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American Society of Microbiology ABMM Sample Questions:

1. A clinical microbiology laboratory is investigating an outbreak of vancomycin-resistantEnterococcus faecium (VRE) in a hospital. Whole-genome sequencing of isolates from different patients reveals the presence of the vanA operon on a mobile genetic element that is highly conserved across all isolates. This finding MOST strongly suggests:

A) Independent acquisition of vancomycin resistance by different E. faecium strains.
B) Clonal spread of a single VRE strain carrying the vanA operon.
C) Horizontal transfer of the vanA operon to multiple susceptible E. faecium strains.
D) Selection of vancomycin-resistant mutants within a susceptible E. faecium population due to antibiotic pressure.

2. A patient presents with a chronic cough, weight loss, and night sweats. Chest X-ray shows cavitarylesions in the upper lobes. Sputum is acid-fast positive. Drug susceptibility testing reveals resistance to isoniazid but susceptibility to rifampin, ethambutol, and pyrazinamide. The MOST appropriate treatment regimen should include:

A) Isoniazid and rifampin
B) Isoniazid, rifampin, pyrazinamide, and ethambutol
C) Rifampin, ethambutol, and pyrazinamide
D) Isoniazid, ethambutol, and pyrazinamide

3. A patient with a history of intravenous drug use develops a bloodstream infection with Enterococcus faecalis.
Antimicrobial susceptibility testing reveals resistance to vancomycin. The MOST likely mechanism of vancomycin resistance in Enterococcus involves:

A) Alteration of the ribosomal target site, preventing vancomycin binding to the ribosome.
B) Production of enzymes that inactivate vancomycin.
C) Increased expression of efflux pumps that actively transport vancomycin out of the cell.
D) Modification of the peptidoglycan precursor, reducing vancomycin binding.

4. A clinical microbiology laboratory is performing antimicrobial susceptibility testing on a Streptococcus pneumoniae isolate recovered from a patient with meningitis. The isolate shows reduced susceptibility to penicillin (MIC = 2 µg/mL). The MOST likely mechanism for this reduced susceptibility is:

A) Production of beta-lactamase enzymes that hydrolyze penicillin.
B) Increased activity of efflux pumps that actively remove penicillin from the cell.
C) Alterations in the penicillin-binding proteins (PBPs) that reduce their affinity for penicillin.
D) Modification of the peptidoglycan structure, preventing penicillin binding.

5. A patient undergoing chemotherapy for leukemia develops a severe pneumonia. Bronchoalveolar lavage fluid is examined, revealing numerous cysts containing crescent-shaped structures upon silver staining. The patient's CD4+ T-cell count is significantly low. The MOST likely diagnosis is infection with:

A) Histoplasma capsulatum
B) Pneumocystis jirovecii
C) Blastomyces dermatitidis
D) Coccidioides immitis

Solutions: