Media lab Exam review with pictures

Large intestinal roundworm

A 10-year-old male presented to the local Appalachian Mountain clinic complaining of vomiting, fever, and severe abdominal pain. Patient history revealed the child lives in substandard conditions and receives only one balanced meal per day. A stool sample was collected and submitted for parasite study. This low power view of the egg, measuring 50 µm by 35 µm, was seen in the stool concentrate. This patient is most likely infected with:

Taenia saginata

A 29-year-old male restaurant owner from Arizona presented to his doctor complaining of weight loss, abdominal pain, and diarrhea. Patient history revealed that the man most all of his meals at his restaurant and his favorite meat is rare sirloin steak. The man also noted that he had recently been placed on anti-parasitic medication. The doctor ordered a stool for parasitic examination. These two suspicious forms were seen. The patient is most likely suffering from an infection with:

Hemolytic Uremic Syndrome (HUS)

A 3-year-old girl was brought to a physician's office because of fever and bacterial-type illness symptoms. Her blood pressure was elevated. Gram stain of peripheral blood shows Gram-negative rods.Hemogram: hemoglobin 9.1g/dL (normal 12.0 - 16.0 g/dL), hematocrit 28% (normal 37 - 48%), MCV 80 fl (normal 86 - 98 fl), RDW 13.1% (normal 11 - 15%), platelets 85.1 X 109/L (normal 150 - 450 X 109/L) WBC 9.9x109/L (normal 4.3 - 10.8 x 109/L). The peripheral blood smear is represented in the photograph. Which of the following is the most likely associated condition?

Microsporum gypseum

A 4-day old colony recovered on Sabouraud's dextrose agar is illustrated in the top photograph. The specimen was taken from a skin infection incurred by a 45-year-old farmer. The microscopic appearance obtained from the surface mycelium of the colony is illustrated in the lactophenol blue mount in the bottom image. What is the identification of this fungal isolate?

insulin dependent diabetes mellitus

A 56-year old female was taken to the emergency room in a coma by her employer's nurse. She had lost 35 pounds in 3 months; she was always thirsty; drinking a lot of water and running to the bathroom. The following are her laboratory results

Streptococcus pneumoniae

A 67-year-old man was seen in the emergency room complaining of cough, fever, and piercing right posterior chest pain. X-ray of the chest revealed consolidation of the right middle lobe of the lung. Sputum culture grew the bacterial species shown in the upper photograph. The lower photomicrograph illustrates a gram-stain of the sputum specimen. The most likely cause of the pneumonia is:

Cryptosporidium parvum

A pathologist was asked to view an H & E - stained section of an endoscopic biopsy of the duodenum (upper left image). The specimen was obtained from a patient with mal-absorption syndrome. After observing tiny acid-fast globules along the intestinal epithelial lining cell (arrows, upper right image), one of the laboratory microbiologists was consulted. Having a presumptive identification in mind (lower left image), the microbiologist prepared an acid-fast stained smear of intestinal fluid (lower right image) and observed tiny 5 µm in diameter oocysts. From the following multiple choices, select what parasite the microbiologist might have reported.

Haemophilus influenzae

A pediatric patient arrived at the doctor complaining of itching eyes that appeared red and slightly purulent. When a sample was submitted to the laboratory, the sample grew only on the chocolate plate as seen in the upper image. When performing a satellite test, the image on the bottom is observed. What is the most likely identity of the organism causing this patient's symptoms?

Mesothelial cells, neutrophils, and red blood cells

After reviewing this cytospin from a pleural fluid, identify the cells that would be the appropriate to report?

Wuchereria bancrofti

An 18-year-old immigrant from the Philippines presented to the local clinic shortly after relocating to the United States complaining of fever and chills. Physical examination of the patient revealed enlarged lymph nodes. Blood was drawn and submitted for culture and parasitic examination. The culture was negative. This suspicious form was seen on the Giemsa-stained blood smear. It measures 225 µm in length. This patient is most likely infected with:

Pink, 1 cell thick, No, Yes

Based on the picture and the criteria below, how would the Gram stain be interpreted?

Pappenheimer (siderotic) bodies

By utilizing a Prussian Blue stain, which of the following red blood cell inclusions would be identifiable if present? Note: Upper image = Wright-Giemsa stain Lower image = Prussian Blue stain

Autoimmune hemolytic anemia

Conditions in which erythrocytes as photographed here may be present in a peripheral blood smear include:

non-utilizer

Examine the Oxidation and Fermentation media images to the right. The image labeled as Bucket A represents what type of organism?

monocyte

Identify the nucleated blood cell:

Blastomyces dermatitidis

Identify the species of dimorphic fungi in its yeast form as observed under the microscope in this image.

amebiasis

Illustrated in the upper image is a stained histological section of a bowel showing a heavy inflammatory reaction within which 10 - 12 µm spherical cysts are observed. The lower image is a close-up view of one of the organisms from a smear preparation of the exudate. There is a distinctive central karyosome, even distribution of the ring of chromatin, and the finely granular cytoplasm. What disease can be presumptively reported?

Fasiola hepatica

Illustrated in this high-power microscopic view is a large spherical ovum measuring 130 µm that was found in a stool specimen. These ova often have brown staining that suggests passage through a biliary duct on its way to the large intestine. Based on the appearance of this ovum, select the correct presumptive identification

Exophiala sporulation

Illustrated in this image is the fruiting head of one of the fungal agents of chromomycosis. Note the small clusters and short chains of elliptical conidia produced from the tip of a conidiophore. Which of the following choices best represents the type of sporulation illustrated in this image?

Listeria monocytogenes

Illustrated in this photograph to the right is a sulfide indole motility (SIM) tube (left) and an esculin hydrolysis slant (right) after inoculation with an unknown gram-positive bacillus and incubation at 30°C for 24 hours. Based on the reactions observed, the most likely identification is:

enterocytozoon species

Illustrated in this photomicrograph is a silver-stained section of duodenal epithelial cells invaded by 1.5 µm in diameter spores (arrows). These spores will appear red in Weber-stained mounts (image not shown here). The presumptive identification is:

Listeria monocytogenes

Observed in the top photographs are colonies growing on blood agar after 24 hours incubation, obtained from a positive blood culture. The colonies are tiny and surrounded by narrow zones of beta hemolysis. The initial presumptive identification was that of a Streptococcus and a CAMP test was set up. A follow-up Gram stain (middle image) revealed Gram-positive bacilli in loose clusters rather than cocci. The lower image demonstrates a rectangular zone of hemolysis in the CAMP test, compared to the arrow-head shape of a control Streptococcus. From these observations, select the most likely presumptive identification of this isolate.

Staphylococcus aureus

Purulent material is obtained from a carbuncle and submitted for bacterial culture. Many Gram-positive cocci and white blood cells were seen on a direct smear (top right image). Colonies on blood agar are, smooth and gold/yellow surrounded by a narrow zone of beta hemolysis (top left image). Coagulase tests are shown in the bottom images. The slide coagulase test is negative, but the tube coagulase test is positive. The probable presumptive identification is:

HbSS

The hemoglobin electrophoresis patterns that are shown on the right include controls for A, S, and C; and A and F above and below the patient results. (NOTE: ASC and AF are simply labels for the controls and do not indicate the order of migration.) The patient was tested in duplicate, and the results are in lanes 5 and 6. The patterns on the left are from alkaline hemoglobin electrophoresis, and the patterns on the right are from acid electrophoresis. These are results from the same patient. The patient lanes displayed in these hemoglobin electrophoresis patterns are consistent with what diagnosis?

glucose non-oxidizer

The set of tubes in the image to the right are the Hugh and Leifson Oxidative/Fermentative (O/F) basal medium with glucose and a pH indicator of bromthymol blue. This image demonstrates a reaction of:

May-Hegglin Anomaly

The structure indicated by the arrow in this image, along with giant platelets (also present in the image), is characteristic of which of the following conditions?

Artifcats

The urine macroscopic (urinalysis test strip) results were completely normal and within range. Upon viewing the microscopic, the technologist noticed these circular elements. What could be the identification of these elements?

May-Hegglin Anomaly

This image is of a peripheral blood smear from a patient with what condition?

Chromosomal AmpC plus Porin Mutation

This isolate, identified as Enterobacter cloacae, was recovered from the urine and blood cultures of a patient who had recently returned from India where he had received a total hip replacement. He presented to the ED with multiple decubiti, sinusitis, and a urinary tract infection