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CRRAB II- Week 2 > Diebel- Case Study > Flashcards

Diebel- Case Study Flashcards

1
Q

What is viral hepatitis associated with?

A

Hepatocyte injury
juandice
elevation of liver enzymes ALT and AST > 500 IJ/L

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2
Q

What are the most common causes of infectious hepatitis (>90% of all cases)?

A

HAV
HBV
HCV

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3
Q

How do the ALT count and AST count compare in HAV, HCV and HBV?

A

ALT count is usually GREATER than the AST

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4
Q

What are other causes of viral hepatitis?

A

hCMV
EBV
yellow fever virus
lassa virus

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5
Q

How can you differentiate alcoholic liver disease from viral hepatitis?

A

Alcoholic liver disease DOES NOT lead to elevated ALT or AST ABOVE 500 IU/L

AST is usually GREATER than ALT

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6
Q

What laboratory results may be indicative of viral hepatitis?

A

Lymphocytic leukocytosis

Elevated:
ALT
AST
biliruibin

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7
Q

What is lymphocytic leukocytosis?

A

Abnormally HIGH number of lymphocytes

Lymphocytes often increase during infections, particularly viral ones.

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8
Q

What is ALT? What are normal ALT levels? What causes it to be released?

A

Alananine aminotransferase

7-56 units/L

Highly concentrated in the LIVER and released into the serum during LIVER INJURY

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9
Q

What is AST? What are normal AST levels? Where is it found?

A

Aspartate aminotransferase

5-40 units/L

Heart, liver, muscle, kidney, brain.

Released into bloodstream upon injury to any of these organs.

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10
Q

What causes high levels of bilirubin?

A

Hepatitis
blood disorders
blockage of the tubes leading to the small intestine

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11
Q

A pt presents with JAUNDICE and DARK YELLOW URINE. He has pain in the RIGHT SIDE OF HIS ABDOMEN AND JOINTS. He was STUCK BY A NEEDLE and he has HEPATOMEGALY. What might this pt hae?

A

HBV

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12
Q

Sxs of hepatitis plus travel outside the US may indicate?

A

HAV

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13
Q

Sxs of hepatitis plus a needle stick may indicate?

A

HBV or HCV

Blood borne pathogen

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14
Q

What is HAV IgM?

A

Ab against HAV infection

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15
Q

What is HBsAg?

A

HBV surface Ag

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16
Q

What is HBeAG? Why is it important to know whether this is present in your blood? Is it part of the virion?

A

HBV e antigen

In blood = RISK OF TRANSMISION

No

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17
Q

What is IgM HBc? It is acute or long term?

A

Ab to the HBV core

ACUTE PHASE

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18
Q

What is IgG Hbc? Acute or long term?

A

Ab to HBV core

Long term protection or chronic state

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19
Q

What is IgG HBs? What is it indicative of?

A

Ab to HBV surface ag

LONG TERM protection by infection of immuniation

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20
Q

What is a hepatitis serology panel?

A

Series of blood tests to detect ANTIBODIES from the pt against hepatitis viral ags (HAV, HBV, HCV)

OR

to detect VIRAL ANTIGENS themselves (HBV)

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21
Q

What serology markers are indicative of an acute HBV infection?

A

HBsAg
IgM HBcAb
Total HBcAb
HBeAg

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22
Q

What serology markers are indicative of a chronic asymptomatic persistent carrier?

A

HBsAG
Total HBcAb
IgG HBeAb

23
Q

What serology markers are indicative of chronic active hepatitis (symptomatic and infectious)

A

HBsAg
Total HBcAb
HBeAg

24
Q

What serology markers are indicatve of past exposure to HBV?

A

IgG HbsAb

Total HBcAb

25
Q

What serology markers are indicative of successful immunization against acute HBV?

A

IgG HBsAb

26
Q

How can you protect someone from contracting HBV?

A

Single dose of HBIG (w/in 48 hrs post exposure) and the HBV vaccine.

27
Q

What are the most common routes for HBV transmission?

A 
IV drug abuse 
tatooing
ear piercing
acupuncture
accidental needle sticks by medical personal
sexual contact (common in US
28
Q

What causes liver damage in HBV?

A

Virus specific cytotoxic T lymphocytes

29
Q

What happens to most adult HBV infections?

A

they self resolve

30
Q

What is chronic HBV infection characterized by?

A

HBV surface Ag in the serum for 6 mos or more

OR

a negative test for HBV core IgM Ab coupled with a positive test for HBV surface Ag

31
Q

What is the chronic state known as?

A

Carrier state or active state

32
Q

What is indicative of a carrier (mild) disease state?

A

HBV surface antigen
HBV core IgG Antibody
HBV e antigen NOT present (not as infectious)

33
Q

What is indicative of an active state?

A

SERIOUS and HIGHLY INFECTIOUS

HBV surface antigen
HBV core IgG antibody
HBV e antigen

34
Q

How do you treat acute HBV infections?

A

supportively

35
Q

How do you treat chronic HBV infections?

A

IFN alpha
Lamivudine (RT inhibitor)
adefovir (RT inhibitor)

36
Q

What do you expect to see on a CBC and UA in a pt with a complicated UTI caused by prostatic hypertrophy?

A

Neutrophilic leukocytosis and WBC casts

37
Q

What is neutrophilic leukocytosis?

A

High number of neutrophils in the blood (common in bacterial infections)

38
Q

What are WBC casts indicative of?

A

Acute pyelonephritis?

39
Q

Semiquantitative midstream urine and blood cultures are most useful in identifying what causes of illness?

A

Enterobacteriacea- complicated UTI

Strep. pyogenes

40
Q

Wet mount, gram stain, culutres and serum ag are most useful in detecting what cause of illness?

A

Candida albicans

41
Q

Ova and parasite examination of midstream urine is most useful in identifying what cause of illness?

A

schistosoma haematobium

42
Q

Elevated levels of IL-1 and TNF is indicative of the presence of what virulence factor?

A

Endotoxin

43
Q

What gram (-) microorganism is associated with endotoxin?

A

Enterobacteriaceae

LPS in the outermembrane of this enterobacteriacae is released into the blood stream during infection causing an increase in IL-1 and TNF levels.

44
Q

A pt presents wtih fever, flank pain, frequent urination and dysuria. He also has a remarkable hx for prostatic hypertrophy. He has a fever and right CVA tenderness. What microorganism is responsible?

A

Gram - enterobacteriacae
Endotoxin–> increased IL-1 and TNF
Neutrophilic leukocytosis and WBC casts

Dx: midstream urine and blood cultures

45
Q

A pt presents wtih fever, N/V, jaundice, hepatomegaly and dark yellow urine. He has no evidence of splenomegaly. His labs are remarkable for liver enzymes and bilirubin. He recently visited Mexico. What is the most likely causative organism?

A

ACUTE HAV

46
Q

A pt that presents with dysurea, increased frequency and urgency for 2 days likely has what?

A

Acute uncomplicated UTI

47
Q

Hematuria w/ UTI is associated w/ what microorganisms?

A
  1. UPEC (uropathogenic E. coli)
  2. Staph. saprophyticus
  3. UTIs from VIRAL infection
48
Q

What are the top four most likely causative organisms of UTI w/ hematuria?

A
  1. UPEC
  2. Staph saprophyticus
  3. Klebsiella pneumoniae
  4. Proteus mirabilis, enterococcus, enterobacter clocae
49
Q

What is the first step towards identifying a causative agent in a pt with a UTI w/ hematuria?

A

Direct microscopy of a gram stained mid stream sample

50
Q

If you suspected a microorganism causing UTI w/ hematuria, and a gram stain showed Gram - rods. You could say with high CONFIDENCE that the causative agent is….

A

E. Coli

51
Q

How would you differentiate E. coli from klebsiella penumoniae?

A

Can’t use MacConkey agar because both organisms are gram (-) lactose fermenters.

HOWEVER e. coli tests POSITIVE for INDOLE test while Klebsiella tests NEGATIVE.

52
Q

If you suspected a microorganism causing UTI w/ hematuria, and a gram stain showed Gram (+) cocci what would you do next. Why?

A

Catalase test

Distinguish between Streptococcus or Enteroccous vs. Staphylococcus.

53
Q

What would a coagulase test tell you?

A

If you had coag pos. staph aureus or coag neg staph aureus.

54
Q

What would a novobiocin test tell yoU?

A

allow you to differentiate between s. epidermidis (novobiocin sensitive) and s. saprophyticus (novobiocin resistant)

CRRAB II- Week 2 (9 decks)

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