse diarrhoea. Apart from a minor intra-operative bile spillage
39 C
incurred during removal of the gallbladder, the procedure was
uncomplicated. What is the most likely diagnosis?

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A. Campylobacter infection
B. E. coli infection
C. Clostridium difficile infection
D. Salmonella infection
E. Pelvic abscess
Which of the following is not a feature of Campylobacter jejuni infection?
A. Infection may present in a similar manner to acute appendicitis
B. Pyrexia is unusual
40 C. They are gram negative organisms B
D. Infection accounts for 26% case of Guillain-Barre syndrome
E. It is the commonest cause of infective diarrhoea arising from non
viral causes
A 68 year old women with previous rheumatic fever is admitted with
pyrexia of unknown origin. Her blood cultures are unhelpful but
transoesophageal echocardiography reveals vegetations on the mitral
valve. Infection with which of the following organisms is most likely?
41 A. Staphylococcus aureus C
B. Streptococcus pyogenes
C. Streptococcus viridans
D. Staphyloccus epidermidis
E. Staphylococcus saprophyticus
A 53-year-old woman is diagnosed with cellulitis surrounding her leg
ulcer. A swab is taken and oral flucloxacillin is started. The following
result is obtained:

Skin Group A
swab: streptococcus
42 D
How should the antibiotic therapy be adjusted?
A. No change
B. Add topical fusidic acid
C. Add clindamycin
D. Add penicillin
E. Add erythromycin
Which of the following statements related to necrotising fasciitis is false?
43 C
A. Mainly polymicrobial

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B. A feature may include 'dirty dishwater fluid' in the wound

C. The presence of crepitus is needed to make the diagnosis
D. Further surgery is mandatory 24-48h after initial surgery to review
extension of infection
E. The muscles are relatively spared
A surgical trainee is incising a groin "abscess" in an intravenous drug
abuser. Unfortunately the "abscess" is a false aneurysm and torrential
bleeding ensues. In the panic of the situation the doctor then stabs himself
in the finger. It transpires that the patient is a Hepatitis B carrier and the
doctor is not immunised! What type of virus is Hepatitis B?
44 A
A. Double stranded DNA virus
B. Single stranded DNA virus
C. Double stranded RNA virus
D. Single stranded RNA virus
E. Retrovirus
What is the commonest cause of an amoebic liver abscess?
A. Hydatid disease
B. Clonorchiasis
45 C
C. Entamoeba histolytica
D. Fasicola hepatica
E. Giardia
A 23 year old man is readmitted following a difficult appendicectomy.
His wound is erythematous and, on incision, foul smelling pus is drained.
Which of the organisms listed below is responsible?
A. Steptococcus bovis
46 B
B. Bacteroides fragilis
C. Staphylococcus aureus
D. Streptococcus pyogenes
E. Clostridium perfringens
A 72 year old man with peripheral vascular disease develops a
gangrenous toe. This becomes infected and there is evidence of infection
in the surrounding tissues. On clinical palpation there is crepitus present
within the tissues. What is the most likely infective organism?
47 D
A. Staphylococcus aureus
B. Streptococcus pyogenes
C. Clostridium difficile
D. Clostridium perfringens

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E. Clostridium botulinum
Which virus is implicated in cervical carcinoma?
A. Human papilloma virus 16
B. Human papilloma virus 2
48 A
C. Human herpes virus 8
D. Human herpes virus 2
E. Epstein-Barr virus
A young woman is admitted to hospital with E-coli 0157 after visiting
Germany during an outbreak. Which of the following is not true of the
condition?
A. It may be complicated by micro-angiopathic haemolytic anaemia.
49 B. Adults typically develop haemolytic uraemic syndome. B
C. It is most commonly transmitted by consumption of contaminated
food.
D. Plasmids typically confer antibiotic resistance.
E. E-Coli is a gram negative organism.
What is the risk of a wound infection in a male undergoing a Hartmanns
procedure for perforated sigmoid diverticular disease?
A. 35%
50 B. 15% A
C. 10%
D. 20%
E. 80%
A 22 year old man returns to the UK from holiday in India. He presents
with painless jaundice. On examination he is not deeply jaundiced and
there is no organomegaly. What is the most likely cause?
A. Hepatitis E infection
51 B
B. Hepatitis A infection
C. Malaria
D. Gilberts syndrome
E. Gallstones
A 25 year old man returns from a backpacking holiday in India. He
presents with symptoms of coughing and also of episodic abdominal
discomfort. Peri anal examination is normal. Stool microscopy
52 D
demonstrates both worms and eggs within the faeces. What is the most
likely infective organism?
A. Cryptosporidium

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B. Ancylostoma duodenale
C. Clonorchis sinensis
D. Ascaris lumbricoides
E. Enterobius vermicularis
Which statement relating to actinomycosis is false?
A. They are gram positive bacilli
B. They are strict aerobes
53 B
C. It may be a cause of chronic multiple abscesses
D. Abdominal cases may develop in the appendix
E. Open biopsy of the lesions is the best diagnostic test
54 A 48 year old women presents with recurrent loin pain and fevers. B
Investigation reveals a staghorn calculus of the left kidney. Infection with
which of the following organisms is most likely?
A. Staphylococcus saprophyticus
B. Proteus mirabilis
C. Klebsiella
D. E-Coli
E. Staphylococcus epidermidis
55 Which of the following statements relating to gas gangrene is untrue? C
A. There is necrosis with putrefaction
B. The causative pathogens may be detected on normal perineal skin
C. Treatment with low dose penicillin is indicated
D. Hyperbaric oxygen may be beneficial
E. Clostridium perfringens is a recognised cause

EMRCS, Microbiology ۱۳ MRCS I.V. Course