High Yield Microbiology and

Immunology Images
Kim Moscatello, Ph.D.
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Image One line vignette or

high yield fact
 High Yield
These images (and or pathogens) have
better than a 50% chance of being on step
USMLE step I
 Neisseria gonorrhoeae
Gram negative diplococci in PMNs

17 year old male with

painful urination and
mucoid discharge.
Giardia lamblia
Malodorous stools
with steatorrhea after
drinking untreated
stream water
Trichomonas vaginalis

Frothy green
malodorous discharge
from a patient who
complains of vaginal
itching
Gardnerella vaginalis
Clue cell

Malodorous watery
discharge
Varicella Zoster Virus
chickenpox

12 year old female

with vesicular rash.
Plasmodium falciparum
banana shaped gamete
Patient who traveled
to Africa with cyclic
fever and rigors
Histoplasma capsulatum
intracellular yeasts

Patient from Ohio

River Valley who
reports respiratory
symptoms
Cryptosporidium parvum Acid-
fast Oocyst
AIDS patient presents
with chronic watery
diarrhea
Borrelia burgdorferi
Bulls eye rash

Patient with fatigue

who was recently
hiking in northeastern
US presents with
fever, fatigue and a
rash.
Coccidiodes immitis
spherule

Patient from Nevada

with respiratory
symptoms and
erythema nodosum
Varicella Zoster Virus
Shingles

50 year old
male with
painful
vesicular rash
 Blastomyces dermatitidis
broad based budding yeasts
Patient from Ohio
River valley with skin
lesions
Human Herpes virus-8
Kaposis sarcoma
30 year old male with
HIV.
 Rubella
congenital rubella syndrome

Infant born with

cataracts from
immigrant mother
who had a exanthem
(rash) during
pregnancy.
 Babesia microti
tetrad, Maltese cross

Co-infection with
Lyme disease
 Epstein Barr Virus
atypical lymphocytes (Downey
cells)
15 year old with
lymphadenopathy,
fatigue and a positive
heterophile antibody
test
 Aspergillus fumigatus
45 angle, septate hyphae

Patient with
hemoptysis, fungus
ball identified in chest
x-ray
Streptococcus pneumoniae
encapsulated diplococci
65 year old patient
with fever, shaking
chills and bloody
(rusty) sputum. Chest
x-ray revealed lobar
pneumonia.
 Cytomegalovirus
Owls eye inclusion
Patient with
lymphadenopathy and
fatigue and
heterophile negative.
 Cryptococcus neoformans
encapsulated, monomorphic yeast

AIDS patient with

meningitis
Human papilloma virus
koilocytes

Results from a pap

smear of sexually
active 18 year old
female.
 Goodpasture
smooth ribbon like pattern
Type II HS
Kidney biopsy of
patient with nephritis
 Lupus or (PSGN)
lumpy bumpy pattern
Type III HS
Kidney biopsy of
patient with nephritis
 Toxoplasma gondii
ring enhancing lesions
HIV+ patient with
severe headache
Enterobius vermicularis
pinworm

Child with perianal

itching, egg found on
scotch tape
Plasmodium falciparum
multiple ring forms
Patient who traveled
to Africa with cyclic
fever and rigors
 Medium yield
These images (and or pathogens) have
between a 25%-50% chance of being on
step I of COMLEX and or USMLE
Schistosoma mansoni

Patient who was in

peace corps with
hepatomegaly
Schistosoma hematobium

Male from Egypt with

hematuria, associated
with bladder cancer
Trichuris trichiura
whipworm
Child with rectal
prolapse
Ascaris lumbricoides
roundworm

Patient found large

round worm in stools
 Malassezia furfur
spaghetti and meatballs on KOH

Patient with
hypopigmented spots
on trunk, does not
complain of itching.
Mucor or Rhizopus species
90 angle, ribbon like (non-
septate) hyphae
Ketoacidotic diabetic
patient with sinusitis
Pneumocystis jiroveci

AIDS patient with

pneumonia and a T
cell count of 25
Rabies virus
Negri bodies
Male bitten in the leg
by a raccoon in the
daytime.
Streptococcus pyogenes

5 year old patient with

pharyngitis.
 Streptococcus pyogenes
Scarlet fever=toxin mediated
10 year old male with
recent pharyngitis and
a sandpaper rash
 Actinomyces israelii
lumpy jaw
anaerobic, Gram positive branching
rod
55 year old male with
recent history of
invasive dental work.
Pseudomonas aeruginosa
ecthyma gangrenosum

Patient with Gram

negative sepsis
Treponema pallidum
primary syphilis
28 year old male with
a painless ulcer on
penis
 Rickettsia rickettsii
Rocky mountain spotted fever
15 year old male
hiking in North
Carolina presents
with rash that began
on wrists and ankles.
Malassezia furfur
Tinea versicolor
Male roofer presents
with hypopigmented
rash on trunk and
extremities.
Fluorescent under
woods lamp.
 B19
Slapped cheek fever
3 year old female with
facial rash and fever.
Sarcoptes scabiei
Isolated from a child
with itching between
digits and in skin folds
Treponema pallidum
secondary syphilis
35 year old male with
history of recent
penile ulcer and
current alopecia and
condylomata lata.
 Coxsackie A16
Hand, foot and mouth disease

5 year old female with

painful lesions on
hands, feet and in
mouth.
Streptococcus pyogenes or
Staphylococcus aureus
impetigo
6 year old male with
honey crusted lesion
on mouth.
Measles virus

2 year old male with

maculopapular rash
and koplik spots.
Phthirus pubis
Crabs

Isolated from a
patient with genital
itching.
Lymphocyte

Expect to be
increased during viral
infections
Neutrophils

1st at the site of

inflammation
Monocytes
Increased in
mononucleosis
Eosinophils

Patient with worm

infection
Basophils
Mediator of the type I
HS reaction
 Low Yield
These images (and or pathogens) have
less than a 25% chance of being on step I
of COMLEX and or USMLE
Sporothrix schenckii
cigar shaped yeasts

Biopsy from skin

lesion of patient who
was stuck with a rose
bush
Yersinia pestis
plague

Blood smear of patient

from Arizona
w/conjunctivitis &
inguinal
lymphadenopathy.
Dracunculus medinensis
Guinea worm

African male presents

with ulcer and worm
emerging from ulcer.
Klebsiella granulomatis
30 year old
immigrant with
painless ulcer on
penis
 Clostridium tetani
spastic paralysis=toxin mediated

8 year old male with

recent puncture
wound and
incomplete
vaccination history
Mycobacterium leprae
tuberculoid leprosy
35 year old male with
hypopigmented,
anesthetic lesions
Mycobacterium leprae
lepromatous leprosy
45 year old male from
India with anesthetic
skin nodules
Smallpox

Government worker
with vesicular rash.
Trypanosoma cruzi - Romaa Sign

Patient from South

America with fever,
anorexia,
lymphadenopathy,
and myocarditis
Entamoeba histolytica Flask-
shaped lesions
Hiker presents with
bloody diarrhea
Trichinella spiralis Encysted
larvae
Bear hunter presents
with myalgias
 Paracoccidioides brasiliensis
Ship Steering Wheel (budding
yeast)
Patient from South
America presents with
chronic pulmonary
disease
 Taenia solium
Neurocysticercosis
Pig farmer presents
with meningitis.
Proglottids identified
in stool sample.
HSV-1 and/or HSV-2 Multinucleated
giant cell on Tzank smear
(could also be from Paramyxoviruses)
Patient presents with
vesicles on the lip and
on the genitals.
Clostridium tetani Terminal
spores on Gram-positive rods
Patient presents with
trismus