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A3 - Microbiology - Harr > 8.2 Enterobacteriaceae > Flashcards

8.2 Enterobacteriaceae Flashcards

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1
Q

Biochemically, Enterobacteriaceae species are gram-negative rods that:
A. Ferment glucose, reduce nitrate to nitrite, and are oxidase negative
B. Ferment glucose, produce indophenol oxidase, and form gas
C. Ferment lactose and reduce nitrite to nitrogen gas
D. Ferment lactose and produce indophenol oxidase

A

A. Ferment glucose, reduce nitrate to nitrite, and are oxidase negative

The family Enterobacteriaceae consists of more than 100 species and represents the most commonly encountered isolates in clinical specimens. ..

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2
Q

The ortho-nitrophenyl-Beta-galactopyranoside (ONPG) test is most useful when differentiating:
A. Salmonella spp. from Pseudomonas spp.
B. Shigella spp. from some strains of Escherichia coli
C. Klebsiella spp. from Enterobacter spp.
D. Proteus vulgaris from Salmonella spp.

A

B. Shigella spp. from some strains of Escherichia coli

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3
Q

The Voges-Proskauer (VP) test detects which end product of glucose fermentation?
A. Acetoin
B. Nitrite
C. Acetic acid
D. Hydrogen sulfide

A

A. Acetoin

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4
Q

At which pH does the methyl red (MR) test become positive?
A. 7.0
B. 6.5
C. 6.0
D. 4.5

A

D. 4.5

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5
Q

A positive Simmons citrate test is seen as a:
A. Blue color in the medium after 24 hours of incubation at 35C
B. Red color in the medium after 18 hours of incubation at 35C
C. Yellow color in the medium after 24 hours of incubation at 35C
D. Green color in the medium after 18 hours of incubation at 35C

A

A. Blue color in the medium after 24 hours of incubation at 35C

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6
Q

In the test for urease production, ammonia reacts to form which product?
A. Ammonium citrate
B. Ammonium carbonate
C. Ammonium oxalate
D. Ammonium nitrate

A

B. Ammonium carbonate

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7
Q

Which of the following reagents is added to detect the production of indole?
A. p-Dimethylaminobenzaldehyde
B. Bromcresol purple
C. Methyl red
D. Cytochrome oxidase

A

A. p-Dimethylaminobenzaldehyde

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8
Q

Decarboxylation of the amino acids lysine, ornithine, and arginine results in the formation of:
A. Ammonia
B. Urea
C. Carbonate
D. Amines

A

D. Amines

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9
Q

Lysine iron agar (LIA) showing a purple slant and a blackened butt indicates:
A. Escherichia coli
B. Citrobacter spp.
C. Salmonella spp.
D. Proteus spp.

A

C. Salmonella spp.

LIA is used as an aid for the identification of Salmonella species. It contains phenylalanine, lysine, glucose, thiosulfate, ferric ammonium citrate, and bromcresol purple. Salmonella spp. produces H2S from thiosulfate. This reduces ferric ammonium citrate, forming ferrous sulfate and causing the butt to blacken. Salmonella also decarboxylate lysine to produce alkaline amines, giving the slant its purple color and differentiating it from Citrobacter spp., which are lysine decarboxylase negative.

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10
Q

Putrescine is an alkaline amine product of which bacterial enzyme?
A. Arginine decarboxylase
B. Phenylalanine deaminase
C. Ornithine decarboxylase
D. Lysine decarboxylase

A

C. Ornithine decarboxylase

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11
Q

Which genera are positive for phenylalanine deaminase?
A. Enterobacter, Escherichia, and Salmonella
B. Morganella, Providencia, and Proteus
C. Klebsiella and Enterobacter
D. Proteus, Escherichia, and Shigella

A

B. Morganella, Providencia, and Proteus

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12
Q

Kligler iron agar (KIA) differs from triple-sugar iron agar (TSI) in the:
A. Ratio of lactose to glucose
B. Ability to detect H2S production
C. Use of sucrose in the medium
D. Color reaction denoting production of acid

A

C. Use of sucrose in the medium

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13
Q

The malonate test is most useful in differentiating which members of the Enterobacteriaceae family?
A. Shigella
B. Proteus
C. Salmonella subgroup 2, 3 (the former Arizone)
D. Serratia

A

C. Salmonella subgroup 2, 3 (the former Arizone)

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14
Q

Which genera of the Enterobacteriaceae family are known to cause diarrhea and are considered enteric pathogens?
A. Enterobacter, Klebsiella, Providencia, and Proteus
B. Escherichia, Salmonella, Shigella, and Yersinia
C. Pseudomonas, Moraxella, Acinetobacter, and Aeromonas
D. Enterobacter, Citrobacter, and Morganella

A

B. Escherichia, Salmonella, Shigella, and Yersinia

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15
Q

An isolate of E.coli recovered from the stool of a patient with severe bloody diarrhea should be tested for which sugar before sending it to reference laboratory for serotyping?
A. Sorbitol (fermentation)
B. Mannitol (oxidation)
C. Raffinose (fermentation)
D. Sucrose (fermentation)

A

A. Sorbitol (fermentation)

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16
Q

Care must be taken when identifying biochemical isolates of Shigella because serological cross reactions occur with:
A. Escherichia coli
B. Salmonella spp.
C. Pseudomonas spp.
D. Proteus spp.

A

A. Escherichia coli

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17
Q

Which species of Shigella is most commonly associated with diarrheal disease in the United States?
A. Shigella dysenteriae
B. Shigella flexneri
C. Shigella boydii
D. Shigella sonnei

A

D. Shigella sonnei

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18
Q

Which of the following tests best differentiates Shigella species from E. coli?
A. H2S, VP, citrate, and urease
B. Lactose, indole, ONPG, and motility
C. Hydrogen sulfide, MR, citrate, and urease
D. Gas, citrate, and VP

A

B. Lactose, indole, ONPG, and motility

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19
Q

Which genera of Enterobacteriaceae are usually nonmotile at 36C?
A. Shigella, Klebsiella, and Yersinia
B. Escherichia, Edwardsiella, and Enterobacter
C. Proteus, Providencia, and Salmonella
D. Serratia, Morganella, and Hafnia

A

A. Shigella, Klebsiella, and Yersinia

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20
Q

Fever, abdominal cramping, watery stools, and fluid and electrolyte loss preceded by bloody stools 2 to 3 days before is characteristic of shigellosis but may also result from infection with:
A. Campylobacter spp.
B. Salmonella spp.
C. Proteus spp.
D. Yersinia spp.

A

A. Campylobacter spp.

Shigella spp. and Campylobacter spp. are both causes of diarrhea, abdominal pain, fever, and sometimes vomiting. Blood is present in the stools of patients infected with Shigella as a result of invasion and penetration of bowel by the organisms. Young children may also exhibit bloody stools when infected with Camplyobacter.

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21
Q

Cold enrichment of feces (incubation at 4C) in phosphate-buffered saline prior to subculture onto enteric media enhances the recovery of:
A. Enterotoxigenic Escherichia coli
B. Salmonella paratyphi
C. Hafnia alvei
D. Yersinia enterocolitica

A

D. *Yersinia enterocolitica

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22
Q

Which group of tests, along with colonial morphology on primary media, aids most in the rapid identification of Enterobacteriaceae?
A. MR and VP, urease, and blood agar plate
B. Phenylalanine deaminase, urease, and CDC agar plate
C. Bacitracin, Beta-lactamase, and MacConkey agar plate
D. Indole, oxidase, MacConkey, and blood agar plates

A

D. Indole, oxidase, MacConkey, and blood agar plates

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23
Q

**A routine, complete stool culture procedure should include media for the isolation of E. coli O157:H7 as well as: **
A. Salmonella, Shigella, Yersinia, Camplobacter, and Staphylococcus aureus
B. Vibrio cholerae, Brucella, and Yersinia spp.
C. Staphylococcus aureus, group B streptococci, and group D streptococci
D. Clostridium difficile, Clostridium perfringens, and Yersinia spp.

A

A. Salmonella, Shigella, Yersinia, Camplobacter, and Staphylococcus aureus

24
Q

Which group of tests best identifies the Morganella and Proteus genera?
A. Motility, urease, and phenylalanine deaminase
B. Malonate, glucose fermentation, and deoxyribonuclease (DNase)
C. Indole, oxidase, MR, and VP
D. Indole, citrate, and urease

A

A. Motility, urease, and phenylalanine deaminase

Morganella and Proteus spp. are motile, produce urease, and deaminate phenylalanine.

25
Q

Which group of tests best differentiates Enterobacter aerogenes from Edwardsiella tarda?
A. Motility, citrate, and urease
B. H2S production, sucrose fermentation, indole, and VP
C. Lysine decarboxylase, urease, and arginine dihydrolase
D. Motility, H2S production, and DNase

A

B. H2S production, sucrose fermentation, indole, and VP

26
Q

Cronobacter sakazakii (formerly Enterobacter sakazakii) can best be differentiated from Enterobacter cloacae by which of the following characteristics?
A. Yellow pigmentation and negative sorbitol fermentation
B. Pink pigmentation and positive arginine dihydrolase
C. Yellow pigmentation and positive urease
D. H2S production on TSI

A

A. Yellow pigmentation and negative sorbitol fermentation

27
Q

Members of the genus Cedecea are best differentiated from Serratia spp. by which test result?
A. Positive motility
B. Positive urease
C. Positive phenylalanine deaminase
D. Negative DNase

A

D. Negative DNase

28
Q

Which of the following organisms is often confused with the Salmonella species biochemically and on plated media?
A. Escherichia coli
B. Citrobacter freundii
C. Enterobacter cloacae
D. Shigella dysenteriae

A

B. Citrobacter freundii

29
Q

A gram-negative rod is recovered from a catheterized urine sample from a nursing home patient. The lactose-negative isolate tested positive for indole, urease, ornithine decarboxylase, and phenylalanine deaminase and negative for H2S. The most probable identification is:
A. Edwardsiella spp.
B. Morganella spp.
C. Ewingella spp.
D. Shigella spp.

A

B. Morganella spp.

30
Q

Which single test best separates Klebsiella oxytoca from *K. pneumoniae?
A. Urease
B. Sucrose
C. Citrate
D. Indole

A

D. Indole

31
Q

Which of the following organisms, found in normal fecal flora, may be mistaken biochemically for the genus Yersinia?
A. Klebsiella spp.
B. Proteus spp.
C. Escherichia coli
D. Enterobacter spp.

A

B. Proteus spp.

32
Q

Why might it be necessary for both pink (lactose-positive) and colorless (lactose-negative) colonies from an initial stool culture on MacConkey agar to be subcultured and tested further for possible pathogens?
A. Most Shigella strains are lactose positive
B. Most Salmonella strains are maltose negative
C. Most Proteus spp. are lactose negative
D. Pathogenic Escherichia coli can be lactose positive or lactose negative

A

D. Pathogenic Escherichia coli can be lactose positive or lactose negative

33
Q

Which agar that is used for routine stool cultures is the medium of choice for the isolation of Yersinia strains from stool specimens?
A. Salmonella-Shigella agar
B. Hektoen enteric agar
C. MacConkey agar
D. CNA agar

A

C. MacConkey agar

CIN medium is the best agar for the isolation of Yersinia strains because it inhibits growth of other coliforms, but it is not used routinely in clinical laboratories. Yersinia spp. grow well on MacConkey agar incubated at 37C, but the colonies are much smaller than the other Enterobacteriaceae species; therefore, 25. is the temperature recommended for isolation. Some serotypes of Yersinia may be inhibited on more selective media, such as Salmonella-Shigella or Hektoen. CNA agar inhibits the growth of gram-negative bacteria.

34
Q

Which organism is sometimes mistaken for Salmonella and will agglutinate in Salmonella polyvalent antiserum?
A. Citrobacter freundi strains
B. Proteus mirabilis strains
C. Shigella sonnei strains
D. Escherichia coli

A

A. Citrobacter freundi strains

35
Q

**A bloody stool cultured from a 26-year-old woman after 3 days of severe diarrhea showed the following results at 48 hours after being plated on the following media: **

MacConkey agar: Little normal flora with many non-lactose-fermenting colonies
Hektoen enteric agar: Many blue-green colonies
Campylobacter blood agar and C. difficile agar: No growth
Clear colonies (from MacConkey agar): Negative for oxidase, indole, urease, motility, and H2S

The most likely identification is:
A. Shigella spp.
B. Salmonella spp.
C. Proteus spp.
D. Escherichia coli

A

A. Shigella spp.

36
Q

Which one of the following organisms (are) is generally positive for Beta-glycosidase (utilizes lactose)?
A. Salmonella spp.
B. Shigella spp.
C. Proteus spp.
D. Escherichia coli

A

D. Escherichia coli

37
Q

In the Kauffmann-White schema, the combined antigens used for serological identification of the Salmonella spp. are:
A. O antigens
B. H antigens
C. Vi and H antigens
D. O, Vi, and H antigens

A

D. O, Vi, and H antigens

38
Q

The drugs of choice for treatment of infections with Enterobacteriaceae are:
A. Aminoglycosides, sulfamethoxazole-trimethoprim, third-generation cephalosporins
B. Ampicillin and nalidixic acid
C. Streptomycin and isoniazid (isonicotinylhydrazide [INH])
D. Chloramphenicol, ampicillin, and colistin

A

A. Aminoglycosides, sulfamethoxazole-trimethoprim, third-generation cephalosporins

39
Q

The Shiga-like toxin (verotoxin) is produced mainly by which Enterobacteriaceae species?
A. Klebsiella pneumoniae
B. Escherichia coli
C. Salmonella typhimurium
D. Enterobacter cloacae

A

B. Escherichia coli

40
Q

Infections caused by Y.pestis are rare in the United States. Those cases that do occur are most frequently located in which region?
A. New Mexico, Arizona, and California
B. Alaska, Oregon, and Utah
C. North and South Carolina and Virginia
D. Ohio, Michigan, and Indiana

A

A. New Mexico, Arizona, and California

Approximately 15 cases of Y. pestis infection are confirmed in the United States annually. Most originate in the Southwest. It is necessary to be aware of this regional occurrence because untreated cases are associated with a mortality rate of approximately 60%. Y. pestis is not fastidious and grows well on blood agar. It is inactive biochemically, and this helps differentiate it from the other Enterobacteriaceae species. Y.pestis is the only member of the Enterobacteriaceae family that infects humans via an insect vector (animal transmission by a flea bite).

41
Q

** A leg culture from a nursing home patient grew gram-negative rods on MacConkey agar as pink to dark pink oxidase-negative colonies. Given the following results, which is the most likely organism?**
TSI= A/A
Indole = Neg
MR = Neg
VP = +
Citrate = +
H2S = Neg
Urease = +
Motility = Neg

Antibiotic susceptibility: Resistant to carbenicillin and ampicilin
A. Serratia marcescens
B. Proteus vulgaris
C. Enterobacter cloacae
D. Klebsiella pneumoniae

A

D. Klebsiella pneumoniae

K. pneumoniae and E.cloacae display similar IMViC (indole, MR, VP, and citrate) reactions (00++) and TSI results. However, approx 65% of E. cloacae stains are urease positive compared with 98% of those of K. pneumoniae. Enterobacter spp. are motile, and Klebsiella are nonmotile. The antibiotic pattern of resistance to carbenicillin and ampicillin is characteristic of the nonmotile Klebsiella spp.

42
Q

Four blood cultures were taken over a 24-hour period from a 20-year-old woman with severe diarrhea. the cultures grew motile (room temperature), gram-negative rods. A urine specimen obtained via catheterization also showed gram-negative rods (100,000 col/mL). Given the following results, which is the most likely organisms?

TSI = A/A gas
Indole = +
VP = Neg
MR = +
H2S = Neg
Citrate = Neg
Urease = Neg
Lysine decarboxylase = +
(PD) Phenylalanine deaminase = Neg

A. Proteus vulgaris
B. Salmonella typhi
C. Yersinia enterocolitica
D. Escherichia coli

A

D. Escherichia coli

E. coli: (++00) (PD = Neg)
S. typhi: (0+00)
Y. enterocolitica: (V+00)
P. vulgaris: (++00) (PD=+)

43
Q

A stool culture from a 30-year-old man suffering from bloody mucoid diarrhea gave the following results on differential enteric media:
MacConkey agar = clear colonies
XLD agar = clear colonies
Hektoen agar = green colonies
Salmonella-Shigella = small, clear colonies

Which tests are most appropriate for identification of this enteric pathogen?
A. TSI, motility, indole, urease, Shigella typing with polyvalent sera
B. TSI, motility, indole, lysine, Salmonella typing with polyvalent sera
C. TSI, indole, MR, VP, citrate
D. TSI, indole, MR, and urease

A

A. TSI, motility, indole, urease, Shigella typing with polyvalent sera

44
Q

A leg-wound culture from a hospitalized 70-year-old man with diabetes grew motile, lactose-negative colonies on MacConkey agar. Given the following biochemical reactions at 24 hours, what is the most probable organism?

H2S (TSI) = Neg
Indole = Neg
MR = Neg
VP = +
DNase = +
Citrate = +
Urease = Neg
(PD) Phenylalanine deaminase = Neg
Ornithine and lysine decarboxylase = +
Arginine decarboxylase = Neg
Gelatin hydrolysis = +

A. Proteus vulgaris
B. Serratia marcescens
C. Proteus mirabilis
D. Enterobacter cloacae

A

B. Serratia marcescens

45
Q

Three blood culture specimens taken from a 30-year-old patient with cancer receiving chemotherapy and admitted with a urinary tract infection (UTI) grew lactose-negative, motile, gram-negative rods prior to antibiotic therapy. Given the following biochemical reactions, which is the most likely organism?

H2S (TSI) = +
Indole = +
MR = +
VP = Neg
Citrate = Neg
Urease = +
DNase = +
(PD) Phenylalanine deaminase = +
Gelatin hydrolysis = +
Ornithine and lysine decarboxylase = Neg

A. Proteus vulgaris
B. Proteus mirabilis
C. Serratia marcescens
D. Klebsiella pneumoniae

A

A. Proteus vulgaris

Although P. mirabilis is more frequently recovered from patients with UTIs, P. vulgaris is commonly recovered from immunosuppressed patients. P. mirabilis is indole negative and ornithine decarboxylase positive but otherwise is very similar to P. vulgaris.

46
Q

Three consecutive stool cultures from a 25 year-old male patient produced scant normal fecal on MacConkey and Hektoen agars. However, colonies on CIN agar displayed “bull’s eye” colonies after 48 hours of incubation. The patient had been suffering from enterocolitis with fever, diarrhea, and abdominal pain for 2 days. What is the most likely identification of this gram-negative rod?

A. Escherichia coli
B. Proteus mirabilis
C. Yersinia enterocolitica
D. Klebsiella pneumoniae

A

C. Yersinia enterocolitica

Most members of the Enterobacteriaceae family produce detectable growth on MacConkey agar within 24 hours. Y. enterocolita produces non-lactose-fermenting colonies on MacConkey agar, salmon-colored colonies on Hektoen agar, and yellow or colorless colonies on XLD agar. If Y. enterocolitica is suspected, specialized agar (CIN) is employed. The typical “bull’s eye” colonies, dark red with a translucent border, can be confused with “Aeromonas” spp. that appear similarly on CIN agar. To differentiate, an oxidase test must be performed because Yersinia spp. are oxidase negative and Aeromonas spp. are oxidase positive.

47
Q

**A 6-year-old female patient was admitted to the hospital following 2 days of severe diarrhea. Cultures from three consecutive stool samples contained blood and mucus. Patient history revealed that she had eaten a hamburger at a fast-food restaurant 3 days earlier. Which pathogen is most likely responsible for the following results? Growth on: **

XLD agar = Yellow colonies
HE agar = Yellow colonies
Mac agar = Light pink and dark pink colonies
Mac with sorbitol agar = Few dark pink colonies

A. Salmonella spp.
B. Shigella spp.
C. Escherichia coli O157:H7
D. Yersinia enterocolitica

A

C. Escherichia coli O157:H7

48
Q

Following a 2-week camping trip to the southwest United States, a 65-year-old male patient was hospitalized with a high fever and an inflammatory swelling of the axilla and groin lymph nodes. Several blood cultures were obtained, and cultures showed growth of gram-negative rods resembling “closed safety pins.” The organism grew on MacConkey agar showing non-lactose-fermenting colonies. Testing demonstrated a nonmotile rod that was biochemically inert. What is the most likely pathogen identified?
A. Yersinia pestis
B. Klebsiella pneumoniae
C. Proteus vulgaris
D. Morganella morganii

A

A. Yersinia pestis

49
Q

The majority of clinical laboratories with a microbiology department should have the capability of serotyping which pathogenic Enterobacteriaceae species?
A. *Yersinia enterocolitica, Shigella spp.**
B. Escherichia coli O157:H7, Salmonella spp., Shigella spp.
C. Yersinia pestis, Salmonella spp.
D. Edwardsiella spp., Salmonella spp.

A

B. Escherichia coli O157:H7, Salmonella spp., Shigella spp.

50
Q

Direct spread of pneumonic plague disease occurs by which route?
A. Fecal-oral route
B. Rate bite
C. Ingestion of contaminated tissue
D. Inhalation of contaminated airborne droplet

A

D. Inhalation of contaminated airborne droplet

51
Q

Which isolates of the Enterobacteriaceae family most commonly produce extended-spectrum Beta-lactamase (ESBL)?
A. Escherichia coli and Klebsiella pneumoniae
B. Yersinia enterocolitica and Yersinia pestis
C. Morganella morganii and Proteus vulgaris
D. Salmonella typhi and Shigella sonnei

A

A. Escherichia coli and Klebsiella pneumoniae

52
Q

Additional methods of definitive identification for the Enterobacteriaceae family include which of the following:
A. Matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF-MS)
B. Serodiagnosis
C. Nucleic acid-based studies
D. All of the above

A

D. All of the above

53
Q

Which of the following Shigella spp. serotypes is the most often isolated in the United States?
A. Serotype A (Shigella dysenteriae)
B. Serotype B (Shigella flexneri)
C. Serotype C (Shigella boydii)
D. Serotype D (Shigella sonnei)

A

D. Serotype D (Shigella sonnei)

54
Q

Which organism is transmitted by ingesting undercooked ground beef or raw milk resulting in inflammation and bleeding of the mucosa of the large intestine (i.e., hemorrhage colitis) which can also lead to hemolytic uremic syndrome (HUS)?
A. Escherichia coli (STEC) — Shiga toxin
B. Escherichia coli (ETEC) — enterotoxigenic
C. Escherichia coli (EAEC) — enteroaggregative
D. Proteus mirabilis

A

A. Escherichia coli (STEC) — Shiga toxin

55
Q

This organism is transmitted by ingesting contaminated fresh water and/or shell fish, resulting in watery, dysentery-like stools and chronic diarrhea. Culture on stool media and initial testing show the following results:

MacConkey agar = Both lactose - fermenting and non-lactose-fermenting colonies
Sheep blood agar = Nonhemolytic, shiny, opaque, smooth, nonspreading
Oxidase = + DNase = Neg string test = Neg

The most likely preliminary identification is?
A. Proteus vulgaris
B. Escherichia coli
C. Salmonella spp.
D. Plesiomonas shigelloides

A

D. Plesiomonas shigelloides

A3 - Microbiology - Harr (12 decks)

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