Diarrhea

Question 1

Bloody diarrhea can be caused by:

Answer 1

1. Salmonella
2. Shigella
3. E Coli - O157H7 or STEC producing
4. Campylobacter
5. Yersinia

Question 2

Chinese food or fried rice.. Vomiting (4hrs post eating) or non-bloody diarrhea (6-24hrs post).

Answer 2

Bacillus cereus

Question 3

Drinking freshwater from mountain streams.

Answer 3

Giardia lamblia

Question 4

Outbreak of non-bloody diarrhea in daycare

Answer 4

Giardia lamblia

Question 5

Drinking contaminated (dead animal) water from a well

Answer 5

Giardia lamblia

Question 6

Chronic foul smelling, fat filled diarrhea.

Answer 6

Giardia lamblia

Question 7

4-6 hrs after a picnic with contaminated food.

Answer 7

Staphylococcus aureus.

Question 8

Gram negative, comma shaped bacteria with polar flagellum

Answer 8

Vibrio cholera

Question 9

Voluminous non-bloody diarrhea, person gets dehydrated after consuming contaminated food.

Answer 9

Vibrio cholera

Question 10

Rice water stool

Answer 10

Vibrio cholera

Question 11

Person with pre-existing liver disease/failure or hepatitis eats raw seafood. Gets non-bloody diarrhea and septic shock.

Answer 11

Vibrio vulnificus

Question 12

Person with open cut swims in salt water and gets a blistering/scalding skin lesion/cellulitis.

Answer 12

Vibrio vulnificus

Question 13

Comma shaped organism, corkscrew motion.
Chicken.
Cow, unpasterized milk

Answer 13

Campylobacter

Question 14

In what season does campylobacter often occur?

Answer 14

summer

Question 15

Pseudo-appendicitis is the presentation of what?

Answer 15

Yersinia (bloody diarrhea)

Question 16

Person is REALLY SICK and has bloody diarrhea

Answer 16

Shigella

Question 17

Most common form of traveler’s diarrhea, all ages.

Answer 17

EnteroPathogenic E. Coli (EPEC)

Question 18

Gram negative rod that attaches to enterocytes of small bowel and causes decreased fluid absorption.

Answer 18

EnteroPathogenic E. Coli

Question 19

Is EPEC acute or chronic?

Answer 19

Can be longer-term, i.e. 12 weeks.

Question 20

Class of students, football team with watery diarrhea

Answer 20

Norwalk

Question 21

Less than 2yo with non-bloody diarrhea.

Answer 21

Rotavirus

Question 22

E coli is gram negative or positive? What shape and what toxin does it release?

Answer 22

gram negative, rod shaped, shiga

Question 23

Organism penetrates into epithelium of small intestine, invasion into Peyer’s patches, invades host macrophages and lives in Lymph Nodes.

Answer 23

Salmonella

Question 24

Salmonella is gram negative or positive?

Answer 24

Gram negative enteric bacillus

Question 25

Rose spots

Answer 25

Salmonella typhi

Question 26

Widal test positive with O and H antigens = ____

Answer 26

Salmonella typhi

Question 27

Bacteremia (spikey fever, colicy pain), multiplies with RES organs (LYMPH NODES, liver, spleen)

Answer 27

Salmonella

Question 28

CD4 less than 50, think?

Answer 28

MAC

Question 29

In anyone HIV+ (CD4 >50) with no-bloody diarrhea, think what two bugs?

Answer 29

Isospora | Cryptosporidium

Question 30

In anyone HIV+ (CD4 >50) with no-bloody diarrhea, what test should you do for the two most common bugs?

Answer 30

Acid Fast stain (both are mildly staining)

Question 31

Mexico vacation. amoeba

Answer 31

Entamoeba histolytica

Question 32

Antibiotics, hospitalized, diarrhea.

Answer 32

Clostridium difficile.

Question 33

Pear shaped trophozoite with four flagella with two nuclei. Use antigen test.

Answer 33

Giardia

Question 34

What type of bacteria is Clostridium Difficile?

Answer 34

Gram positive rod

Question 35

What does C. diff secrete? What test to diganose?

Answer 35

Secretes enterotoxin and cytotoxin, forming a pseudomembrane. Get a stool sample for stool antigens.

Question 36

Gram negative nonlactose fermenting rod that produces a potent cytotoxin.

Answer 36

Shigella

Question 37

Gram negative lacatose fermenting rod that secretes and adenylate cyclase activating toxin? Characerize the diarrhea and fecal test.

Answer 37

Enterotoxigenic E. Coli - ETEC. | Watery, non-bloody diarrhea that lacks mucous or fecal leukocytes.

Question 38

Use fecal leukocyte test to look for what?

Answer 38

Bacterial infection, like salmonella, shigella, campylobacter.

Question 39

Comma shaped organism, microaerophilic and urease negative.

Answer 39

Helicobacter

Question 40

Shiga toxin producing bacteria (2)

Answer 40

E. coli and shigella

Question 41

Gram positive round organism with long chains (watery diarrhea)

Answer 41

Strep pyogenes

Question 42

Clumps of gram positive round organisms (watery diarrhea)

Answer 42

Staph auerus

Question 43

Define tenesmus

Answer 43

A continual or recurrent inclination to evacuate the bowels, caused by disorder of the rectum or other illness.

Question 44

Associate this disease with pyoderma gangrenosum, uveitis and ankylosing spondylitis

Answer 44

Ulcerative colitis

Question 45

What type of anemia is associated with IBD?

Answer 45

Hyperchromic Microcytic Anemia

Question 46

What three tests can be used for celiac, which is the best serologic test?

Answer 46

1. Positive antigliadin antibodies. 2. Postive IgA serum antiendomysial antibody (goes away with gluten free diet). 3. Positive IgA antitissue transglutaminase (IgA TTG).

Question 47

Dermatitis herpetiformes... what is this?

Answer 47

Celiac | -flattened villi and hyperplastic crypts, small intestine, autoimmune

Question 48

longest worm, may come out of nose, oval eggs and abdominal discomfort.

Answer 48

Ascaris lumbricoides, 20cm.

Question 49

Worm associated with bare feet

Answer 49

Strongyloides stercoralix

Question 50

Worm associated with fish

Answer 50

diphyllobothrium latum (fish tapeworm)

Question 51

Fluke with snail/water lifecycle. #2 most common cause of esophageal varices in Africa. Cysts form where in human?

Answer 51

Schistosoma mansoni. Cysts form in liver

Question 52

MacConkey agar - what two organisms

Answer 52

1. Shigella - clear growth | 2. E. coli - PINK growth

Question 53

What causes this? Petechiae on lower extremities. Schistocytes and decreased platelets on peripheral smear. BR elevated. Elevated LDH.

Answer 53

* EHEC O157H7 causing Hemolytic Uremic Syndrome* - Elevated LDH from hemolysis. - Petechiae dt low platelets - worry about DIC development

Question 54

What does rotavirus look like on transmission electron microscope?

Answer 54

Wagon wheel

Question 55

During carrier state, where does salmonella typhi reside? In later stages of the disease, what can occur?

Answer 55

gallbladder. | In later stages intestinal bleeding possible

Question 56

Gram negative organism that causes splenomegaly, relative sinus, bradycardia, neutropenia

Answer 56

salmonella typhi

Question 57

Painless rectal bleeding and presentation of acute appendicitis in a 3+yo, think:

Answer 57

Meckel's diverticulum - remnant of omphalomesenteric (vitelline) duct

Question 58

free flowing hydatid sand like appearance on CT of abdomen, some icterus, structure resides in RUQ

Answer 58

Echinococcus liver cyst

Question 59

Bacterial Rods that cause diarrhea

Answer 59

E. coli - Gram negative Shigella - Gram negative Clostridium - Gram positive

Question 60

Comma shaped bacteria that cause diarrhea

Answer 60

Campylobacter - corkscrew Vibrio cholera - with flagella Helicobacter - urease negative

Question 61

100+ slowly evolving colorectal polyps, AD, cancer by 35yo if untreated, defect in APC. Congenital hypertrophy of retinal pigment on slit lamp

Answer 61

FAP

Question 62

AD, SI/LI/endometrium, increased risk of colon CA by 45yo | Look for family history of EARLY cancer

Answer 62

"HNPCC" lynch syndrome

Question 63

50yo, 20-100 polyps

Answer 63

Attenuated FAP

Question 64

Brain tumors, colorectal CA by 40

Answer 64

Turcot's

Question 65

Freckles, buccal mucosa, AD, young adults, LKB1 mutation on ch19, 3-5% get adenocarcinoma

Answer 65

Peutz-Jaeger

Question 66

Osteoma of long bones/skull/mandible, supernumerary teeth, AD, adenomatous colon polyps, 95% with colorectal polyps

Answer 66

Gardner's