MICROBIOLOGY QUARTER 1 • C.

Clostridium botulinum
• D. Clostridium perfringens
Answer: D. Clostridium perfringens
CHAPTER 11: SPORE-FORMING GRAM-POSITIVE
BACILLIA: BACILLUS AND CLOSTRIDIUM SPECIES 8. The neurotoxin produced by Clostridium botulinum causes:
• A. Spastic paralysis
1. Which of the following is the most common pathogen among • B. Flaccid paralysis
the Bacillus species? • C. Cardiac arrest
• A. Bacillus anthracis • D. Hypotension
• B. Bacillus cereus Answer: B. Flaccid paralysis
• C. Bacillus subtilis
• D. Bacillus megaterium 9. Which Clostridium species is associated with antibiotic-
Answer: A. Bacillus anthracis associated diarrhea and pseudomembranous colitis?
• A. Clostridium tetani
2. Bacillus anthracis causes disease primarily through the • B. Clostridium botulinum
production of: • C. Clostridium difficile
• A. Exotoxins • D. Clostridium perfringens
• B. Endotoxins Answer: C. Clostridium difficile
• C. Lipopolysaccharide
• D. Capsule 10. Which Bacillus species is commonly associated with food
Answer: A. Exotoxins poisoning due to improperly cooked rice?
• A. Bacillus anthracis
3. Which of the following forms of anthrax is the most lethal if • B. Bacillus subtilis
untreated? • C. Bacillus cereus
• A. Cutaneous anthrax • D. Bacillus megaterium
• B. Inhalational anthrax Answer: C. Bacillus cereus
• C. Gastrointestinal anthrax
• D. Injectional anthrax 11. Which component of Bacillus anthracis is required for its
Answer: B. Inhalational anthrax virulence?
• A. Polypeptide capsule
4. The toxin of Bacillus cereus that causes vomiting is best • B. Endotoxin
described as: • C. Pili
• A. Emetic toxin • D. Flagella
• B. Enterotoxin Answer: A. Polypeptide capsule
• C. Neurotoxin
• D. Cytotoxin 12. Which of the following is true regarding Clostridium
Answer: A. Emetic toxin botulinum spores?
• A. They are easily killed by heat
5. Which Clostridium species is primarily responsible for • B. They are resistant to heat and can survive
tetanus? standard cooking temperatures
• A. Clostridium botulinum • C. They do not produce toxins
• B. Clostridium tetani • D. They are non-infectious
• C. Clostridium perfringens Answer: B. They are resistant to heat and can survive standard
• D. Clostridium difficile cooking temperatures
Answer: B. Clostridium tetani
13. Which of the following toxins inhibits the release of
6. What is the mechanism of action of the tetanus toxin? acetylcholine at neuromuscular junctions?
• A. Inhibits acetylcholine release • A. Tetanus toxin
• B. Inhibits inhibitory neurotransmitter release • B. Botulinum toxin
• C. Activates T-cells • C. Anthrax toxin
• D. Stimulates the immune system • D. Alpha toxin
Answer: B. Inhibits inhibitory neurotransmitter release Answer: B. Botulinum toxin

7. Which species is the most common cause of gas gangrene? 14. In what form of anthrax do the characteristic black eschar
• A. Clostridium tetani lesions appear?
• B. Clostridium difficile • A. Inhalational anthrax
• B. Cutaneous anthrax
 • C. Gastrointestinal anthrax Answer: A. Formation of gas bubbles in tissues
• D. Injectional anthrax
Answer: B. Cutaneous anthrax 22. What is the primary treatment for tetanus?
• A. Antibiotics alone
15. The major virulence factor for Clostridium difficile is: • B. Tetanus immunoglobulin and muscle relaxants
• A. Alpha toxin • C. Antiviral drugs
• B. Toxin A and Toxin B • D. Antitoxin and antibiotics
• C. Neurotoxin Answer: B. Tetanus immunoglobulin and muscle relaxants
• D. Botulinum toxin
Answer: B. Toxin A and Toxin B 23. Clostridium difficile infections are often associated with the
use of:
16. Which Clostridium species produces an exotoxin known as • A. Antivirals
alpha-toxin, which has phospholipase C activity? • B. Antibiotics
• A. Clostridium perfringens • C. Antifungals
• B. Clostridium botulinum • D. Vaccinations
• C. Clostridium tetani Answer: B. Antibiotics
• D. Clostridium difficile
Answer: A. Clostridium perfringens 24. The primary target of the anthrax toxin's lethal factor is:
• A. Cardiovascular system
17. How is anthrax most commonly transmitted to humans? • B. Immune cells
• A. Person-to-person transmission • C. Neuromuscular junction
• B. Ingestion of contaminated food • D. Gastrointestinal tract
• C. Inhalation of spores Answer: B. Immune cells
• D. Direct contact with an infected person
Answer: C. Inhalation of spores 25. Which of the following Clostridium species is associated
with food poisoning due to consumption of improperly canned
18. Which of the following conditions is caused by Clostridium foods?
difficile infection? • A. Clostridium botulinum
• A. Tetanus • B. Clostridium tetani
• B. Botulism • C. Clostridium perfringens
• C. Pseudomembranous colitis • D. Clostridium difficile
• D. Anthrax Answer: A. Clostridium botulinum
Answer: C. Pseudomembranous colitis
26. Bacillus anthracis is a Gram-positive, spore-forming
19. Bacillus cereus causes two types of foodborne illnesses: bacillus. Which staining technique is most useful for identifying
emetic and diarrheal. Which type is associated with rice its spores?
consumption? • A. Gram stain
• A. Emetic • B. Acid-fast stain
• B. Diarrheal • C. Endospore stain
• C. Neurotoxic • D. Capsule stain
• D. None of the above Answer: C. Endospore stain
Answer: A. Emetic
27. Clostridium tetani spores are typically introduced into the
20. The botulinum toxin acts by blocking the release of which body via:
neurotransmitter? • A. Inhalation
• A. Dopamine • B. Skin puncture wounds
• B. Serotonin • C. Ingestion of contaminated food
• C. Acetylcholine • D. Blood transfusion
• D. GABA **Answer: B. Skin
Answer: C. Acetylcholine 28. Which of the following is a notable characteristic of Bacillus
anthracis under the microscope?
21. What is the main characteristic of gas gangrene caused by • A. Bamboo stick appearance
Clostridium perfringens? • B. Curved rod shape
• A. Formation of gas bubbles in tissues • C. Clustered cocci
• B. Inflammation of the nerves • D. Flagellated bacilli
• C. Flaccid paralysis Answer: A. Bamboo stick appearance
• D. High fever with rash
29. Which of the following Clostridium species is often Answer: A. Listeria monocytogenes
implicated in nosocomial infections?
• A. Clostridium botulinum 6. Which medium is most commonly used for culturing
• B. Clostridium perfringens Corynebacterium diphtheriae?
• C. Clostridium difficile • A. Löwenstein-Jensen medium
• D. Clostridium tetani • B. Tellurite agar
Answer: C. Clostridium difficile • C. Chocolate agar
• D. MacConkey agar
30. The anthrax toxin's edema factor primarily causes: Answer: B. Tellurite agar
• A. Fluid accumulation
• B. Neurological impairment 7. Which bacterial species causes respiratory diphtheria,
• C. Immune suppression characterized by a grayish pseudomembrane in the throat?
• D. Tissue necrosis • A. Corynebacterium diphtheriae
Answer: A. Fluid accumulation • B. Listeria monocytogenes
• C. Mycobacterium tuberculosis
CHAPTER 12: NON-SPORE-FORMING GRAM-POSITIVE • D. Bacillus cereus
BACILLI Answer: A. Corynebacterium diphtheriae
1. Which of the following bacteria is a common cause of
neonatal meningitis? 8. What is the main mechanism of action of the diphtheria
• A. Listeria monocytogenes toxin?
• B. Corynebacterium diphtheriae • A. Inhibition of protein synthesis
• C. Bacillus cereus • B. Destruction of cell membranes
• D. Clostridium perfringens • C. Inhibition of acetylcholine release
Answer: A. Listeria monocytogenes • D. Destruction of cAMP signaling
Answer: A. Inhibition of protein synthesis
2. Which of the following organisms is known for its
characteristic "tumbling motility"? 9. Which of the following is the recommended treatment for
• A. Listeria monocytogenes diphtheria?
• B. Corynebacterium diphtheriae • A. Antitoxin and antibiotics
• C. Lactobacillus species • B. Vaccination only
• D. Bacillus anthracis • C. Supportive care only
Answer: A. Listeria monocytogenes • D. Antibiotics alone
Answer: A. Antitoxin and antibiotics
3. Listeria monocytogenes primarily invades which type of cells
to spread in the body? 10. In addition to respiratory diphtheria, Corynebacterium
• A. Red blood cells diphtheriae can cause:
• B. Epithelial cells • A. Cutaneous diphtheria
• C. Macrophages • B. Listeriosis
• D. Lymphocytes • C. Gas gangrene
Answer: C. Macrophages • D. Tetanus
Answer: A. Cutaneous diphtheria
4. Which of the following is a major virulence factor of Listeria
monocytogenes that allows it to escape from the phagosome? 11. A 3-year-old child presents with a sore throat, fever, and a
• A. Listeriolysin O thick grayish membrane covering the tonsils and pharynx.
• B. Diphtheria toxin What is the most likely diagnosis?
• C. Alpha toxin • A. Diphtheria
• D. Botulinum toxin • B. Streptococcal pharyngitis
Answer: A. Listeriolysin O • C. Scarlet fever
• D. Epiglottitis
5. A 25-year-old pregnant woman contracts a febrile illness Answer: A. Diphtheria
after consuming soft cheeses. The causative organism is most
likely: 12. Which of the following bacterial species is a common
• A. Listeria monocytogenes inhabitant of the normal gastrointestinal tract but can cause
• B. Corynebacterium diphtheriae endocarditis in immunocompromised individuals?
• C. Staphylococcus aureus • A. Lactobacillus species
• D. Clostridium perfringens • B. Corynebacterium diphtheriae
• C. Listeria monocytogenes
 • D. Clostridium difficile • C. Anaerobic metabolism only
Answer: A. Lactobacillus species • D. Production of exotoxin A
Answer: A. Facultative intracellular growth
13. The clinical presentation of listeriosis in a neonate includes
all of the following EXCEPT: 20. A newborn presents with sepsis shortly after birth. The
• A. Meningitis mother had a flu-like illness during the third trimester. What is
• B. Sepsis the most likely causative organism?
• C. Skin rash • A. Listeria monocytogenes
• D. Pneumonia • B. Escherichia coli
Answer: C. Skin rash • C. Group B Streptococcus
• D. Staphylococcus aureus
14. Which of the following populations is most at risk for Answer: A. Listeria monocytogenes
developing severe listeriosis?
• A. Pregnant women 21. Which of the following organisms is known to grow at
• B. Healthy adults refrigeration temperatures (4°C)?
• C. Children over 5 years old • A. Listeria monocytogenes
• D. Elderly men • B. Corynebacterium diphtheriae
Answer: A. Pregnant women • C. Mycobacterium tuberculosis
• D. Bacillus anthracis
15. Which of the following is a key diagnostic feature of Answer: A. Listeria monocytogenes
Corynebacterium diphtheriae on a Gram stain?
• A. Club-shaped Gram-positive rods 22. The ability of Listeria monocytogenes to survive within host
• B. Long chains of Gram-positive cocci cells and spread between them is mediated by:
• C. Gram-negative diplococci • A. Actin-based motility
• D. Branching Gram-positive filaments • B. Flagellar motility
Answer: A. Club-shaped Gram-positive rods • C. Endospore formation
• D. Capsule formation
16. Which test is used to confirm the production of diphtheria Answer: A. Actin-based motility
toxin by Corynebacterium diphtheriae?
• A. Elek test 23. The primary treatment of choice for listeriosis is:
• B. Schick test • A. Ampicillin
• C. Quellung reaction • B. Ciprofloxacin
• D. Mantoux test • C. Clindamycin
Answer: A. Elek test • D. Vancomycin
Answer: A. Ampicillin
17. A 40-year-old immunocompromised patient presents with a
low-grade fever, malaise, and a faint erythematous rash after 24. Which of the following is a clinical feature of respiratory
consuming unpasteurized milk. What is the most likely diphtheria?
diagnosis? • A. Formation of a pseudomembrane in the throat
• A. Listeriosis • B. Severe muscle spasms
• B. Diphtheria • C. Bilateral facial paralysis
• C. Botulism • D. Diarrhea with blood and mucus
• D. Gas gangrene Answer: A. Formation of a pseudomembrane in the throat
Answer: A. Listeriosis
25. A pregnant woman is at risk of vertical transmission of
18. Which of the following is the most common route of which of the following non-spore-forming Gram-positive bacilli?
transmission for Listeria monocytogenes? • A. Listeria monocytogenes
• A. Ingestion of contaminated food • B. Corynebacterium diphtheriae
• B. Person-to-person contact • C. Clostridium tetani
• C. Inhalation of aerosolized bacteria • D. Clostridium difficile
• D. Vector-borne transmission Answer: A. Listeria monocytogenes
Answer: A. Ingestion of contaminated food
26. Corynebacterium diphtheriae exotoxin has its primary
19. Listeria monocytogenes exhibits which of the following effect on which cellular component?
characteristics? • A. Elongation factor 2 (EF-2)
• A. Facultative intracellular growth • B. DNA polymerase
• B. Strict extracellular growth • C. Cell membrane integrity
 • D. Acetylcholine release 3. Which of the following virulence factors of Staphylococcus
Answer: A. Elongation factor 2 (EF-2) aureus is responsible for causing toxic shock syndrome?
• A. Enterotoxins
27. Which of the following is a major preventive measure • B. Toxic shock syndrome toxin-1 (TSST-1)
against diphtheria? • C. Alpha-toxin
• A. DPT vaccine • D. Exfoliatin
• B. Oral polio vaccine Answer: B. Toxic shock syndrome toxin-1 (TSST-1)
• C. Bacille Calmette-Guerin (BCG) vaccine Explanation: TSST-1 is a superantigen that causes toxic shock
• D. Meningococcal vaccine syndrome by massive T-cell activation and cytokine release.
Answer: A. DPT vaccine
4. A 20-year-old woman presents with fever, vomiting, and
28. The organism responsible for diphtheria is classified as: diffuse erythematous rash after using tampons. What is the
• A. Gram-positive bacillus most likely pathogen?
• B. Gram-negative coccus • A. Staphylococcus aureus
• C. Acid-fast bacillus • B. Staphylococcus epidermidis
• D. Gram-positive coccus • C. Streptococcus pyogenes
Answer: A. Gram-positive bacillus • D. Neisseria gonorrhoeae
Answer: A. Staphylococcus aureus
29. Listeriosis is most commonly contracted through the Explanation: Staphylococcus aureus, producing TSST-1, is
ingestion of which of the following foods? associated with toxic shock syndrome in tampon users.
• A. Unpasteurized dairy products
• B. Contaminated water 5. Which of the following antibiotics is most appropriate for
• C. Raw shellfish treating methicillin-resistant Staphylococcus aureus (MRSA)
• D. Undercooked poultry infection?
Answer: A. Unpasteurized dairy products • A. Penicillin
• B. Methicillin
30. In listeriosis, which patient population is particularly • C. Vancomycin
susceptible to severe invasive disease? • D. Amoxicillin
• A. Immunocompromised individuals Answer: C. Vancomycin
• B. Healthy adults Explanation: MRSA is resistant to beta-lactam antibiotics and
• C. Adolescents is treated with vancomycin.
• D. Young children
Answer: A. Immunocompromised individuals 6. What enzyme produced by Staphylococcus aureus allows it
to break down penicillin?
CHAPTER 13: STAPHYLOCOCCUS • A. Catalase
1. Which of the following is the most common pathogen • B. Coagulase
associated with acute bacterial endocarditis? • C. Beta-lactamase
• A. Staphylococcus aureus • D. Protein A
• B. Streptococcus viridans Answer: C. Beta-lactamase
• C. Staphylococcus epidermidis Explanation: Beta-lactamase produced by Staphylococcus
• D. Enterococcus faecalis aureus breaks down penicillin and other beta-lactam
Answer: A. Staphylococcus aureus antibiotics.
Explanation: Staphylococcus aureus is the leading cause of
acute bacterial endocarditis, particularly in IV drug users. 7. Staphylococcus epidermidis is most commonly associated
with infections in which of the following?
2. Which feature is most characteristic of Staphylococcus • A. Skin and soft tissues
aureus? • B. Intravenous catheters and prosthetic devices
• A. Catalase-negative • C. Gastrointestinal tract
• B. Coagulase-positive • D. Lower respiratory tract
• C. Gram-negative Answer: B. Intravenous catheters and prosthetic devices
• D. Beta-lactamase-negative Explanation: Staphylococcus epidermidis is a common cause
Answer: B. Coagulase-positive of infections involving implanted medical devices.
Explanation: Staphylococcus aureus is coagulase-positive,
distinguishing it from other staphylococci. 8. Staphylococcus saprophyticus is primarily associated with
which clinical condition?
• A. Urinary tract infections (UTIs)
• B. Endocarditis
 • C. Toxic shock syndrome
• D. Osteomyelitis 14. The staphylococcal scalded skin syndrome (SSSS) is
Answer: A. Urinary tract infections (UTIs) primarily caused by which toxin?
Explanation: Staphylococcus saprophyticus is a common • A. Alpha-toxin
cause of UTIs, particularly in sexually active young women. • B. Exfoliatin
• C. Enterotoxin
9. Which structural component of Staphylococcus aureus helps • D. TSST-1
it evade the immune system by binding the Fc region of Answer: B. Exfoliatin
immunoglobulins? Explanation: Exfoliatin causes staphylococcal scalded skin
• A. Teichoic acids syndrome by cleaving desmoglein in the epidermis.
• B. Protein A
• C. Hyaluronidase 15. Which test differentiates Staphylococcus aureus from other
• D. Coagulase staphylococcal species?
Answer: B. Protein A • A. Catalase test
Explanation: Protein A binds the Fc region of IgG, preventing • B. Coagulase test
opsonization and phagocytosis. • C. Oxidase test
• D. Gram stain
10. What is the primary mechanism by which MRSA acquires Answer: B. Coagulase test
resistance to methicillin? Explanation: Staphylococcus aureus is coagulase-positive,
• A. Alteration of penicillin-binding proteins (PBP) while other staphylococcal species are coagulase-negative.
• B. Production of beta-lactamase
• C. Efflux pumps 16. Which of the following diseases is commonly caused by
• D. Increased permeability of the bacterial cell wall Staphylococcus epidermidis?
Answer: A. Alteration of penicillin-binding proteins (PBP) • A. Prosthetic valve endocarditis
Explanation: MRSA acquires resistance through the mecA • B. Toxic shock syndrome
gene, which encodes a modified PBP (PBP2a) that has a low • C. Gastroenteritis
affinity for beta-lactam antibiotics. • D. Osteomyelitis
Answer: A. Prosthetic valve endocarditis
11. Which of the following is a superantigen produced by Explanation: Staphylococcus epidermidis is a common cause
Staphylococcus aureus? of infections associated with prosthetic devices.
• A. Staphylococcal enterotoxins
• B. Beta-lactamase 17. Staphylococcus aureus food poisoning typically presents
• C. Leukocidin with which symptom?
• D. Hyaluronidase • A. Vomiting
Answer: A. Staphylococcal enterotoxins • B. Fever
Explanation: Staphylococcal enterotoxins are superantigens • C. Hematuria
that can cause food poisoning and systemic toxic effects. • D. Rash
Answer: A. Vomiting
12. A patient presents with boils and abscesses on the skin. Explanation: Staphylococcal food poisoning is caused by
What is the most likely causative organism? enterotoxins, which typically lead to nausea and vomiting.
• A. Staphylococcus aureus
• B. Streptococcus pyogenes 18. A newborn presents with erythema, blisters, and peeling
• C. Pseudomonas aeruginosa skin. Cultures grow Staphylococcus aureus. What is the most
• D. Escherichia coli likely diagnosis?
Answer: A. Staphylococcus aureus • A. Staphylococcal scalded skin syndrome (SSSS)
Explanation: Staphylococcus aureus is a common cause of • B. Impetigo
localized skin infections like abscesses and boils. • C. Bullous pemphigoid
• D. Erythema multiforme
13. Which of the following is the most common virulence factor Answer: A. Staphylococcal scalded skin syndrome (SSSS)
that allows Staphylococcus aureus to form abscesses? Explanation: SSSS is caused by exfoliative toxins produced by
• A. Coagulase Staphylococcus aureus, leading to widespread skin damage in
• B. Catalase newborns.
• C. Hyaluronidase
• D. Leukocidin 19. What role does Protein A play in Staphylococcus aureus
Answer: A. Coagulase infections?
Explanation: Coagulase helps Staphylococcus aureus form • A. Prevents phagocytosis by binding to Fc region of
fibrin clots, leading to abscess formation. antibodies
 • B. Destroys red blood cells • D. Pneumonia
• C. Activates complement system Answer: C. Endocarditis
• **D. Forms pus Explanation: Neutropenic patients with Staphylococcus aureus
Answer: A. Prevents phagocytosis by binding to Fc region of bacteremia are at high risk for endocarditis.
antibodies
Explanation: Protein A binds the Fc region of IgG, interfering 25. A young woman develops vomiting and diarrhea 4 hours
with opsonization and phagocytosis. after eating custard at a picnic. What is the likely cause?
• A. Staphylococcus aureus enterotoxin
20. Staphylococcus saprophyticus is typically resistant to which • B. Bacillus cereus emetic toxin
of the following antibiotics? • C. Clostridium perfringens toxin
• A. Novobiocin • D. Shigella dysenteriae
• B. Penicillin Answer: A. Staphylococcus aureus enterotoxin
• C. Vancomycin Explanation: Staphylococcal food poisoning occurs quickly
• D. Clindamycin (within 4-6 hours) after ingestion of pre-formed enterotoxin.
Answer: A. Novobiocin
Explanation: Staphylococcus saprophyticus is novobiocin- 26. Which of the following is the primary mechanism by which
resistant, differentiating it from Staphylococcus epidermidis. Staphylococcus epidermidis causes disease in patients with
implanted medical devices?
21. A 45-year-old man with a prosthetic knee joint develops a • A. Biofilm formation
low-grade fever and joint pain. Cultures grow Staphylococcus • B. Production of exotoxins
epidermidis. What is the appropriate treatment? • C. Hemolysin production
• A. Penicillin • **D. Protein A-mediated immune evasion
• B. Vancomycin with removal of the prosthetic device Answer: A. Biofilm formation
• C. Methicillin Explanation: Staphylococcus epidermidis forms biofilms on
• D. Amoxicillin-clavulanic acid medical devices, protecting it from host immune responses and
Answer: B. Vancomycin with removal of the prosthetic device antibiotics.
Explanation: Staphylococcus epidermidis often forms biofilms
on prosthetic devices, and removal of the device is required 27. A patient with Staphylococcus aureus bacteremia develops
along with antibiotic therapy. septic arthritis. Which joint is most commonly involved?
• A. Hip
22. Staphylococcus aureus produces hyaluronidase, which • B. Knee
facilitates which of the following actions? • C. Shoulder
• A. Breakdown of connective tissue • **D. Ankle
• B. Destruction of leukocytes Answer: B. Knee
• C. Formation of blood clots Explanation: The knee joint is the most common site of septic
• **D. Inhibition of complement arthritis caused by Staphylococcus aureus.
Answer: A. Breakdown of connective tissue
Explanation: Hyaluronidase degrades hyaluronic acid, allowing 28. A 25-year-old man presents with fever and a painful,
the spread of infection through tissues. swollen knee after a skin infection caused by Staphylococcus
aureus. What is the most likely diagnosis?
23. Staphylococcus aureus is associated with osteomyelitis • A. Osteomyelitis
due to which virulence factor? • B. Septic arthritis
• A. Hemolysins • C. Cellulitis
• B. Coagulase • D. Bursitis
• C. Leukocidin Answer: B. Septic arthritis
• **D. Protein A Explanation: Staphylococcus aureus is the most common
Answer: A. Hemolysins cause of septic arthritis, particularly after a skin infection.
Explanation: Hemolysins, particularly alpha-toxin, contribute to
the ability of Staphylococcus aureus to damage tissues and 29. What role does coagulase play in the pathogenesis of
cause osteomyelitis. Staphylococcus aureus?
• A. Promotes blood clot formation
24. A neutropenic patient develops Staphylococcus aureus • B. Breaks down clots
bacteremia. Which of the following complications is this patient • C. Destroys red blood cells
at risk for developing? • **D. Activates complement
• A. Septic arthritis Answer: A. Promotes blood clot formation
• B. Empyema Explanation: Coagulase converts fibrinogen to fibrin, promoting
• C. Endocarditis
blood clot formation and helping Staphylococcus aureus evade
immune responses. 5. Which complication is associated with untreated
Streptococcus pyogenes pharyngitis?
30. Staphylococcus aureus produces leukocidins, which are • A. Rheumatic fever
toxins that: • B. Glomerulonephritis
• A. Destroy leukocytes • C. Scarlet fever
• B. Inhibit phagocytosis • D. All of the above
• C. Break down collagen Answer: D. All of the above
• **D. Lyse red blood cells Explanation: Untreated Streptococcus pyogenes pharyngitis
Answer: A. Destroy leukocytes can lead to complications such as rheumatic fever,
Explanation: Leukocidins, such as Panton-Valentine leukocidin glomerulonephritis, and scarlet fever.
(PVL), kill leukocytes, weakening the host's immune response.
6. Streptococcus agalactiae is most commonly associated with:
CHAPTER 14: STREPTOCOCCUS • A. Pharyngitis
• B. Neonatal meningitis
• C. Otitis media
1. The primary virulence factor of Streptococcus pyogenes is: • D. Endocarditis
• A. M protein Answer: B. Neonatal meningitis
• B. Capsule Explanation: Streptococcus agalactiae (Group B
• C. Lipoteichoic acid Streptococcus) is a common cause of neonatal meningitis and
• D. Streptokinase sepsis.
Answer: A. M protein
Explanation: M protein is the major virulence factor of 7. Which of the following is a major virulence factor of
Streptococcus pyogenes, helping the bacteria resist Streptococcus pneumoniae?
phagocytosis. • A. M protein
• B. Hyaluronidase
2. Streptococcus pneumoniae can evade host defenses • C. Polysaccharide capsule
primarily due to: • D. Protein A
• A. Hyaluronidase Answer: C. Polysaccharide capsule
• B. Polysaccharide capsule Explanation: The polysaccharide capsule is the most important
• C. Streptolysin O virulence factor for Streptococcus pneumoniae, helping it
• D. DNase evade phagocytosis.
Answer: B. Polysaccharide capsule
Explanation: The polysaccharide capsule of Streptococcus 8. Which type of hemolysis is produced by Streptococcus
pneumoniae allows it to evade phagocytosis, making it highly pneumoniae on blood agar?
virulent. • A. Beta-hemolysis
• B. Alpha-hemolysis
3. The most common cause of bacterial pharyngitis is: • C. Gamma-hemolysis
• A. Streptococcus pyogenes • D. Double-zone hemolysis
• B. Streptococcus pneumoniae Answer: B. Alpha-hemolysis
• C. Streptococcus agalactiae Explanation: Streptococcus pneumoniae produces alpha-
• D. Enterococcus faecalis hemolysis on blood agar, which gives a greenish discoloration
Answer: A. Streptococcus pyogenes around colonies.
Explanation: Streptococcus pyogenes (Group A
Streptococcus) is the most common cause of bacterial 9. The drug of choice for treating Streptococcus pyogenes
pharyngitis (strep throat). pharyngitis is:
• A. Erythromycin
4. The rapid antigen detection test for strep throat detects: • B. Penicillin
• A. Streptolysin O • C. Vancomycin
• B. M protein • D. Ciprofloxacin
• C. Group A carbohydrate antigen Answer: B. Penicillin
• D. Capsule antigens Explanation: Penicillin remains the drug of choice for treating
Answer: C. Group A carbohydrate antigen Streptococcus pyogenes (Group A Streptococcus) pharyngitis.
Explanation: The rapid antigen detection test for strep throat
detects the Group A carbohydrate antigen of Streptococcus 10. Streptococcus pneumoniae is the most common cause of:
pyogenes. • A. Bacterial meningitis in adults
• B. Neonatal sepsis
 • C. Impetigo
• D. Urinary tract infections 16. Which of the following Streptococcus species is most
Answer: A. Bacterial meningitis in adults associated with dental caries?
Explanation: Streptococcus pneumoniae is a leading cause of • A. Streptococcus pneumoniae
bacterial meningitis in adults. • B. Streptococcus pyogenes
• C. Streptococcus mutans
11. The Quellung reaction is used to detect: • D. Streptococcus agalactiae
• A. M protein Answer: C. Streptococcus mutans
• B. Capsule swelling Explanation: Streptococcus mutans is a significant contributor
• C. Streptolysin O to dental caries by producing acids that demineralize tooth
• D. Hyaluronidase activity enamel.
Answer: B. Capsule swelling
Explanation: The Quellung reaction is used to detect the 17. The Lancefield grouping of streptococci is based on:
capsule of Streptococcus pneumoniae, which causes the • A. Hemolytic properties
capsule to swell and become more visible under a microscope. • B. Carbohydrate antigens in the cell wall
• C. Capsule composition
12. Streptococcus pyogenes can cause which of the following • D. Toxin production
skin infections? Answer: B. Carbohydrate antigens in the cell wall
• A. Impetigo Explanation: Lancefield grouping classifies streptococci based
• B. Cellulitis on specific carbohydrate antigens in their cell walls.
• C. Erysipelas
• D. All of the above 18. Enterococcus faecalis belongs to which Lancefield group?
Answer: D. All of the above • A. Group A
Explanation: Streptococcus pyogenes can cause various skin • B. Group B
infections, including impetigo, cellulitis, and erysipelas. • C. Group D
• D. Group G
13. Scarlet fever is caused by: Answer: C. Group D
• A. Exotoxin produced by Streptococcus pyogenes Explanation: Enterococcus faecalis is classified in Group D of
• B. Lipopolysaccharide produced by Streptococcus the Lancefield system.
pneumoniae
• C. Capsule of Streptococcus agalactiae 19. Streptococcus pneumoniae can be differentiated from other
• D. Endotoxin produced by Enterococcus faecalis alpha-hemolytic streptococci by its:
Answer: A. Exotoxin produced by Streptococcus pyogenes • A. Sensitivity to bacitracin
Explanation: Scarlet fever is caused by exotoxin-producing • B. Sensitivity to optochin
strains of Streptococcus pyogenes. • C. Resistance to bile
• D. Growth in high salt concentration
14. The main virulence factor of Streptococcus agalactiae that Answer: B. Sensitivity to optochin
facilitates colonization of the vagina is: Explanation: Streptococcus pneumoniae is optochin-sensitive,
• A. Fimbriae while other alpha-hemolytic streptococci are not.
• B. Capsule
• C. Lipoteichoic acid 20. The organism responsible for puerperal sepsis is:
• D. Streptokinase • A. Streptococcus pneumoniae
Answer: B. Capsule • B. Streptococcus pyogenes
Explanation: The capsule of Streptococcus agalactiae helps it • C. Enterococcus faecalis
evade phagocytosis and is important for its virulence. • D. Streptococcus mutans
Answer: B. Streptococcus pyogenes
15. Rheumatic fever is a result of: Explanation: Streptococcus pyogenes is historically known for
• A. Toxin-mediated injury causing puerperal sepsis, an infection of the reproductive tract
• B. Autoimmune reaction to Streptococcus pyogenes following childbirth.
antigens
• C. Direct invasion of heart tissues by the bacteria 21. What is the main cause of post-streptococcal
• D. Exotoxin production by Streptococcus agalactiae glomerulonephritis?
Answer: B. Autoimmune reaction to Streptococcus pyogenes • A. Immune complex deposition in the kidneys
antigens • B. Direct bacterial invasion of the kidneys
Explanation: Rheumatic fever results from an autoimmune • C. Exotoxin release in the bloodstream
reaction to Streptococcus pyogenes antigens that cross-react • D. Hyaluronic acid degradation
with human tissues, especially the heart.
Answer: A. Immune complex deposition in the kidneys 27. The CAMP test is used to identify:
Explanation: Post-streptococcal glomerulonephritis is caused • A. Streptococcus pneumoniae
by immune complex deposition in the kidneys following a • B. Streptococcus pyogenes
Streptococcus pyogenes infection. • C. Streptococcus agalactiae
• D. Enterococcus faecalis
22. Streptococcus pneumoniae is a leading cause of which of Answer: C. Streptococcus agalactiae
the following diseases? Explanation: The CAMP test is a confirmatory test for
• A. Otitis media identifying Streptococcus agalactiae (Group B Streptococcus).
• B. Meningitis
• C. Pneumonia 28. The drug of choice for treating invasive Streptococcus
• D. All of the above agalactiae infections is:
Answer: D. All of the above • A. Penicillin
Explanation: Streptococcus pneumoniae is a common cause of • B. Ciprofloxacin
otitis media, meningitis, and pneumonia, especially in young • C. Vancomycin
children and the elderly. • D. Erythromycin
Answer: A. Penicillin
23. The following virulence factor of Streptococcus pyogenes Explanation: Penicillin is the drug of choice for treating invasive
helps in spreading the infection by dissolving clots: infections caused by Streptococcus agalactiae.
• A. Streptokinase
• B. DNase 29. What is the characteristic feature of Enterococcus species
• C. Hyaluronidase in a laboratory setting?
• D. M protein • A. Resistance to bile
Answer: A. Streptokinase • B. Sensitivity to bacitracin
Explanation: Streptokinase helps Streptococcus pyogenes • C. Growth in 6.5% NaCl
spread through tissues by dissolving blood clots. • D. Alpha-hemolysis on blood agar
Answer: C. Growth in 6.5% NaCl
24. The streptococcal toxin responsible for the rash in scarlet Explanation: Enterococcus species can grow in 6.5% NaCl, a
fever is: distinguishing characteristic from other streptococci.
• A. Streptolysin O
• B. Pyrogenic exotoxin 30. Which of the following Streptococcus species is commonly
• C. DNase found in dental plaque and associated with endocarditis?
• D. Streptokinase • A. Streptococcus mutans
Answer: B. Pyrogenic exotoxin • B. Streptococcus agalactiae
Explanation: The rash in scarlet fever is caused by pyrogenic • C. Streptococcus pneumoniae
exotoxins produced by Streptococcus pyogenes. • D. Enterococcus faecalis
Answer: A. Streptococcus mutans
25. Streptococcus mutans is primarily associated with: Explanation: Streptococcus mutans, found in dental plaque,
• A. Sinusitis can enter the bloodstream and is associated with bacterial
• B. Dental caries endocarditis.
• C. Skin infections
• D. Neonatal sepsis CHAPTER 15: ENTERIC GRAM-NEGATIVE RODS
Answer: B. Dental caries 1.
Explanation: Streptococcus mutans is a key organism in the Which of the following is a common cause of traveler's
development of dental caries due to its acid production and diarrhea?
plaque formation. A) Salmonella enterica
B) Escherichia coli
26. Which test is used to detect previous Streptococcus C) Shigella dysenteriae
pyogenes infections? D) Vibrio cholerae
• A. ASO titer (Anti-streptolysin O titer) • Answer: B) Escherichia coli (specifically
• B. Blood culture Enterotoxigenic E. coli)
• C. Gram stain
• D. PCR 2.
Answer: A. ASO titer (Anti-streptolysin O titer) Which enteric pathogen is most commonly associated with
Explanation: The ASO titer is used to detect antibodies against undercooked poultry?
streptolysin O, indicating a recent or past Streptococcus A) Escherichia coli
pyogenes infection. B) Salmonella enterica
C) Shigella sonnei • Answer: C) Klebsiella pneumoniae
D) Yersinia enterocolitica
• Answer: B) Salmonella enterica 9.
Which enteric pathogen can cause a "rose spot" rash during
3. systemic infection?
Which serotype of Escherichia coli is responsible for hemolytic- A) Shigella dysenteriae
uremic syndrome (HUS)? B) Escherichia coli
A) EPEC C) Salmonella Typhi
B) ETEC D) Vibrio cholerae
C) EHEC • Answer: C) Salmonella Typhi
D) EAEC
• Answer: C) EHEC (Enterohemorrhagic E. coli, often 10.
O157 Which virulence factor of Enteropathogenic E. coli (EPEC)
) allows it to adhere to intestinal epithelial cells?
A) Heat-labile toxin
4. B) Heat-stable toxin
Which of the following bacteria is a common cause of C) Intimin
dysentery, characterized by bloody diarrhea? D) Shiga toxin
A) Enterotoxigenic E. coli • Answer: C) Intimin
B) Shigella dysenteriae
C) Salmonella Typhi 11.
D) Klebsiella pneumoniae Which enteric gram-negative rod produces a red pigment on
• Answer: B) Shigella dysenteriae culture plates and is associated with catheter-related
infections?
5. A) Serratia marcescens
The primary virulence factor of E. coli in causing urinary tract B) Proteus mirabilis
infections is: C) Salmonella Typhi
A) Lipopolysaccharide (LPS) D) Klebsiella pneumoniae
B) Fimbriae (pili) • Answer: A) Serratia marcescens
C) Capsule
D) Exotoxin 12.
• Answer: B) Fimbriae (pili) Which of the following bacteria is urease-positive and
commonly associated with urinary tract infections and kidney
6. stones?
Which organism is the primary cause of typhoid fever? A) Escherichia coli
A) Escherichia coli B) Proteus mirabilis
B) Yersinia enterocolitica C) Klebsiella pneumoniae
C) Salmonella Typhi D) Enterobacter cloacae
D) Proteus mirabilis • Answer: B) Proteus mirabilis
• Answer: C) Salmonella Typhi
13.
7. Shigella species cause disease primarily by:
A primary reservoir for Yersinia enterocolitica is: A) Endotoxin release
A) Birds B) Production of heat-stable toxin
B) Fish C) Invasion of intestinal epithelial cells
C) Pigs D) Formation of biofilms
D) Cattle • Answer: C) Invasion of intestinal epithelial cells
• Answer: C) Pigs
14.
8. Which enteric gram-negative rod is most associated with
Which of the following species is most commonly associated nosocomial outbreaks and produces an extended-spectrum
with hospital-acquired infections, particularly pneumonia and beta-lactamase (ESBL)?
urinary tract infections? A) Klebsiella pneumoniae
A) Enterobacter cloacae B) Shigella flexneri
B) Proteus mirabilis C) Escherichia coli
C) Klebsiella pneumoniae D) Proteus mirabilis
D) Shigella flexneri • Answer: A) Klebsiella pneumoniae
 21.
15. Which of the following organisms is a common cause of
Which of the following enteric pathogens produces a "rice- gastroenteritis associated with undercooked seafood?
water" stool in infected individuals? A) Escherichia coli
A) Shigella dysenteriae B) Vibrio parahaemolyticus
B) Salmonella enterica C) Shigella dysenteriae
C) Vibrio cholerae D) Klebsiella pneumoniae
D) Escherichia coli • Answer: B) Vibrio parahaemolyticus
• Answer: C) Vibrio cholerae
22.
16. Which of the following bacteria is primarily responsible for
Which virulence factor of Enterohemorrhagic E. coli (EHEC) is causing hospital-acquired pneumonia in patients on
responsible for causing bloody diarrhea and hemolytic-uremic mechanical ventilation?
syndrome? A) Escherichia coli
A) Heat-stable toxin B) Klebsiella pneumoniae
B) Shiga-like toxin C) Shigella sonnei
C) Lipopolysaccharide D) Vibrio cholerae
D) Exotoxin A • Answer: B) Klebsiella pneumoniae
• Answer: B) Shiga-like toxin
23.
17. Which of the following is characteristic of infections caused by
Which of the following organisms is most likely to cause Enteroaggregative E. coli (EAEC)?
septicemia in patients with sickle cell disease? A) Hemolytic uremic syndrome
A) Salmonella enterica B) Persistent watery diarrhea
B) Escherichia coli C) Invasive colitis
C) Shigella dysenteriae D) Lobar pneumonia
D) Vibrio cholerae • Answer: B) Persistent watery diarrhea
• Answer: A) Salmonella enterica
24.
18. What is the primary mode of transmission for Salmonella
Which of the following enteric bacteria are oxidase-positive? enterica in humans?
A) Salmonella enterica A) Fecal-oral route
B) Escherichia coli B) Respiratory droplets
C) Vibrio cholerae C) Direct skin contact
D) Shigella sonnei D) Sexual contact
• Answer: C) Vibrio cholerae • Answer: A) Fecal-oral route

19. 25.
Which of the following is a zoonotic pathogen associated with What is a common characteristic of Proteus species in
rodents and can cause a bubonic or pneumonic form of the laboratory cultures?
disease? A) Production of blue-green pigment
A) Salmonella Typhi B) Swarming motility
B) Yersinia pestis C) Lack of urease production
C) Escherichia coli D) Alpha-hemolysis
D) Proteus mirabilis • Answer: B) Swarming motility
• Answer: B) Yersinia pestis
26.
20. Which of the following is true about Vibrio vulnificus infections?
Which test differentiates between Shigella and Salmonella A) Associated with the consumption of raw oysters
species? B) Leads to rice-water stools
A) Urease test C) Causes UTI in immunocompromised patients
B) Lactose fermentation test D) Commonly causes traveler’s diarrhea
C) H2S production on triple sugar iron (TSI) agar • Answer: A) Associated with the consumption of raw
D) Catalase test oysters
• Answer: C) H2S production on TSI agar (Salmonella
produces H2S; Shigella does not) 27.
Which of the following is most characteristic of Yersinia 3. Pseudomonas aeruginosa is resistant to many antibiotics
enterocolitica infections? due to which mechanism?
A) Erythema migrans rash a) Production of beta-lactamases
B) Appendicitis-like abdominal pain b) Alteration of target ribosomes
C) Invasive pneumonia c) Inhibition of efflux pumps
D) Chronic diarrhea in immunocompetent adults d) Mutation in topoisomerase genes
• Answer: B) Appendicitis-like abdominal pain Answer: a) Production of beta-lactamases

28. 4. Which pigment is commonly associated with Pseudomonas

Which strain of E. coli is most likely to cause a self-limiting aeruginosa?
watery diarrhea in infants in developing countries? a) Pyocyanin
A) Enterotoxigenic E. coli (ETEC) b) Hemolysin
B) Enteropathogenic E. coli (EPEC) c) Urease
C) Enterohemorrhagic E. coli (EHEC) d) Hydrogen sulfide
D) Uropathogenic E. coli (UPEC) Answer: a) Pyocyanin
• Answer: B) Enteropathogenic E. coli (EPEC)
5. Pseudomonas aeruginosa primarily causes infections in
29. which population?
Which of the following bacteria is the most common cause of a) Healthy individuals
urinary tract infections? b) Immunocompromised hosts
A) Escherichia coli c) Young children
B) Klebsiella pneumoniae d) Pregnant women
C) Proteus mirabilis Answer: b) Immunocompromised hosts
D) Enterobacter cloacae
• Answer: A) Escherichia coli 6. The hallmark virulence factor of Pseudomonas aeruginosa
that facilitates adhesion to respiratory epithelium is:
30. a) Flagella
Which of the following organisms produces a potent neurotoxin b) Pili
leading to the "lockjaw" symptom? c) Exotoxin A
A) Vibrio cholerae d) Alginate
B) Yersinia enterocolitica Answer: d) Alginate
C) Clostridium tetani
D) Salmonella enterica 7. Pseudomonas aeruginosa is often associated with which
• Answer: C) Clostridium tetani (Note: included for type of biofilm-associated infection?
comparison) a) Otitis media
b) Cystic fibrosis lung infection
CHAPTER 16: PSEUDOMONAS, ACINETOBACTER, c) Streptococcal pneumonia
UNCOMMON GRAM-NEGATIVE BACTERIA d) Enteric fever
Answer: b) Cystic fibrosis lung infection

1. Which of the following characteristics is typical of 8. Which of the following uncommon gram-negative bacteria is
Pseudomonas aeruginosa? a cause of nosocomial infections and is highly resistant to
a) Catalase-negative multiple drugs?
b) Oxidase-positive a) Acinetobacter baumannii
c) Glucose fermenter b) Streptococcus pneumoniae
d) Gram-positive cocci c) Clostridium difficile
Answer: b) Oxidase-positive d) Neisseria gonorrhoeae
Answer: a) Acinetobacter baumannii
2. Pseudomonas aeruginosa is commonly associated with
which type of infections? 9. Acinetobacter species are often associated with:
a) Skin infections in burn patients a) Gastrointestinal infections
b) Urinary tract infections in healthy individuals b) Nosocomial pneumonia
c) Meningitis in neonates c) Diarrhea in infants
d) Endocarditis in patients without underlying conditions d) Septic arthritis
Answer: a) Skin infections in burn patients Answer: b) Nosocomial pneumonia
10. Which of the following antibiotics is commonly used for a) Exotoxin A
treating infections caused by Acinetobacter baumannii? b) Elastase
a) Penicillin G c) Pyoverdine
b) Polymyxin B d) Phospholipase
c) Amoxicillin Answer: a) Exotoxin A
d) Clindamycin
Answer: b) Polymyxin B 18. Acinetobacter infections are most commonly associated
with which of the following settings?
11. Which characteristic distinguishes Stenotrophomonas a) Long-term care facilities
maltophilia from Pseudomonas aeruginosa? b) Intensive care units (ICUs)
a) Motility c) Community health centers
b) Oxidase negativity d) Private practice clinics
c) Lactose fermentation Answer: b) Intensive care units (ICUs)
d) Capsule production
Answer: b) Oxidase negativity 19. The clinical presentation of Pseudomonas aeruginosa
bloodstream infection often includes:
12. The primary mode of transmission of Pseudomonas a) Skin rash and fever
aeruginosa in hospitals is through: b) Severe diarrhea
a) Person-to-person contact c) Lymphadenopathy
b) Contaminated respiratory equipment d) Jaundice
c) Fecal-oral route Answer: a) Skin rash and fever
d) Sexual contact
Answer: b) Contaminated respiratory equipment 20. Pseudomonas aeruginosa produces which pigment that
acts as a siderophore?
13. Which of the following infections is Stenotrophomonas a) Pyoverdine
maltophilia most commonly associated with? b) Hemagglutinin
a) Wound infections c) Lethal factor
b) Hospital-acquired pneumonia d) Phospholipase
c) Gastroenteritis Answer: a) Pyoverdine
d) Cellulitis
Answer: b) Hospital-acquired pneumonia 21. Acinetobacter species are:
a) Non-motile
14. Burkholderia cepacia complex is most commonly b) Motile with flagella
associated with infections in patients with: c) Gram-positive
a) Cystic fibrosis d) Facultative anaerobes
b) Diabetes mellitus Answer: a) Non-motile
c) Chronic kidney disease
d) Multiple sclerosis 22. Burkholderia cepacia complex exhibits intrinsic resistance
Answer: a) Cystic fibrosis to:
a) Aminoglycosides
15. Which of the following mechanisms allows Burkholderia b) Tetracyclines
cepacia to survive in the environment? c) Fluoroquinolones
a) Biofilm formation d) Macrolides
b) Endospore production Answer: a) Aminoglycosides
c) Antigenic variation
d) Superantigen production 23. Pseudomonas aeruginosa produces which of the following
Answer: a) Biofilm formation proteases that degrades elastin?
a) Elastase
16. Pseudomonas aeruginosa can be easily cultured on: b) Urease
a) Chocolate agar c) Exotoxin A
b) MacConkey agar d) Pyocyanin
c) Lowenstein-Jensen medium Answer: a) Elastase
d) Thayer-Martin medium
Answer: b) MacConkey agar 24. Which of the following uncommon gram-negative bacteria
is known to be associated with human infection in tropical
17. Which of the following virulence factors of Pseudomonas climates?
aeruginosa inhibits host protein synthesis?
a) Burkholderia pseudomallei a) Vibrio cholerae
b) Neisseria gonorrhoeae b) Vibrio parahaemolyticus
c) Acinetobacter baumannii c) Vibrio vulnificus
d) Escherichia coli d) Vibrio alginolyticus
Answer: a) Burkholderia pseudomallei Answer: b) Vibrio parahaemolyticus

25. The typical transmission of Burkholderia pseudomallei 2. What is the main virulence factor of Vibrio cholerae
involves: responsible for its pathogenesis?
a) Inhalation of aerosols a) Hemolysin
b) Contaminated water or soil b) Cholera toxin (CTX)
c) Sexual transmission c) Lipopolysaccharide (LPS)
d) Fecal-oral route d) Flagellum
Answer: b) Contaminated water or soil Answer: b) Cholera toxin (CTX)

26. A distinguishing feature of Pseudomonas aeruginosa is its 3. Which bacterium is commonly associated with
ability to: Guillain-Barré syndrome?
a) Produce spores a) Vibrio cholerae
b) Produce blue-green pigment b) Campylobacter jejuni
c) Ferment glucose c) Helicobacter pylori
d) Cause rheumatic fever d) Vibrio vulnificus
Answer: b) Produce blue-green pigment Answer: b) Campylobacter jejuni

27. Which of the following tests helps to differentiate 4. What is the typical mode of transmission for
Pseudomonas aeruginosa from other non-fermenters? Campylobacter jejuni?
a) Urease test a) Person-to-person contact
b) Oxidase test b) Contaminated food, especially undercooked poultry
c) Lactose fermentation c) Inhalation of droplets
d) Coagulase test d) Insect vectors
Answer: b) Oxidase test Answer: b) Contaminated food, especially undercooked poultry

28. Burkholderia pseudomallei is the causative agent of which 5. Which type of diarrhea is caused by Vibrio cholerae?
disease? a) Bloody diarrhea
a) Melioidosis b) Rice-water stools
b) Lyme disease c) Inflammatory diarrhea
c) Q fever d) Dysenteric diarrhea
d) Cholera Answer: b) Rice-water stools
Answer: a) Melioidosis
6. Which of the following bacteria is most likely to cause
29. Which of the following infections is Pseudomonas severe wound infections after exposure to seawater
aeruginosa least likely to cause? or shellfish?
a) Keratitis a) Campylobacter jejuni
b) Diarrhea b) Vibrio vulnificus
c) Otitis externa c) Helicobacter pylori
d) Urinary tract infection in catheterized patients d) Salmonella typhi
Answer: b) Diarrhea Answer: b) Vibrio vulnificus
30. The Burkholderia cepacia complex is primarily resistant to:
a) Carbapenems 7. Which of the following factors increases the
b) Sulfonamides susceptibility to severe Vibrio vulnificus infections?
c) Beta-lactams a) HIV infection
d) Vancomycin b) Liver disease (e.g., cirrhosis)
Answer: c) Beta-lactams c) Chronic kidney disease
d) Diabetes mellitus
CHAPTER 17: VIBRIO, CAMPYLOBACTER, AND Answer: b) Liver disease (e.g., cirrhosis)
ASSOCIATED BACTERIA
8. What is the most important diagnostic tool for
1. Which species of Vibrio is most commonly associated identifying Vibrio cholerae in a stool sample?
with seafood-related gastroenteritis? a) Blood culture
 b) Stool culture on thiosulfate-citrate-bile salts- 15. In what type of culture environment does
sucrose (TCBS) agar Campylobacter jejuni grow best?
c) PCR a) Anaerobic conditions
d) Immunofluorescence b) Microaerophilic conditions (5% oxygen)
Answer: b) Stool culture on thiosulfate-citrate-bile salts-sucrose c) High carbon dioxide (CO2) conditions
(TCBS) agar d) Aerobic conditions
Answer: b) Microaerophilic conditions (5% oxygen)
9. What is the first-line treatment for severe dehydration
caused by Vibrio cholerae infection? 16. What is the recommended treatment for severe Vibrio
a) Intravenous antibiotics vulnificus infections?
b) Oral rehydration therapy (ORT) a) Tetracyclines
c) Intravenous fluids b) Doxycycline combined with a third-generation
d) Antidiarrheal agents cephalosporin
Answer: c) Intravenous fluids c) Amoxicillin-clavulanate
d) Macrolides
10. Which of the following is a characteristic of Answer: b) Doxycycline combined with a third-generation
Campylobacter jejuni? cephalosporin
a) Gram-positive cocci
b) Curved, Gram-negative rod with a "seagull-wing" 17. Which of the following is a characteristic of
appearance Helicobacter pylori?
c) Facultative anaerobe a) Non-flagellated
d) Forms spores b) Produces urease
Answer: b) Curved, Gram-negative rod with a "seagull-wing" c) Strict aerobe
appearance d) Gram-positive rod
Answer: b) Produces urease
11. What is the primary reservoir of Vibrio cholerae in
nature? 18. What is the primary mode of transmission of
a) Poultry Helicobacter pylori?
b) Humans a) Fecal-oral route
c) Saltwater environments b) Aerosol transmission
d) Freshwater environments c) Bloodborne transmission
Answer: c) Saltwater environments d) Insect vector
Answer: a) Fecal-oral route
12. Which of the following antibiotics is most commonly
used to treat severe Campylobacter infections? 19. Which laboratory test is most commonly used to
a) Azithromycin confirm an active Helicobacter pylori infection?
b) Amoxicillin a) Blood culture
c) Ciprofloxacin b) Urea breath test
d) Metronidazole c) Urinalysis
Answer: a) Azithromycin d) PCR for bacterial DNA
Answer: b) Urea breath test
13. What characteristic distinguishes Vibrio cholerae O1
and O139 serogroups from other serogroups? 20. Which of the following antibiotics is part of the
a) Ability to produce hemolysins standard treatment regimen for Helicobacter pylori
b) Production of cholera toxin (CTX) infection?
c) Antibiotic resistance a) Doxycycline
d) Capsule formation b) Amoxicillin
Answer: b) Production of cholera toxin (CTX) c) Ciprofloxacin
d) Vancomycin
14. Which of the following is the most common clinical Answer: b) Amoxicillin
manifestation of Campylobacter infection?
a) Watery diarrhea 21. Which of the following bacteria is a major cause of
b) Dysentery (bloody diarrhea) traveler's diarrhea?
c) Rice-water stools a) Vibrio cholerae
d) Respiratory tract infection b) Campylobacter jejuni
Answer: a) Watery diarrhea c) Vibrio vulnificus
d) Helicobacter pylori
Answer: b) Campylobacter jejuni c) Levofloxacin
d) Metronidazole
22. Which of the following is the most appropriate first-line Answer: b) Amoxicillin
treatment for mild cases of Vibrio cholerae infection? 29. Which diagnostic tool is most specific for confirming
a) Doxycycline the presence of Helicobacter pylori?
b) Intravenous fluids a) Urea breath test
c) Oral rehydration therapy b) Stool antigen test
d) Azithromycin c) Endoscopic biopsy with rapid urease test
Answer: c) Oral rehydration therapy d) Blood antibody test
Answer: c) Endoscopic biopsy with rapid urease test
23. What is the hallmark of infection caused by
Campylobacter jejuni? 30. Which of the following describes a typical clinical
a) Severe abdominal cramps and bloody diarrhea presentation of a Vibrio vulnificus infection?
b) Respiratory symptoms a) Gastroenteritis after eating undercooked poultry
c) Hemolytic-uremic syndrome b) Cellulitis and septicemia after exposure to
d) Sepsis seawater
Answer: a) Severe abdominal cramps and bloody diarrhea c) Respiratory symptoms following a viral infection
d) Pneumonia following exposure to contaminated
24. Which serogroup of Vibrio cholerae is most commonly water
associated with pandemics? Answer: b) Cellulitis and septicemia after exposure to seawater
a) O1
b) O139
c) O157 CHAPTER 18: HEMOPHILUS, BORDETELLA, BRUCELLA,
d) O121 AND FRANCISELLA
Answer: a) O1 1.
Which of the following is a key virulence factor of Haemophilus
25. Which of the following is a potential complication of influenzae type b?
Campylobacter infection? A) Lipopolysaccharide (LPS)
a) Guillain-Barré syndrome B) Pili
b) Hemolytic anemia C) Polysaccharide capsule
c) Meningitis D) Flagella
d) Rheumatic fever • Answer: C) Polysaccharide capsule
Answer: a) Guillain-Barré syndrome 2.
What is the most common site of infection for Haemophilus
26. Which of the following is true regarding the influenzae type b in unvaccinated children?
pathogenesis of Vibrio cholerae? A) Skin
a) It invades intestinal epithelial cells B) Central nervous system
b) It produces an exotoxin that activates adenylate C) Lungs
cyclase D) Urinary tract
c) It causes direct cytotoxicity through LPS • Answer: B) Central nervous system (leading to
d) It produces a superantigen meningitis)
Answer: b) It produces an exotoxin that activates adenylate 3.
cyclase Which agar is required for the growth of Haemophilus
influenzae?
27. What is the primary reservoir of Campylobacter A) MacConkey agar
jejuni? B) Thayer-Martin agar
a) Saltwater environments C) Chocolate agar
b) Humans D) Blood agar
c) Poultry and cattle • Answer: C) Chocolate agar
d) Freshwater sources 4.
Answer: c) Poultry and cattle Which of the following is required by Haemophilus influenzae
for growth?
28. Which of the following is the preferred antibiotic for A) Factor V (NAD)
treating Helicobacter pylori infections? B) Factor X (Hemin)
a) Vancomycin C) Both A and B
b) Amoxicillin D) Neither A nor B
 • Answer: C) Both A and B C) Tularemia
5. D) H. influenzae infection
Which organism causes whooping cough? • Answer: C) Tularemia
A) Bordetella pertussis 13.
B) Haemophilus influenzae What is the primary mode of transmission for Francisella
C) Brucella abortus tularensis?
D) Francisella tularensis A) Inhalation of respiratory droplets
• Answer: A) Bordetella pertussis B) Tick bites or handling infected animals
6. C) Fecal-oral route
Which of the following is characteristic of the catarrhal stage of D) Sexual transmission
pertussis? • Answer: B) Tick bites or handling infected animals
A) Intense coughing fits 14.
B) Rhinorrhea and mild cough Which stage of Bordetella pertussis infection is the most
C) Cyanosis contagious?
D) Pneumonia A) Paroxysmal stage
• Answer: B) Rhinorrhea and mild cough B) Catarrhal stage
7. C) Convalescent stage
What is the gold standard for diagnosing Bordetella pertussis? D) Incubation stage
A) Polymerase chain reaction (PCR) • Answer: B) Catarrhal stage
B) Sputum culture 15.
C) Blood culture Which antibiotic is the treatment of choice for tularemia?
D) Serology A) Doxycycline
• Answer: A) Polymerase chain reaction (PCR) B) Ciprofloxacin
8. C) Streptomycin
Which of the following is a zoonotic infection caused by D) Amoxicillin
handling infected animal products? • Answer: C) Streptomycin
A) Pertussis 16.
B) Brucellosis What clinical syndrome is most commonly associated with
C) Tularemia Haemophilus ducreyi infection?
D) Influenza A) Pharyngitis
• Answer: B) Brucellosis B) Chancroid
9. C) Epiglottitis
Which species of Brucella is most associated with cattle? D) Conjunctivitis
A) Brucella abortus • Answer: B) Chancroid
B) Brucella melitensis 17.
C) Brucella suis Which of the following vaccines helps protect against
D) Brucella canis Bordetella pertussis?
• Answer: A) Brucella abortus A) DTP
10. B) MMR
What is the preferred diagnostic method for brucellosis? C) Hib
A) Blood culture D) Varicella
B) Urine culture • Answer: A) DTP
C) Stool culture 18.
D) Serologic testing Which of the following bacteria requires cysteine for growth?
• Answer: A) Blood culture A) Bordetella pertussis
11. B) Brucella abortus
Which of the following is NOT a characteristic of Francisella C) Francisella tularensis
tularensis? D) Haemophilus influenzae
A) Gram-negative coccobacillus • Answer: C) Francisella tularensis
B) Transmitted by ticks 19.
C) Causes glandular fever Which of the following diseases presents with undulant fever?
D) Requires chocolate agar for growth A) Pertussis
• Answer: D) Requires chocolate agar for growth B) Tularemia
12. C) Brucellosis
Which disease is known as "rabbit fever"? D) Epiglottitis
A) Brucellosis • Answer: C) Brucellosis
B) Pertussis 20.
Which of the following is NOT a common complication of Which of the following infections is NOT typically associated
Haemophilus influenzae infection? with Haemophilus influenzae?
A) Meningitis A) Conjunctivitis
B) Epiglottitis B) Otitis media
C) Osteomyelitis C) Endocarditis
D) Sinusitis D) Epiglottitis
• Answer: C) Osteomyelitis • Answer: C) Endocarditis
21. 28.
Which bacterial factor of Haemophilus influenzae allows it to Which of the following statements about Bordetella pertussis is
evade phagocytosis? TRUE?
A) IgA protease A) It is an obligate intracellular pathogen
B) Lipopolysaccharide B) It is transmitted via contaminated water
C) Outer membrane proteins C) It is transmitted via respiratory droplets
D) Polysaccharide capsule D) It can be effectively treated with ampicillin
• Answer: D) Polysaccharide capsule • Answer: C) It is transmitted via respiratory droplets
22. 29.
What is the main virulence factor of Bordetella pertussis that Which of the following organisms can be transmitted through
causes severe coughing? inhalation of contaminated animal products, causing
A) Tracheal cytotoxin respiratory infections?
B) Capsule A) Brucella melitensis
C) Urease B) Francisella tularensis
D) Lipid A C) Bordetella pertussis
• Answer: A) Tracheal cytotoxin D) Haemophilus ducreyi
23. • Answer: A) Brucella melitensis
A patient presents with a soft, painful genital ulcer and tender 30.
inguinal lymphadenopathy. What is the likely pathogen? What is the typical presentation of tularemia?
A) Neisseria gonorrhoeae A) Diarrhea and vomiting
B) Treponema pallidum B) Fever and lymphadenopathy
C) Haemophilus ducreyi C) Rash and arthritis
D) Chlamydia trachomatis D) Severe cough and chest pain
• Answer: C) Haemophilus ducreyi • Answer: B) Fever and lymphadenopathy
24.
Which of the following causes atypical pneumonia and is also CHAPTER 19: YERSINIA, PASTEURELLA
transmitted by aerosols? 1.
A) Haemophilus influenzae Which of the following bacteria is most commonly associated
B) Brucella abortus with plague?
C) Francisella tularensis A) Yersinia enterocolitica
D) Bordetella pertussis B) Pasteurella multocida
• Answer: C) Francisella tularensis C) Yersinia pestis
25. D) Bartonella henselae
What is the main mode of transmission of brucellosis in • Answer: C) Yersinia pestis
humans? Rationale: Yersinia pestis is the causative agent of
A) Airborne droplets plague, a zoonotic infection transmitted by fleas.
B) Contaminated water
C) Consumption of unpasteurized dairy products 2.
D) Person-to-person contact What is the primary mode of transmission of Yersinia pestis?
• Answer: C) Consumption of unpasteurized dairy A) Direct contact with infected animals
products B) Inhalation of respiratory droplets
26. C) Flea bites
Which stage of pertussis is characterized by paroxysms of D) Ingestion of contaminated food
violent coughing followed by a high-pitched "whoop"? • Answer: C) Flea bites
A) Catarrhal stage Rationale: Yersinia pestis is primarily transmitted by
B) Convalescent stage flea bites, especially from fleas that have fed on
C) Paroxysmal stage infected rodents.
D) Latent stage
• Answer: C) Paroxysmal stage 3.
27.
Which form of plague is characterized by swollen, painful factor of Yersinia pestis, allowing it to evade
lymph nodes? phagocytosis.
A) Bubonic plague
B) Septicemic plague 8.
C) Pneumonic plague In which region of the world is Yersinia pestis still considered
D) Cutaneous plague endemic?
• Answer: A) Bubonic plague A) Western United States
Rationale: Bubonic plague is the most common form, B) Northern Europe
characterized by painful, swollen lymph nodes called C) Southern Africa
buboes. D) Southeast Asia
• Answer: A) Western United States
4. Rationale: Plague is still endemic in parts of the
Which of the following infections is typically associated with western United States, particularly in rural areas
exposure to domestic animals, especially cats and dogs? where rodent populations are reservoirs for Yersinia
A) Yersinia enterocolitica pestis.
B) Pasteurella multocida
C) Yersinia pestis 9.
D) Francisella tularensis What is the primary reservoir of Yersinia pestis in the wild?
• Answer: B) Pasteurella multocida A) Birds
Rationale: Pasteurella multocida is commonly found B) Rodents
in the mouths of cats and dogs and can cause C) Cattle
infection following animal bites or scratches. D) Reptiles
• Answer: B) Rodents
5. Rationale: Wild rodents, such as rats and prairie
Which of the following Yersinia species is commonly dogs, serve as the primary reservoir for Yersinia
associated with foodborne gastroenteritis? pestis.
A) Yersinia pestis
B) Yersinia pseudotuberculosis 10.
C) Yersinia enterocolitica Which of the following conditions is typically associated with
D) Yersinia ruckeri infection by Pasteurella multocida?
• Answer: C) Yersinia enterocolitica A) Skin abscesses
Rationale: Yersinia enterocolitica is associated with B) Septic arthritis
foodborne illnesses, particularly from contaminated C) Cat-scratch fever
pork products. D) Pneumonia after animal bites
• Answer: D) Pneumonia after animal bites
6. Rationale: Pasteurella multocida can cause
Which of the following is the recommended treatment for a pneumonia, cellulitis, and other soft tissue infections
Yersinia pestis infection? following animal bites, particularly from cats.
A) Amoxicillin
B) Doxycycline 11.
C) Ciprofloxacin A zoonotic infection causing gastroenteritis and mesenteric
D) Streptomycin lymphadenitis in humans is most commonly caused by which
• Answer: D) Streptomycin Yersinia species?
Rationale: Streptomycin is considered the drug of A) Yersinia pestis
choice for treating Yersinia pestis infections. B) Yersinia enterocolitica
C) Yersinia pseudotuberculosis
7. D) Yersinia intermedia
Which of the following is a key virulence factor of Yersinia • Answer: B) Yersinia enterocolitica
pestis that contributes to its ability to evade the immune Rationale: Yersinia enterocolitica is often associated
system? with zoonotic gastroenteritis and mesenteric
A) Exotoxin production lymphadenitis, mimicking appendicitis.
B) Capsule formation
C) Hemolysin production 12.
D) Adhesin proteins Which of the following factors contributes to the pathogenesis
• Answer: B) Capsule formation of Yersinia enterocolitica?
Rationale: The F1 capsule is an important virulence A) Production of shiga-like toxins
B) Urease production
C) Lipopolysaccharide (LPS) endotoxin What is the recommended treatment for infections caused by
D) Heat-stable enterotoxin Pasteurella multocida?
• Answer: B) Urease production A) Penicillin
Rationale: Urease production is an important factor in B) Azithromycin
the pathogenesis of Yersinia enterocolitica, helping C) Tetracycline
the bacteria survive in the gastrointestinal tract. D) Ciprofloxacin
• Answer: A) Penicillin
13. Rationale: Penicillin is the drug of choice for treating
What is the most common clinical manifestation of Yersinia Pasteurella multocida infections, often acquired
enterocolitica infection in children? through animal bites.
A) Bloody diarrhea
B) Acute appendicitis-like symptoms 18.
C) Chronic cough A patient presents with gastroenteritis after eating
D) Recurrent urinary tract infections undercooked pork. Cultures reveal a gram-negative organism
• Answer: B) Acute appendicitis-like symptoms that can grow at cold temperatures. What is the likely
Rationale: Yersinia enterocolitica infection in children organism?
often presents with fever, right lower quadrant pain, A) Yersinia pestis
and mesenteric lymphadenitis, mimicking B) Yersinia enterocolitica
appendicitis. C) Pasteurella multocida
D) Brucella abortus
14. • Answer: B) Yersinia enterocolitica
Which of the following diseases is caused by Yersinia Rationale: Yersinia enterocolitica is a psychrophilic
pseudotuberculosis? (cold-tolerant) organism commonly associated with
A) Bubonic plague foodborne gastroenteritis from undercooked pork.
B) Pneumonic plague
C) Gastroenteritis and septicemia 19.
D) Cat-scratch fever Which virulence factor of Yersinia pestis aids in its ability to
• Answer: C) Gastroenteritis and septicemia spread within the human host?
Rationale: Yersinia pseudotuberculosis causes A) Heat-stable enterotoxin
gastroenteritis and septicemia, similar to Yersinia B) Yersinia outer proteins (Yops)
enterocolitica. C) Urease
D) Capsule production
15. • Answer: B) Yersinia outer proteins (Yops)
Which of the following best describes the transmission of Rationale: Yersinia outer proteins (Yops) are key
Pasteurella multocida? virulence factors that enable Yersinia pestis to evade
A) Flea bite the immune response and spread in the host.
B) Inhalation of aerosolized droplets
C) Ingestion of contaminated food 20.
D) Animal bites or scratches Which of the following clinical signs is most characteristic of
• Answer: D) Animal bites or scratches septicemic plague caused by Yersinia pestis?
Rationale: Pasteurella multocida is most commonly A) Buboes
transmitted via animal bites, particularly from cats and B) Disseminated intravascular coagulation (DIC)
dogs. C) Pneumonia
D) Gastroenteritis
16. • Answer: B) Disseminated intravascular coagulation
What type of bacteria is Pasteurella multocida? (DIC)
A) Gram-positive coccus Rationale: Septicemic plague often leads to DIC,
B) Gram-negative coccobacillus which can cause widespread clotting and bleeding in
C) Gram-positive bacillus the body.
D) Acid-fast rod A patient presents with fever, headache, and a large
• Answer: B) Gram-negative coccobacillus tender lymph node near a recent cat scratch. What is
Rationale: Pasteurella multocida is a gram-negative the most likely causative organism?
coccobacillus commonly associated with zoonotic A. Bartonella henselae
infections.
B. Pasteurella multocida
C. Yersinia pestis
17.
D. Francisella tularensis D. Horses
Answer: A Answer: B

22. Infections caused by Yersinia enterocolitica can 28. What type of infection is most commonly caused
mimic which of the following diseases? by Yersinia pseudotuberculosis?
A. Crohn’s disease A. Enterocolitis
B. Acute appendicitis B. Mesenteric adenitis
C. Ulcerative colitis C. Pneumonia
D. Irritable bowel syndrome D. Meningitis
Answer: B Answer: B

23. A patient with a Yersinia enterocolitica infection 29. The most common presentation of bubonic
may develop which of the following complications? plague is:
A. Endocarditis A. Large ulcerative skin lesions
B. Reactive arthritis B. High fever with pneumonia
C. Encephalitis C. Septic shock and disseminated intravascular
D. Skin abscess coagulation
Answer: B D. Fever with painful swollen lymph nodes (buboes)
Answer: D
24. Which of the following best describes the
appearance of Yersinia pestis on Gram stain? 30. Which of the following organisms is most likely to
A. Gram-positive diplococci cause an infection after a dog bite?
B. Gram-negative rods with a “safety-pin” appearance A. Staphylococcus aureus
C. Gram-negative rods in chains B. Streptococcus pyogenes
D. Gram-positive bacilli C. Pasteurella multocida
Answer: B D. Clostridium tetani
Answer: C
25. A patient in a rural area presents with high fever,
chills, and a swollen, painful inguinal lymph node. He
reports frequent handling of rodents. Which organism CHAPTER 20: NEISSERIA
is the most likely cause? 1. Which of the following is the most common cause of
A. Bartonella henselae bacterial meningitis in adolescents and young adults?
B. Yersinia pestis A. Neisseria gonorrhoeae
C. Leptospira interrogans B. Haemophilus influenzae
C. Streptococcus pneumoniae
D. Brucella melitensis
D. Neisseria meningitidis
Answer: B Answer: D
26. Which of the following laboratory findings would 2. What is the most important virulence factor of Neisseria
you expect in a case of Pasteurella multocida meningitidis that allows it to evade the immune system?
infection? A. Exotoxin production
A. Alpha-hemolysis on blood agar B. Polysaccharide capsule
B. Beta-hemolysis on blood agar C. Pili
C. Non-hemolytic on blood agar D. Lipooligosaccharide (LOS)
D. Gamma-hemolysis on blood agar Answer: B
Answer: C
3. Which of the following tests is commonly used for the rapid
27. Which of the following animals is a known diagnosis of Neisseria gonorrhoeae infection?
A. Gram stain of cerebrospinal fluid
reservoir for Yersinia enterocolitica?
B. Enzyme immunoassay (EIA)
A. Sheep C. Nucleic acid amplification test (NAAT)
B. Pigs D. Blood culture
C. Dogs Answer: C
4. Which of the following is the primary mode of transmission 11. What is the primary function of the IgA protease produced
of Neisseria gonorrhoeae? by Neisseria species?
A. Respiratory droplets A. Degrades IgA antibodies to evade mucosal immunity
B. Fecal-oral route B. Inhibits complement activation
C. Sexual contact C. Prevents phagocytosis
D. Insect bites D. Neutralizes host toxins
Answer: C Answer: A

5. A 19-year-old woman presents with purulent discharge and 12. Which of the following is a characteristic feature of
dysuria. Gram stain shows gram-negative diplococci. What is Neisseria species on Gram stain?
the most likely pathogen? A. Gram-positive cocci in chains
A. Escherichia coli B. Gram-negative diplococci
B. Neisseria gonorrhoeae C. Gram-negative bacilli
C. Chlamydia trachomatis D. Gram-positive bacilli
D. Staphylococcus aureus Answer: B
Answer: B
13. Which of the following vaccines provides protection against
6. Which virulence factor of Neisseria gonorrhoeae is primarily multiple serogroups of Neisseria meningitidis?
responsible for its attachment to host cells? A. Meningococcal conjugate vaccine (MenACWY)
A. IgA protease B. Pneumococcal vaccine
B. LOS C. Hepatitis B vaccine
C. Pili D. Influenza vaccine
D. Porin proteins Answer: A
Answer: C
14. A neonate develops purulent conjunctivitis within a few
7. The primary reservoir for Neisseria meningitidis is: days of birth. The mother was not screened for sexually
A. Dogs transmitted infections. What is the most likely pathogen?
B. Humans A. Staphylococcus aureus
C. Birds B. Chlamydia trachomatis
D. Cows C. Neisseria gonorrhoeae
Answer: B D. Group B Streptococcus
Answer: C
8. Which of the following clinical manifestations is most
commonly associated with disseminated gonococcal infection 15. What is the primary mode of transmission of Neisseria
(DGI)? meningitidis?
A. Meningitis A. Sexual contact
B. Arthritis and dermatitis B. Respiratory droplets
C. Endocarditis C. Blood transfusion
D. Gastroenteritis D. Contaminated food
Answer: B Answer: B

9. Which of the following antibiotics is the first-line treatment for 16. Which of the following is a major complication of untreated
gonorrhea in the United States? gonorrhea in women?
A. Azithromycin A. Endocarditis
B. Ceftriaxone B. Pelvic inflammatory disease (PID)
C. Doxycycline C. Septic arthritis
D. Ciprofloxacin D. Pneumonia
Answer: B Answer: B

10. Neisseria meningitidis is most likely to cause outbreaks in 17. The characteristic skin rash associated with Neisseria
which of the following settings? meningitidis infection is typically described as:
A. Daycare centers A. Vesicular
B. College dormitories B. Maculopapular
C. Public transportation C. Petechial or purpuric
D. Hospitals D. Erythematous
Answer: B Answer: C
18. Which of the following serogroups of Neisseria meningitidis C. C5-C9 (terminal complement pathway) deficiency
is most commonly associated with outbreaks in the United D. C3 deficiency
States? Answer: C
A. Serogroup A
B. Serogroup B 25. Which of the following is the best diagnostic test for
C. Serogroup C meningococcal meningitis?
D. Serogroup W A. Blood culture
Answer: B B. Gram stain of cerebrospinal fluid
C. Urine antigen test
19. Which of the following laboratory findings is most D. Chest X-ray
consistent with Neisseria meningitidis infection in cerebrospinal Answer: B
fluid (CSF)?
A. Low protein, high glucose, and few neutrophils 26. A 25-year-old male presents with painful, swollen joints and
B. High protein, low glucose, and neutrophilic pleocytosis a history of urethral discharge. Which organism is the most
C. Normal protein, normal glucose, and lymphocytic likely cause of his symptoms?
pleocytosis A. Staphylococcus aureus
D. High glucose, high protein, and lymphocytes B. Neisseria gonorrhoeae
Answer: B C. Treponema pallidum
D. Chlamydia trachomatis
20. Which of the following virulence factors allows Neisseria Answer: B
gonorrhoeae to evade host immune responses?
A. Capsule 27. A vaccine is available for which of the following Neisseria
B. Antigenic variation of pili species?
C. Exotoxin production A. Neisseria gonorrhoeae
D. Biofilm formation B. Neisseria lactamica
Answer: B C. Neisseria meningitidis
D. Neisseria elongata
21. Which of the following is a preventive measure to reduce Answer: C
the risk of neonatal conjunctivitis caused by Neisseria
gonorrhoeae? 28. What is the most appropriate next step in the management
A. Administration of erythromycin eye ointment of a sexually active patient with gram-negative diplococci
B. Administration of the meningococcal vaccine detected on urethral swab?
C. Use of antiviral eye drops A. Prescribe penicillin
D. Avoidance of breastfeeding B. Obtain culture and sensitivity testing
Answer: A C. Administer ceftriaxone and azithromycin
D. Begin antiviral therapy
22. Which of the following antibiotics is recommended for Answer: C
prophylaxis after exposure to a case of meningococcal
meningitis? 29. Which of the following organisms is frequently isolated from
A. Ciprofloxacin the nasopharynx of healthy individuals but can cause invasive
B. Penicillin disease under certain conditions?
C. Doxycycline A. Neisseria gonorrhoeae
D. Amoxicillin B. Neisseria meningitidis
Answer: A C. Neisseria lactamica
D. Escherichia coli
23. Which of the following populations is at the highest risk for Answer: B
invasive Neisseria meningitidis infections?
A. Pregnant women 30. Which of the following diagnostic techniques is most useful
B. Newborns in identifying Neisseria gonorrhoeae in women with suspected
C. People with asplenia cervical infection?
D. People with HIV A. Gram stain of cervical swab
Answer: C B. Culture of cervical discharge
C. Nucleic acid amplification test (NAAT)
24. The complement deficiency most commonly associated D. Rapid antigen test
with recurrent Neisseria infections is: Answer: C
A. C1 deficiency
B. C2 deficiency
CHAPTER 22: LEGIONELLA, BARTONELLA, AND • C) Summer
UNUSUAL BACTERIAL PATHOGEN • D) Late summer to autumn
Answer: D
Legionella pneumophila was first identified after an outbreak in The intracellular growth of Legionella primarily occurs in:
which city? • A) Alveolar macrophages
• A) New York • B) Polymorphonuclear leukocytes
• B) Philadelphia • C) Epithelial cells
• C) Chicago • D) B cells
• D) Boston Answer: A
Answer: B Which of the following is NOT a risk factor for Legionella
What is the primary reservoir for Legionella pneumophila? infection?
• A) Humans • A) Smoking
• B) Water systems • B) Alcohol misuse
• C) Birds • C) Diabetes mellitus
• D) Soil • D) Hypertension
Answer: B Answer: D
Legionella species are primarily: Which diagnostic test is specific for detecting Legionella
• A) Gram-positive bacteria pneumophila serogroup 1?
• B) Gram-negative bacteria • A) Sputum culture
• C) Acid-fast bacteria • B) Urinary antigen test
• D) Fungi • C) PCR
Answer: B • D) Chest X-ray
Which of the following is a common medium for growing Answer: B
Legionella? Legionella pneumophila primarily causes which disease?
• A) MacConkey agar • A) Pontiac fever
• B) Buffered charcoal yeast extract (BCYE) agar • B) Lobar pneumonia
• C) Blood agar • C) Meningitis
• D) Sabouraud agar • D) Urinary tract infection
Answer: B Answer: B
What stain is recommended for visualizing Legionella in What is the first-line treatment for Legionella infection?
tissue specimens? • A) Penicillin
• A) Gram stain • B) Macrolides or fluoroquinolones
• B) Acid-fast stain • C) Tetracycline
• C) Silver stain • D) Aminoglycosides
• D) Methylene blue Answer: B
Answer: C Which pathogen can be associated with Pontiac fever?
Which Legionella species is most commonly associated with • A) L. pneumophila
human disease? • B) Bartonella henselae
• A) Legionella longbeachae • C) Pasteurella multocida
• B) Legionella pneumophila • D) Streptococcus pneumoniae
• C) Legionella micdadei Answer: A
• D) Legionella jordanis Pontiac fever typically presents with which symptoms?
Answer: B • A) Severe pneumonia
What virulence factor of Legionella allows it to invade • B) Fever and myalgia
macrophages? • C) Neurological symptoms
• A) OspA • D) Gastrointestinal symptoms
• B) Mip protein Answer: B
• C) Pili Legionnaires' disease is commonly acquired by:
• D) Endotoxin • A) Drinking contaminated water
Answer: B • B) Person-to-person transmission
In what season are Legionella infections most common? • C) Inhalation of contaminated aerosols
• A) Winter
• B) Spring
 • D) Insect bites • D) Only occurs in tropical climates
Answer: C Answer: C
Which antibiotic is ineffective against Legionella due to the Which of the following is an effective environmental control
production of β-lactamase? for Legionella?
• A) Erythromycin • A) Superheating water systems
• B) Ciprofloxacin • B) Reducing air humidity
• C) Penicillin • C) UV light exposure
• D) Azithromycin • D) Sealing windows
Answer: C Answer: A
The Mip protein in Legionella assists in: What histological finding is characteristic of Legionella
• A) Iron capture infection?
• B) Macrophage invasion • A) Dense intra-alveolar exudate
• C) Antibody neutralization • B) Interstitial fibrosis
• D) Toxin release • C) Granulomas
Answer: B • D) Hyaline membranes
Which Legionella species is sometimes acid-fast? Answer: A
• A) Legionella pneumophila Which protein secretion system is essential for Legionella
• B) Legionella micdadei virulence?
• C) Legionella bozemanae • A) Type I
• D) Legionella jordanis • B) Type II
Answer: B • C) Type III
Which of the following laboratory tests can confirm a • D) Type IV
diagnosis of Legionnaires' disease? Answer: D
• A) ELISA Which diagnostic method has low sensitivity but high
• B) Gram stain specificity for Legionella?
• C) Urinary antigen test • A) Direct fluorescent antibody test
• D) CBC • B) Culture
Answer: C • C) Urinary antigen test
What is the typical incubation period for Legionnaires' • D) PCR
disease? Answer: A
• A) 12-24 hours The first outbreak of Legionnaires' disease occurred in what
• B) 2-10 days year?
• C) 1 month • A) 1965
• D) 6-12 hours • B) 1976
Answer: B • C) 1985
What characteristic lesion is commonly found in • D) 1992
Legionnaires' disease? Answer: B
• A) Cystic cavities in lungs In which part of the lungs does Legionella typically cause
• B) Patchy pulmonary infiltration infection?
• C) Meningeal irritation • A) Bronchi
• D) Bronchial ulcers • B) Alveoli
Answer: B • C) Pleura
Legionella species grow best at which temperature? • D) Trachea
• A) 25°C Answer: B
• B) 35°C What is a common non-respiratory symptom of Legionnaires'
• C) 40°C disease?
• D) 10°C • A) Skin rash
Answer: B • B) Diarrhea
Which of the following is true about Legionella transmission? • C) Joint pain
• A) Person-to-person transmission is common • D) Liver failure
• B) It is transmitted through food Answer: B
• C) It is transmitted by aerosolized water
 Which of the following Legionella species can cause • D) 1 month
pneumonia? Answer: B
• A) Legionella bozemanii Which population is at increased risk of Legionella infection?
• B) Legionella dumoffii • A) Children under 5
• C) Legionella micdadei • B) Healthy young adults
• D) All of the above • C) Immunocompromised patients
Answer: D • D) Pregnant women
Which staining method can be used to detect Legionella in Answer: C
tissue? Which diagnostic test has the potential for rapid diagnosis of
• A) Warthin-Starry Legionella from culture isolates?
• B) Crystal violet • A) ELISA
• C) Ziehl-Neelsen • B) MALDI-TOF MS
• D) India ink • C) Gram staining
Answer: A • D) Agglutination test
What is a potential complication of severe Legionnaires' Answer: B
disease? What is the mortality rate during some outbreaks of
• A) Brain abscess Legionnaires' disease?
• B) Renal failure • A) 1-2%
• C) Peripheral neuropathy • B) 5-10%
• D) Thrombocytopenia • C) 15-20%
Answer: B • D) 25-30%
Legionella infections are common in which of the following Answer: B
settings? In which part of the world did the first outbreak of Pontiac
• A) Schools fever occur?
• B) Hospitals • A) Europe
• C) Farmlands • B) South America
• D) Beaches • C) North America
Answer: B • D) Asia
What is the role of charcoal in BCYE agar used for growing Answer: C
Legionella? What enzyme is commonly produced by Legionella species?
• A) As a carbon source • A) DNase
• B) To detoxify the medium • B) Catalase
• C) To provide nutrients for the bacteria • C) Oxidase
• D) To act as a reducing agent • D) Coagulase
Answer: B Answer: B
Which organ system is primarily affected by Legionnaires' Which of the following is a method for controlling Legionella
disease? in water systems?
• A) Nervous system • A) Filtering all drinking water
• B) Respiratory system • B) Use of UV light treatment
• C) Digestive system • C) Hyperchlorination and superheating
• D) Cardiovascular system • D) Reducing water flow
Answer: B Answer: C
Which of the following is a common feature of Pontiac fever? What symptom is more prominent in Legionnaires' disease
• A) Severe pneumonia compared to Pontiac fever?
• B) Self-limited febrile illness • A) Diarrhea
• C) Meningitis • B) Pneumonia
• D) Urinary tract infection • C) Fever
Answer: B • D) Headache
What is the typical duration of Pontiac fever? Answer: B
• A) 12-24 hours What type of organism does Legionella often coexist with in
• B) 2-5 days water systems?
• C) 1-2 weeks • A) Bacteria
 • B) Viruses o D) Sputum culture
• C) Fungi Answer: C
• D) Amebae • What characteristic makes the Legionella pneumophila
Answer: D membrane distinct, aiding in its identification?
What is the role of the Dot/Icm secretion system in o A) Presence of specific 16- to 19-carbon
Legionella? branched-chain fatty acids
o B) Presence of mycolic acid in the cell wall
• A) It helps evade the immune system
o C) High levels of teichoic acid in the
• B) It assists in iron acquisition
membrane
• C) It is essential for intracellular survival o D) Unique surface pili
• D) It neutralizes antibiotics Answer: A
Answer: C • Which intracellular trafficking pathway does Legionella
Which diagnostic test is NOT commonly used for Legionella pneumophila modify to promote its survival within host
detection? cells?
• A) Sputum Gram stain o A) Rab5-mediated early endosome
• B) PCR trafficking
• C) Urinary antigen test o B) ER-Golgi transport
• D) Culture on BCYE agar o C) Autophagosome formation
Answer: A o D) Lysosome fusion with phagosomes
Answer: B
What characteristic of Legionella colonies differentiates them
• In which environments does Legionella preferentially
from other bacteria on BCYE agar?
proliferate, thereby enhancing its transmission
• A) They appear after 1 day potential?
• B) They have iridescent color o A) Alkaline lakes
• C) They are round with entire edges o B) Soil contaminated with organic matter
• D) They are bright red o C) Warm, moist environments like cooling
Answer: B towers and air conditioning units
• Which specific genetic region is often amplified by PCR o D) Saltwater marshes
for the detection of Legionella pneumophila? Answer: C
o A) 23S rRNA gene • Why are β-lactam antibiotics generally ineffective in
o B) Mip gene treating Legionella pneumophila infections?
o C) FimA gene o A) Legionella actively effluxes β-lactams
o D) GyrB gene o B) Legionella produces β-lactamases and
Answer: B resides intracellularly
• Which secretion system in Legionella pneumophila is o C) β-lactams have poor penetration through
crucial for its ability to survive within macrophages the outer membrane of Legionella
and avoid phagolysosome fusion? o D) Legionella is intrinsically resistant to β-
o A) Type II secretion system lactams due to altered PBPs
o B) Type III secretion system Answer: B
o C) Type IV secretion system (Dot/Icm) • The intracellular replication of Legionella pneumophila is
o D) Type VI secretion system highly dependent on the availability of which molecule
Answer: C within the host cell?
• Legionella is able to survive within human alveolar o A) Calcium
macrophages due to which mechanism? o B) Iron
o A) Preventing lysosomal fusion with o C) Magnesium
phagosomes o D) Potassium
o B) Inhibiting macrophage apoptosis Answer: B
o C) Inducing lysosomal rupture • Which of the following Legionella species is most
o D) Inhibiting oxidative burst commonly associated with Pontiac fever rather than
Answer: A severe pneumonia?
• Which of the following diagnostic approaches is the most o A) Legionella pneumophila
rapid for confirming a diagnosis of Legionnaires' o B) Legionella bozemanii
disease in the acute phase? o C) Legionella micdadei
o A) Blood culture o D) Legionella longbeachae
o B) Serologic antibody tests Answer: C
o C) Urinary antigen test for L. pneumophila
serogroup 1
• The diagnosis of Legionella pneumophila infection by o C) Increased mitochondrial association with
urinary antigen detection is limited to which LCVs
serogroup? o D) Activation of Toll-like receptors (TLRs) on
o A) Serogroup 4 the vacuole
o B) Serogroup 6 Answer: B
o C) Serogroup 1 • Which class of antibiotics is most effective in treating
o D) Serogroup 10 Legionnaires' disease due to its intracellular
Answer: C penetration?
• Which immune evasion strategy is unique to Legionella o A) β-lactams
pneumophila in its interaction with host o B) Fluoroquinolones
macrophages? o C) Aminoglycosides
o A) Secretion of protease to degrade o D) Sulfonamides
antibodies Answer: B
o B) Inhibition of major histocompatibility • Which of the following is true regarding the genetic
complex (MHC) class II antigen presentation variability of Legionella pneumophila?
o C) Hijacking host cell's endoplasmic o A) It has a stable genome with little
reticulum for vesicle trafficking horizontal gene transfer.
o D) Production of toxins that lyse T cells o B) It frequently acquires genes from
Answer: C amoebae and other environmental microbes
• Which component of Legionella's type IV secretion via horizontal gene transfer.
system is responsible for subverting host cellular o C) Legionella's genome is static due to
processes to favor bacterial replication? limited interaction with other
o A) IcmT protein microorganisms.
o B) IcmX protein o D) Its genetic variability is restricted to
o C) DotA protein mutations within the Mip gene.
o D) Icm/Dot ATPase complex Answer: B
Answer: C • Which laboratory test is most specific for the rapid
• Which histopathological feature is most commonly diagnosis of Legionella species other than serogroup
associated with severe Legionella infections? 1?
o A) Extensive interstitial fibrosis o A) PCR targeting the Mip gene
o B) Necrotizing granulomas in the lungs o B) Urinary antigen test
o C) Dense intra-alveolar exudates with o C) Culture on BCYE agar
polymorphonuclear leukocytes o D) Direct fluorescent antibody test
o D) Bronchial hyperplasia and fibrosis Answer: A
Answer: C
• Legionella bacteria thrive in biofilms within water
systems. Which cohabiting organisms enhance their
persistence in these environments?
o A) Free-living amoebae
o B) Yeast
o C) Mycobacteria
o D) Cyanobacteria
Answer: A
• The intracellular replication of Legionella is most closely
associated with which host cell process?
o A) Lysosomal degradation
o B) Phagosome maturation arrest
o C) Increased oxidative burst
o D) Phagosome fusion with mitochondria
Answer: B
• What feature of Legionella-containing vacuoles (LCV)
prevents them from being targeted for lysosomal
fusion?
o A) Their ability to rapidly acidify
o B) Recruitment of ER vesicles to the vacuole
membrane