NEET-PG 2015 Practice Questions

Q: What is the most common form of leptospirosis?

Anicteric form. ***Anicteric form*** - The **anicteric form** accounts for about 90% of all leptospirosis cases, presenting with milder, flu-like symptoms without jaundice. - Patients typically experience **fever, headache, myalgia**, and conjunctival suffusion during the initial septicemic phase [1], followed by an immune phase that can involve meningitis or uveitis [1]. *Icteric form* - The **icteric form** (Weil's disease) is a severe manifestation, characterized by jaundice, renal failure, and hemorrhage, occurring in a minority of cases (5-10%). - Although more severe and often life-threatening, it is **less common** than the anicteric presentation [1]. *Hepatorenal form* - This term describes the severe complications of leptospirosis, including **liver and kidney dysfunction**, specifically associated with Weil's disease. - While a critical aspect of severe leptospirosis, it is a description of the organ involvement rather than a distinct common form of the disease. *Weil's disease* - **Weil's disease** is the most severe and potentially fatal form of leptospirosis, characterized by **jaundice, renal failure, hemorrhage, and myocarditis**. - It is a severe subset of the icteric form, making it a very serious but **uncommon variant** of the overall disease.

Q: Which of the following statements about Chromobacterium violaceum is false?

Normal flora in human. **This question asks for the FALSE statement about *Chromobacterium violaceum*.** ***Normal flora in human*** ✓ (FALSE STATEMENT - This is the correct answer) - *Chromobacterium violaceum* is **not considered normal flora** in humans. It is an environmental bacterium typically found in **soil and water** in tropical and subtropical regions. - Its presence in humans usually signifies a serious **opportunistic infection**, often resulting from exposure to contaminated environments. - Since this statement is FALSE, this is the correct answer. *Gram negative* (TRUE statement) - *Chromobacterium violaceum* is indeed a **Gram-negative bacterium**. This characteristic is crucial for its identification and determining appropriate antibiotic treatment. - Like other Gram-negative bacteria, it possesses an **outer membrane** containing lipopolysaccharide (LPS). *Causes cellulitis* (TRUE statement) - *Chromobacterium violaceum* can cause severe infections in humans, including **cellulitis**, often following skin breaches like cuts or abrasions. - The infections are frequently aggressive and can lead to systemic disease such as **sepsis and abscess formation**. *Produces violet-colored pigment* (TRUE statement) - *Chromobacterium violaceum* is notable for producing **violacein**, a distinctive **violet-colored pigment**. - This pigment production is a key identifying feature on culture media and is associated with some of its pathogenic properties.

Q: Oil paint appearance on nutrient agar is seen in -

Staphylococcus aureus. ***Staphylococcus aureus*** - *Staphylococcus aureus* forms characteristic **golden-yellow, smooth, opaque colonies** on nutrient agar with a **buttery or creamy consistency** - Some texts describe this appearance as **"oil paint-like"** due to the pigmented, smooth, and glistening surface that can resemble brushed paint - Colonies are typically **2-4 mm in diameter**, round, and show **golden pigmentation** (due to carotenoid pigments) - On **blood agar**, *S. aureus* shows **beta-hemolysis** with golden colonies *Streptococcus pyogenes* - *Streptococcus pyogenes* grows poorly on plain nutrient agar and requires **enriched media** like blood agar - On blood agar, it forms **small, translucent, grey-white colonies** surrounded by a wide zone of **beta-hemolysis** - Colonies are typically **pinpoint** in size and do not show pigmentation *Bordetella pertussis* - *Bordetella pertussis* is a **fastidious organism** that does **not grow on plain nutrient agar** - Requires specialized enriched media like **Bordet-Gengou agar** (with potato-glycerol-blood) or **Regan-Lowe agar** - On Bordet-Gengou agar, colonies appear as **small, smooth, pearl-like** or **"mercury droplet"** colonies after 3-7 days *H. influenzae* - *Haemophilus influenzae* is also fastidious and requires **X factor (hemin)** and **V factor (NAD)** for growth - Does **not grow on plain nutrient agar** - On **chocolate agar**, forms **small, smooth, translucent, greyish colonies** with a characteristic musty odor - Colonies are typically **1-2 mm** in diameter

Q: What is the most common age group affected by Streptococcus pyogenes?

5-15 years. ***5-15 years*** - **Streptococcus pyogenes** (Group A Strep) commonly causes **pharyngitis** (strep throat), which primarily affects school-aged children. - This age group is more susceptible due to increased exposure in school and daycare settings. *<5 years* - While younger children can get strep infections, it is less common in those under **3 years of age**, as viral etiologies are more prevalent for pharyngitis in this group. - They are more prone to **non-streptococcal bacterial infections** and certain viral infections. *20-25 years* - Although adults can get **Streptococcus pyogenes** infections, the incidence significantly decreases after childhood. - Pharyngitis in this age group is more often **viral** in origin. *30-40 years* - The prevalence of **Streptococcus pyogenes** infections, particularly pharyngitis, is typically low in this age group compared to children. - Infections, if they occur, may stem from exposure to infected children or close contact environments.

Q: Naegler's reaction is due to:

Lecithinase. ***Lecithinase*** - The **Naegler reaction** is a bacterial identification test used to detect the production of **lecithinase** (also known as alpha-toxin) by certain bacteria, particularly *Clostridium perfringens*. - This enzyme hydrolyzes **lecithin** (a lipid found in egg yolk), resulting in a visible opaque precipitate around the bacterial colonies on egg yolk agar. *Coagulase* - **Coagulase** is an enzyme produced by some bacteria (e.g., *Staphylococcus aureus*) that causes the coagulation of blood plasma. - While it is an important virulence factor, it is not involved in the **Naegler reaction**. *Hyaluronidase* - **Hyaluronidase** is an enzyme that breaks down **hyaluronic acid**, a component of connective tissue, facilitating the spread of bacteria. - It is often referred to as a **spreading factor** but is not detected by the **Naegler reaction**. *None of the options* - This option is incorrect because **Lecithinase** is directly responsible for the **Naegler reaction**.

Q: Disruption of which of the following oropharyngeal commensals predisposes to candidiasis?

Streptococcus. ***Streptococcus*** - **Streptococcus** species, particularly *S. sanguinis* and *S. mitis*, are major commensals in the oral cavity that **inhibit the growth of *Candida albicans*** through competition for nutrients and production of antimicrobial substances. - Disruption of this normal **streptococcal flora**, often by broad-spectrum antibiotics, creates an environment where *Candida albicans* can proliferate, leading to candidiasis. *Staphylococcus* - **Staphylococcus** species are primarily skin and nasal commensals; while *S. aureus* can be found in the oral cavity, it is not a primary competitor against *Candida* in the same way as streptococci. - Their presence or absence is not typically a direct predisposing factor for oral candidiasis compared to the dominant streptococcal flora. *Lactobacillus* - **Lactobacillus** species are common in the gastrointestinal tract and vagina, where they maintain an acidic environment that inhibits pathogen growth; however, they are less dominant in the oropharynx as a defense against *Candida*. - While beneficial for overall host health, their disruption in the oral cavity does not typically precipitate candidiasis as directly as that of the **streptococcal flora**. *Hemophilus influenzae* - *Haemophilus influenzae* is a common inhabitant of the **upper respiratory tract** and can be an opportunistic pathogen, but it is not known to have a significant role in directly inhibiting *Candida* growth in the oropharynx. - Its presence or absence in the commensal flora in the oral cavity does not typically influence the development of candidiasis.

Q: Brill-Zinsser disease is a recrudescent form of which infection?

Recrudescence of R prowazekii infection. **Recrudescence of R prowazekii infection** - Brill-Zinsser disease is a **late-onset complication** of **epidemic typhus**, caused by *Rickettsia prowazekii*. - It occurs years after the initial infection, due to **reactivation of dormant bacteria** in the body. *Recrudescence of R typhi infection* - *Rickettsia typhi* causes **murine typhus**, but its recrudescent form is not referred to as Brill-Zinsser disease. - Murine typhus is typically a **milder disease** compared to epidemic typhus. *Recrudescence of Coxiella burnetii infection* - *Coxiella burnetii* causes **Q fever**, which can have a chronic form but is not a recrudescence of a typhus infection. - Q fever presents with different clinical manifestations, such as **endocarditis** or **hepatitis**, not typically a rash or neurological symptoms seen in typhus. *None of the options* - This option is incorrect because the specific recrudescent form described in the question clearly points to *Rickettsia prowazekii*.

Q: Listeria escapes from phagosomes (phagolysosomes) due to:

beta-hemolysin. ***beta-hemolysin*** - *Listeria monocytogenes* produces **listeriolysin O (LLO)**, a **beta-hemolysin**, which is a pore-forming toxin that lyses the phagosomal membrane. - This allows the bacteria to escape into the host cell cytoplasm, thus **avoiding destruction** by lysosomal enzymes and neutralizing the microbicidal environment. *Caspases* - **Caspases** are a family of proteases that play essential roles in programmed cell death (apoptosis) and inflammation. - While bacteria can manipulate host cell apoptosis, caspases themselves are **host enzymes** and do not directly confer resistance to phagosome destruction. *Cell membrane adhesion molecules* - **Adhesion molecules** facilitate bacterial attachment to host cells and internalisation, but they do not directly provide a mechanism for **escaping the phagosome** once internalised. - Examples include internalins, which are involved in bacterial entry into cells. *Opacity associated protein (OAP)* - **Opacity associated proteins (OAPs)** are primarily associated with *Neisseria gonorrhoeae* and are involved in adherence to host cells and evasion of the immune response. - They are not a mechanism for **phagosomal escape** or directly related to *Listeria's* intracellular survival.

Q: Primary complex of M bovis involves:

Tonsil and intestine. ***Tonsil and intestine*** - *Mycobacterium bovis* is primarily transmitted through **consumption of contaminated milk and dairy products**, making the **alimentary tract** the main route of infection - The primary complex (Ghon complex) involves the **initial site of infection plus regional lymph nodes** - In alimentary tuberculosis, the organisms enter through the **intestinal mucosa** (Peyer's patches) or **tonsillar tissue**, creating foci with associated mesenteric or cervical lymphadenopathy - Both tonsils and intestines are part of the **alimentary system**, representing the typical primary complex for M. bovis in humans *Tonsil and lung* - This incorrectly combines **two different routes of entry** (alimentary and respiratory) - A primary complex involves a **single portal of entry**, not multiple unrelated organ systems - While M. bovis can rarely cause pulmonary TB through inhalation, this would create a separate lung + hilar node complex, not a combined tonsil-lung complex *Tonsil and skin* - **Skin involvement** requires direct inoculation through cuts or abrasions and does not form a primary complex with tonsillar infection - These represent different portals of entry and would not occur together as a primary complex *Skin and Intestine* - **Skin infection** by M. bovis is rare and requires occupational exposure with direct inoculation (e.g., veterinarians, butchers) - This incorrectly pairs two different routes of infection that would not form a single primary complex

Q: At what age group is Streptococcus pneumoniae pneumonia most commonly observed?

< 5 years. ***< 5 years*** - *Streptococcus pneumoniae* pneumonia is particularly common and severe in **young children**, especially those under the age of 5, due to their developing immune systems. - This age group has a higher incidence of **invasive pneumococcal disease**, including pneumonia and meningitis, making vaccination crucial. *5 - 15 years* - While pneumonia can occur in this age group, it is **less common** than in very young children or older adults. - The immune system is generally more developed and effective at this age, leading to a **lower incidence** of severe pneumococcal infections. *20 - 25 years* - This age group generally has a robust immune system, making *Streptococcus pneumoniae* pneumonia **uncommon** unless there are underlying risk factors such as immunocompromise or chronic medical conditions. - Most cases of pneumonia in young adults are often due to **viral pathogens** or *Mycoplasma pneumoniae*. *30 - 40 years* - Similar to the 20-25 years age group, incidence of *Streptococcus pneumoniae* pneumonia remains **relatively low** in healthy individuals in their 30s and 40s. - Increased risk is typically associated with **chronic illnesses**, smoking, or conditions that weaken the immune system.

Question 1

What is the most common form of leptospirosis?

Accepted Answer

Anicteric form

Answer

Icteric form

Answer

Hepatorenal form

Answer

Weil's disease

Question 2

Which of the following statements about Chromobacterium violaceum is false?

Accepted Answer

Normal flora in human

Answer

Gram negative

Answer

Causes cellulitis

Answer

Produces violet-colored pigment

Question 3

Oil paint appearance on nutrient agar is seen in -

Accepted Answer

Staphylococcus aureus

Answer

Streptococcus pyogenes

Answer

Bordetella pertussis

Answer

H. influenzae

Question 4

What is the most common age group affected by Streptococcus pyogenes?

Accepted Answer

5-15 years

Answer

30-40 years

Answer

<5 years

Answer

20-25 years

Question 5

Naegler's reaction is due to:

Accepted Answer

Lecithinase

Answer

Coagulase

Answer

Hyaluronidase

Answer

None of the options

Question 6

Disruption of which of the following oropharyngeal commensals predisposes to candidiasis?

Accepted Answer

Streptococcus

Answer

Staphylococcus

Answer

Lactobacillus

Answer

Haemophilus influenzae

Question 7

Brill-Zinsser disease is a recrudescent form of which infection?

Accepted Answer

Recrudescence of R prowazekii infection

Answer

Recrudescence of R typhi infection

Answer

None of the options

Answer

Recrudescence of Coxiella burnetii infection

Question 8

Listeria escapes from phagosomes (phagolysosomes) due to:

Accepted Answer

beta-hemolysin

Answer

Opacity associated protein (OAP)

Answer

Caspases

Answer

Cell membrane adhesion molecules

Question 9

Primary complex of M bovis involves:

Accepted Answer

Tonsil and intestine

Answer

Tonsil and skin

Answer

Tonsil and lung

Answer

Skin and Intestine

Question 10

At what age group is Streptococcus pneumoniae pneumonia most commonly observed?

Accepted Answer

< 5 years

Answer

5 - 15 years

Answer

20 - 25 years

Answer

30 - 40 years

NEET-PG 2015

Internal Medicine

Microbiology

Pathology

Pediatrics