A twenty-seven year old Caucasian male presents at the Emergency Room with a complaint of frequent bloody diarrhea, fever and chills. He says he has been this way for the past day and a half. He works as a chef in a French restaurant, and says he began to have sharp abdominal pain while preparing for the evening meal.
He says he thinks the problem began the day after he returned from a visit to his brother's dairy farm on the edge of town when he had started to have some loose stools. While on the farm he had tasted fresh cheese and milk straight from the cow.
Question 1 - Single Best Answer
Consumption of unpasteurized dairy products may expose humans to infection by which bacteria? Bugs Database
Brucella abortus Campylobacter jejuni Coxiella burnetti Listeria monocytogenes all of the above
After the first sharp pain at the restaurant he ran to the rest room and vomited. He felt nauseous, as he does now, and cannot keep any food down. He does not feel hungry and feels weak from not eating. He says he has had bad diarrhea before, on a trip to Mexico, but not with chills and fever. He is anxious about the blood in his stool that he noticed after his most recent visit to the rest room. Until then he had only watery stools, with no blood. Overall he has had seven loose stools in the past twenty-four hours.
Question 2 - Single Best Answer
The three most common causes of diarrhea in the world are: Bugs Database
spicy food, hepatitis A virus, rotavirus rotavirus, hepatitis B, Vibrio cholera Campylobacter jejuni, rotavirus, Shigella dysenteriae rotavirus, C. jejuni, E. coli hepatitis B, C. jejuni, E. coli
Question 3 - Single Best Answer
The two major kinds of diarrhea are: Bugs Database
toxic and mechanical inflammatory and toxic inflammatory and secretory secretory and toxic infectious and chemical
He says he does drink wine with his meals, but no other forms of alcohol. He occasionally smokes his pipe, but is not a cigarette smoker. At the end of your interview he has another bowel movement and you take the opportunity to collect a stool sample.
Upon physical exam you note his temperature is at 101.5 F and he is perspiring. He shivers occasionally. EENT exam is unremarkable. His lymph nodes are not swollen and there is no sign of physical trauma. There is diffuse tenderness over his stomach upon palpation. There is also abdominal distension, and it seems hyper motile upon auscultation. You order tests, and then order IV fluids.
Question 4 - Single Best Answer
Which type of sample will most likely yield the offending organism? Bugs Database
CSF blood bile liver biopsy stool
Question 5 - Single Best Answer
Inflammatory diarrhea may be diagnosed by the presence of? Bugs Database
lipids in the stool (steatorrhea) antibodies in the stool PMNs in the stool high lymphocyte concentration in the bloodstream mixed flora in the stool
Based on the lab data you decide to use oral Erythromycin at 250mg, four times daily. As in other diarrheal related illnesses the patient must be given continual fluid support until the bowels have returned to normal. You replace equal amounts of fluid that he loses in his bouts with the diarrhea.
After two days in the hospital his diarrhea ceases and you return him to soft food. The next day he feels much better. You ask him to continue the antibiotics for the next week, and avoid alcohol and solid food for a few more days until his system has recovered.
Based on the available data you decide that this was most likely a Campylobacter jejuni infection. Though it produces similar symptoms to Salmonella and other enteric pathogens, laboratory isolation showed no evidence of other pathogens.
Question 6 - Single Best Answer
What organism causes the most severe secretory diarrhea? Bugs Database
E. coli Shigella dysenteriae Clostridium botulinum Vibrio cholera Bacteroides fragilis
Question 7 - Single Best Answer
In terms of pathogenesis, what is the major difference between bugs that cause inflammatory diarrhea and those that cause watery diarrhea? Bugs Database
only those that cause watery diarrhea produce exotoxins only those that cause inflammation produce endotoxin only those that produce watery diarrhea have adhesins those that cause inflammatory diarrhea always reach the bloodstream those that cause watery diarrhea generally do not invade the mucosa