_.harsh.

_75

Only for 2nd year RMC Microbiology Practical Exam

Harsh Chaudhari
(Batch 2022)
Que.1 A 42-year-old female patient was brought to the emergency
department with complaints of sudden episode of high-grade fever and
acute pain in the right hypochondrium. She had a history of dysentery
and jaundice for the last two months. Ultrasound scan of the abdomen
revealed enlarged liver with acute peritonitis. Pus aspirated from liver
was thick chocolate brown in color. Microscopy of liver pus revealed
necrotic hepatocytes without any pus cells.

Diagnosis – Amoebic Liver Abscess

Causative agent – Protozoan parasite, E. histolytica
Que.2 A 8-year-old girl came to the pediatric OPD for school health
check-up. On examination, she had pallor. Peripheral blood smear
revealed microcytic, hypochromic anemia. Stool microscopy (saline
mount) showed round to oval non-bile stained egg with segmented
ovum (four blastomeres).

Diagnosis – Hookworm infection

Causative agent – Ancylostoma duodenale
Que.3 A 75-year-old man was hospitalized with fever (101°F), severe
back-pain and weakness in lower limbs. On examination, few non-
tender, small erythematous nodular lesions on soles were seen.
Echocardiogram showed valvular vegetations on mitral valve. He was
diagnosed to have a cardiac valve vegetations 3 years back. Laboratory
tests showed CRP 2.5 mg/dL, ESR 66 mm/h, leukocytes 15.6 × 109/L
and creatinine 4.6 mg/ dL. Two pairs of blood cultures were sent which
sub sequently were positive for viridans streptococci. The patient was

immediately started on benzyl penicillin.

Diagnosis – Infective Endocarditis

Causative agent – Viridans streptococci
Que.4 A 28-year-old male is presented with elevated temperature of
(102°F) for >3 weeks. The patient is hospitalized for the past five days
without elucidation of a cause.

Diagnosis – Fever of Unknown origin

Que.5 A 4-year-old boy developed severe watery diarrhea and vomiting.
The stool collected has a rice water type of appearance. It was sent for
bacteriological analysis.

Diagnosis – Cholera
Causative agent – Vibrio Cholera
Que.6 A 3-year-old boy presented with recurrent episodes of foul
smelling diarrhea, foul flatus, sulfurous belching and profound weight
loss. The wet mount examination of the stool sample revealed pear
shaped trophozoites with falling leaf-like motility.

Diagnosis – Giardiasis
Causative agent – Giardia lamblia or G. duodenalis
Que.7 Neha, a 17-year student who has recently joined MBBS, has
come back to the hostel after the first vacation. After entering to her
hostel room, she suddenly developed an episode of severe sneezing, and
dyspnea. She had to be admitted to the casualty and when asked, she
told that she has faced similar episodes since her childhood.

Diagnosis – Type I Hypersensitivity Rxn

Que.8 Meena, a young adult female was admitted to the hospital with
intense headache, abdominal discomfort for the past 5 days. She had
also developed fever which is of remittent type with gradual rise in a step
ladder fashion. On examination, she was toxic with temperature of
101°F, tongue was coated and mild splenomegaly was present.

Diagnosis – Enteric Fever

Causative agent – Salmonella typhi & S. paratyphi
Que.9 A 25-year-old male with history of multiple sex partners is
admitted with complaints of unexplained fever, progressive loss of
weight, persistent diarrhea and generalized lymphadenopathy for the
past 6 months.

Diagnosis – HIV/AIDS
Que.10 A 7-year-old female child presented to the cardiology OPD with
swollen, red, and/or tender joints, which migrates from one joint to
another (knees, ankles, hips, and elbows) over a period of hours. The
child was having an abnormal gait. She also complained of painless,
small, mobile lumps beneath the skin overlying bony prominences,
particularly of the hands, feet, and elbows. On auscultation, murmur
was heard over the mitral valve area. ECG showed prolongation of P-R
interval. On inquiry, it was found that the child had an episode of sore
throat 3 weeks back.

Diagnosis – Acute Rheumatic Fever

Causative agent – Group A Streptococci
Que.11 A 40-year-old male presented with history of loss of appetite,
malaise and jaundice of 2 months duration. On examination, there was
icterus, hepatomegaly and tenderness in the right hypochondriac region.
He gave a history of blood transfusion in the past. On laboratory
examination, he was found to be positive for HBsAg.

Diagnosis – Hepatitis B infection

Que.12 A 24-year-old woman presented with complaints of pain in the
right hypochondrium. Ultrasonography revealed a single space
occupying cystic lesion in the right lobe of the liver. The cyst was
removed surgically and subjected to histopathological examination,
which revealed three layered cyst wall with attached brood capsules.

Diagnosis – Hydatid Disease

Causative agent – Echinococcus granulosus
 Que.13 Graft vs Host
➢ Transplant immnology is the study of the immune response that occurs when an organ or tissue is
moved (grafted) from one individual to another.
➢ A condition that occurs when donated stem cells or bone marrow (the graft) see the healthy tissues in
the patient’s body (the host) as foreign and attack them. It can also occur after an organ transplant.
➢ Graft-versus-host disease can cause damage to the host’s tissues and organs, especially the skin, liver,
intestines, eyes, mouth, hair, nails, joints, muscles, lungs, kidneys etc.
➢ There are two main categories of GVHD:
✓ Acute graft-versus-host disease
✓ Chronic graft-versus-host disease

➢Acute GVHD symptoms :- Chronic GVHD Symptoms :-

✓Mouth (A very dry mouth, Difficulty
✓A rash eating, Gum disease)
✓Nausea, vomiting, abdominal cramps, ✓Skin (A rash, Dry, tight, itchy skin)
✓Nails (Changes in nail texture, Hard &
loss of appetite and other GI problems brittle nails, Nail loss)
✓Jaundice (yellowing of the skin or eyes). ✓Scalp and Body Hair (Loss of hair on the
head, Premature gray hair, Loss of body
✓Abnormalities of liver function hair)
Que.14 A 35-year-old female from a village of Bihar came to the
hospital with history of fever on and off for the past one year and
recently developed unilateral swelling of the left lower limb. Her blood
sample was sent for peripheral blood smear examination which revealed
microfilariae, 240 μm in length, tail tip pointed free of nuclei.

Diagnosis – Lymphatic Filariasis

Causative agent – Wuchereria bancrofti
Brugia malayi & Brugia timori
Que.15 A group of patients presented to the emergency department
with chief complaints of fever, vomiting and diarrhea. All of them had
attended a birthday party 4–6 hours back.

Diagnosis – Food Poisoning

Causative agent – S. aureus,C. perfringens
Vibrio cholerae, Enterotoxigenic [Link], Shigella species
Que.16 A 54-year-old male from Chhattisgarh presented with fever,
chills and rigor for a duration of four days. The patient developed
convulsions prior to admission. He was started on ceftriaxone by a
private medical practitioner, but did not improve. On physical
examination, muscle tone and tendon reflexes were reduced. Anemia
and splenomegaly were present. The blood sample was collected for
peripheral blood smear examination which showed accole form,
multiple ring forms and crescent shaped gametocytes inside RBCs.

Diagnosis – Falciparum malaria or Cerebral Malaria

Causative agent – Plasmodium falciparum
Que.17 A 39-year-old farmer presented to the emergency department
with a 4-day history of fever, headache, and non-pruritic rashes on his
face, extremities with an eschar on left lower leg.

Diagnosis – Scrub typhus

Causative agent – Orientia tsutsugamushi
Que.18 A 21-year-old vegetarian female presented with recurrent
episodes of seizure, headache vomiting and vertigo. MRI scan of brain
showed cystic lesion in brain parenchyma, following which surgery was
performed. The cysts were surgically removed which appeared yellowish
white in color, measuring 0.5–1.5 cm size, slightly oval in shape,
containing a bladder like sac with a white spot.

Diagnosis – Neurocysticercosis
Causative agent – Cysticercus cellulose larva
of T. solium
Que.19 Alisha, A 4-year-old girl from Bhubaneswar was brought to the
emergency room by her parents due to an acute onset of fever,
productive cough and dyspnea for past two days. Physical examination
revealed dull note on percussion. Direct examination of the sputum
revealed plenty of pus cells and gram positive, lanceolate-shaped
diplococci surrounded by a halo.

Diagnosis – Pneumococcal pneumonia

Causative agent – Streptococcus pneumoniae, Haemophilus
influenzae, Staphylococcus aureus, Gram-negative bacilli.
Que.20 A child aged 7 years with high grade fever, toxic, pain in the
throat, inability to swallow was brought to the casualty. On examination,
a white patch was found on the fauces, which started bleeding when
touched. No history of immunization is available.

Diagnosis – Diphtheria
Causative agent – Corynebacterium diphtheriae
Que.21 Mr. Michel, a 25-year-old Australian visited his local doctor
complaining of difficulty in swallowing liquids, loss of appetite and
restlessness. He had a travel history to India one month back and did
mention being bitten by a street dog in Puducherry.

Diagnosis – Rabies
Que.22 A 9-week-old baby named Sweety was brought to the
emergency room with weakness in her right leg. On examination, her
right leg appeared flaccid and no deep tendon reflex or Babinski reflex
can be elicited, although sensation was intact. The tone, movement,
sensation, and reflexes of her other limbs were normal. Her
immunization records were up-to-date according to the National
Immunization Schedule of India. CSF demonstrates elevated protein
with normal glucose levels. Fecal sample was collected and then sent to
the referral center where the poliovirus is identified as a vaccine strain
(not the “wild-type” strain) of poliovirus type-1 was isolated.

Diagnosis – Polio
Que.23 A 32-year-old female was admitted with dysuria (burning
micturition) and increased frequency of micturition for the past 2 days.
Culture of the urine specimens revealed lactose fermenting colonies on
MacConkey agar.

Diagnosis – Lower UTI

Causative agent – [Link], Klebsiella pneumoniae
Que.24 A 40 year old male having history of sexual exposure with
commercial sex workers presented to a STD clinic with painless hard
indurated genital ulcer covered by thick exudate. On examination the
patient also had painless hard enlarged bilateral inguinal lymph nodes.

Diagnosis – Primary Syphilis

Causative agent – Treponema palladium
Que.25 Rajesh, a 28-year-old male, was admitted to the hospital with
complaints of low-grade fever, loss of weight and appetite and chronic
cough with expectoration for past 6 months. Sputum examination
revealed long, slender and beaded acid-fast bacilli.

Diagnosis – Tuberculosis
Causative agent – Mycobacterium tuberculosis
Que.26 In early 2018, a 62-year-old debilitated man from Maharashtra
presented with symptoms of severe upper respiratory tract infection. He
had a history of exposure to a patient having similar condition.
Nasopharyngeal swab collected was sent to the reference laboratory for
real time PCR which revealed that causative agent as influenza
A/H1N1.

Diagnosis – Viral flu (H1N1)

Causative agent – H. influenzae
Que.27 A 29-year-old HIV-infected male presents to the clinic with
history of high-grade fever and altered mental status. On examination,
his blood pressure was found as 90/60 mm of Hg, and respiratory rate
was increased to 28 per minute. Blood cultures yielded creamy white
colonies which on Gram stain revealed gram-positive oval budding yeast
cells with pseudohyphae.

Diagnosis – Candidemia
Causative agent – Candida albicans
Que.28 A farmer presented to the outpatient department with history of
papulovesicular lesion over the neck region, which later on developed
into a coal black, necrotic wound for the past 3 to 4 days. After being
examined, the doctor sent a tissue from that necrotic area to the
laboratory. Gram staining revealed gram-positive rod shaped bacilli
arranged in chains.

Diagnosis – Cutaneous Anthrax

Causative agent – Bacillus anthracis
Que.29 A 21-year-old male had developed characteristic well-
demarcated annular or ring-shaped pruritic scaly skin lesions with
central clearing and raised edges. Culture of the skin scraping done on
Sabouraud’s dextrose agar reveals velvety colonies with red pigment on
the reverse. Microscopy of the culture isolate reveals plenty of tear drop
shaped microconidia and few, long, pencil-shaped macroconidia.

Diagnosis – Dermatophytosis
Causative agent – Tinea corporis or T. rubrum
Que.30 A 7-year-old girl was admitted to the hospital with complaints
of high-grade fever, headache, vomiting, altered mental status, seizure
and neck rigidity. CSF sample was collected by lumbar puncture in a
sterile container and sent to the laboratory for biochemical analysis,
direct microscopic test, culture and sensitivity testing.

Diagnosis – Acute Bacterial Meningitis

Causative agent – Streptococcus pneumoniae, Neisseria
meningitidis, Hemophilus influenzae
Que.31 Rajesh, a 23-year-old male was admitted 5 days after a crush
injury to his right leg following a road traffic accident. He had been
treated by a local village quack. On examination, the wound which was
bandaged with a soiled gauze, appeared to be heavily contaminated with
soil, the local muscles appeared to have been crushed, there was edema
and pain at the site and crepitus was felt on palpation.

Diagnosis – Gas gangrene

Causative agent – C. perfringens (most common, 60%)
and C. novyi and C. septicum (20–40%)
Que.32 A 7-year-old boy had developed multiple painful vesicles over
the lips and buccal mucosa. His parents revealed that two children of his
school had a similar presentation few days back. Scrapings taken from
the lesion demonstrated presence of multinucleated giant cell (Tzanck
cell).

Diagnosis – Herpes simplex virus infection

Que.33 A 27-year-woman had developed mucopurulent discharge,
followed by development of dysuria and urethral irritation. She had a
history of multiple sexual partners. Microscopy of the urethral swab
revealed sterile pyuria and presence of compact inclusion bodies which
are later stained by Lugol’s iodine.

Diagnosis – Chlamydia trachomatis

Infections
 Prepare these topics also,
1. Dysentery
2. Septicaemia
3. Intestinal taeniasis
4. Subcutaneous fungi (dimorphic fungi)
5. Upper Respiratory Tract Infection
6. Abscess
7. Gonococcal Urethritis
8. Chronic Schistosomiasis