1. health and fitness
2. disease

Year 1 Medical Microbiology and Virology OSPE
(Objective structured practical examination)
SAMPLE OSPE QUESTIONS
The following OSPE questions are examples. They are intended to allow candidates to become familiar
with the style and content of the Year 1 OSPE.
Answers, together with marks for each question, are also provided below. Please remember that the
marking scheme is a general guide for the assessors/examiners.
Please note that assessors/examiners, when marking OSPE papers will consider additional information
provided by the candidates and may assess the overall standard of the responses.
No
Topic
Additional materials provided
at station
1
(Bank 6)
2
(Bank 12)
Hepatitis B
Hepatitis Report
No
MRSA infection and
infection control
Laboratory report
No
3
(Bank
16a)
4
(Bank 17)
Parvovirus B19 in
pregnancy
None
No
Coagulase negative
staphylococcus in
blood culture, i.e.
likely contaminant
x 4 Images
No
5
(Bank 20)
Containment Level 3
Laboratory (CL3)
Picture of CL3 laboratory
Cat 1 safety cabinet
No
6
(Bank
30a)
7
(Bank 45)
Catheter-associated
UTI
None
No
Writing a report:
Understanding the
concept of coloniser
rather than pathogen
 CLED plate with a moderate pure growth of NLF.
Image B
 Give oxidase result – positive
 Gram film of typical colony from CLED plate, Image A
 Image C: Mueller-Hinton agar (and appropriate
sensitivities) with Pseudomonas aeruginosa –
producing clear green pigmentation – with zone sizes
and sensitivities, given (sensitive to ceftazidime,
ciprofloxacin, gentamicin, pip-tazo and meropenem).
8
(Bank 50)
Candidaemia
ASM
Assessor
present?
 Slide/Image with Gram’s stain of positive blood culture
containing a yeast (Candida spp.)
April 2013
Page 1 of 17
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No
No
QUESTION 1 – HEPATITIS B
Aims
To assess:

ability to interpret the results of investigations (Good Medical Practice curriculum - good
clinical care).

ability to liaise and discuss investigations with colleagues and to advise them appropriately
(Good Medical Practice curriculum - good clinical care)

understanding of wider public health issues

understanding the role of immunisation in the protection of contacts
Materials required
 Hepatitis report (included)
Assessor required

No
Question
A 24-year-old gay man visits his GP with a four-day history of increasing malaise, nausea and
vomiting. That morning he noticed that his sclera were a deep yellow colour. His GP sent blood to
virology and asked him to return the next day.
Please examine the virology results and answer the following questions.
1.
What is the most likely diagnosis in this patient? (5 marks)
2.
Explain the hepatitis A results. (2 marks)
3.
Explain the Hepatitis B results. (2 marks)
4.
Explain the Hepatitis C results. (2 marks)
5.
Give three possible risk factors for infection in this case. (3 marks)
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April 2013
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Marking scheme
No.
Question
Answer
Marks
A 24-year-old gay man visits his GP with a four-day history of increasing malaise,
nausea and vomiting. That morning he noticed that his sclera were a deep
yellow colour. His GP sent blood to virology and asked him to return the next
day.
Please examine the virology results and answer the following questions.
1
What is the most likely
diagnosis in this patient?
Acute Hepatitis B.
Hepatitis B infection.
No marks for other answers.
5
2
(Max 5)
2
Explain the hepatitis A
results.
Past exposure to hepatitis A as total antibody is
positive and IgM negative.
2
3
Explain the Hepatitis B
results.
All markers positive including HepB core IgM.
All markers positive.
4
Explain the Hepatitis C
results.
No serological evidence of hepatitis C.
2
1
(Max 2)
2
5
Give three possible risk
factors for infection in this
case.
Intravenous drug use.
Sharps/needle stick injury.
Male homosexuality.
Transfusion of blood products.
Tattoos and other piercing (contaminated
instruments).
1
1
1
1
1
(Max 3)
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QUESTION 2 – MRSA INFECTION AND INFECTION CONTROL
Aims
To assess:
To assess:

core reporting skills, and be able to offer basic advice on the interpretation of laboratory results
(fundamental skills)

ability to analyse a clinical history in a relevant succinct and logical manner (good clinical
care).

ability to interpret the results of investigations (good clinical care).

Ability to analyse and advise on clinical infection problems (good clinical care)

a basic understanding of the management (under supervision) of common nosocomial
infections (core knowledge)

understanding of routes of transmission and methods of preventing nosocomial spread of
common and important infecting organisms (core knowledge)
Materials required
 Laboratory report (included)
Assessor required

No
Question
You receive a phone call from one of the FY2 doctors in the Minor Injuries Unit about a wound
swab (taken a couple of days ago) that is awaiting authorisation. The patient has re-presented and
is to be admitted with severe cellulitis spreading from the leg wound, temperature 38.5C with
rigors. Look at the report that is provided and answer the following questions.
Bigtown General Hospital
Microbiology Laboratory
Name: Susan Smith
Age: 30
Ward: Minor injuries unit
Specimen: Wound swab
Clinical details: Fall at work, injury to leg.
Culture Report:
Staphylococcus aureus ++
Resistant to: penicillin, flucloxacillin, erythromycin
Sensitive to: tetracycline, vancomycin, fusidic acid, rifampicin
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1.
How is the organism that has been reported commonly known? (3 marks)
2.
The FY2 wants to start the patient on cefuroxime. Is this a suitable choice? Justify your
answer. (4 marks)
3.
From the antimicrobials whose sensitivities have been reported, which agent/s would you
recommend to treat this infection and by which route? (3 marks)
4.
What other microbiology specimens would you advise taking? (3 marks)
Marking scheme
No.
Question
Answer
Marks
You receive a phone call from one of the FY2 doctors in the Minor Injuries Unit about a wound swab
(taken a couple of days ago) that is awaiting authorisation. The patient has re-presented and is to be
admitted with severe cellulitis spreading from the leg wound, temperature 38.5C with rigors. Look at
the report that is provided and answer the following questions.
1
How is the organism that has been
reported commonly known?
MRSA.
Methicillin-resistant S. aureus.
Meticillin-resistant S. aureus.
Any other name.
2
The FY2 wants to start the patient on
cefuroxime. Is this a suitable choice?
Justify your answer.
No.
Yes.
MRSA are cefuroxime resistant.
Other justification.
3
4
From the antimicrobials whose
sensitivities have been reported,
which agent/s would you recommend
to treat this infection and by which
route?
Vancomycin, i.v.
(plus or minus any sensitive oral agent).
Vancomycin as oral therapy.
What other microbiology specimens
would you advise taking?
Blood cultures
MRSA screen (eg, nose & groin/perineum)
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April 2013
Any two sensitive oral agents.
Any single sensitive oral agent.
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3
3
3
0
(Max 3)
3
0
1
0
(Max 4)
3
0
1
0
(Max 3)
2
1
(Max 3)
QUESTION 3 - PARVOVIRUS B19 IN PREGNANCY
Mapping to Blueprint
Good Medical Practice – good clinical care
Stage A Curriculum – core knowledge – basic diagnosis and ability to distinguish between
significant and non-significant pathogens
Aims
To assess:

To assess knowledge of basic skills of viral diagnostics

ability to liaise and discuss investigations with colleagues and to advise them appropriately
(Good Medical Practice curriculum - good clinical care)

Basic understanding and knowledge of the range of therapies available for infectious disease
and the clinical indications for their use (Stage A - core knowledge)

understanding of wider public health issues
Materials required
 None
Assessor required
 No
Question
An ultrasound scan of a fetus was carried out at 22 weeks gestation because the mother reported
having a maculopapular rash at 14 weeks gestation. This scan revealed a hydropic fetus.
1.
What is the most likely viral diagnosis? (4 marks)
2.
What is the risk of congenital malformation from this infection? (2 marks)
3.
What virological tests would you request on the mother? (4 marks)
4.
What virological tests would you request on the fetus? (2 marks)
5.
What treatment is available for the fetus? (2 marks)
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Marking scheme
No.
Question
Answer
Marks
1
What is the most likely
viral diagnosis?
Parvovirus B19 (erythrovirus) infection
Human parvovirus
4
4
2
What is the risk of
congenital malformation
from this infection?
No excess risk
2
3
What virological tests
would you request on the
mother?
Paired serology (IgG) on booking blood and current
sample.
Serum B19 virus IgM
B19 Virus PCR
2
4
What virological tests
would you request on the
fetus?
B19 Virus PCR on amniotic fluid/fetal blood
2
5
What treatment is
available for the fetus?
Intrauterine blood transfusion
2
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April 2013
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2
1
(Max 4)
QUESTION 4 - COAGULASE NEGATIVE STAPHYLOCOCCUS IN BLOOD
CULTURE, I.E. LIKELY CONTAMINANT
Mapping to Blueprint
Good Medical Practice – good clinical care
Stage A Curriculum – core knowledge – basic diagnosis and ability to distinguish between
significant and non-significant pathogens
Aims
To assess:

ability to analyse a clinical history in a relevant succinct and logical manner (Good Medical
Practice curriculum - clinical care)

ability to identify common bacterial pathogens with confirmation of identity and distinction
between significant and non-significant pathogens (Stage A – core knowledge)

whether candidate has sufficient understanding of microbiology to offer basic advice on the
interpretation of laboratory results (Stage A – core knowledge)
Materials required
 x 4 Images (online on the College website)
Assessor required

No
Question
This question is based on a blood culture taken in your Accident and Emergency Department from a 68 year old female with clinical details given as: 'Fever ? UTI'.
Please write a laboratory report with interpretive comments for this peripheral blood culture
investigation positive in the aerobic bottle only after 3 days incubation. (16 marks)
Image A
Culture (A) derived from the single positive blood culture, on blood agar incubated aerobically for
24h
Image B
Gram film of typical colony from A
Image C
Staphaurex test on typical colony from A
Image D
Tube coagulase test on typical colony from A
Image E
Sensitivity plate from organism growing on A
The sensitivity results are as follows:
Cefoxitin = methicillin resistant
clarithromycin resistant
fusidic acid sensitive
rifampicin sensitive
gentamicin sensitive
vancomycin sensitive
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April 2013
Page 8 of 17
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Marking scheme
No.
Question
Answer
Marks
This question is based on a blood culture taken in your Accident and
Emergency Department - from a 68 year old female with clinical details
given as: 'Fever ? UTI'.
1
Please write a
laboratory report with
interpretive comments
for this peripheral blood
culture investigation
positive in the aerobic
bottle only after 3 days
incubation.
ASM
Coagulase negative staphylococcus isolated.
From one of 2 bottles.
After 3 days incubation.
3
2
1
(Max 6)
Skin commensal of low pathogenic potential or
likely skin contaminant or similar.
Please repeat if clinically appropriate.
No contaminant comment.
No repeat requested.
5
April 2013
Page 9 of 17
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3
0
0
(Max 5)
QUESTION 5 – CONTAINMENT LEVEL 3 LABORATORY (CL3)
Mapping to Blueprint
Curriculum Stage A – core knowledge, health and safety
Aims
To assess:

Ability to understand principles of standard precautions, hazard groups and containment levels
(Core knowledge)

Knowledge of the essential features of a Containment Level 3 (CL3) laboratory (Core
knowledge)
Materials required
 Picture of a CL3 Laboratory - Images A&B (online on the College website)
Assessor required

No
Question
1.
What sort of laboratory is featured in Images A&B? (5 marks)
2.
List FIVE essential features of this laboratory. (5 marks)
3.
Which ACDP group(s) of organisms would be handled safely in this laboratory?
[List groups not organisms] (5 marks)
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Marking scheme
No.
Question
Answer
Marks
1
What sort of laboratory is featured in
Images A&B?
CL3
5
2
List FIVE essential features of this
laboratory.
Negative pressure
HEPA - filtered exhaust
Sealable
Separate work area
Incorporate a lobby
Glass window
Dedicated equipment
Warning sign
Lockable door
Authorised personnel only
Internal alarm
External switch for fumigation
3
Which ACDP group(s) of organisms
would be handled safely in this
laboratory?
(List groups not organisms)
Groups 1,2,& 3
Group 3
1 & or 2
Any mention of group 4
1
1
1
1
1
1
1
1
1
1
1
1
(Max 5)
5
4
1
0
(Max 5)
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April 2013
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QUESTION 6 - CATHETER-ASSOCIATED UTI
Mapping to Blueprint
Aims

Be able to analyse a clinical history in a relevant succinct and logical manner (Good clinical
care).

Be able to interpret the results of investigations (Good clinical care).

Be able to analyse and advise on clinical infection problems (Good clinical care)

Be able to understand principles of standard precautions, hazard groups and containment
levels (Core knowledge)

To have a basic understanding of the management (under supervision) of common
nosocomial infection (Core knowledge)

To have a basic understanding and knowledge of the range of therapies available for
infectious disease, the clinical indications for their use and their side effect (Core knowledge)
Materials required
 None
Assessor required

No
Question
A 75-year old female was admitted following a fall at home. She had been very well until this event,
and had had little contact with healthcare services. A urinary catheter was inserted for urinary
retention. After several days, a urine culture showed the presence of Pseudomonas aeruginosa.
The patient was systemically well until 3 weeks after admission when she became confused and
developed a temperature of 38oC. She was started on oral nitrofurantoin. The following day, she
remained febrile and had a rigor.
1.
Would you routinely treat a patient with a positive catheter urine culture in the absence of
systemic or urinary symptoms? Give TWO reasons to justify your answer. (3 marks)
2.
Give TWO reasons why the episode of catheter-related infection is unlikely to respond to
nitrofurantoin. (2 marks)
3.
Name TWO antimicrobial agents that could be used to treat this patient, assuming
P.aeruginosa is the cause of her infection. One of these should be suitable for use in a
patient with a confirmed anaphylactic reaction to penicillin. (2 marks)
4.
Does this patient require isolation on infection control grounds? Justify your answer.
(2 marks)
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Marking scheme
No.
Question
Answer
Marks
1
Would you routinely treat a No
patient with a positive
Yes
catheter urine culture in
the absence of systemic or
urinary symptoms?
1
0
Give TWO reasons to
justify your answer.
1
Antibiotics do not eradicate the organism from
the catheter
May promote resistance
Antibiotics do not reduce risk of febrile episodes
Antibiotics predispose to C.difficile
1
1
1
Total
2
3
4
(Max 3)
1
1
Give TWO reasons why
the episode of catheterrelated infection is unlikely
to respond to
nitrofurantoin.
Name TWO antimicrobial
agents that could be used
to treat this patient,
assuming P.aeruginosa is
the cause of her infection.
One of these should be
suitable for use in a
patient with a confirmed
anaphylactic reaction to
penicillin.
Pseudomonas is resistant to nitrofurantoin.
Nitrofurantoin only reaches therapeutic
concentrations in the urine, serum levels
inadequate to treat systemic infection
Does this patient require
isolation on infection
control grounds?
Justify your answer.
No
1
Standard precautions when handling the
catheter should be adequate to prevent spread
of the organism.
1
ASM
April 2013
Ceftazidime, piperacillin/tazobactam,
meropenem
(Max 2)
1
1
Gentamicin*, ciprofloxacin* (*In allergy)
(Max 2)
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QUESTION 7 - WRITING A REPORT: UNDERSTANDING THE CONCEPT
OF COLONISER RATHER THAN PATHOGEN
Mapping to Blueprint
Fundamental skills
 gained a basic understanding of quality assurance in the diagnostic laboratory
 developed, under supervision, core reporting skills
 sufficient understanding of microbiology, virology, mycology and parasitology to offer basic
advice on the interpretation of laboratory results
Core knowledge
 Basic biology
 Biological variability
 Host pathogen relationships
 Basic principles of diagnostic microbiology and virology
 Clinical syndromes - advice and management
Good Medical Practice
 Clinical practice history, examination, management of chronic disease, continuity of care
 Investigation
 Decision-making
 Overall clinical judgement
 Epidemiology and screening
Materials required
 CLED plate with a moderate pure growth of NLF. Image B
 Give oxidase result – positive
 Gram film of typical colony from CLED plate, Image A
 Image C: Mueller-Hinton agar (and appropriate sensitivities) with Pseudomonas aeruginosa –
producing clear green pigmentation – with zone sizes and sensitivities, given (sensitive to
ceftazidime, ciprofloxacin, gentamicin, pip-tazo and meropenem).
The images are available on the College website
Assessor required

No
Question
History





52-year old female. 48 hours post cholecystectomy.
She has a fever of 37.5 degrees centigrade and is clinically well.
Wound has clear serous ooze without erythema.
Patient had received ceftriaxone and metronidazole as prophylaxis.
The wound swab is put up on blood agar (incubated aerobically and anaerobically) and on
CLED*.
Please examine Images A, B & C.
Image B is derived from the wound swab after 18h of aerobic incubation and shows typical
colonies on a CLED *(Cystine – Lactose - Electrolyte Deficient) agar plate. Moderate growth.
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Image A is a Gram film of a typical colony from the CLED plate.
Typical colonies from the CLED plate are Oxidase Positive.
Image C shows a Mueller-Hinton agar plate with sensitivity tests on typical colonies.
Disk
Cip 5
TZP 110
Antibiotic
ciprofloxacin
Piperacillintazobactam
meropenem
ceftazidime
amikacin
gentamicin
Mem 10
Caz 30
AK 30
CN 10
1.
Zone size
28mm
27mm
Interpretation
sensitive
sensitive
25mm
25mm
22mm
21mm
sensitive
sensitive
sensitive
sensitive
Write the laboratory report for this specimen that will be delivered to the ward. (10 marks)
Marking scheme
No.
Question
Answer
Marks
1
Write the laboratory report
for this specimen that will
be delivered to the ward.
Moderate numbers of Pseudomonas aeruginosa
isolated
Moderate numbers of Pseudomonas species
Moderate numbers of oxidase positive GNB
2
Significance doubtful/likely coloniser only
No interpretation of significance
4
0
Sensitivities available on request/not reported
Sensitivities reported
4
0
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April 2013
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2
1
(Max 2)
QUESTION 8 - CANDIDAEMIA
Aims

Be able to demonstrate competence in taking relevant clinical/infection history

To assess ability to identify common viral/microbial pathogens with confirmation of identity,
and distinction between significant and non-significant pathogens

To have a basic understanding of the management of deep infection (e.g. septicaemia,
endocarditis, bone infection)

To have a basic understanding of the management of common nosocomial infection (e.g.
device-associated infection)


Materials required
Slide/Image with Gram’s stain of positive blood culture containing a yeast (Candida spp.)
(online on the College website)
Assessor required
Yes
The aerobic bottle of a blood culture from a 62-year old man became positive after 48 hours of
incubation. He had been in the intensive care unit for the preceding 10-days with necrotising
pancreatitis and had initially received piperacillin-tazobactam. He subsequently developed a fever,
and was switched to intravenous meropenem although the fever had not resolved despite 5-days’
treatment with this.
1.
What can be seen in the Gram’s stain of the blood culture? (2 marks)
2.
When discussing this positive blood culture with the clinical team, what further information
would you seek? (9 marks)
3.
You discover that he has low blood pressure (82/50mmHg) but no other organ failure, has a
central venous catheter in situ for CVP monitoring, and has received no antifungal drugs
during this admission. (2 marks)
What immediate patient management advice would you offer? (2 marks)
4.
What advice about duration of treatment would you give? (4 marks)
What further THREE investigations could help to guide duration? (3 marks)
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April 2013
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Marking scheme
No.
Question
Answer
Marks
1
What can be seen in the Gram’s
stain of the blood culture material?
Yeasts or Candida
Fungi
2
1
(Max 2)
2
3
4
When discussing this positive blood
culture with the clinical team, what
further information would you seek?
Severity of illness markers
(haemodynamic status, inotrope
requirements, ventilation requirements,
white cell count, other organ failure,
pancreatitis severity score etc).
3
Current/recent antifungal drug
prescription
2
Presence of a central venous catheter
Other interventions/surgical/radiological
2
2
(Max 9)
You discover that he has low blood
pressure (82/50mmHg) but no other
organ failure, has a central venous
catheter in situ for CVP monitoring,
and has received no antifungal
drugs during this admission.
Any amphotericin B preparation
Any echinocandin
Voriconazole
Fluconazole
Itraconazole
2
2
2
2
1
What immediate patient
management advice would you
offer?
Advise CVC removal/exchange
2
What advice about duration of
treatment would you give?
Typically 2 weeks (if uncomplicated)
From fever resolution/last positive
culture
2
2
(Max 4)
What further THREE investigations
could help to guide duration?
Repeat blood culture
Image abdomen (- ?collection for
drainage)
Fundoscopy
Blood marker response
1
1
(Max 4)
1
1
(Max 3)
(Total
Max 7)
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April 2013
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