1. Year 2 Revision * = best answer

3. These organisms are: Gram positive bacilli Gram positive cocci*
Gram negative bacilli
Gram negative cocci

4. They are:
Streptococci*
Staphylococci
Coliforms
Neisseria

6. These organisms are:
Streptococci
Staphylococci
Coliforms*
Neisseria

7. Gastrointestinal infection
A 21 year old medical student develops abdominal pain and diarrhoea 48 hours after eating a meal containing chicken and rice from a “dodgy” fast food shop. There is also blood the stool.

8. Which is the most likely infecting organism?
Salmonella enteritidis
Campylobacter sp.*
E.coli O157
Shigella sonnei

9. Which treatment would you recommend?
Metronidazole
Erythromycin
Ciprofloxacin
Symptomatic treatment only*

10. When would it be appropriate to prescribe an antibiotic?
If the diarrhoea lasts longer than 1 week
If the patient has severe abdominal pain
If the patient's mother demands it
If there are signs of systemic illness*

11. What is the most likely vehicle of Campylobacter infection?
Undercooked chicken*
Undercooked beef
Unpasteurised milk
Reheated rice

12. If the rice had been the vehicle of infection, which organism would you suspect?
Clostridium perfringens
Staph aureus
Bacillus cereus*
E coli O157

13. When should the medical student return to his classes (which involve him examining patients on the wards at Ninewells)?
When the vomiting stops, even if he has mild diarrhoea
When all his symptoms have completely settled
24 hours after his symptoms have settled
48 hours after his symptoms have settled*

14. An elderly lady on a care of the elderly ward develops diarrhoea 1 week after finishing a course of antibiotics for a chest infection
No-one else on the ward has diarrhoea or vomiting

15. What is the most likely infecting organism?
Clostridium difficile*
Salmonella typhimurium
Norovirus
Campylobacter sp.

16. Which antibiotic would you give?
Ciprofloxacin
Vancomycin
Metronidazole*
No antibiotics

17. How should the antibiotic be given?
Intravenously
Intramuscularly
Orally*

18. A 20 year old student returns from his gap year travelling around the world with intermittent diarrhoea, abdominal discomfort and “bloating”. The organism shown is seen on microscopy of jejeunal aspirate

19. This organism is:
A bacterium
A virus
A parasite*
A fungus

20. The recommended treatment is:
Ciprofloxacin
Metronidazole*
Vancomycin
None

21. A 30 year old male is admitted to hospital with jaundice and some R upper quadrant abdominal discomfort. His liver function tests show raised transaminases, but not an obstructive jaundice picture. Abdominal ultrasound rules out gallstones and liver abscesses. You suspect he may have infectious hepatitis.
He visited India on business 1 month previously and this involved travel to rural areas

22. Which is the most likely cause?
Hepatitis A*
Hepatitis B
Hepatitis C
Hepatitis E

23. By which route is this virus transmitted?
Blood-blood spread
Direct contact
Faecal-oral route*
Vertical spread

24. What is the incubation period for Hepatitis A?
2 – 6 days
2 – 6 weeks*
2 – 6 months

25. Which viruses are NOT spread by the faecal oral route?
Hepatitis A,B,C,D
Hepatitis B,C,D*
Hepatitis B,C,E

26. A man who attends a hepatology out-patient clinic has Hepatitis B serology as follows:
HBsAg negative
HBsAb positive
HBcAb positive
(all other markers are negative)

27. These results mean: He has been immunised and is immune
He is a highly infectious carrier of Hep B
He is immune because he has had Hepatitis B in the past*

28. Which organisms make up bowel flora?
Coliforms,enterococci,anaerobes*
Coliforms,streptococci,anaerobes
Coliforms,enterococci,aerobes
Coliforms,anaerobes

29. Which antibiotics are best for the treatment of intra-abdominal sepsis?
Cefuroxime and metronidazole
Cefuroxime,co-amoxiclav, metronidazole
Gentamicin and metronidazole
Amoxicillin,gentamicin, metronidazole*

30. Why are 3 antibiotics given?
For their synergistic effect
To cover a wide range of organisms*
To prevent the development of resistance

31. Urinary tract infection
A 30 year old female attends your GP complaining of dysuria and frequency for 2 days.
Her urine dipstick test is positive for protein, leucocytes and nitrites and the organism shown is seen on urgent microscopy of her urine

32. What is the most likely infecting organism?
Proteus sp.
Staph. saprophyticus
Escherichia coli*
Klebsiella sp.

33. Which antibiotic would you choose?
Co-amoxiclav
Amoxicillin
Ciprofloxacin
Trimethoprim*

34. Which antibiotic would be suitable if the patient were penicillin hypersensitive?
Erythromycin
Trimethoprim*
Cefuroxime
Co-amoxclav

35. Where has the infection come from?
Patient's own bacterial flora*
The normal bladder flora
Hands of nursing staff
From infected equipment

36. Which indicates a significant bacteriuia?
1,000 organisms per ml
10,000 organisms per ml
100,000 organisms per ml*
1,000,000 organisms per ml

37. A 45 year old man is admitted with fever acute onset severe R sided back pain and is thought clinically to have a kidney stone. This diagnosis is later confirmed by a imaging of his R kidney and ureter. Dipstick testing of his urine shows the presence of protein, blood leucocytes and nitrites and culture of urine confirms he has a UTI.

38. Which organism is particularly associated with renal calculi?
Klebsiella sp.
Escherichia coli
Group B Streptococcus
Proteus sp.*

39. Which antibiotic treatment would you choose for this patient?
Trimethoprim
Nitrofurantoin
Cephalexin
Amoxicillin and gentamicin*

40. A 25 year old pregnant female attends for her first ante-natal appointment at hospital. She complains of no symptoms. A mid-stream specimen of urine is sent to the Microbiology lab and grows >105 organisms/ml of E. coli on culture.

41. Which of the following does she have?
Urinary tract infection
Abacterial cystitis
Aymptomatic bacteriuria*

42. Should she receive antibiotic treatment?
Yes* No
Only if she develops symptoms of a UTI

43. Bone and Joint Infection
A 60 year old previously healthy male is admitted to the orthopaedic ward with a fever and a hot swollen knee joint. You suspect he has septic arthritis and send a blood culture and an aspirate from the knee to Microbiology. The knee aspirate Gram film result is telephoned back to you as “Many polymorphs and a few Gram positive cocci in clusters seen”.

44. Which is the most likely infecting organism?
Staphylococcus aureus*
Staphylococcus epidermidis
Streptococcus pneumoniae
Streptococcus pyogenes

45. Which antibiotic would you give?
Penicillin
Flucloxacillin*
Vancomycin
Ciprofloxacin

46. How should the antibiotic be given initially?
Orally
IV*

47. A 78 year old man develops a hot swollen knee joint 12 weeks after a prosthetic joint has been inserted. You suspect infection in the prosthetic joint.
Gram film of joint aspirate shows this organism

48. Which is the most likely infecting organism?
Staphylococcus aureus
Staphylococcus epidermidis*
Streptococcus pneumoniae
Streptococcus pyogenes

49. Which antibiotic would you choose?
Penicillin
Vancomycin*
Gentamicin
Flucloxacillin

50. Why are the coagulase negative Staphs particularly associated with infection in prosthetic material?
Because they produce toxins
Because they produce spores
Because they produce “slime”*
Because they are resistant to antibiotics

51. Respiratory
An 80 year old male is admitted to hospital with a severe community-acquired pneumonia (CAP). The organism shown was seen on microscopy of sputum

52. Which is the likely infecting organism?
Escherichia coli
Streptococcus pneumoniae*
Mycoplasma pneumoniae
Legionella pneumophila

53. Which is the best microbiology specimen to send in order to make this diagnosis?
Blood culture*
Sputum*
Clotted blood for serology
Urine for antigen detection

54. Which antibiotic(s) would you use to treat severe CAP empirically?
Amoxicillin
Co-amoxiclav and gentamicin
Co-amoxiclav and clarythromycin*
Clarythromycin and gentamicin

55. Why are 2 antibiotics given?
For their synergistic effect
To cover a wide range of organisms*
To prevent the development of resistance

56. Which antibiotic would you choose if he is hypersensitive to penicillin?
Gentamicin
Levofloxacin*
Erythromycin
Ciprofloxacin

57. Which is NOT an"atypical" pneumonia organism?
Legionella pneumophila
Moraxella catarrhalis*
Mycoplasma pneumoniae
Chlamydia psittaci

58. A 40 year old previously healthy female is admitted to hospital with a 3 day history of cough, fever and worsening shortness of breath.
Her husband recently was diagnosed with influenza A and you suspect she now has it too

59. Which is the best specimen for rapid diagnosis?
Throat swab*
Induced sputum specimen
Nasopharyngeal aspirate
Pernasal swab

60. Who should receive influenza vaccine?
Healthy elderly patients
People with COPD
Patients with HIV
All of the above*

61. What do "H" and "N" stand for in H1N1?
Haematinic and neurotoxin
Haemagglutinin and neuraminidase*
Hamolysin and neurotropic

62. A 70 year old female has a 3 month history of chronic cough despite 2 courses of antibiotics, fever at night and has lost 10kg weight. You send sputum to the lab and the organism shown is seen on microscopy

63. What type of film is this?
Gram film
Ziehl-Neelson film*
Haematoxylin and eosin

64. What is the name of the causal organism?
Mycoplasma tuberculosis
Mycobacterium tuberculosis*
Mycobacterium tuberculi
Mycoplasma tuberculum

65. What is the best specimen for diagnosis?
Blood culture
Sputum*
Throat swab
Early morning urine

66. Treatment of TB
Having discussed this with colleagues, most patients now are started on 4 anti-TB drugs; rifampicin, isoniazid, pyrazinamide and ethambutol.
(4for 2 followed by 4 for 4)
Sorry for any confusion.

67. Why are 4 antibiotics given?
For their synergistic effect
To cover a wide range of organisms
To prevent the development of resistance*