Review Test 4 - Helminths
Parasitology Exam (Helminths)
***Reminder: Slides and examination questions are
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1. The
incorrect match between organism and the appropriate diagnostic
procedure is:
a. Onchocerca volvulus – examination of skin snips
b. Cryptosporidium – modified acid fast stain
c. Echinococcus granulosus – routine ova and parasite examination
d. Schistosoma haematobium –– examination of urine sediment
ANSWER (c): The appropriate
procedure for the diagnosis of Echinococcus
granulosus (hydatid disease) would involve the microscopic examination of
hydatid fluid aspirated from a cyst.
Immature scolices and/or hooklets would be found in the centrifuged
fluid sediment and could be identified under the microscope.
2.
Charcot-Leyden crystals in
stool may be associated with an immune response and are thought to be the
breakdown products of:
a. neutrophils
b. eosinophils
c. monocytes
d. lymphocytes
ANSWER (b): When eosinophils
disintegrate, the granules reform into Charcot-Leyden crystals. Eosinophils are more likely to be present in
patients with helminth infections (rather than protozoa).
3. Morphological
characteristics of the rhabditiform (non-infective) larvae of Strongyloides stercoralis are:
a. a short buccal capsule and large genital primordium
b. a long buccal capsule and pointed tail
c. a short buccal capsule and small genital primordium
d. a small genital primordium and notch in tail
ANSWER (a): The rhabditiform
larvae of Strongyloides stercoralis
are characterized by the short buccal capsule (mouth) and large genital
primordium; these hookworm larvae have a long buccal capsule and very small
genital primordium.
4.
Visceral and ocular larva
migrans are associated with which of the following organisms and diagnostic
test?
a. Toxocara – serology
b. Onchocerca – skin snips
c. Dracunculus – skin biopsy
d. Angiostrongylus – CSF examination
ANSWER (a): Toxocara spp. cause visceral and/or ocular larva migrans, which occurs when
humans accidentally ingest the infective eggs of the dog or cat ascarid. The larvae migrate through the deep tissues,
including the eye; and the appropriate test of choice is the serology.
5. The
following organisms are linked with specific, relevant information. The incorrect combination is:
a. Strongyloides stercoralis – internal autoinfection
b. Echinococcus granulosus – hydatid disease
c. Taenia solium – human can serve as definitive and intermediate hosts
d. Schistosoma mansoni – common within the
ANSWER (d): Schistosoma mansoni is a blood fluke that is pathogenic for humans;
these particular worms reside in the veins over the large intestine. The egg has a very large lateral spine; eggs
can be recovered from the stool in infected patients. The infection is not endemic within the
6.
Examination of a 24 hour
unpreserved urine specimen is sometimes helpful in the recovery of:
a. Trichomonas vaginalis trophozoites
b. Schistosoma haematobium eggs
c. Enterobius vermicularis eggs
d. Strongyloides stercoralis larvae
ANSWER (b): Schistosoma haematobium blood flukes reside in the veins over the
bladder. When the eggs are passed from
the body, they are often found in urine; egg viability can also be determined.
7.
The examination of sputum
and stool may be necessary to diagnose infection with:
a. Paragonimus westermani
b. Trichinella spiralis
c. Wuchereria bancrofti
d. Fasciola hepatica
ANSWER (a): Paragonimus westermani adult worms are found in the lung and eggs may
be coughed up in the sputum. Consequently, both sputum and/or stool (if the
sputum containing the eggs is swallowed) are the recommended specimens for
examination for the eggs.
8.
Two helminth eggs that may
resemble one another are:
a. Diphyllobothrium latum and Paragonimus westermani
b. Opisthorchis sinensis and Fasciolopsis buski
c. Taenia saginata and Hymenolepis nana
d. Ascaris lumbricoides and Trichostrongylus
ANSWER (a): Both Diphyllobothrium latum and Paragonimus westermani eggs are
operculated and approximately the same size.
The morphology is similar, in spite of the fact that D. latum has a knob at the abopercular
end and P. westermani has a thickened
abopercular end and shoulders into which the operculum fits.
9.
Eating poorly cooked pork
can lead to an infection with:
a. Taenia solium and Trichinella spiralis
b. Taenia saginata and Hymenolepis nana
c. Trichuris trichiura and Hymenolepis diminuta
d. Diphyllobothrium latum and Ascaris lumbricoides
ANSWER (a): Both Taenia solium (pork tapeworm) and Trichinella spiralis can be acquired
from the ingestion of raw or poorly cooked infective pork.
10. An operculated cestode egg that can be recovered in human
feces is:
a. Clonorchis sinensis
b. Diphyllobothrium latum
c. Paragonimus westermani
d. Dipylidium
caninum
ANSWER (b): Diphyllobothrium latum is the only
operculated cestode egg that is found in humans; the infection is acquired from
the ingestion of raw fresh water fish.
11. The adult tapeworm of Echinococcus
granulosus is found in the intestine of:
a. Humans
b. Sheep
c. Dogs
d. Cattle
ANSWER (c): While the hydatid cysts are found in sheep or in humans
(accidental intermediate host), the adult tapeworms of Echinococcus granulosus are found in the intestine of the dog.
12. In
infections with Taenia solium, man
can serve as the:
a. definitive host
b. intermediate host
c. definitive and/or the intermediate host
d. none of the above
ANSWER (c): If humans ingest Taenia solium cysticerci in uncooked or
rare pork, the adult tapeworm will mature within the intestine (human will
serve as definitive host); if eggs from the adult tapeworm are ingested, then
the cysticerci will develop in human tissues (accidental intermediate host),
causing cysticercosis.
13. Humans acquire infections with Diphyllobothrium latum adult worms by:
a. ingestion of fresh water crabs
b. skin penetration of cercariae
c. ingestion of water chestnuts
d. ingestion of infected raw fresh water fish
ANSWER (d): The ingestion of raw
fresh water fish containing the encysted larvae of Diphyllobothrium latum will result in the development of an adult
tapeworm within the human intestine.
14. Humans
can serve as both the intermediate and definitive host in infections caused by:
a. Enterobius vermicularis
b Hymenolepis nana
c. Schistosoma japonicum
d. Ascaris lumbricoides
ANSWER (b): Hymenolepis nana is one of the tapeworms where humans serve as both
intermediate and definitive hosts. When
ingested, the oncosphere penetrates the intestinal mucosa, develops into the
mature cysticercoid (human is intermediate host), and returns to the gut where
the adult tapeworm matures (human is definitive host).
15. Organisms (and infections) that under normal conditions could
not be transmitted in the laboratory are:
a. Hymenolepis nana – dwarf tapeworm disease
b. Taenia solium – cysticercosis
c. Ascaris lumbricoides – ascariasis
d. Enterobius vermicularis – pinworm infection
ANSWER (c): Ascaris lumbricoides eggs require a period of development in the
soil before they are infective for humans.
The other organisms listed could be transmitted within the laboratory or
in the hospital setting.
16. Which
microfilariae are usually not found circulating in the peripheral blood?
a. Brugia malayi
b. Loa
loa
c. Wuchereria bancrofti
d. Onchocerca volvulus
ANSWER (d): The microfilariae of
Onchocerca volvulus are normally
found in the fluid right under the outer layer of skin. Therefore, the skin snip is the proper
specimen to examine.
17. The miracidial hatching test helps to demonstrate the
viability of:
a. eggs of Taenia species.
b. eggs of Schistosoma species.
c. eggs of hookworm species.
d. eggs of Opisthorchis.
ANSWER (b): The determination of
egg viability is important in schistosomiasis; therefore, the miracidial
hatching test would be helpful in demonstrating the egg viability of Schistosoma species. Once the eggs were hatched, the living
miracidium larvae would be visible in the water.
18. The incorrect match between organism and
characteristic is:
a. Fasciola hepatica and liver infection
b. Trichuris trichiura and eggs with polar plugs
c. Echinococcus granulosus and daughter cysts
d. Schistosoma mansoni and egg with terminal spine
ANSWER (d): The egg of Schistosoma mansoni is characterized by
having a large lateral spine; S.
haematobium has the characteristic terminal spine.
19. An immunosuppressed male had several episodes of pneumonia,
intestinal pain, and sepsis with Gram negative rods, and a history of military
service in
a. Fasciolopsis buski
b. Strongyloides stercoralis
c. Hookworm
d. Paragonimus
westermani
ANSWER (b): A latent infection
with Strongyloides stercoralis
acquired years before may cause severe symptoms in the immunosuppressed patient
(“autoinfective” capability of life cycle and migratory route through the
body).
20. Eosinophilic meningoencephalitis is a form of larva migrans
causing fever, headache, stiff neck, and increased cells in the spinal
fluid. It is generally a mild and
self-limited infection and is caused by:
a. Necator americanus
b. Angiostrongylus cantonensis
c. Ancylostoma braziliense
d. Strongyloides stercoralis
ANSWER (b): Eosinophilic
meningoencephalitis is a form of larva migrans and is caused by Angiostrongylus cantonensis, the rat
lungworm. This Pacific area infection is
associated with CSF symptoms and sometimes eye involvement.
21. When humans have cystic hydatid disease, the causative agent
and host classification are:
a. Echinococcus granulosus – accidental intermediate host.
b. Echinococcus granulosus – definitive host.
c. Taenia solium – accidental intermediate host.
d. Taenia solium – definitive host.
ANSWER (a): The cause of cystic hydatid
disease is Echinococcus granulosus
and the human is classified as the accidental intermediate host. Infection occurs when humans ingest E. granulosus eggs and the hydatid
cyst(s) develop in the liver and lung of the human instead of sheep (normal
cycle).
22. A 45 year old hunter developed fever, myalgia, and
periorbital edema. He has a history of
bear meat consumption. The most likely
causative agent is:
a. Toxoplasma gondii
b. Taenia solium
c. Hymenolepis nana
d. Trichinella
spiralis
ANSWER (d): Infected bear meat
is an excellent source of Trichinella
spiralis. In this case, the patient
had evidently consumed poorly cooked bear meat, thus ingesting the encysted
larvae of T. spiralis.
23. This condition results from the accidental ingestion of helminth
eggs. In this instance the human becomes
the intermediate rather than the definitive host. The correct answer is:
a. trichinosis
b. cysticercosis.
c. ascariasis.
d. strongyloidiasis.
ANSWER (b): The accidental
ingestion of Taenia solium eggs can
result in the disease we call cysticercosis.
The cysticerci will develop in a number of different tissues, including
the brain, and the human is the accidental intermediate host.
24. After returning from a 2 year stay in India, the patient had
eosinophilia, an enlarged left spermatic cord and bilateral inguinal
lymphadenopathy. The most likely
clinical specimen and organism match would be:
a. thin blood films and Leishmania spp.
b. urine and concentration for Trichomonas vaginalis.
c. thin blood films and Babesia.
d. thick blood films and microfilariae.
ANSWER (d): Based on the
history, the most relevant procedure to perform would be the preparation and
examination of thick blood films for the recovery and identification of
microfilariae. The symptoms suggest
early filariasis.
25. Which of the following is true about onchocerciasis?
a. The adult worm is present in the blood.
b. The microfilariae are in the blood during the late evening hours.
c. The diagnostic test of choice is the skin snip.
d. The parasite resides in the deep lymphatics.
ANSWER (c): The adult Onchocerca volvulus reside in
subcutaneous nodules and the microfilariae are found in the fluids right under
the outer layers of skin; thus the appropriate diagnostic test is the
microscopic examination of skin snips for the presence of microfilariae.
26. Worldwide, the most
prevalent helminth to infect humans is:
a. Enterobius vermicularis, the pinworm.
b. Ascaris lumbricoides, the large intestinal roundworm.
c. Taenia saginata, the beef tapeworm.
d. Schistosoma mansoni, one of the blood flukes
ANSWER (a): The pinworm, Enterobius vermicularis, may be the most
common parasitic infection throughout the world and the eggs are infective
within just a few hours. Some have said
that “You either had the infection as a child, have it now, or will have it
again when you have children.”
27. A helminth egg is
described as having terminal polar plugs.
The most likely helminth would be:
a. Hookworm
b. Trichuris trichiura
c. Fasciola hepatica
d. Dipylidium caninum
ANSWER (b): The eggs of Trichuris trichiura (the whipworm) have
been described as being barrel-shaped with a thick shell and two polar
plugs.
28. Ingestion of which of
the following will result in human infection:
a. Egg of Strongyloides stercoralis
b. Egg of Schistosoma japonicum
c. Egg of Toxocara canis
d. Egg of Opisthorchis sinensis
ANSWER (c): The eggs of Toxocara canis are infectious for humans
and cause visceral larva migrans. These
ascarid eggs of the dog can infect humans; the eggs hatch and the larvae wander
though the deep tissues, occasionally the eye.
In this case, the human becomes the accidental intermediate host.
29. A helminth egg is described as having a thick radially
striated shell and the shell contains a six-hooked embryo called the
oncosphere. This egg is:
a. Hookworm
b. Schistosoma spp.
c. Strongyloides stercoralis
d. Taenia spp.
ANSWER (d): Taenia spp. cestode eggs have a thick radially striated shell that
contains a six-hooked embryo called the oncosphere. Although the oncosphere can usually be seen
in eggs found in fresh or recently preserved stool, occasionally the embryo may
be more difficult to see in eggs that have been stored for long periods in
formalin. The radial striations can be
seen more closely in the middle and right eggs.
31. The
following proglottid was seen in a fresh stool specimen; the proglottid was subsequently
injected with India ink. Which of the
following is the correct identification?
a. Taenia
saginata
b. Hymenolepis
diminuta
c. Dipylidium caninum
d. Taenia
solium
ANSWER (a): Based on the number
of uterine branches (counted on one side only), T. saginata generally has around 16-18 lateral branches (more than
12), while T. solium tends to have
about 8-10 (less than 12). It is
important to remember to count the branches right where they come off the
central stem and to count one side only.
32. A freshwater snail is always a part of the life cycle in which
of the following groups?
a. Cestodes
b. Trematodes
c. Filarial worms
d. Intestinal nematodes
ANSWER (b): In all groups of
trematodes, there is a freshwater snail in the life cycle. These worms are represented by liver and lung
flukes, intestinal flukes, and the blood flukes, all of which are trematodes.
33. In the left hand column fill in the blank preceding the name of
the organism or topic with one letter from the right hand column. Use each letter only once.
1. _____ Hymenolepis nana a. proglottids wider than long
2. _____ Schistosoma mansoni egg b. 3/8" long
3. _____ Enterobius vermicularis adult c.giant intestinal fluke
4. _____ Taenia solium egg d.large lateral spine
5. _____ Trichuris trichiura egg e internal infection, hyperinfection syndrome
6. _____ Taenia solium proglottid f. sheathed microfilariae
7. _____ Hymenolepis diminuta egg g. egg similar to Trichuris, but with striated shell
8. _____ Wuchereria bancrofti h.responsible for blood-loss anemia
9. _____ Echinococcus granulosus i. egg with polar filaments
10._____ Fasciola hepatica j. daughter cysts
11. _____ Paragonimus spp. k.recovery of helminth eggs and larvae
12. _____ Ascaris lumbricoides egg l. egg with bumpy shell
13. _____ Sedimentation concentration m. scolex with four suckers and no hooks
14. _____ Hookworm spp. n less than 12 lateral uterine branches
15. _____ Permanent stained smear o. egg with no polar filaments
16. _____ Fasciolopsis buski p.confirm protozoa (trophozoites, cysts)
17. _____ Capillaria spp. q.oval shaped with polar plugs
18. _____ Strongyloides stercoralis r.examine both stool and sputum for eggs
19. _____ Diphyllobothrium latum s.radially striated shell containing oncosphere
20. _____ Taenia saginata adult t.liver fluke
ANSWER: The appropriate responses are listed below:
1. i 6. n 11. r 16. c
2. d 7. o 12. l 17. g
3. b 8. f 13. k 18. e
4. s 9. j 14. h 19. a
5. q 10. t 15. p 20. m
34. Because
mature infectious eggs are ingested from the soil, which of the following
parasites might be seen in the same patient at the same time?
a. Hookworm and Ascaris lumbricoides
b. Ascaris lumbricoides and Trichuris trichiura
c. Trichuris trichiura and Schistosoma japonicum
d. Schistosoma japonicum and Hookworm
ANSWER (b): The eggs of both Ascaris lumbricoides and Trichuris trichiura must mature for a
period of time in the soil before they are infectious. Infection occurs when the human ingests these
infectious eggs from the soil. Since
both nematodes are endemic in the same areas of the world, they are often seen
as a mixed infection in humans who have accidentally ingested the mature eggs
from contaminated soil.
35. Which
of the following helminth eggs would not float using the zinc sulfate flotation
concentration method?
a. Paragonimus spp. and Diphyllobothrium latum
b. Opisthorchis sinensis and Taenia spp.
c. Fasciola
hepatica and Hymenolepis nana
d. Unfertilized Ascaris lumbricoides and Trichuris trichiura
ANSWER (a): Using the zinc
sulfate flotation concentration method, heavy eggs (unfertilized A. lumbricoides eggs) and operculated
eggs (Paragonimus, D. latum, O. sinensis,
F. hepatica) will not float using this method. The egg opercula pop open due to the high
specific gravity of the zinc sulfate, fill with zinc sulfate, and sink to the
bottom of the tube. Therefore, using
this method, both the surface film and sediment must be examined before
reporting the concentration as negative.
REFERENCES
Garcia, L.S. 2016. Diagnostic Medical Parasitology, 6th Ed., ASM Press, Washington, D.C.
