Level 4 Laboratory Technician MCQs

1. Which of the following organisms is most commonly associated with urinary tract
infections?
A. Klebsiella pneumoniae
B. Shigella flexneri
C. Salmonella typhi
D. Escherichia coli
✅ Answer: D
2. A major distinguishing feature between Salmonella and Shigella on TSI agar is:
A. Lactose fermentation
B. Urease activity
C. H2S production
D. Citrate utilization
✅ Answer: C
3. Which organism is often linked to traveler's diarrhea?
A. Salmonella typhi
B. Shigella flexneri
C. Escherichia coli (ETEC)
D. Klebsiella pneumoniae
✅ Answer: C
4. What is the mode of transmission of Shigella?
A. Inhalation
B. Blood transfusion
C. Fecal-oral
D. Sexual contact
✅ Answer: C
5. Which of the following is a lactose fermenter?
A. Salmonella
B. Klebsiella
C. Shigella
 D. Yersinia
✅ Answer: B
6. Which E. coli pathotype is associated with bloody diarrhea and hemolytic uremic
syndrome (HUS)?
A. ETEC
B. EPEC
C. EHEC
D. EAEC
✅ Answer: C
7. Which organism causes typhoid fever?
A. Shigella sonnei
B. Klebsiella pneumoniae
C. Escherichia coli
D. Salmonella typhi
✅ Answer: D
8. Which of the following organisms produces mucoid colonies on MacConkey agar?
A. Salmonella
B. Shigella
C. Klebsiella
D. E. coli
✅ Answer: C
9. Which one is a facultative intracellular pathogen?
A. E. coli
B. Klebsiella
C. Salmonella
D. Shigella
✅ Answer: C
10. Which organism causes bacillary dysentery with frequent, small-volume bloody stools?
A. E. coli (ETEC)
B. Shigella dysenteriae
C. Salmonella typhimurium
 D. Klebsiella pneumoniae
✅ Answer: B
11. Which Enterobacteriaceae is most associated with hospital-acquired pneumonia?
A. Salmonella
B. E. coli
C. Klebsiella pneumoniae
D. Shigella
✅ Answer: C
12. Which organism is commonly transmitted through contaminated poultry and eggs?
A. Klebsiella
B. Shigella
C. Salmonella
D. E. coli
✅ Answer: C
13. Which of the following grows colorless colonies on MacConkey and black centers on
XLD?
A. Shigella
B. Salmonella
C. Klebsiella
D. E. coli
✅ Answer: B
14. Which E. coli strain is responsible for HUS and is sorbitol-non fermenting?
A. ETEC
B. EHEC (O157:H7)
C. EAEC
D. EPEC
✅ Answer: B
15. A lactose-fermenting, indole-positive Gram-negative rod most likely indicates:
A. E. coli
B. Klebsiella
C. Salmonella
 D. Shigella
✅ Answer: A
16. A 5-year-old presents with bloody diarrhea. Non-motile, non-lactose fermenter identified.
Likely organism?
A. E. coli
B. Shigella
C. Salmonella
D. Klebsiella
✅ Answer: B
17. A woman develops UTI after catheterization; indole-positive, lactose fermenter found.
Likely cause?
A. E. coli
B. Shigella
C. Salmonella
D. Klebsiella
✅ Answer: A
18. A malnourished child with rose spots and high fever. Likely diagnosis?
A. Shigella
B. Klebsiella
C. Salmonella typhi
D. E. coli
✅ Answer: C
19. Diabetic alcoholic with pneumonia and currant jelly sputum. Most likely organism?
A. E. coli
B. Shigella
C. Klebsiella pneumoniae
D. Salmonella
✅ Answer: C
20. Child with seizures, bloody diarrhea, and HUS. Sorbitol-negative strain found. Cause?
A. EPEC
B. EHEC (O157:H7)
 C. EAEC
D. ETEC
✅ Answer: B
21. Hospital patient’s sputum reveals mucoid pink colonies on MacConkey agar. Pathogen?
A. Shigella
B. E. coli
C. Klebsiella
D. Salmonella
✅ Answer: C
22. Burn patient develops sepsis from lactose fermenter, capsule-producer. Likely cause?
A. E. coli
B. Klebsiella pneumoniae
C. Shigella
D. Salmonella
✅ Answer: B
23. Traveler with rice-water-like diarrhea; culture shows heat-stable/heat-labile toxins.
Likely cause?
A. EHEC
B. ETEC
C. EPEC
D. EAEC
✅ Answer: B
24. Infant with watery diarrhea and failure to thrive; lactose fermenter, non-motile Gram-
negative rods.
A. E. coli (EPEC)
B. Shigella
C. Klebsiella
D. Salmonella
✅ Answer: A
25. Stool sample reveals non-lactose fermenter, H2S-negative, motile rods. Likely diagnosis?
A. Shigella
 B. Salmonella
C. Klebsiella
D. E. coli
✅ Answer: B
26. Which Gram-positive cocci grow in clusters?
A. Streptococcus
B. Neisseria
C. Staphylococcus
D. Enterococcus
✅ Answer: C
27. Which of the following is coagulase-positive?
A. Staphylococcus epidermidis
B. Streptococcus pyogenes
C. Staphylococcus aureus
D. Streptococcus pneumoniae
✅ Answer: C
28. Which test is commonly used to differentiate Staphylococcus from Streptococcus?
A. Catalase test
B. Coagulase test
C. Oxidase test
D. Indole test
✅ Answer: A
29. Streptococcus species are arranged in:
A. Clusters
B. Chains or pairs
C. Spirals
D. Tetrads
✅ Answer: B
30. Which organism causes impetigo, boils, and abscesses?
A. Streptococcus pyogenes
B. Staphylococcus aureus
 C. Streptococcus pneumoniae
D. Enterococcus faecalis
✅ Answer: B
31. The most likely cause of hospital-acquired infections from catheters:
A. Streptococcus pyogenes
B. Staphylococcus epidermidis
C. Streptococcus pneumoniae
D. Staphylococcus aureus
✅ Answer: B
32. Which Gram-positive cocci is optochin-sensitive and has a capsule?
A. Streptococcus pyogenes
B. Streptococcus pneumoniae
C. Staphylococcus aureus
D. Staphylococcus epidermidis
✅ Answer: B
33. Which of the following causes toxic shock syndrome?
A. Streptococcus pneumoniae
B. Staphylococcus aureus
C. Streptococcus viridans
D. Enterococcus faecalis
✅ Answer: B
34. A Gram-positive cocci that grows on Mannitol Salt Agar (MSA) and ferments mannitol
is:
A. Streptococcus pyogenes
B. Staphylococcus aureus
C. Streptococcus pneumoniae
D. Enterococcus
✅ Answer: B
35. A patient develops sepsis after catheter insertion. The isolate is coagulase-negative,
catalase-positive. Most likely cause?
A. Streptococcus pyogenes
 B. Staphylococcus epidermidis
C. Staphylococcus aureus
D. Streptococcus pneumoniae
✅ Answer: B
36. A 70-year-old man has pneumonia with rust-colored sputum. Gram stain shows lancet-
shaped cocci in pairs. Diagnosis?
A. Staphylococcus aureus
B. Streptococcus pneumoniae
C. Streptococcus pyogenes
D. Enterococcus
✅ Answer: B
37. A young woman has fever, rash, and hypotension after using tampons. Blood culture
grows coagulase-positive Staphylococcus. Likely toxin?
A. Streptolysin
B. Pyrogenic exotoxin
C. Toxic shock syndrome toxin (TSST-1)
D. Pneumolysin
✅ Answer: C
38. A child has red, scaly skin that peels. Swab shows coagulase-positive Gram-positive
cocci. Likely disease?
A. Impetigo
B. Scarlet fever
C. Scalded skin syndrome
D. Erysipelas
✅ Answer: C
39. A heart patient develops endocarditis after dental work. Blood cultures grow alpha-
hemolytic Streptococcus. Likely organism?
A. S. pyogenes
B. S. pneumoniae
C. S. viridans
 D. S. epidermidis
✅ Answer: C
40. A newborn develops meningitis. CSF shows Gram-positive cocci in chains, catalase-
negative. Likely cause?
A. Streptococcus agalactiae (Group B)
B. Streptococcus pneumoniae
C. Staphylococcus aureus
D. Staphylococcus epidermidis
✅ Answer: A

41. Which of the following best defines Multidrug-Resistant TB (MDR-TB)?

A. TB resistant to any two antibiotics
B. TB resistant to Rifampicin only
C. TB resistant to Isonazid and Rifampicin
D. TB resistant to second-line drugs
✅ Answer: C
42. A patient diagnosed with pulmonary TB is not responding to first-line treatment after 2
months. What is the next appropriate step?
A. Increase dose of rifampicin
B. Repeat sputum microscopy and perform drug susceptibility testing
C. Switch to second-line drugs immediately
D. Prescribe antibiotics for pneumonia
✅ Answer: B
43. Which method increases sensitivity for TB detection in sputum by concentrating the
bacilli?
A. Cold staining
B. Heat fixation
C. Sodium hypochlorite (bleach) digestion and centrifugation
D. Direct smear from saliva
✅ Answer: C
44. In a TB control program, why is a “spot–morning–spot” sample collection strategy
recommended?
A. It reduces sample contamination
B. It improves sputum quality
C. It increases the chance of detecting TB bacilli
D. It minimizes patient visits
✅ Answer: C
45. Which of the following symptoms is most specific to pulmonary TB?
A. Shortness of breath
B. Productive cough lasting more than 2 weeks
C. Headache and vomiting
D. Abdominal pain
✅ Answer: B
46. A lab technician finds 7 AFB in 100 oil immersion fields of a patient’s sputum smear.
How should this be reported?
A. +
B. ++
C. Report as “7 AFB/100 fields”
D. +++
✅ Answer: C
47. Which of the following increases the risk of developing MDR-TB?
A. Overuse of antibiotics in general
B. Taking first-line drugs irregularly or incompletely
C. Living in cold climate
D. Having a low hemoglobin level
✅ Answer: B
48. What is the primary route of transmission of Mycobacterium tuberculosis?
A. Contaminated food
B. Fecal-oral route
C. Airborne droplets from cough/sneeze
 D. Sexual contact
✅ Answer: C
49. Which group is at highest risk for TB reactivation?
A. Healthy adults
B. Children under 5
C. HIV-positive individuals
D. Pregnant women
✅ Answer: C
50. In a rural health center with limited resources, what is the most practical test for TB
diagnosis?
A. Chest CT scan
B. Direct sputum smear microscopy
C. Blood culture
D. Xpert MTB/RIF only
✅ Answer: B
51. A patient suspected of TB submitted sputum. Ziehl-Neelsen stain was negative. What
next?
A. Report as negative
B. Use Gram stain
C. Examine additional specimens
D. Discard the sample
✅ Answer: C
52. Gram-stained smear shows intracellular Gram-negative diplococci. Most likely
organism?
A. Neisseria gonorrhoeae
B. Streptococcus pneumoniae
C. Escherichia coli
D. Staphylococcus aureus
✅ Answer: A
53. An old bacterial culture stains Gram-negative though it was Gram-positive. Reason?
A. Incorrect stain
 B. Over-decolorization
C. Old iodine solution
D. Aging culture
✅ Answer: D
54. A thick Gram smear causes what error?
A. False gram-negative
B. False gram-positive
C. No visible organisms
D. Over-decolorization
✅ Answer: B
55. In capsule staining, what replaces water for rinsing?
A. Ethanol
B. Copper sulfate
C. Acetone
D. Lugol’s iodine
✅ Answer: B
56. Bleach-treated sputum improves AFB detection because:
A. Fixes smear
B. Increases fluorescence
C. Concentrates bacilli
D. Promotes growth
✅ Answer: C
57. Water directly poured on heat-fixed CSF smear during rinse can cause:
A. Lysis
B. Dark staining
C. Smear loss
D. Enhanced violet stain
✅ Answer: C
58. Why is alcohol fixation preferred for intracellular bacteria detection?
A. Faster fixation
B. Preserves leukocytes
 C. Better contrast
D. Reduces evaporation
✅ Answer: B
59. Overheating Ziehl-Neelsen stain causes:
A. Under-staining
B. Crystal artifact
C. Counterstain loss
D. Low background stain
✅ Answer: B
60. Why is steaming done in spore staining with malachite green?
A. Fixes smear
B. Activates counterstain
C. Increases spore wall permeability
D. Destroys vegetative cells
✅ Answer: C