FACULTY OF HEALTH AND ALLIED SCIENCE
DIPLOMA IN MEDICAL LABORATORY TECHNOLOGY
UNIVERSITY FIRST SITTING AND SUPPLIMENTARY EXAM
DML6326 – DIAGNOSTIC PATHOLOGY IN MICROBIOLOGY AND IMMUNOLOGY
DATE: 19/10/2023
TIME: 3 HOURS
INSTRUCTIONS
1. Read this paper carefully.
2. This paper contains FOUR (4) sections. Section A, B, C and D.
3. This paper contains EIGHT (8) printed pages.
4. Answer all Questions in section A, B, C and D.
5. Follow the instructions given on each SECTION carefully.
6. Total Marks is 100.
7. Cellular Phone and any paper work outside the exams room is
prohibited and not allowed.
8. Use Provided booklets for answering the questions.
9. Do not leave with Question paper and Answer sheet out of exam room.
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SECTION A: MULTIPLES CHOICES QUESTIONS.
(20 MARKS)
This section consists of ten (20) questions. Choose the letter of the most
correct answer. There is only one correct answer. 1 (one) mark will be
awarded for each correct answer.
1. A gram negative has produced an alkaline Slant and acid Butt in KIA
which of the following sugar has been fermented
A. Lactose
B. Sucrose
C. Glucose
D. Dulcitol
E. Maltose
2. Blood culture bottle is added with an anticoagulant which prevents
clotting and neutralize bactericidal power of the blood
A. Heparin
B. EDTA
C. Liquoid
D. Sodium fluoride
E. Lithium
3. The class of antibiotics known as the quinolones are bactericidal.
Their mode of action on growing bacteria is thought to be
A. Inhibition of DNA gyrase
B. Inactivation of penicillin-binding protein II
C. Inhibition of lactamase
D. Prevention of the cross-linking of glycine
E. Inhibition of reverse transcriptase
4. A 12 years old girl was playing soccer when she began to limp; she has
pain on her right leg. Her temperature is 102OF. X-ray on femur was
reveals the periosteum was eroded suggestive osteomyelitis. Blood
culture yield gram positive bacteria cocci in cluster. Which of the
following is the most likely etiologic agent?
A. Streptococcus faecalis
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B. Staphylococcus saprophyticus
C. Staphylococcus aureus
D. Bacillus anthracis
E. Streptococcus pneumonia
5. Staphylococcus aureus is distinguished from Staphylococcus
epidermidis and S. saprophyticus by
A. Catalase test where Staphylococcus aureus is catalase positive and
the others are negative
B. Coagulase test where Staphylococcus aureus is coagulase positive
and the others are negative
C. Coagulase test where Staphylococcus aureus is coagulase negative
and the others are positive
D. Catalase test where Staphylococcus aureus is catalase negative
and the others are positive
E. Staphylococcus aureus is gram positive cocci in cluster and the
others are gram positive cocci in chain
6. Which of the following test will NOT help to differentiate among
members of the Enterobacteriaceae
A. Motility
B. Urease activity
C. Citrate utilization
D. Gram stain
E. Antibiotic sensitivity pattern
7. S. aureus causes a wide variety of infections, ranging from wound
infection to pneumonia. Treatment of S. aureus infection with penicillin
is often complicated by the
A. Inability of penicillin to penetrate the membrane of S. aureus
B. Production of penicillinase by S. aureus
C. Production of penicillin acetylase by S. aureus
D. Lack of penicillin binding sites on S. aureus
E. Allergic reaction caused by staphylococcal protein
8. A patient with symptoms of urinary tract infection had a culture taken,
which grew and counting number of colonies 8. The laboratory reported
it as “insignificant”. The most clinically appropriate action is
A. Do no further clinical workup
B. Suggest to the laboratory that low colony counts may reflect
infection
C. Determine if fluorescent microscopy is available for the diagnosis of
actinomycosis
D. Consider vancomycin as an alternative drug
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E. Suggest a repeat antibiotic susceptibility test
9. The antibiotic of choice for pneumococcal pneumonia is
A. Penicillin
B. Ampicillin
C. Erythromycin
D. Vancomycin
E. Ceftriaxone
10. To isolate specific bacteria from clinical specimens, it is
necessary to use a variety of artificial media, some of which is
selective, others of which are nonselective. N. gonorrhoeae is a
fastidious pathogen and found in sites often contaminated with normal
flora. The best medium for isolation is
A. Sheep blood agar
B. Loffler’s medium
C. Thayer-Martin agar
D. Thiosulfate citrate bile salts sucrose medium
E. Lowenstein – Jensen medium
11. V. cholerae, the causative agent of cholera, is best isolated using
A. Sheep blood agar
B. Loffler’s medium
C. Thayer-Martin agar
D. Thiosulfate citrate bile salts sucrose medium
E. Lowenstein-Jensen medium
12. M. tuberculosis can be found in the sputum of patients with
tuberculosis. After digestion of the sputum, isolation is best
accomplished using
A. Sheep blood agar
B. Löffler’s medium
C. Thayer-Martin agar
D. Thiosulfate citrate bile salts sucrose medium
E. Löwenstein-Jensen medium
13. S. aureus has a distinctive appearance on which one of the
following media?
A. Sheep blood agar
B. Löffler’s medium
C. Thayer-Martin agar
D. Thiosulfate citrate bile salts sucrose medium
E. Löwenstein-Jensen medium
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14. In order to recognize abnormal bacteria, it is necessary to know
which bacteria are predominant normal floras of certain body sites.
Which of the following is the predominant organism on skin commonly
seen as a blood culture contaminant?
A. Hemolytic streptococci
B. Lactobacillus
C. S. epidermidis
D. Escherichia coli
E. B. fragilis
15. If the venipuncture site is inadequately disinfected, blood
cultures are most often contaminated with which one of the following
bacteria?
A. Escherichia coli
B. Haemophilus influenzae
C. Pseudomonas aeruginosa
D. Staphylococcus epidermidis
E. Streptococcus pneumoniae
16. The main purpose of performing a throat culture is to detect the
presence of which one of the following bacteria?
A. Neisseria meningitidis
B. Staphylococcus aureus
C. Staphylococcus epidermidis
D. Streptococcus pneumoniae
E. Streptococcus pyogenes
17. You’re in the clinical lab looking at a Gram stain when the
laboratory technician comes up to you and says, “I think your patient
has Staphylococcus epidermidis (bacteremia) Which one of the
following sets of results did the tech find with the organism recovered
from the blood culture?
A. Gram-positive cocci in chains, catalase-positive, coagulase-positive
B. Gram-positive cocci in chains, catalase-negative, coagulase-
negative
C. Gram-positive cocci in clusters, catalase-positive, coagulase-
negative
D. Gram-positive cocci in clusters, catalase-negative, coagulase-
positive
E. Gram-positive diplococci, catalase-negative, coagulase-positive
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18. Of the following antibiotics, which one is the most appropriate to
treat a severe necrotizing skin infection caused by an MRSA strain of
Staphylococcus aureus?
A. Amoxicillin
B. Ceftriaxone
C. Ciprofloxacin
D. Gentamicin
E. Vancomycin
19. Your patient is a 6-year-old boy who is complaining that his ear
hurts. His mother says this began yesterday and that he has a fever of
103°F. On physical exam, you see a perforated ear drum that is exuding
a small amount of pus. Using a swab, you obtain a sample of the pus
and do a Gram stain and culture. The Gram stain reveals small
coccobacillary rods. There is no growth on a blood agar plate, but a
chocolate agar plate supplemented with X and V factor grows small
grey colonies. Which one of the following bacteria is the most likely
cause of his otitis media?
A. Bordetella pertussis
B. Haemophilus influenzae
C. Klebsiella pneumoniae
D. Legionella pneumophila
E. Pseudomonas aeruginosa
20. A culture of skin lesions from a patient with pyoderma (impetigo)
shows numerous colonies surrounded by a zone of beta hemolysis on a
blood agar plate. A Gram-stained smear shows gram-positive cocci. If
you found the catalase test to be negative, which one of the following
organisms would you MOST probably have isolated?
A. Streptococcus pyogenes
B. Staphylococcus aureus
C. Staphylococcus epidermidis
D. Streptococcus pneumonia
SECTION B: TRUE AND FALSE QUESTIONS.
(20 MARKS)
Answer “T” on the statement which is correct and “F” on the statement
which is incorrect. Half a mark will be awarded for each correct response
1. Regarding Cephalosporin’s
A. _______ Cefepime
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B. _______ Oxacillin
C. _______ Ceftriaxone
D. _______ Vancomycin
E. _______ Amikacin
2. Regarding Urease test
A. ___________ Indicator used phenol red
B. ___________ Urease positive changing in colour from red to purple
C. ___________ Alkali production (NH3)
D. ___________Positive reaction Escherichia
E. ___________Negative reaction P. mirabilis
3. On MacConkey Agar,
A. __________ Non-lactose fermenting bacteria will use peptone as their
energy source instead?
B. __________ Growth medium that is selective for gram negative bacteria
and differential for enteric bacilli that ferment lactose
C. __________ NLF organisms’ gives alkaline and absorb neutral red
D. __________ Contains lactose and pH indicator bromothymol blue
E. __________ Lactose fermenting organisms will change the color to pink
example Pseudomonas
4. Cystine-Lactose-Electrolyte-Deficient (CLED) medium
A. __________ Lactose Fermentors produce yellow colonies on CLED agar?
B. __________ The medium supports the growth of all urinary potential
pathogens and provides distinct colony morphology.
C. __________ It supports the growth of urinary pathogens and
contaminants and gives good colonial differentiation without the
spread of Proteus species due to its lack of electrolytes
D. __________ The color change is indicated by the presence of the pH
indicator Neutral red
E. __________ Sugar fermentation lowers the pH and the phenol red
indicator registers this by changing to yellow
SECTION C: SHORT ANSWER QUESTION.
(30 MARKS)
Answer all Questions.
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1. List 5 antibiotics that are protein synthesis inhibitors
2. List five methods used to identify the different type of bacteria.
3. What are the Common ingredients of any culture media
4. List five biochemical identification tests
5. Briefly explain the differences between Blood agar and Chocolate agar
6. Briefly explain classification of media based on consistency
SECTION D: ESSAY QUESTIONS. (40
MARKS)
This section consists of three (3) questions which are supposed to be
answered in a narrative way. Write your answer on a separate sheet of paper
provided; each question should start on a new page.
1. The diagram below represents hypothetical changes the number of
microorganism cells over time in a fermentation broth.
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i. Names the phases of growth A, B, C and D
ii. Explain the observed changes in the number of cells during each phase
2. Classification of antibiotics on basis of modes of action with examples
3. In detail explain Cell Wall Synthesis Inhibitors antibiotic with at least two
examples
“WISH YOU ALL THE BEST”
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