Home

AboutMedicalParasitology
ParasitologyExam(HELMINTHS)

NewInfections ***Reminder:Slidesandexaminationquestionsarecopyrightedandcannotbecopied
Ova&Parasite(O&P)Exams forpublication.

CPTCodes2016 1.Theincorrectmatchbetweenorganismandtheappropriatediagnosticprocedure
Quizzes is:
ReviewTests
a.Onchocercavolvulusexaminationofskinsnips
FAQ b.Cryptosporidiummodifiedacidfaststain
InformationTables c.Echinococcusgranulosusroutineovaandparasiteexamination
d.Schistosomahaematobiumexaminationofurinesediment
OrganismIndex(AZ)
ANSWER(c):TheappropriateprocedureforthediagnosisofEchinococcusgranulosus
(hydatid disease) would involve the microscopic examination of hydatid fluid aspirated
fromacyst.Immaturescolicesand/orhookletswouldbefoundinthecentrifugedfluid
sedimentandcouldbeidentifiedunderthemicroscope.

2.CharcotLeydencrystalsinstoolmaybeassociatedwithanimmuneresponse
andarethoughttobethebreakdownproductsof:

a.neutrophils
b.eosinophils
c.monocytes
d.lymphocytes

ANSWER(b):Wheneosinophilsdisintegrate,thegranulesreformintoCharcotLeyden
crystals.Eosinophilsaremorelikelytobepresentinpatientswithhelminthinfections
(ratherthanprotozoa).

3. Morphological characteristics of the rhabditiform (noninfective) larvae of
Strongyloidesstercoralisare:

a.ashortbuccalcapsuleandlargegenitalprimordium
b.alongbuccalcapsuleandpointedtail
c.ashortbuccalcapsuleandsmallgenitalprimordium
d.asmallgenitalprimordiumandnotchintail

ANSWER(a):TherhabditiformlarvaeofStrongyloidesstercoralisarecharacterizedby
theshortbuccalcapsule(mouth)andlargegenitalprimordiumthesehookwormlarvae
havealongbuccalcapsuleandverysmallgenitalprimordium.

4. Visceral and ocular larva migrans are associated with which of the following
organismsanddiagnostictest?

a.Toxocaraserology
b.Onchocercaskinsnips
c.Dracunculusskinbiopsy
d.AngiostrongylusCSFexamination

ANSWER(a):Toxocaraspp.causevisceraland/orocularlarvamigrans,whichoccurs
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
choiceistheserology.

5. The following organisms are linked with specific, relevant information. The
incorrectcombinationis:

a.Strongyloidesstercoralisinternalautoinfection
b.Echinococcusgranulosushydatiddisease
c.Taeniasoliumhumancanserveasdefinitiveandintermediatehosts
d.SchistosomamansonicommonwithintheUnitedStates

ANSWER(d): Schistosoma mansoni is a blood fluke that is pathogenic for humans
theseparticularwormsresideintheveinsoverthelargeintestine.Theegghasavery
large lateral spine eggs can be recovered from the stool in infected patients. The
infection is not endemic within the UnitedStates. However, the eggs may be seen in
proficiency testing specimens. So, although it is not common, laboratories must still
beabletoidentifytheseorganisms.

6.Examinationofa24hourunpreservedurinespecimenissometimeshelpfulin
therecoveryof:

a.Trichomonasvaginalistrophozoites
b.Schistosomahaematobiumeggs
c.Enterobiusvermiculariseggs
d.Strongyloidesstercoralislarvae

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
viabilitycanalsobedetermined.

7.The examination of sputum and stool may be necessary to diagnose infection

with:

a.Paragonimuswestermani
b.Trichinellaspiralis
c.Wuchereriabancrofti
d.Fasciolahepatica

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
examinationfortheeggs.

8.Twohelmintheggsthatmayresembleoneanotherare:

a.DiphyllobothriumlatumandParagonimuswestermani
b.OpisthorchissinensisandFasciolopsisbuski
c.TaeniasaginataandHymenolepisnana
d.AscarislumbricoidesandTrichostrongylus

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
thickenedabopercularendandshouldersintowhichtheoperculumfits.

9.Eatingpoorlycookedporkcanleadtoaninfectionwith:

a.TaeniasoliumandTrichinellaspiralis
b.TaeniasaginataandHymenolepisnana
c.TrichuristrichiuraandHymenolepisdiminuta
d.DiphyllobothriumlatumandAscarislumbricoides

ANSWER (a): Both Taenia solium (pork tapeworm) and Trichinella spiralis can be
acquiredfromtheingestionofraworpoorlycookedinfectivepork.

10.Anoperculatedcestodeeggthatcanberecoveredinhumanfecesis:

a.Clonorchissinensis
b.Diphyllobothriumlatum
c.Paragonimuswestermani
d.Dipylidiumcaninum

ANSWER(b):Diphyllobothriumlatumistheonlyoperculatedcestodeeggthatisfound
inhumanstheinfectionisacquiredfromtheingestionofrawfreshwaterfish.

11.TheadulttapewormofEchinococcusgranulosusisfoundintheintestineof:

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
intestineofthedog.

12.IninfectionswithTaeniasolium,mancanserveasthe:

a.definitivehost
b.intermediatehost
c.definitiveand/ortheintermediatehost
d.noneoftheabove

ANSWER(c):IfhumansingestTaeniasoliumcysticerciinuncookedorrarepork,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(accidentalintermediatehost),causingcysticercosis.

13.HumansacquireinfectionswithDiphyllobothriumlatumadultwormsby:

a.ingestionoffreshwatercrabs
b.skinpenetrationofcercariae
c.ingestionofwaterchestnuts
d.ingestionofinfectedrawfreshwaterfish

ANSWER(d): The ingestion of raw fresh water fish containing the encysted larvae of
Diphyllobothriumlatum will result in the development of an adult tapeworm within the
humanintestine.

14. Humans can serve as both the intermediate and definitive host in infections
causedby:

a.Enterobiusvermicularis
bHymenolepisnana
c.Schistosomajaponicum
d.Ascarislumbricoides

ANSWER(b):Hymenolepisnanaisoneofthetapewormswherehumansserveasboth
intermediate and definitive hosts. When ingested, the oncosphere penetrates the
intestinal mucosa, develops into the mature cysticercoid (human is intermediate host),
andreturnstothegutwheretheadulttapewormmatures(humanisdefinitivehost).

15. Organisms (and infections) that under normal conditions could not be
transmittedinthelaboratoryare:

a.Hymenolepisnanadwarftapewormdisease
b.Taeniasoliumcysticercosis
c.Ascarislumbricoidesascariasis
d.Enterobiusvermicularispinworminfection

ANSWER(c): Ascarislumbricoides eggs require a period of development in the soil

before they are infective for humans.The other organisms listed could be transmitted
withinthelaboratoryorinthehospitalsetting.

16.Whichmicrofilariaeareusuallynotfoundcirculatingintheperipheralblood?

a.Brugiamalayi
b.Loaloa
c.Wuchereriabancrofti
d.Onchocercavolvulus

ANSWER(d):ThemicrofilariaeofOnchocercavolvulusarenormallyfoundinthefluid
right under the outer layer of skin. Therefore, the skin snip is the proper specimen to
examine.

17.Themiracidialhatchingtesthelpstodemonstratetheviabilityof:

a.eggsofTaeniaspecies.
b.eggsofSchistosomaspecies.
c.eggsofhookwormspecies.
d.eggsofOpisthorchis.

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 Schistosomaspecies. Once the eggs were hatched, the living miracidium
larvaewouldbevisibleinthewater.

18.Theincorrectmatchbetweenorganismandcharacteristicis:

a.Fasciolahepaticaandliverinfection
b.Trichuristrichiuraandeggswithpolarplugs
c.Echinococcusgranulosusanddaughtercysts
d.Schistosomamansoniandeggwithterminalspine

ANSWER (d): The egg of Schistosoma mansoni is characterized by having a large

lateralspineS.haematobiumhasthecharacteristicterminalspine.

19. An immunosuppressed male had several episodes of pneumonia, intestinal

pain, and sepsis with Gram negative rods, and a history of military service in
SoutheastAsia20yearsearlier.Theorganismis:
a.Fasciolopsisbuski
b.Strongyloidesstercoralis
c.Hookworm
d.Paragonimuswestermani

ANSWER (b): A latent infection with Strongyloides stercoralis acquired years before
may cause severe symptoms in the immunosuppressed patient (autoinfective
capabilityoflifecycleandmigratoryroutethroughthebody).

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
mildandselflimitedinfectionandiscausedby:

a.Necatoramericanus
b.Angiostrongyluscantonensis
c.Ancylostomabraziliense
d.Strongyloidesstercoralis

ANSWER (b): Eosinophilic meningoencephalitis is a form of larva migrans and is

causedbyAngiostrongyluscantonensis,theratlungworm.This Pacific area infection
isassociatedwithCSFsymptomsandsometimeseyeinvolvement.

21. When humans have cystic hydatid disease, the causative agent and host
classificationare:

a.Echinococcusgranulosusaccidentalintermediatehost.
b.Echinococcusgranulosusdefinitivehost.
c.Taeniasoliumaccidentalintermediatehost.
d.Taeniasoliumdefinitivehost.

ANSWER(a):ThecauseofcystichydatiddiseaseisEchinococcusgranulosusandthe
humanisclassifiedastheaccidentalintermediatehost.Infectionoccurswhenhumans
ingestE.granulosus eggs and the hydatid cyst(s) develop in the liver and lung of the
humaninsteadofsheep(normalcycle).
22.A45yearoldhunterdevelopedfever,myalgia,andperiorbitaledema.Hehasa
historyofbearmeatconsumption.Themostlikelycausativeagentis:

a.Toxoplasmagondii
b.Taeniasolium
c.Hymenolepisnana
d.Trichinellaspiralis

ANSWER(d):Infected bear meat is an excellent source of Trichinellaspiralis.In this

case, the patient had evidently consumed poorly cooked bear meat, thus ingesting the
encystedlarvaeofT.spiralis.

23.Thisconditionresultsfromtheaccidentalingestionofhelmintheggs.Inthis
instance the human becomes the intermediate rather than the definitive host.
Thecorrectansweris:

a.trichinosis
b.cysticercosis.
c.ascariasis.
d.strongyloidiasis.

ANSWER(b):TheaccidentalingestionofTaeniasoliumeggscanresultinthedisease
we call cysticercosis. The cysticerci will develop in a number of different tissues,
includingthebrain,andthehumanistheaccidentalintermediatehost.

24. After returning from a 2 year stay in India, the patient had eosinophilia, an
enlargedleftspermaticcordandbilateralinguinallymphadenopathy.Themost
likelyclinicalspecimenandorganismmatchwouldbe:

a.thinbloodfilmsandLeishmaniaspp.
b.urineandconcentrationforTrichomonasvaginalis.
c.thinbloodfilmsandBabesia.
d.thickbloodfilmsandmicrofilariae.

ANSWER(d):Based on the history, the most relevant procedure to perform would be

thepreparationandexaminationofthickbloodfilmsfortherecoveryandidentification
ofmicrofilariae.Thesymptomssuggestearlyfilariasis.

25.Whichofthefollowingistrueaboutonchocerciasis?

a.Theadultwormispresentintheblood.
b.Themicrofilariaeareinthebloodduringthelateeveninghours.
c.Thediagnostictestofchoiceistheskinsnip.
d.Theparasiteresidesinthedeeplymphatics.

ANSWER(c):TheadultOnchocercavolvulusresideinsubcutaneousnodulesandthe
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
presenceofmicrofilariae.

26.Worldwide,themostprevalenthelminthtoinfecthumansis:

a.Enterobiusvermicularis,thepinworm.
b.Ascarislumbricoides,thelargeintestinalroundworm.
c.Taeniasaginata,thebeeftapeworm.
d.Schistosomamansoni,oneofthebloodflukes

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.SomehavesaidthatYoueitherhadtheinfectionasachild,haveitnow,orwill
haveitagainwhenyouhavechildren.

27.A helminth egg is described as having terminal polar plugs.The most likely
helminthwouldbe:

a.Hookworm
b.Trichuristrichiura
c.Fasciolahepatica
d.Dipylidiumcaninum

ANSWER(b):The eggs of Trichuristrichiura (the whipworm) have been described as

beingbarrelshapedwithathickshellandtwopolarplugs.

28.Ingestionofwhichofthefollowingwillresultinhumaninfection:

a.EggofStrongyloidesstercoralis
b.EggofSchistosomajaponicum
c.EggofToxocaracanis
d.EggofOpisthorchissinensis

ANSWER(c):TheeggsofToxocaracanisareinfectiousforhumansandcausevisceral
larvamigrans. 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
humanbecomestheaccidentalintermediatehost.

29. A helminth egg is described as having a thick radially striated shell and the
shellcontainsasixhookedembryocalledtheoncosphere.Thiseggis:

a.Hookworm
b.Schistosomaspp.
c.Strongyloidesstercoralis
d.Taeniaspp.

ANSWER(d):Taeniaspp.cestodeeggshaveathickradiallystriatedshellthatcontains
a sixhooked embryo called the oncosphere.Although the oncosphere can usually be
seenineggsfoundinfreshorrecentlypreservedstool,occasionallytheembryomaybe
more difficult to see in eggs that have been stored for long periods in formalin. The
radialstriationscanbeseenmorecloselyinthemiddleandrighteggs.

31.Thefollowingproglottidwasseeninafreshstoolspecimentheproglottidwas
subsequently injected with India ink. Which of the following is the correct
identification?

a.Taeniasaginata
b.Hymenolepisdiminuta
c.Dipylidiumcaninum
d.Taeniasolium

ANSWER(a):Basedonthenumberofuterinebranches(countedononesideonly),T.
saginata generally has around 1618 lateral branches (more than 12), while T. solium
tends to have about 810 (less than 12). It is important to remember to count the
branchesrightwheretheycomeoffthecentralstemandtocountonesideonly.

32. A freshwater snail is always a part of the life cycle in which of the following
groups?

a.Cestodes
b.Trematodes
c.Filarialworms
d.Intestinalnematodes

ANSWER(b):Inallgroupsoftrematodes,thereisafreshwatersnailinthelifecycle.
These worms are represented by liver and lung flukes, intestinal flukes, and the blood
flukes,allofwhicharetrematodes.

33.Inthelefthandcolumnfillintheblankprecedingthenameoftheorganismor
topicwithoneletterfromtherighthandcolumn.Useeachletteronlyonce.

1._____Hymenolepisnanaa.proglottidswiderthanlong
2._____Schistosomamansonieggb.3/8"long
3._____Enterobiusvermicularisadultc.giantintestinalfluke
4._____Taeniasoliumeggd.largelateralspine
5._____Trichuristrichiuraeggeinternalinfection,hyperinfectionsyndrome
6._____Taeniasoliumproglottidf.sheathedmicrofilariae
7._____Hymenolepisdiminutaeggg.eggsimilartoTrichuris,butwithstriatedshell
8._____Wuchereriabancroftih.responsibleforbloodlossanemia
9._____Echinococcusgranulosusi.eggwithpolarfilaments
10._____Fasciolahepaticaj.daughtercysts
11._____Paragonimusspp.k.recoveryofhelmintheggsandlarvae
12._____Ascarislumbricoideseggl.eggwithbumpyshell
13._____Sedimentationconcentrationm.scolexwithfoursuckersandnohooks
14._____Hookwormspp.nlessthan12lateraluterinebranches
15._____Permanentstainedsmearo.eggwithnopolarfilaments
16._____Fasciolopsisbuskip.confirmprotozoa(trophozoites,cysts)
17._____Capillariaspp.q.ovalshapedwithpolarplugs
18._____Strongyloidesstercoralisr.examinebothstoolandsputumforeggs
19._____Diphyllobothriumlatums.radiallystriatedshellcontainingoncosphere
20._____Taeniasaginataadultt.liverfluke

 ANSWER:Theappropriateresponsesarelistedbelow:
1.i6.n11.r16.c
2.d7.o12.l17.g
3.b8.f13.k18.e
4.s9.j14.h19.a
5.q10.t15.p20.m

34. Because mature infectious eggs are ingested from the soil, which of the
followingparasitesmightbeseeninthesamepatientatthesametime?

a.HookwormandAscarislumbricoides
b.AscarislumbricoidesandTrichuristrichiura
c.TrichuristrichiuraandSchistosomajaponicum
d.SchistosomajaponicumandHookworm

ANSWER (b): The eggs of both Ascaris lumbricoides and Trichuris trichiura must
matureforaperiodoftimeinthesoilbeforetheyareinfectious.Infectionoccurswhen
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
humanswhohaveaccidentallyingestedthematureeggsfromcontaminatedsoil.

35. Which of the following helminth eggs would not float using the zinc sulfate
flotationconcentrationmethod?

a.Paragonimusspp.andDiphyllobothriumlatum
b.OpisthorchissinensisandTaeniaspp.
c.FasciolahepaticaandHymenolepisnana
d.UnfertilizedAscarislumbricoidesandTrichuristrichiura

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)willnotfloatusingthismethod.Theeggoperculapopopendue
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
mustbeexaminedbeforereportingtheconcentrationasnegative.

REFERENCES
Garcia,L.S.2016.DiagnosticMedicalParasitology,6thEd.,ASMPress,
Washington,D.C.

Copyright20052015MedicalChemicalCorporation(MCC).Allrightsreserved.
WebsitedevelopedbyXciteMarketingServicesandmaintainedbyAlexWang