Exam 3 - (CH 17) Neisseria Species and Moraxella catarrhalis Textbook Review Questions

Question 1

Neisseria gonorrhoeae and Neisseria meningitidis require ____ for growth.
A. transferrin
B. iron
C. nitrate
D. catalase

Answer 1

B. iron

Question 2

Which is the most common in men with gonorrhea?
A. Asymptomatic infection
B. Dysuria
C. Eschars
D. Epididymitis

Answer 2

B. Dysuria

Question 3

Which of the following conditions is a complication of pelvic inflammatory disease associated with inflammation of the peritoneal coating of the liver?
A. Ectopic pregnancy
B. Sterility
C. Fitz-Hugh–Curtis syndrome
D. Ophthalmia neonatorum

Answer 3

C. Fitz-Hugh–Curtis syndrome

Question 4

A Gram stain with this description suggests nongonococcal urethritis with organisms such as Chlamydia trachomatis or Ureaplasma urealyticum?
A. Greater than five polymorphonuclear neutrophils per field but no bacteria
B. Greater than five squamous epithelial cells covered in gram-negative organisms per field
C. Less than 10 polymorphonuclear neutrophils with intracellular diplococci per field
D. Greater than five leukocytes per field with abundant bacteria

Answer 4

A. Greater than five polymorphonuclear neutrophils per field but no bacteria

Question 5

Which species is most likely given the following results?
1. Catalase positive
2. Acid produced from glucose, maltose, lactose, and sucrose
A. Neisseria lactamica
B. Neisseria flavescens
C. Neisseria meningitidis
D. Neisseria sicca

Answer 5

Neisseria sicca

Question 6

Due to the extensive antibiotic resistance associated with Neisseria gonorrhoeae, this class of antibiotic is currently recommended for treatment.
A. Fluoroquinolones
B. Cephalosporins
C. Glycopeptides
D. Sulfonamides

Answer 6

B. Cephalosporins

Question 7

Which of the following meningococcal serogroups is most common in the United States?
A. W-135
B. A
C. L
D. Y

Answer 7

D. Y

Question 8

On a Gram-stain smear of cerebrospinal fluid (CSF), meningococci typically appear as
A. intracellular and extracellular gram-negative diplococci.
B. extracellular gram-negative rods.
C. intracellular gram-negative cocci in clusters.
D. intracellular and extracellular gram-positive cocci in pairs.

Answer 8

A. intracellular and extracellular gram-negative diplococci.

Question 9

Older colonies of Moraxella catarrhalis may give this appearance.
A. Punctiform
B. Breadcrumb
C. Wagon-wheel
D. Medusa head

Answer 9

C. Wagon-wheel

Question 10

Which of the following is helpful in differentiating Neisseria cinerea from Neisseria gonorrhoeae?
A. Colony pigmentation
B. Glucose utilization
C. DNase
D. Colistin susceptibility

Answer 10

D. Colistin susceptibility

Question 11

Most Neisseria species are:
a. Oxidase-positive, gram-positive diplococci
b. Oxidase-positive, gram-negative diplococci
c. Oxidase-negative, gram-negative diplococci
d. Oxidase-negative, gram-positive diplococci

Answer 11

b. Oxidase-positive, gram-negative diplococci

Question 12

Identify the virulence factor of the pathogenic Neisseria spp. that is responsible for the initial attachment of the organism to host tissues.
a. Pili
b. Endotoxin
c. Cell membrane proteins
d. Peptidoglycan

Answer 12

c. Cell membrane proteins

Question 13

4. What is the optimal specimen to collect for the diagnosis of gonorrhea by culture in male patients?
   a. Pharyngeal swab
   b. Rectal swab
   c. Urethral swab
   d. Urine

Answer 13

c. Urethral swab

Question 14

Direct Gram stain for the diagnosis of gonorrhea:
a. Is appropriate on vaginal specimens
b. Can accurately detect urethritis in males
c. Can accurately diagnosis gonococcal pharyngitis
d. All of the above

Answer 14

b. Can accurately detect urethritis in males

Question 15

Identify a selective medium that allows the isolation of N. gonorrhoeae and N. meningitidis:
a. Sheep blood agar (SBA)
b. Chocolate (CHOC) agar
c. Columbia nalidixic acid
d. Modified Thayer-Martin (MTM)

Answer 15

d. Modified Thayer-Martin (MTM)

Question 16

Identify the test that can be used for definitive identification of both N. gonorrhoeae and N. meningitidis.
a. Gram stain
b. Catalase
c. Oxidase
d. Carbohydrate utilization

Answer 16

d. Carbohydrate utilization

Question 17

The advantage of nucleic acid amplification tests for diagnosing gonorrhea is that the tests:
a. Are approved for use in testing in boys in cases of sexual abuse
b. Detect viable organisms in the specimen
c. Are sensitive and do not require invasive specimens
d. Require strict transport conditions

Answer 17

c. Are sensitive and do not require invasive specimens

Question 18

What are the current recommendations for treatment of genital gonorrhea?

Answer 18

Uncomplicated genital infections with gonorrhea are treated with ceftriaxone. Azithromycin is also recommended as dual therapy.

Question 19

Moraxella catarrhalis is not often associated with:
a. Meningitis
b. Septicemia
c. Endocarditis
d. Lower respiratory tract infections

Answer 19

d. Lower respiratory tract infections

Question 20

Entrance of N. meningitidis into the bloodstream may lead to:
a. Meningococcemia
b. Meningitis
c. Waterhouse-Friderichsen syndrome
d. All of the above

Answer 20

d. All of the above

Question 21

The test that can accurately differentiate N. lactamica from N. meningitidis is:
a. ONPG
b. Catalase
c. Acid from maltose
d. Acid from sucrose

Answer 21

a. ONPG

Question 22

Which organism is an opportunistic pathogen associated with otitis media and sinusitis in children?
a. M. catarrhalis
b. N. lactamica
c. N. meningitidis
d. N. sicca

Answer 22

a. M. catarrhalis

Question 23

Describe the colony morphology of M. catarrhalis, and explain how it is identified in the laboratory.

Answer 23

Moraxella catarrhalis will grow on SBA and CHOC agar, producing smooth, opaque, gray to white colonies. Identification tests will show that M. catarrhalis is oxidase- and catalase-positive. The organism is asaccharolytic, and it may be differentiated from Neisseria spp. by positive DNase or butyrate esterase reactions. Several of the commercial multitest systems for the identification of Neisseria species also identify M. catarrhalis (see Table 17.3).

Question 24

Erythromycin eye drops are placed into the eyes of newborns to prevent infections caused by:
a. N. meningitidis
b. N. gonorrhoeae
c. N. cinerea
d. M. catarrhalis

Answer 24

b. N. gonorrhoeae

Question 25

Points to Remember

Answer 25

■ Most Neisseria spp. are gram-negative diplococci that occur in pairs, with adjacent sides flattened.
■ Species of the genus Neisseria are oxidase-positive, aerobic organisms that grow best in increased CO2 and humidity.
■ N. gonorrhoeae and N. meningitidis are the primary human pathogens of the genus.
■ All other Neisseria species are considered opportunistic pathogens and must be differentiated from N. gonorrhoeae and N. meningitidis.
■ Pathogenic species are fastidious organisms requiring enriched and selective media for optimal recovery. ■ Growth of the primary human pathogens on selective media, such as modified Thayer-Martin (MTM) or New York city agars, is not considered confirmatory. Gram stain of the colony, oxidase, and additional laboratory tests must be performed to confirm identification.
■ M. catarrhalis is a commensal of the upper respiratory tract and is associated with opportunistic infections, including otitis media, sinusitis, and lower respiratory infections.
■ M. catarrhalis is asaccharolytic, and it is differentiated from Neisseria spp. by being tributyrin hydrolysis positive or DNase positive.
■ The incidence of infections caused by commensal Neisseria spp. is very low. They are not usually identified unless found in a specimen from a normally sterile site and are rarely associated with septicemia and endocarditis.