2
Examine the photomicrograph shown in Figure 1 and answer questions 1-4.
A B
Figure1. Gram stain (A) and agar cultures (B) of a purulent cerebrospinal fluid sample
collected from a 5 year old Jamaican child with suspected meningitis.
1. The Gram stain shows:
a) No organisms
b) Gram positive bacilli and pus cells
c) Gram positive cocci in chains
d) Gram positive diplococcic and pus cells
2. The likely causative agent in this case is:
a) Lactbacillus
b) Streptococcus pneumoniae
c) Streptococcus pyogenes
d) Klebsiella pneumonia
3. The drug of choice for treatment of this case is:
a) Intravenous Penicillin
b) Oral Erythromycin
c) Oral cephalosporin
d) Intravenous gentamicin
4. Meningitis caused by this organism:
a) Can be prevented by vaccines targeting the capsule
b) Can be prevented by serotype vaccines targeting the M protein
c) Has a low mortality rate when treated appropriately
d) Poses no increased risk to any group of persons
3
Examine the electron photomicrograph shown in Figure 2 and answer questions 5-6
Figure 2. A
photomicrograph of a
preparation of
cerebrospinal fluid from a
50 year old male patient
with suspected meningitis
and a history of pigeon
rearing.
5. The photomicrograph shows
a) Gram negative cocci
b) Polymorphonuclear leucocytes
c) Budding encapsulated yeast cells
d) Replicating bacteria with capsule
6. Groups at risk for infection with the organism include:
a) Infants under 2 years of age
b) Elderly persons over 65 years of age
c) Immunocompromised persons
d) Immunocompetent long stay hospitalized patients
Semester 2 2010/2011
4
Examine the organism shown in Figure 3 and answer questions 7-8
Figure 3. Agar plates with the organisms grown from blood cultures in a case of
neonatal meningitis.
7. The likely organism is:
a) Haemophilus influenzae
b) Listeria monocytogenes
c) Group B streptococcus
d) Ecshericheria coli
8. Microscopic examination of a swab of brain abscess in a 65 year old man showed
Gram positive cocci in clusters. The swab was used to inoculate blood agar plates
which showed growth of creamy white non haemolytic colonies after overnight
incubation at 37°C.
The test to be performed to identify the bacterial colonies is:
a) Coagulase test
b) Catalase test
c) Sensitivity test
d) Haemolysin test
Semester 2 2010/2011
5
Examine the electron photomicrograph shown in Figure 4 and answer questions 9-10
Figure 4. The organism shown in the
photomicrograph was seen in a preparation
of cerebrospinal fluid (CSF) from a 20-year
old patient with a history of travel to
Seattle [Link] Prevention Training Center Source: Negusse Ocbamlchaet
Europe.
9. Which of the following best describes the gram stain appearance of the CSF?
a) White blood cells only
b) Red blood cells only
c) Gram negative bacilli
d) Intracellular and extracellular Gram negative diplococcic
10. Which of the following is correct?
a) Vaccines are available for all serogroups of the organism
b) Household contacts should be given prophylactic antibiotics
c) The organism requires X and V factor for growth
d) The organism is endemic and a common cause of meningitis in Jamaica
Semester 2 2010/2011
6
Questions 11 and 12 are based on the following table which reflects the data from the
use of Bupivacaine versus Ropivacaine to induce epidural anesthesia during labour.
Decrease in pain (%)
Dose (mg) 5 10 15 20 30 40
Bupivacaine 5 50 70 85 78 79
Dose (mg) 7 15 20 30 45 60
Ropivacaine 4 55 60 68 80 85
11. Which of the following explains the action ofRopivacaine and Bupivacaine?
a) They bind to ligand gated sodium channels
b) They promote hyperpolarization of neurons
c) They prolong refractory period of neurons
d) They acts as agonists of opioid receptors
12. Which of the following statements is correct?
a) Both drugs are examples of esters
b) Only Bupivacaine is an ester
c) Ropivacaine is more efficacious
d) Bupivacaine has greater potency
13. Orbital aneasthesia was conducted in two groups of patient using NaHC03
butTered -lignocaine (pH = 7.2) versus hyaluronidase-mixed lignocaine (pH =
4.2). How is this difference in pH of the solution likely to affect the anaesthesia of
lignocaine?
a) Hyaluronidase-mixed lignocaine will be more efficacious
b) Hyaluronidase-mixed lignocaine will have a slower onset of action
c) NaHC03 buffered -lignocaine will not produce anaesthesia
d) NaHC03 buffered -lignocaine will have the slower onset of action
Semester 2 2010/2011
7
14. The following table present data obtained from a student who volunteered to drink
rum during an experiment.
RUM Before TIME (mins) after
drinking drinking alcohol
DRINKERS o min 15 min 30 min
Alcohol Content /% 0.00 0.05 0.08
BAC
Key Tapping 90 102 125
(Device tappedfor 15
seconds)
Memory (numbers 4 4 6
remembered correctly
out of six)
Which of statements is TRUE?
a) The student was unlikely to be consuming alcohol for the first time
b) The student's blood alcohol concentration (BAC) is reflective of a state of euphoria
c) There must have been an error in recoding the data for the key tapping score
d) The students' BAC reading is likely to be to be higher after one hour
15. One week after the same student was asked to volunteer to repeat the procedure;
however Drug X was given to the student orally before rum was imbibed. The table
below reflect the change in the results
RUM Before TIME (mins) after
drinking drinking alcohol in the
presence of Drug X
DRINKERS o min 15 min 30 min
Alcohol Content /% 0.00 0.05 0.10
BAC
Key Tapping 90 102 65
(Device tapped for 15
seconds)
Memory (numbers 4 4 1
remembered correctly
out of six)
Which of the following is likely to be Drug X?
a) Methotrexate
b) Metronidazole
c) Midazolam
d) Methanol
END OF QUESTION PAPER
Semester 2 2010/2011
