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Microbiology > Case vingette or key clues/Causal organisms and/or diagnosis > Flashcards

Case vingette or key clues/Causal organisms and/or diagnosis Flashcards

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1
Q

Furuncles or carbuncles on neck, face, axilla, buttocks

A

S. aureus

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2
Q

Furuncles or carbuncles with follicles from neck down

A

P. aeruginosa (hot tub folliculitis)

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3
Q

Inflammation of follicles & sebaceous glands

A

Propionibacterium acnes (acne vulgaris)

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4
Q

Initially vesicular; skin erosion; “honey crusted” lesions; catalase -ve

A

S. pyogenes (impetigo)

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5
Q

Initially vesicular with long lasting bullae; catalase +ve

A

S. aureus (impetigo)

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6
Q

Vesicular lesions that sometimes preceded by neurologic pain

A

Herpes

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7
Q

Solitary or lymphocutaneous lesions, rose gardeners or florists, sphagnum moss

A 
Sporothrix schenckii (rose gardener disease)
Mycetoma (swelling with pain, sinus tract formation, yellow granules in exudate)
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8
Q

Subcutaneous swelling (extremities & shoulders)

A

Mycetoma (swelling with pain, sinus tract formation, yellow granules in exudate)
Bacteria: actinomyces, nocardia
Fungi: Madurella, Pseudallescheria, Sporothrix

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9
Q

Jaw area, associated with carious teeth, dental extraction, or trauma

A

Actinomyces israelii “lumpy jaw”

Mycetoma (swelling with pain, sinus tract formation, yellow granules in exudate)

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10
Q

Pustule with dark red fluid-filled, tumor-like lesion that lead to necrosis & black eschar surrounded by red margin

A

Malignant pustule

Bacillus anthracis, & Pseudomonas septicemia (ecthyma gangrenosum)

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11
Q

Blue-green pus, grape-like odor, burns

A

P. aeruginosa (cellulitis)

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12
Q

Dermal pain, edema, heat & rapid spread.

Red, raised butterfly facial rash

A

S. pyogenes [Erysipelas] (cellulitis)

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13
Q

Hot inflamed tissues. Deeper tissues from extension of skin lesions or wounds including surgical

A

S. aureus, S. pyogenes, gram (-ve) rods, Clostridium & anaerobes (cellulitis)

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14
Q

Surgical wounds (clean)

A

S. aureus

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15
Q

Surgical wound (dirty)

A

S. aureus, Enterobacteriaceae, anaerobes

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16
Q

Trauma wounds

A

Clostridium, Enterobacteriaceae, Pseudomonas

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17
Q

Shallow puncture wound through tennis shoe sole

A

P. aeruginosa

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18
Q

Various animal bites

A

Pasteurella multocida

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19
Q

Human bites, fist fights

A

Eikenella corrodens

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20
Q

Dog bites

A

Capnocytophaga canimorsus

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21
Q

Rat bites

A

Streptobacillus moniliformis & Spirillum minus

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22
Q

Cat scratches resulting in lymphadenopathy with stellate granulomas

A

Bartonella henselae

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23
Q

Red, bulging tympanic membrane, fever 102-103 F; pain goes away if drum ruptures or if ear tubes are patent

A 
Acute otitis media:
S. pneumoniae
H. influenzae (often nontypeable, recurs)
Moraxella catarrhalis
RSV
Rhinovirus
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24
Q

Ear pain

A 
Otitis externa (often mixed infections):
S. aureus (NF)
Candida albicans (NF)
Proteus (water organism)
Pseudomonas (water)
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25
Q

Severe ear pain in diabetic; life threatening

A

P. aeruginosa (malignant otitis externa)

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26
Q

Sinus pain; low grade fever

A 
Sinusitis: 
S. pneumoniae
H. influenzae (often nontypeable, recurs)
Moraxella catarrhalis
RSV
Rhinovirus
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27
Q

Painful mouth; overgrowth of spirochetes & fusiform bacteria

A

Fusobacterium & treponemes (normal oral spirochetes)

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28
Q

Sore mouth with thick white coating (painful red base under); increased risk: premature infants, AIDS, IC patients, patients on antibiotics, vitamin C deficiency

A

Candida

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29
Q

Inflamed tonsils/pharynx, which may be purulent & may develop abscesses; cervical lymphadenopathy, fever, stomach upset; sandpaper rash

A

Sore throat: S. pyogenes (group A), rash indicates presence of erythrogenic exotoxin A

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30
Q

White papules with red base on posterior palate & pharynx, fever

A

Coxsackie A

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31
Q

Throat looking like Strep with severe fatigue, lymphadenopathy, fever, rash; heterophile (+ve); Downey type II cells

A

Epstein-Barr virus

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32
Q

Low grade fever with a 1-2 day gradual onset of membranous nasopharyngitis &/or obstructive laryngotracheitis; bull neck from lymphadenopathy; elevated BUN; abnormal ECG; little change in WBC (toxin). Exudate bleeds profusely when dislodged

A

Corynebacterium diphtheriae (diphtheria)

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33
Q

Rhinitis, sneezing, coughing

A 
Common cold:
Rhinoviruses (summer-fall)
Coronaviruses (winter-spring)
Human metapneumovirus
Adenovirus, & many others
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34
Q

Bilateral eyelid swelling, > 10% eosinophilia, fever, muscle pain, earlier GI symptoms

A

Trichinella

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35
Q

Stye

A

S. aureus

Propionibacterium acnes

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36
Q

Unilateral inflammation at bite site often around the eye or mouth; travel to Mexico, Central or South America

A

Trypanosoma cruzi

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37
Q

Red itchy eye(s)/pus; onset 2-5 days in neonates

A

Bacterial pink eye (conjunctivitis)

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38
Q

Red itchy eye(s)/pus; onset 5-10 days in neonates

A

Conjunctivitis: Neisseria gonorrhoeae, Chlamydia trachomatis (serotypes D-K U.S.)

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39
Q

Neonate with “sticky eye”

A

S. aureus

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40
Q

Red, itchy eye(s), thin exudate; pain, photophobia

A

Viral pink eye: adenovirus (more common than bacterial pink eye)

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41
Q

Red eye, pus

A

S. aureus, group A Strep, Strep pneumoniae (all gram [+]), H. influenzae, H. aegypticus

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42
Q

Red eye, pus, presence of inclusion bodies in scraping

A

Chlamydia trachomatis serotypes D-K (inclusion conjunctivitis)

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43
Q

Granulomas & inturned eye lashes, corneal scarring, blindness

A

Chlamydia trachomatis serotypes A, B, Ba, C (trachoma)

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44
Q

Chorioretinitis in neonates or AIDS

A

Toxoplasma, CMV

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45
Q

Retinopathy with keratitis in baby of an IV drug abuser mother

A

Treponema pallidum (congenital syphilis)

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46
Q

Acute endocarditis in IV drug user

A

S. aureus

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47
Q

Acute endocarditis in non IV drug user

A

S. aureus

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48
Q

Subacute endocarditis in patients with poor oral hygiene or dental work

A

Viridans streptococci (55% of cases in native hearts)

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49
Q

Subacute endocarditis with gram -ve (normal oral flora)

A 
HACEK organisms:
Haemophilus aphrophilus
Actinobacillus actinomycetemcomitans
Cardiobacterium hominis
Eikenella corrodens
Kingella kingae
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50
Q

Subacute endocarditis in biliary or urinary tract infection, & GU manipulation inn elderly men

A

Enterococcus faecalis

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51
Q

Subacute endocarditis in IV drug user

A 
S. epidermidis
Aspergillus (branching <45)
Candida (pseudohyphae)
Pseudomonas 
Viridans streptococci
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52
Q

Dilated cardiomyopathy in rural South America

A

Trypanosoma cruzi

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53
Q

Inflamed epiglottis; patients often 2-3 years & unvaccinated, thumb sign on x-ray

A

H. influenzae type b (Hib) (epiglottitis)

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54
Q

Infant with fever, sharp barking cough, inspiratory stridor, hoarse phonation

A

Parainfluenza virus (croup)

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55
Q

Wheezy; infant or child < or = 5 years

A

RSV (bronchitis)

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56
Q

Wheezy; > 5 years

A

Bronchitis:

H. influenzae, M. pneumoniae, Chlamydophila pneumoniae

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57
Q

Wheezy; > 9 years, afebrile, with cough > 2 weeks

A

Bordetella pertussis

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58
Q

Typical pneumonia in poorly nourished, unvaccinated baby/child; giant cell pneumonia with hemorrhagic rash

A

Measles: malnourishment increase the risk of pneumonia & blindness

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59
Q

Typical pneumonia in adults (including alcoholics), rusty sputum, often follows influenza

A

Streptococcus pneumoniae

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60
Q

Typical pneumonia in neutropenic patients, burn, CGD, & CF

A

Pseudomonas

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61
Q

Typical pneumonia with foul smelling sputum, aspiration possible

A

Anaerobes, mixed infection (Bacteroides, Fusobacterium, Peptococcus)

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62
Q

Typical pneumonia in alcoholics, abscess formation, aspiration, facultative anaerobe, gram -ve bacterium with huge capsule, currant jelly sputum

A

Klebsiella pneumoniae

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63
Q

Typical pneumonia, nosocomial, ventilator, post-influenza, abscess formation, gram +ve, catalase +ve, coagulase +ve, salmon colored sputum

A

S. aureus

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64
Q

Atypical pneumonia in teens/young adults; bad hacking cough; initially non-productive color

A

Mycoplasma pneumoniae (most common cause of pneumonia in school age children)

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65
Q

Atypical pneumonia with air conditioning exposure especially > 50 years of age, heavy smoker, drinker

A

Legionella spp.

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66
Q

Atypical pneumonia with bird exposure, hepatitis

A

Chlamydophila psittaci

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67
Q

Atypical pneumonia in AIDS patients with staccato cough; “ground glass” x-ray; biopsy: honeycomb exudate with silver staining cysts, progressive hypoxia

A

Pneumocystis jiroveci

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68
Q

ARDS with history of travel to Far East, winter, early spring, hypoxia

A

SARS-CoV

69
Q

ARDS in spring, 4 corner region, exposure to rodents

A

Hanta virus

70
Q

Acute pneumonia or chronic cough with weight loss, night sweating, calcifying lesions, over 55 years, HIV +ve, or immigrant from developing country

A

M. Tuberculosis

71
Q

Acute pneumonia or chronic cough with weight loss, night sweating, calcifying lesions, dusty environment with bird or bat fecal contamination (Missouri chicken farmers), yeasts packed into phagocytic cells

A

Histoplasma capsulatum

72
Q

Acute pneumonia or chronic cough with weight loss, night sweating, calcifying lesions, desert sand, SW U.S.

A

Coccidioides immitis

73
Q

Acute pneumonia or chronic cough with weight loss, night sweating, calcifying lesions, rotting contaminated wood, North & South Carolina

A

Blastomyces dermatitidis

74
Q

Urethritis with gram -ve diplococci in PMNs in urethral exudate

A

Neisseria gonorrhea

75
Q

Urethritis with -ve culture & inclusion bodies

A

Chlamydia trachomatis

76
Q

Urethritis with urease +ve & no cell wall organism

A

Ureaplasma urealyticum

77
Q

Urethritis with flagellated protozoan with corkscrew motility

A

Trichomonas vaginalis

78
Q

Frequent & painful urination, hematuria, & fever

A

Cystitis:

E. coli, other gram -ve enterics, Pseudomonas, Proteus

79
Q

Cystitis in young; newly sexually active individual; gram +ve cocci

A

S. saprophyticus

80
Q

Frequent & painful urination, hematuria, flank pain, & prominent fever

A

Pyelonephritis:

E. coli, Staphylococcus

81
Q

Friable, inflamed cervix with mucopurulent discharge

A

Cervicitis:
Neisseria gonorrheae (gram -ve diplococci)
Chlamydia trachomatis (non-staining obligate intracellular parasite)
Herpes simplex

82
Q

Vaginal itching, pain, adherent yellowish discharge, pH>5, fishy amine odor in KOH, clue cells; gram -ve cells dominate

A

Bacterial vaginosis: overgrowth of Gardnerella vaginalis & anaerobers

83
Q

Vaginal itching, pain, with vulval pruritis, erythema, and discharge: consistency of cottage cheese

A

Candida spp.

84
Q

Vaginal itching, pain, with foamy, purulent discharge, many PMNs & motile trophozoites microscopically (corkscrew motility)

A

Trichomonas vaginalis

85
Q

Adnexal tenderness, bleeding, deep dyspareunia, vaginal discharge, fever; tenderness from cervical movement, possibly palpable inflammatory mass on bimanual exam, onset often follows menses

A

PID: Neisseria gonorrheae or Chlamydia trichomatis or both or a variety of other organisms

86
Q

Genital warts

A

HPV (most common U.S. STD), Treponema pallidum, molluscum contagiosum

87
Q

Multiple genital vesicular, painful, coalescing lesions that recur

A

Herpes simplex

88
Q

Non-tender genital indurated ulcer healing spontaneously 2-10 weeks

A

Treponema pallidum

89
Q

Non-indurated, painful genital papule, suppurative with adenopathy, slow to heal

A

Haemophilus ducreyi

90
Q

Soft, painless genital ulcer, patient from Caribbean or New Guinea, gram -ve intracellular bacilli

A

Klebsiella granulomatis (granuloma inguinale)

91
Q

Genital elephantitis with initial papule heals; lymph nodes enlarge & develop fistulas

A

Chlamydia trichomatis L1-L3

92
Q

Genital elephantitis with microfilariae in blood stream, patient from Tropics

A

Wuchereria or Brugia (filarial nematodes)

93
Q

Diarrhea develops 1-6 hrs after eating Ham, potato salad or cream pastries

A

S. aureus (Heat stable enterotoxin)

94
Q

Diarrhea after eating fried rice

A

Bacillus cereus: emetic form (heat stable toxin causes vomiting)

95
Q

Diarrhea in infants & toddlers that persists for 5-7 days

A

Rotaviruses

96
Q

Diarrhea in young kids & IC patients

A

Adenovirus 40/41

97
Q

Diarrhea in infants in developing countries

A

Enteropathogenic E. coli (adherence to enterocytes through pili causes damage to adjoining villi)

98
Q

Diarrhea in older kids & adults

A

Norwalk virus

99
Q

Diarrhea (watery) after eating beef, poultry, gravies

A

C. perfringens (enterotoxin)

100
Q

Diarrhea (profuse watery) “rice water stool”

A

V. cholerae (toxin stimulates adenylate cyclase & causes increase in cAMP in small intestine without inflammation or invasion)

101
Q

Diarrhea after eating raw or undercooked shellfish

A

V. parahaemolyticus

102
Q

Diarrhea that develops 12-72 hrs after drinking water, or eating undercooked fruits or vegetables

A

Enterotoxigenic E. coli (heat labile toxin (LT) stimulates adenylate cyclase resulting in efflux of water & ions into small intestinal lumen)

103
Q

Diarrhea after eating ham-burger with blood, but no fever

A

Enterohemorrhagic E.coli (verotoxin, which is a cytotoxin, causes bloody diarrhea)

104
Q

Diarrhea (loose, pale, greasy) with mild to severe malabsorption syndrome after camping

A

Giardia lamblia (multiply & attach to intestinal villi by sucking disk)

105
Q

Diarrhea (chronic severe) in AIDS or IC patients with acid fast spores/oocytes in stool

A

Cryptosporidium parvum, Isospora belli, Cyclospora, Microsporidia

106
Q

Diarrhea (occult blood) poultry, domestic animals, water develops after 3-5 days

A

Campylobacter jejuni (multiply in the small intestine; invades epithelium)

107
Q

Diarrhea (occult blood) poultry, domestic animals develops 8-48 hrs

A

Salmonella gastroenteritis (PMN & PG response, which stimulates cAMP)

108
Q

Diarrhea (first watery then bloody)

A

Shigella (shallow mucosal ulceration & dysentery; septicemia rare)

109
Q

Diarrhea wild domestic animals

A

Yersinia enterocolotica (difficult to distinguish from appendicitis, grow in cold)

110
Q

Diarrhea associated with use of broad spectrum antibiotics (commonly clindamycin)

A

C. difficile

111
Q

Diarrhea (bloody) in adults

A

Enteroinvasive E. coli

112
Q

Diarrhea (bloody) with history of travel to tropical areas

A

Entamoeba histolytica (characteristic flask-like lesions & extra intestinal abscesses)

113
Q

Hepatitis food born without chronicity, sturdy naked RNA virus

A

Hepatitis A (picornavirus)

114
Q

Hepatitis in IV drug abuse, needle stick, chronic carrier state, cirrhosis, primary hepatocellular carcinoma; DNA virus easily inactivated by alcohol

A

Hepatitis B (Hepandavirus)

115
Q

Hepatitis in transfusion, IV drug abuse, or prison acquired tatoos, chronic active hepatitis; enveloped RNA virus

A

Hepatitis C (Flavivirus)

116
Q

Hepatitis enterically transmitted with high fatality in pregnant women, no chronic form

A

Hepatitis E (Hepevirus)

117
Q

Acute abdominal pain due to intestinal blockage

A

Ascaris lumbricoides or Diphyllobothrium latum

118
Q

Bile duct blockage

A 
Ascaris lumbricoides (following surgery)
Fasciola hepatica
119
Q

Peritonitis

A

Bacteroides fragilis or E. coli

120
Q

Cirrhosis with history of travel to Puerto Rica, Peace Corps; egg granulomas block triads leading to fibrosis

A

Schistosoma mansoni

121
Q

Cirrhosis in IV drug use

A

Hepatitis viruses

122
Q

Pancreatitis (generally with swelling of salivary glands)

A

Mumps virus

123
Q

Megaloblastic anemia

A

Diphyllobothrium latum

124
Q

Normocytic anemia

A

Chronic infections

125
Q

Microcytic hypochromic anemia (iron deficiency anemia)

A

Ancylostoma, Necator, Trichuris

126
Q

Decreased Hb, hematocrit with cyclic fever, often travel to tropics; rings or schizonts in RBCs

A

Plasmodium spp.

127
Q

New England, splenectomized patient, hemolytic anemia, no history of travel, summer months (tick exposure), with multiple ring forms inside RBCs

A

Babesia microti

128
Q

Reduced CD4 cell count

A

HIV

129
Q

Infectious mononucleosis, Downey type II cells (reactive T cells) sore throat, lymphadenopathy, young adult, heterophile (+ve)

A

EBV

130
Q

Infectious mononucleosis with heterophile (-ve)

A

CMV
Toxoplasma
Listeria (Listeriosis)

131
Q

Unvaccinated child, hypoglycemic, lymphocytosis with paroxysmal cough, stridor on inspiration

A

Bordetella pertussis

132
Q

Meningitis in neonates to 2 months

A

S. agalactiae
E. coli
Listeria monocytogenes

133
Q

Meningitis in 3 months to 2 years; unvaccinated child

A

H. influenzae type B (gram -ve pleomorphic rod with polyribitol capsule)

134
Q

Meningitis in 3 months to young adults. Prodrome may be very rapid; child may be properly vaccinated; rash

A

Neisseria meningitidis (ferments maltose)

135
Q

Meningitis in less than 2 years and in young adults to elderly

A

S. pneumoniae

136
Q

Meningitis in renal transplant patient

A 
Cryptococcus neoformans (encapsulated; urease +ve yeast)
Listeria monocytogenes (motile gram +ve rode)
137
Q

Meningitis in endemic areas

A 
Coccidioides (Southwestern U.S.)
Histoplasma capsulatum (near U.S. great river beds with exposure to bird or bat feces)
138
Q

Meningitis with low cell mediated immunity, nerve palsies in a patient with T.B. & low CSF glucose

A

M. tuberculosis

139
Q

Meningoencephalitis after swimming & diving in warm waters (hot springs) prefrontal headache, high fever, disturbance of smell

A

Naegleria

140
Q

Meningoencephalitis in IC patients

A

Acanthamoeba or Toxoplasma

141
Q

Encephalitis summer-fall, mosquito born from bird reservoirs

A

Western equine encephalitis (midwest & west U.S.)
St. Louis encephalitis (elderly blacks with hypertension, most severe infections)
West Nile virus (North America)
California encephalitis (entire U.S. & rodent reservoir)
Eastern equine encephalitis

142
Q

Encephalitis with focal uptake of radionucleotide, RBCs in CSF, high opening pressure, frontal & temporal lobes involvement

A

Herpes simplex encephalitis

143
Q

Child following a viral illness with pernicious vomiting, lethargy & irritability, which may lead to brain swelling, indication of aspirin usage

A

Reye syndrome:

Influenza or varicella infection

144
Q

Epilepsy onset after age of 20, Mexico, immigrant

A

Taenia solium (neurocysticercosis)

145
Q

Systemic disease following bull’s eye rash & may be associated with Bell palsy

A

Borrelia burgdorferi

146
Q

Guillain-Barre with GI tract problems

A

Campylobacter jejuni

147
Q

Guillain-Barre with respiratory problems

A

Influenza

148
Q

Sandpaper like rash (trunk & neck to extremities)

A

Scarlet fever (S. pyogenes [exotoxin A-C])

149
Q

Diffuse sunburn like rash (trunk & neck to extremities), with desquamation on palms & soles

A

Toxic shock syndrome (S. aureus [TSST-1])

150
Q

Perioral erythema, bullae, vesicles, desquamation except tongue & palate (trunk & neck to extremities)

A

Staphylococcal skin disease: scalded skin disease (S. aureus [exofoliatin])

151
Q

Petechial rash that progress to purpura (trunk to extremities), spares palms, soles, & face

A

Epidemic typhus (Rickettsia prowazekii [endotoxin])

152
Q

Petechial rash that progress to purpura at ankles & wrists then generalized with palms & soles

A

Rocky Mountain spotted fever, most common on East Coast (Rickettsia rickettsii [endotoxin])

153
Q

Petechial rash that progress to purpura (generalized)

A

Early meningococcemia (Neisseria meningitidis [endotoxin])

154
Q

Generalized cutaneous maculopapular rash involving palms & soles (bronze or copper colored) & mucous membranes: condyloma

A

Secondary syphilis (Treponema pallidum [endotoxin])

155
Q

Confluent erythematous maculopapular rash (head to entire body), Koplik spots

A

Measles (Rubeola virus [rash from T cell destruction of virus infected cells in capillaries])

156
Q

Erythematous concentric rings (Bull’s eye) with outward progression from site of tick bite

A

Lyme disease (Borrelia burgdorferi)

157
Q

Osteomyelitis in adults, infants, & children without major trauma or special conditions

A

S. aureus

158
Q

Osteomyelitis in neonates

A

S. aureus

Group B Streptococcus, gram -ve rods (E. coli, Klebsiella, Proteus, Pseudomonas)

159
Q

Osteomyelitis in sickle cell anemia

A

Salmonella

160
Q

Osteomyelitis in trauma

A

Pseudomonas

161
Q

Arthritis in all age groups (except 15-40)

A

S. aureus

162
Q

Arthritis in age group 15-40

A

N. gonorrheae

163
Q

Arthritis in prosthetic joint

A

Coagualse -ve Staphylococci

164
Q

Viral Arthritis

A

Rubella, Hepatitis B, & parvovirus

165
Q

Arthritis (chronic onset, mono)

A

M. tuberculosis or fungi

166
Q

Arthritis of large joint after tick bite or erythema migrans

A

Borrelia burgdorferi

167
Q

Arthritis (post-infectious) following GI infection

A 
Reactive arthritis (Reiter's syndrome):
Salmonella, Shigella, Campylobacter, or Yersinia enterocolitica
168
Q

Arthritis (post-infectious) following sexual contact

A

Reactive arthritis (Reiter’s syndrome): Chlamydia trachomatis

Microbiology (8 decks)

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