Pathology & Microbiology (No=253)

Which is FALSE regarding exotoxins:

they are heat-resistant
tetanus toxoid is an example
they produce an antibody response
they are proteins

Your answer was CORRECT

Explanation
Exotoxins are proteins released by Gram-positive bacteria and produce specific effects at sites
distant to their release. They are highly toxic, antigenic and are readily destroyed by heat.
 
Sterilisation can be achieved by all of the following EXCEPT:
ethylene oxide
an autoclave with steam to a temperature of 121 degrees C for 120 minutes
Gamma-radiation
a dry fan-assisted oven to a temperature of 160 degrees C for 1 hour

Your answer was CORRECT

Explanation
Dry heat takes much longer than steam and a temperature of 160 degrees in a fan-assisted oven
will take several hours to achieve sterilization.
 
Dysplasia:
is associated with a reduced cell number
involves the transformation of one mature cell type into another
is irreversible
is associated with increased cell staining with haematoxylin

Your answer was CORRECT

Explanation
Dysplasia is associated with increased cell number and nuclear abnormalities such as
hyperchromasia (increased cell staining with haematoxylin) and pleomorphism (altered nuclear
size and nuclear shape). Dysplasia may be caused by diverse cellular insults including physical,
chemical and viral insults. It may be reversible in its early stages. Metaplasia is the transformation
of one mature cell type into another.
 
Which of the following metals can produce a pyogenic response if retained in tissue:
copper
iron
magnesium
zinc
aluminium

Your answer was CORRECT

Explanation
Retained tissue copper produces a pyogenic immune response for reasons that are not understood.
 
Which is the site of pathology in Coats disease:
the arteriolar and venular endothelium
the basement membrane of capillaries
the intima of large vessels
the media of medium and small vessels
the pericytes

Your answer was CORRECT

Explanation
The vascular abnormality in Coats disease is the result of an abnormal endothelium in arterioles
and venules. This causes massive leakage of lipid-rich plasma into the retina and the subretinal
space.
 
All of the following are true about Hepatitis B EXCEPT:
a carrier is identified by the presence of surface antigen in the presence of Ig G against hepatitis B
it has an incubation period of 2 to 6 weeks
it is associated with hepatocellular carcinoma
it is a DNA virus

Your answer was CORRECT

Explanation
Hepatitis B is a DNA virus. It has an incubation period of 2 to 6 months. About 10% of infected
individuals become chronic carriers. Hepatitis B surface antigen (HBsAg) is a protein antigen
produced by the virus. This antigen is the earliest indicator of acute hepatitis B and frequently
found in infected people before symptoms appear. HBsAg disappears from the blood during the
recovery. In some patients, chronic infection occurs and the HBsAg remains positive. Chronic
hepatitis B carrier is associated with a high risk of developing hepatocellular carcinoma.
 
Which statement regarding Cytomegalovirus is FALSE:
it is the most common viral infection in HIV patients
in normal people it usually remains dormant in the nerve ganglia
it is a double-stranded DNA virus
it rarely cause retinitis if the patient has a CD4 counts of more than 200 per cubic mm

Your answer was CORRECT

Explanation
Cytomegalovirus is a double-stranded DNA virus. It rarely causes problems for immunocompetent
patients. In HIV patients, cytomegaloviral retinitis usually indicates decreased CD4+ counts to
less than 50 per mm3. Most cases of cytomegalovirus infection in the immunocompromised are
the result of reactivation. The precise site where these viruses remain latent following initial
infection of the immunocompetent patient is not yet known.
 
Which is FALSE regarding amyloid:
Waldenstrom macroglobulinaemia is a systemic form of amyloidosis
amyoid demonstrates red birefringence in polarized light
amyloid is an insoluble protein
amyloid is deposited in the cornea in lattice dystrophy

Your answer was CORRECT

Explanation
Amyloid demonstrates apple-green birefringence when stained with Congo red and examined with
polarized light.

Exotoxins are liberated from:

Gram positive bacteria
Gram negative bacteria
fungi
mycobacteria

Your answer was CORRECT

Explanation
Exotoxins are proteins released by Gram-positive bacteria and produce specific effects at sites
distant to their release. They are antigenic and are readily destroyed by heat.

Phthisis bulbi is an example of:

senile calcification
metamorphic calcification
metastatic calcification
dystrophic calcification
Your answer was CORRECT
Explanation
Phthisis bulbi is an example of dystrophic calcification where calcium is deposited in diseased or
necrotic tissue. In phthisis bulbi, calcification usually occurs in the metaplastic fibrous tissue
derived from the proliferation of RPE cells in a hypotonic eye.

Which statement is FALSE regarding Acanthamoeba:

swimming with contact lenses is a risk factor for acanthamoeba keratitis

it is the most common cause of corneal ulcer in contact lens wearer

it can be cultured from the nasopharynx of normal people

acanthamoeba keratitis is difficult to treat with conventional antibiotics

Your answer was CORRECT

Explanation
Acanthamoeba corneal infection is rare and usually occurs in contact lens wearers. It is not the
most common infection in contact lenses wearers, however. The most common cause of corneal
ulcer in contact lens wearer is bacterial infection. Swimming with contact lenses is a risk factor for
acanthamoeba. It can be killed by chemical means such as hydrogen peroxide or by boiling
contaminated water for 10 minutes at a temperature of 70-80 degrees centigrade. Acanthamoeba
keratitis is difficult to eradicate

Which is FALSE regarding polyarteritis nodosa:

it leads to ischaemia of tissues including heart, lung and kidney

it affects medium and small sized arteries

it can affect retinal and choroidal vessels

it causes coagulative necrosis of vessel walls

Your answer was INCORRECT

Explanation
Polyarteritis causes fibrinoid necrosis of vessel walls leading to thrombosis and ischaemia.

Sterilization at 121 degrees Celsius at 100 kPa requires:

3 minutes

15 minutes
100 minutes

60 minutes

Your answer was INCORRECT

Explanation
Sterilisation at 120 degrees Celsius requires at least 15 minutes. At 132 degrees Celsius
sterilization can be achieved in 3 minutes.

Which of the following is most appropriate for culturing Neisseria gonorrhea?

Lowerstein-Jensen medium

MacConkey agar

Thioglycate agar

Blood agar

Thayer-Martin medium

Your answer was INCORRECT

Explanation
Thayer-Martin medium is specific to gram negative cocci.

Culture Medium Organisms grown

Thayer-Martin medium Gram negative cocci (e.g. Neisseria)
MacConkey agar Lactose fermenting gram negatives
Most bacteria except Haemophilus, Neisseria and
Blood agar
Moraxella
Like Blood agar but allows Haemophilus, Neisseria and
Chocolate agar
Moraxella
Cooked meat broth Anaerobes and fastiduous organisms
Thioglycate agar Aerobes on the surface and anaerobes inside
Lowenstein-Jensen Mycobacteria tuberculosis
McCoy agar Obligate intracellular bacteria
Non-nutient agar with
Acanthamoeba
E.coli
Sabouraud agar Fungi
What is the most basic difference between Candida and Fusarium is:

Fusarium is a mold, and Candida is dimorphic

Fusarium as a yeast has pseudohyphae, whereas Candida has true hyphae

Fusarium is a mold, and Candida is a yeast

Fusarium is a yeast, and Candida is a mold

Fusarium is dimorphic, and Candida is a mold

Your answer was CORRECT

Explanation
Fungi may be classified into three groups: (i) molds, or filamentous fungi (e.g., Fusarium,
Penicillium); (ii) yeasts (e.g., Candida); and (iii) dimorphs (may exist as either mold or yeast,
depending on environment e.g. Histoplasma and Coccidioides). Filamentous fungi grow as rods
(hyphae), which may or may not have internal divisions (septa).

Regarding wound infections all of the following are TRUE except:

necrotizing fasciitis is caused by streptococcus

MRSA wound infection can occur due to wound contamination by hospital staff

opportunistic infections occur in patients with reduced immune defences

Staphylococcus aureus is a rare cause of surgical wound infections

Your answer was CORRECT

Explanation
Staph aureus is a commensal on the skin and is the most common cause of post-surgical wound
infection. Other options are true.

Which is FALSE regarding Chlamydia trachomatis:

it is an obligate intracellular parasite

it is highly sensitive to erythromycin

immunofluorescence can be used to identify infection

it grows in McCoy culture media

subtypes D to K cause trachoma

Your answer was CORRECT

Explanation
Subtypes A to C cause trachoma (eye to eye contact) while subtypes D to K cause paratrachoma
(sexually transmitted).

Hyalinization of vessel walls is associated with all EXCEPT:

hypertension

ageing

hyperlipidaemia

diabetes

Your answer was INCORRECT

Explanation
Hyalinization of vessel walls occurs when the walls become thickened due to deposition of
collagen. It occurs with ageing, diabetes and hypertension. Hyperlipidaemia predisposes to
atheroma but it is not a cause of hyalinization.

Which statement regarding apoptosis is FALSE:

it is the normal physiological process of programmed cell death

it causes the plasma membrane to undergo zeiosis

it results in products that are removed by phagocytosis

it causes inflammation which may damage surrounding cells

Your answer was CORRECT

Explanation
Apoptosis is a normal physiological process of programmed cell death. Apoptosis does not cause
inflammation (unlike necrosis). The plasma membrane undergoes blebbing called zeiosis. The
products of apoptosis are removed by phagocytosis.

All of the following are useful stains for identifying fungi EXCEPT:
Gram stain
PAS (periodic acid-Schiff)
Gomori methenamine silver
Haematoxylin and eosin (H & E)

Your answer was CORRECT

Explanation
Fungi stain:
 pink with H & E
 purple with PAS
 black with Gomori methenamine silver

Which of the following is FALSE regarding central retinal artery occlusion:

it often leads to rubeotic glaucoma

it is associated with hypertension

it is more commonly due to embolus than thrombosis

it results in a cherry red spot on fundoscopy

Your answer was CORRECT

Explanation
Central retinal artery occlusion leads to total infarction of the inner retinal tissue. This means there
are no vasoactive factors released to drive neovascularisation. As a result rubeotic glaucoma is
rare occurring in fewer than 5% of cases, unlike CRVO where up to 50% are affected with
rubeosis.

Dot hemorrhages are due to rupture of capillaries in which layer:

Bruch's membrane

the outer plexiform layer

the inner plexiform layer

the nerve fibre layer

the internal limiting membrane

Your answer was CORRECT

Explanation
Dot hemorrhages are a result of rupture of capillaries in the outer plexiform layers. They are
smaller and more circumscribed than flame hemorrhages.

Gomori-methenamine silver stain is most useful to identify which organism?

Fungi
Anaerobes
 Mycobacteria
Acanthamoeba
Gram positive cocci

Your answer was CORRECT

Explanation
Gomori-methenamine silver is useful to stain fungi, as is Calcofluor white, Grocott hexamine
silver, and Periodic acid-Schiff.

Some of the popular stains are listed below:

 Grocott hexamine silver stains fungi and acanthamoeba black
 Alcian blue stains mucopolysaccharides classically seen in macular dystrophy of the cornea
 Oil red O stains lipid red (e.g. sebaceous gland carcinoma)
 Prussian blue stains iron, which is usually intracellular
 Ziehl Neilson is used for mycobacteria
 Alizarin red stains calcium red
 Von Kossa stains calcium
 Masson Trichrome stains new collagen blue (Reis-Buckler) and hyaline material red (granular
dystrophy)
 Congo red stains amyloid

Which is FALSE regarding Borrelia burgdoferi:

it can cause Lyme disease

infection cannot be detected by ELISA

it is best visualized by dark-ground microscopy

it is a spirochaete

Your answer was CORRECT

Explanation
Borrelia is a spirochaete and in common with this family it is helical in structure, flagellate and is
best visualized by dark-ground microscopy. It causes Lyme disease with transmission via ticks. It
can be detected by ELISA to measure specific IgM and IgG antibodies.

All of the following are Gram negative rods EXCEPT:

Haemophilus

E. coli

Pseudomonas

Neisseria
Brucella

Your answer was CORRECT

Explanation
Neisseria are Gram negative cocci. All other options are Gram negative rods.

All are true of mycobacteria EXCEPT:

they are aerobic

they are usually Gram negative

they are acid fast

they are best cultured on Lowenstein-Jensen medium

Your answer was CORRECT

Explanation
Mycobacteria cannot be stained with Gram stain and require special staining techniques such as
the Ziehl-Neelsen stain.

Which is FALSE regarding retinal vascularization:

it occurs under the control of factors including VEGF

blood vessels form from the arterial side of the capillary bed
it can occur both within and on the surface of the retina

the new vessels always leak on fluorescein angiography

Your answer was CORRECT

Explanation
New vessels arise from the venous side of the capillary bed. Other options are true.

Staphylococcus epidermidis is a:

Gram positive cocci, coagulase negative

Gram positive cocci, beta-haemolytic

Gram positive cocci, coagulase positive

 Gram positive cocci, alpha-haemolytic

Your answer was INCORRECT

Explanation
Staph epidermidis is a coagulase negative, Gram positive cocci. It is the most common cause of
post-operative endophthalmitis. Staph aureus is a coagulase positive, Gram positive cocci.

 
Antibodies perform all of the following functions EXCEPT:
opsonisation
facilitate differentiation of B cells
neutralization of toxins
trigger the complement cascade

Your answer was INCORRECT

Explanation
Antibody binding:
 facilitates phagocytosis (a process termed opsonisation)
 neutralizes bacterial toxins
 triggers the complement cascade

Antibody binding plays no role in the differentiation of B cells.

 
What is the preferred method for determining the presence of intra-cytoplasmic inclusion bodies?
Giemsa stain

thioglycolate broth

Sabouraud's agar

Ziehl-Neelsen stain

blood agar with Staphylococcus aureus cultures

Your answer was INCORRECT

Explanation
Giemsa stain is useful for determining intra-cytoplasmic inclusions, such as occurs with
chlamydial disease. Giemsa also stains fungi.

 
All are true of herpes simplex virus type 1 EXCEPT:
latent virus resides in the trigeminal ganglion

corneal stromal disease is caused by immune hypersensitiviy not replicating virus

can be auto-inoculated at the site of trauma and present as blisters

single-stranded DNA virus

Your answer was CORRECT

Explanation
HSV is a double-stranded DNA virus. Other options above are true.

 
Which is FALSE regarding the acute inflammatory response:

it is non-adaptive

there is a cellular phase followed by a vascular phase

it is non-specific

vascular permeability increases

Your answer was CORRECT

Explanation
In the acute inflammatory response, there is a vascular phase (with release of histamine, kinins
and prostaglandins causing increased vascular permeability) followed by a cellular phase with
recruitment of macrophages and neutrophils. Unlike an immune response, the acute response is
non-specific, non-adaptive and does not exhibit memory.

 
Which is FALSE regarding bacterial virulence factors:

collagenase allows bacterial spread by disrupting connective tissue

coagulase facilitates deposition of a protective fibrin coat on the bacteria

streprokinase initiates clot formation by its effect on plasmin

hyalurondiase dissolves extracellular matrix hyaluronate

Your answer was CORRECT

Explanation
Streptokinase activates fibrinolysin, causing release of plasmin and resulting in dissolution of
clots, allowing bacteria to spread through tissues.
 
Options for microbial sterilization include all of the following EXCEPT:

gamma irradiation

ethylene oxide

high temperature steam of 134 degrees Celsius for 3 minutes

160 degree Celsius dry heat for 30 minutes

Your answer was CORRECT

Explanation
Dry heat sterilization requires a temperature of 160 degrees Celsius for a duration of at least 120
minutes. Steam sterilization can be achieved at 120 degrees Celsius in 15 minutes or at 134
degrees Celsius in 3 minutes.

 
Which statement regarding HIV is FALSE:

its core protein p24 can be used to monitor progression of AIDS

it is a single-stranded DNA virus

it gains entry into cells with CD4 cell-surface receptor molecules

it can be passed from mother to foetus

Your answer was CORRECT

Explanation
HIV is a single-stranded RNA virus. Other options are true.

 
Gram negative rods include all EXCEPT:

Haemophilus influenza

Proteus vulgaris

Pseudomonas aeruginosa

Streptococcus pneumoniae

Your answer was CORRECT

Explanation
 Streptococcus is a Gram positive cocci, not a Gram negative rod. All other options are Gram
negatives which can cause ocular disease.

 
Which of the following is NOT an example of apoptosis?
the formation of synapses in the brain
the sloughing off of the endometrium during menstruation
the killing of virus infected cells by cytotoxic T-cells
coagulative necrosis of myocytes following myocardial infarction
the formation of fingers and toes during embryogenesis

Your answer was CORRECT

Explanation
Apoptosis is programmed cell death and does not trigger inflammation. It can be induced by:
 Signals arising within the cell
 Death activators binding to the cell surface
 Reactive oxygen species
 
Which is TRUE about Staphylococcus epidermidis:

they appear as Gram positive cocci in chains

they are destroyed by povidone iodine

they are coagulase positive

the majority are sensitive to penicillin

Your answer was CORRECT

Explanation
Staphylococcus epidermidis are coagulase negative Gram +ve cocci which occur in bunches. They
are resistant to penicillin. Although they are skin commensals, they can give rise to infection.
They are destroyed by povidone iodine.

 
Which of the following is a Gram-positive cocci:

Moraxella sp.

Streptococcus sp.

Meningococcus sp.

E. coli sp.

Haemophilus sp.
Your answer was CORRECT
Explanation
Streptococcus species are Gram positive cocci. Other options supplied are all Gram negative
species

 
Which statement is FALSE regarding Streptococcus pneumoniae:

it is a Gram positive cocci

it is capable of alpha-haemolysis

it is susceptible to phagocytosis
it is aerobic and non-motile

Your answer was CORRECT

Explanation
Strep pneumoniae produces a capsular polysaccharide which makes it resistant to phagocytosis.
Other options are true.

 
Which of the following is an appropriate histopathological stain for calcium:

von Kossa

Congo red

Masson trichrome

Prussian blue

Your answer was CORRECT

Explanation
Von Kossa stains calcium black. Alizurin red can also be used, and stains calcium red.

 
Brushfield spots are associated with:
Neurofibromatosis Type 1
Down's syndrome
Sturge-Weber syndrome
Neurofibromatosis Type 2

Your answer was CORRECT

 Explanation
Brushfield spots are small nodules on the iris and occur in Down's syndrome. The ocular features
of Down's syndrome include:
 keratoconus
 cataract
 myopia
 Brushfield spots
 epicanthal folds
 
All of the following substances are used in Gram staining EXCEPT:
Crystal violet
alcohol
Congo red
safranin
iodine

Your answer was CORRECT

Explanation
Congo red is not used in Gram staining. The Gram staining process is as follows:
 Crystal violet (which is purple in colour) is applied and this attaches to negatively charged
groups in the cell wall, membrane and cytoplasm.
 The further addition of iodine strengthens this attachment.
 The addition of alcohol or acetone-alcohol decolorizes the crystal violet and iodine causing the
stain to diffuse out of the cell. This diffusion is lower in Gram-positive cell walls because of
the greater thickness and chemical composition (particularly teichoic acids).
 Safranin or neutral red is then used as a counter-stain. This binds to free negatively charged
groups that are not already binding to crystal violet.

Human T cell lymphotrophic viruses (HTLV) are implicated in all of the following EXCEPT:

nasopharyngeal carcinoma
mycosis fungoides

T cell lymphomas

Sezary syndrome

Your answer was CORRECT

Explanation
HTLV is implicated in T cell lymphomas including mycosis fungoides and Sezary syndrome. It is
endemic in Japan, Africa and the Caribbean. EBV is associated with nasopharyngeal carcinoma.
Which is FALSE regarding blot hemorrhages:

they are larger than dot hemorrhages but formed from the same process

they arise from microaneurysms

they can be viewed with the red-free filter on ophthalmoscopy

they occur in the inner plexiform layer

Your answer was CORRECT

Explanation
Dot and blot haemorrhages are typical of diabetic retinopathy and are easily visible on
ophthalmoscopy. Often the red-free filter is useful for identifying retinal haemorrhages. Dot and
blot haemorrhages arise when microaneurysms (which are outpouchings of capillary walls in the
superficial retinal layers due to pericyte loss) rupture in the deeper layers of the retina, such as the
inner nuclear and outer plexiform layers. Blot hemorrhages are bigger than dot hemorrhages but
they arise from the same process.

Stevens-Johnson syndrome is an example of which type of hypersensitivity reaction?

I
II
III
IV

Your answer was CORRECT

Explanation
 Table: Hypersensitivity reactions (click to enlarge)

Stevens-Johnson syndrome is an example of a Type IV hypersensitivity reaction sub-type C.

The most common precipitants of SJS are:

 drugs: sulphonamides, penicillin, phenytoin
 viruses: HSV, HIV
 malignancy

Which is FALSE regarding endotoxins:

they are produced by Gram negative bacteria
they are proteins
they are heat stable
they cause fever

Your answer was CORRECT

Explanation
Endotoxins are lipopolysaccharides derived from the cell wall of lysed or dead Gram-negative
bacteria. They are heat stable and non-antigenic. They produce:
 fever
 septic shock
 induction of complement
Epstein-Barr virus is implicated in all of the following EXCEPT:
nasopharyngeal carcinoma
infectious mononucleosis
Burkitt's lymphoma
non-Hodgkin's lymphoma

Your answer was CORRECT

Explanation
EBV is implicated in:
 Burkitt's lymphoma
 nasopharyngeal carcinoma
 infectious mononucleosis

The scarring of disciform macular degeneration is the result of:

hyperplasia of RPE

dysplasia of RPE

hyalinization of RPE

fibrous metaplasia of RPE

Your answer was CORRECT

Explanation
Following choroidal neovascularization with haemorhage and leakage into the retina there is
fibrous metaplasia of RPE cells with deposition of collagen causing the disc-shaped mass known
as a disciform scar.

All are true of Human Papilloma virus EXCEPT:

it is an RNA virus

serotypes HPV-16 and HPV-18 are implicated in cervical carcinoma

it induces epithelial proliferation

it can cause conjunctival papillomas

Your answer was CORRECT

Explanation
HPV is a DNA virus. Other options are true.
Which nutrient medium is NOT correctly matched with the organisms it encourages to grow:

Lowenstein-Jensen: tuberculosis

Sabouraud's agar: fungus

Theyer-Martin: gonococcus

non-nutrient e.coli-enriched agar: pseudomonas

Your answer was CORRECT

Explanation
Non-nutrient e.coli-enriched agar is used to cultivate acanthoemeba. Other options are correctly
matched.

All of the following statements regarding the culture mediums in microbiology are true EXCEPT:

McConkey agar is best for Gram negative bacteria

Chocolate agar is best for the growth of Haemophilus and Neisseria organisms

Nutrient poor agar with E.coli overlay is useful for acanthamoeba

Blood agar is best for anaerobic microbes

Lowenstein-Jensen medium is best for mycobacteria

Your answer was CORRECT

Explanation
Blood agar is best for aerobic microbes. Chocolate agar is a nutrient medium used in culturing
fastidious organisms such as Haemophilus species and Neisseria. It comprises sheep blood that
provides factors X (hemin) and V (nicotinamide adenine dinucleotide) necessary for Haemophilus
growth. McConkey agar is used in identification of lactose fermenting, Gram-negative enteric
pathogens and for inhibiting growth of Gram-positive organisms. Nutrient poor agar with E. coli
overlay provides nutrient for the growth of acanthamoeba. Lowenstein-Jensen medium is used
primarily for mycobacteria culture.

All are true of Neisseria gonorrhoeae EXCEPT:

its growth is optimal on blood agar

it is sensitive to penicillin

it can cause Ophthalmia neonatorum

it is a Gram-negative diplococcus
Your answer was CORRECT
Explanation
Growth of Neisseria is optimal on enriched chocolate media such as Thayer-Martin.

Fungi are stained with all of the following EXCEPT:

Periodic acid-Schiff
Giemsa
Grocott hexamine silver
Gomori methanamine silver

Your answer was CORRECT

Explanation
Giemsa stain is for Chlamydia.

Fungi are stained with:

 Grocott hexamine silver
 Gomori methanamine silver
 Periodic acid-Schiff
 Calcoflour white

All are true of adenovirus EXCEPT:

it is a common cause of upper respiratory tract symptoms

serotypes 3,7,8 and 19 are responsible for pharnygoconjunctival fever

it contains double-stranded DNA

it contains an icosahedral capsid

it can be spread by droplet infection

Your answer was CORRECT

Explanation
Adenovirus has two ocular disease presentations: pharyngoconjunctival fever (in which upper
respiratory tract symptoms precede ocular features) and keratoconjunctivitis (in which ocular
involvement predominates). Serotypes 3, 7, 8 and 19 are responsible for epidemic
keratoconjunctivitis while serotypes 1, 2, 3, 5, 7 and 14 cause pharyngoconjunctival fever.

Which is true of endotoxin:

it is involved in botulism

it elicits an antibody response which may protect the host from future attack

it cannot survive autoclaving

it is derived from the cell wall of Gram negative bacteria

Your answer was CORRECT

Explanation
Endotoxins are lipopolysaccharides derived from the cell wall of gram negative bacteria. They are
heat stable, non-antigenic, cause septicaemia and fever and activate the alternative complement
pathway.

All are true of E.coli EXCEPT:

it grows well on MacConkey agar

it ferments glucose

it is a facultative anaerobe

it is a Gram negative rod

it is non-motile

Your answer was CORRECT

Explanation
E. coli is motile with polar flagella. Other options are true.

All of the following are examples of metastatic calcification EXCEPT:

hyperparathyroidism

hypervitaminosis

atheroma

skeletal metastasis

Your answer was CORRECT

Explanation
Metastatic calcification occurs where there is deposition of calcium in normal tissue due to
hypercalcaemic states. Atheroma, where calcium is deposited as a consequence of hyalinised and
necrotic tissue, is an example of dystrophic calcification.
Which of the following is a Gram positive bacterium?

Neisseria meningitides

Pseudomonas aeroginosa

Haemophilus influenza

Propionibacterium acnes

Your answer was CORRECT

Explanation
Propionibacterium acnes is a Gram positive bacillus. It is known to cause chronic endophthalmitis
many months or even years after cataract surgery by inhabiting the lens capsule.

The features below are strongly suggestive of malignancy EXCEPT:

increased nuclear to cytoplasmic ratio

poor differentiation

increased heterogeneity of cells

displacing surrounding tissue

Your answer was CORRECT

Explanation
Displacement of surrounding tissues can occur in many benign growths.

Which of the following occurs locally in acute inflammation:

early, transient vasodilation of the small blood vessels followed by vasoconstriction

histamine concentration is increased

monocytes are the first cells seen in the extracellular space

reduced vascular permeability

Your answer was CORRECT

Explanation
In acute inflammation, there is early, transient vasoconstriction, which is followed by
vasodilatation; there is relative stasis of blood and retraction of the endothelial cells making the
blood vessels more permeable. Neutrophils are the first cells seen in the extracellular space.
Histamine is an important mediator that causes vasodilatation and increased vascular permeability.

All are true of Acanthoemeba EXCEPT:

acanthoemeba keratitis is resistant to conventional antibiotic drops

it is a common cause of corneal ulcer in contact lens wearers

it is best grown on non-nutrient E.coli infused agar

it is a commensal and may be recovered from nasal and pharyngeal swabs

Your answer was CORRECT

Explanation
Acanthoemeba is an uncommon cause of contact lens related corneal ulceration, which is usually
caused by pseudomonas. However, it is more likely in contact lens wearers. It is grown on non-
nutrient e.coli agar and is difficult to culture. It responds poorly to conventional first-line
antibiotic drops.

A 56-year-old man is diagnosed with Horner's syndrome following carotid surgery. Which of the
following is NOT a symptom of Horner's syndrome:

pupillary constriction

lack of lacrimation

ptosis

apparent enophthalmos

absence of sweating on the face and neck

Your answer was CORRECT

Explanation
Symptoms of Horner syndrome include miosis, ptosis, anhydrosis and enophthalmos. It is due to
an interruption in the sympathetic nerve supply to the eye. Causes include carotid pathology
(tumors, aneurysm and dissection), neck injuries, a syrinx and lung lesions, especially apical
squamous cell carcinoma. Note: lacrimation is not a sympathetic-mediated action.

Which is TRUE of sterilisation:

it can be achieved by boiling surgical instruments in water for 10 minutes

moist heat takes longer than dry heat to sterilize instruments

it involves the removal of all microorganisms except spores

ethylene oxide gas is used to sterilise instruments which are heat sensitive

it can be achieved by wiping surgical instruments with alcohol swab

Your answer was CORRECT

Explanation
Sterilisation is the removal of all microorganisms including spores. Disinfection is the removal of
most but not all microorganisms. Sterilisation can be achieved with moist heat in autoclave which
takes shorter period than dry heat. Ethylene oxide gas is useful for heat sensitive instruments.
Irradiation and chemical germicides are other techniques of sterilisation.

Which statement about Clostridium tetani is FALSE:

it produces an exotoxin

it is motile

it causes gas gangrene

it is an obligatory anaerobe

Your answer was CORRECT

Explanation
Clostridium is a genus of Gram positive obligate anaerobes capable of producing endospores.
Gangrene is caused by Clostridium perfringins while tetanus is produced by the tetanus toxoid of
Clostridium tetani.

Which of the following materials is LEAST likely to cause a granulomatous tissue reaction:

wood

silicone

vegetable matter

cotton suture

sebum

Your answer was CORRECT

Explanation
Silicone is relatively inert immunologically hence its use as implant material e.g. intraocular
lenses and glaucoma drainage tubes.
Neisseria gonorrhoea is a:

Gram negative bacillus

Gram negative diplococcus

Gram positive coccobacilli

Gram positive bacillus

Gram positive cocci

Your answer was CORRECT

Explanation
Neisseria are Gram negative diplococci.

Which is FALSE regarding Staphylococcus aureus:

it is the main commensal of the outer eye

it can produce exotoxins

it is a Gram positive bacteria

it is anerobic and non-motile

it grows well on blood agar

Your answer was CORRECT

Explanation
Staphylococcus is aerobic. Other options supplied are true.

Which is FALSE regarding Haemophilus influenzae:

it is best grown on chocolate agar

it is always encapsulated
it is a common cause of sinusitis

it is a Gram negative coccobacilli

Your answer was CORRECT

Explanation
 Haemophilus is not always encapsulated with a polysaccharide coat but when it is the virulence is
enhanced as it can avoid phagocytosis.

Regarding oedema all are true EXCEPT:

increased venous capillary hydrostatic pressure increases oedema

in oedema secondary to cardiac failure, the permeability of the vessel walls is unchanged

it is caused by increased escape of fluid from capillaries and venules

the tissue pressure is important in controlling the amount of oedema

transudate contains more protein than exudates

Your answer was CORRECT

Explanation
A transudate contains less protein than an exudate. All other options are true.

A patient with fetal alcohol syndrome is MOST likely to have:

microphthalmos
optic nerve hypoplasia
cataract
coloboma

Your answer was CORRECT

Explanation
Fetal alcohol syndrome is characterized by optic nerve hypoplasia in up to 50% of cases. Other
common features are retinal vessel tortuosity and adnexal changes such as short horizontal
palpebral fissures, epicanthus, ptosis and telecanthus. Cataract has been reported in a few cases.

This question came in the 2014 FRCOphth.

Ocular features of fetal alcohol syndrome:

 shortened horizontal palpebral fissures
 epicanthal folds
 strabismus
 blepharophimosis
 long eyelashes
 microphthalmia
 telecanthus
 Peter's anomaly
 anterior segment dysgenesis
 tortuous retinal vessels
 optic nerve hypoplasia
 persistent hyaloid vessel
 cataract

Which of the following Gram positive organisms occur as cocci in clusters and produce coagulase:

Staphylococcus epidermis

Streptococcus faecalis

Streptococcus pneumoniae

Staphylococcus aureus

Streptococcus veridans

Your answer was CORRECT

Explanation
Staph aureus occur in clusters and produce coagulase; while Staph epidermis occur in clusters and
are coagulase negative. Streptococci often occur as chains or as pairs (Strep pneumoniae).

Psammoma bodies are seen histologically in:

choroidal melanoma

optic nerve glioma

retinoblastoma

optic nerve meningioma

Your answer was CORRECT

Explanation
Psammoma bodies are seen histologically in mengiomas.

Which is TRUE of acanthamoeba?

easy to grow on nutrient agar

trophozoites are inactive cysts

difficult to see with microscope

grow easily in garden soil

Your answer was CORRECT

Explanation
Acanthamoeba are free-living protozoa found in soil, dust, air and water. They are difficult to
culture and require E. coli-inoculated, non-nutrient agar. The trophozoite is the active stage while
the cyst is the inactive form.

This question appeared in the 2014 FRCOphth Part 2.

All are true of Hepatitis C except:

intravenous drug users are more at risk

it is a single stranded RNA virus

it is less likely to lead to liver cirrhosis than Hepatitis B

it is implicated in malignant tranformation

Your answer was CORRECT

Explanation
Hepatitis C is more likely to lead to carrier status and chronic hepatitis (up to 60% of infections)
that Hep B.

MRSA (methicillin-resistant Staphylococcus aureus):

is resistant to iodine solution

is sensitive to vancomycin

is more likely to cause deeper tissue invasion than ordinary Staphylococcus aureus strains

is not usually present in healthy immunocompetent adults

Your answer was CORRECT

Explanation
MRSA is no more invasive than other strains of Staph aureus. MRSA is a commensal that may
colonize the nose, axilla and groins. It is an important nosocomial pathogen that may be
transmitted between patients via the hands of health workers. It is killed by exposure to iodine
and Vancomycin is an effective antibiotic therapy.

Which of the following is most appropriate for culturing Chlamydia trachomis?

Thioglycate agar

McCoy agar
Thayer-Martin medium

Lowerstein-Jensen medium

MacConkey agar

Your answer was CORRECT

Explanation
Culture Medium Organisms grown
Thayer-Martin medium Gram negative cocci (e.g. Neisseria)
MacConkey agar Lactose fermenting gram negatives
Most bacteria except Haemophilus, Neisseria and
Blood agar
Moraxella
Like Blood agar but allows Haemophilus, Neisseria and
Chocolate agar
Moraxella
Cooked meat broth Anaerobes and fastiduous organisms
Thioglycate agar Aerobes on the surface and anaerobes inside
Lowenstein-Jensen Mycobacteria tuberculosis
McCoy agar Obligate intracellular bacteria (e.g. Chlamydia)
Non-nutient agar with
Acanthamoeba
E.coli
Sabouraud agar Fungi

All of the following are examples of non-granulomatous inflammatory reactions EXCEPT:

Bechet's disease

multiple sclerosis

syphilis
thyroid eye disease

Your answer was CORRECT

Explanation
Syphilis is characterized by a granulomatous inflammatory process.

A benign, focal lesion composed of tissue elements normally found at that site but which are
growing in a disorganized mass is known as a:
hamartoma
phakomatosis

choristoma

dermoid

Your answer was CORRECT

Explanation
A hamartoma is comprised of tissue elements normally found at that site; while a choristoma is
comprised of normal tissue in an abnormal location (e.g. a dermoid).

Regarding the herpes zoster virus:

it is a RNA virus

it remains in the nerve ganglia for life in patients with previous infection

shingles results from primary infection of herpes zoster virus

it can be inactivated by the administration of intravenous gentamycin

Your answer was CORRECT

Explanation
Herpes zoster virus is a DNA virus. It can be inactivated by acyclovir. Following the initial
infection (chickenpox) it stays in the nerve ganglia for life and can become reactivated in time of
weakened immune system. The reactivation usually takes the form of shingles.

Which of the following is a basic dye that stains acidic substances purple?
Haematoxylin
Prussian Blue
Alcian Blue
Eosin
Masson Trichrome

Your answer was CORRECT

Explanation
Haematoxylin is a basic dye that stains acidic substances purple. Eosin is the other half of the
H&E stain, and it is an acidic dye that stains basic substances pink.

Some of the popular stains are listed below:

 Grocott hexamine silver stains fungi and acanthamoeba black.
 Alcian blue stains mucopolysaccharides classically seen in macular dystrophy of the cornea
 Oil red O stains lipid red (e.g. sebaceous gland carcinoma)
 Prussian blue stains iron, which is usually intracellular
 Ziehl Neilson is used for mycobacteria
 Alizarin red stains calcium red
 Von Kossa stains calcium
 Masson Trichrome stains new collagen blue (Reis-Buckler) and hyaline material red (granular
dystrophy)
 Congo red stains amyloid

Which of the following is TRUE about exotoxins:

it is produced only by Gram positive bacteria

it is resistant to inactivation by heat

it is produced by Clostridium botulinum

it can be detected using the Limulus test

Your answer was CORRECT

Explanation
Exotoxins are produced predominantly by Gram positive bacteria, though some Gram negative
bacteria produce exotoxins such as E.coli (a gram negative rod that produces both a heat labile and
heat stable toxin) and Shigella (a Gram negative rod that produces shiga exotoxin). Exotoxin is
made up of protein and is inactivated by heat. When injected into the body it causes the formation
of antibodies. Botulinum toxin is an exotoxin produced by Clostridium botulinum. Limulus Tests
is a sensitive method for detection of bacterial endotoxins.

Actinomyces is most likely to cause:

conjunctivitis

trabeculitis

keratitis

acute retinal necrosis

canaliculits

Your answer was CORRECT

Explanation
Actinomyces is a Gram-positive filament which is a common cause of canaliculitis and
dacrocystitis.
Diabetic retinopathy is characterized histologically by all EXCEPT:

hyalinization of vessels

degeneration of capillary endothelial cells

thinning of the capillary basement membrane

cotton wool spots due to nerve fibre ischemia

loss of pericytes

Your answer was CORRECT

Explanation
In diabetes there is thickening and multilayering of the basement membrane of small vessels.
Other statements are true.

Which of the following cells is typically found in a granuloma:

Neutrophils

Epithelioid cells

B lymphocytes
Langerhan's cells

Your answer was CORRECT

Explanation
A typical granuloma contains multinucleated giant cells (called Langhan's cells) surrounded by
epithelioid cells, which are activated macrophages. Langhan's cells must not be confused with
Langerhan's cells, which are dendritic cells in the epidermis.

Which is FALSE of Candida?

it stains with Periodic Acid Schiff and Grocott's methenamine silver stain

it is Gram positive and stains with Calcofluor-white

in agar it grows in characteristic yellow-green colonies

it grows better on Sabouraud dextrose agar than blood agar

Your answer was CORRECT

Explanation
 In agar, macroscopic colonies of Candida appear white. Other options supplied are true.

This question appeared in the 2014 FRCOphth Part 2.

Which of the following stains organisms that grow on Lowenstein-Jensen media?

Alizarin red
Grocott hexamine silver stain
Haematoxylin
Ziehl Nielson
Masson Trichrome

Your answer was CORRECT

Explanation
Ziehl Nielson stains mycobacteria, which grow on specialized media such as Lowenstein-Jensen
media.

Some of the popular stains are listed below:

 Grocott hexamine silver stains fungi and acanthamoeba black.
 Haematoxylin is basic and stains acids purple
 Eosin is acidic and stains bases pink
 Alcian blue stains mucopolysaccharides classically seen in macular dystrophy of the cornea
 Oil red O stains lipid red (e.g. sebaceous gland carcinoma)
 Prussian blue stains iron, which is usually intracellular
 Ziehl Neilson is used for mycobacteria
 Alizarin red stains calcium red
 Von Kossa stains calcium
 Masson Trichrome stains new collagen blue (Reis-Buckler) and hyaline material red (granular
dystrophy)
 Congo red stains amyloid

All of the following definitions are correct EXCEPT:

hypoplasia is failure of formation of an embryonic mass

dysgenesis is failure of organization of tissue into an anatomically correct organ

aplasia is failure of differentiation of an embryonic cell mass to organ specific tissue

metaplasia is differentiation of a mature tissue into a different mature tissue

Your answer was CORRECT

Explanation
Hypoplasia is failure of a developing organ to reach its full size. Agenesis is failure of formation
of an embryonic mass. All other definitions are correct.
The most appropriate culture medium for acanthoemaba is:

nutrient-deficient agar with E.coli overlay

McConkey agar

Lowenstein-Jensen medium

chocolate agar

Your answer was CORRECT

Explanation
Acanthoemeba is notoriously difficult to culture. The best medium is nutrient-deficient agar with
E.coli overlay.

Which is FALSE regarding sterilization:

it involves the destruction of all microbial life so that none can replicate

it can be achieved with ethylene oxide

dry heat is more effective than wet heat

it can be achieved with gamma radiation

it can be achieved at high pressures using an autoclave

Your answer was CORRECT

Explanation
Moist heat is more effective than dry heat, which requires higher temperatures and longer
exposure to achieve sterilization.

A teratoma is a tumour deriving from:

cartilage

meningeal tissue

germ cells

striated muscle

Your answer was CORRECT

Explanation
A teratoma is a tumour arising from germ cells.

Zeil-Neilsen stain is best used to visualize:

Acanthoemeba

Treponema pallidum

Mycobacterium tuberculosis

Haemophilus

Your answer was CORRECT

Explanation
Zeil-Neilsen stain is used for mycobacteria.