E5 Flashcards
1
Q
Gastritis
A
Inflammation of the stomach
2
Q
Gastroenteritis
A
inflammation of the stomach and intestines
-syndrome characterized by nausea, vomiting, diarrhea and abdominal discomfort/pain
3
Q
Diarrhea
A
- frequent loose and fluid filled stools
- usually resulting in disease of the small intestine
4
Q
Dysentery
A
- inflammatory disorder of the GI tract often associated
- diarrhea with blood and pus in the feces
- pain, fever, abdominal cramps
- usually resulting form disease of the large intestine
5
Q
Enteritis
A
inflammation of the intestines, especially the small intestine
6
Q
Enterocolitis
A
inflammation of the mucosa of the samll and large intestine
7
Q
Colitis
A
inflammation of the colon
8
Q
inflammatory GI bacteria
A
- elicit intestinal inflammation by causing damage to intestine
- more likely to see fecal occult or visible blood
- fecal leukocytes due to increased immune response in lumen
- non-typhoidal salmonella, campy, c.diff, EHEC, EIEC, shigella, vibrio parahaemolyticus, yersinia
9
Q
non-inflammatory GI bacteria
A
- passing through the intestine or adhere to intestinal epithelium without symptomatic damage to epithelium
- no known toxins or produce non-cytotoxic toxin
- increase in electrolyte and water efllux
- EPEC, ETEC, Vibrio cholerae, Listeria monocytogenes
10
Q
Bacteria with watery/bloody diarrhea
A
EHEC Campy SHigella Yersinia EIEC C Diff Vibrio parahaemolyticus
11
Q
Bacteria with watery non-bloody diarrhea
A
EPEC ETEC food-poisoning Cl perferingens BAcillus cereus Bibrio cholerae Salmonella Listeria monocytogenes
12
Q
When does symptom onset occur from bacterial preformed toxin?
A
1-8 hours after ingestion
-staph aureus, bacilius cereus, c botulinum
13
Q
When does symptom onset occur from bacterial toxin produced after ingestion?
A
8-16 hours after ingestion
- eat a lot of organisms or spores
- bacilus cereus, C perferingens, C botulinum
14
Q
When does symptom onset occur from virulence factor producing bacteria?
A
16+ hours after ingestion
adherence, growth, and then virulence factor production
-shigella, salmonella, listeria, EHEC, EPEC ETEC, EIEC, Campy, Vibrio
15
Q
What are the two types of bacterial food poisoning?
A
- toxins produced by bacteria in food before consumption
- large numbers of spores ingested, which germinate in intestine and bacteria produce toxins
16
Q
What four bacteria cause food poisoning?
A
staph aureus
C botulinum
C perferingens
B cereus
17
Q
What bacteria affects the stomach?
A
Helicobacter pylori
18
Q
What bacteria is associated with home canning and honey?
A
Clostridium botulinum
19
Q
What bacteria is associated with floppy baby disease and worstening symptoms 1-3 days post onset of symptoms?
A
Clostridium botulinum
20
Q
What bacteria is associated with meat and gravies below reccomended temperature?
A
Clostridium perfringens
21
Q
What bacteria is associated with improper storage of cooked rice?
A
Bacillus cereus (emetic form)
22
Q
Which bacteria associated with food poisoning onset within 1-8 hours post ingestion?
A
- staph aureus
- clostridium botulinum
- bacillus cereus (emetic form)
23
Q
Which bacteria associated with food poisoning onset within 8-16 hours post ingestion
A
- clostridium botulinum
- clostridium perferingens
- bacillus cereus (diarrheal form)
24
Q
What bacteria is assoicated with heart burn, nausea, and dull stomach pain?
A
Helicobacter pylori
25
What bacteria is diagnosed by C13 labeled CO2 exhaled in a urea breath test?
Helicobacter pylori
26
What bacteria are associated with small intestine infections?
- listeria monocytogenes
- EPEC
- ETEC
- Salmonella typhi
- Nontyphoidal Salmonella
- campylobacteri jejuni
- vibrio cholerae
- vibrio parahemolyticus
- yersinia enterocoltica
27
What bacteria is associated with ready to eat meats and raw vegetables?
Listeria monocytogenes
28
What bacteria is associated with Internalin A, LLO, and ActA?
Listeria monocytogenes
29
What bacteria is diagnosed by presence in normally sterile areas and by cold enrichment, B-hemolytic and motility testing?
Listeria monocytogenes
30
What is the treatment for listeria?
beta lactam or trimethoprim-sulfamethoxazole
31
What is MacConkey agar used for?
- check for lactose fermentation
- red = positive (e coli)
- white = negative (shigella and salmonella)
32
What is an indole test used for?
- test for indole production
- red = positive (E coli, Vibrio)
- white = negative (salmonella)
33
What is Hektoen agar used for?
- test for H2S porduciton
- positive = black = Salmonella
- negative = non-black = Shigella
34
What bacteria uses VacA and CagA?
Helicobacter pylori
- VacA = create vacuoles in host cell
- CagA = T4SS cytoskeletal disruption
35
What bacteria is associated with infant watery diarrhea w/o fever (developing countries)?
EPEP
36
What bacteria is associated with BfpA, intimin, and TiR?
EPEP
37
What bacteria is associated with a loss of microvili due to formation of an actin pedestal?
EPEP
38
How does EPEP present in culture?
positive MacConkey = lactose fermentation
| postive Indole
39
What bacteria is associated with traverlers diarrhea from contaminated water and ice?
ETEC
40
What bacteria is associated with LT and ST toxins?
ETEC
- LT heat liable = AB toxin increase cAMP
- ST heat stable = increase cGMP
41
What bacteria is associated with a 13 day incubation, and 4 weeks of fever?
Salmonella Typhi
42
What bacteria is associated with infection of the gall bladder?
Salmonella Typhi
43
What bacteria is associated with ruffled M cells?
Salmonella Typhi
44
How does Salmonella Typhi present in culture?
Negative MacConkey = no lactose ferment
| + H2S on Hektoen
45
What is the treatment for Salmonella Typhi?
Depends on susceptiblity
- fluoroquinolone
- trimethoprim-sulfamethoxazole
- broad spectrum cephalosporin
46
What bacteria are associated with turtles and peanut butter?
Non typhoidal salmonella
47
What bacteria is associated with onset 6-48 hrs post ingestion with bloody diarrhea 3-4 days up to 1-2 weeks?
Non typhoidal salmonella
48
How does Non-typhoidal salmonella present in culture?
Negative MacConkey = no ferment lactose
| Positive H2S on Hektoen
49
What bacteria is associated with guillen barre syndrome?
campylobacter jejuni
50
What bacteria is the major GI infection in developed countries?
campylobacter jejuni
51
How does campy present in culture?
Grows at 42C and in microaerophilic environment
52
What bacteria is associated with abrupt onset of massive amounts of rice water diarrhea?
Vibrio Cholera
53
What bacteria is associated with natural disasters and poor sanitation conditions?
Vibrio Cholera
54
What is the action of cholera toxin?
Increase cAMP = efflux of water
55
What bacteria is associated with Kanagwa hemolysin?
Vibrio Parahaemolyticus
56
What is the mechanism of action of Kanagwa hemolysin?
Induce chloride secretion to cause watery diarrhea
57
What bacteria is associated with consumption of raw shellfish?
Vibrio parahaemolyticus
58
What bacteria presents with acute mesenteric lymphadenitis with fever and bloody diarrhea?
Yersinia enterocolita
59
What bacteria is associated with improperly cooked pork (Europe)?
Yersinia enterocolita
60
How does yersinia enterocolita present in culture?
safety pin
61
What bacteria cause infection of the large intestine?
Clostridium difficle
EHEC
Shigella
EIEC
62
What bacteria is associated with fulminant colitis with toxic megacolon (potential obstruction and easy perforation)?
Clostridium difficile
63
What bacteria is associated with opportunistic infection post antibiotic treatment?
Clostridium difficile
64
What is the treatment for clostridium difficile?
Oral vancomycin or metronidazole
65
What bacteria is associated with contamination of hamburger, veggies, and fruit?
EHEC
66
What bacteria is associated with sequelae and kidney failure?
EHEC
67
What bacteria is associated with Shiga toxin?
EHEC and shigella
68
How does shiga toxin work?
- AB cleave parts of 60S subunit of ribosome blocking translation
- travels in blood to receptor Gb3 found in glomeruli causing renal damage
69
What bacteria is associated with fever, bloody diarreah, tenesmis that lasts 3-5 days?
Shigella (dysenteriae)
70
What bacteria is associated with T3SS of Ipa and movement by actin polymerization?
Shigella
71
How does shigella present in culture?
Negative MacConkey = no lactose ferment
| Negative H2S in Hektoen
72
What presents like Shigella without toxin?
EHEC
73
What bacteria can be vaccinated prophylactically?
Salmonella typhi
| -intramuscular or oral
74
What are the protozoa that infect the GI tract?
- amoeba = entabmoeba histolitica
- flagellates = giardia lamblia
- ciliates = balantiasis
- sporozoans = cryptosporidium parvum, cyclospora cayetanesis, isospora belli, microsporidia
75
What presents with heme positive stool and no fever?
entamoeba histolitica = amebiasis
76
What protozoa is diagnosed by presence of an amoeba +/- cyst in stool?
entamoeba histolitica = amebiasis
77
What protozoa is associated with greasy floating foul-smelling stools with lots of flatulence?
Giardia lamblia = giardiasis
78
What protozoa is diagnosed by presence of cysts in formed stool and trophozoite in loose stool?
Giardia lamblia = giardiasis
79
What protozoa presents as bloody diarrhea associated with pigs or swine?
balantidium coli = balantidiasis
80
What protozoa is associated with watery diarrhea and acid-fast oocyte presence in stool that lasts 1-2 weeks?
cryptosporidium parvum = cryptosporidiasis
81
What protozoa is associated with contaminated raspberries and basil (produce from central and south america)?
cyclospora cayetanesis = cyclosporiasis
82
What protozoa is associated with watery diarrhea that is prolonged over time and presents with acid-fast oocyte (UV fluoresce) in the stool?
cyclospora cayetanesis = cyclosporiasis
83
What protozoa is associated with diarrhea with fever and acid-fast fluorescent oocyte in the stool?
Isospora belli = isosporiasis
84
What protozoa is associated with dissemination to eyes and organs?
microsporidia = microsporiosis
85
How is entamoeba treated?
metronidazole: interfere with energy prod and nucleic acids
86
How is giardia treated?
metronidazole: interfere with energy prod and nucleic acids
87
How is cryptosporidium treated?
nitazoxamide: interfere with energy metabolism
88
How are cyclospora and isospora treated?
sulfonamide/sulfadiazine: interfere with folic acid synthesis
89
What are the major characteristics of nematodes?
- roundworms
- non segmented bodies
- separate sexes: need infected by 2 or more to be shedding eggs
- adult worms do not replicate in man
- complete digestive system
- non fatal, cause malnutrition
- children = symptomatic
- disease = adult presence in GI
- Most common in SE US
- identified by egg morphology
- some pass through other tissues = eosinophilia
90
What is a geohelminth?
- nematode infection acquired through contact with infected soil
- needs to spend part of its life cycle in soil
- ascaris and trichuris = ingesion of infectious eggs
- strongyloids and hookworms = penetration of skin
91
What nematode presents as eggs in stool ready to infect that appear flat on one side?
Enterobius vermicularis = pinworm
92
What nematode presents as lemon shaped eggs in stool?
Trichuris trichura = whipworm
93
What nematode presents as rectal prolapse in children?
trichuris trichura = whip worm
94
What nematode presents as bumpy eggs in stool? or larvae and eosinophils in sputum?
ascaris lumbricoides = ascariasis
95
What nematode requires eggs to be in soil for 3 weeks to mature internal larvae?
trichuris trichura = whipworm
96
What nematode requires eggs to develop in soil for two weeks?
ascaris lumbricoides = ascariasis
97
What nematode presents as plain eggs in stool?
necator americanus and ancylostoma duodenale = hookworm
98
What nematode requires eggs to hatch in soil?
Hookworm necator americanus
99
What nematode presents as larvae in the stool?
strongyloides stercoralis = strongyloidiasis
100
What nematode can reproduce in human or in soil so that larvae may penetrate skin?
strongyloides stercoralis = strongyloidiasis
101
What nematode infection is commonly seen disseminated in patients taking immunosuppressive glucocorticoid therapy?
strongyloides stercoralis = strongyloidaisis
102
What are the treatements for pinworm (enterobus vermicualris)?
- mebendazole = inhibit mitosis in parasite
| - pyrantel pamoate = muscle paralysis in parasite
103
What are the treatments for whipworm (trichuris trichiura)?
mebendazole = inhibit mitosis in parasite
104
What are the treatements for ascariasis (ascaris lumbricoides)?
mebendazole: inhibit mitosis in parasite
105
What are the treatments for hookworm (necator americanus)?
albendazole and mebendazole: inhibit mitosis in parasite
106
What are the treatments for strongyloidiasis (strongyloides stercoralis)?
thiabendazole: inhbiit mitosis in parasite
| - ivermectin: cause muscle paralysis in parasite
107
What are the three basic structures of adult tapeworms (cestodes)?
- scolex: rounded head of worm with hooks +/- suckers
- neck: area from which new body segments are generated
- body (strobila): long segmented structure where individual segmetns are called proglottids
108
What are the characteristics of cestodes?
- tapeworms
- segmented bodies
- hermaphroditic
- absorb nutrients
- one type humans are definitive host where adults reside in small intestine: beef, pig, and fish
- second type humans are intermediate host where larvae are present in various tissues : dog and pig
109
What are the characteristics of trematodes?
- flukes
- non-segmented (leaf shape)
- hermaphroditic
- primitive gut
- humans are definitive host
- freshwater snails act as intermediate host
- larval form released from snail encyst on fish, shellfish, or vegetation, and are acquired by ingestion
110
What cestode is associated with consumption of contaminated undercooked beef?
taenia saginata = beef tapeworm
111
What cestode is associated with consumption of contaminated undercooked pork?
taenia solium = pork tapeworm
112
What cestode is associated with fecal oral contamination without Hx of dog?
Taenia solium = pork tapeworm
113
What cestode is associate with punctate lesions on MRI?
taenia solium = pork tapeworm
114
What cestode is associated with consumption of contaminated raw fish?
diphylobothrium latum = fish tapeworm
115
what cestode is associated with macrolytic anemia caused by a B12 deficiency?
diphylobothrium latum = fish tapeworm
116
What cestode is not associated with consumption of contaminated meat?
echinococcus granulosus = dog tapeworm
117
What cestode is associated with hyatid cysts that can perpetuate anaphylaxis when ruptured?
echinococcus granulosus = dog tapeworm
118
What is the treatment for cestode/tapeworm?
- GI: praziquantal = increase Ca permeability of worm tegument = depolarization causing increase immune detection and spastic paralysis
- Extra: benzimidazole = inhibit mitosis
119
What is the trematode associated with diarrhea, hemorrage, ulcers, and abcess after consumption of fresh water plant?
-fasicolopsis buski = intestinal fluke
120
What is the trematode associated with fever, eosinophila, and biliary obstruction after consumption of fresh water plant?
fasicola hepatica = liver fluke
121
what is the trematode associated with biliary obstruction, jaundice, hepatomegally, gallstones and increased biliary cancer risk after consumption of raw fish?
opsithicorsis (clonorchis) sinensis = liver fluke
122
What is the treatment for trematodes associated with the liver?
-proziquantal= increase Ca permeability fo worm to cause depolarization allowing increased immune detection and spastic paralysis
123
What is the treatment for trematodes associated with the intestines?
Benzimadole to inhibit mitosis
124
What are the three main clinical presentations of hepatitis?
acute hepatitis
chronic hepatitis
fulminant hepatitis
125
What are the symptoms of acute viral hepatitis?
- jaundice: yellowing of the skin and eyes due to increased bilirubin levels
- dark urine
- acholic stool: light, clay colored stool due to reduction in bile production
- prodrome: 1-2 week prior to jaundice = headache, myalgia, arthralgia, fatigue, nausea, vomiting, pharyngitis, mild fever
126
What are the blood tests associated with acute viral hepatitis?
- bilirubin >3mg/dL
- bilirubin in urine = liver disease
- ALT and AST elevation
- ALT 1000U/L
127
What is chronic viral hepatitis?
- hepatitis that does not resolve within 6 months
- predisposes to liver cirrhosis and hepatocellualr carcinoma
- immune system responsible for liver destruction
128
What is fulminant viral hepatitis?
- rapid severe hepatitis
- massive hepatic necrosis
- encephalopathy = confusion, disorientation, death
- edema
- complications: cerebral edema, brainstem compression, GI bleed, sepsis, organ failure
- liver transplant to survive
129
Which strains of hepatitis are fecal-oral transmitted?
A and E
130
Which strains of hepatitis have DNA?
B
131
Which strains of hepatitis can have chronic infection?
B, C, and D
132
What type of hepatitis is associated with 28 day incubation and resolution in 2 months with no chronic illness?
HAV
133
What type of vaccine is the HAV vaccine?
inactivated whole virus
| -2 dose injection for children at 1 yr and those at high risk for infection or complication from infection
134
What type of hepatitis is associated with potent surface antigen during active infection?
HBV
135
What type of hepatitis is associated with incubation of 90 days and increased chronic disease in younger populations?
HBV
136
What type of vaccine is the HBV vaccine?
- HBsAg injection 3 doses
| - children at birth and adults at risk for infection
137
What is the treatment for HBV?
- acute = none
| - chronic = oral polymerase inhibitor or cell intrinsic immune modulator
138
What is the procedure for post-exposure prophylaxis for HBV?
- give HBV vaccine and HBIg
- premature infants with HBsAg+ mom
- fullterm infant with HBsAg+ mom
- percuatneous exposed health care worker
139
What type of hepatitis is associated with chronic infection after infection with contaminated needles?
HCV
140
What is the testing for HCV?
- screen test = Ab fro anti-HCV Ab
| - confirmatory = nucleic acid base test for detection of viral genome
141
What is the treatment for HCV?
-12-24 week oral combo direct acting antiviral
142
What drug works for HCV NS3/4A?
protease inhibitor
143
What drug works for HCV NS5A?
virion assembly inhbiitors
144
What drug works for HCV NS5B?
RNA polymerase inhibitor
145
What type of hepatitis is associated with dependency on another hepatitis virus?
HDV needs HBV
146
What hepatitis causes increased fulminant?
HDV HBV coinfection
147
What hepatitis directly causes hepatic injury?
HDV
148
What hepatitis is associated with US travel to western asia and increased death in pregnant women?
HEV
149
What are the viruses associated with gastroenteritis?
rotavirus
norovirus
adenoviruses 40 and 41
astrovirus
150
What virus is associated with flacid paralysis?
poliomyelitis
151
What is the current mode of vaccination for polio?
inactivated virus for 4 doses
152
What virus has a 1-3 day incubation and presents in diarrhea, and vomiting for 4-7 days?
Rotavirus
153
What virus is common in immunosuppressed children but not AIDS pt?
Rotavirus
154
What virus is associated with the NSP4 toxin that causes calcium release in the intestine?
Rotavirus
155
What type of vaccine is used for rotavirus?
- oral
- 2006 2 dose cross b/w human and bovine
- 2008 3 dose live attenuated
- all children before 12 weeks
156
What virus manifests 24-48 hours incubation with nausea vomit and diarrhea for 24-60 hours?
Norovirus
157
What virus is the most common cause of non-bacterial gastroenteritis in the US?
norovirus
158
What virus manifests after 8-10 days with diarrhea for 7-8 days?
Adenovirus
