A 22-year-old college student complained to his physician of a purulent discharge from his penis. He also found that it was painful to urinate. A 22-year-old college student complained to his physician of a purulent discharge from his penis. He also found that it was painful to urinate.
Question 1 - Single Best Answer
What is the most likely cause of the purulent penile discharge?
A) Neisseria gonorrhoea
B) Haemophilus ducreyi
C) Treponema pallidum
D) Herpes virus
E) Chlamydia trachomatis
Question 2 - Single Best Answer
How could a diagnosis of gonorrhea be confirmed?
A) casts in the urine
B) antibody to the gonococcal pili
C) Gram stain of the pus
D) DTH (skin test) using the outer membrane of N.g.
E) Growth of a Gram positive diplococcus on blood agar
Question 3 - Single Best Answer
If intracellular Gram negative diplococci are seen in the Gram stain of the urethral exudate, is there any reason to culture the organism?
A) yes
B) no
C) only if the patient is allergic to penicillin
Question 4 - Single Best Answer
How should Neisseria gonorrhoea be cultured and identified?
A) blood agar - beta haemolysis
B) blood agar - catalase positive
C) Thayer Martin agar - oxidase positive
D) MacConkey agar - lactose positive
E) chocolate agar - Hershey test
A positive diagnosis of gonorrhea was made and he was given amoxicillin (oral penicillin) and probenecid (an agent which increases the blood level of amoxicillin). He improved initially, but returned to his doctor after 7 days because he noticed he had a milder but persistent urethral discharge and that the pain on urination had returned. Initially, he thought that this was just the gonorrhea in the process of being cured, but now he was getting worried. His girlfriend, worried that he might have AIDS, accompanied him on this second visit to the doctor. The doctor examined them both and found that the man did, indeed, have a clear watery discharge from his penis. His girlfriend had no pain or discharge. However, her cervix was seen to be slightly inflamed and was secreting a small amount of pus. Gram stains of the secretions of both individuals showed numerous neutrophils, but no Gram negative cocci.
Question 5 - Single Best Answer
What is the most likely cause of the new problem in the young man?
A) a different strain of Neisseria gonorrhoea
B) the same strain of Neisseria gonorrhoea
C) a yeast infection accompanying AIDS
D) Chlamydia trachomatis
E) a penicillin resistant strain of E. coli that grew when the normal flora were killed by the antibiotic
Question 6 - Single Best Answer
How could you confirm your diagnosis of Chlamydia infection?
A) culture the discharge on Thayer-Martin agar
B) directly look for chlamydiae using a fluorescent antibody
C) grow the suspected organism in tissue culture (a culture of human epithelial cells)
D) PCR for Chlamydia DNA
E) more than one of the above
Question 7 - Single Best Answer
Why did the chlamydia infection not manifest itself until the gonorrhea infection was treated?
A) the two infections do not occur together
B) the symptoms of the chlamydia infection were masked
Question 8 - Single Best Answer
How should the young man have been treated initially (on his first visit)?
A) antibiotic treatment for a resistant gonococcal infection
B) antibiotic treatment for Chlamydia
C) treatment for N. gonorrhoeae and Chlamydia
D) treatment for every known bacterium
Question 9 - Single Best Answer
What do you think is the cause of the girlfriend's cervical inflammation?
A) Treponema pallidum
B) Neisseria gonorrhoeae
C) Chlamydia trachomatis
D) HIV infection
E) more than one of the above is possible
Question 11 - Single Best Answer
How could you be sure?
A) VDRL (serology)
B) HIV antibody test
C) streak a swab of the cervix on Thayer-Martin agar
D) fluorescein-labeled anti-chlamydia antibody or PCR for Chlamydia DNA
E) both C and D
A fluorescent antibody was used and detected chlamydiae on a cervical smear. Nothing grew on the Thayer-Martin plate. How should the young woman be treated?
Question 12 - Single Best Answer
What might be the consequences for her if she had not been diagnosed and treated?
A) infection and scarring of her Fallopian tubes
B) inability to become pregnant
C) premature delivery if she is pregnant
D) pneumonia or conjunctivitis in her infant if she is pregnant
E) all of the above
Question 13 - Single Best Answer
What is an elementary body?
A) the intracellular form of the chlamydiae
B) the extracellular form of the chlamydiae
C) the inclusion body in the host cell that contains the replicating chlamydiae
D) the adhesin by which the reticulate body attaches to the host cell
E) the vesicle that the chlamydiae use to get ATP from the host cell into their ( the chlamydia's) mitochondria