MBBS 2nd Year Clinical Cases & Spotter Questions (PDF)

GASTROINTESTINAL AND HEPATOBILIARY SYSTEMS  Enteric Fever  A 25 year old patient complains of headache, fever, malaise and abdominal discomfort for the last 10 days.  On examination, he had hepatosplenomegaly.  Routine blood examination showed WBC count o...

GASTROINTESTINAL AND HEPATOBILIARY SYSTEMS  Enteric Fever  A 25 year old patient complains of headache, fever, malaise and abdominal discomfort for the last 10 days.  On examination, he had hepatosplenomegaly.  Routine blood examination showed WBC count of 3000 cells/cu.mm.  Blood was collected for culture and serology.  The Gram’s stained smear, culture plate & biochemical reactions are kept for identification. 1. Report on Gram’s Staining? 2. Identify the medium and describe the colony morphology? 3. Interpret the biochemical reactions? 4. Identify the Organism? 5. What is the Clinical diagnosis? 6. How do you detect the carrier state of this disease? 7. State other indications of Blood Culture? 8. Mention the antibiotics used for this disease? 1. Answer- Gram negative bacilli 2. Answer- Mac Conkey’s Agar – small-medium, round, moist, non-lactose fermenting colonies. 3. Answer- Triple Sugar Iron Agar- Alkaline/Acid (K/A), no gas, Trace H2S produced. SIM media-H2S-positive, Indole-negative, motile. Citrate tests- Negative. Urease test- Negative 4. Answer- Salmonella typhi. 5. Answer- Typhoid. 6. Answer- a) Culture- Bile, Stool & Urine culture. b) Serology- Vi Antibodies. 7. Answer- Subacute Bacterial Endocarditis(SBE), Brucellosis, Pneumonia. 8. Answer- Ampicillin, Co-trimoxazole, Chloramphenicol, Ciprofloxacin, & Ceftriaxone.  Cholera A 45 year old male presented with profuse painless watery diarrhea associated with nausea and vomiting, low pulse and cold clammy skin. On examination, patient had signs of dehydration and low B.P. There is no history of fever. Stool culture on a selective medium is displayed. Questions: 1. Identify the medium and most probable organism that has grown. 2. How do you confirm the identification of the organism? 3. What is the mechanism in causation of diarrhea in this case? 4. What is the treatment? 5. List two other bacteria that can cause similar type of diarrhea. Answers: 1. Thiosulphate citrate bile salt sucrose agar showing large moist yellow colored colonies of Vibrio cholerae due to sucrose fermentation 2. a. Microscopy: Gram staining : Gram negative curved bacilli b. Motility test: This organism shows darting motility c. Biochemical tests: Oxidase test: positive SIM media : H2S negative, Indole positive, Motile Nitrate reduction test: positive Ferments: glucose, sucrose, mannose, mannitol and maltose d. Slide agglutination test with specific antisera. 3. Cholera toxin in small intestine activates adenylate cyclase→ increased cAMP→Hypersecretion of water and electrolytes to lumen of intestine. 4. a. Fluid replacement by ORS and iv fluids. b. Doxycycline / Tetracycline 5. Enterotoxigenic E. coli Enteropathogenic E. coli  Viral Hepatitis A 30yr old male presented with fever, nausea, malaise and anorexia of 1 week duration. Later he developed abdominal discomfort and passage of dark-colored urine. He gives history of blood transfusion 4-5 months back. No one else has similar symptoms. Liver function test showed total bilirubin: 4mg (direct 3mg, indirect 1mg), alanine aminotransferase 600U/L, alkaline phosphatase 100 U/L and urine are normal, except positive for bilirubin. Questions 1. What is your diagnosis? 2.What are the important serological markers to confirm the diagnosis? 3. What are the other modes of transmission of the above pathogen? 4. What are the preventive measures that can be followed? 5. What are the complications associated with this? Answers: 1. Viral Hepatitis (HBV & HCV); Transfusion transmitted hepatitis. 2. HbsAg, HBeAg, Anti HBc, Anti Hbe, AntiHBs 3. Unprotected sex, contact with blood and body fluids, transplacental, I.V. drug abuse. 4. a) Screening of blood transfusion. b) Universal safety precautions while handling blood and body fluids. c) Vaccination d) safer sex guidelines. 5. Cirrhosis, hepatocellular carcinoma.  Viral hepatitis – Hepatitis B Virus A 42 year old health care worker had history of finger prick injury while performing an invasive procedure in the dental OPD. He presented with complaints of malaise, anorexia, weakness, myalgia, nausea and vomiting. On examination, he was alert his vital sign were within normal limits. Significant physical findings included right upper quadrant abdominal tenderness on palpations and icterus. The laboratory findings showed elevated levels of serum aspartate aminotransferases. The serological test was done and found to be positive. Questions: 1) What is your diagnosis? And name serological test. 2) Name the serological markers of the diagnosis. 3)Mention the mode of transmission of this? 4) Name three preventive measures. 5) Name the vaccine currently used against this disease. Answers: 1.Viral hepatitis B. Rapid, sensitive and accurate one step immunoassay for the qualitative detection of HBsAg. The other one is ELISA plate for detection of antigen or antibody. 2.HBsAg, Anti-HBc IgM, HBeAg, Anti-Hbe, Anti HBs etc. 3.Blood, body fluids, sexual transmission etc. 4.a) Screening of blood transfusion. b) Universal safety precautions while handling blood & body fluids. c) Vaccination d) Safer sex guidelines. 5. Recombinant Baker yeast vaccine.  Viral Diarrhea – Rotavirus An 8 month old child presented with mild fever, watery diarrhea and moderate dehydration. An electron photomicrograph is provided to you. Questions: 1.Identify the causative agent. 2.Describe the salient morphological features. 3.Name four other etiologies agents of viral gastroenteritis. 4.Enumerate four methods of diagnosis of viral gastroenteritis. Answers: 1. Rota virus. 2. Cart wheel shape, double stranded RNA virus, 65-75 nm in diameter, icosahedral symmetry. 3. Corona virus, Calici virus, Adeno virus, Norwalk virus, Astro virus. 4. Antigen detection by EIA, Immune electron microscopy, latex agglutination tests and PCR.  Hydatid cyst A 30 year old male complains of abdominal pain and swelling. Ultrasound of abdomen showed cyst in liver. Surgical resection is done and the specimen is kept for identification. Questions: 1) Identify the specimen? 2) Name the etiological agent of this disease? 3) How humans get this infection? 4) What are the different sites involved? 5) How do you diagnose? Answers: 1. Hydatid cyst 2. Echinococcus granulosus 3. Ingestion of food or water contaminated by dog feces containing eggs. 4. Liver, lungs, spleen, bone, pelvic organs and brain 5. Radiological findings (USG, CT, MRI), Serological tests and Casoni’s test. RENAL ELECTROLYTE SYSTEM  Urinary Tract Infection by Escherichia coli A 25 year old female presented with dysuria, urgency and frequency of micturition, fever with chills and rigors since two days. Urine sample was sent to microbiology laboratory. Stained smear, culture and biochemical reactions are provided. Questions: 1. What is the clinical diagnosis? 2. How do you collect the sample? 3. Describe the growth. 4. Comment on microscopy. 5. Interpret the biochemical reactions and identify. 6. Name three other bacteria associated with this condition. Answers: 1.Urinary Tract Infection 2.Clean catch midstream urine sample collected in sterile wide mouthed bottle under aseptic precaution. 3.MacConkey agar: Medium, moist lactose fermenting colonies (≥105 CFU/ml) of urine. 4.Gram stain shows Gram negative bacilli 5. TSI – A/A with gas SIM- Motile , Indole –Positive, H2S – Negative Urease – Negative Citrate – Negative The organism is Escherichia coli 6. Klebsiella spp, Proteus spp, Pseudomonas spp.  Urinary Tract Infection by Klebsiella A 25 year old female presented with dysuria, urgency and frequency of micturition, fever with chills and rigor since two days. Urine sample was sent to microbiology laboratory. Stained smear, culture and biochemical reactions are provided. Questions: 1. What is the clinical diagnosis? 2. How do you collect the sample? 3. Describe the growth. 4. Comment on microscopy. 5. Interpret the biochemical reactions and identify. 6. Name three other bacteria associated with this condition. 7. How do you preserve the sample if there is delay in processing? 8. Mention the antibiotics used to treat this condition. Answers: 1.Urinary Tract Infection 2.Clean catch mid-stream urine sample collected in sterile wide mouthed container under aseptic conditions. 3.Medium mucoid lactose fermenting colonies with growth ≥105 CFU/ml 4.Gram stain shows short stout Gram negative bacilli. 5. a. TSI – A/A with gas SIM – non-motile, Indole – Negative, H2S – Negative Urease – Negative Citrate – Positive Organism Klebsiella spp. 6. Escherichia coli, Proteus, Pseudomonas 7. Refrigeration, adding boric acid. 8. Ampicillin, Nitrofurantoin, Norfloxacin, Gentamicin, Cotrimoxazole REPRODUCTIVE SYSTEM  Syphilis A 29 year old male came to the STD clinic with low-grade fever, malaise, anorexia, papular skin rashes and mucous patches in the oropharynx. He gave a past history of sexual exposure and painless ulcer on the genitalia. A serological test was done and provided to you. Questions: 1. Identify the serological test and report. 2. What type of antigen-antibody reaction is this? 3. What is the antigen used? 4. What is your clinical diagnosis? 5. Mention the specific serological tests done for this condition. 6. What are the advantages/merits of this test over VDRL? 7. Mention other bacterial STDs. Answers: 1. Rapid plasma reagin test Report: Reactive 2. Precipitation/Flocculation 3. Cardiolipin (non specific/non treponemal antigen) 4. Syphilis o Treponema Pallidum Haemagglutination (TPHA) o Fluorescent Treponemal Antibody (FTA) o Treponema Pallidum Immobilization (TPI) 5. The merits of RPR are: o No inactivation of serum o Microscopy is not essential o Finger prick blood is sufficient o Useful for field survey 6. Gonorrhea, Soft chancre, LGV  HIV Infection A 28 year old male complained of recurrent cough, chest pain, fever, and severe weight loss. His sputum sample was positive for Mycobacterium tuberculosis and his CD4 count was found to be below 200/µl. The serological test was performed and is provided to you. Questions: 1) Name the serological tests. 2) How do you report the serological test? 3) What is your diagnosis? 4) Name confirmatory test. 5) What are the different modes of transmission of this disease? 6) Name the common oral manifestations that are seen in this disease. 7) List three preventive measures.  Control POSITIVE for HIV- 1 (Reactive for HIV-1) NEGATIVE (Non-Reactive Diagrammatic representation of Rapid Test Internal control HIV 1 HIV 2 gp41 gp36 gp120 Positive Negative Answers: 1. ELISA, Western Blot test and Tridot test. 2. A) ELISA: a) Development of yellow color – Positive test. b) No color – Negative test B) Western blot test: If any two out of (gp 41, gp 120/gp160, p24) observed : Positive If only control band : Negative test C) Tridot test: Only control spot: Negative 3 dots : Reactive for HIV-1 & HIV-2 2 dots : Reactive for HIV-1 or HIV-2 3. HIV Infection 4. Western Blot Test 5. Sexual contact, parenteral, transplacental. 6. Oral candidiasis, Oral hairy leucoplakia 7. In the lab- wearing of aprons, gloves, mask, mouth pipetting to be avoided, use of hypochlorite solution in discarding jars In the hospitals wearing of gloves, gowns, boots, goggles. Barrier method of contraception, sexual abstinence etc.  Bacterial Viral Fungal Parasitic Mycobacterium tuberculosis Cytomegalovirus (CMV) Cryptococcal Sporozoa other than meningitis plasmodium Atypical mycobacteria Herpes simplex virus (HSV) Candidiasis- Salmonella-recurrent infections Epstein-Barr virus esophageal & Strongyloides stercoralis intestinal Varicella-zoster virus(VZV) Malignancies- Kaposi’s sarcoma B- cell lymphoma Non-Hodgkin’s lymphoma  Oral Candidiasis A 32 year old female seropositive for HIV presented with extensive white patches in the oral cavity and difficulty in swallowing. On examination the white patches were easy to remove and on removal they left bleeding erythematous patches. The white patches were swabbed and sent for microbiological examination. Gram stained smear, culture of the white patch and a special test done with the organism is provided. Questions: 1. What is the probable clinical diagnosis? 2. Comment on the Gram stained smear. 3. Identify the culture medium and describe the growth. 4. Identify the special test provided here. 5. Identify the organism. 6. List two other species of this organism. 7. What are the predisposing factors for this infection? Answers: 1. Oral Candidiasis (oral thrush) 2. Gram positive yeast like organism with pseudohyphae 3. Sabouraud dextrose agar with cream colored, pasty colonies 4. Germ tube test to separate the species of Candida 5. Candida albicans 6. Candida tropicalis, Candida kruseii 7. AIDS, Cancer chemotherapy, Broad spectrum antibiotic therapy, Organ transplantation CENTRAL NERVOUS SYSTEM AND SPECIAL SENSES  Meningitis A 5 year old boy was brought to emergency room with high fever, severe headache vomiting, neck rigidity and altered sensorium. Cerebrospinal fluid (CSF) was collected. CSF was turbid and had 1,200cells/cumm with 98% polymorphonuclear neutrophils. A stained smear of CSF and bacteriological culture plates after 48hours of incubation is provided. Questions: 1) What is the probable diagnosis? 2) Identify the bacterium? 3) List two confirmatory tests for this bacterium. 4) List other 2 other bacteria causing similar illness. 5) Name the rapid laboratory test to diagnose this condition Optochin sensitivity Bile solubility Answers: 1.Acute pyogenic meningitis. 2. Streptococcus pneumoniae (Pneumococci) Because:  Gram staining shows plenty of pus cells and Gram positive Lanceolate diplococci.  Blood agar shows Alpha hemolytic Draughtsman’s colonies. 3. Optochin sensitivity and bile solubility 4. a. Haemophilus influenzae b. Neisseria meningitidis 5. Capsular antigen detection by latex agglutination test.  Rabies A 12 year old boy bitten by street dog 1 month ago presented with painful spasms of throat muscles while swallowing. Subsequently he developed convulsive seizure and paralysis, coma and died due to respiratory failure. The pathogens responsible is shown in the picture below. Questions: 1. Identify the organism, stating two morphological properties. 2. What is the source of infection? Mention the important modes of transmission. 3. List 3 methods of diagnosis of human infection. 4. List 4 important methods of prophylaxis. 5.List the different types of vaccines available for prophylaxis. 6. Which lab animal is commonly used in the diagnosis of this infection? 7. What is the classical histopathological feature in CNS observed in this condition. Answers: 1. Rabies virus, bullet shape, ssRNA virus, enveloped. 2. Infected animals. Animal bites and licks on skin and mucous membranes. 3. Immunofluorescence, isolation of virus, demonstration of Negri bodies & detection of specific antibodies in CSF by ELISA. 4. Wound cleaning, active immunization, passive immunization and combined immunization 5. Neural vaccines- Semple vaccine, Beta-propiolactone vaccine. Non neural vaccines- Human diploid cell vaccine, purified Vero cell rabies vaccine, purified chick embryo cell vaccine 6. Suckling mice 7. Intracytoplasmic inclusion bodies ( Negri bodies) in the neurons of hippocampus & cerebellum  Cryptococcal meningitis A 45 year old man who is HIV seropositive has persistent headache, low grade fever for the past 2 weeks. Lumbar puncture was done to obtain the CSF. Culture and smear done is provided. Questions: 1) What is the staining and what is your observation? 2) What is the diagnosis? 3) Identify the media and describe the growth. 4) What is the causative agent? 5) What is the rapid method used for diagnosis. 6) What is the source? 7) Name two other clinical manifestations caused by this organism. 8) Mention the drugs used for treatment. Answers: 1.India ink preparation showing budding yeast with capsule 2.Cryptococcal meningitis 3.SDA slant with cream colored/brownish mucoid colonies. 4.Cryptococcus neoformans 5.Latex agglutination test to detect the capsular polysaccharide antigen in CSF. 6.Pigeon droppings 7.Pneumonia, subcutaneous infections 8.Amphotericin B and flucytosine. SPOTTERS Thiosulphate Citrate Bile salt sucrose agar (TCBS agar) Questions: 1) Identify the medium. 2) What type of medium is it? 3) What is the use of this medium? 4) Name two other solid media used for this purpose. 5) Name the enrichment medium used for this organism. Answers: 1. Thiosulphate Citrate Bile salt sucrose agar. 2. Selective medium 3. Isolation of Vibrio cholerae from stool. 4. Monsur’s gelatin taurocholate trypticase tellurite agar. (GTTA) and alkaline bile salt agar (BSA) 5. Alkaline peptone water. Enzyme-Linked Immunosorbent Assay test plate Questions: 1. Identify the spotter. 2. What is the principle of the test? 3. Mention 2 enzymes used. 4. How do you interpret the test? 5. Write 2 clinical applications? Answers: 1. Enzyme linked Immunosorbent assay (ELISA) test plate. 2. It is an antigen - antibody reaction. The microassay plate wells are coated with either antigen / antibody depending on the detection of antibodies / antigens & treated with sample, enzyme conjugate & substrate. The substrate will spilt the enzyme conjugate if present to form yellow color. 3. The two enzymes used are a) Horse radish peroxidase b) Alkaline phosphatase. 4. Development of yellow color - Positive test No color change - Negative test. 5. The two clinical applications are a) Detection of HIV antibodies. b) Detection of Hepatitis B surface antigens. Embryonated egg Questions: 1.Identify the spotter? 2. What is its application in diagnostic microbiology? 3. Enumerate various routes of inoculation giving example for each. Answers: 1.Chick embryo 2. Cultivation of Rickettsiae and viruses and preparation of viral vaccines. 3.A. Chorio allantoic membrane – variola virus, vaccinia virus, herpes simplex virus. B. Allantoic cavity – Influenza virus, Parainfluenza virus. C. Amniotic cavity – Influenza virus, Parainfluenza virus. D. Yolk sac – Rabies virus, Rickettsiae Giardia lamblia (Trophozoite and Cyst) Questions: 1) Identify the given wet mount of stool. 2) Mention the important identifying features. 3) What are the diseases caused? Answers: 1. Trophozoite and Cyst of Giardia lamblia 2. Trophozoite: Tear-drop shaped bilaterally symmetrical having two nuclei and four pairs of flagella. Size 15x9x4 microns. Mature Cyst: Ovoid in shaped having tough hyaline cyst wall with four nuclei Size 8-14 microns long and 6-10 microns wide. 3. Watery diarrhea, malabsorption etc. Entamoeba histolytica (Quadrinucleate Cyst) Questions: 1) Identify the given wet mount of stool. 2) Mention the important identifying features. 3) What are the diseases caused? Answers: 1. Mature cyst (quadrinucleate cyst) of Entamoeba histolytica. 2. Size is 12-15µm and spherical in shape with highly refractile cyst wall and 4 nuclei. 3. Dysentery, flask shaped ulcer and liver abcess. Ascaris lumbricoides (Adult male and female) Questions: 1) Identify the given parasite. 2) What is the common name? 3) What is the normal habitat? 4) What is the mode of infection to humans? 5) Which is the infective form? 6) Mention three complications cause. Answers: 1. Ascaris lumbricoides 2. Round worm 3. Small intestine 4. Ingestion of food or water contaminated with embryonated egg (egg having rhabditiform larva inside) 5. Embryonated egg 6. Nutritional deficiency, intestinal obstruction, Loeffler’s syndrome etc. Ascaris lumbricoides (Fertilized and unfertilized eggs) Questions: 1) Identify the given microscopic findings in the wet mount of stool. 2) Mention the important identifying and differentiating features. Answers: Fertilized and unfertilized eggs of Ascaris lumbricoides. Both are bile stained. Fertilized Unfertilized Round or oval (60-75X40-50 µm) Longer (90X45 µm) Outer albuminous coat thick Outer coat scanty and irregular Contain large unsegmented ovum or granular Contain a small atrophied ovum with a mass of mass with a clear space at each pole disorganized, highly refractive granules of various sizes. Floats in saturated salt solution Does not float in saturated salt solution The outer mamillated coat may be absent celled decorticated egg in both cases. Ankylostoma duodenale & Necator americanus (adult male and female) Questions: 1) Identify the given parasite. 2) What is the common name? 3) What is the normal habitat? 4) What is the mode of infection to humans? 5) Which is the infective form? 6) Mention the complications of this infections? Answers: 1. Ankylostoma duodenale and Necator americanus 2. Hookworm 3. Small Intestine 4. Skin penetration by 3rd stage (filariform) larva 5. 3rd stage (filariform) larva 6. Ground itch and wound infection, Iron deficiency anemia due to blood loss etc. Differential features of A. duodenale and N. americanus A. duodenale N. americanus Size: Male 8-11X0.45 mm 7-9X 0.3mm Female 10-15X0.6mm 9-11X0.4mm Shape: Head Bent in same direction as body Bent in opposite direction to body Buccal capsule 4 ventral teeth & 2 dorsal 2 ventral and 2 dorsal cutting plates rudimentary teeth Bursa of male 13 rays, dorsal ray tripartite 14 rays, dorsal ray bipartite Caudal spine in female Present Absent Vulval opening Ventrally at a junction of posterior Ventrally at a junction of anterior 1/3rd & 1/3rd & middle 1/3rd of body middle 1/3rd Buccal capsule shape Elongated, pear-shaped Almost spherical 3rd stage larva Longer Shorter Pulmonary reactions& More common Less common Peripheral eosinophilia Ankylostoma duodenale egg Questions: 1) Identify the finding in a given wet mount of stool. 2) Mention the important identifying features. Answers: 1. Egg of hookworm (Ankylostoma duodenale) 2. Oval, (55-65X35-40 µm), colorless (not bile stained) surrounded by a clear membrane. Contains multiple blastomers inside egg. Floats in saturated solution of common salt. Enterobius vermicularis egg Questions: 1) Identify the microscopic finding in the given wet mount of stool. 2) Mention the important identifying features. 3) What are the diseases caused? Answers: 1. Egg of Enterobius vermicularis 2. Colorless (Non bile stained) with a double layered clear shell. Plano convex (flattened on one side and convex on the other side), 55X30µm. Contains a coiled tadpole like larva and floats on saturated solution of common salt. 3. Pruritis ani, appendicitis etc. Trichuris trichiura (male and female) Questions: 1) Identify the given parasite. 2) What is the common name? 3) What is the normal habitat? 4) What is the mode of infection to humans? 5) Which is the infective form? 6) Mention the complications of this infections? Answers: 1. Trichuris trichiura 2. Whipworm 3. Large intestine 4. Ingestion of food of water contaminated by embryonated eggs. 5. Embryonated eggs. 6. Diarrhea, appendicitis, anemia, rectal prolapse etc. Trichuris trichiura egg Questions: 1) Identify the given wet mount of stool. 2) Mention the important identifying features. Answers: 1. Egg of Trichuris trichiura 2. Barrel with projecting mucus plugs on either side, bile stained having double shell, 50-55 x 20-25 µm. Contains a central granular mass as the ovum.Floats in saturated solution of common salt. Scolex and proglottid of Taenia solium and Taenia saginata Questions: 1) Identify the given parasite and its body part. 2) What are the differentiating features? 3) What are their larval forms known as? Answers: Scolex (head) of Taenia solium and Taenia saginata along with their proglottids. T. saginata T. solium Scolex Large, quadrate, 4 suckers, no rostellum Small, globular, 4 suckers with rostellum & hooklets (1-2mm) and hooks (1mm) Proglottids Longer with more number of uterine Shorter with less number of uterine brances branches Laval form Cysticercus bovis Cysticercus cellulosae  Features T. saginata T. solium Length 5-10 meters 2-3 meters Scolex Large, quadrate, 4 suckers, no rostellum & Small, globular, 4 suckers with rostellum and hooklets (1-2mm) hooks (1mm) Neck Long and narrow Short Proglottids 1000-2000 (expelled singly) Below 1000 (expelled in chains) Uterus Lateral branches 15-30 on each side Lateral branches 7-13 on each side Vagina Vaginal sphincter present Absent Ovaries 2 in number, no accessory lobe 2 in number with accessory lobe Testes 300-400 follicles 150-200 follicles Life span (adult) 10 years or more Up to 25 years T. saginata: Long narrow and more than 15 lateral uterine branches (one side). T. solium: Shorter and less than 14 lateral uterine branches (one side) Egg of Taenia solium Questions: 1. Identify the given egg. 2. Mention the identifying features. 3. What is the mode of infection in humans? Answers: 1. Egg of Taenia solium 2. The outer shell or embryophore which is radially striated surrounds the embryo (onchosphere) having 3 pairs of hooklets. 33-43 µm in diameter 3. Ingestion of improperly cooked pork meat having encysted larva (cysticercus cellulosae) Neurocysticercosis Questions: 1. Identify the gross finding in brain autopsy. 2. What is the causative agent? 3. What is the mode of transmission? 4. What are clinical features? Answers: 1. Autopsy finding of brain with cystic lesions 2. Cysticercus cellulosae (larval form of T. solium in brain) 3. Improperty cooked pork meat containing encysted larva (Cysticercus cellulosae) 4. Major cause of adult onset epilepsy, paralysis, paresis, dizziness, headache, nausea, vomiting, diplopia/visual problems, mental disorder, meningoencephalitis. Echinococcus granulosus (Dog tapeworm) Questions: 1) Identify the given parasite. 2) What is the size? 3) What is the mode of infection in humans? 4) What is the disease caused in humans? Answers: 1. Echinococcus granulosus 2. 3-6mm 3. Ingestion of food or water contaminated by dog feces containing eggs. 4. Hydatid cyst disease in liver, lungs, spleen, bone etc. Hydatid cyst Questions: 1. Identify the given per-operative findings. 2. What is the causative agent? 3. Which organ most commonly suffers from this disease? Answers: 1. Hydatid cyst 2. Echinococcus granulosus 3. Liver Scolex and Proglottids of Fish tapeworms Questions: 1) Identify the given parasite. 2) What are the important identifying features. 3) What is the infective stage for humans and where is it present. 4) What are the clinical manifestations due to infection by this parasite Answers: 1. Scolex and proglottids of Diphyllobothrium latum (Fish tapeworm) 2. Scolex (head) is elongated, spoon-shaped and measures 2-3x1mm bearing two slit like longitudinal sucking grooves (bothria), one dorsal and the other ventral. There is no rostellum and no hooklets. Each proglottids is more broader than longer. 3. Plerocercoid larvae present in fish muscles and connective tissues 4. Epigastric pain, nausea, vomiting, intestinal obstruction and Vitamin B12 deficiency anemia. Egg of Diphyllobothrium latum Questions: 1. Identify the given parasite egg. 2. What are important identifying features. Answers: 1. Egg of Diphyllobothrium latum. 2. Pale yellow, oval to elongated, 70X45µm, with a thick, light brown shell (bile stained). Possesses an operculum at one end and often a knob-like thickening at the other. Contains mass of granulated yolk material. Does not float in saturated solution. Fasciola hepatica Questions: 1. Identify the given parasite. 2. What are the important morphological features. 3. Where is the normal habitat inside human body? 4. What are the diseases caused? Answers: 1. Fasciola hepatica (liver fluke) 2. Large leaf-shaped measuring 30X13 mm. brown, pale grey in color with spiny tegument. Two suckers, the oral and the ventral. Intestinal caeca shows a number of lateral compound branches. Hermaphrodite. 3. Hepatobiliary system 4. Liver necrosis, cholangitis, cholecystitis etc Clonorchis sinensis Questions: 1. Identify the given parasite. 2. What are the important morphological features. 3. Where is the normal habitat inside human body? 4. What are the diseases caused? Answers: 1. Clonorchis sinensis 2. 10-20mmX3-4 mm reddish, spatulate, elongated, flat, tapering anteriorly and round posteriorly. Oral sucker is slightly larger than ventral sucker, the latter located at the junction of the anterior and middle-third of the body. Intestinal caeca are simple and extend to the caudal region. Hermaphrodite. 3. Hepatobiliary system 4. Diarrhea, hepatomegaly, cholangitis and cholangiocarcinoma. Schistosoma haematobium Questions: 1. Identify the given parasite. 2. What are the important morphological features. 3. Where is the normal habitat inside human body? 4. What are the diseases caused? Answers: 1. Schistosoma haematobium 2. Body is covered by a fine tuberculated cuticles.Integument of mature male has two long flaps, the gynaecophoral/gynaecophoric canal where the female is held. Male is 10-15X0.75mm and female is 16- 20X0.25mm. 3. Veins surrounding bladder (vesical plexus) 4. Swimmer’s itch, hematuria, proteinuria, hydronephrosis, bladder cancer etc. Infective larva (Cercaria) of Schistosoma haematobium Questions: 1. Identify the given organism. 2. What are important morphological features? 3. How does it infect humans? Answers: 1. Cercaria of Schistosoma (infective form for humans) 2. Forked-tailed cercariae 0.4-0.6 mm (larval form) 3. Skin penetration Questions can be: Identify the given egg. What is the important morphological features. Morphology of schistosome eggs A. S. haematobium egg found in urine sample. Egg is large (~140 µm long), with a terminal spine. B. S. mansoni egg found in feces. Egg is large (~150 µm long), with a thin shell and lateral spine. C. S. japonicum egg found in feces. Egg is smaller than that of S. mansoni (~90 µm long), with a small spine or hooklike structure. D. S. mekongi egg found in feces. Egg is similar to that of S. japonicum but smaller (~65 µm long). E. S. intercalatum egg found in feces. Egg is larger than that of S. haematobium (~190 µm long), with a longer, sharply pointed spine. Gram stain of Neisseria gonorrhoeae Questions: 1) Comment on the smear and identify the organism. 2) Name the culture media used to grow this microorganism. 3) Mention the important biochemical characteristics of this organism. 4) Mention two important complications caused by this microorganism. Answers: 1. Gram stained smear shows kidney shaped Gram negative cocci in pairs with concavity facing each other found both intracellular and extracellular. Identification: Neisseria gonorrhoeae 2. Blood agar, Chocolate agar, Mueller Hinton agar, Selective- Thayer Martin medium. 3. Catalase test positive, Oxidase test positive, ferments glucose. 4. Male- Chronic urethritis leading to stricture urethra Female- Chronic salpingitis and Pelvic inflammatory disease leading to infertility.  Venereal Disease Research Laboratory test slide Questions: 1) Identify the spotter 2) What is the principle of the test? 3) What is the composition of the Antigen? 4) How do you interpret test? 5) Mention two merits & demerits of the test. 6) What is the significant titer? 7) What is its clinical application? Answers: 1. VDRL test slide 2. Slide flocculation test 3. Cardiolipin, Lecithin, cholesterol 4. The reaction is observed under the low power objective lens of microscope. If clumps /floccules are seen – Reactive (test is positive) If uniformly distributed crystals seen – Non reactive 5. Two Merits – rapid diagnostic test, prognostic indication Two Demerits – non specific, biological false positive reaction e.g. Malaria, SLE) 6. Significant titer is 1:8 7. Screening test for Syphilis. Rapid Plasma Reagin test card Questions: 1) Identify the spotter. 2) What is the principle of the test? 3) What is the composition of the Antigen? 4) How do you interpret test? 5) Mention two demerit of the test. 6) What is the significant titer? 7) What is its clinical application? Answers: 1. Rapid Plasma Reagin test card. 2. Slide flocculation test 3. Cardiolipin, Lecithin, cholesterol 4. Reaction is observed grossly and if clumps /floccules are seen – Reactive (test is positive).If uniformly distributed particles seen – Non reactive 5. Two Demerits –Biological false positive reaction and it cannot be done for CSF. 6. Significant titer is 1:8 7. Screening test for Syphilis.