MCQs on Neisseria gonorrhoeae and Neisseria meningitidis: Medical microbiology

                

                       

              Multiple Choice Questions on Neisseria species (Gram-negative cocci)

1) A 19-year-old female college freshman, presented to the university health center with a severe headache, fever, and a stiff neck. She lived in a dormitory and was active in various social activities. She had received all her childhood vaccinations but had not received a booster for the meningococcal vaccine recommended before college entry.

Clinical Presentation:

On day 1, the patient experienced a sudden onset of fever (39.5°C or 103.1°F), severe headache, nausea, and vomiting. She also noticed a rash on her trunk and legs.

Over the next two days, her symptoms deteriorated further, leading to photophobia and altered mental status. Concerned, her roommates brought her to the university health center.

Physical Examination was performed, temperature was 39.8°C (103.6°F). Petechial skin rash on the trunk, lower extremities, and mucous membranes.

Laboratory diagnosis:

Complete blood count (CBC) showed elevated white blood cell count with neutrophilia. CSF analysis showed elevated white blood cell count (pleocytosis), increased protein, and decreased glucose.

CSF Gram stain showed Gram-negative diplococci.

i) All of the following describe the indicative cultural characteristics of gram-negative diplococci, EXCEPT
    a) Can be isolated in both aerobic and anaerobic conditions
    b) Fastidious microorganism that require enriched media (blood)
    c) Have smooth, unpigmented colonies with diplococcus shape
    d) Require 20 to 25 % CO2 for the proper cultivation and isolation 

ii) Why is it recommended for college students to receive a booster for the meningococcal vaccine before starting college?

    a) To prevent outbreaks of meningitis in the close living quarters of dormitories

    b) To prevent respiratory infections

    c) To ensure general immunity against common colds

    d) To reduce the risk of developing pneumonia

2) All of the following infections are the common clinical manifestations caused by N. gonorrhoeae, EXCEPT
a) Genital gonorrhea in women
b) Pelvic inflammatory disease in men
c) Neonatal conjunctivitis
d) Pharyngitis

3) N. gonorrhoeae consists of conjugate plasmids that makes the bacterium resistant to which of the following antibiotics?
a)Tetracycline

b)Penicillin
c)Chloramphenicol
d) Ketoconazole

4) All, except one, are the examples of protein present in the antigenic structure of Neisseria gonorrhoeae that helps the bacteria to invade a host cell
a) Por proteins
b) Rmp proteins
c) Opa proteins
d) IgM protease

5)Name the antimicrobial drug that is not added in the culture media to prevent the growth of other bacteria and promote the growth and isolation of Neisseria gonorrhoeae. 
a) Penicillin
b) Vancomycin
c) Amphotericin
d) Colistin

6) Which statement is true about the Nucleic Acid Amplification Tests used for the direct detection of Neisseria gonorrhoeae in the genitourinary specimens?
a) The test has low sensitivity and specificity in symptomatic and high prevalence populations
b) The test has equal sensitivity and specificity as Neisseria gonorrhoeae in symptomatic and high prevalence populations
c) The test has high sensitivity and specificity in symptomatic and high prevalence populations
d) The test has high sensitivity and low specificity in symptomatic and high prevalence populations

7)There are various serogroups of Neisseria meningitidis.

Which of these are the most important associated with meningococcal infection?
a) A, B, C, Y and W135
b) A, B, C, X, Y, and W135
c) A, B, C, X, Y, and W125
d) A, B, C, X and W135

8) The meningococcal infections are predominant in which of the following age group?
a) Infants only
b) Children and Young adults
c) Adults only
d) Children and Adults

9) What is the one effective method of treatment for the primary stages of gonorrheal infections?

a) Antibiotics

b) Use of condom

c) No treatment available

d) Vaccine

10) What condition is also known as Fitz-Hugh–Curtis syndrome, associated with pelvic inflammatory disease (PID) caused by N. gonorrhoeae?

a) Arthritis

b) Bacteremia

c) Ectopic pregnancy

d) Perihepatitis

11) Which of the following component may not be required for the culture of blood specimens taken from the individuals with meningococcal infection?
a) Sodium sulfonate
b) Sodium gluconate
c) Sodium polyanethol sulfonate
d) Sodium polyascorbate

12) What serological test is used to measure the antibodies to meningococcal polysaccharides?
a) Latex agglutination test
b) Hemagglutination test
c) Latex and hemagglutination tests
d) None of the above

13) What is the drug of choice for the treatment of the meningococcal disease?
a) Penicillin
b) Amphotericin
c) Methicillin
d) Penicillin G

14) Which of the following route is not the common route for the transfer and spread of N.gonorrhoea?

a) Through kissing and hugging

b) Sexual intercourse 

c) Infected mother to fetus

d) All of the above

15) Which of the following tests can be used to differentiate between Moraxella catarrhalis and saprophytic Neisseria spp from sputum specimens?
a) Oxidase
b) Butyrate esterase
c) Gram stain
d) Catalase

16) Vertical transmission of gonococcal infection to neonates can occur through an infected mother during the delivery.

What is the most common type of gonococcal infection seen in newborns?

a) Liver infection

b) Ocular infection (conjunctivitis)

c) Mastitis

d) Meningitis

17) N. gonorrhoeae infection of the genitourinary tract can develop into a pelvic inflammatory disease in women.

What are the most common life-threatening infections that may occur due to the infection? 

Choose all the correct answers:

a) Infertility

b) Endometritis 

c) Ectopic pregnancy

d) Meningitis

18) All of the following statement is true for meningococcal disease, except?

a) A vaccine is accessible for individuals aged 10 and above to prevent the disease.

b) Immunocompromised individuals, including those with HIV or sickle cell anemia, are vulnerable.

c) Three primary serogroups are responsible for the majority of infections.

d) Meningococcus is transmitted from person to person through respiratory droplets.

19) All of the following are commonly used specific tests for the identification of N. gonorrhea and N. meningitidis, Except?

a) Nucleic Acid Amplification Tests (NAATs)

b) Enzyme immunoassays for gonococcal antigen 

c) Rapid antigen detection by latex agglutination

d) Venereal disease laboratory test (VDRL)

20) Which of the following bacteria are the leading cause of meningitis around the world?

Select all the correct answers:

a) Neisseria meningitidis

b) Haemophilus influenzae
c) Group B Streptococcus
d) Coccidioides immitis 

21) A 30-year-old sexually active male presents to the clinic with complaints of urethral discharge and discomfort during urination for the past week. He reports having a new sexual partner in the last month and has not used protection consistently. 

On examination, the healthcare provider observes a purulent urethral discharge. The genital examination reveals mild erythema of the urethral meatus.

A Gram stain of the urethral discharge is performed, revealing intracellular gram-negative diplococci inside polymorphonuclear leukocytes. A urethral swab is collected for NAAT testing, which detects the genetic material of Neisseria gonorrhoeae. 

Which of the following antibiotic is recommended as first-line treatment for uncomplicated gonococcal cases?

a) Ampicillin

b) Bacitracin

c) Cotrimoxazole

d) Ceftriaxone

22) Which of the following drug is recommended in bacterial meningitis to decrease inflammation and prevent neurological complications?

a. Bacitracin

b. Dexamethasone

c. Methylprednisolone

d. Prednisone

Multiple Choice Question Answers:

1- i) d) Require 20 to 25 % CO2 for the proper cultivation and isolation.

Neisseria spp are fastidious microorganism and grow well in selective media such as Thayer Martin media with 5-10 % of CO2 requirements.

    ii)  a) To prevent outbreaks of meningitis in the close living quarters of dormitories.

2-b)Pelvic inflammatory disease in men
3-a)Tetracycline
4-d)IgM protease
5-a)Penicillin
6-c) The test has high sensitivity and specificity in symptomatic and high prevalence populations
7-b) A, B, C, X, Y, and W135
8-b) Children and Young adults
9-a) Antibiotics
10-d) Perihepatitis

11-c) Sodium polyanethol sulfonate (SPS). Used as a common anticoagulant component in blood culture but not suitable for the isolation of N. meningitidis

12 c) Latex and hemagglutination tests

13 d)Penicillin G

14-a)Through kissing and hugging
15-b) Butyrate esterase

16-d) Ocular infection

17-a), b), and c)

18- c) Three serogroups of virus are most prevalent for the majority of the infection. There are several serogroups of meningococcus, including A, B, C, W, X, and Y. The distribution of serogroups can vary globally.

19- d)  Venereal disease laboratory test (VDRL), is a common and primary screening test for Syphilis 

20- a) Neisseria meningitidis, b) Haemophilus influenzae and c) Group B Streptococcus, 

d) Coccidioides immitis is a fungi that causes fungal meningitis.

21- d) Ceftriaxone

22- b) Dexamethasone. It is a synthetic glucocorticoid steroid with potent anti-inflammatory and immunosuppressant properties. In bacterial meningitis, dexamethasone is used to reduce inflammation and prevent neurological complications.