Microbiology - Analytic Procedures for Bacteriology

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64. What bacterial species is rarely part of normal microbiota of healthy humans? A. Pseudomonas aeruginosa B. Burkholderia cepacia C. Burkholderia mallei D. Pseudomonas fluorescens

80. Which of the following is MOST often determined to be the cause of sepsis? A. Parasites B. Bacteria C. Fungal organisms D. Viruses

81. A non-hemolytic organism was isolated from the blood culture of a patient. The organism shows positive reactions in 6.5% NaCl broth and on bile esculin agar. With further testing, this isolate will most likely be identified as: A. Streptococcus pneumoniae B. Enterococcus spp. C. Streptococcus agalactiae D. Streptococcus bovis

52. The Carba NP confirmatory test is used to detect all of the following carbapenemases EXCEPT? A. KPC (Klebsiella pneumoniae carbapenemase) B. NDM-1 (New Delhi metallo-beta-lactamase) C. VIM (Verona integron-encoded metallo-beta-lactamase) D. ESBL (Extended Spectrum Beta-Lactamase)

348. Which organisms/conditions would be classified as Biosafety Level 3 agents? A. Mycobacterium tuberculosis and Coxiella burnetti B. Marburg virus and Congo-Crimean hemorrhagic fever C. Bacillus subtilis and Naegleria gruberi D. HIV and hepatitis B virus

354. A tech is working with a large, spore-forming, Gram-positive bacillus that they believe is Bacillus spp. Which of the following tests could the tech use to ensure this organism is not Bacillus anthracis? A. Motility positive B. Susceptibility to Penicillin C. Non-hemolytic on blood agar D. No growth on phenylethyl alcohol agar (PEA)

356. A tech is working with a small Gram-negative coccobacillus that may be Francisella tularensis. Which of the following tests could the tech use to rule out this organism? A. Catalase negative B. Beta-lactamase positive C. Urease negative D. Oxidase negative

165. When performing quantitative cultures from protected brush specimens, which of the following colony forming units per milliliter indicates a true bacterial pneumonia? A. >10^4 colony forming units/mL B. >10^3 colony forming units/mL C. >10^2 colony forming units/mL D. >10^1 colony forming units/mL

331. Carbapenemases are produced by various organisms such as Enterobacteriaceae, Pseudomonas aeruginosa, and Acinetobacter species. Detecting the presence of carbapenemase activity in these organisms is important to prevent spreading of the resistant organisms. Which of the following methods is used to detect the presence of carbapenemase producing organisms? A. D test B. Modified Hodge Test C. ESBL Test D. Beta-lactamase test

338. What organism has a toxin that, when released, causes profuse, watery diarrhea? A. Yersinia pestis B. Vibrio cholerae C. Bacillus anthracis D. Mycobacterium tuberculosis

339. Which is the most commonly reported organism in cases of laboratory-acquired bacterial infection? A. Francisella tularensis B. Brucella species C. Burkholderia species D. Yersinia pestis

298. Penicillin G, ampicillin, carbenicillin, and methicillin are antimicrobial agents whose MAIN biological function is to: A. Induce abnormal protein synthesis by targeting ribosomal subunits B. Inhibit cell wall synthesis C. Deteriorate the cell membrane D. Inhibit DNA synthesis

299. The McFarland Comparison Card is used to: A. Perform susceptibility testing B. Standardize concentrations of organisms C. Q.C. broth media D. Determine MICs

301. Which one of these Gram-positive species has a high incidence of vancomycin-resistance? A. Aerococcus species B. Enterococcus faecium C. Group D streptococci D. Streptococcus pyogenes

304. MIC is an acronym for: A. Maximum inhibitory concentration B. Minimum inhibitory concentration C. Microbial inhibition concentration D. Microbial incubation curve

340. A tech is working with a small, Gram-negative coccobacillus that may be Brucella spp. Which of the following tests could the tech use to rule out this organism? A. Oxidase positive B. Urease negative C. Catalase positive D. Motility negative

343. Agar plates on a positive blood culture are incubated for 48 hours and no growth is visible on the agar plates. The tech reviews the initial Gram stain from the blood culture bottle, which reveals tiny pleomorphic Gram-negative coccobacilli. What organism should the tech suspect and what should the tech do next? A. Campylobacter jejuni; Set up a CVA plate in the 42 degree incubator B. Francisella tularensis; Sub blood culture bottle to a media with cysteine for optimal growth C. Yersinia pestis; Sub blood culture bottle to media at room temperature incubation D. Streptococcus pneumoniae; Organism has autolysed in blood culture bottle

222. A 22-year-old construction worker incurred 3rd degree burns to the chest and arms when a boiler he was installing blew up. On the 5th hospital day the weeping wounds became infected, exuding what was described as green pus. The Gram stain prepared on a direct smear of the exudate shows slender gram-negative bacilli. What is the MOST likely bacterial cause of the infection? A. Chryseobacterium indologenes B. Alcaligenes faecalis C. Acinetobacter baumannii D. Pseudomonas aeruginosa

209. The bacterial species commonly found in association with deep tissue actinomycosis is: A. Actinobacillus spp. B. Streptococcus species C. Aggregatobacter aphrophilus D. Aggregatibacter actinomycetemcomitans

216. All of the following statements concerning Rickettsia species are true, EXCEPT: A. They are obligate intracellular parasites. B. They are gram negative bacilli. C. Associated diseases are usually diagnosed by serology. D. They are cultured in many hospital laboratories.

224. A gram-negative rod isolated from a burn patient produced a bluish green pigment and the following test results: Characteristic fruity odorTriple sugar iron (TSI) agar: Alkaline/alkalineMotility: PositiveOxidase: PositiveOxidative/fermentation (OF) glucose: Oxidative utilization only What is the MOST probable genus of this isolate? A. Acinetobacter B. Alcaligenes C. Moraxella D. Pseudomonas

68. Which of the following organisms is known to be a strict halophilic organism? A. Vibrio vulnificus B. Staphylococcus aureus C. Erysipelothrix rhusiopathiae D. Salmonella typhi

317. The following is true of the disk diffusion method of measuring antimicrobial sensitivity: A. Provides a semi-quantitative MIC value B. Provides only an interpretation value of sensitive, intermediate, or resistant correlated to MIC values C. Requires minimal standardization D. Commonly automated method of antimicrobial susceptibility testing

32. Which strictly human pathogen causes chancroid, a highly contagious, sexually transmitted genital ulcer disease? A. Treponema pallidum subsp. pallidum B. Haemophilus ducreyi C. Chlamydia trachomatis D. Neisseria gonorrhoeae

320. Oxacillin resistance of MRSA is due to production of which of the following penicillin binding proteins (PBPs)? A. PBP2 B. PBP2a C. PBP3 D. PBP4

322. Which of the following media is commonly used when performing the Kirby-Bauer disk diffusion? A. Chocolate agar B. Mueller-Hinton agar C. Thayer-Martin agar D. MacConkey agar

323. Which of the following antibiotics inhibits protein synthesis by binding to the 30S ribosomal subunits and provides coverage against Gram positive and Gram negative aerobes? A. Beta-lactams B. Aminoglycosides C. Fluoroquinolones D. Polymyxins

7. Sulfonamides, such as sulfamethoxazole (SMZ), and trimethoprim (TMP), work by targeting: A. Penicillin-binding proteins; disrupting bacterial cell wall synthesis B. Tetrahydrofolate synthesis; preventing bacterial DNA synthesis C. 30S ribosomal subunits; inhibiting bacterial protein translation D. 50S ribosomal subunits; inhibiting bacterial protein translation

77. Which one of the following organisms is typically urease negative: A. Klebsiella B. Escherichia C. Proteus D. Haemophilus

146. A patient came into the emergency department with a swollen knee and the physician drained 20 mL of fluid from the patient's knee. What is the name of the fluid collected? A. Pleural fluid B. Ascitic fluid C. Synovial fluid D. Pericardial fluid

147. All of the following are collected from sterile sites, EXCEPT: A. Urine B. Pleural Fluid C. Abscess fluid D. Cerebrospinal fluid (CSF)

218. Edwardsiella tarda is known to be associated with which of the following animals? A. Poultry B. Cockroaches C. Reptiles D. Rats and other rodents

109. Which of the following organisms is the leading cause of bacterial meningitis in infants, young children, and adults in the United States? A. Haemophilus influenzae B. Neisseria meningitidis C. Pediococcus spp. D. Streptococcus pneumoniae

333. Which of the following statements is true about the emergence of penicillin-resistant strains of Streptococcus pneumoniae? A. Resistance to penicillin disk diffusion is reliable. B. A zone size = 20 mm surrounding a 1µg oxacillin disk must be confirmed. C. Penicillin resistance is reliable and reportable with a zone size of = 20 mm with the oxacillin disk screen. D. A zone size of = 20 mm with the oxacillin disk screen must be confirmed with an MIC method to determine if Penicillin is susceptible or resistant

313. Each of the following organisms may possess extended-spectrum beta-lactamase (ESBL) activity except: A. Escherichia coli B. Klebsiella oxytoca C. Proteus mirabilis D. Pseudomonas aeruginosa

307. A patient grew out a Staphylococcus lugdunensis and after susceptibility testing, the isolate gave results indicating probable resistance to oxacillin. Which of the following is the best method to detect the mec-A gene to determine if the organism has true oxacillin resistance? A. Oxacillin agar screen B. Cefoxitin disk diffusion C. Vancomycin agar screen D. D-zone test

316. The disease most commonly associated with the novobiocin-resistant staphylococcus is: A. Septic arthritis B. Community-acquired urinary tract infection C. Endocarditis D. Wound infection

349. All of the following organisms are considered select agents for a bioterrorism event, EXCEPT? A. Bacteria B. Viruses C. Toxins D. Parasites

361. The following Clostridium difficile virulence factor is significant in the cause of antibiotic-associated pseudomembranous colitis: A. Alpha toxin B. Tetanospasmin C. Neurotoxin D. Cytotoxin A or B

277. Which of the following organisms is the most common cause of acute cystitis? A. Escherichia coli B. Klebsiella pneumoniae C. Chlamydia trachomatis D. Staphylococcus epidermidis

343. From the following organisms, which one is considered to be the LEAST pathogenic to humans? A. Corynebacterium ulcerans B. Bacillus anthracis C. Listeria monocytogenes D. Nocardia brasiliensis

328. The organisms Klebsiella pneumonia, Enterobacter cloacae, and Escherichia coli can produce carbapenemases due to which of the following genes? A. mec A B. van A C. blaKPC D. erm

240. Throughout history, plague pandemics have killed millions. Transmission of the human plague may still occur through bites of rodent fleas or contact with infected animals. What is the causative agent of plague? A. Vibrio cholerae B. Bacillus anthracis C. Clostridium botulinum D. Yersinia pestis

244. Rocky Mountain spotted fever (RMSF) is transmitted by the bite of a tick infected with: A. Coxiella burnetti B. Borrelia burgdorferi C. Borrelia recurrentis D. Rickettsia rickettsii

25. Serotypes of Salmonella are differentiated by various antigens found within the organism. All of the following antigens are used to serotype Salmonella EXCEPT? A. O antigen B. H antigen C. Vi antigen D. F1 antigen

254. What is the BEST method for detection of Chlamydia trachomatis in cases of sexually transmitted disease (STD)? A. Non-culture EIA methods B. Cervical tissue culture C. Culture of Thayer-Martin agar D. DNA amplification techniques

314. Beta-lactam antibiotics interfere with cell wall synthesis by all of the following, EXCEPT: A. Binding with a transpeptidase B. Preventing the final stage of peptidoglycan synthesis C. Interfering with PBPs D. Targeting the 30S ribosomal subunit

389. Which of the following is the most commonly encountered enterococcal species? A. Enterococcus gallinarum B. Enterococcus faecium C. Enterococcus casseliflavus D. Enterococcus faecalis

4. A tech is interpreting a urine culture from a catheter as the source. There is 1 colony of Staphylococcus epidermidis present on the blood agar which was streaked with a 0.001 loop. What should the tech do next? A. Reject culture due to contamination B. Perform sensitivity on S. epidermidis C. Report culture as no growth D. List S. epidermidis as a possible contaminant

171. A patient with cystic fibrosis is admitted with a fulminant lung infection. A sputum culture grows a non-lactose fermenting, oxidase positive, Gram-negative bacilli. It is pyocyanin negative, nitrate reduction variable, and it is arginine dihydrolase negative. A. Stenotrophomonas maltophilia B. Burkholderia cepacia C. Pseudomonas aeruginosa D. Acinetobacter baumannii

176. An alpha hemolytic slightly concave isolate from a respiratory specimen gave a zone of inhibition of 18 mm around the optochin disk. What should the next step be? A. Report the isolate as optochin sensitive. B. Report this organism as Streptococcus pneumoniae. C. Report this organism as Viridans streptococci. D. Repeat the optochin susceptibility test.

78. Since Brucella species are facultative intracellular organisms that infect the reticuloendothelial system, specimens of choice for recovery include: A. Urine and feces B. Blood and bone marrow C. Bronchoalveolar lavage and sputum D. Seminal fluid or vaginal fluid

234. Which of these organisms is associated with the condition known as toxic shock syndrome? A. Clostridium difficile B. Staphylococcus aureus C. Enterococcus faecalis D. Micrococcus luteus

237. A 25-year-old man was experiencing some difficulty in chewing and swallowing food. He had incurred a deep laceration of the lower leg in a lawn mower incident one week before. The wound was healing but signs of infection persisted. The image shows the Gram stain of a spreading, gray colony isolated from an aspirate of the wound, incubated under anaerobic conditions. Three additional bacterial species were recovered on blood agar incubated aerobically. What is the most likely identification of this anaerobic organism? A. Clostridium ramosum B. Clostridium tetani C. Clostridium botulinum D. Clostridium septicum

241. A fusiform-shaped, Gram negative, oxidase negative bacillus that produces colonies with marginal finger-like projections was recovered from the oral cavity of a patient with periodontal disease. The most likely identification is: A. Capnocytophaga canimorsus B. Capnocytophaga ochracea C. Actinobacillus actinomycetemcomitans D. Eikenella corrodens

242. All of the following descriptions about Pasteurella species are true, EXCEPT: A. Forms large amounts of indole. B. Grows well on MacConkey agar. C. Many infections are caused by domestic animals. D. P. multocida is the species most frequently isolated from humans.

245. What is the probable identity of an organism isolated from a wound culture that demonstrates the following test results? Phenylalanine Deaminase = negative TSI = A/A gas Citrate = positive Lysine = positive SIM = negative/negative/negative Urea = weakly positive A. Escherichia coli B. Klebsiella pneumoniae C. Klebsiella aerogenes D. Proteus vulgaris

246. The gram negative bacillus was recovered from a skin wound incurred while the patient was swimming in sea water around the Western U.S. coast of the Gulf of Mexico. Note that the gray-yellow colonies grow well on blood agar, but the colonies on TCBS agar are pale green, indicating the lack of sucrose utilization. The short, slightly curved gram negative bacilli seen in a gram stain are consistent with Vibrio species, but not species specific. Select the presumptive identification of this isolate. A. Vibrio cholerae B. Vibrio vulnificus C. Aeromonas hydrophila D. Plesiomonas shigelloides

250. Human dog bite infections may be caused by each of the following bacterial species except: A. Pasteurella multocida B. Capnocytophaga ochracea C. Capnocytophaga cynodegmi D. Neisseria weaveri

252. A woman came to see her physician as she was having vaginal/vulvar itching and some pain upon urination. To obtain a diagnosis of a yeast infection, which of the following is the test of choice? A. Fungal culture B. Wet preparation C. Routine vaginal culture D. Nucleic acid base test

253. A male urethral specimen was sent to the laboratory for a gonococcal culture and Gram stain. The specimen was received on a calcium alginate swab and cultured to chocolate and Thayer-Martin agars. A Gram stain was performed and presented intracellular and extracellular Gram negative diplococci. After 24, 48, and 72 hours of 37°C incubation in CO2, no growth was seen on either chocolate or Thayer-Martin agars. Which of the following is the most probable cause for lack of Neisseria gonorrhoeae growth? A. The plates were not incubated in appropriate conditions B. Inappropriate swab was used for collection C. Neisseria gonorrhoeae is heat labile D. The specimen was delayed in transportation to the laboratory

260. Which one of the following tests should be used to monitor a patient's response to treatment for syphilis: A. TP-PA titer B. RPR titer C. TP-HA titer D. FTA-ABS titer

305. Fluoroquinolones, such as ciprofloxacin, work by targeting: A. Penicillin-binding proteins; disrupting bacterial cell wall synthesis B. Tetrahydrofolate synthesis; preventing bacterial DNA synthesis C. Topoisomerases, inhibiting bacterial DNA replication D. 50S ribosomal subunits, inhibiting bacterial protein translation

308. With regards to identifying resistance in Enterococcus species, all of the statements below are true, EXCEPT: A. Both disk diffusion and broth microdilution tests should be incubated a full 24 hours to detect vancomycin resistance. B. BHI agar with 6 µg/mL vancomycin can be employed as a screening methodology for vancomycin resistance. C. All antibiotics on a gram-positive panel should be reported. D. Methodologies employed should also address the detection of high level resistance to gentamicin and streptomycin.

273. All of the following organisms have capsular material as a defense mechanism EXCEPT: A. Haemophilus influenzae B. Streptococcus pneumoniae C. Neisseria meningitidis D. Staphylococcus saprophyticus

274. A urine culture contains the following organisms: Proteus mirabilis: 2,000 cfu/mL Klebsiella pneumoniae: 10,000 cfu/mL In which of the following urine sources would both organisms be worked up with a full sensitivity? A. Catheterized urine B. Midstream clean catch urine C. Nephrostomy D. Suprapubic aspiration

282. A rapid urine screening test that can be performed to detect the presence of Staphylococcus species is which of the following tests? A. Niacin test B. Nitrate reduction test C. Leukocytes esterase test D. Catalase test

293. Group A beta-hemolytic streptococci are best characterized by which of the following: A. Positive CAMP test B. Optochin sensitivity C. Bile esculin-hydrolysis D. Bacitracin sensitivity

199. A gram-negative coccobacillus produces small gray colonies surrounded by a zone of hemolysis on potato-blood-glycerol agar. The organism also grew on chocolate agar, but NOT on sheep blood agar. This is MOST likely to be which organism? A. Alcaliqenes fecalis B. Bordetella pertussis C. Franciscella tularensis D. Hemophilus influenzae

215. Each of the following bacterial species are commonly associated with wound infections following a dog bite except? A. Staphylococcus intermedius B. Bordetella bronchiseptica C. Pasteurella multicida D. Capnocytophaga cynodegmi

217. What bacteria is responsible for the bubonic plaque? A. Mycobacterium tuberculosis B. Yersinia pestis C. Vibrio cholerae D. Corynebacterium diphtheriae

17. A CSF specimen was sent to the laboratory for analysis. A glucose, protein, and cell count were performed. Based on the following results, what would be the probable cause? Glucose - 50 mg/dL Protein - 25 mg/dL Leukocytes - 2 cells/mm^3 A. Normal CSF B. Viral infection C. Purulent infection D. Tuberculosis or fungi infection

18. Many organisms have developed resistance to antibiotics. What mode of resistance has MRSA acquired? A. Acquisition of new targets B. Enzymatic inactivation of antibiotics C. Efflux D. Target site modification

107. An organism grew out of a spinal shunt. The protocol for growth of this organism is to notify infection control and the public health department. In addition, any health care worker who came in contact with the patient must be treated promptly with antibiotic prophylaxis. Which of the following organisms requires this type of protocol? A. Neisseria meningitidis B. Neisseria gonorrhoeae C. Enterococcus species D. Staphylococcus aureus

367. A stool culture is received and inoculated to sorbitol MacConkey agar, where is exhibits reddish-pink colonies. Based on this colony morphology, which one of the organisms below can you rule out? A. Escherichia coli O157:H7 B. Yersinia enterocolitica C. Shigella species D. Campylobacter jejuni

223. Which of the following organisms "pits" the agar, and smells like bleach? A. Clostridium difficile B. Eikenella corrodens C. Proteus vulgaris D. Pasteurella multocida

230. Which of the following animals is a a likely source of human tularemia infections? A. Wild rats B. Wild rabbits C. Dairy cattle D. Domestic cats

111. The most common cause of acute meningitis associated with CSF shunts is: A. Coagulase-negative staphylococci B. Naegleria fowleri C. Citrobacter koseri D. Streptococcus pneumoniae

134. A purulent fluid was collected between the lung and the chest wall. What is the name of this fluid? A. Thoracentesis fluid B. Paracentesis fluid C. Ascitic fluid D. Synovial fluid

303. For an isolate of Escherichia coli, Klebsiella, or Proteus species testing positive for ESBL (Extended Spectrum Beta Lactamases), all of the following antibiotics should be reported as resistant except: A. Aztreonam B. Cefazolin C. Cefoxitin D. Ceftriaxone

1. A Staphylococcus species recovered from a CSF shunt culture was found to produce acid from sucrose and maltose and showed alkaline phosphatase activity. The Staphylococcus was also coagulase negative. The most likely identification is: A. Staphylococcus epidermidis B. Staphylococcus aureus C. Staphylococcus schleiferi D. Staphylococcus saprophyticus

73. Although an uncommon isolate in most microbiology laboratories, this bacterial species is included in the microbiota of the mouth and intestinal tract. The colonies on blood agar are irregular in size, smooth, non-hemolytic, entire, convex, and ranging from gray-white to light yellow. Distinctive is the "dog bone" appearance of branching Gram-positive bacilli in the Gram stain. Biochemical activity is limited to fermentation of glucose and lactose. With these observations, select the presumptive identification A. Bifidobacterium species B. Cutibacterium (Propionibacterium) acnes C. Actinomyces israeli D. Clostridium septicum

53. A clean-catch midstream urine specimen from a woman was sent to the microbiology laboratory for culture. The patient had a history of dysuria, frequent urination, suprapubic pain, no fever, no flank pain, or any urinary symptoms in the last 4 weeks before her current episode. The urine grew out 1,000 cfu/mL of Escherichia coli. Which of the following categories would the patient be classified? A. Acute, uncomplicated pyelonephritis B. Acute, uncomplicated UTI in women C. Asymptomatic bacteriuria in female patients D. Asymptomatic bacteriuria in male patients

62. Matrix-assisted laser desorption-ionization time-of-flight (MALDI-TOF) is used for identification of aerobic bacterial isolates on a urine culture bench. Upon placing the target into the MALDI-TOF instrument, no peaks were found on any target spots, including the quality control. What caused this issue? A. Quality control organism was not added to the target wells B. Matrix solution was not added to the target wells C. The target was not cleaned properly D. Quality control organism has deteriorated

63. Which of the following instrument-based systems are considered a continuous monitoring system? A. MALDI-TOF B. BACTEC C. Microscan D. Vitek

71. Which Gram positive bacilli will show a positive result for urease? A. Lactobacillus species B. Actinomyces naeslundii C. Erysipelothrix species D. Cutibacterium (Propionibacterium) acnes

23. A beta-hemolytic gram-positive cocci, isolated from the CSF of an infant, grew on sheep blood agar under aerobic conditions and was resistant to a bacitracin disc. Which of the following tests should be performed for the presumptive identification of the organism? A. Oxidase production B. Catalase formation C. Latex agglutination test D. Esculin hydrolysis

26. Which of the following substances produced by Group A Streptococci is responsible for producing type specific immunity? A. Streptolysin O B. Streptolysin S C. M antigen D. T antigen

33. Molecular methods offer improvements in sensitivity, but they are dependent upon what factor? A. The presence of significant numbers of organisms in the specimen B. Meeting unique/fastidious culture requirements C. The availability of specific instrumentation D. Maintaining the viability of the organism

35. From the choices listed below, which organism is classified as an aerotolerant anaerobe? A. Clostridium novyi B. Staphylococcus aureus C. Lactobacillus species D. Neisseria species

36. Which Enterobacteriaceae are non-lactose fermenters on MacConkey (MAC) agar, have green colonies with black centers on Hektoen enteric (HE) agar, and on xylose-lysine-deoxycholate (XLD) agar will have red colonies with black centers? A. Proteus spp. B. Edwardsiella spp. C. Salmonella spp. D. Shigella spp.

100. A D-test is performed to determine if Staphylococcus aureus or Streptococcus agalactiae has an inducible resistance to clindamycin. This inducible resistance is due to which of the following mechanisms? A. vanC gene B. msrA gene C. erm gene D. mecA gene

11. In an urinalysis, tests are performed that serve as a method of screening for urinary tract infections. Which of following tests detects the presence of inflammatory cells? A. Niacin test B. Nitrate reduction test C. Leukocyte esterase test D. Catalase test

19. Eikenella corrodens is associated with which of the following? A. Localized juvenile periodontitis B. Aortic valve infection C. Clenched fist infection D. Juvenile osteomyelitis

2. Isolates of nonmotile and nonpigmented enterococci that are resistant to vancomycin can be assumed to have an acquired resistance by the transfer of which of the following genes? A. van A and van C genes B. van B and van C genes C. van A and van B genes D. mec A and van C genes

54. Which of the following growth factor(s) is necessary for the proper culture of Haemophilus influenzae? A. X factor B.V factor C. Hemoglobin D. Both X and V factors

12. A microbiology laboratory recently purchased a rapid identification instrument that uses a laser on the microorganisms, which produces an ion cloud. These ions are then separated in a tube and travel within the tube to a detector. The time of travel will be measured and a mass spectrum will be produced. Which of the following techniques uses this methodology? A. API 20E B. Vitek C. Microscan D. MALDI-TOF

24. All of the following organisms are known to be resistant to vancomycin EXCEPT? A. Staphylococcus aureus B. Enterococcus faecium C. Enterococcus faecalis D. Rhodococcus equii

55. A urine culture and sensitivity (C&S) specimen is collected at 8 AM at an outpatient clinic and the courier will not be able to pick it up until 2 PM that same day. If refrigeration is not available, how should the specimen be stored until testing is performed? A. The test results will not be affected by a 6 hour delay in testing if specimen is kept at room temperature. B. The test results will not be affected by a 6 hour delay if the specimen is kept at 37° C (body temperature). C. The patient should be instructed to wait 6 hours to void the urine specimen because there is no refrigerator or courier available to pick up the specimen. D. The specimen should be placed in a container with the proper preservative.

57. The purpose of the additive SPS (sodium polyanethol sulfonate) that is in continuous monitoring system blood culture bottles, is all of the following EXCEPT? A. Inactivates and absorbs out complement B. Inactivates and absorbs out coagulation factors C. Inactivates neutrophils and monocytes D. Inactivates and absorbs out antimicrobial agents

65. Pseudomonas aeruginosa is often used as a bacterial species for the quality control of Kligler Iron Agar (KIA). The expected reaction is: A. Acid slant/acid deep B. Alkaline slant/acid deep C. Alkaline slant/acid deep/H2S D. Alkaline slant/alkaline deep

251. Which of the following organisms is a cause of cutaneous infections? A. Nocardia brasiliensis B. Nocardia cyriacigeorgica C. Nocardia farcinica D. Gordonia bronchialis

261. Each of the following bacterial species work synergistically to produce bacterial vaginitis EXCEPT: A. Streptococcus agalactiae B. Prevotella species C. Gardnerella vaginalis D. Mobiluncus curtisii

Which of the following organisms causes Q fever? A. Coxiella burnetii B. Anaplasma spp. C. Orientia tsutsugamushi D. Rickettsia rickettsii

257. Isolation and detection of Gardnerella vaginalis from vaginal secretions is improved by which of the following? A. Utilization of human blood agar B. Incubation at 35-37º C ambient air C. Cold enrichment D. Utilization of Thayer-Martin agar

10. On MacConkey (MAC) agar, an isolate from a stool sample produced clear, colorless colonies. On Hektoen enteric (HE) agar, colonies were green with black centers, indicative of H2S production. Additional biochemical tests were positive for methyl red, and negative for indole, VP, citrate, and PAD. From the choices listed, which species best matches the characteristics described? A. Salmonella Typhi B. Proteus mirabilis C. Shigella sonnei D. Escherichia coli

102. Which one of the following organisms can be isolated from bone marrow specimens? A. Histoplasma capsulatum B. Staphylococcus aureus C. Aeromonas hydrophilia D. Aspergillus fumigatus

212. Erythema migrans, spirochetemia, and chronic arthritis are three stages in the progress of: A. Leptospirosis B. Lyme disease C. Syphilis D. Rat bite fever

101. Infections of the bone marrow are not only caused by bacteria and fungi, they can be caused by viruses as well. Which of the following viruses can often be isolated from bone marrow specimens? A. Varicella-Zoster Virus B. Herpes Simplex Virus C. Parvovirus B19 D. Respiratory Syncytial Virus

104. Brucella suis and Salmonella typhi can commonly infect the spleen, liver, and bone marrow. Which of the following reasons allow these two organisms to cause a systemic infection? A. They both can only infect the spleen, liver, or bone marrow B. They are ingested by eosinophils and the eosinophils take them to the spleen, liver, and bone marrow C. They are both ingested by monocytes and/or macrophages within the spleen, liver, and bone marrow D. They both have the capability to suppress interleukins of the immune system, which will allow the spread of the organisms throughout the blood stream causing infections of the spleen, liver, and bone marrow

108. When a lumbar puncture is performed, what volume of spinal fluid is needed for optimal recovery of meningitis causing organisms? A. 4-5 mL B. 1-2 mL C. 5-10 mL D. 3-5 mL

117. A patient tested positive for cryptococcal antigen and rheumatoid factor. The results of the cryptococcal antigen should be reported as? A. False positive B. True positive C. Uninterpretable D. True negative

226. A methicillin-resistant Staphylococcus aureus was recovered from a wound infection. Which antibiotic would be used for treatment? A. Methicillin B. Nafcillin C. Vancomycin D. Oxacillin

306. Oxacillin resistance in clinical strains of staphylococci is confirmed by the detection of _______ gene. A. vanA B. vanB C. mecA D. mefA

105. Blood culture bottles used in continuous monitoring systems, such as the BacTec, uses resins or charcoal to do which of the following? A. Inactivates and absorbs out complement B. Inactivates and absorbs out coagulation factors C. Inactivates neutrophils and monocytes D. Inactivates and absorbs out antimicrobial agents

149. Direct Gram stain from a peritoneal fluid specimen appeared as Gram-positive cocci. After 24 hours, clear, convex, entire colonies grew on blood agar and faint lavender colonies were noted on MacConkey, grown aerobically. Gram stain was repeated and appeared as Gram-negative coccobacilli. The isolate was oxidase negative, catalase positive, non-motile, and resistant to penicillin. What is the presumptive identification? A. Acinetobacter baumannii B. Pseudomonas aeruginosa C. Neisseria species D. Moraxella catarrhalis

286. Prior to receiving antibiotic therapy, a patient had a urinary tract infection with gram-negative, motile rods producing the following reactions: Indole: pos H2S (TSI): pos MR: pos VP: neg Phenylalanine deaminase: pos Urea: pos Citrate: pos Ornithine decarboxylase: neg Gelatin hydrolysis: pos Based on the reactions above, what organism is MOST likely causing the infection? A. Proteus vulgaris B. Enterobacter cloacae C. Serratia marcescens D. Klebsiella pneumoniae

369. When serotyping Salmonella, Shigella, and Escherichia coli 0157:H7, typing should be performed from a non-sugar-containing medium, such as 5% sheep blood agar. The reason for this is which of the following? A. To prevent false positive results B. To prevent false negative results C. To prevent both false positive and false negative results D. It does not matter what type of media as there is no interference in serotyping

376. A small, microaerophilic, curved, gram-negative rod which was isolated from a diarrhea stool specimen gave the following results: Grew best at 42 ºC Oxidase positive Resistant to cephalosporin Susceptible to nalidixic acid Hippurate hydrolysis positive What is the MOST probable identification of this organism? A. Campylobacter jejuni B. Campylobacter coli C. Salmonella species D. Vibrio cholera

378. A day-care outbreak of diarrhea revealed an oxidase-negative, non-lactose fermenting, nonmotile, gram-negative rod. These characteristics presumptively indicate which organism? A. Shigella species B. Salmonella species C. E. coli 0157:H7 D. Campylobacter jejuni

381. Which of the following is a selective media recommended for the isolation of Clostridium difficile? A. Cefoxitin-cycloserine-fructose agar (CCFA) B. Buffered-charcoal yeast extract(BCYE) agar C. Kanamycin Vancomycin laked blood (LKV) agar D. Thiosulphate citrate bile salts sucrose (TCBS) agar

384. A microbiologist was surprised when he could not recover Helicobacter pylori from gastric biopsies in which organisms were seen in the tissue sections. He was advised to switch from the Campy BAP selective medium to Skirrow's blood agar because the latter is: A. Free of cephalothin B. Incorporates lysed horse instead of sheep blood C. Free of amphotericin B D. Has reduced concentrations of vancomycin and trimpthoprim

385. One of the key biochemical characteristics by which Escherichia coli serogroup O157 can be screened from stool specimens is? A. Failure to ferment sorbitol B. Failure to ferment lactose C. Positive methyl red D. Lack of motility

391. A stool culture from a hospitalized patient produces the following characteristics: Gram-negative bacillus Urease positive Weakly fermentative TSI slant is A/A These reactions suggest that the organism is most likely: A. Yersinia enterocolitica B. Escherichia coli C. Plesiomonas shigelloides D. Pasteurella multocida

365. Which culture medium is specifically formulated to recover Salmonella typhi from stool specimens? A. Selenite broth B. Bismuth sulfite agar C. Salmonella/Shigella (SS) agar D. Deoxycholate citrate agar

133. Enteroviruses are common etiologic agents of percarditis and myocarditis. To identify a viral infection, viral cultures or immunoassays are typically the tests of choice. However, viral nucleic acid probe testing may be most appropriate in which of the following situations? A. If the immunoassay has increased specificity B. If viral culture is too slow to grow or not possible C. If the immunoassay has an increased sensitivity D. The viral load is low

136. A joint fluid was received in the microbiology laboratory. The specimen was cloudy with many neutrophils and Gram negative coccobacilli seen on the Gram stain. The specimen was inoculated to sheep blood and chocolate agar and grew a small, gray to tan colony on chocolate with no growth observed on the sheep blood. Which of the following is most likely the organism? A. Neisseria gonorrhoeae B. Haemophilus influenzae C. Bacteroides fragilis D. Streptococcus pyogenes

145. Sexually active women can develop peritonitis in the form of perihepatitis, inflammation of the liver surface, due to which of the following organisms? A. Streptococcus pneumoniae B. Neisseria gonorrhoeae C. Mycobacterium tuberculosis D. Staphylococcus saprophyticus

151. Blood specimens are typically sterile; however, if an organism is suspected, a peptide nucleic acid probe (PNA) FISH can be used to identify the organism directly from the specimen. Which of the following microscopes can be used to exam PNA FISH slides? A. Electron microscope B. Fluorescent microscope C. Polarized microscope D. Light microscope

157. The antiphagocytic capsule of Streptococcus pneumoniae is composed of: A. Proteins B. Polysaccharides C. Lipids D. Lipoproteins

275. A tech is interpreting a urine culture with a source of suprapubic aspiration. There is one colony of Staphylococcus epidermidis present on the blood agar which was streaked with a 0.01 loop. What should the tech do next? A. List the S. epidermidis as a contaminate from collection B. List and provide a sensitivity for the S. epidermidis C. Report the culture as "No growth" D. Quantitate and report mixed urethral flora

376. This member of the Enterobacteriaceae was isolated from a stool specimen and gave the following biochemical reactions: TSI: K/A, no gas, no H2S Citrate: Positive Lysine decarboxylase: Negative Ornithine decarboxylase: Positive Indole: Negative This organism agglutinated in Group D Shigella antiserum . All of the above biochemical results are consistent with this identification, EXCEPT? A. TSI B. Citrate C. Lysine D. Indole

379. When serotyping Salmonella typhi, false negative reactions can occur when testing. For example, a Salmonella typhi isolate tested Vi antiserum positive and O antiserum negative. What should be done next? A. Report out results as they are correct B. Heat specimen and repeat O antiserum test C. Heat specimen and repeat Vi antiserum test D. Check antiserum expiration date

386. Shigella serotyping is performed by using a polyvalent somatic (O) antisera. A Shigella species grew from culture and serotyped as Group A. Which of the following Shigella species serotypes as Group A? A. Shigella sonnei B. Shigella dysenteriae C. Shigella flexneri D. Shigella boydii

388. Shigella species generally exhibit which of these characteristics? A. Urease positive B. Non-motile C. Oxidase positive D. Lactose fermentation

392. A patient presents to the emergency room with hemorrhagic diarrhea. A stool specimen was sent to the microbiology laboratory for culture. The specimen was plated on blood agar, MacConkey (MAC) agar, and Sorbitol MacConkey (SMAC) agar. A Gram-negative, oxidase negative rod (bacilli) grew as a lactose fermenter on the MacConkey agar and as clear colonies on Sorbitol MacConkey agar. Biochemical testing revealed the organism was lysine decarboxylase positive and did not produce hydrogen sulfide (H2S). Which organism is suspected? A. Citrobacter freundii B. Escherichia Coli possibly 0157:H7 C. Shigella sonnei D. Klebsiella pneumoniae

Which one of the following organisms is commonly cultured from the nasopharynx of healthy people but is RARELY pathogenic? A. Beta hemolytic streptococci B. Corynebacterium species C. Haemophilus influenzae D. Neisseria meningitidis

319. The mechanism by which certain strains of Enterococcus species have developed resistance to the synergistic combination of an aminoglycoside and beta-lactam antibiotics is considered: A. Alteration of penicillin binding proteins B. Beta lactamase activity against the beta-lactam moiety C. High level gentamicin resistance D. Efflux of antibiotics from the bacterial cell

382. A new tech has a presumptive Shigella species via biochemical identification on a stool culture. To confirm, serological testing is performed. The serological testing is negative and the quality control which was run simultaneously passed. What should the tech do next? A. Repeat biochemical testing or use an alternate method B. Repeat serological testing C. Heat a suspension of the organism and then repeat the serological testing D. Report out the organism as E.coli

383. The cytochrome oxidase-positive bacterial species that is DNAse negative, ornithine decarboxylase positive, and is associated with gastroenteritis in children after the ingestion of contaminated water is most likely: A. Aeromonas hydrophila B. Salmonella enterica C. Plesiomonas shigelloides D. Shigella sonnei

390. Which bacterial species listed is a select agent, which is capable of producing an extremely potent, lethal neurotoxin? A. Aggregatibacter aphrophilus B. Moraxella catarrhalis C. Clostridium botulinum D. Corynebacterium striatum

C. A protected brush specimen was received into the microbiology laboratory from an ICU patient and cultured using a 0.001-mL loop. The culture grew 3 colonies of Pseudomonas aeruginosa. Which of the following is the correct way to report out the organism? A. Report out 3 CFU/mL of Pseudomonas aeruginosa B. Report out 300 CFU/mL of Pseudomonas aeruginosa C. Report out 3,000 CFU/mL of Pseudomonas aeruginosa D. Report out as glucose nonfermenting Gram-negative rods.

116. A CSF specimen is received from a patient with suspected meningitis. Positive Gram stain, along with the results shown here suggest what type of condition? -Elevated WBC count -Neutrophils predominant -Marked protein elevation -Marked glucose decrease -Lactate level = 37 mg/dL A. Viral meningitis B. CSF leakage C. Multiple sclerosis D. Bacterial meningitis

203. A beta-hemolytic Streptococcus was isolated from a throat culture. It gave the following biochemical reactions: -Bacitracin - Susceptible -Bile esculin - Negative -6.5% NaCl - No growth -CAMP - Negative -SXT - Resistant What is the presumptive identification? A. Beta hemolytic Streptococcus, group B B. Beta hemolytic Streptococcus, not group A, B, or D C. Beta hemolytic Streptococcus, Group G D. Beta hemolytic Streptococcus, Group A

332. Which of the following statements concerning vancomycin resistance in Enterococci is TRUE? A. Van A and Van C are the most clinically significant phenotypes. B. Van B confers intrinsic low level resistance to vancomycin only. C. High level vancomycin resistance is characteristic of E. gallinarum and E. casseliflavus. D. Both ampicillin and vancomycin resistance are found more frequently in E. faecium than in E. faecalis.

88. What is the one principle that is conserved between all continuous monitoring blood culture systems? A. pH detection B. H2 detection C. O2 detection D. CO2 detection

14. An Enterobacteriaceae grows as a clear colony on MacConkey but a salmon-colored colony with a black center on Hektoen enteric agar. Which of the following TSI reactions would match these morphologies? A. Alk/A H2S B. A/A H2S C. Alk/A no H2S D. A/A no H2S

15. What is the role of a sentinel laboratory within the Laboratory Response Network (LRN)? A. Performs tests to detect and confirm or "rule-in" the presence of a threat agent B. Use standardized testing protocols to rule-out critical biological agents or refer them to one of the LRN reference laboratories for identification C. Act as the highest level in the LRN to handle highly infectious agents and have the ability to identify specific agent strains D. Development of new diagnostic tests for identification of potential bioterror agents

21. The tech in microbiology receives a call from the ER where the doctor suspects a patient has inhalation anthrax. What should the tech indicate is a proper specimen for collection to detect inhalation anthrax? A. Sputum B. Blood C. Urine D. Stool

28. Enterococcus spp. are commonly resistant to all of the following antimicrobial drug types EXCEPT: A. Aminoglycosides B. Phenicols C. Beta-lactams D. Glycopeptides

20. The organism growing on Blood Agar and MacConkey Agar was recovered from the burn wound of a patient. This organism is a non-fermenter and can grow at increased temperatures (42 °C). Upon additional testing, the organism was positive for pyocyanin production. Which of the following is the most likely presumptive identification of this organism? A. Burkholderia cepacia B. Delftia (formerly Comamonas) acidovorans C. Pseudomonas stutzeri D. Pseudomonas aeruginosa

30. Any media that supports the growth of Staphylococcus aureus can be used to recover Methicillin-Resistant Staphylococcus aureus (MRSA). However, to improve the recovery of MRSA, selective media for MRSA will provide the best sensitivity. Which of the following media is most helpful in recovering MRSA from surveillance cultures? A. Columbia-Colistin Nalidixic Acid (CNA) media B. Sheep Blood Agar C. Mannitol-salt agar D. CHROMagar MRSA agar

38. A tech is working on a urine culture and finds the following isolate: Escherichia coli: 5,000 cfu/mL How should the tech continue with the culture work up? A. Perform sensitivity on E.coli B. Reject the culture due to contamination C. Report the culture as no growth D. List the E.coli as a possible contaminant

43. Clenched-fist cellulitis is commonly found in patients whom have been in a physical altercation. Which organism below is the most likely cause of this condition? A. Neisseria gonorrhoeae B. Staphylococcus aureus C. Streptococcus anginosus group D. Eikenella corrodens

97. A cancer patient was admitted to the hospital with fever, tachycardia, and a drop in blood pressure. Due to the patient being treated for cancer, her chemotherapy had been administrated through an intravenous catheter. To rule out a catheter-related infection, the physician ordered two sets of blood cultures with one set being collected from the catheter site and the second set being collected by venipuncture. After 48 hours, the patient had positive blood cultures that grew Staphylococcus epidermidis. How will the physician know if the Staphylococcus epidermidis present is due to an infected catheter or is a contaminant? A. Both blood culture sets (catheter and venipuncture) must have no growth B. The blood culture collected via venipuncture will be positive while the blood culture collected via catheter will be negative C. The blood culture collected via venipuncture must always be negative D. Both blood culture sets (catheter and venipuncture) will be positive

90. What virulence factor is not inherent to bacterium? A. Presence of a polysaccharide capsule B. Production of a proteolytic enzymes C. Production of opsonins D. Presence of surface membrane attachment receptors

84. All of the following organisms have been linked to cause endocarditis EXCEPT? A. Aggregatibacter aphrophilus B. Cardiobacterium hominis C. Eikenella corrodens D. Hemophilus influenzae

16. Specimen handling from patients with symptoms consistent with tularemia requires work in a biological safety cabinet. Although PCR may confirm infection with Francisella tularensis, the following culture characteristics and tests aid in presumptive identification: A. Slow growth on MAC, fast growth on CHOC; oxidase positive, negative catalase, X and V factor requirement positive B. No growth on MAC, slow growth on CHOC; oxidase negative, positive catalase and ß-lactamase C. Fast growth on SBA and MAC; oxidase, catalase, and urease positive D. Slow growth on MAC and EMB; oxidase, catalase, and urease negative

94. Abiotrophia defectiva (formerly Streptococcus defectivus) and Granulicatella adiacens (formerly S. adjacens, then A. adiacens) are the names currently given to two species of what were previously called nutritionally variant streptococci (NVS). What supplement must be added to blood culture medium to recover these organisms in cases of "culture negative endocarditis?" A. Thiamine B. Pyridoxyl C. Sodiumpolyanethol sulfonate (SPS) D. Synthetic resins

98. All of the following statements about blood cultures are correct EXCEPT? A. A specific amount of blood is required to fill blood culture bottles to optimize the growth and detection of bacteria. B. If two separate sets (two bottles each set) of blood cultures are requested, draw them both from the same site at the same time. C. Prior to performing the venipuncture, allow the cleansing agent to air dry completely on the skin to ensure sterilization of the venipuncture site. D. If two separate sets (two bottles each set) of blood cultures are requested, it is recommended to draw each set from different sites. Some recommend collecting the sets at different times (approximately an hour apart).

99. The condition most likely to predispose a person to septicemia by viridans streptococci is: A. Hypertrophy of the prostate gland B. Poor oral hygiene C. Chronic obstructive pulmonary disease D. Indwelling catheter

6. Which of the following Enterobacteriaceae produces H2S? A. Klebsiella species B. Escherichia species C. Salmonella species D. Yersinia species

45. Each of the bacterial species listed below may be associated with culture-negative endocarditis EXCEPT: A. Cardiobacterium hominis B. Streptococcus abiotropha C. Brucella abortis D. Staphylococcus epidermidis

46. If a bacteria produces the enzyme tryptophanase to break down the amino acid tryptophan, which of the following tests will be positive with Kovac's reagent? A. Oxidase test B. Esculin test C. Catalase test D. Indole test

48. All of the following are common causes of infective endocarditis, EXCEPT? A. Streptococcus mutans B. Cardiobacterium hominis C. Staphylococcus epidermidis D. Corynebacterium jeikeium

66. Which of the following best describes the benefits of the RPR or VDRL tests: A. Diagnostic of active syphilis B. Diagnostic of latent syphilis C. Diagnostic of neuro-syphilis D. Monitoring course of treatment

79. Organisms such as coagulase-negative Staphylococcus, Corynebacterium, and alpha streptococcus species are all found on the skin and represent normal skin flora. All of the following are functions of normal skin flora EXCEPT? A. They provide substances that are toxic to other organisms B. They inhibit growth of more harmful microorganisms C. They provide a level immunity to protect against the formation of infections D. They aid in the transmission of nosocomial infections

85. A mucoid alpha hemolytic translucent colony suspected of being Streptococcus pneumoniae was isolated from a blood culture. All of the of the following are appropriate tests to make a presumptive or definitive identification of this organism EXCEPT? A. Bile solubility test B. Specific co-agglutination assay C. Optochin susceptibiity D. Bacitracin susceptibility

50. The following is a spore-forming anaerobe that is associated with neutropenic enterocolitis: A. Clostridium septicum B. Porphyromonas spp. C. Bacteroides fragilis D. Fusobacterium nucleatum

72. Which of the following is used to standardize the bacterial inoculum used in a disk diffusion test (Kirby-Bauer method)? A. 0.1 McFarland standard B. 0.5 McFarland standard C. 1.0 McFarland standard D. 2.0 McFarland standard

29. Which anaerobic bacteria incidence is increasing in CSF shunt infections? A. Bacterioides fragilis B. Cutibacterium (Propionibacterium) acnes C. Fusobacterium nucleatum D. Candida albicans

40. The following is true of the disk diffusion method of measuring antimicrobial sensitivity: A. Provides a semi-quantitative MIC value B. Provides only an interpretation value of sensitive, intermediate, or resistant correlated to MIC values C. Requires minimal standardization D. Commonly automated method of antimicrobial susceptibility testing

3. Some strains of Group F Strep can carry the group A antigen, potentially leading to a false positive identification of group A, Streptococcus pyogenes. A spot test that is helpful in differentiating these two species and thus preventing a false report is: A. Catalase B. Bile solubility C. Pyrrolidonyl-b-naphthylamide (PYR) D. Cytochrome oxidase

67. An organism isolated from the spinal fluid of a newborn produced small, grayish, slightly translucent beta-hemolytic colonies on sheep blood agar. A Gram stain of the colony showed small Gram-positive rods that look like diphtheroids. The organism is MOST likely: A. Corynebacterium diphtheriae B. Erysipelothrix rhusiopathiae C. Listeria monocytogenes D. Streptococcus agalactiae

70. All of the following statements concerning biochemical reactions are true, EXCEPT: A. Enterococcus faecalis is positive for esculin hydrolysis B. Bordetella bronchiseptica gives a strong positive urease reaction C. Escherichia coli is positive for utilization of sodium citrate. D. Morganella morganii is positive for phenylalanine deaminase

76. A clean-catch midstream urine specimen from a 30-year-old woman was sent to the microbiology laboratory for culture. The patient had no urinary symptoms, but the urine culture grew out 100,000 cfu/mL of Escherichia coli from two cultures collected 24 hours apart. Which of the following categories would the patient be classified? A. Acute, uncomplicated UTI in women B. Acute, uncomplicated pyelonephritis C. Asymptomatic bacteriuria in female patients D. Asymptomatic bacteriuria in male patients

82. Which of the following is characterized by hypotension due to systemic infection that does not respond to fluid resuscitation (an attempt to replenish body fluid)? A. Systemic inflammatory response syndrome (SIRS) B. Sepsis C. Septic shock D. Bacteremia

83. Which of the following instruments is used for continuous monitoring of mycobacterial growth? A. MALDI-TOF B. DNA microarray C. MGIT 960 D. BacT/ALERT

89. What is the methodology used for detecting the presence of bacteria in blood samples that are loaded onto a BACTEC analyzer? A. pH change B. Gas pressure change C. Fluorescent change D. Chemiluminescent change

9. Which of the following serological tests would be used for the diagnosis of Q-fever? A. Weil-Felix test B. Quellung test C. EIA or indirect immunoflourescence D. Cold agglutinin test

346. An occupation or avocation that should be avoided to prevent infection with Francisella tularensis is: A. Hunting and skinning small game B. Raising quarter horses C. Slaughtering pigs D. Managing a dog kennel

126. Elizabethkingia is the new genus name for the bacterium formerly called Chryseobacterium meningosepticum, an important agent of neonatal mentingitis (now E. meningoseptica). What biochemical characteristic is unique for the family Flavobacteriaceae among the nonfermenters? A. Indole production B. Esculin hydrolysis C. Glucose oxidation D. Resistance to penicillin

13. Which of the following is oxidase positive? A. Pseudomonas aeruginosa B. Serratia marscescens C. Edwardsiella tarda D. Providencia rettgeri

137. Beyond direct detection, what molecular method listed below is being widely used in clinical laboratories across the United States and allows for rapid detection of a bacteria from an isolated colony? A. MALDI-TOF B. Nanotechnology C. Next generation sequencing D. Pyrosequencing

138. Osteomyelitis can only be diagnosed by collection and subsequent culture of a sample collected from which source? A. Bone B. CSF C. Blood D. Urine

139. Septic arthritis can be caused by Neisseria meningitidis, Streptococcus pyogenes, and Streptobacillus moniliformis. Diagnosing these organisms from joint fluid can be difficult because they may not grow in culture. Which of the following contributes to the cause of non-culturable septic arthritis? A. Antigen/Antibody complexes accumulate in the joint B. T-cells and macrophages invade the joint C. IgE antibodies attach to and activate basophils to the joint D. Antibodies act on red blood cell antigens in the joint

143. A small gram-negative rod isolated from an eye grows on chocolate agar and it produces satellite growth around staphylococci colonies on sheep blood agar. The organism requires: A. X factor and V factor B. X factor only C. V factor only D. Neither X factor nor V factor

150. A body fluid was sent to the microbiology laboratory for culture and after 48 hours of non-CO2 incubation, a small catalase positive, coagulase negative, Gram positive cocci in clusters grew on sheep blood agar. This organism was considered to be a possible contaminate, since this organism is part of the normal skin microbiota. Which of the following organisms grew in the body fluid? A. Staphylococcus epidermidis B. Cutibacterium (Propionibacterium) acnes C. Corynebacterium species D. Bacillus subtilis

155. Performing quantitative cultures on bronchoalveolar lavage and protected brush specimens are better than performing routine semi-quantitative cultures because in quantitative cultures there should be which of the following? A. Low numbers of contaminating normal respiratory flora and colonizing organisms and higher numbers of potential pathogens. B. Low numbers of contaminating normal respiratory flora and colonizing organisms and low numbers of potential pathogens. C. High numbers of contaminating normal respiratory flora and colonizing organisms and higher numbers of potential pathogens. D. High numbers of contaminating normal respiratory flora and colonizing organisms and lower numbers of potential pathogens.

156. A suspected nocardioform bacterial species was recovered from sputum. The isolate produced mucoid colonies with pink pigment after 4 days on SBA, as shown in the associated image. Staining demonstrated diphtheroid, Gram positive rods with a few branching filaments. It also stained partially acid fast. The most likely identification is: A. Rhodococcus equi B. Corynebacterium pseudotuberculosis C. Klebsiella pneumoniae D. Cutibacterium (Propionibacterium) acnes

161. Which organism is a cell wall deficient bacterium that commonly causes primary atypical or "walking pneumonia?" A. Mycoplasma pneumoniae B. Pneumocystis carinii C. Mycobacterium xenopi D. Bifidobacterium dentium

166. What organism produced outside a bioterrorism event causes glanders disease? A. Burkholderia mallei B. Francisella tularensis C. Yersinia pestis D. Variola virus

175. When performing quantitative cultures from bronchoalveolar lavage specimens, which of the following colony forming units per milliliter indicates a true bacterial pneumonia? A. >10^4 colony forming units/mL B. >10^3 colony forming units/mL C. >10^2 colony forming units/mL D. >10^1 colony forming units/mL

181. Granular, wrinkled, yellow-pigmented colonies were recovered on chocolate agar after 48 hours of incubation from a respiratory specimen collected from a patient with cystic fibrosis. Colonies on the surface of blood agar are flat, granular, and only slightly wrinkled. On MacConkey agar the colonies lack lactose fermentation and lack pyocyanin production. The spot oxidase test is positive, and nitrates are reduced. With these observations, select the presumptive identification of this isolate. A. Pseudomonas stutzeri B. Burkholderia cepacia C. Elizabethkingia meningoseptica D. Acinetobacter baumannii

182. Which of the following is a presumptive test for the identification of Lancefield group A Streptococcus: A. Bacitracin susceptibility B. Positive coagulase C. Hippurate hydrolysis D. Gram stain

184. Which two of the following tests are helpful for documenting previous streptococcal throat and skin infections? A. ASO titer & anti-DNase B B. CAMP & PYR C. Coagulase & catalase D. Bacitracin & SXT

186. On sheep blood agar, Haemophilus influenzae may exhibit satellitism around all of the following bacteria, EXCEPT: A. Pseudomonas spp. B. Neisseria spp. C. Staphylococcus spp. D. Streptococcus pneumoniae

195. All of the following are usually associated with Group A Beta Streptococci, EXCEPT? A. Bacteremia B. Glomerular nephritis C. Rheumatic fever D. Scarlet fever

196. All of the following are usually associated with Group A Beta Strep, EXCEPT? A. Scalded Skin Syndrome B. Necrotizing fasciitis C. Pharyngitis D. Rheumatic fever

200. The colonies growing on the surface of a 5% sheep blood agar plate, with ß-hemolysis, were recovered from a throat swab of a 19-year-old girl with acute pharyngitis. Gram stain revealed club-shaped Gram positive bacilli with rudimentary branching. What is this species? A. Arcanobacterium hemolyticum B. Streptococcus pyogenes C. Listeria monocytogenes D. Corynebacterium pseudodiphtheriticum

201. A gram-negative diplococcus is isolated from a throat culture. The isolate grows on Thayer-Martin agar, produces acid from maltose, lactose, and glucose and is ONPG positive. What is the most likely identification of this isolate? A. Neisseria lactamica B. Neisseria meningitidis C. Neisseria gonorrhoeae D. Moraxella catarrhalis

204. Growing on the surface of the anaerobic blood agar plate are indistinct small, gray, convex, translucent colonies free of beta hemolysis. Gram negative cocci lying singly and in clusters are seen on Gram stain. Nitrates are reduced, indole is negative, and carbohydrates are not utilized (asaccharolytic). This isolate being part of the microbiota of the mouth, upper respiratory tract and intestine. What is this organism? A. Veillonella parvula B. Prevotella melaninogenica C. Bacteroides fragilis D. Fusobacterium nucleatum

207. An 18-year-old woman woke up in the morning to find that her left knee was hot, swollen, and very painful. She could not walk to work and a friend offered her a ride to the clinic. She had never had a swollen joint before. Physical exam revealed a tender knee joint which yielded purulent synovial fluid on aspiration. Gram negative intracellular diplococci were seen on Gram stain. She also had a cervical discharge that was cultured. The cause of her infection would grow best on: A. Modified Thayer Martin (MTM) agar at 35º C with CO2 B. LIM (Todd Hewitt Broth w/Colistin and Nalidixic Acid) broth with refrigerated temperature C. Blood agar at 42º C with microaerophilic conditions D. V (human blood) agar at 35º C with CO2

213. Corynebacterium jeikeium is often associated with which of the following conditions? A. Infected indwelling devices in AIDS patients B. Erythrasma C. Toxic diphtheria-like pharyngitis D. Suppurative granulomatous lymphadenitis

214. A 27-year-old man who had recently worked as a medical laboratory scientist on the Navajo Native American reservation presented to the emergency department with high fever, diarrhea, and prostration. Axillary lymph nodes were hemorrhagic and enlarged. A smear was prepared from a lymph node aspirate and many Gram negative bacilli were noted. The bacilli demonstrated a marked bipolar staining reaction described as a "safety-pin appearance" with Wayson stain. What is the most likely identification of this organism? A. Yersinia pestis B. Streptobacillus moniliformis C. Capnocytophaga D. Brucella melitensis

22. Which statement about assays for the antigenic detection of both Clostridium difficile toxins A and B is TRUE? A. The antigenic assays give rapid results. B. The assays can only detect simultaneous production of toxin A and toxin B. C. The assays provide a high level of sensitivity. D. Assays that detect toxin A alone will detect all clinically significant strains.

228. A well circumscribed, ulcerating pustule evolved over 8 days following direct contact with raw animal hides that had been shipped from Central Asia. The lesion began as a small papule, which progressively enlarged, ultimately ulcerated and became covered centrally with a black eschar. A gram stain prepared from a colony that grew within 48 hours on blood agar showed spore-forming, "boxcar-shaped" gram positive bacilli. The most likely agent of this infection is: A. Bacillus anthracis ("malignant pustule") B. Erysipelothrix rhusiopathiae (erysipeloid) C. Francisella tularensis D. Streptococcus pyogenes (pyoderma)

231. Infections with this organism typically either present as primary septicemia or wound infections. Septicemia likely occurs after the organism is ingested while consuming shellfish. Wound infections are associated with some type of aquatic exposure. What organism does this describe? A. Vibrio vulnificus B. Staphylococcus aureus C. Erysipelothrix rhusiopathiae D. Salmonella typhi

232. A 30-year-old woman developed progressive, painful swelling of the right foot after incurring traumatic penetration of the soft tissue by a splinter. The wound initially healed. A direct Gram stain of purulent material expressed from a sinus tract demonstrates a sulfur granule at the periphery of the branching, Gram-positive filaments (red arrows). The colony that grew out in 72 hours demonstrates yellow, chalky colonies which had a "musty" odor. The most likely identification is: A. Nocardia brasiliensis B. Rhodococcus equi C. Streptomyces anulatus (fromerly griseus) D. Actinomyces israelii

347. The tech in microbiology receives a call from the ER where the doctor suspects a patient has GI anthrax. What should the tech indicate is a proper specimen for collection to detect GI anthrax? A. Blood B. Skin swab C. Sputum D. Urine

233. A culture was taken of a conjunctival exudate. The bacterial species, represented by the tiny colonies seen on this chocolate agar plate were recovered after 48 hours incubation at 35°C. The isolate was cytochrome oxidase positive and highly susceptible to penicillin. What is the most likely identification of this organism? A. Moraxella lacunata B. Moraxella catarrhalis C. Neisseria subflava D. Haemophilus aphrophilus

236. A Gram stain of drainage from an open wound revealed gram-positive bacilli with spores. This description would commonly rule out which one of the following organisms? (Choose the BEST response.) A. Clostridium perfringens B. Bacillus cereus C. Clostridium septicum D. Bacillus anthracis

259. Which of the following infections is caused by Chlamydia trachomatis? A. Trachoma, a major cause of preventable blindness in the world. B. Zoonosis in birds and the cause of parrot fever in humans. C. A skin disease found predominantly in tropical areas. D. Pneumonia with pleural effusion.

268. Direct microscopic examination of a wet preparation of vaginal discharge provides the simplest rapid diagnostic test for which of the following organisms? A. Trichomonas vaginalis B. Chlamydia trachomatis C. Neisseria gonorrhoeae D. Streptococcus agalactiae

276. A tech is working on a urine culture and finds the following isolates: Escherichia coli: >100,000 cfu/mL Staphylococcus epidermidis: 5,000 cfu/mL How should the tech continue with the culture work up? A. Perform sensitivity on E. coli and list the S. epidermidis as a contaminant B. Perform sensitivity testing on both organisms C. Quantitate culture and report as mixed urethral flora/contaminants D. Perform sensitivity testing on S. epidermidis and list E. coli as a contaminant

280. Gram positive cocci isolated from a catheterized urine culture on a 76-year-old male gave the following reactions: Blood agar- creamy, white, opaque colonies with are not hemolytic Catalase- positive Slide coagulase- negative Tube coagulase- negative Novobiocin- susceptible The next action that the medical laboratory professional should take is to: A. Report the isolate as coagulase negative staphylococcus B. Report the isolate as Staphylococcus epidermidis C. Report the isolate as Staphylococcus saprophyticus D. Perform further testing to speciate the organism

281. A tech is working on a urine culture and finds the following isolates: Escherichia coli: >100,000 cfu/mL Enterococcus faecalis: 50,000 cfu/mL Klebsiella pneumoniae: 30,000 cfu/mL How should the tech continue with the culture work up? A. Quantitate culture and report as mixed urethral flora/contaminants B. Perform sensitivity on the E.coli and list other as contaminants C. Perform sensitivity on the E. coli and K. pneumoniae and list E. faecalis as a contaminant D. Reject culture due to contamination

284. All of the following patients may submit an urine specimen from an indwelling catheter EXCEPT? A. Patient seen for an annual physical B. Hospitalized patient C. Long-term care facility patient D. Oncology patient

300. Based on the results of in-vitro susceptibility testing, patients with septicemia from each of the bacterial species listed below can potentially be treated with vancomycin EXCEPT: A. Leuconostoc species B. Listeria monocytogenes C. Bacillus cereus D. Corynebacterium jeikeium

302. A patient is being treated with gentamicin for a Gram negative bacterial infection. The chemistry department has repeating peak and trough orders on the patient. Which of the following antibiotic classes does gentamicin belong? A. Aminoglycosides B. Beta-lactams C. Fluoroquinolones D. Polymyxins

309. A small, microaerophilic, curved, gram-negative rod which was isolated from a diarrhea stool specimen gave the following results: Grew best at 42 ºC Oxidase positive Resistant to cephalosporin Susceptible to nalidixic acid Hippurate hydrolysis positive What is the MOST probable identification of this organism? A. Campylobacter jejuni B. Campylobacter coli C. Salmonella species D. Vibrio cholera

31. Which of the following Corynebacterium species is lipophilic? A. Corynebacterium jeikeium B. Corynebacterium amycolatum C. Corynebacterium ulcerans D. Corynebacterium striatum

311. Bacitracin susceptibility testing is useful for: A. Distinguishing staphylococci from micrococci B. Presumptive identification of Group B streptococci C. Identification of Haemophilus spp. D. Identification of Neisseria spp.

312. Cultures from a post-abdominal cellulitis specimen grew Gram negative pleomorphic rods with the following characteristics: -Grows on KV agar but does not show fluorescence -Produces black colonies BBE agar -Resistant to penicillin Which of the following is the MOST likely identification? A. Bacteroides fragilis B. Fusobacterium nucleatum C. Prevotella species D. Veillonella species

318. Which of the following enzymes, produced by Staphylococcus aureus is responsible for preventing penicillin antibiotics from being effective? A. Beta-lactamase B. Coagulase C. Catalase D. Hyaluronidase

326. Enterococcus faecium is: A. Often vancomycin resistant B. Susceptible to the aminoglycosides C. Arabinose negative D. Motile

329. A tech receives a call from the floor regarding antimicrobial therapy. The patient culture yielded an aerobic Gram-negative bacillus and the physician would like to use an antibiotic that inhibits DNA synthesis. Which of the following antibiotics would be the best choice? A. Ciprofloxacin B. Cefazolin C. Tetracycline D. Gentamycin

337. The tech working on an aerobic wound culture is identifying a colony that is large, gray, and non-hemolytic on blood agar. The tech prepares a Gram stain of the colony and notices a consistency similar to whisked egg whites. Gram stain reveals a large Gram-positive bacillus. What is the most likely identification of this colony? A. Bacillus anthracis B. Bacillus cereus C. Burkholderia mallei D. Francisella tularensis

34. A culture was performed on a stool sample. After growth was obtained on the blood agar plate, the gram stain showed curved gram negative rods. The oxidase, catalase, and urease were positive. What is the most likely bacterial identification? A. Helicobacter pylori B. Campylobacter concisus C. Helicobacter cinaedi D. Arcobacter spp.

357. A 62-year-old female undergoing chemotherapy for breast cancer developed fever, abdominal pain, and foul-smelling diarrhea after receiving clindamycin for 5 days. The photomicrograph is an H & E-stained section of colon biopsy revealing focal ulceration and pseudomembranous inflammation. Each of the following laboratory findings will confirm the presumptive diagnosis of Clostridium difficile-associated colitis EXCEPT: A. Recovery of C. difficile in the stool B. Detection of cytotoxin B of C. difficile C. Positive latex agglutination of glutamate dehydrogenase of C. difficile D. Positive EIA for C. difficile enterotoxin

358. All of the organisms below are known to cause gastroenteritis, EXCEPT: A. Moraxella catarrhalis B. Campylobacter jejuni C. Vibrio cholerae D. Aeromonas hydrophila

363. A culture was performed on a stool sample. After growth was obtained on the blood agar plate, the gram stain showed curved gram negative rods. The oxidase, catalase, and urease were positive. What is the most likely bacterial identification? A. Helicobacter pylori B. Campylobacter concisus C. Helicobacter cinaedi D. Arcobacter spp.

364. The following is a spore-forming anaerobe that is associated with neutropenic enterocolitis: A. Clostridium septicum B. Porphyromonas spp. C. Bacteroides fragilis D. Fusobacterium nucleatum

366. In the Escherichia coli 0157:H7 serotype. The 0157 portion of the serotype refers to which of the following? A. O somatic antigen B. Vi capsular antigen C. H flagellar protein D. F1 antigen

41. The detection of a distinct odor is often helpful in the presumptive identification of bacterial culture isolates. Which bacterial species may produce a distinctive odor of butterscotch or honeysuckle? A. Streptococcus anginosus B. Pseudomonas aeruginosa C. Proteus mirabilis D. Eikenella corrodens

5. Small, transparent, gray-yellow 48 hour colonies incubated at 37°C are surrounded by wide zones of beta hemolysis. This culture was obtained from a throat swab of a patient with pharyngitis. The isolate is susceptible to the bacitracin "A" disc. What is the presumptive identification of this isolate? A. Streptococcus pyogenes (Group A) B. Streptococcus agalactiae (Group B) C. Streptococcus pneumoniae D. Streptococcus anginosus (Group F)

58. Which of the following organisms is responsible for myonecrosis with gas gangrene, food poisoning as well as necrotizing enteritis, a life threatening that causes ischemic necrosis of the jejunum? A. Clostridium perfringens B. Prevotella melanogenica C. Cutibacterium (Propionibacterium) spp. D. Fusobacterium necrophorum

60. The susceptibility of a bacterium to each drug on a sensitivity plate using antibiotic disks is demonstrated by the diameter of the zone of: A. Inhibition B. Resistance C. Beta hemolysis D. Gamma hemolysis

74. On a plate growing Streptococcus pneumoniae, the zone of inhibition around the disk has been measured at 23 mm. Based on this result, you should: A. Report oxacillin-susceptible B. Repeat the test C. Check the potency of the disk D. Perform a minimum inhibitory concentration (MIC) test on the isolate

86. Which one of the following pathogenic anaerobic bacteria is MOST frequently isolated in clinical laboratories? A. Bacteroides fragilis B. Prevotella melaninogenica C. Clostridium ramosum D. Peptostreptococcus anerobius

87. A laboratory recently purchased a continuous monitoring system for blood culture analysis. The system is able to detect CO2 production by growing organisms and as a result will produce a color change in the sensor located at the bottom of the blood culture bottle. The instrument will detect this color change and alert the staff that a blood culture is positive for bacterial growth. Which of the following instruments uses this methodology? A. BacT/ALERT B. BACTEC C. Versa TREK System D. MALDI-TOF

91. A patient had a transfusion reaction to red blood cells and the remains from the unit of blood were sent to the microbiology laboratory for culture. The organism that grew was a gram-negative bacilli that was catalase and oxidase positive and was negative for gelatin hydrolysis. The organism was inoculated on a Pseudo F agar slant and incubated for 24 hours. Fluorescence was observed when using a UV light. This organism is most likely: A. Pseudomonas putida B. Pseudomonas stutzeri C. Burkholderia cepacia D. Pseudomonas alcaligenes

93. The most common organism that causes septic arthritis in patients under 30 years of age is: A. Neisseria gonorrhoeae B. Staphylococcus aureus C. Treponema pallidum D. Chlamydia trachomatis

96. Which of the following is considered a normal skin flora organism? A. Bacillus subtilis B. Salmonella typhi C. Bacillus anthracis D. Pseudomonas aeruginosa

A culture from a sputum specimen grew a mucoid, lactose fermenting organism. Biochemical testing on this isolate gave the following key reactions: VP: positive Indole: negative Urea: 1+ Motility: nonmotile Citrate: positive. What is the most likely organism given the site of isolation and biochemical reactions? A. Klebsiella pneumoniae B. Escherichia coli C. Klebsiella oxytoca D. Klebsiella aerogenes

103. A technologist subcultures a positive blood culture and notes the following characteristics on the isolated colonies: - Growth of non-hemolytic colonies with a ground-glass appearance, displaying a "Medusa Head", as indicated by the arrows - Gram stain reveals a large, gram-positive rod with central and subterminal spores that do NOT swell the cells - Catalase positive - Non-motile What would be the MOST likely conclusion and action? A. Organism is NOT Bacillus anthracis, continue identification per laboratory procedures B. Cannot rule out Bacillus anthracis, refer isolate to your Laboratory Response Network (LRN) Reference Laboratory C. Organism is likely Bacillus cereus, continue identification per laboratory procedures D. Organism is likely Bacillus anthracis, continue identification testing for confirmation

106. A patient is showing signs of an intravenous catheter associated infection. The physician has removed the catheter and sent the catheter tip along with a skin swab of the catheter site to the laboratory for testing. The physician ordered a Gram stain of the skin entry site and a culture of the catheter tip. On which of the following media should the catheter tip be plated? A. GN Broth and Sheep Blood Agar B. Sheep Blood Agar and Thioglycollate Broth C. Thayer Martin and SIM Broth D. Sheep Blood Agar and Bismuth Sulfite Broth

112. The cryptococcal antigen test used to diagnosis Cryptococcus neoformans meningitis is based on what type of rapid methodology? A. Immunodiffusion B. Latex agglutination C. Hemagglutination D. Complement fixation

113. When three tubes of cerebrospinal fluid are received in the laboratory they should be distributed to the various laboratory sections as follows: A. #1 Hematology, #2 Chemistry, #3 Microbiology B. #1 Chemistry, #2 Microbiology, #3 Hematology C. #1 Microbiology, #2 Hematology, #3 Chemistry D. #1 Chemistry, #2 Hematology, #3 Microbiology

115. Immunosuppressed or diabetic patients with ketoacidosis may present with symptoms of a brain abscess caused by which of the following? A. Metabolic acidosis B. Phycomycosis C. Hyperglycemia D. Metabolic alkalosis

118. What is the most common agent of infection in CSF shunts? A. Candida sp. B. Stahpylococcus sp. C. Enterococcus sp. D. Enterobacter sp

119. Spinal fluid cultures on a 3-day-old infant revealed beta-hemolytic, gram-positive cocci occurring in pairs and chains. The organism was catalase-negative and bile esculin-negative. Resistance to bacitracin was noted. The other test necessary to identify this organism is a positive test by: A. Bile solubility B. CAMP C. Coagulase D. PYR

125. A 3-year old girl was brought to the ER with a temperature of 103ºF, lethargy, and cervical rigidity. Three tubes of cloudy CSF were delivered to the Lab, and preliminary test results showed: WBC: 4,500/µL Differential: 88% neutrophils Glucose: 15 mg/dL 12% lymphocytes Protein: 140 mg/dL Gram stain: No organisms observed From these results, what preliminary diagnosis SHOULD the physician consider? A. Brain tumor B. Bacterial meningitis C. Viral meningitis D. Subdural hematoma

127. Which of the following tests would you employ to examine a CSF for syphilis: A. RPR B. VDRL C. Both D. Neither

128. Which organism is associated with sinusitis and otitis and is also considered a leading cause of meningitis with or without bacteremia? A. Streptococcus viridans B. Streptococcus pneumoniae C. Streptococcus pyogenes D. Streptococcus agalactiae

129. A CSF spinal shunt specimen grew out an Enterococcus species. What parasitic species should be of concern when an Enterococcus species is isolated from a spinal fluid? A. Trichuris trichiura B. Strongyloides stercoralis C. Necator americanus D. Ancylostoma duodenale

130. Small, gray, alpha hemolytic colonies with indented centers were isolated on sheep blood agar from a peritoneal fluid. The following biochemicals were performed: - Gram Stain: Gram positive lancet-shaped cocci in chains and pairs - Catalase: Negative - Optochin susceptibility: Sensitive >14 mm Identify the organism from the choices provided. A. Alpha hemolytic streptococcus species B. Streptococcus pneumoniae C. Streptococcus pyogenes D. Streptococcus agalactiae

131. A bone biopsy from a jaw sent to a microbiology laboratory for culture grew out an Actinomyces species. What would be the most probable contributing factor to this infection? A. Poor circulation B. Poor oral hygiene C. Break in skin D. Pelvic infection

132. Which molecular methodology is used to detect multiple targets in a single sample of CSF when meningitis/encephalitis is suspected? A. Nested PCR B. Multiplex PCR C. Northern blot D. Broad range PCR

160. Bacteria may be the agents of infections in plants as well as in animals. This organism is the agent of onion bulb rot in plants, but is also an important agent of hospital-acquired infections in humans. A. Shewanella putrifaciens B. Burkholderia cepacia C. Pantoea agglomerans D. Raoutella planticola (Klebsiella planticola)

335. Which of the following Clostridium spp. produces a toxin that is a potential bioweapon? A. Clostridium perfringens B. Clostridium tetani C. Clostridium botulinum D. Clostridium sordellii

167. The following is a non-fermenting, oxidase positive, motile, opportunistic pathogen that most commonly causes respiratory infections associated with chronic granulomatous disease and cystic fibrosis. On sheep blood agar, the organism is described as being small, entire, gray-yellow colonies. On MacConkey, it may appear light pink as shown in the photograph. Identification tests that assist in the identification include Alk/Non-reactive on TSI, lysine decarboxylase positive, oxidation of glucose, lactose, and xylose. It also does not produce gas from nitrate reduction. Which of the following organisms matches the description? A. Moraxella catarrhalis B. Burkholderia cepacia C. Alcaligenes faecalis D. Acinetobacter baumannii

169. Which of the following is the primary virulence factor in Streptococcus pneumoniae? A. Lipoteichoic acids B. Capsular polysaccharide C. M protein D. Protein A

183. Satellitism observed in cultures is most commonly associated with which of the following bacteria? A. Neisseria meningitidis B. Haemophilus influenzae C. Pasteurella canis D. Bordetella pertussis

189. Acute obstructive epiglottitis, both in adults and children, is most commonly caused by a specific bacterial species that can be recovered on chocolate agar and requires both hematin and NAD. The most likely identification is: A. Haemophilus parainfluenzae B. Haemophilus influenzae C. Haemophilus aphrophilus D. Haemophilus haemolyticus

191. A patient with an upper respiratory infection submits a sputum for culture. A gram stain performed on the sputum specimen reveals gram-negative diplococci. Oxidase testing is positive and carbohydrate degradation tests are inactive. What is the MOST likely identification? A. Haemophilus influenzae B. Moraxella catarrhalis C. Streptococcus pneumoniae D. Staphylococcus aureus

192. Procedures that may enhance the recovery of Streptococcus pyogenes from throat cultures include: A. Extraction of streptococcal grouping antigen B. Incorporation of sulfamethoxazole and trimethoprim in the culture media C. Incubation at 42° C D. Use of culture media with increased concentrations of glucose

193. A patient shows signs of conjunctivitis including itching of the eyes, reddening of the conjunctiva, purulent secretion and lid edema. A culture was taken of the secretion and a Gram negative coccobacilli was seen on both the Sheep's blood and chocolate agars. There was no growth observed on the MacConkey agar. Additionally, the colonies were oxidase positive, catalase positive, reduced nitrate to nitrite, and liquefied gelatin. The identification of this organism is: A. Haemophilus influenzae B. Moraxella lacunata C. Neisseria gonorrhoeae D. Acinetobacter lwoffii

197. Which of the following organisms has been isolated from nasal secretions and causes atrophic rhinitis, a tissue-destructive disorder in the nose? A. Cronobacter sakazakii B. Klebsiella pneumoniae subsp. ozaenae C. Yersinia pseudotuberculosis D. Morganella morganii

198. The bacterial species, a typical colony of which is illustrated in this photograph, and a common bacterial cause of otitis externa, also known as "swimmer's ear", can be identified as: A. Serratia marcescens B. Pseudomonas aeruginosa C. Alcaligenes odorans D. Streptococcus pneumoniae

219. Which of the following organisms produces a double zone of hemolysis on blood agar? A. Clostridium septicum B. Clostridium perfringens C. Clostridium difficile D. Clostridium tetani

220. The following is the BEST test to differentiate between Aeromonas hydrophila and Escherichia coli from a wound culture: A. Gram's stain B. Oxidase production C. Glucose fermentation D. Lactose fermentation

221. All of the following organisms are aerobic organisms, EXCEPT? A. Francisella tularensis B. Bacteroides fragilis C. Pseudomonas aeruginosa D. Neisseria meningitidis

265. Growth of off-white, convex colonies with internal flecking after anaerobic incubation for 48 hours is seen on anaerobic blood agar. Beta hemolysis is not observed. The colonies were recovered from a uterine cervix specimen obtained from a 30 year-old female with post-partum endometritis. The gram stain reveals small gram-positive cocci arranged in short chains and pairs. A spot indole and catalase test were negative. From these observations, select the presumptive identification of this isolate. A. Porphyromonas asaccharolytica B. Peptostreptococcus anaerobius C. Veillonellla parvula D. Bacteroides fragilis

27. The following is the primary virulence factor produced by Streptococcus pneumoniae that prevents phagocytosis: A. Streptolysin O B. Capsule C. M protein D. Exfoliative toxin

270. Which of the following urine specimens is a method of collection for uncontaminated urine from the bladder in uncooperative patients or patients unable to void due to physiologic conditions? A. Clean-Catch Midstream Urine B. Straight Catheterized Urine C. Suprapubic Bladder Aspiration Urine D. Indwellng Catheter Urine

271. This member of the Enterobacteriacea gave these reactions: H2S (TSI) - Negative Ornithine - Negative Lysine - Positive Citrate - Positive Urea - Positive Phenylalanine - Negative Motility - Negative What is this organism? A. Enterobacter cloacae B. Klebsiella pneumoniae C. Escherichia coli D. Yersinia enterocolitica

272. If a blood agar plate and an EMB plate are both inoculated with 0.001 mL of urine, and 90 colonies of Staphylococcus aureus grew on the blood agar plate, what should be reported? A. 90 colony forming units/mL of Staphylococcus aureus B. 90,000 colony forming units/mL of Staphylococcus aureus C. 9,000 colony forming units/mL of Staphylococcus aureus D. 9 colony forming units/mL of Staphylococcus aureus

283. A clean-catch midstream urine specimen from a 57-year-old woman was sent to the microbiology laboratory for culture. The patient had a history of fever, chills, and flank pain upon examiation. The urine grew out 10,000 cfu/mL of Escherichia coli. Which of the following categories would the patient be classified? A. Acute, uncomplicated UTI in women B. Acute, uncomplicated pyelonephritis C. Asymptomatic bacteriuria in female patients D. Asymptomatic bacteriuria in male patients

296. Which two antibiotics are used to confirm the presence of carbapenemase production in Enterobacteriaceae? A. Cefotaxime and Cefotaxime-clavulanate B. Ertapenem and Meropenem C. Cefoxitin and Oxacillin D. Clindamycin and Erythromycin

345. A tiny Gram negative coccobacilli was isolated on chocolate agar from a wound on a man who had been hunting wild boar. The microbiologist performed the following test: Oxidase - Positive Urease - Positive Motility - Nonmotile Colony morphology - Small, nonhemolytic Which of the following species is most probable? A. Bacillus anthracis B. Brucella species C. Francisella tularensis D. Yersinia pestis

350. The Laboratory Response Network (LRN) consists of all of the following except: A. Sentinel laboratories B. Department of Defense (DOD) C. Reference laboratories D. National laboratories

351. A Gram negative rod exhibiting bipolar staining was isolated from sheep blood agar after 24 hours of incubation. Oxidase - Negative Urease - Negative Catalase - Positive Indole - Negative Which of the following species is most probable? A. Brucella species B. Yersinia pestis C. Bacillus anthracis D. Francisella tularensis

352. What is one of the BIGGEST challenges with isolating Francisella? A. The production of wide zones of hemolysis B. Organism growth is slow. C. The overgrowth other organisms. D. The production of greenish colonies like Pseudomonas.

353. A tech is working on a culture from an aspirated lesion. The culture grows non-hemolytic colonies with flattened edges and raised centers, resembling a fried egg on blood agar. Gram stain of the colonies shows plump Gram-negative bacilli with bipolar staining. What is the likely identification of the organism? A. Francisella tularensis B. Yersinia pestis C. Bacillus anthracis D. Burkholderia mallei

360. The recovery of this bacterial species from diarrhea stool specimens requires the use of selective culture media such as Butzler selective media or Skirrow blood agar incubated at 42° C in an atmosphere of 5% oxygen, 10% CO2, and 85% nitrogen. Growth on Skirrow blood agar are confluent smooth non-hemolytic colonies growing along the streak line with lateral extensions (arrows). Slender, long branching, S-shaped Gram negative rods are observed on Gram stain. Positive reactions for oxidase, indoxyl, and hippurate provide for a more definitive identification. With these observations, select the name of this isolate. A. Campylobacter coli B. Campylobacter jejuni C. Helicobacter cinaedi D. Cardiobacterium hominis

42. A tech is working with a small Gram-negative coccobacillus that may be Burkholderia pseudomallei. Which of the following tests could the tech use to rule out this organism? A. Growth on MacConkey agar B. Oxidase negative C. Indole negative D. Resistant to polymyxin B or colistin

47. Which of the following has been compared to a hockey puck when discussing its morphology on chocolate agar? A. Neisseria subflava B. Moraxella catarrhalis C. Neisseria lactamica D. Neisseria sicca

49. A CSF specimen was sent to the laboratory for analysis. A glucose, protein, and cell count were performed. Based on the following results, what would be the probable cause? Glucose - 50 mg/dL Protein - 100 mg/dL Leukocytes - 80 cells/mm^3 mononuclear A. Normal CSF B. Viral infection C. Purulent infection D. Tuberculosis or fungi infection

51. The following organism is an anaerobic organism that produces spores and a double-zone of beta-hemolysis. A. Pseudomonas aeruginosa B. Clostridium perfringens C. Enterobacter aerogenes D. Cutibacterium (Propionibacterium) acnes

61. All of the organisms listed below are matched with the most likely clinical condition found in patients with that organism, EXCEPT: A. Escherichia coli, serogroup O157H7 - hemolytic uremic syndrome B. Streptococcus pneumoniae - cellulitis C. Klebsiella pneumoniae - lobar pneumonia D. Yersinia enterocolitica - transfusion induced sepsis

75. If septic arthritis is suspected, specimens from which of the following normally sterile sites should be collected to detect the microorganism causing the condition? A. Serous fluid B. Synovial fluid C. Cerebrospinal fluid (CSF) D. Blood

8. In patients who present with a classic "strep throat", the beta-hemolytic, catalase negative, Gram positive bacillus that must be included in the differential diagnosis is: A. Actinomyces species B. Arcanobacterium haemolyticum C. Listeria monocytogenes D. Gardnerella vaginalis

110. A spinal fluid was sent to the laboratory for testing. When the hematology tech performed the cell differential, she noticed encapsulated yeast as seen in the images to the right. Upon further investigation, she determined that the patient was immunocompromised and had a recent history of pneumonia. Which of the following would be the most beneficial test to determine a diagnosis? A. CSF Gram Stain B. Fungal Culture C. Cryptococcus neoformans antigen test D. India Ink

122. Molecular methods are commonly used for direct detection of organisms in clinical specimens. One specimen type that can be used is cerebrospinal fluid. This is important as patients who are immunocompromised can succumb to neural infections quite easily when compared to immunocompetent patients. Which of the following is an advantage of performing molecular testing on CSF patients? A. Better reliability as there is a lack of cross contamination B. More specimen volume is needed for testing C. Can detect viable and nonviable organisms D. Better reliability due to lack of inhibition

123. A CSF specimen was sent to the laboratory for analysis. A glucose, protein, and cell count were performed. Based on the following results, what would be the probable cause? Glucose - 15 mg/dL Protein - 150 mg/dL Leukocytes - 1,000 cells/mm3 neutrophils A. Normal CSF B. Viral infection C. Purulent infection D. Tuberculosis or fungal infection

124. A CSF shunt tip specimen was sent to the microbiology laboratory for culture. The shunt specimen was inoculated to sheep blood agar, chocolate agar, and a thioglycollate broth. After 24 hours of CO2 and non CO2 incubation at 37°C, the sheep blood agar, chocolate agar, and the thioglycollate broth had growth. The microbiology tech evaluated the media and observed the following: - Growth: Sheep blood grew small, white non-hemolytic colonies. Chocolate grew small, white colonies. - Gram Stain: Gram positive cocci in clusters - Biochemical: Catalase positive; coagulase negative Which of the following organisms is most likely the cause of the CSF shunt tip infection? A. Staphylococcus aureus B. Cutibacterium (Propionibacterium) acnes C. Coagulase negative staphylococci D. Viridans group streptococci

135. A thoracentesis specimen was collected and sent to the laboratory for testing. What body area was this specimen collected? A. Pericardium B. Joint C. Thorax D. Abdominal cavity

142. When vitreous fluid is collected, it must be transported to the laboratory within 15 minutes and set up immediately for culture. This specimen type must be handled with care as this specimen type is not easy to obtain. What body site is this specimen collected from? A. Lungs B. Central Nervous System C. Eye D. Heart

144. A body fluid was sent to the microbiology laboratory for culture and after 48 hours of non-CO2 incubation, a small catalase positive, non-spore forming, diphtheroid shaped Gram positive rod grew on sheep blood agar. This organism was considered to be a possible contaminate, since this organism is part of the normal skin microbiota. Which of the following organisms grew in the body fluid? A. Staphylococcus epidermidis B. Cutibacterium (Propionibacterium) acnes C. Corynebacterium species D. Bacillus subtillis

149. Mycobacterium tuberculosis can be identified from body fluids in disseminated infections through molecular testing. In fact, antibiotic resistance can be detected in this organism as well by using isothermal amplification. However, this organism must be grown in culture before testing can be performed. All of the following are examples of isothermal amplification methods EXCEPT? A. Loop mediated isothermal amplification (LAMP) B. Nucleic acid sequence based amplification (NASBA) C. Hybridzation D. Helicase dependent amplification (HDA)

159. The colonies observed are non-pigmented and dry to chalky. They were recovered from an expectorated sputum sample of an immunocompromised 70-year-old man with pneumonia. The Gram stain depicts delicate, branching bacilli. Based on this information, what is the most likely identification of this pathogen? A. Bacillus cereus B. Erysipelothrix rhusiopathiae C. Nocardia asteroides D. Listeria monocytogenes

163. With the widespread use of the pneumococcal vaccine, there has been a decline in the incidence of community-acquired pneumonia by which of the following organisms? A. Mycoplasma pneumoniae B. Haemophilus influenzae C. Streptococcus pneumoniae D. Chlamydia pneumoniae

174. Direct detection methods are available for Bordetella pertussis from nasopharyngeal specimens; however, caution should be used when collecting the specimen because inhibition can occur based on the type of swab that is used. Which of the following swabs have an inhibitory effect on PCR testing for Bordetella pertussis? A. Rayon swabs on plastic shaft B. Dacron swabs on plastic shaft C. Calcium-alginate swabs on wire shaft D. Flocked swabs on plastic shaft

177. A Gram stain of sputum obtained from a 55-year-old man with symptoms of bacterial pneumonia illustrates many background segmented neutrophils and many gram positive diplococci. The growth of an inoculum from the specimen on 5% sheep blood agar, on which had been placed an optochin ("P") and a 1 µg oxacillin disk after 18 hours incubation at 37°C in 5% CO2, the zone around the optochin disk is 18 mm and around the OX disk is 8 mm. The interpretation is that the organism is most likely: A. Normal flora and not the cause of pneumonia B. A viridans group streptococcus, penicillin sensitive C. A pneumococcus, penicillin resistant D. A pneumococcus, penicillin sensitive

179. Which of the following anthrax infections is also known as "woolsorter's disease"? A. Cutaneous anthrax B. Gastrointestinal anthrax D. Inhalation anthrax C. Injectional anthrax

180. A physician called the microbiology laboratory and asked what he needed to order to diagnose Bordetella pertussis from a child who had what appeared to be having whooping cough. Which of the following should the physician be told to order? A. Direct fluorescent antibody (DFA) test only B. Culture only C. Both direct fluorescent antibody (DFA) test and culture D. IgG and IgM antibody tests

194. An aerobic Gram negative coccobacillus was isolated from a nasopharyngeal swab 48 hours after culture from a 6-month-old with the following culture characteristics on Bordet-Gengou agar: -Small zones of beta-hemolysis -Urease: positive (24 hours) -Oxidase: negative -Motility: negative The MOST probable identification of this isolate is: A. Pasteurella multocida B. Bordetella pertussis C. Bordetella parapertussis D. Bordetella bronchiseptica

202. The infectious diseases listed below are listed with the most commonly associated bacterium, EXCEPT: A. Haemophilus aegyptius - "Pink eye" B. Pseudomonas aeruginosa - "Swimmer's ear" C. Aspergillus niger - "Black lung" D. Burkholderia pseudomallei - "Meliodosis"

206. The bacterial species most likely associated with bacillary angiomatosis is: A. Afipia felis B. Bartonella elizabethae C. Bartonella henselae D. Bartonella bacilliformis

210. Which of the following organisms is most likely to be associated with gas gangrene: A. Clostridioides difficile B. Pseudomonas aeruginosa C. Clostridium perfringens D. Escherichia coli

211. An abdominal wound culture grows E. coli on the aerobic culture. The anaerobic culture has growth of two, gram- negative rods, one of which is aerobic. The other gram negative rod has 2+ growth on BBE plate and is resistant to kanamycin, colistin, and vancomycin disc. What is this organism's identification? A. Veillonella B. Prevotella intermedia C. Bacteroides fragilis group D. Fusobacterium necrophorum

225. An 8-year-old boy underwent a laparotomy for clinical signs and symptoms of acute appendicitis. Instead, the appendix did not appear inflamed, but the mesenteric lymph nodes were enlarged and edematous. A close-in photomicrograph H & E section of an area within one of the lymph nodes, shows hyperplasia and focal necrotizing inflammation. What bacterial species most likely causing this reaction? A. Citrobacter freundii B. Shigella sonnei C. Yersinia enterocolitica D. Enteroinvasive Escherichia coli

229. The ability of streptococci to spread within the tissues and cause rapidly advancing cellulitis is due to the production of several virulence factors. Each of the following correctly describes the effects of the specific virulence factor EXCEPT: A. Streptokinase causes the hydrolysis of fibrin clots. B. Streptolysin O is toxic to many cell types, including neutrophils and monocytes. C. Streptolysin S is associated with the rash of scarlet fever and the pathogenesis of streptococcal toxic shock like syndrome. D. Hyaluronidase depolymerizes the ground substance in connective tissue.

239. The diffuse erythroderma and edema of the hand shown in the upper photograph is of a 24 year old female with fever, headache and hypotension. The blood agar plate shows large, opaque, white, beta hemolytic colonies most consistent with Staphylococcus species and was inoculated with purulent material aspirated from a vertebral disk abscess. The most likely condition is: A. Scalded skin syndrome B. Exfoliative erythroderma C. Toxic shock syndrome D. Scarlet fever

243. The organism that is a strict anaerobe, non-motile, gram-negative bacillus, occurring in abscesses and associated with peritonitis is MOST likely: A. Haemophilus spp. B. Bordetella spp. C. Bacteroides spp. D. Brucella spp.

247. The anaerobe producing the double zone of hemolysis can be presumptively identified as Clostridium perfringens. The enzyme producing the outer zone of hemolysis is: A. Cytotoxin A B. Beta hemolysin C. Lecithinase D. Endotoxin

248. Smooth, entire, gray-white colonies growing on blood agar are faintly beta hemolytic and light pink-red pigmented entire, smooth colonies grew on MacConkey agar. These isolates were recovered from a skin infection incurred by a 28 year old man after swimming in a lake. The pink-red pigmentation of colonies on MacConkey agar suggest lactose fermentation. Biochemical reactions included Acid/Acid KIA reactions indicating fermentation of glucose. Oxidase was positive. Other positive reactions include indole, DNAse, and esculin. Additional biochemical tests identified this isolate as Aeromonas species. The pink-red colonies growing on MacConkey may suggest one of the Enterobacteriaceae. Which of the following choices will exclude this possibility? A. Beta hemolysis on blood agar B. Pink red colonies on MacConkey Agar C. Positive oxidase reaction D. Positive esculin reaction

249. Infections with Eikenella corrodens is associated with: A. Ingestions of food contaminated with saliva B. Bites from canines or felines C. Trauma associated with human teeth D. Inhalation of respiratory droplets

255. A physician suspected that a young, sexually active woman had bacterial vaginosis. Which of the following specimen sources is the correct specimen of choice to support a bacterial vaginosis infection? A. Urethral B. Endocervical C. Vaginal D. Cervical

262. What is the medium of choice for isolating Gardnerella vaginalis? A. Modified Thayer-Martin (MTM) agar B. Malonate broth C. Human blood bilayer Tween (HBT) agar D. New York City (NYC) medium

263. The laboratory test most commonly used to establish a definitive diagnosis of primary syphilis is: A. Rapid plasma reagin (RPR) B. Recovery of spirochetes via culture C. Direct fluorescent antibody test D. Fluorescent treponemal antibody (FTA) with adsorption test

264. The clinical Gram stain taken from an endocervix revealed many WBC's with both intracellular and extracellular gram-negative diplococci. The specimen was plated onto a Modified Thayer-Martin plate and incubated. Following incubation, colonies resembling Neisseria gonorrhoeae were inoculated into separate CTA tubes containing glucose, lactose, sucrose and maltose. The fluorescent monoclonal antibody test was positive as well as the CTA maltose and glucose tubes. What is the most appropriate next step? A. Issue a final report of Neisseria meningitidis B. Issue a final report of Neisseria gonorrhoeae C. Analyze another maltose tube using a known strain of Neisseria gonorrhoeae D. Request a new specimen

267. A combination of nontreponemal testing (VDRL or RPR) and treponemal testing (TP-PA or EIA) is used to confirm: A. Chlamydia B. Genital herpes C. Syphilis D. Gonorrhea

269. The recovery of Mycoplasma hominis from the genital tract of females has been associated with all of the following clinical syndromes EXCEPT: A. Premature rupture of membranes B. Delivery of low birth weight infants C. Bronchitis D. Prematurity

278. In an urinalysis, tests are performed that serve as a method of screening for urinary tract infections. Which of following tests detects the presence of inflammatory cells? A. Niacin test B. Nitrate reduction test C. Leukocyte esterase test D. Catalase test

279. A urine sample yielded a lactose-negative, Gram-negative bacillus on primary isolation. Biochemical testing showed the following reactions: -Oxidase negative -H2S positive -Urea positive -Phenylalanine deaminase positive The organism which most closely fits this profile belongs to the genus: A. Escherichia B. Providencia C. Proteus D. Salmonella

285. A female was seen by her physician with symptoms of fever, flank pain, frequency, urgency, and dysuria. A urinalysis was performed and had the following results. Which of the following clinical manifestations will this patient have? pH - 7.6 Protein - Positive Blood - Positive Nitrite - Positive Leukocyte esterase - Positive Bacteria - Gram Negative Rods 4+ Casts - White Cell cast; Red Cell cast Culture - 100,000 cfu/mL of Escherichia coli A. Cystitis B. Acute Urethral Syndrome C. Pyelonephritis D. Urosepsis

287. A urine specimen, from a premature infant, was sent for culture to the microbiology laboratory and it grew out 30,000 cfu/mL of a coagulase negative staphylococcus. The physician felt that the growth was skin contamination as the urine was collected in a U-Bag that was attached around the infant's genitalia area. The physician sent a second specimen for culture and it was reported as no growth after 48 hours. Which of the following specimens is the most probable specimen type for the second specimen that was sent to the microbiology laboratory for culture? A. Straight Catheterized Urine B. Clean-Catch Midstream Urine C. Suprapubic Bladder Aspiration Urine D. Indwelling Catheter Urine

288. Smooth, non-hemolytic, white 48 hour old colonies incubated at 37oC grow on the surface of blood agar. This isolate was recovered from a urine culture. Microscopic examination of a gram stain reveals gram positive cocci. The catalase reaction was positive and the coagulase test was negative. The isolate demonstrates resistance to novobiocin. This isolate is a common agent of urinary tract infections. What is the name of this isolate? A. Staphylococcus aureus B. Staphylococcus epidermidis C. Staphylococcus saprophyticus D. Micrococcus spp.

290. A 25-year-old female patient suspects of having an urinary tract infection (UTI) and presents to her doctor for a check-up. Her urine specimen is slightly turbid and the chemical and microscopic urinalysis results are as follows: - Specific Gravity - 1.009 -Glucose - 0 -pH - 8 -Protein - 1+ -WBC - 15/hpf - RBCS - 1/hpf -Crystals - None -Casts - 2 hyaline/hpf -Epithelial cells - 0/hpf -Bacteria - 2+ What should her doctor do next? A. Nothing, these results are perfectly normal. B. Recollect the specimen, this is clearly a contaminated specimen. C. Order a culture and sensitivity D. Perform a urine glucose test using the Clinitest method

291. A bacterium was isolated as the cause of a urinary tract infection. The organism showed no lactose fermentation on MacConkey agar (MAC). On triple sugar iron (TSI) media, the organism produced an A/A with H2S. What organism is most likely observed? A. Enterobacter aerogenes B. Proteus mirabilis C. Proteus vulgaris D. Edwardsiella tarda

294. Most infections caused by Streptococcus anginosus can be treated with any of the following antibiotics, EXCEPT: A. Penicillin B. Ampicillin C. Aztreonam D. Cefazolin

297. Which of these describes the mode of action of the beta-lactam class of antibiotics? A. Inhibits protein synthesis B. Inhibits DNA synthesis C. Inhibits cell wall synthesis D. Inhibits RNA synthesis

315. Minimum inhibitory concentration (MIC) susceptibility tests should be performed against other beta lactam antibiotics for Streptococcus pneumoniae isolates from blood cultures and other sterile body fluids. The reason for this is due to an emerging resistance against penicillin and other beta lactam antibiotics. However, there is one antibiotic that is used to treat drug resistant Streptococcus pneumonia infections and MIC results should be questioned when a resistant susceptibility is found. Which of the following antibiotics does Streptococcus pneumonia still remain sensitive? A. Cefotaxime B. Ceftriaxone C. Vancomycin D. Tetracycline

324. This is a catalase-positive, coagulase-negative, gram-positive coccus isolated from a urine specimen from a 20-year-old female college student. A Mueller Hinton plate streaked with a 0.5 MacFarland standardized inoculum and a 5 microgram disk of novobiocin after overnight incubation shows a lack of zone of inhibition. What is the identification of the isolate? A. Staphylococcus epidermidis B. Staphylococcus aureus C. Staphylococcus saprophyticus D. Staphylococcus lugdenensis

330. The surface of a MacConkey agar plate growing colonies of a non-fermentative Gram negative bacillus recovered from a wound specimen shows iridescent light pink colonies that suggest Acinetobacter species. Each of the following characteristics are helpful in supporting this identification EXCEPT: A. Lack of motility B. Oxidation of glucose C. Denitrification of nitrates D. Resistance to penicillin

334. Based on the results below, what is the most likely organism? Gram stain: Positive cocci Catalase: Positive Coagulase: Negative Bacitracin susceptibility: Resistant Novobiocin susceptibility: Resistant A. Micrococcus species B. Staphylococcus epidermidis C. Staphylococcus saprophyticus D. Staphylococcus aureus

336. Which of the following statements is TRUE with regard to the agents of bioterrorism? A. The agents of bioterrorism can be manipulated on an open bench. B. None of the agents of bioterrorism have been known to cause laboratory-acquired infections. C. At least a class II biological safety cabinet (BSC) should be used. D. gents of bioterrorism are very expensive and need very sophisticated equipment to produce.

344. What biosafety level (BSL) is required by the Centers for Disease Control and Prevention (CDC) for working with Mycobacterium tuberculosis, if there is a possibility that aerosols might be released? A. BSL-1 B. BSL-2 C. BSL-3 D. BSL-4

355. The tech in microbiology receives a call from the outpatient center where the doctor wants to test a patient's wound to determine if is caused by cutaneous anthrax. What should the tech indicate is a proper specimen for collection to detect cutaneous anthrax? A. Blood B. Urine C. Swab under edge of skin lesion D. Stool

359. From the multiple choices below, select the most appropriate culture medium for optimum recovery and differentiation of Salmonella and/or Shigella. A. Columbia colistin-nalidixic acid (CNA) agar B. Thiosulfate citrate bile salts sucrose (TCBS) agar C. Hektoen enteric (HE) agar D. Sabouraud dextrose agar

362. Which of the following stool pathogens would demonstrate the following reactions: TSI: A/A with H2S production LIA: R/A A. Morganella spp. B. Providencia spp. C. Proteus spp. D. Citrobacter spp.

368. Which statement about bacterial culture for Clostridioides (Clostridium) difficile is TRUE? A. Routine bacteriological media will provide adequate recovery. B. The culture is specific for toxigenic strains. C. Culture on appropriate media provides an effective means of recovering the organism. D. Culture for C. difficile provides desirable turnaround times.

37. Examine the following test results and identify what action you would take. -CAMP: Arrowhead appearance -Bacitracin disk: 6mm zone of inhibition -PYR: Negative -Bile Esculin: Tan appearance, no darkening A. Report the isolate as Streptococcus pyogenes B. Repeat the PYR test because you would expect it to be positive in this case C. Report the isolate as Streptococcus agalactiae D. Perform a 6.5% NaCl tolerance test to rule out Enterococcus species

370. Shigella serotyping is performed by using a polyvalent somatic (O) antisera. A Shigella species grew from culture and serotyped as Group D. Which of the following Shigella species serotypes as Group D? A. Shigella boydii B. Shigella dysenteriae C. Shigella sonnei D. Shigella flexneri

371. Which of the following statements is correct regarding the glutamate dehydrogenase (GDH) assay for Clostridium difficile? A. The GDH test can differentiate toxin producing strains of C. difficile from nontoxigenic strains. B. The GDH assay is a valuable confirmatory test for C. difficile. C. Detection of the GDH gene and 16srRNA genes for C. difficile without the presence of a toxin gene indicates a carrier or nonpathogenic state. D. GDH assays can be used as stand-alone assays.

372. Shigella serotyping is performed by using a polyvalent somatic (O) antisera. A Shigella species grew from culture and serotyped as Group B. Which of the following Shigella species serotypes as Group B? A. Shigella dysenteriae B. Shigella boydii C. Shigella flexneri D. Shigella sonnei

373. Which of the following organisms causes disease by direct invasion of tissues? A. Clostridium botulinum B. Vibrio cholerae C. Yersinia enterocolitica D. Shigella sonnei

374. Which of the following conditions is associated with a typical Bacillus cereus infection? A. "Foot rot" or "pitted karyolysis" B. Subcutaneous mycetoma C. Food borne enteritis D. Alkaline encrusted cystitis

377. Although some strains may possess K antigen, which member of Enterobacteriaceae is classified serologically by O antigen, because it lacks H antigen? A. Escherichia coli B. Salmonella Typhi C. Shigella species D. Proteus mirabilis

39. The growth on a blood agar plate was prepared from the surface drainage of a subcutaneous abscess of a 50-year-old man following a deep penetrating splinter wound. The colonies on this young culture are small, rough, gray-white, and non-hemolytic. Older larger colonies became sunken centrally having a "molar tooth" appearance. The Gram stain reveals gram-positive branching filaments. Key biochemical reactions include hydrolysis of Esculin, nitrate reduction, and negative catalase. From these observations, select from the multiple choices the identification of this isolate: A. Bifidobacterium species B. Cutibacterium (Propionibacterium) species C. Actinomyces israeli D. Clostridium septicum

44. The term "HACEK" is often associated with infective endocarditis. All of the following organisms are included in the "HACEK" group, EXCEPT? A. Kingella kingae B. Cardiobacterium hominis C. Haemophilus influenzae D. Eikenella corrodens

56. A Staphylococcus species recovered from a blood culture was found to produce acid from sucrose and maltose and showed alkaline phosphatase activity. The Staphylococcus was also coagulase negative. The same organism was also found in a culture from the central line tip. The most likely identification is: A. Staphylococcus saprophyticus B. Staphylococcus schleiferi C. Staphylococcus epidermidis D. Staphylococcus aureus

59. A tech working in the laboratory receives a phone call from a doctor who is upset that his patient has a negative urine culture. The doctor indicates that the urinalysis result is positive for leukocyte esterase so the culture should be positive. The doctor feels that the urine culture was not properly handled. How can you explain the discrepancy in the urinalysis and culture to the doctor? A. Incorrect agar plates were used for culture B. The culture may have been stored incorrectly, causing the organisms to lose viability C. The patient could have another infection, such as a sexually transmitted infection (STI) D. The culture may have been set up with a 0.01 loop instead of a 0.001 loop

95. An autopsy of a 1-year-old female admitted to the emergency room 4 hours prior to her death revealed Waterhouse-Friderichsen syndrome. Blood and nasopharyngeal cultures taken prior to her death should reveal an oxidase-positive, Gram-negative diplococcus with the following biochemical reactions: A. Glucose positive, Maltose positive, ONPG positive and DNase negative B. Glucose positive, Maltose positive, Sucrose positive and Lactose negative C. Glucose positive, Maltose positive, Lactose negative and Sucrose negative D. Glucose positive, Maltose negative, Lactose negative and Sucrose negative

114. Gram stain of a spinal fluid revealed pleomorphic, gram-negative rods. Colonies that appeared on chocolate agar after 24 hours of incubation were gray, opaque, and medium in size. A musty odor was noted when the plate was opened. Gram stain of the colonies on chocolate agar showed small, gram-negative coccobacilli. No growth was seen on sheep blood or MacConkey agar. The next step taken by the technologist to identify this isolate would be to show that the organism: A. Ferments lactose and produces indole B. Decarboxylates lysine C. Requires cysteine D. Requires X and V factors

120. A patient came into the emergency department with symptoms of meningitis. The patient was suspected of having a blocked cerebral shunt, which can cause meningitis. The shunt was drained and sent to the microbiology laboratory for culture. All of the following organisms are associated with shunt infections EXCEPT? A. Coagulase Negative Staphylococcus B. Klebsiella pneumoniae C. Escherichia coli D. Neisseria meningitidis

121. The FilmArray meningitis/encephalitis panel is a multiplex panel that detects all of the following microorganism types, EXCEPT? A. Bacteria B. Viruses C. Fungi D. Parasites

140. All of the following are virulence factors utilized by Streptococcus pneumoniae to evade host defenses when causing meningitis, EXCEPT: A. Polysachharide capsule B. Pneumolysin C. Hyaluronidase D. M protein

141. Pericarditis may occur as a complication from endocarditis caused by Staphylococcus aureus. Virulence mechanisms attributed to the spread of this organism include all of the following EXCEPT: A. Hyaluronidase B. Protein A C. Coagulase D. M protein

152. Streptococcus pneumoniae can be isolated from peritoneal fluid and identified by molecular testing. One method of testing used to identify Streptococcus pneumoniae is molecular hybridization. All of the following steps must be followed to ensure that false positive results do not occur when testing for Streptococcus pneumoniae EXCEPT? A. Salt concentration must be standardized in the buffer B. Temperature must be standardized C. Concentration of destabilizing agents must be controlled D. Inhibitors must be removed

153. Which of the following organisms is both a transient colonizer of skin, as well as the most common cause of bacterial skin infections? A. Cutibacterium (Propionibacterium) acnes B. Streptococcus pyogenes C. Escherichia coli D. Staphylococcus aureus

154. The organism Acinetobacter baumannii is known to have caused which of the following outbreaks? A. Berry outbreak B. Camper/hiker outbreak C. Milwaukee water outbreak D. Afghanistan and Iraq U.S. soldiers outbreak

158. The optochin (ethylhydrocupreine hydrochloride) disk is most often used for the identification of which organism? A. Staphylococcus aureus B. Haemophilus influenzae C. Streptococcus pyogenes D. Streptococcus pneumoniae

162. All of the following organisms have capsular material as a defense mechanism EXCEPT: A. Haemophilus influenzae B. Streptococcus pneumoniae C. Neisseria meningitidis D. Staphylococcus saprophyticus

164. The Gram stain of a sputum is unremarkable but the culture reveals many small gram-negative rods that are able to grow only on charcoal yeast extract agar. What is the MOST likely diagnosis? A. Leishmaniasis B. Leprosy C. Leptospirosis D. Legionnaire's disease

168. A sputum specimen submitted for culture is brick red in color. The organism causing this sputum color, also has a distinct polysaccharide capsule and is non motile. What organism can be associated with this sputum? A. Yersinia B. Pasteurella C. Salmonella D. Klebsiella

170. Which of the following organisms typically produces umbilicate (depressed center, concave) colonies? A. Yeast B. Staph aureus C. Proteus mirabilis D. Streptococcus pneumoniae

178. All of the following statements about Coxiella burnetii are true, EXCEPT: A. It causes Q fever B. It has a worldwide distribution C. It is an obligate intracellular organism D. It is best diagnosed by culture of the organism

185. A nasopharyngeal specimen is processed and fixed onto a microscope slide. Next, fluorescein-conjugated antibody is added to the slide. The specimen is incubated with the labeled antibody, washed, and then observed for fluorescence. Which of the following techniques best describes this process? A. Enzyme-linked immunosorbent assay (ELISA) B. Latex agglutination C.Indirect immunofluorescence D. Direct immunofluorescence

187. 48-hour-old colonies growing on the surface of blood agar had been incubated anaerobically. The colonies are small, gray-white and convex with irregular borders and internal flecking. Long, slender fusiform Gram negative bacilli with tapered ends are seen in the Gram stain. The indole reaction is strongly positive and glucose fermentation is variable; other biochemical reactions are negative except for H2S production by some strains. This isolate is commensal in the upper respiratory tract and has been associated with hospital acquired aspiration pneumonia, lung abscesses, and empyema in hospitalized patients. Based on these observations, select from the multiple choices the name of this isolate. A. Veillonella parvula B. Prevotella melaninogenica C. Bacteroides fragilis D. Fusobacterium nucleatum

188. The diagnosis of diphtheria must be confirmed by: A. Observing metachromatic granules in a methylene blue stain of an oropharyngeal swab B. Recovering Corynebacterium diphtheriae in culture C. Performing a biochemical identification of a culture isolate D. Determining that a culture isolate is a toxin producing strain

205. From the choices listed below, which organism is classified as an obligate anaerobe? A. Mycobacteria B. Staphylococcus aureus C. Neisseria species D. Clostridium novyi

208. Each of the following statements regarding Rickettsiaceae are correct EXCEPT: A. Serodiagnosis using enzyme immunoassay or indirect immunofluorescence methods are preferred over the Weil-Felix reaction to diagnosis rickettsial disease. B. Most cases of ehrlichiosis are transmitted by the Lone Star tick. C. Rickettsia rickettsii is the agent of Rocky Mountain spotted fever. D. Rocky mountain spotted fever is almost always geographically restricted to the Rocky mountain region.

227. An 87-year old patient had a foot wound that grew gram-negative rods on McConkey agar as pink to dark pink oxidase-negative colonies along with the following results: TSI: A/A Indole: neg. MR: neg. VP: pos. Citrate: pos. H2S: neg. Urea: pos. Motility: neg. Ornithine: neg. Antibiotic susceptibility: Carboxicillin and ampicillin resistant, all others sensitive What is the MOST likely organism? A. Serratia marcescens B. Proteus vulgaris C. E. coli D. Klebsiella pneumonia

235. Each of the bacterial species listed below may be associated with culture-negative endocarditis EXCEPT: A. Cardiobacterium hominis B. Streptococcus abiotropha C. Brucella abortis D. Staphylococcus epidermidis

238. A group of Canadian travelers were visiting the island of Kauai in Hawaii for a summer vacation. They noticed a cave in the middle of the island that contained a 10 ft deep pool of water. Much to their surprise, they were the only individuals enjoying this newly discovered swimming hole. A few days later, all swimmers became ill. Their physician believed they all had Weil disease. Which of the following organisms can cause this disease? A. Chlamydia trachomatis B. Treponema pallidum C. Borrelia burgdorferi D. Leptospira interrogans

256. Of the following organisms, which organism is known to cause bacterial vaginosis? A. Actinomyces israelii B. Bacteroides fragilis C. Clostridium botulinum D. Mobiluncus species

258. Which serogroup of Neisseria meningitidis is no longer recognized? A B C D

266. A women presents to her physician with complaint of a foul smelling vaginal discharge. The following are reported from the submitted sample of the yellow vaginal secretion: -Wet prep: Many WBCs seen, no Clue cells seen, microorganism (20µm) seen with jerky motility -Vaginal pH: 6.0 -Amine (Whiff) Test: Positive -What is the most likely cause of this vaginal infection? A. Candida albicans B. Bacterial vaginosis C. Atrophic vaginitis D. Trichomonas vaginalis

289. An alpha-hemolytic streptococcus isolated from a urine culture is resistant to optochin and bactracin, grows in 6.5% NaCI broth, and is PYR positive. The organism is MOST likely: A. Streptococcus pyogenes B. Streptococcus agalactiae C. Streptococcus pneumoniae D. Enterococcus species

292. A tech receives a call from the floor regarding antimicrobial therapy. The patient culture yielded an aerobic Gram-negative bacillus and the physician would like to use an antibiotic that inhibits cell wall synthesis. Which of the following antibiotics would be the best choice? A. Gentamycin B. Tetracycline C. Ciprofloxacin D. Cefazolin

295. The area of suppressed growth surrounding a disk impregnated with an antimicrobial on a sensitivity plate is referred to as the zone of: A. Resistance B. Breakpoint C. MIC D. Inhibition

310. A tech receives a call from the floor regarding antimicrobial therapy. The patient culture yielded an aerobic Gram-positive coccus and the physician would like to use an antibiotic that inhibits RNA synthesis. Which of the following antibiotics would be the best choice? A. Ciprofloxacin B. Ceftazidime C. Vancomycin D. Rifampin

321. While many isolates of this organism remain susceptible to penicillin, resistance is increasing in some areas due to the organism's altered penicillin binding proteins. In such cases, the recommended treatment is erythromycin or chloramphenicol. Which of the following organisms does this desribe? A. Enterococcus faecium B. Staphylococcus aureus C. Klebsiella pneumoniae D. Streptococcus pneumoniae

325. A tech receives a call from the floor regarding antimicrobial therapy. The patient culture yielded an aerobic Gram-negative bacillus and the physician would like to use an antibiotic that inhibits protein translation. Which of the following antibiotics would be the best choice? A. Vancomycin B. Levofloxacin C. Daptomycin D. Tetracycline

327. A D-test is performed on gram positive cocci to determine inducible resistance to clindamycin when the isolate is sensitive to clindamycin and resistant to which antibiotic? A. Methicillin B. Vancomycin C. Cefoxitin D. Erythromycin

341. A wound specimen was received into the laboratory and a large Gram positive rod was isolated. The microbiologist suspected the isolate was a probable Bacillus anthracis and had to rule in/out before reporting. All of the following tests must be performed before calling the species Bacillus anthracis EXCEPT? A. Catalase B. Motility C. Presence of hemolysis D. Oxidase

380. A tech is using the H (flagellar) antigen to serotype a suspected Salmonella species. The results of the serotyping are agglutination with one well that indicates a group of possible serotypes, not one particular serotype. Quality control passed. Why did this occur? A. The tech contaminated the suspension used for serotyping B. The organism is not a Salmonella species C. The Vi antigen is covering the somatic antigen so serotyping is inaccurate D. Some Salmonella H antigens can occur in multiple strains and serotypes

387. Which one of the following statements about E.coli O157:H7 is false? A. It has been reported in contaminated unpasteurized milk, unpasteurized apple juice, and undercooked hamburger B. It can cause hemolytic-uremic syndrome (HUS) in children C. It causes hemorrhagic diarrhea, abdominal pain, and other symptoms D. It ferments sorbitol rapidly

92. Which of the following is a rapid latex agglutination method for detecting Methicillin-Resistant Staphylococcus aureus (MRSA)? A. Beta-Lactamase B. Coagulase C. Cefoxitin D. PBP2a

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