Practice test for Microbiology 1 on tuberculosis for DelTech Owens
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
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| Tuberculosis primary affects what area of the body? | respiratory
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| Tuberculosis can become systemic and affect what 5 body systems? | 1. kidneys 2. skin 3. bones 4. reproductive 5. urinary
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| TB bacilli progress from the __ into the blood stream or lymphatic system. | alveoli
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| The immune system kills many TB bacilli, but local tissues are __ in the process. | necrotized
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| What do macrophages do to the TB bacilli when they are unable to eliminate them? | wall them off
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| When macrophages wall off the TB bacilli, what does this form? | granuloma
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| Name 3 modes of transmission for TB. | 1. airborne droplet 2. inhalation 3. close proximity
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| TB bacilli progress from the alveoli into the __ or __. | blood stream or lymphatic system
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| When you first catch TB, what symptoms are presented? | none
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| TB can remain latent for how long? | years
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| A latent TB infection can become active after how long? | any given time
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| A primary TB infection causes a persistent ? | productive cough
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| When does a cough due to TB infection often produce? | 1. phlegm 2. blood
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| A victim of TB often (gains or loses?) weight. | loses
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| A person with TB may feel pain where? | chest
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| A victim of TB does this a lot, especially at night. | sweats
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| What are the 7 symptoms often associated with TB? | 1. cough 2. weight loss 3. chest pain 4. sweating 5. fatigue 6. fever 7. trouble breathing 8. wheezing
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| TB granulomas often look like grey __ on an X-ray. | splotches
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| What are the 2 primary drugs used to treat TB? | 1. Isoniazid 2. Rifampin
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| How long does TB drug therapy take to work? | 6-12 months
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| The prognosis for someone with TB is __ if caught early. | excellent
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| TB patients have an excellent prognosis if they take their __ as prescribed. | medications
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| What are the 4 drugs used to treat TB? | 1. Isoniazid 2. Rifampin 3. Ethambutol 4. Pyrazinamide (list did not include aminoglycosides and fluoroquinolones, but they also apply)
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| If TB patients don't get their meds or go untreated, the mortality rate is ? | 50-60%
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| The main reason that people are dying of TB is due to lack of ? | meds
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| Patients with TB must be kept in a special __ room. | isolation
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| The isolation rooms for TB are private and have __ air pressure. | negative
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| How many air exchanges are allowed per hour in a TB patient's room? | 6
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| A lab that is working with TB must have __ pressure and is allowed __ air exchanges per hour. | negative, 6-12
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| What kind of equipment must be worn in a lab working with TB? | 1. gloves 2. lab coat 3. N95 respirator
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| What kind of light is used to disinfect a biological safety cabinet after personnel have left? | UV
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| For patients who can't be relied upon to take their TB meds without deviation, what sort of therapy must be applied? | direct observed therapy
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| Mycobacterium tuberculosis and other mycobacterium related to it are __ __ bacilli. | acid fast
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| What organs or tissues are vulnerable to infection by acid fast bacilli (AFB)? | almost all of them
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| Successful isolation of acid fact bacilli (AFB) depends on quality of the specimen, appropriate processing, and ? | culture techniques
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| When is the best time to collect sputum samples from a patient coughing up AFB. | morning
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| How many morning samples should you get of a patient's sputum to test for TB? | 3
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| If you are unable to obtain a good sputum sample from a patient, you can obtain one by what 3 means? | 1. bronchial wash 2. brushings or scrapings 3. gastric lavage
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| How might you obtain a sputum sample from a patient who is senile or paralyzed and unable to cough? | gastric lavage
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| What are 4 other types of samples you can use to test for AFB if sputum isn't working? | 1. body fluids 2. tissues 3. stool 4. wounds or lesions
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| Body fluids for AFB testing include ? | 1. urine 2. blood
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| In a patient with AIDS and a MAC AFB infection, you would likely test which kind of fluid? | blood
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| When obtaining a sample for AFB testing from a wound or lesion, you would __ the area because using a swab would not yield enough of the mycobacterium. | aspirate
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| When obtaining a sputum sample, why would you want it to be as concentrated as possible? | saliva is a contaminant
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| Can all AFB specimens be preserved? | no
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| Can you obtain AFB samples from bone? | yes
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| The cell walls of acid fast bacilli (AFB) are waxy because they have a high __ content. This also renders them hard to stain. | lipid
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| AFB grow very slowly because their cell walls are afraid of what? | water (they're hydrophobic)
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| The hydrophobic cell walls of AFB make it harder for them to obtain ? | nutrients
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| If an AFB takes on any color when being gram stained, it will be ? | purple
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| Use of __ when staining AFBs allows them to take on the color of the stain. | acid
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| Specimens of AFB taken from nonsterile sites must be __. | decontaminated
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| When disinfecting your work area after working with an AFB, you should use what ratio of sodium hypochlorite? | 1:10-1:50
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| A solution of 5% __ can be used to disinfect your work area after working with AFB. | phenol
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| A phenol-__ mixture can be used to disinfect an area exposed to an AFB. | soap
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| What else can be used to disinfect an area exposed to an AFB besides sodium hypochlorite, phenol, or a phenol-soap solution? | aldehydes
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| How long do most disinfectants need to be applied to an area to safely rid it of an AFB? | 10-30 mins
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| Most disinfectants must be applied for 10-30 mins to clear it of an AFB. One must be applied for a full 30 mins to work. Which one? | aldehydes
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| Which disinfectant is best for use against an AFB? | sodium hypochlorite
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| Which disinfectant is 2nd best for use against an AFB? | phenol-soap mixture
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| Which allows for faster identification of a Mycobacterium: A broth or agar culture? | Broth
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| The optimal growth temp for many Mycobacterium (but not all) is ? | 37 C
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| Mycobacterium is considered a fast grower if colonies can be seen in less than __ days. | 7
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| The higher the Runyon group, the faster the AFB ? | grows
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| Runyon group I mycobacterium are slow growing and ? | photochromogens
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| Runyon group II mycobacterium are slow growing and ? | scotochromogens
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| Runyon group III mycobacterium are slow growing and ? | nonchromogens
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| Runyon group IV mycobacterium are ? | rapid growers
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| Name the 3 culture media used when trying to grow mycobacterium. | 1. Lowenstein Jensen 2. Middlebrook 7H10 3. Middlebrook 7H11
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| Which of the 3 culture media for mycobacterium is egg based? | Lowenstein Jensen
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| Which of the 3 culture media for mycobacterium is a solid? | Middlebrook 7H10/7H11
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| Photochromogens belong in which Runyon group? | Group I
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| Nonchromogens belong in which Runyon group? | Group III
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| Scotochromogens belong in which Runyon group? | Group II
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| The only Runyon group with rapid growing mycobacterium is ? | Group IV
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| Which kind of stain is used primarily when looking for AFBs? | Modified Kinyoun-phenol
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| Which kind of AFB stain is fluorescent? | Auramine
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| Auramine will stain the AFBs a fluorescent __ color, meaning that the test is positive. | orange
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| If you find AFBs using an auramine fluorescent stain, what would you do to confirm the presence of Mycobacterium? | Modified Kinyoun-phenol stain
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| How many fields must be checked for the presence of Mycobacterium before you can declare a sample free of the infection when viewing the specimen with a Modified Kinyoun-phenol/ethanol stain? | 300
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| How many fields must be viewed when examining a specimen with a fluorescent auramine stain? | 30
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| When is a Mycobacterium specimen unacceptable? | If pooled or obtained on a swab.
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| Which kind of media is most commonly used for AFBs? | Lowenstein Jensen Agar
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| Why does Lowenstein Jensen Agar use malachite? | It inhibits the growth of other bacteria.
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| Does malachite green inhibit the growth of Mycobacteria? | Yes
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| When using Lowenstein Jensen Agar, you should incubate the sample in CO2 at what temperature? | 35-37 C
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| How long should you let a sample grow on Lowenstein Jensen Agar? | up to 8 weeks
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| Besides checking daily on a sample that has been placed on the Lowenstein Jensen Agar to grow, what else should you do to it daily? | Record its growth to determine which Runyon group it belongs to.
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| Lowenstein Jensen Agar comes in a slant and is __ green. | green
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| How do you know there isn't any Mycobacteria when viewing it on a slide that uses fluorescent auramine stain? | It will be all black and have no orange spots.
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| What color will Mycobacteria appear under a Kinyoun stain? | red
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| What 4 things are important when using colonial morphology to ID a Mycobacteria? | 1. growth rate 2. color (pigmentation) 3. best temperature for growth 4. appearance on the media
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| Fluorescent auramine is more __ while Modified Kinyoun stain is more __ to Mycobacteria. | sensitive, specific
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| A type of broth culture with a radio-labeled carbon compound is called ? | Bactec
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| How can you tell if Mycobacteria are growing on a Bactec media before visible signs of growth appear? | CO2 will be released into top of bottle due to bacterial metabolic processes.
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| All Mycobacteria produce niacin. But M. tuberculosis can't convert it to ? | nicotine acid mononucleotide
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| What kind of test can separate M. tuberculosis from other bacteria? | Niacin test
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| Since M. tuberculosis can't convert niacin into nicotine acid mononucleotide the way other bacteria can, what will accumulate in a colony of M. tuberculosis? | niacin (duh)
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| All positive cultures need what kind of test? | NAP (p-nitro-a-acetylamino-b-hydroxypropiophenone)
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| If M. tuberculosis is present when running a Niacin test, how do you know the results are positive? | turns yellow
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| How do you know when a sample is negative for niacin when running a niacin test? | clear or milky looking
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| An NAP test distinguishes between Mycobacterium tuberculosis and ? | NTM (nontuberculosis Mycobacteria)
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| What are the steps when running a niacin test? | 1. extract niacin 2. incubate at room temp for 20 mins 3. treat with cyanogen bromide 4. check results (yellow=positive)
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| If an NAP test is positive, you split the positive sample in half and then what? | add NAP to one but not the other (it's a control)
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| How long do you incubate your samples after you've split them in half during an NAP test? | 4 days
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| During an NAP test, how do you know if the sample is an NTM? | control growth will be less than in the test bottle
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| During an NAP test, how do you know if the sample is a M. tuberculosis? | control growth will be greater than in the test bottle
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| What other Mycobacteria can cause the colony in the control bottle to grow faster than the test bottle? | Mycobacterium bovis
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| When running a nitrate test, red is (positive or negative)? | positive
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| If the sample does not turn red during a nitrate test, how do you confirm that it is truly negative? | add zinc dust
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| After adding zinc dust to a sample when running a nitrate test, how do you know if it's truly negative? | it will turn red
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| How does a sample of Mycobacterium tuberculosis look? | rough and buff
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| What color is buff colony? | off white
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| What is the most common nontuberculosis lung disease caused by a Mycobacterium? | M. Kansasii
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| What kind of Mycobacterium causes fish tank granuloma? | M. marinum
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| Which has a smoother appearance: M. tuberculosis or M. marinum? | M. marinum
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| M. scrofulaceum causes what in children? | cervical lymphadenitis
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| MAC (Mycobacterium avium complex) is a slow grower that can be a serious problem for patients who are already ? | immunocompromised
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| MAC (Mycobacterium avium complex) comes out what color? | buff
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| What is the causitive agent of leprosy? | Hansen's disease
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| Which kind of Mycobacterium is very hard to culture in a lab? | M. leprae
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| How can M. leprae by cutlured in a lab? | using mouse or armadillo foot pads
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| Which Mycobacterium causes a smoldering pulmonary disease in patients with chronic lung disease? | M. xenopi
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| What is the counterstain when staining TB with fluoresent stain? | Potassium permanganate
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| What is the most common entryway for TB to enter the body? | inhalation
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| What color should E. coli be under a Kinyoun stain? | blue
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| What color should TB be under a Kinyoun stain? | red
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| If your control and your test specimen are the wrong color after staining, what should you do? | repeat the stain/test
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| A PPD test tells us if you've been exposed to TB ? | antibodies
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| If a PPD test on a patient is positive for TB antibodies, but cell samples taken from the patient are negative for TB, what has happened? | The patient was exposed to TB does not have the disease.
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| Why are Mycobacterium called "acid fast bacteria?" | Acid-fast organisms are difficult to stain using Gram staining. Once stained, these organisms resist the dilute acid and/or ethanol-based de-colorization procedures common in many staining protocols—hence the name acid-fast.
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| Contaminated sputum samples must be ? | decontaminated
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| Can you see a Mycobacteria that has been gram stained? | usually not
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| What does PPD stand for? | purified protein derivative
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| Skeletal TB of the spine is called ? | Pott disease
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| A patient with meningitis caused by M. tuberculosis will reveal what abnormalities? | 1. high protein 2. low glucose 3. lymphocytes
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| TB is likely to build a resistance to antibiotics under what 2 circumstances? | 1. the patient fails to complete the course of treatment correctly 2. only one drug is given instead of two or more
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| Mult-drug resistant Mycobacterium tuberculosis (MDR-TB) is defined as ? | resistance to at least isoniazid and rifampin and a patient with no previous history of TB.
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| Extensively drug resistant tuberculosis (XDR-TB) is defined as ? | resistance to isoniazid and rifampin AND fluoroquinolone and at least 1 of 3 injectable second-line anti-TB drugs.
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| The Mycobacteria from Runyon group III and the TB complexes are all __ pathogenic. | strictly
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| All the Mycobacteria from Runyon group I are __ pathogenic. | usually
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| Mycobacterium tuberculosis (TB) is __ pathogenic and __ in the US. | strictly pathogenic and common in the US
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| Mycobacterium tuberculosis (TB) has a __ appearance. | dry rough
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| Mycobacterium tuberculosis (TB) grows best at what temperature? | 35-37 C
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| Mycobacterium tuberculosis (TB) has a __ color. | buff
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| Mycobacterium tuberculosis (TB) is niacin (positive or negative?). | positive
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| Mycobacterium tuberculosis (TB) is nitrate reduction (pos or neg?). | positive
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| Mycobacterium tuberculosis (TB) is inhibited or uninhibited by a NAP test? | inhibited
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| Mycobacterium bovis is __ pathogenic and __ in the US. | strictly pathogenic and uncommon in the US
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| Mycobacterium bovis grows best at what temperature? | 37 C
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| Mycobacterium bovis appears what color? | nonpigmented
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| Mycobacterium ulcerans is __ pathogenic and __ in the US. | strictly pathogenic and rare in the US
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| Mycobacterium ulcerans grow best as what temps? | 30-33 C
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| How can Mycobacterium leprae most easily be identified? | It doesn't grow on artificial media.
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| M. tuberculosis, M. leprae, M. africanum, M. bovis, M. ulcerans all belong to what complex of Mybacteria? | Mycobacterium tuberculosis complex
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| Mycobacterium kansasii is __ pathogenic and __ in the US. | usually pathogenic and common in the US
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| Mycobacterium kansassi grows best at what temp? | 37 C
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| M. kansassi is photochromagenic, forming what color of crystals in the light? | dark red
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| Mycobacterium kansassi can be detected by using what kind of probe? | nonisotopic nucleic acid probe
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| Mycobacterium kansassi is in what Runyon group? | I
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| Mycobacterium marinum is __ pathogenic and __ in the US. | usually pathogenic and uncommon in the US.
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| Mycobacterium marinum turns what color when exposed to light? | yellow
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| Mycobacterium marinum grows best at what temp? | 28-32 C
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| Mycobacterium marinum belongs to which Runyon group? | I
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| Mycobacterium szulgai is __ pathogenic and __ in the US. | usually pathogenic and uncommon in the US.
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| Mycobacterium szulgai grow best at what temp? | 37 C
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| Mycobacterium szulgai become photochromogenic at what temp? | 22 C
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| Mycobacterium szulgai become scotochromogenic at what temp? | 37 C
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| Mycobacterium szulgai belong to Runyon group ? | II
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| Which Mycobacterium were we told is tween negative? | Mycobacterium scrofulaceum
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| Mycobacterium scrofulaceum is __ pathogenic and __ in the US. | sometimes pathogenic and uncommon
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| Mycobacterium scrofulaceum turns orange in the (presence or absence) of light? | absence
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| Mycobacterium xenopi is __ pathogenic and __ in the US. | sometimes pathogenic and uncommon in the US.
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| Mycobacterium xenopi grow best at what temp? | 42 C
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| Mycobacterium scrofulaceum grow best at what temp? | 25-37 C
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| Mycobacterium gordonae is __ pathogenic and __ in the US. | sometimes pathogenic and common in the US.
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| Mycobacterium gordonae is (pos or neg?) for nitrate reduction. | negative
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| Mycobacterium gordonae grow best at what temp? | 22-37 C
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| M. szulgai, M. scrofulaceum, M. xenopi and M. gordnae all belong to what Runyon group? | II
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| Mycobacterium avium complex are all __ pathogenic and __ in the US. | strictly pathogenic and common in the US.
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| Mycobacterium avium complex grow best at what temp? | 37 C
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| Mycobacterium genavense are __ pathogenic and __ in the US. | strictly pathogenic and uncommon in the US.
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| Mycobacterium genavense grow best at what temp? | They don't grow on routine solid media, but can grow using BACTEC. Temp not specified.
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| M. avium complex and M. genavense belong to what Runyon group? | III
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| The fastest growing Mycobacterium on our list are ? | Mycobacterium fortuitum and Mycobacterium chelonae
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| Mycobacterium fortuitum and Mycobacterium chelonae belong to which Runyon group? | IV
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| Mycobacterium fortuitum are __ pathogenic and __ in the US. | sometimes pathogenic and common in the US.
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| Mycobacterium fortuitum grow best at what temp? | 37 C
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| Mycobacterium fortuitum is (pos or neg?) for nitrate reduction. | positive
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| Mycobacterium chelonae is __ pathogenic and __ in the US. | sometimes pathogenic and common in the US.
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| Mycobacterium chelonae grow best at what temp? | 37 C
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| What kind of agar is used to grow Mycobacterium chelonae? | McConkey
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| Which Mycobacterium belong to the Mycobacterium tuberculosis complex? | M. tuberculosis, M. africanum, M. leprae, M. ulcerans, M. bovis
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| Which Mycobacterium belong to Runyon group I? | M. kansasii, M. marinum
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| Which Mycobacterium are Scotochromogens? | M. szulgai, M. scrofulaceum, M. xenopi, M. gordonae
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| Which Mycobacterium are Photochromogens? | M. kansasii, M. marinum (Runyon group I)
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| Which Mycobacterium belong to Runyon group II? | M. szulgai, M. scrofulaceum, M. xenopi, M. gordonae (they're all Scotochromogens)
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| Which Mycobacterium belong to Runyon group III? | M. avium complex, M. genavense
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| Which Mycobacterium are Nonchromogens? | M. avium complex, M. genavense (Runyon group III)
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| Scotochromogens turn yellow or orange under what conditions? | light or no light
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| Photochromogens turn yellow or orange under what conditions? | light
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| Nonchromogens change color under what conditions? | none-they are buff
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| When are stool samples likely to be collected from a TB patient? | Stools are primarily collected from AIDS patients to determine Mycobacterium avium complex (MAC)
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| When are blood samples likely to be collected from a TB patient? | Blood is taken most commonly from AIDS and other immunosuppressed patients
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| Why are tissue samples/aspirates collected from a TB patient instead of a swab? | The number of organisms in that site are rare
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| What kind of samples from TB patients must be digested? | Sputums or other viscous specimens
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| How does decontamination take place in TB cases? | Specimen from non-sterile site is mixed with an agent that will kill non-mycobacterium bacteria
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| Name 3 decontamination agents used in TB cases. | 1. NaOH (most common) 2. Benzalkonium chloride (Zephiran) 3. Oxalic acid
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| What happens after a TB sample has been decontaminated? | The agent must be neutralized so that it will not eventually kill the Mycobacterium.
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| How does the process of digestion help us grow Mycobaterium cultures? | Liquefying mucus enables the mycobacterium to contact and use the nutrients in the agar medium
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| After decontamination and digestion, the specimen is centrifuged in a closed, vented centrifuge to __ the organisms. | concentrate
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| After centrifugation, the __ at the bottom of the tube is used to make a smear and to inoculate media. | button
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| Labs with large volumes of Mycobacterium cultures use an automated reader called ? | BACTEC
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| BACTEC broth contains 14C-labeled substrate; so when the organisms grow, 14C in the form of 14CO2 is released and detected __. | radiometrically
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| __ produce carotene pigment upon exposure to light. | Photochromogens
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| __ produce pigment in light or dark | Scotochromogens
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| __ Mycobacteria produce no pigment; these colonies are a buff color | Nonchromogenic
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| These days, most labs use __ __ __ with or without __ to detect Mycobacteria. | nucleic acid probes, PRC
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| What is the difference between M. gordonae and M. scroflaceum? | M. gordonae is tween + grows 22-37C. Turns yellow-orange with or without light. Found in soil. Rarely causes disease. M. scrofulaceum is tween - and grows 25-37C. Found in tap water. Pulmonary infections. Drug resist. Turns yellow-orange under light.
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| The vaccination for TB is called ? | BCG
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| How can you identify TB? | 1. Blood Test 2. Chest Radiograph (X-ray) 3. Sputum Smear Microscopy 4. Culture 5. Nucleic Acid Amplification Tests (NAATs)
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| How do you treat TB that has reached the central nervous system? | antibiotics and steroids; isoniazid is the most important antibiotic. http://www.hindawi.com/journals/trt/2011/798764/
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