1.

A 42 year old female presented with fever, chills and rigors, confusion, anxiety, difficulty in breathing,
malaise and vomiting. Gram Negative infection in blood is suspected. On examination following signs
were noticed:

- Body temperature 102°f

Heart rate 106 per minute

Respiratory rate 24/minute

Blood pressure 90/60 mm of hg

Urine output was significantly decreased

a. What is the probable clinical diagnosis?

b. Which sample will you collect for diagnosis?

c. How will you collect the specimen?

a. The probable clinical diagnosis is sepsis, possibly caused by a Gram-negative bacterial infection.

b. For diagnosis, a blood culture should be collected.

c. To collect the specimen, aseptic technique should be followed. Clean the skin with an antiseptic, and
then collect blood directly into blood culture bottles from different venipuncture sites. It's crucial to
avoid contamination during the collection process.

2. A 75 year old man was hospitalized with fever (101°f), severe back pain and weakness in lower limbs.
On examination, few non-tender, small erythmatous nodular lesions on soles were seen. ECG showed
valvular vegetations on mitral valve. He was diagnosed to have cardiac valve vegetations 3 years back.
Laboratory tests showed CRP 2.5 mg/dl, ESR 66 mm/h, leukocytes 15.6 X109/L and creatinine 4.6 mg/dl.

a. What is the propable clinical diagnosis

b. What are the type of etiological agents of this clinical condition?

c. How will you collect the specimen for this condition?

a. The probable clinical diagnosis is infective endocarditis.

b. The etiological agents of infective endocarditis can include bacteria, fungi, or other microorganisms.
Common bacterial causes are Staphylococcus and Streptococcus species.

c. To collect a specimen for diagnosis, blood cultures should be obtained. Typically, multiple blood
cultures from different sites and at different times are recommended to increase the likelihood of
detecting the causative microorganism.
3. A 20 year old man presented to emergency department with complaints of high grade fever,
productive cough, chest pain and dyspnea for past 3 days. Physical examination revealed dull note on
percussion. Chest X-ray revealed consolidation over right lower lobe.

a. What is clinical diagnosis and its common causative

organism? b. Which and how sample should be collected for

diagnosis?

c. Briefly describe laboratory diagnosis.

a. The clinical diagnosis is likely community-acquired pneumonia, and a common causative organism
could be Streptococcus pneumoniae.

b. For diagnosis, a sputum sample should be collected. A good quality, deep coughed sputum specimen
is preferred.

c. Laboratory diagnosis involves examining the sputum sample for the presence of the infectious agent.
This can be done through Gram staining, culture, and sensitivity testing. Gram staining helps identify the
type of bacteria, and culture helps in growing and isolating the organism. Sensitivity testing is performed
to determine the antibiotic susceptibility of the identified pathogen. Additionally, other diagnostic
methods like chest X-ray aid in confirming the presence of pneumonia and assessing its extent.

4. Six years old patient from Bhavnagar visited OPD for fever, pain in throat and difficulty in swallowing.
On examination he was found to have cervical lymphadenopathy and tonsil covered with whitish
discharge. Pharyngeal wall was covered with grey white membrane. His vaccination history was not
known.

a. What is your probable diagnosis of this case?

b. Which bacterial agent is responsible for this?

c. Which sample will you collect for diagnosis?

a. The probable diagnosis is acute bacterial tonsillitis, potentially complicated by the formation of a
membrane, which might indicate diphtheria.

b. The bacterial agent responsible for diphtheria is Corynebacterium diphtheriae.

c. For diagnosis, a throat swab or culture should be collected. This sample helps in identifying the
presence of the bacteria and confirming the diagnosis. Additionally, a blood test might be conducted to
check for antibodies against diphtheria toxin.
5. A 32 year old vegetarian male presented with recurrent episodes of seizures, headache, vomiting and
vertigo. MRI of the brain showed cystic lesion in subarachnoid space.

a. What is your clinical diagnosis and which etiological agent is associated with it?

b. What is the infective form, host, pathogenic form and mode of transmission for this disease?

c. How will you treat this condition.

a. The clinical diagnosis is likely neurocysticercosis, and the etiological agent associated with it is the
larval form of the pork tapeworm, Taenia solium.

b. Infective Form: The infective form is the larval stage (cysticercus) of Taenia solium.

Host: Humans are the definitive host for Taenia solium.

Pathogenic Form: The larval cysts in the brain cause neurocysticercosis.

Mode of Transmission: Transmission occurs through the ingestion of undercooked pork contaminated
with the eggs of Taenia solium.

c. Treatment typically involves antiparasitic drugs such as albendazole or praziquantel to kill the
cysticerci. In some cases, anti-seizure medications may also be prescribed to manage seizures. Surgical
intervention may be considered in certain situations, such as hydrocephalus or when the cysts are in a
location that requires removal.

6. A 40 year old female from a slum area was admitted in emergency ward with complaints of rice
watery diarrhea since last two days. There is no history of fever, abdominal pain or passage of blood &
mucus in stool. There was history of leg cramps, decreased urine output & intense thirst. Similar cases
were found in the same area.

a. What is your probable diagnosis?

b. Which bacterial agent is responsible for this condition? c. Which sample is to be collected to diagnose
this case?

d. Which transport media and culture media will you use for this sample?

a. The probable diagnosis is cholera.

b. The bacterial agent responsible for cholera is Vibrio cholerae.

c. To diagnose this case, a stool sample should be collected.

d. Transport Media: Cary-Blair medium or other appropriate transport media for the preservation of
Vibrio cholerae.
Culture Media: Thiosulfate-citrate-bile salts-sucrose (TCBS) agar is commonly used for isolating Vibrio
cholerae.

7. A 10 year old boy living in a slum area presented to medicine OPD with abdominal pain, nausea and
vomiting. Many children were affected in the same area with similar complains. On examination he had
yellowish sclera. Lab report showed raised bilirubin and SGPT level.

a. What is the propable diagnosis?

b. Which laboratory investigations will be done for the diagnosis?

c. How can this infection can be prevented?

a. The probable diagnosis is acute viral hepatitis.

b. Laboratory investigations for the diagnosis may include:

Liver function tests, including bilirubin levels and SGPT (serum glutamic pyruvic transaminase).

Serological tests for specific hepatitis viruses (e.g., hepatitis A, B?, or E).

c. Prevention of hepatitis infections involves:

Vaccination: Depending on the specific type of hepatitis, vaccines are available (e.g., hepatitis A and B
vaccines).

8. A 35 years old male patient had complaints of abdominal pain and mild fever. After 1 day, he had
frequency of stool with blood and mucus. Patient gave history of eating food in local restaurant. Stool
sample was send for investigation and it show present of RBC, mucus and plenty of pus cells.

a. Which clinical condition would you suspect?

b. Which bacteria are responsible for this condition?

a. The clinical condition that would be suspected is dysentery, likely bacillary dysentery or shigellosis.

b. The bacteria responsible for bacillary dysentery or shigellosis are various species of Shigella bacteria,
such as Shigella dysenteriae, Shigella flexneri, Shigella boydii, and Shigella sonnei.
9. A 27 year old medical resident was admitted to the surat civil hospital because of sudden onset of
fever to 39°c & headache. Two weeks prior he had vacation In rural area of Surat, where he had visited
rice fields. Blood tests indicated renal function abnormality & elevated bilirubin & other liver function
testes. Routine blood, urine & CSF Cultures were negative. Dark ground microscopy revealed thin, tightly
coiled organism with hooked ends in urine sample.

a.What is your probable diagnosis?

b. Which bacterial agent is responsible

a. The probable diagnosis is leptospirosis, also known as Weil's disease.

b. The bacterial agent responsible for leptospirosis is the spirochete bacterium Leptospira interrogans.

10. A 35 year old male who is a worker in a wool factory, was admitted to hospital with prolonged fever,
with chills, night sweats and chest discomfort with blood stained sputum. By looking at his occupation
and clinical condition Biorisk level IV pathogen infection is suspected.

A. What may be the propable agent for this condition? B. Briefly describe laboratory diagnosis.

a. The probable agent for this condition could be inhalation anthrax, considering the occupation in a
wool factory and the symptoms described.

b. Laboratory diagnosis for inhalation anthrax involves:

Blood Cultures: To isolate Bacillus anthracis from the bloodstream.

Chest X-ray and Imaging: To identify characteristic mediastinal widening and pleural effusion.

Gram Stain and Culture of Respiratory Secretions: To detect the presence of Bacillus anthracis in sputum
or other respiratory secretions.

Serological Tests: Detecting specific antibodies against Bacillus anthracis.

PCR (Polymerase Chain Reaction): To amplify and identify the DNA of Bacillus anthracis.

11. A 32 year old female was admitted with dysuria (burning Micturition) and increased frequency of
micturition for the past 2 days. Culture of the urine specimens revealed lactose fermenting colonies on
MacConkey agar.
 a. What is your clinical diagnosis and probable etiological agents?
b. What are the risk factors associated, pathogenesis and clinical manifestations of this disease?
c. Describe the laboratory diagnosis in detail.
d. How will treat this clinical condition?

a. The clinical diagnosis is likely urinary tract infection (UTI), and the probable etiological agent, based on
lactose fermenting colonies on MacConkey agar, could be Escherichia coli (E. coli).

b.Risk Factors: Risk factors for UTI include female gender, sexual activity, urinary tract abnormalities,
catheter use, and conditions that affect the immune system.

Pathogenesis: UTIs often result from the ascent of bacteria, such as E. coli, from the urethra to the
bladder. In some cases, the infection can progress to the kidneys.

Clinical Manifestations: Dysuria (burning micturition), increased frequency of urination, urgency, lower
abdominal pain, and sometimes fever.

c. Laboratory Diagnosis:

Urine Culture: A urine sample is cultured on selective media like MacConkey agar to isolate and identify
the causative bacteria.

Gram Stain: Gram staining of the urine sediment may reveal the presence of bacteria.

Antibiotic Sensitivity Testing: Determines the most effective antibiotic for treatment.

d. Treatment involves antibiotics based on the sensitivity testing results. Commonly used antibiotics for
uncomplicated UTIs include trimethoprim/sulfamethoxazole, ciprofloxacin, or nitrofurantoin. Adequate
hydration is also recommended.

12. A 30 year old female sex worker visited STI clinic with complain of genital ulcer. There was serous
discharge form the ulcer since last 15 days. On examination ulcer was painless and indurated.

A.What is your probable diagnosis of this condition?

b. What agent is responsible for this condition?

a. The probable diagnosis of this condition is syphilis.

b. The agent responsible for syphilis is the bacterium Treponema pallidum.

13. 35 year old male presented in OPD with History of accident before one month. At present he is
having complain of Lock Jaw and Facial spasm. Patient is also having Difficulty in Swallowing.

d. What is your probable diagnosis of this condition?

f. Which Vaccine is Required to prevent this disease and mention schedule of vaccination?

d. The probable diagnosis is tetanus.

e. The agent responsible for tetanus is the bacterium Clostridium tetani.